HomeAnswersGeneral MedicineolmesartanCan Olmezest be stopped without consulting a doctor?

Can I stop Olmezest without doctor's consent for blood pressure?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. Divya Banu M

Published At April 18, 2019
Reviewed AtDecember 19, 2019

Patient's Query

Hello doctor,

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 mmHg. 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 mmHg. 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 mmHg, 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 mmHg. 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 mmHg 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?

Thank you.

Hello,

I am glad you chose icliniq for your medical-related queries.

I understand your concern.

You may stop Olmezest (Olmesartan) if blood pressure falls. You will likely need another antihypertensive along with Asomex (Amlodipine) 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 blood pressure regularly, ideally thrice a day for one to two weeks till medicine dosage are optimized. And as soon blood pressure 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.

Patient's Query

Hi doctor,

Thank you for your response.

Should I take Asomex 2.5 mg for 1 to 2 weeks, and then if my systolic pressure increases to 135 to 140 mmHg, I will have to take plain Olmezest 20 mg in the morning and Asomex 2.5 mg at night? Can I send you the scanned copies of my ECG, urine, and blood reports? Could you please advise?

Regards.

Hello,

Welcome back to icliniq.com.

Yes, you may send them.

Regards.

Patient's Query

Hello doctor,

Thank you for the reply.

I am sending you the photo images of my blood, urine and ECG reports.

Hello,

Welcome back to icliniq.com.

I have gone through your reports (attachments removed to the 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 (erythrocyte sedimentation rate), 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 (Cholecalciferol) 60,000 units once a week for eight weeks and then once a month for the next six months. Your ECG (electrocardiogram) is normal. Other tests were fine. Keep blood pressure 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.

Patient's Query

Hi doctor,

Thank you for your advice.

Regards.

Hello,

Welcome back to icliniq.com.

Feel free to ask anything, if necessary.

Regards.

Patient's Query

Hello doctor,

Thanks for your response.

I have repeated the blood tests as advised by you previously, and I have shared the blood reports with you. Currently, I am using Asomex 2.5mg, and today my BP was 125/81 in the morning. Do you suggest I discontinue Asomex 2.5 mg and start with Olmezest plain 20 mg? Last time, I did not mention that I had a cyst in my liver obtained through USG of the upper abdomen. Do you think that I need to do anything about this cyst? I am also sending you reports of my USG report.

Thank you.

Hi,

Welcome back to icliniq.com.

Firstly, your iron and folic acid are on the lower side which is a probable cause for low hemoglobin. So, you need to start on supplements. So, should have tablet Fericip XT (a combination of ferrous ascorbate and folic acid) twice daily after meals, which contains both. Repeat hemoglobin after four weeks of medicine in order to see the response. Increase intake of jaggery, green leafy vegetables, dates. I guess you do not 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 a cause of low hemoglobin, so for that, we ask for two stool tests, which is called stool for occult blood testing. So, it is better to obtain it before starting iron supplements, in order to be certain regarding the absence of gastrointestinal bleeding. The rest of your tests are fine. It is better to shift to Olmezest (Olmesartan medoxomil) instead of Asomex (Amlodipine). Monitor blood pressure more frequently for an initial one to two days. Liver cysts are not worrisome usually.

Patient's Query

Hello doctor,

Thank you for your response.

As suggested by you, I have stopped taking Asomex 2.5 mg 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 mmHg and today in the morning my BP was 140/ 93 mmHg. 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?

Thank you.

Hello,

Welcome back to icliniq.com.

Yes, in my opinion, the dose should be increased to twice a day. Later on, the tablet may be taken 40 mg once a day as well. If you are increasing the dose then you should monitor blood pressure frequently for a day or two for low blood pressure. The optimal range is 110 to 140 mmHg systolic.

Thank you.

Patient's Query

Hello doctor,

Today at night, when I monitored my BP, it increased to 183/111 mmHg. Today I had only taken Olmezest 20 mg. Now, after seeing this high BP, I took another dose of Olmezest 20 mg. What should I do now? Why is my BP increasing like this? Is this an indication of stroke? Please give me your valuable opinion.

Thank you.

Hello,

Welcome back to icliniq.com.

Did you have any precipitating factors like stress, coffee, pain killers, a missing dose of medicine, or high salt intake? If you do not have any other symptoms, then it is not a stroke. It simply means you need some dose escalation. If blood pressure (BP) continues to stay in this range, and if you have any other symptoms, then I suggest you get yourself checked by a local doctor.

Thank you.

Patient's Query

Hello doctor,

Thank you for your response.

Yes, doctor, I was having joint pain so I took homeopathic medicine to reduce pain. After taking them my BP suddenly increased last night. Today in the morning my BP reduced to 165/92 mmHg. I had taken Olmezest 20 yesterday in the morning. In total, I had taken it thrice. I will take Olmezest 20 again . If this case of high BP occurs again and especially at night when no doctor is available, Can you suggest me some urgent medicine to reduce high BP at that crucial moment?

Regards.

Hello,

Welcome back to icliniq.com.

