I am a 60-year-old non-diabetic woman. I am married with a daughter. I had a hysterectomy operation. I am hypertensive and was on Asomex 2.5 mg for the last three years. But taking Asomex 2.5 mg, my BP level fluctuated and sometimes it even increased to about 170/90. I am unable to take Asomex 5 mg as it leads to swelling of my legs and frequent urination. I am on service so on telling my doctor he reduced the dosage to Asomex 2.5 mg.
Two months back, I was having a little discomfort and even experiencing pain on the left side of my chest. On monitoring, my BP at my Omron digital BP machine my BP came out to be 180/102. So on the next day, I immediately consulted a general physician and he prescribed me two drugs. Olmezest CH 40 to be taken in the morning and Asomex 2.5 mg to be taken at night or Asomex 1.25 mg if the BP goes below 120/80. I started taking these two drugs from the next day and even regularly monitored my BP using Omron digital BP machine. After 20 days of regularly taking these drugs my BP came down to 123/78, so I took Olmezest CH 40 in the morning and Asomex 1.25 at night and continued this medication for one month.
A week ago I was feeling quite weak and on monitoring my BP I saw my BP came down to 90/60. So, now I have stopped taking Olmezest CH40 for the last six days and now I am only taking Asomex 2.5 mg. Today in the morning my BP was 118/70 and my pulse level was 73. Is it safe to stop Olmezest CH 40 like this? What hypertensive drugs can I take and in what dose to stop my BP level fluctuating in this manner?
You may stop Olmezest if BP falls. You will likely need another antihypertensive along with Asomex 2.5 which is not enough for you and we will not be able to increase it due to side effects. Olmezest takes some time for its full action so when it achieves its full action, it leads to hypotension. So, you will likely need 20 mg of plain Olmezest instead of Olmezest CH 40 which contains two antihypertensives.
So, in my opinion, you should continue to monitor your BP regularly, ideally thrice a day for one to two weeks till medicine dosage are optimized. And as soon BP starts rising above 135 to 140 systolic, you should start plain Olmezest 20 mg once a day in the morning. This will help in preventing the future episode of accelerated hypertension. Also, continue with a low salt diet, regular exercises. Hope this helps you and get back if you have any doubts.
Thank you so much. As advised by you I should take Asomex 2.5 mg for 1 to 2 weeks and then if my systolic pressure increases to 135 to 140 then I will have to take plain Olmezest 20 mg in the morning and Asomex 2.5 mg at night? Shall I send you the scanned copies of my ECG, urine and blood reports?
I have gone through your reports (attachment removed to protect patient identity). I have noticed some abnormalities.
Firstly, your hemoglobin was on the lower side. The usual cause for this is Iron deficiency. However, it is better to confirm the cause with serum iron studies, vitamin B12, and folic acid levels. And subsequently, you may need Iron supplements like Fericip XT once a day. Next thing, your ESR was elevated and there was A/G reversal which is suggestive of some inflammation or infection in the body. Did you have any symptoms of infection during blood work up?
So, before going ahead, you should get these abnormal tests repeated. So, you should get hemogram with ESR, liver function test, serum iron studies, vitamin B12, and folic acid levels done. Also, request for serum fasting lipid profile, blood sugar as a precautionary test, if not done recently.
Your vitamin D was also low and I guess, you must be on supplements for those. If not, you should have tablet Uprise D3 60,000 units once a week for eight weeks and then once a month for the next six months. Your ECG is normal. Other tests were fine. Keep BP under control in order to keep albuminuria under control. Also, in you, Olmezest is better drug option than Asomex as it will prevent progression of albuminuria as well. So, next time, if necessary we will add Olmezest only.
As prescribed by you I have repeated the blood tests and am sending you the photo images of the blood reports. Now I am only taking Asomex 2.5mg and today my BP was 125/81 in the morning. Do you now suggest me to stop Asomex 2.5mg and start with Olmezest plain 20 mg? Last time I forgot to tell you that I have a cyst in my lever obtained through USG of upper abdomen. Do you think I need to do anything about this cyst? I am also sending you photo image of my USG report.
Firstly, your iron and folic acid are on lower side which is probable cause for low hemoglobin. So, need to start on supplements. So, should have Tab Fericip XT twice daily after meals, which contains both. Repeat hemoglobin after 4 weeks of medicine in order to see the response. Increase intake of jaggery, green leafy vegetables, dates etc.
