What is the next course of action for my 81-year-old father with increasing creatinine levels and swelling? - #29312

I’m a periodontist and academician with a strong clinical and teaching background. Over the last 4 years and 8 months, I’ve been actively involved in dental education, guiding students at multiple levels including dental hygienist, BDS, and MDS programs. Currently, I serve as a Reader at MMCDSR in Ambala, Haryana—a role that allows me to merge my academic passion with hands-on experience. Clinically, I’ve been practicing dentistry for the past 12 years. From routine procedures like scaling and root planing to more advanced cases involving grafts, biopsies, and implant surgeries. Honestly, I still find joy in doing a simple RCT when it’s needed. It’s not just about the procedure but making sure the patient feels comfortable and safe. Academically, I have 26 research publications to my credit. I’m on the editorial boards of the Archives of Dental Research and Journal of Dental Research and Oral Health, and I’ve spent a lot of time reviewing manuscripts—from case reports to meta-analyses and even book reviews. I was honored to receive the “Best Editor” award by Innovative Publications, and Athena Publications recognized me as an “excellent reviewer,” which honestly came as a bit of a surprise! In 2025, I had the opportunity to present a guest lecture in Italy on traumatic oral lesions. Sharing my work and learning from peers globally has been incredibly fulfilling. Outside academics and clinics, I’ve also worked in the pharmaceutical sector as a Drug Safety Associate for about 3 years, focusing on pharmacovigilance. That role really sharpened my attention to detail and deepened my understanding of drug interactions and adverse effects. My goal is to keep learning, and give every patient and student my absolute best.

I completed my medical degree in 2023, but honestly, my journey in healthcare started way before that. Since 2018, I’ve been actively involved in clinical practice—getting hands-on exposure across multiple departments like ENT, pediatrics, dermatology, ophthalmology, medicine, and emergency care. One of the most intense and defining phases of my training was working at a District Government Hospital for a full year during the COVID pandemic. It was chaotic, unpredictable, and exhausting—but it also grounded me in real-world medicine like no textbook ever could. Over time, I’ve worked in both OPD and IPD setups, handling everything from mild viral fevers to more stubborn, long-term conditions. These day-to-day experiences really built my base and taught me how to stay calm when things get hectic—and how to adjust fast when plans don’t go as expected. What I’ve learned most is that care isn't only about writing the right medicine. It’s about being fully there, listening properly, and making sure the person feels seen—not just treated. Alongside clinical work, I’ve also been exposed to preventive health, health education, and community outreach. These areas really matter to me because I believe real impact begins outside the hospital, with awareness and early intervention. My approach is always centered around clarity, empathy, and clinical logic—I like to make sure every patient knows exactly what’s going on and why we’re doing what we’re doing. I’ve always felt a pull towards general medicine and internal care, and honestly, I’m still learning every single day—each patient brings a new lesson. Medicine never really sits still, it keeps shifting, and I try to shift with it. Not just in terms of what I know, but also in how I listen and respond. For me, it’s always been about giving real care. Genuine, respectful, and the kind that actually helps a person heal—inside and out.

I am a qualified medical doctor with MBBS and DNB Diploma in Family Medicine from NBEMS, and my work has always been centered on treating patients in a complete, not just symptom based way. During my DNB training I rotated through almost every core department—Internal medicine, Pediatrics, Obstetrics & Gynecology, Surgery, Orthopedics, ENT, Dermatology, Psychiatry, Emergency medicine. That mix gave me the skill to manage acute illness, long term disease and preventive care together, something I find very important in family practice. In psychiatry I worked closely with patients who struggled with depression, anxiety, stress related problems, insomnia or substance use. I learned not just about medication but also about simple psychotherapy tools, psycho education and how to talk openly without judgement. I still use that exp in family medicine, specially when chronic disease patients also face mental health issues. My time in General surgery included assisting in minor and major procedures, managing wounds, abscess, sutures and emergencies. While I am not a surgeon, this gave me confidence to recognize surgical cases early, provide first line care and refer fast when needed, which makes a big difference in online or OPD settings. Now I work as a consultant in General medicine and Family practice, with focus on both in-person and online consultation. I treat conditions like fever, infections, gastrointestinal complaints, respiratory illness, and also manage diabetes, hypertension, thyroid disorders, and lifestyle related chronic diseases. I see women for PCOS, contraception counseling, menstrual health, and children for common pediatric issues. I also dedicate time to preventive health, lifestyle counseling and diet-sleep-exercise advice, since these small changes affect long term wellness more than we often realize. My key skills include holistic diagnosis, evidence based treatment, chronic disease management, mental health support, preventive medicine and telemedicine communiation. At the center of all this is one thing—patients should feel heard, safe, and guided with care that is both professional and personal.