I suggest you avoid painkillers. You may use topical gel or spray, or plain Paracetamol 500/650 or 1000 mg is safest depending upon the response. Another pain killer is Ultracet (Paracetamol and Tramadol), which is safer. Blood pressure (BP) may remain elevated till that medicine is out of the body for another day or two. It would help if you kept Asomex (S-Amlodipine) 2.5 /5 mg with you for emergency purposes. Have Olmezest (Olmesartan Medoxomil) up to 40 mg today, and if BP is still more, then have Asomex 2.5 mg.

Thank you.

Patient's Query

Hello doctor,

Thank you for your response.

I had taken Olmezest 40mg, then after 2 hours later when I monitored my BP it was 165/94 mmHg. Now about half an a ago I was not feeling well so I monitored my BP and it increased suddenly to 179/109 mmHg. Do you think now I should take Asomex 2.5mg? I am feeling very tensed. Why is my BP fluctuating like this. Will my BP not get controlled?

Thank you.

Hello,

Welcome back to icliniq.com.

Yes, you should take Asomex (S- Amlodipine) . It is likely due to pain killer. In my opinion you have nothing to worry about. Take some time of a day or to settle and calm down and have rest. You need not worry and stress due to this. I suggest you to avoid activities and high salt food, coffee or tea. Visit nearby doctor if you are having any symptoms or your blood pressure continues to rise.

Thank you.

Patient's Query

Hello,

Thank you for your response.

Yes, I generally take black tea four times a day, and I am addicted to it. Do you think now I should permanently stop having black tea?

Thank you.

Hello,

Welcome back to icliniq.com.

I suggest you to reduce it but you need not stop it completely. However, at present, you should not consume it till your blood pressure is controlled.

Thank you.

Patient's Query

Hello doctor,

Thank you for your response.

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 mmHg in the morning. I want your suggestion on a particular matter. This mid-year, my family and I went on a trip with a travel agency. Unfortunately, my daughter and I suffered from severe diarrhea, which comprised loose motion about five to 6 times a day and even frequent vomiting. I even had a stomach ache as soon as I used to take the food supplied by the travel agency. We were simply on ORS (oral rehydration solution), Tricaine antacid, and hard biscuits, but still, we did not recover.

We used Zeolin in our drinking water supplied from the hotel. During our bus journey, even though we used to take Avomin (Promethazine) tablets at least 2 hours before our bus journey, we still vomited every day. We did not take mineral water but used Zeoline in our drinking water. Can this illness happen because of this? Is this the reason which made us sick? This year, I am again planning a tour with my family to another place. 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?

Thank you.

Hello,

Welcome back to icliniq.com

From your description, food is likely the culprit. It may be due to bad food quality, but Zeolin (Sodium hypochlorite) 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 Zeoline.

And for the next trip, it is better to change travel agents to one with a better plan for bad health. You yourself should carry some Antibiotics like Norflox TZ (Norfloxacin, and Tinidazole), Antidiarrhhoea medicine like Redotil (Racecadotril) and it is important to use Zeolin inappropriate amount or better to use mineral water rather than Zeolin.

Thank you.

Patient's Query

Hello doctor,

Thank you for your response.

Can you please suggest some medicines to avoid vomiting during the bus journey as Avomin did not work for me during this trip?

Regards.

Hello,

Welcome back to icliniq.com.

Other than Avomine (Promethazine), you may have Emeset (Ondansetron) 4 or 8 mg according to your need. Also, Antacids like Rantac (Ranitidine) or Pantoprazole can be taken before journey. Please always remember to carry Probiotics like capsule Vizylac (Lactobacillus) for proper digestion.

Thank you.

Patient's Query

Hello doctor,

Thanks for your response.

I have been Olmezest CH 40 for my high BP since last week. 2 weeks ago my BP was quite high, about 180/ 98 mmHg, 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 mmHg 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?

Thank you.

Hello,

Welcome back to icliniq.com.

In my opinion, this is not alarming, but ideally, blood pressure should be in the range of 110 to 130 mmHg. So, you should modify your medications. It would be best if you had plain Olmezest (Olmesartan Medooxmil) rather than a CH component in it. This might help in regulating your BP. This usually may cause potassium and sodium disturbances, but only patients who have initiated the therapy and in kidney disorder patients. So, I suggest you get a kidney function test, including sodium, potassium urea, and creatinine, after initiation of drug therapy.

Thank you.

Patient's Query

Hello doctor,

Thank you for your response.

I have been quite tense the past few days. My sister-in-law passed away. She was 70 years old with high diabetes. She had an epilepsy-like disorder with blackouts, so we performed some medical tests for her. We found aortic sclerosis of her heart in the ECHO test and another age-related abnormality in her brain through a CT scan. After taking insulin also, her blood sugar level was 300 mg/dL in fasting blood sugar. She died of complete negligence from her family's end. I am 60 years old and have a family to care for. I am not diabetic, but my BP level fluctuates, and I have fatty liver and a cyst in my liver. So my question is, can I also die like my sister-in-law? It would be of great help you would suggest me some medical tests.

