Tuesday, January 29, 2013

1268. Head-ache, can't stand up in an older woman

Jan 28, 2013.

Older women with high cholesterol and high blood pressure could suffer from strokes. When the mother could not get up in the morning unlike previous times, I suspected an early stroke.  Nausea, Head-ache. I got her a pail as she vomited white water. Dizzy.

I instructed her son to send her to Singapore General Hospital. "Mount Alvernia is nearer and less traffic jam," he said. Proximity is what the young generation wants. I believe in capability and I believe SGH has better care and treatment. It is also branding and perception.

At SGH, a CAT scan and ECG etc. Not allowed to go home. Doctors are careful nowadays as there are cases of litigation. An overnight warding for observation revealed nothing abnormal. So, it was good news and the patient went home at 1 pm yesterday. She was tired and sleepy as nurses kept waking her up every hour to take temperature and check on her in Ward 45 Room 10 Bed 2. Noisy. No complete rest.

But today, Jan 30, 2013, the mother feels headache on one side. So, what's the diagnosis? I still believe it is an early stroke and so no changes are seen in CAT scan etc.

Recently I had two dogs. A female unspayed Maltese 6 years old, head tilted to right. Cannot stand up. A 13-year-old with full cataracts had right head tilt but was able to stand. So, what are the causes? Some lesions affecting the brain. A stroke? For the Maltese, her male progeny usually pounced on her and I suspected trauma to one part of the brain. "Don't charge me too high. I come to you because the breeder refers me to you," said the lady with diamond ear rings and Mercedes.

The Maltese was hand fed and given IV drips and medication for 3 days. She could lift up her head but was unable to stand. No spinal pain. Has strong pain reflexes from the paws. Blood tests showed nothing abnormal.

The Terrier X owner wanted the dog home 24 hours later. Blood test done. It is hard to diagnose what caused the right head tilt as there is a reluctance of owners to pay for tests. A specialist has the CT scans which would cost $1,000/scan. These two dog owners will not want to pay for these tests.  

 

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