I am a general dentist with 3+ years of working in real-world setups, and lemme say—every single patient teaches me something diff. It’s not just teeth honestly, it’s people… and how they feel walking into the chair. I try really hard to not make it just a “procedure thing.” I explain stuff in plain words—no confusing dental jargon, just straight talk—coz I feel like when ppl *get* what's going on, they feel safer n that makes all the difference. Worked with all ages—like, little kids who need that gentle nudge about brushing, to older folks who come in with long histories and sometimes just need someone to really sit n listen. It’s weirdly rewarding to see someone walk out lighter, not just 'coz their toothache's gone but coz they felt seen during the whole thing. A lot of ppl come in scared or just unsure, and I honestly take that seriously. I keep the vibe calm. Try to read their mood, don’t rush. I always tell myself—every smile’s got a story, even the broken ones. My thing is: comfort first, then precision. I want the outcome to last, not just look good for a week. Not tryna claim perfection or magic solutions—just consistent, clear, hands-on care where patients feel heard. I think dentistry should *fit* the person, not push them into a box. That's kinda been my philosophy from day one. And yeah, maybe sometimes I overexplain or spend a bit too long checking alignment again but hey, if it means someone eats pain-free or finally smiles wide in pics again? Worth it. Every time.

I am a 2023 batch passout and working as a general physician right now, based in Hanumangarh, Rajasthan. Still kinda new in the bigger picture maybe, but honestly—every single day in this line teaches you more than textbooks ever could. I’ve had the chance to work under some pretty respected doctors during and after my graduation, not just for the clinical part but also to see how they handle people, real people, in pain, in panic, and sometimes just confused about their own health. General medicine covers a lot, right? Like from the smallest complaints to those random, vague symptoms that no one really understands at first—those are kinda my zone now. I don’t really rush to label things, I try to spend time actually listening. Feels weird to say it but ya, I do take that part seriously. Some patients just need someone to hear the whole story instead of jumping to prescription pads after 30 seconds. Right now, my practice includes everything from managing common infections, blood pressure issues, sugar problems to more layered cases where symptoms overlap and you gotta just... piece things together. It's not glamorous all the time, but it's real. I’ve handled a bunch of seasonal disease waves too, like dengue surges and viral fevers that hit rural belts hard—Hanumangarh doesn’t get much spotlight but there’s plenty happening out here. Also, I do rely on basics—thorough history, solid clinical exam and yeah when needed, investigations. But not over-prescribing things just cz they’re there. One thing I picked up from the senior consultants I worked with—they used to say “don’t chase labs, chase the patient’s story”... stuck with me till now. Anyway, still learning every single day tbh. But I like that. Keeps me grounded and kind of obsessed with trying to get better.

I'm Dr. Alan Reji, a general dentist with a deep-rooted passion for helping people achieve lasting oral health while making dental visits feel less intimidating. I graduated from Pushpagiri College of Dental Sciences (batch of 2018), and ever since, I've been committed to offering high-quality care that balances both advanced clinical knowledge and genuine compassion for my patients. Starting Dent To Smile here in Palakkad wasn’t just about opening a clinic—it was really about creating a space where people feel relaxed the moment they walk in. Dental care can feel cold or overly clinical, and I’ve always wanted to change that. So I focused on making it warm, easygoing, and centered completely around you. I mix new-age tech with some good old-fashioned values—really listening, explaining stuff without jargon, and making sure you feel involved, not just treated. From regular cleanings to fillings or even cosmetic work, I try my best to keep things smooth and stress-free. No hidden steps. No last-minute surprises. I have a strong interest in patient education and preventive dentistry. I genuinely believe most dental issues can be caught early—or even avoided—when patients are given the right information at the right time. That’s why I take time to talk, not just treat. Helping people understand why something’s happening is as important to me as treating what’s happening. At my practice, I’ve made it a point to stay current with the latest innovations—digital diagnostics, minimally invasive techniques, and smart scheduling that respects people’s time. I also try to make my services accessible and affordable, because good dental care shouldn’t be out of reach for anyone.