Regards.

Hello,

Welcome back to iclniq.com.

In my opinion, you need not worry about it. Your sister-in-law did have treatment, but it did not work out for her. She probably had intermittent heart block, which could have been treated very well. If blood pressure was well controlled. Intermittent BP elevation is expected and not worrisome.

However, it would be best to focus on a healthy lifestyle like fewer calories, light dinner, daily walking, avoid weight gain. Also, undergo screening tests like blood sugar, fasting lipid profile, and high-sensitivity C reactive protein (hs-CRP). Additionally, I also advise an echo and treadmill test (TMT) to rule out the possibility of asymptomatic blockages.

Thank you.

Patient's Query

Hello doctor,

I have recently performed some of my medical tests like some blood tests, ECG, ECHO tests. In my ECHO test, I have observed some abnormalities in the report. Are these abnormalities in the ECHO report dangerous? Can they be cured? I am sending you all of my medical reports. Now I am taking Olmezest 40, and my BP is well controlled. Today my BP was 122/ 83 mmHg in the morning. Please give me your valuable opinion on this.

Thank you.

Hello,

Welcome back to icliniq.com.

Your electrocardiogram (ECG) and echocardiogram seem good based on your reports (attachments removed to protect the patient's identity). Your electrocardiogram (ECG) and echocardiogram seem good. An echocardiogram shows some minor changes which are related to hypertension. These are not worrisome and need no treatment. However, your erythrocyte sedimentation rate (ESR) is elevated, and hemoglobin is low, for which you need evaluation. The usual cause for ESR elevation is infection. Do you have a fever, any current weight or appetite loss? If you do not, then other rarer causes need to be ruled out. So, it would help if you visited a nearby physician. Also, Vitamin D is low, for which you need supplements like tablet Uprise-D3 60,000 IU (Cholecalciferol) once a week for eight weeks and then once a month for the next six months.

Thank you.

Regards.

Patient's Query

Hello doctor,

Thank you for your response.

I have reduced weight in the last few months. However, I am following a healthy diet. I did not have any infections recently. My appetite is also good.

Regarding my hemoglobin, it is also constant to 10 from months. I follow a diet. I eat vegetables, dal, soya, fish, eggs, and chicken. I have performed my urine microalbumin test and have sent you the reports. I cannot take iron supplements as I feel nausea and even vomit sometimes. Even the Dexorange capsule does not suit me. Would you please suggest to me some iron supplements? What should I do regarding elevated ESR? My uric acid level and one of my cholesterol levels are high. Do I have to perform my treadmill test?

Regards.

Hello,

Welcome back to icliniq.com.

Your LDL cholesterol and uric acid are borderline elevated. So you need not have any medicines for it but continue a healthy lifestyle. There is no absolute need for treadmill test (TMT), but if you have any family history of heart disease or stroke, you should have it. Even otherwise, there is no significant harm in having it done. You can have syrup Haem Up ( Alcohol, Cupric sulphate, Ferric ammonium citrate, Hemoglobin, Manganese sulphate, Zinc sulphate, Zinc sulphate) liquid one teaspoon after lunch as an iron supplement. Initially, try having Dexorange (Cyanocobalamin, Ferric ammonium citrate, and Folic acid) syrup after meals.

Did you have any previous erythrocyte sedimentation rate (ESR) readings that are elevated? Anyways, since it is more than 100 mm/hour which is relatively high. It needs attention. You should also get c-reactive protein (CRP) level and repeat the ESR test to confirm and rule out false readings. Two other possibilities need to be ruled out other than infections like multiple myeloma and giant cell arteritis. For multiple myeloma, you should undergo a serum-free light assay and serum protein electrophoresis. And for giant cell arteritis, you may get a doppler ultrasound of head and neck vessels. In this regard, I would suggest you get examined by a local doctor.

Thank you.

Patient's Query

Hello doctor,

Thanks for your response.

I want to discuss my daughter. My daughter is 27 year old unmarried woman and a patient of PCOD. She has been under hormonal treatment for a few months. she has been sweating and always under the air conditioning. When she woke up, she told me that she was having headaches and pain in her eyes and hands. When I checked her temperature, I saw that she had 100.6 Farenheit with pain in her hands and legs. So I gave her Calpol 500 mg, and she was under complete bed rest. She is not coughing or sneezing. Can this be a sign of dengue? she had dengue once before.

What can I do if her fever does not come down? Would you please advise some medications? Though her headache, eye pain, and hand pain have reduced since morning still is present in a significant amount.

Regards.

Hello,

Welcome back to icliniq.com.

These are the signs of viral infection, and it can undoubtedly be dengue fever. So, if you can get her tested for dengue virus antigen detection test, it would be better.

If you want to wait, then viral infections do not 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 Calpol (Paracetamol) 500 may be taken 4-6 hours if necessary or do cold sponging, but not other pain killers. Avoid doing activities that would predispose to trauma. Avoid straining at urination or passing stool. She should have plenty of water, say around 2.5 to 3 liters a day.