I guess you don't have any blackish stool at present or any abdominal pain or acidity problems. In your age group, we tend to rule out gastrointestinal bleeding as cause of low hemoglobin, so for that we ask for two stool tests, which is called as STOOL FOR OCCULT BLOOD TESTING. So, it's better to obtain it before starting iron supplements, in order to be certain regarding absence of GI bleeding.
Rest of your tests are fine.
It's better to shift to olmezest instead of asomex. Monitor bp more frequently for initial 1-2 days. Liver cyst are not worrisome usually.
As suggested by you, I have stopped taking Asomex 2.5mg and have switched to Olmezest 20. But after taking Olmezest 20 my BP level has increased since the last week to about 150/90. The day before yesterday my BP was 147/ 87 and today in the morning my BP was 140/ 93. Do you think I should increase my dosage of Olmezest 20? I am also seldom experiencing a burning sensation on both of my palms for a few days. Can this be a side effect of Olmezest 20?
Yes, in my opinion dose should be increased to twice a day. Later on tablet may be taken 40 mg once a day as well.
If you are increasing the dose then should monitor bp frequently for a day or two for low bp. Optimal range is 110-140 systolic.
Sorry to disturb you at this time of night, but today at 12.30 am at night when I monitored my BP my BP increased to 183/111. Today I have taken only olmezest 20mg. Now after seeing this high BP I took another dose of olmezest 20mg at 12.30am. What should I do now? Why is my BP increasing like this? Is this an indication of stroke?
Sorry for late reply..
If you don't have any other symptoms then it doesn't mean mean stroke. It simply means you need some dose escalation. Did you have any precipitating factor for it like any stress, coffee, pain killers, missing dose of medicine, high salt intake etc.?
If bp continues to stay in this range or having any other symptoms, you should get yourself checked by local doctor. You ll need olmezest twice a day. Keep monitoring bp.
Yes doctor I was having joint paint so I took homeopathic Arnica medicine to reduce pain. After taking arnica my BP suddenly increased last night. Today in the morning my BP reduced to 165/92 as I had taken 2 doses of olmezest 20 I.e Olmezest 40 last night.I had also taken olmezest 20 yesterday in the morning. Yesterday in total I had consumed olmezest 60. I will take olmezest 20 again now in the morning.
Another thing I want to ask you doctor, if this case of high BP occurs again and especially at night when no doctor is available, can you prescribe me some urgent medicine to reduce high BP at that crucial moments?
Okay.. you should avoid all form pain killers. You may use topical pain killers like volini gel or spray, or plain paracetamol 500/650 or 1000 mg is safest depending upon the response. Another pain killer is ultracet which is safer.
Bp may remain elevated till that medicine is out of the body for another day or two. You should keep asomex 2.5 /5 mg with you for emergency purpose. Have olmezest up-to 40 mg today and if bp is still more then have asomex 2.5.
This is to inform you that today in the morning I had taken Olmezest 40mg, then after 2 hours later when I monitored my BP it was 165/94. Now about 30mins ago I was not feeling well so I monitored my BP and it increased suddenly to 179/109. Do you think now I should take Asomex 2.5mg? I am feeling very tensed. Why is my BP fluctuating like this. Is it really very serious doctor? Will my BP not get controlled?
Yes, you should take asomex now. It's likely due to pain killer, doesn't appear serious and may take some time of a day or two to settle. Calm down and have rest. Don't take any kind-of stress due to this as this will settle down. Avoid activities and high salt food, coffee or tea.
Visit nearby doctor if you are having any symptoms or bp continues to rise for IV medicines.
Ok doctor, Thankyou very much for your help. Yes doctor I generally take black tea four times a day and am addicted to it. Do you think now I should permanently stop having black tea?
You should reduce it but may not stop completely. However, at present, you should not have it till bp is controlled.
This is to inform you that I am now much better after taking Olmezest 40 for a few weeks. Now my BP has come down to normal. Today my BP was 121/78 in the morning.