I am currently working as a urologist and kidney transplant surgeon at Graphic Era Medical College & Hospital, Dehradun. It's a role that keeps me on my toes, honestly. I handle a pretty wide range of urology cases—stones, prostate issues, urinary tract obstructions, infections, you name it. Some are straightforward, others way more complex than you expect at first glance. Every patient walks in with a different story and that’s what keeps the work real for me. Kidney transplant surgery, though, that’s a whole different zone. You’re not just working on anatomy—you’re dealing with timelines, matching, medications, family dynamics, emotional pressure... and yeah, very precise coordination. I’m part of a team that manages the entire transplant process—from evaluation to surgery to post-op care. Not gonna lie, it’s intense. But seeing someone who’s been on dialysis for years finally get a new shot at life—there’s nothing really like that feeling. In the OR, I’m detail-focused. Outside of it, I try to stay accessible—patients don’t always need answers right away, sometimes they just need to feel heard. I believe in walking them through what’s going on rather than just giving reports and instructions. Especially in transplant cases, trust matters. And clear, honest conversation helps build that. Urology itself is such a misunderstood field sometimes. People ignore symptoms for years because it feels “awkward” or they think it’s not serious until it becomes unmanageable. I’ve had patients who came in late just because they were embarassed to talk about urine flow or testicular pain. That’s why I also try to make the space judgment-free—like whatever it is, we’ll figure it out. At the end of the day, whether I’m scrubbing in for surgery or doing OPD rounds, I just want to make sure what I do *actually* helps. That the effort’s not wasted. And yeah, some days are frustrating—some procedures don’t go clean, some recoveries take longer than they should—but I keep showing up, cause the work’s worth doing. Always is.

I am a doctor who finished my medical degree in 2024, but honestly my real start in healthcare kinda goes back to 2019 when I first got pulled into day-to-day clinical work. I moved through ENT, pediatrics, dermatology, ophthalmology, general medicine and emergency care—sometimes bouncing between them faster than I expected. That mix gave me a pretty wide view of how different systems in the body act up in totally different ways, and I still catch myself thinking about a case from one department while working in another, which sounds confusing but somehow helps me connect things better. During my year at the District Government Hospital in the middle of the COVID mess (no other word fits), I was doing everything from rapid triage to dealing with patients who needed urgent respiratory support. Those days were long and somtimes a bit chaotic; protocols kept changing, supplies came and went, and we had to adjust on the fly. But that year grounded me in real-world medicine more than any lecture ever could. I learned how to read a situation fast, when to slow down even if everyone is rushing, and how to stay focused even when my mind felt like it was slipping off track. I try to bring that same practical, patient-first mindset into my clinical practice now. Whether I am looking at a kid with a stubborn cough or checking an older patient’s chronic issues, I pay attention to the small clues—skin changes, airway patterns, vision complaints, odd ENT symptoms—because they often lead to what’s really going on. My approach is not fancy; I just like to keep things clear, evidence-based, and kinda down to earth, even if my wording gets a bit messy sometimes or I miss a comma here or tehre. I suppose what matters most is that every part of my early training shaped how I care for people today. And even if I still feel like I am figuring out the “perfect” way to explain things, I stay committed to giving patients practical guidance they can actually use, backed by the clinical exposure I have lived through rather than just read about.