If fever persists for more than a few days, then she needs to be evaluated for bacterial infections like typhoid and urine infection. I guess she does not have burning urination.

I hope this helps.

Regards.

Patient's Query

Hello doctor,

Thank you for responding.

This is to inform you that my daughter has recovered from her fever, but she still has a cough. I did not consult her to the local doctor or get her blood test done, she was only under Calpol 500 mg, and now her body temperature is also normal. Past few days, I have been affected by fever too. At first, I had a fever of 102.4 degrees Fahrenheit, with a cough and severe back pain. I did not get my blood tests done. Three days have passed, and I am taking Calpol 500 mg. Today in the morning, my fever was 101 degrees Fahrenheit, and I also have severe back pain for which I cannot even sleep at night. Do you have suggestion for this back pain? Will I continue with Calpol 500 mg? I am using raw ginger in my mouth to get rid of cough as using cough syrups, my cough increases. Would you please give me your valuable opinion on this?

Regards.

Hello,

Welcome back to icliniq.com

Yes, is 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 virus antigen detection and dengue immunoglobulin IgM, also hemogram and liver function tests (LFT), and renal function tests (RFT). Till the time, we do not rule out the possibility of dengue, you cannot be able to take other routine pain killers. However, you may have Ultracet (Paracetamol and Tramadol) occasionally besides Paracetamol or Calpol. You can use local gel and hot water bag application for relief. I would advise you to get examined by a local doctor and get tested.

Regards.

Patient's Query

Hello doctor,

Thanks for all your assistance

I generally take Olmezest CH 20 for my BP, and after taking this medicine, my BP usually stays 122/78 mmHg. Now I have started taking soya milk walnuts, almonds, red grapes, and some cherries as lunch past few days. Today, I was not feeling quite well, I checked my BP half an hour ago, and it was 159/90 mmHg, which is higher than my normal range. You advised me to consult a local doctor, who then suggested tablet Rozavel TZ, tablet Nexpro RD for my cholesterol level, and my BP medication. So now I am using three medicines regularly. My question to you is taking walnuts, almonds, cherries, red grapes, and soymilk increases BP? As I am even taking cholesterol medications, can I take these dry fruits? My BP is a bit high, so do I have to take another tablet of Olmezest CH 20? I am having acidity & even gas after taking Rozavel and Nexpro RD tablets. Please give me your valuable advice.

Regards.

Hello,

Welcome back to icliniq.com.

Since you have noticed an elevation in your blood pressure, you should have an additional dose of Olmezest CH. You should monitor BP frequently, three times a day or whenever possible for a week. If the majority of your readings are 140 mmHg systolic, then you may use it regularly and have Olmezest (Olmesartan Medoxomil) twice daily. I hope you did not have any pain killers which can cause such elevated BP. Increased salt intake may cause high BP, but it is unlikely to increase due to nuts or soya milk consumption. Intermittently, BP may increase due to internal body changes as well. You can have these food items with your medicines. You should avoid fatty, oily, and spicy food, walk after having meals rather than resting immediately. Avoid heavy meals and dinner. Have Rozavel (Rosuvastatin) after dinner. If gastritis persists, I request you to change to Atorvastatin 10 mg instead of Rozavel.

I hope this helps you.

Thank you.

Patient's Query

Hello doctor,

Thank you for your response.

Now my BP has come down to 138/83 mmHg. This is another problem I have to discuss with you. Whenever I eat chicken or egg curry, I face constipation problems. Yesterday I had chicken, as a result of which I did not pass any stool yesterday. Today I did not have chicken, so my constipation problem is better than tomorrow. Do I need to avoid chicken and egg entirely to prevent constipation? And answering your previous questions, I did not take any painkillers. Can constipation problem increase BP? I have taken Tricaine syrup for my acidity.

Regards.

Hello,

Welcome back to icliniq.com.

Yes, constipation or acidity, if causing discomfort, then may raise blood pressure. It is better to avoid chicken or eggs considering problems they cause or have it occasionally only. Now, the current BP reading seems fine. I suggest you avoid additional dosages. You should continue measuring it frequently for a week atleast. You may have tricaine syrup whenever necessary. There is no issue in taking it for acidity.

Thank you.

Patient's Query

Hello doctor,

I was a bit tense with my fluctuating blood pressure. hence I went ahead and had some recent tests like blood tests, ECG, ECHO. I have also performed the CT scan of my brain as a few days ago cupboard door fell on my head while I was sleeping and there was swelling of my head which was quite painful. I am sharing my reports with you. I have seen that now my platelet level has come down to 1 lakh. I am not having a fever now. There is also a sinus abnormality visible in my CT Scan report. Is it harmful? Now I am only taking Olmezest CH 20 for my BP. Today my BP was 118/63 mmHg and my body temperature was 97.4 degrees Fahrenheit. Would you please give me your opinion on this?

Thank you.

Hello,

Welcome back to icliniq.com.