I want your suggestion in a particular matter. This year in the month of April I and my family went on a trip to Kumaon( Uttarakhand) with a travel agency. Unfortunately, from the 2nd day of our tour, I and my daughter suffered from severe diarrhoea which comprised of loose motion for about 5 to 6 times a day and even frequent vomiting. I even had stomach ache as soon as I used to take the food supplied by travel agency. It was really a very remote place with no medical facility, even medical shops were rare to be found. We were simply on ORS, tricaine antacid, Rantac and had biscuits, muri and chira as solid food for most of the time of our tour but still the diarrhoea didnot stop. We received no help from our tour manager and had to carry on our tour with this illness. There was network available so I couldn't consult with you online. We didnot take mineral water, but used zeolin in our drinking water supplied from hotel. We avoided the food supplied by our travel agency as far possible and were on ORS, biscuits, muri, chira for most of the time. This is because as soon as we used to have travel agency food the diarrhoea recurred. But as we came to Nainital and started taking mineral water our diarrhoea reduced much. During our long bus journey even though we used to take Avomin tablet atleast 2 hours before our bus journey, still we vomited everyday. The whole tour was a horrifying experience for me and my family and we received no medical help from our travel agency team members and had to carry on our whole tour with this illness and simply on dry food and ORS. The illness made me very weak and I stayed in my hotel room and missed most of the trips. It was simply Gods grace that we returned home alive.
1) My question to you is do you think this happened because of the bad quality food supplied by our travel agency?
2) We didnot take mineral water but used zeolin in our drinking water, can this illness happen because of this?
3) This year in the month of October I am again planning a tour with my family to Gujarat, is it safe for me to travel? Do you think I should change this travel agency as I received no help from them during my illness?
It's possible that it's due to bad food quality, but zeolin also can cause these side effects. So, you have to correlate, whether relief was after avoiding food or symptoms were continued despite being off food. This is because symptoms of both gastroenteritis, due to bad food, and zeolin effects are similar. So, just try to correlate symptoms with food or zeolin. From your description, food is likely a culprit.
And for next trip, it's better to change travel agents to one with better plan for bad health. You yourself should carry some antibiotics like norflox tz, antidiarrhhoea medicine like redotril, and it's important to use zeolin in appropriate amount or better to use mineral water rather than zeolin if available.
Hope this helps you and get back if you have any doubts.
Thankyou Doctor for your advice.
Can you please suggest me some medicines to avoid vomiting during bus journey as Avomin didnot work for me during this trip...
Other than avomine, you may have emeset 4 or 8 mg according to need. Also, antacids like rantac or pantoprazole should be taken before journey. Also, don't forget to carry probiotics like cap Vizylac for proper digestion.
This is to inform you that now I am taking Olmezest CH 40 for my high BP since last 2 weeks. 2 weeks ago my BP was quite high, about 180/ 98, so I started taking olmezest CH 40. But now after taking this medicine, my BP has reduced a lot and now I am having low blood pressure. Today in the morning my BP was 105/ 61 measured through omron digital pressure machine. Is this alarming? Do I need to reduce my dosage of olmezest CH 40? Can olmezest CH 40 lead to sodium potassium level imbalance in body?
No, this is not alarming, but ideally bp should be in the range of 110 to 130 mmhg. So, should modify medicine. You should have plain olmezest rather than CH component in it. Hopefully this should get bp in range.
These may cause potassium and sodium disturbances in some patients only, but usually causes at the initiation of therapy and in kidney patient. So, once kidney function test including sodium potassium urea and creatinine should be done 2 weeks after initiation of drug therapy.
Thankyou, doctor for your advice. Doctor I am quite tensed for a few days regarding a mishap in my family and I want your advice in this matter.
You know doctor, 5 days ago my sister in law passed away. She was 70 years old with high diabetes. A few months ago she was having an epilepsy like disorder with blackouts so we had performed some medical tests for her, where we found Aortic sclerosis of heart in the ECO test and another age related abnormality in her brain through CT scan. After taking insulin also, her blood sugar level was 300 in fasting blood sugar. I had thought of consulting with you regarding her health issues, but no one in her family cared to send me her medical reports. She died of complete negligence from her family's end. All her family members were interested in her property rather than her health. In the last few months she had many epilepsy like attacks, blackouts, but no one in her family cared to admit her to the hospital and 5 days ago after having this attack again she finally died and we all are very shocked.
Doctor, I am now 60 years old and have a family to care for. I am not diabetic but my BP level fluctuates, and I have fatty lever and a cyst in my lever. Sorry, to ask you this question, doctor can I also die like my sister in law? My sister in laws sudden death has left all of us quite shocked.
Doctor, if you want you can prescribe some medical tests for me and I will surely perform them as you suggest. I don't want to die now doctor.
Sorry to hear that..
But, I don't see that anything like that in you. She has given enough time for treatment but it's her bad luck that she could not avail treatment. She probably had intermittent heart block which could have been treated very well.
