Dr Kenneth Chew 12jun24 N 22July24 inr N Kenneth chew

Prednisone 5mg - everyday.  Gain weight. Bones are too weak. Every day - get pain. Nausea - but nothing comes out.

Cellcept mumbai.  India- it is veg or not? Plants.

Kenneth  -

Puffy - moi !

Treponine. 

Blood tests report. 

Is slightly elevated that it is not any higher than it usually is.  So it means you do need something. 

You do need Prednisonal or mmf.

Mmf !

I cut and I take twice a day.

Not a capsule. It's A Tablet. 

Cut it. Once in the morning,  once in the evening  ??

250bp morning  and 250 to take in the night.255!

Mail it. Dhl.

Dont crush it.

Travel. ?

Car - 3000 mrt. Steps. 

Blood pressure is low. We can give you . But low. 

Lowish side. 

Entresto - once a day 

Storonolactone - no more. 

Dignoxine  lanocine - yes

Heart function is very weak. I don't think it would improve much better from the last scan.

Honest !

3000 steps a day.

I don't think we can go higher or very well recovered - 

We are doing now - is maintain you on  your level of activity. At least you can get a good quality of life.

But to take a look at your heart function  - from the time we are scanned your heart - October last year - your heart function is 15 to 20 per cent of heart.

My feeling is - today I do the scan then - 

Then it would ve around 15 to 20 per cent of heart rate. 

Now - that's a number. You don't have to be affected by this. Numbers.

You know how you are feeling more spirited than you were 1 year or one and a half years ago. 2 years ago.

So, I don't think we have made quite a lot of progress. 

But at the same time I have to warn you that there is a risk your heart running into a very abnormal heart rhythm -which can cause the heart to fibrilate. Fibrillation. 

Suddenly goes STOP.

If you happen to be in Singapore  - then someone will come and help you. 

Rush to your aids.  Give you an electric shock from the nearest AND machine. AED ? 

But you go abroad then I don't think you get the help that you need.

What is your solution? 

Battery under your sin - defribulator. 

Not pace makers.

After a while,  you don't seem to know it is there. But there is a wire that is there - sighted within your heart. For your whole life.

You don't even know it's there.

Xray then! 

They're is a little infilter infilter that monitors your heart - abnormal heart rthym - little jolt to your heart - set to doing your heart rate to the normal rhythm. 

In doing so, it reduces the risk of sudden cardiac death.

Limitation of how much more we can do.

Travel - just under skin.

Penang- 

15 or 20 - not good.

40 per cent - then Yaya? 

Echo..scan.

Icd DR

Dr. Kenneth Chew 12/6/2024

Weaker. Breathless.

Inr tests done 3 days ago. 

Inr 2.18 that is good.

Polyclinic  5th 2.30

2 to 3. Inr

Warfarin same dose.

Predisolane. 

Kidney function  is stable. No issue there.

Blood sugar is fine.  Polyclinic n sgh.

Inr is ok. Warfarin is stable.

Blood count is completely normal. 

The time that you are sick - in Oct last year. Your hemoglobin red blood cells level was 10. Below normal.  And now - it has come up to 14. Good sign. Better place than Oct. Generally ok. Below 10 - anemic. 

12 is normal. 

14 now - it's normal. 

Treponin 

Constituent of your heart muscles. 

We measure the of treponin- to measure the of inflammation of the heart .muscles. 

Heart valve. Oct last year. Weak and ill.

Inflammation. 

Prednisolone gives you weight gain. Hungry.

Higher the pritinine - the more plain your heart is.

Nov - stabilizes.  But not normal. 

Latest treponin is 103. 

Anything more than 30 - is considered high. 

Oct 700

Nov 900.

Doctor says this is stable. 103. 

If I take out that steroids you may return back to that spike. 

At the same time, we don't want you to be affected by steroids which is weakening of the bones and so on.

We do a trial - no steroids. Or no 2 -

Which does have the side effects of steroids. 

Risk. 

MMF

Twice a day - not vegetarian!!!

Biopsy 

Inflammation  heart muscles - 

How much Inflammation there is left. And no2 what is the cause of the Inflammation. 

May give doctor a chance to see if he won't miss anything out.

Pincer through Vein. In neck. Within the heart we then deploy the clipper - small sample.

Sedation!!

 

The next thing is 

Mri in March. 

1. The amount of edema  has improved.  Inflammation has improved.  Since the last time you had. Oct Nov last year. 

Not surprised. Treponin has generally Improved. Condition has Improved.  Happy with it. But

Heart function is very weak. Left side of your heart is generally very weak lah. 15 per cent 14 per cent.  Mri.

50 per cent mri.

Anti probiante - is a marker of how strong or how weak your heart is. 

Mri ultrasound scan - gives a number- that number doesn't mean anything. 

Many people which had 14 or 15 per cent- they are much better feeling themselves.  Stronger than ef of 30 percent. 

Bmt- gives me a reflection that how your heart is doing. 

Higher the better. 

September- you are well. 

Oct - 11000. Very high. 

March 2024 - 5700. Cut down.

You have made progress. Even though the mri. Your blood test numbers have improved. 

Current situation- strengthen your heart further. 

To do that I need you to be on medication. 

As much as you can tolerate. 

Balance out the medication with side effects. 

Dizzy quite easily with. Medication. 

Sweet spot.

Heart scan with me. Ultrasound scanning in September. Restart your medication. 

Echo cardiogram- see an improvement!!

October. See him.

2nd of October. 

Nurse clinic- do some adjustments. 

Treponin. 

Blood pressure is ok. Not crazy low and not feeling giddy. 

15 Aug. Back. Europe. 

Monday.  22nd hsac.

Liver- fatty.

Covid ?

Pneumococal 

13ml. Flu - without gelatin. 

Covid -- bedok.

Travel.

Blood booster?

Defibrillator.  Battery. Electric shock- to improve your heart.

Starve off cardiac arrest. 

Risk is there! Half of iphone. 

Day surgery- overnight stay.

Safer.

--------

1. How were blood reports? 

2. Inr - polyclinic and inr hospital  

     Are the same. Polyclinic costs 45.00

     Hospital charges?

      Hospital covers more ground than polyclinic  for Singapore heart  centre medication. 

3. Driving  - later? Low BP. Dizziness 

4. En tresto - Dizziness 

5. Entresto - increase in appetite.

Faeces in panty. See last Inr report.

6. Phenmococcal

Flucaccine

 Polyclinic nurse wants a memo from you or  cardio Dr can do at hospital. 2 or 3 doses?