I am unable to see your reports. Your Blood pressure is acceptable at present, and you should continue with Olmezest CH (Olmesartan Medoxomil). Once in a while, if BP goes above 140 mmHg, you need not worry. Sinus abnormalities are not usually harmful, and most of the time, these are allergic. Since you do not have any recent history of fever, generalized body aches, fatigue, then a low platelet count is unlikely to be related to infection. I guess your hemoglobin and white blood cells (WBC) count are average. Fall in platelets count may occur with age or sometimes may occur in Vitamin deficiencies or some bone marrow issues. So, it's better to get yourself tested for Vitamin B12 and folic acid levels tests. Also, i suggest you to see a hematologist for knowing the reason behinf your low platelet count .

Thank you.

Patient's Query

Hello doctor,

I am facing technical issues in uploading my medical. i will get back to you as soon as i can

Thank you.

Hello,

Welcome to icliniq.com.

Your reports are fine (attachments removed to protect patient's identity) except for Vitamin D, platelets, and hemoglobin. Echocardiogram looks good, and diastolic dysfunction is expected with age and hypertension. So, you should have Tablet Uprise D3 (Vitamin D3) 60,000 units once a week for eight weeks and then once a month for the next six months. Electrocardiogram and CT look normal as well. As I have mentioned earlier, you should obtain a hematologist's opinion for low platelet count and get Vitamin B12 and folic acid levels to look for the cause of your low platelet count.

Thank you.

Patient's Query

Hello doctor,

Thanks for your reply.

In my last ECHO report, there was mild concentric LV hypertrophy. Has this LV hypertrophy change occurred because my BP is now controlled?

Another issue that I am facing is regarding my daughter's health. My daughter is 27 years old, unmarried, has PCOD, and is under treatment of PCOD. She has a breathing problem. She is even quite overweight. Her weight is about 73 kg. This breathing trouble increases during the summer season, pollution, and even when she travels in overcrowded buses or metros. She takes Clonazepam medication for breathing trouble which was prescribed to her by an ENT specialist. I have recently performed some of her medical tests like blood, ECG. In her ECG report, sinus tachycardia was mentioned. What is this? Is it harmful? My daughter is allergic to certain drugs like PAN-D, Cifran CT, Norflox, Nortini. I am trying to send you her medical reports. Would you please give me your valuable opinion?

Regards.

Hello,

Welcome back to icliniq.com.

If blood pressure is persistently under control, then hypertrophy may regress to some extent. But this is not marked. The usual reason for such variations is a measurement error. Since echo is an observer-dependent investigation, few variations do occur during measurement. But it does not matter. We have to focus on BP readings only. And regarding your daughter, sinus tachycardia is not harmful at all. It is a normal form of heart rate elevation like whenever one exercise, is anxious, breathless then heart rate may increase (sinus tachycardia). So it is not worrisome. Shortness of breath in her case is likely related to allergy. So, she may have some antiallergic medicines like Montair LC (Levocetirizine and Montelukast) bedtime, or she can use inhalers like Asthalin (Salbutamol) to tackle this. However, relief with Clonazepam suggests that there is some component of anxiety or phobia responsible for breathlessness.

I hope this helps you.

Thank you.

Patient's Query

Hello doctor,

Thank you for the reply.

I am taking Olmezest CH 20 regularly. But my BP has become relatively low in the last few days. Today my BP was 108/64 mmHg; hence I have decided to avoid my BP medication. Today I want advice from you. As you know that there is a strict protection measure being taken throughout our country for the Novel Coronavirus( COVID 19). People are now cautioned not to go outstation. But in news channels, it is shown that people are thoroughly examined at airports, and suspected candidates are sent for medical examination and then kept in quarantine for several days, which scares me. However, we are not having any symptoms of COVID 19. Do you think it is safe to travel during this period? We have not made any bookings yet. We are waiting for your advice.

Thank you.

Hello,

Welcome to icliniq.com

You may avoid Olmezest, but you have to keep strict watch over the bp. And you will have to restart it once Bp again starts rising. If BP starts increasing in the range of 130 to 140 mmHg then you may have half a tablet. Regarding corona, better not to book tickets now and wait for a week atleast. Because we know how it is going to be in the coming days. If it worsens then you will face a lot of trouble at airports besides the risk of acquiring it, which is truly high at airports. Also, the majority of tourist places may be closed in that case. Even now many places are already closed. You would face problems at every step including residence and all. So, better to wait for a week and if recedes then you may safely book.

Thank you

Patient's Query

Hello doctor,

Is it now safe to have chicken or eggs? We would take boiled eggs if you allow, and chicken will be washed in boiling water before cooking it. Is it permissible? Another thing I want to ask you, doctor, about my daughter. She is pretty overweight (72kgs) and a patient of PCOD, so now, to reduce weight, she is taking Herbalife, a meal supplement. She is taking solid food twice a day and resting. She is taking this Herbalife tea and shake twice a day. Her BP has come down a lot after taking this product to 95/52 mmHg, and I am giving her ORS water every day to enhance her BP level. My daughter even has a gas problem. She gives out gases (farts) seldom, which is quite embarrassing. Can you please recommend some gas medicines for my daughter to avoid such awkward situations? Her gas problem has increased after taking Herbalife. She is allergic to certain drugs like PAN D, Cifran CT, Norflox, Nortini. Would you please give me your opinion on this?

