Need a Doctors Advice On the Patients Condition

This is the report i have received.

Diagnosis:

*Ca Breast
*RHD (sever MS, sever MR with sever pulmonary hypertension)
*Chronic A. FIB
*Right-sided pneumonia
*COPD

The patient is a 67 years old female, admitted under surgical service on the 5th of June 2007 for investigation of right breast mass, which proved to be malignancy.

FNAC, CT – abdomen, chest, pelvic, bone scan done
Good LV systolic function with normal LV size, EF = 67%
LA dilated 5.3 cm
Right sided chambers and dilated
Mitral valve: rheumatic with MVA = 1.15 cm with sever MR
Aortic valve: tricuspid rheumatic with mild AR, sever TR with PASP = 75mmgh

Patient under went Right Modified Mastectomy under GA on 14th June 2007

Post Operative Course:

2nd day post operatively, patient developed haematoma at the site of operation, which required evacuation twice.

She received multiple blood transfusions for drop in the hemoglobin levels.
Her INR lever was fluctuating reaching up to 5.
Her condition complicated by developing [RT] sided PNEUMONIA and RESPIRATORY FALIURE which required a MECHANICAL VENTILATOR.

Currently, patient is on VENTILATOR. Her haemodynamic status is stable.

Patient on current treatment:

1. Meropenum 1gm q8h – 6th day
2. Digoxin 0.125mg – OD
3. MonoTidem 200mg – OD
4. M. Vitamin I – OD
5. Ferrous Sulphate 300mg – TDS
6. BronchoDiltor
7. Erythromycin 500mg – q6h
8. Inj. Lasix 40mg – BD
9. Nitrophos 90ml - TDS

This report was written on the 7th of June. An updated report with be posted once received.

She is currently on respiratory support. She can breathe herself, but she needs O2 supply as a back up. The hospital has been practicing with her to breathe independently a few hours a day, and increase the amount of time she depends on herself every few days. But it has been hard for them to remove and re-insert the O2 supply tube, because the insertion is agonizing for her, to a level that her face goes blue at times. They are also looking into cutting open a hole in her throat to insert the O2 supply, because they fear infections through oral insertion, and she might lose her voice as well.

She also suffered from acinetobacter but has been cured of it with the use of vancomicyn.

The operation was for breast cancer that was diagnosed very early.

Would a doctor suggest any specialists within the vicinity of the middle east? The patient is located in Bahrain. Any help or advice would be very helpful.

Thank you.

Kind regards, Salman