I am working in general medicine opd from 3 years now and that gave me wide exposure to all kind of patients walking in with different complain, sometimes mild, sometimes really serious. Most common I handle are seasonal allergies, gestational issues during pregnancy, diabetes and hypertension, but I also see cases of infections like dengue or malaria that need quick attention. In OPD you never know what the next case will be, one moment its a child with fever and next a adult with uncontrolled blood sugar, and I learnt to switch fast and think clear. I focus on proper diagnosis first, using detailed history and examination rather than rushing, cause many conditions overlap and can confuse. For example a viral fever might look like dengue in early days, or hypertension can stay hidden till it shows as headache or dizziness. I try to explain to patients in simple words what is happening with their health, as many come with fear and half information. Making them comfortable and giving them trust matters more than only prescribing medicines. Over these years I also developed a flexible approach in management, not every patient need same treatment plan. Like gestational diabetes require a very diff care compared to a young person with type 1 diabetes. Lifestyle counselling became important part of my practice, talking about diet, exercise, sleep routine and follow-up. Even with allergies or seasonal flu, guiding them on prevention and hygiene reduce re-occurence a lot. In opd practice volume is high and decision making has to be quick but safe. Sometimes you only have a few minutes, still I try to balance efficiency with personal care. Seeing patients recover and come back with gratitude motivate me everyday. Working across such diverse case made me more confident, but also humble because medicine is never fully predictable. There are times I doubt, recheck, ask for labs before final call, and I think that caution is also strength.

I am Dr Mahavir and honestly sometimes I’m still surprized how fast these 5+ years in medicine moved, working day after day in gmc and learning under many specialist senior doctors from across India. I work mainly as a clinican who really tries to understand what’s going on behind a patient’s symptoms, even when the picture looks a bit messy at first... sort of like my notes here. My experience came from handling a wide range of medical cases while observing different approaches from seniors, and that mix gave me a broader way of thinking, maybe not perfect but practical. I am often shifting between careful clinical assessment and quick decision-making, because in hospital setting things don’t always wait for your comfort. Sometimes I recheck a detail twice, sometimes I catch myself typing too fast and missing a comma or two, but the focus stays on providing dependable care. Being around specialists helped me understand varied treatment strategies, disease patterns, and the small clues that guide management, even if I still keep refining my own style every other week. I am working with patients from all backgrounds, trying to keep communication simple enough so they don’t feel overwhelmed by medical terminology—but I don’t shy away from using proper clinical terms when needed for accurate explaination. I try to maintain that balance, though at times I wonder if I’m overthinking it. Still, every case adds something: more confidence, more questions, more clarity on what truly matters in patient care. I am committed to staying attentive, learning continuously, and making sure patients feel heard. Maybe my path isn’t always perfectly straight-lined, but it’s real, and grounded in hands-on experience with senior specialists who shaped how I diagnose, treat, and support people who come for help!!

I am someone who got to work in a government setup for 1 full year, and honestly that one year felt more like 3... in a good way. It was a rotational post, which meant I had to shift across wards, ICU, OT, and even casualty — no chance to get too comfortable in one place. Every few weeks brought new responsibilities, new types of patients, and yeah, new kinds of pressure too. In casualty I saw a lot — from road traffic injuries to sudden breathlessness, fevers that wouldn’t come down, old patients just collapsing... and you don’t get time to overthink, you just act. You learn fast where to focus. I also handled geriatric OPD and that was a different kind of challenge. Older patients need more listening, more patience. Most come with multiple issues — joint pain, sugar, BP, digestion, insomnia — and sometimes they just want to talk too. You realize pretty quick that care isn’t only treatment. ICU postings taught me to stay alert all the time. Alarms don’t wait. I had to assist in serious cases, learn to track vitals, respond to sudden dips, push meds under supervision. OT experience was equally hands-on... mostly assisting but you pick up the flow of surgical steps, sterilization rules, emergency prep and post-op care that textbooks just can’t really explain. What I liked most about that whole year was the exposure — I wasn’t limited to one age group or one type of disease. From paediatric fevers to elderly fall injuries, from asthma attacks to appendicitis — saw a bit of everything. And the system might be hectic, but it teaches you how to function under pressure and still think clearly. That year gave me the kind of foundation you can’t just study. It was about real people, real-time decisions, and not just following protocol but also figuring out what works when there’s no perfect setup. Definitely made me sharper, more grounded, and honestly more ready for whatever comes next in clinical life.