Thank you.

Hello,

Welcome to icliniq.com.

Regarding your daughter, is herbal helping in her weight loss? If it is genuinely helping her, she can continue, but it is better to stop if not or even has a marginal effect. No one exactly knows what it contains, and one cannot assume that herbal products are always safe. Also, it is common for herbal products to cause farting as they are not adequately digested. Yes, you can have eggs or chicken, but it should be nicely cooked or boiled, not undercooked. Does she have constipation? If yes, then should be treated and may have syrup Cremaffin ( Liquid paraffin and Milk of magnesia) and two teaspoons of A-plus syrup at bedtime (sugar-free). If she is on Metformin, then it should be taken after meals. She should identify the food which precipitates or increases farting, like chana, which should be avoided. Daily exercises are essential. Some walk after meals. Next step, if this is not helpful, she can have syrup Aristozyme (Diastase and Pepsin) one teaspoon after meals which would be beneficial in digestion and preventing farting. Over and above, if the problem persists, then she can gas clearing medications Tab Simethicone 40 mg with each meal.

Also, she should make some behavioral changes, like whenever she gets an urge to fart, she should go to the washroom even for farting so that it would not be embarrassing even if it is loud.

I hope this helps.

Thank you.

Patient's Query

Hello doctor,

This is regarding my daughter's present health condition. For two days, she is having a little cold and dry cough. She even sneezed at times. There is no pain in her throat, nor is there any breathing trouble. Yesterday she even had about 100 degrees Fahrenheit fever. Then I gave her Calpol (500mg), and in the evening, the fever came down to 99.2 Fahrenheit. Today in the morning, she had a slight dry cough, but her body temperature was 98.5 Fahrenheit. She has been doing a lot of house chores, which could be the reason for her sickness. Can this be a symptom of COVID 19? Does my daughter need a medical examination of COVID 19? As for your information, we have never visited outside India in our whole life, nor did we see outside our state, West Bengal, in the last few months. We both also have not contacted any person who has done any foreign tours. We have not even gone to any social gatherings in the last two months. But we have gone to the market near our home in the previous few days. My daughter is allergic to certain drugs like PAN- D, Cifran CT, Nortini, Norflox. Would you please give me your valuable opinion?

Thank you.

Hello,

Welcome to icliniq.com.

It is a viral infection and can be Covid-19 as well. Because symptoms overlap with other viral infections, there is no way to differentiate between the two. The probability of disease is less as there was no significant contact, and It is not that rampant during market visits.

So, we should treat it on the line of Covid-19. She should get her test. It is just a swab test. You can also call a private lab at your home for testing. So inform the nearby hospital, and negative testing will clear all your doubts. She should isolate herself, and you also stay away from her as much as possible. There is nothing to worry about as 97 percent of individuals recover well from it even if it is a covid 19 infection.

Thank you.

Patient's Query

Hello doctor,

Thank you for your response.

I have been consulting with you for quite a long time. This is to inform you that my daughter is feeling better now. The last time I consulted with you regarding her health condition, her health condition began to improve after that, and I did not get her tested for Covid-19.

Today, I am consulting with you regarding my present health condition. As you know that I regularly take Olmezest CH 20 for my BP, and now my BP is quite normal, 122/82 mmHg today in the morning. But the matter of tension in my sugar level. A few days back, my sugar level was 118 mg/dL in fasting, which I had measured at home at my glucometer. Today, my fasting sugar level was 124 mg/dL. I have been having cookies, biscuits, mangoes, and litchis for the last few days. But you know the doctor, I take tea without sugar and even in our food we take sugar lite, instead of sugar. Last year also I took mangoes, litchis but my sugar level did not increase. By increasing the sugar levels is a matter of concern for me. Will you suggest me any medicine for diabetes now? What should I do now to control my sugar level?

Regards.

Hello,

Welcome back to icliniq.com.

Firstly, it is not diabetes at present, but just an impaired glucose tolerance, but yes, indeed, it can worsen with time. This means you tend to have diabetes in the future and should take precautions for it. You need to have a healthy lifestyle for a few months, then repeat sugar and see the response with present sugar levels. You need not be on medications.

You should repeat your sugar testing in fasting and 2 hours post-lunch. Now you should have dinner at the proper time, have fruits in moderation only, and avoid cookies. And after this, if fasting is less than 110 mg/dL and post-lunch is less than 140 mg/dL, you need to have a healthy lifestyle like avoiding sweets, fruits in moderation, regular exercises (maybe in-home), weight loss. Avoid late-night dinners and have light dinners. If you are overweight, then try to lose some weight. So cut on the calories. Include more salads, green leafy vegetables.

The next step will be to change Olmezest (Olmesartan Medoxomil) CH to plain Olmezest if blood pressure rises because the CH component causes hyperglycemia. So, in a nutshell, you need to make some modifications before considering medications. Despite all these measures if sugar is more than 110 mg/dL fasting and 140 mg/dL post-lunch, you would need drugs like metformin.