There is nothing to worry if bp is well controlled. Intermittent bp elevation is expected and not worrisome.
However, you should focus on healthy lifestyle like less of calories, light dinner, daily walking, avoid weight gain etc. Also, undergo some screening tests like blood sugar, fasting lipid profile and HSCRP if not had recently. Also, echo and treadmill test, if not had recently, to rule out possibility of asymptomatic blockages.
I have recently performed some of my medical tests like some blood tests, ECG, ECHO test. In my ECHO test I have observed some abnormalities in the report. Are these abnormalities in ECHO report dangerous? Can they be cured? I am sending you the photo images of all my medical reports. Now I am taking olmezest 40 and my BP is well controlled. Today my BP was 122/ 83 in the morning.
Your ecg and echo is fine. Echo is fine with some minor changes which are related to hypertension. These are not worrisome and needs no treatment.
However, your esr is elevated and hemoglobin is low, for which you need evaluation. Usual cause for esr elevation is infections so do you have any fever, any recent weight or appetite loss? If you not, then other rarer causes needs to be ruled out. So, you should visit nearby medicine doctor.
Also, Vit D is low, for which you need supplements like tab uprise d3 60,000 units once a week for eight weeks and then once a month for next six months.
So, cardiac part is fine but need evaluation for elevated esr.
Yes, doctor I am having weight loss. I have reduced much weight in last few months, although I am following a healthy diet. My weight was 68kg a about 5 months ago, and now it has come down to 65kg. I didn't have any infections recently. My appetite is also good. Regarding my haemoglobin, it is also static to 10 since last 4 months, though I eat vegetables, dal, soya, fish, eggs, and seldom chicken. I have performed my urine microalbumin test and have send you the reports now. I am unable to take iron supplements as after taking them I feel nausea and even vomit sometimes, even dexorange tablet doesnot suite me. Doctor would you please suggest me some iron supplements? What should I do regarding elevated ESR? My uric acid level and one of my cholesterol level is high.
Doctor do I need to perform my treadmill test?
LDL cholesterol and uric acid are borderlinely elevated, so need not have any medicines for it and just continue healthy lifestyle. There is no absolute need for TMT, but if you have any family history of heart diseases or stroke then you should have it. Even otherwise, there is no significant harm in having it.
You may have syrup haem up one teaspoon after a lunch for iron. Initially, try having dexorange after meals.
Did you have any previous esr readings which are elevated? Anyways, since it's more than 100 which is quite high, it needs attention. You should also get CRP level done and may repeat esr level to confirm and rule out false reading. There are two other possibilities which needs to be ruled out other than infections like multiple myeloma and giant cell arteritis.
For multiple myeloma, you should undergo serum free light assay and serum protein electrophoresis. And for giant cell arteritis, you may get ultrasound Doppler of head and neck vessels. In this regard, it's better to get once examined by local doctor so examination and detailed history will guide further investigations.
Today I am consulting with you for my daughter. My daughter is a 27 year old unmarried woman and a patient of PCOD. She is under hormonal treatment since last 6 months.
Since the last few months she hasbeen sweating a lot and thus doesnt wear clothes at home and stays under A.C. As a result of this today morning when she woke up, she told me that she was having headache and pain in her eyes and hands. When I took her temperature, I saw that she was having 100.6 F fever. So I gave her Calpol 500mg and she was under complete bed rest. Then occassionally she was telling me that she was feeling uncomfortable, headache, eye pain, and pain in her hands. Now, about 1 hour ago she took her lunch, and again took her temperature and to my surprise her temperature was 102.2 F. So, she again took another 500mg calpol tablet. But now her headache and eyepain has reduced much, but surprisingly her body temperature is high. She is not coughing or sneezing.
You know doctor, now dengue has broken out in epidemic form in our city. I am really worried for my daughter. Can this be a sign of dengue? My daughter had dengue about 8 years back. Then I saw that she had severe headache, fever, and there were red patches throughout her body that time. But now her condition is not that worse, though she is feeling weak, yet she is able to walk and even has interest to eat.
What can I do if her fever doesnt come down? Can you please prescribe some medications. Though her headache, eye pain, and hand pain has reduced since morning but still it is present in significant amount.
So these are signs of viral infection and it can be certainly be a dengue. So, if you can get her tested for dengue with NS1 antigen test, it would be better.
