Young Hypertension - and YM's Multitude of Medical Conditions.

YM came in today to review her blood results and also to complain about her incessant coughs lasting more than three weeks. She was the young lady who was the subject of my last posting. Her kidney function was essentially normal but her urine showed the presence of blood (hematuria) and albumin (albuminuria), these are not good signs. On top of that she also had a high level of cholesterol and triglyceride ( another form of lipid in the body). Her thyroid function test was normal.

Her coughs  started following an acute episode of tonsillitis for which I had prescribed a course of antibiotics for  her. The tonsillitis had healed but the coughs continued and were worse at nights when it was colder. Last night was particularly bad. The coughing had made her unable to sleep. I asked her about a family history of asthma and she admitted that her younger brother was suffering from asthma and that she had childhood asthma! I examined her chest but could not elicit any signs.

The clinic protocol is when a patient has been coughing for more than three weeks, a pulmonary Tuberculosis (PTB) screening needs to be done. So I ordered for sputum examination on three occasion and a chest x-ray. The chest radiograph showed heavy congestion in the middle lobe of her right lung. Otherwise no other signs suggestive of TB. I prescribed her with a combination of two antibiotics for a week.

Now, I have asked her a month ago to wait for her menses and to come to the laboratory for specific day of the menstruation to take blood for hormonal studies to diagnose the cause of her absent menstruation/infertility. Unfortunately the menses was still absent (for six months) and today I requested the hormonal studies to be conducted straightaway. The studies are designed to determine the cause of her prolonged absent menses ( secondary amenorrhea) and for later referral to the Gynaecologist.

YM had gone to see the Cardiologist I referred her to. Unfortunately all relevant radiological investigations are slotted for October 2011 due to the hospital's heavy workload. One of the essential investigations was to exclude renal stenosis (narrowing) so I asked her whether she could afford to get it done in private which would take only a few days. She promptly said yes. I filled out a form for her and sent to to my colleague, a private Consultant Radiologist. And I also noted that the heart specialist had given her a six -month appointment. To me it is a rather long time of waiting. I put myself in her shoes. I place her on my clinic follow-up every two months. She needs the necessary motivation at this early stage to continue with her life-long medications. It is what we at primary care do best.

Fortunately her blood pressure reading had stabilised within normal limits. But her high blood cholesterol and triglyceride was troubling. A young person should not have this aberrant lipid picture. I have tried asking my patients with high blood lipid to control their diet,less fried foods etc but I can tell you,  only one  (10%) person out of ten succeeded; that too because he did not eat outside foods. YM travels a lot due to the nature of her job so I started her on a cholesterol lowering drug plus dietary advice.

And so, in a matter of about six weeks, I have discovered YM, a 30-year old lady professional, who initially came with a complaint of a bad headache, to have the following: Hypertension, secondary amenorrhea. infertility, hematuria. albuminuria, hypercholesterolemia, hypertriglyceridemia, lobar pneumonia and infection-triggered asthma. 

So young a life, so fraught with  medical conditions! I will ensure she has the best care we can give.