Thank you.

Patient's Query

Hello doctor,

Thank you for your response.

About a month ago when I used to brush my teeth I had nosebleeds. I generally suffer from constipation so there I used to apply pressure and nose bleeds took place. It occurred for a few days and then it automatically stopped. As my BP was quite normal at that time I did not inform anybody. Is it something to worry about? I was quite tense during that time due to Covid-19.

Regards.

Hello,

Welcome back to icliniq.com.

Most of the time, it is nothing to worry about, and since it has not recurred since then further unlikely to be anything serious. The likely cause may be straining at stools. Also, allergies or nose-picking may precipitate it. However, generally, we advise getting it checked once to be sure. You may use Otrivin (Oxymetazoline) nasal drop twice daily whenever it recurs.

Thank you.

Patient's Query

Hello doctor,

Thank you for your response.

This is to inform you that my daughter is not feeling well since yesterday. She has about 100 degrees Fahrenheit and is even feeling relatively weak. Yesterday we went to the bank after we came from the visit she fell sick. I am troubled regarding my daughter's health because of this ongoing pandemic COVID 19. We have not gone out of our home for long. My daughter even had eye pain, but after taking Calpol 500 mg twice today, her eye pain is gone, but her fever and weakness are there. Her appetite is good now. There are no other symptoms. My daughter has been taking antidepressants Desvenlafaxine 50 mg and Aripripazole 5 mg for the last 10days prescribed to her by a psychiatrist. She has become paranoid owing to this ongoing pandemic and lockdown. Could you advise her a medicine? Should I continue with Calpol 500? My daughter is allergic to certain drugs like Norflox, Nortini, Pan-d, Cifran CT.

Regards.

Hello,

Welcome to icliniq.com

In this pandemic era, we should consider it a Covid-19 and take all precautions. So even if it is a Covid-19, it is harmless in most individuals. Only testing can verify it. However, if not able to test, she should isolate herself and try to contact others as much as possible. Does she have any other symptoms like sore throat, difficulty in swallowing or breathing, burning urination, or cough? If yes, then she will need some medications based on the symptoms. If she does not have any symptoms, continue with Calpol (Paracetamol) for a day or two. But if fever persists, then you will have to get her tested with hemogram, malaria, dengue and swab test for Covid-19, urine routine testing. Suppose she has any symptoms like cough, sore throat. In that case, she should be started on Azithromycin 500 mg once daily for five days, Calpol whenever needed, and Antacids like Rabeprazole 20 mg before breakfast once daily for days. She should also have Betadine gargle thrice a day if she has a sore throat.

Regards.

Patient's Query

Hello doctor,

My daughter has been taking Calpol 500 mg for two days. Now her fever has come down. It was 99.2 degrees Farenheit today in the morning, so she took one dose of Calpol today. Today she is having slight breathing trouble and says that she cannot stand too long as it is giving her discomfort. Whenever she is standing in a place to do some work, she wants to sit, but she does not have body pain or sore throat, or difficulty in swallowing. She even does not have a cough or cold. Her appetite is good. Her BP is normal. But she is having difficulty standing in a place for long and slight breathing trouble today.

As I told you before, she is taking two antidepressants, Aripiprazole 5 mg, and Desvenlafaxine 50 mg. Is it due to the side effects of these drugs? Will she continue with Calpol 500? Will you prescribe her any other medicines? She is allergic to certain medications like Norflox, Nortini, Pan-d, Cifran-CT.

Regards.

Hello,

Welcome back to icliniq.com.

I suggest you stop Calpol and see if the fever is recurring. Now inability to stand may be related to weakness due to recent fever, but unlikely to be related to side effects as she must be on these medications for a relatively long period. Coming to shortness of breath, is it at rest or on exertion or both? True shortness of breath usually occurs on work and relieves with rest, and in later may even present at rest. However, shortness of breath may be related to generalized weakness due to a recent fever. But if she has clear and noticeable shortness of breath, you have to take her to her hospital for testing. If fever continues to persist after stopping Calpol, she should also visit a nearby doctor for examination and blood tests because we need to ascertain the cause for fever. It will not be possible for me to prescribe any medications without examination. However, she may take multivitamins supplements like Neurobion forte for two weeks for weakness.

Regards.

Patient's Query

Hello doctor,

This is to inform you that now my daughter's fever has come down. Yesterday it was 98.5 degrees Farenheit when she took no Calpol and today as she was having 99.2 degrees Farenheit fever so she took 1 dose of Calpol 500mg and now her fever is 97 degrees Farenheit. She does not have a sore throat or cough. Her appetite is good and she can smell and taste food. I did not get her tested for COVID 19 as she was very scared and unwilling to get tested in the fear of neighbors. Now she is fully at home and is taking a rest most of the time.

But you know she is having a little cold as well as a bit of running nose. Can you suggest some medications for running their nose to her?

Also, is it safe for her to do gargle with betadine gargle if she doesn't have a cough or sore throat? She is allergic to certain drugs like Norflox, Nortini, Pand-d, Cifran CT.

