Dr. Mehak Agarwal
Otolaryngology (E.N.T)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My wife is 70 years old. She is diabetic and hypertensive. She has dry and itchy skin for which she is taking head bath and applying oil on scalp. She is prone to sinus problems. Now for a couple of days there are boils inside and outside her left ear. It is troubling her very much. Please suggest some medication or remedy for immediate relief.
Hello,
Welcome to icliniq.com.
I read your query and understood your concern.
I have reviewed the pictures you attached (attachments removed to protect the patient’s identity), it appears to be a hair follicle infection of the small hair in the ear canal. Considering her age and the fact that she suffers from diabetes and hypertension (diabetic individuals tend to have slightly lower immunity compared to non-diabetic individuals), I suggest she take antibiotics. I suggest she take a tablet containing Amoxicillin and Clavulanic acid 625 mg three times a day after meals for five days, a tablet containing Trypsin and Chymotrypsin three times a day before meals for three days, and a tablet Paracetamol 650 mg as needed for pain, with a maximum of three tablets per day in divided doses. For the affected area, I suggest she use an ointment containing Mupirocin IP 2.0 % w/w with a clean little finger, applying it thrice daily. If she use ear buds, be cautious not to insert them deeply and avoid injuring the ear drum. While bathing, ensure that water does not enter the ear. Insert a cotton plug into the affected ear after applying some ointment or Vaseline, and remove it after bathing. This condition is known as acute localized otitis externa (furuncle of the external ear). From the picture you provided, it seems to be a single boil with significant redness. It can be quite painful. I suggest she continue her regular diabetic and hypertension medications as prescribed. Ensure that she is taking them consistently and that her blood sugar levels are controlled. For a few days, I suggest she refrain from applying oil to her hair. Once her condition improves, she can resume applying oil to her scalp. If there is any worsening of the condition, you can reach out. Allow three days for the antibiotics and medications to take effect. I hope this has helped you. Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Hi doctor,
Thank you very much for your immediate response. She is allergic to Penicillin. Will the antibiotic you prescribed suit her? She has taken Levofloxacin earlier. Can she take that? We will follow all your advice.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern. Do not give her a tablet containing Amoxicillin if she is allergic to Penicillin. I suggest she take a tablet containing Cefixime and Clavulanate 200 mg twice daily for five days (after food). Rest of the drugs you can continue like I have prescribed before. I hope this has helped you. Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Thank you doctor for the reply,
she has followed your advice and taken all the medicines and applied ointment and taken proper care. Now she has got full relief. My daughter helped in oozing out the pus and my wife feels alright now. Thanking you for kind advice and timely help.
Hello,
Welcome back to icliniq.com.
I also suggest that she make sure that water does not go inside her ears. And also take diabetes medicines properly. I hope this has helped you. Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Thank you doctor for your response,
I will ask my wife to be careful.
Hello,
Welcome back to icliniq.com.
I wish her good health. Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Hello doctor,
I have already consulted you regarding my wife's ear problem. I wish to continue regarding some other issues. She is a diabetic and thyroid patient for nearly 30 years. Recently she is taking insulin injection also for couple of months. She is using Diclofenac Gel 0.2%, Glimepiride-Metformin, Teneligliptin for diabetes, and Levothyroxine 125 mcg for thyroid. Additionally, she has been using Ibandronic Acid 150 mg for the past ten years, Atorvastatin 10 mg, Methylcobalamin 100 mcg, and Rosuvastatin 20mg. Presently her hemoglobin level is 7.9 which is causing concern. The iron tablets do not suit her and she gets diarrhea upon using them. There are a lot of dark and white patches on her body and she has uncontrollable itching. We are staying with our only daughter. She is a scientist in cell biology. I am attaching the recent as well as previous reports. I request your kind provide your insight regarding all the issues I have mentioned. Her overall health is good, she is active throughout the day, she helps my daughter a lot in kitchen, we are mainly worried about the low level of hemoglobin and the reaction for iron pills. Her sugar level is also high and she is having six units of insulin for the past two months. We have consulted a dermatologist regarding her skin problem also. The reports shows there is some thing positive in her autoimmune test, but as the doctor said there is not much worry. She is applying some ayurvedic oils to get relief. Kindly provide your insight.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern. Yes, you can send me the current reports as the ones you have sent were done almost six months ago. I understand she has low iron and hemoglobin. For that I suggest she repeat her CBC (complete blood cell count), fasting sugar, postprandial sugar and HbA1C (glycated hemoglobin). Kindly follow up with the reports and also follow up if you have more doubts.
Thank you.