If you want to wait, then viral infections doesn't need any specific medicine for cure. They are self limiting and need only symptomatic treatment. So there are certain things which should be remembered, like only paracetamol is allowed and no other medicines for pain or fever. Paracetamol or colpol 500 may be taken 4-6 hourly if necessary or do cold sponging, but not other pain killers. Avoid doing activities which would predispose to trauma, avoid straining at urination or passing stool. She should have plenty of water say around 2.5 to 3 litres.
If fever persists more than 3-4 days then she needs to be evaluated for bacterial infections like typhoid, urine infection. I guess she doesn't have burning urination.
Hope this helps you and get back if you have any doubts.
This is to inform you that now my daughter has recovered from her fever, but now she is having cough. I didnot take her to the local doctor or get her blood test done, she was only under calpol 500mg and now her body temperature is also normal.
But now since last few days I am myself affected by fever. At first I had 102.4 F fever, with cough and even had severe back pain. I didn't get my blood tests done yet. Three days have passed and I am taking calpol 500mg. Today in the morning my fever was 101F but now after taking 2 doses of Calpol 500mg, now my fever is 100.4F. But doctor I am having severe back pain for which I am unable to even sleep properly at night.Is there any cure for this back pain? Will I continue with calpol 500mg? I am taking just raw ginger in my mouth to get rid of cough as on taking cough syrups my cough increases.
It's a viral infection and there is a possibility of dengue as severe backache is one of the symptoms of dengue.
In my opinion, you should get yourself tested for dengue with NS1 ANTIGEN and dengue IgM, also hemogram and LFT/RFT.
Till the time, we don't rule out possibility of dengue, you won't be able to take other routine pain killers. However, you may have ultracet occasionally besides paracetamol or calpol. You can use local gel like volini and hot water bag application for relief.
So, I would advise to get once examined by local doctor and get tested.
I am consulting with you after a long time. I generally take olmezest CH 20 for my BP and after taking this medicine my BP usually stays 122/78, in this range.
Now I have started taking soyamilk since last 12 days daily one cup at evening and as I feel hungry at office so I had taken 3 walnuts, 4 almonds, red grapes and some cherries as tiffin. This tiffin I had taken for last 3 days. Today after taking this tiffin of nuts, grapes & cherries I started having hiccups at office. Now as I was not feeling quite well, I took my BP half an hour ago, and it was 159/90, which is higher than my regular BP level.
Doctor, another thing I should tell you that last time when you advised me to get examined by local doctor, the local doctor prescribed me tablet Rozavel TZ, tablet Nexpro RD for my cholesterol level along with my BP medication. So now doctor I am taking 3 medicines regularly, Nexpro RD, Rozavel TZ and olmezest CH 20.
My question to you is taking walnuts, almonds, cherries, red grapes and soyamilk can increase BP?
As I am even taking cholesterol medications can I take these food stuffs?
As now my BP is a bit high so do I need to take another tablet of olmezest CH 20?
I am having acidity & even gas after taking Rozavel and Nexpro RD tablets.
Now since it's elevated, you should have an additional dose of olmezest CH. You should monitor bp frequently like three times a day or as whenever possible for a week period and majority of bp readings are 140 systolic then you may need to regularly have olmezest twice daily. I guess, you didnt have pain killers which can cause such elevated bp.
Increase salt intake may cause elevated bp, but it's unlikely to increase due to nuts or soya milk consumption. Intermittently, bp may go up due to internal body changes as well. You may have these food with your medicines.
You should avoid fatty oily and spicy food. have some walk after having meals rather than resting immediately. Avoid heavy meals and dinner. Have rozavel after dinner. If gastritis still persists then you request to change to Atorvastatin 10 mg instead of rozavel.
Thanks for your reply. You know doctor whenever I eat chicken or egg curry, I face a lot of constipation problem. Yesterday I had chicken as a result of which yesterday I didnot pass any stool. Today I didnot have chicken so my constipation problem is much better than tomorrow. Do I need to avoid chicken and egg fully to avoid constipation? No I didnot take any painkillers. Can constipation problem increase BP?
Doctor as now I had a bit acidity so I have taken Tricaine syrup, as this antacid suits me.
Now my BP has come down to 138/83, I measured it 7 minutes ago at omron digital BP machine.
Yes, constipation or acidity if causing discomfort then may raise bp. It's better to avoid chicken or eggs considering problems they cause or have it occasionally only.
Now, current bp reading is fine so may avoid additional dosage. Still you should measure it frequently for a week atleast.
You may have tricaine syrup whenever necessary.
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