OpenHealth Q&A

Seeking Guidance for a Second Opinion

Patient Profile: 80-year-old female, 5 feet 5 inches tall, weighing 170 pounds. Current Situation: The patient does not have an official diagnosis despite experiencing chronic health issues. Medication Overview: While specifics on dosages may not be clear for every medication, here's what I do know: - 150 mg of Sertraline - 600 mg of Droxidopa - 88 mcg of Levothyroxine - 0.5 mg of Florinef - Claritin taken daily - Pantoprazole (exact dose unknown) - Aspirin - Cyclobenzaprine used as needed - Zofran as needed - Supplement regimen includes: 1,000 mg of Vitamin C, Vitamin D, Vitamin B12, cranberry tablets, Senokot, Dulcolax, and Miralax. Concern: The patient has a nephrostomy tube placed in her back, and after today's doctor’s visit, I feel there was a lack of thorough examination. I'm contemplating whether obtaining a second opinion would be appropriate. Earlier today, I brought my mother to her appointment because she has been acting strangely this past week. There has been a concerning amount of sediment in her nephrostomy bag, with colors varying from dark yellow to light yellow. Notably, there was a significant presence of thick white floaters yesterday, which is unusual as her bags typically remain clear. Two days ago, the sediment appeared black. This unsettling change occurred following a medication mix-up that involved combining a drug that had been discontinued with a new one, resulting in severe nausea and vomiting, although she appears to have improved now. However, I remain worried about her nephrostomy site, which is exhibiting redness, emits a foul odor reminiscent of moldy corn chips, and has brown discharge saturating the bandage. Previous guidance involved using clotrimazole and betamethasone dipropionate cream to treat a different fungal infection, but I'm uncertain of the next steps since the attending doctor dismissed my concerns, claiming everything looked fine. Additionally, I’ve noticed unsettling signs: new levels of fatigue, unexpected chills despite a warm room, paleness, and increased exhaustion, alongside redness, swelling, and localized pain at the nephrostomy site. I'm baffled by the doctor’s nonchalance regarding these symptoms. Would it be advisable to continue using the cream until her condition improves, or should we seek a second opinion that might consider prescribing an oral antifungal medication? Despite my concerns over the necessity of a culture test—given her past bacterial colonization and potential fungal presence—the doctor disputed my view on the testing process and now I question my understanding. Any insights or advice on how to navigate this situation would be immensely appreciated. I’m eager to learn and make informed decisions regarding my mother's health. Your guidance would mean a lot as I try to comprehend these medical complexities.

Answers (1)

8/8/2025, 10:10:53 PM

OpenHealth AI

It's understandable to feel concerned given your mother's complex health situation, especially with the symptoms you've described. Here’s a summary of what to consider regarding her nephrostomy care and the possible next steps.

Main Points:

1. Your mother's symptoms, including changes in sediment color and character in the nephrostomy bag, redness, odor, and discharge from the site are concerning and warrant further evaluation.
2. Seeking a second opinion may be a wise option if you feel your concerns are not being adequately addressed.
3. Continuing to use the topical medication without clear guidance may not be ideal; a reassessment is important.

Explanation:

The changes you've observed can indicate potential infections, either from the nephrostomy tube or from skin integrity issues around the site. The foul odor and unusual discharge can be suggestive of infection, while symptoms like fatigue, chills, and pallor raise concerns about her overall health status.

Given her medication complexity, including a recent mix-up that caused nausea and vomiting, it’s crucial to ensure her treatment plan is safe and effective. The presence of symptoms indicative of either a bacterial or fungal infection near the nephrostomy site is significant, and your proactive approach is important for her well-being.

Next Steps:

1. Seek a Second Opinion: Definitely consider consulting a different healthcare provider who specializes in nephrology or urology. This is particularly important if the current doctor has not addressed your concerns satisfactorily.
2. Monitor Symptoms Closely: Keep a detailed log of her symptoms, including changes in the nephrostomy outlet, discharge characteristics, and any new symptoms like fatigue or pain. This information will be valuable for the next healthcare provider.
3. Evaluate Medication Use: While waiting for the second opinion, do not continue antibiotic or antifungal creams without guidance. If she is currently using the clotrimazole and betamethasone cream, stop using it unless directed by a doctor.
4. Consider Potential Tests: When consulting the new doctor, emphasize the need for a culture test or assessment for any infections, as this could guide the appropriate treatment.
5. Prepare for the Appointment: Bring all her medication records, a list of symptoms, and any relevant notes (like dates and descriptions of changes) to the next appointment.

Your vigilance in monitoring her health and advocating for her well-being is vital. It’s commendable that you're seeking to understand her medical situation better. Please know that addressing these concerns promptly is essential, considering her age and overall health context.