Patient's Query
Thank you doctor for the reply,
She underwent all those reports two days ago. I am sending the reports. She also have undergone stool examination, I will send the results soon. currently, her hemoglobin level has further fallen to 7.9 g/dl. Kindly help.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern. I have reviewed the reports you attached (attachments removed to protect the patient’s identity), they are recent ones. I suggest you send me the prescription also where you have all the details of her current medicines including thyroid, diabetes and iron tablets. Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Hello doctor,
I have sent the prescription. We have also been consulting another doctor, and I have their prescription as well. Kindly review it.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern. My main concern is her HbA1c level, which is high. Even the TSH is slightly elevated, but that's okay. Are you regularly monitoring her blood sugar levels at home? This includes fasting and post-prandial readings. I hope this has helped you. Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Hello doctor,
Since yesterday she has been complaining of stomach pain and antacid containing a combination of Aluminium Hydroxide, Magnesium Hydroxide, and Sodium Alginate is helpful to a certain extent. Kindly help.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern. Has she recently begun taking iron tablets? They can cause acidity and discomfort for some individuals. Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Thank you for the reply doctor,
She recently attempted to use iron tablets again for the past two days. I am monitoring her blood sugar levels frequently, although not consistently. Her fasting blood sugar is fine, but her postprandial levels consistently range from 200 to 240, sometimes even higher. This is why she also takes Voglibose an alpha-glucosidase inhibitor in the afternoon and in the morning. For breakfast, she typically eat healthy rice breakfast with unsweetened coffee. She has been avoiding sweet dishes for over 20 years and does not experience cravings for them. Kindly help.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern. Could you please check her fasting and postprandial levels tomorrow and let us know? Depending on the results, we might need to adjust her insulin dosage. Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Hello doctor,
My wife had lunch at 1.30 afternoon. Here, we have access to various fruits within the quarters, and she consumes them as much as she can due to her dental issues. Additionally, I obtained date powder for her, which she is currently using.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern. I need to know the name of her insulin injection to provide further guidance. Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Hello doctor,
I have also sent some photos of the patches, as the itching is a significant issue for her.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern.
I have reviewed the reports you attached (attachments removed to protect the patient’s identity), it seems fungal infection. I suggest she apply an ointment containing Betamethasone and Gentamicin locally. I hope this has helped you. Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Hello doctor,
Her insulin injection's each ml contains 100 units insulin glargine (equivalent to 3.64 mg).
Hello,
Welcome back to icliniq.com.
I suggest if her itching does not reduce, consult a dermatologist and take the medications with their consent. I hope this has helped you. Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Thank you doctor,
I will check her sugar level tomorrow and get back to you.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern. For her diarrhea you can give her sachet containing Saccharomyces boulardii and let me know if she feels better. I hope this has helped you. Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Thank you doctor for the reply,
I will try the suggested ointment and sachet ,but she has stopped iron tablets and her diarrhea has also stopped. Kindly suggest some other suitable iron supplement apart from food?
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern. Yes, she can take another iron preparation as an alternative. Iron tablets should not cause diarrhea though. I hope this has helped you. Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Hello,
Welcome back to icliniq.com.
Good morning. Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Hello doctor,
I have taken the fasting sugar reading, and it is 125. I have also placed an order for the medications you suggested, which I am likely to receive today. I will check the postprandial reading after 11 am and inform you.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern. Her fasting blood sugar level is slightly high. Let me know the postprandial blood sugar level also. Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Hello doctor,
I have checked her postprandial reading, and it is 235. Doctor, does high sugar levels have anything to do with iron absorption?
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern. No, sugar levels are not related to iron deficiency. We might have to increase her insulin dosage. Can you give me the details of insulin pen she is using?
Patient's Query
Hello doctor,
The insulin injection pen she is using contains 100 IU (3.6378 mg) insulin glargine. I am also sending the picture. Regarding food, chewing is a bit difficult as almost all her front teeth have undergone root canal treatment. Although the molar teeth are still present, the gums have receded significantly, resulting in high sensitivity. No dentist is willing to remove the teeth as they believe the roots are strong. Due to these challenges, she faces genuine difficulty in eating various types of food, and her appetite is also affected. Considering these factors, I kindly request your advice on her dietary choices to help her manage her blood sugar levels. Her appetite is also quite low. I have one more question, would it not be possible to change the medications or increase their dosage instead of relying on insulin? She has only been taking insulin for the past month. For about 20 years, we have been able to manage her condition with oral medications. Kindly suggest.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern. Let her continue taking insulin for now. Is she still taking six units of insulin in the morning and at night? She should avoid sweets and white rice, as that should be sufficient to help control her blood sugar levels. I hope this has helped you. Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Thank you for the reply doctor,
She is taking six units of insulin only at night.
Hello,
Welcome back to icliniq.com.
I suggest she increase the dosage to ten units. Keep monitoring her blood sugar levels. For instance, if you administer ten units today, check her fasting and postprandial readings tomorrow morning and inform me. Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Thank you doctor,
I have also sent the stool test results just now. Additionally, I was only able to obtain capsules containing Saccharomyces boulardii for now. Can they be used regularly to improve digestion?
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern. No, it cannot be used regularly. Capsules can be used instead of sachets. I have reviewed the stool reports. I would suggest you consult an internal medicine doctor. They will be able to provide better guidance regarding her anemia issue. I hope this has helped you. Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Thank you doctor for the suggestions.
Hello,
Welcome back to icliniq.com.
I hope this has helped you. Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Thank you for the reply doctor,
Both my wife and daughter are somewhat hesitant about increasing the insulin dosage. Nevertheless, I am grateful for all the advice you have provided, especially regarding the anemia issue. We have acquired syrup containing the salts Ferric Ammonium Citrate (160 mg), Cyanocobalamin (7.5 mcg), Folic Acid (0.5 mg/15 ml) as suggested. She has also commenced using the ointment. My daughter has been offering beetroot juice and other remedies. Therefore, I will reconnect with you after some time. Additionally, given my age of 77, I am also taking medication for cardiac problems under the guidance of a cardiologist here.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern. You are welcome. I hope this has helped you. Kindly follow up if you have more doubts.
Thank you.
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Otolaryngology (E.N.T)
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