Regards.

Hello,

Welcome to icliniq.com.

Yes, betadine gargles can be done even without an apparent sore throat.

She can have Tablet Allegra (Fexofenadine) 120 mg once daily for three days for running nose. Alternative to Allegra is Levocetirizine 5 mg whenever needed upto two times a day.

All the best.

Patient's Query

Hello doctor,

Thank you for your response.

For a few days, I am myself suffering from a running nose. In this pandemic situation, I am not letting my maid in, only my cook is coming to my home only twice a week. As a result, the whole workload is on me and my daughter. I am washing lots of utensils daily, cook, and am always in contact with water. So, I have caught a cold and am having a running nose. My body temperature is normal today about 98.5F. I don't have a sore throat and can smell and taste food. Now my only problem is running my nose. Can you please prescribe me some medication for running nose now? I am now 61 years old and am nondiabetic. I take only one BP medication Olmezest AM as prescribed by you. Can I gargle with betadine gargle like my daughter though I don't have a cough or sore throat?

Regards.

Hello,

Welcome back to icliniq.com.

You may also do gargles with betadine. And you may have the same medications as I mentioned above, either levocetirizine 5 mg upto two times a day, or alternatively you may have Allegra (Fexofenadine) 120 mg once daily at bedtime for three days.

Regards.

Patient's Query

Hello doctor,

I want to discuss my BP medicine Olmezest AM . I have been taking this medicine for the last twenty days as prescribed by you. After taking this medicine for the last few days I am having an indigestion problem accompanied by gas and sometimes lose motion. Can this be a side effect of OImezest AM? The medicine, in general, is fine with me but can you prescribe some medicine for indigestion like an antacid which I can take along with Olmezest AM. Previously, I used to take Olmezest CH 20 but it was changed by you as it was enhancing my sugar level and I even had a nose bleed once. Now after taking Olmezest AM, for the last 20 days, my sugar level has come down to 113 mg/dL in fasting from 125 mg/dL in fasting. So, please suggest what I should do regarding my indigestion problem with Olmezest AM.

Regards.

Hello,

Welcome back to icliniq.com.

This may be related to gastritis due to medications, however, it can also be related to other factors like any other medications, dietary changes, stress, inadequate sleep, lack of activities.You should have Rabeprazole 20 mg, thirty minutes before breakfast once daily for seven days and then stop. You can it afterward whenever needed. Also, have Olmezest AM, one hour after breakfast or any meal. In general, have less oily spicy meals, avoid heavy meals, have some activities after the meals.

Regards.

Patient's Query

Hello doctor,

This is regarding my daughter's obesity. She is a patient of PCOD and is quite overweight with about 156.53 pounds weight. She gains weight very quickly, but her weight loss regime is prolonged. It is now a period of lockdown. She is at home and is not getting to eat fast food or junk food for a long time. She is even working at home but still is unable to lose weight. I told you earlier that she is taking a Herbalife weight loss meal supplement twice a day for weight loss. But you know, this product has many side effects, and she did not lose much weight after taking it, so now she is taking it once in a day. She has irregular periods. As a mother, I should not be asking you, as I am pretty concerned regarding her obesity and her future. Is it possible for you to prescribe any weight loss medication for my daughter? It will be of great help for her to control her weight. She is allergic to certain drugs like Norflox, Nortini, Pan-d, Cifran CT.

Thank you.

Hello,

Welcome to icliniq.com.

They are no good weight loss medications. Either they are not effective or come with a lot of side effects. That is why bariatric surgeries are performed. Now since she has polycystic ovarian disease PCOD, I guess she must be on metformin and had her thyroid tested. So does of metformin should be adjusted and if there are even minor thyroid derangements, then medications should be optimized.

The simple fundamental is that when we eat more than what we need, the body gains weight. Her metabolism is slow, which means she needs very little food for her body. And weight loss is challenging as it requires good motivation and dedication for calorie restriction. So she has to be counseled to restrict her calorie intake. Practically, skipping dinner or just having salad, total limitation of sweets even tea should be without sugar or use sugar-free, low-fat milk, more green vegetables, all meals should be light. Food in between the meals should be restricted. It would take atleast 4 to 5 months to achieve a good weight loss with sincere calorie restriction. So the best way is calorie restriction, and weight loss would solve most of the problems.

Regards.

Patient's Query

Hello doctor,

This is regarding my daughter's health. Since yesterday evening, she has had a little discomfort in her throat. It does not precisely soar as she is not experiencing any pain while swallowing. It is a type of discomfort in the throat which occurs when one is affected by the cold. She has no cough. She can taste and smell food. Today in the morning, her body temperature was 99.1 F. There is no pain in her body. But she is agitated regarding her throat. She could not sleep a bit at night, presuming it to be COVID 19. Today in the morning, she did gargle once with betadine gargle and then took one dose of Calpol 500mg. Will she need any other medications for her throat? She is allergic to certain drugs like Norflox, Nortini, Pan-D, Cifran CT.

Thank you.

Hello,

Welcome back to icliniq.com.

As of now, she should do Betadine gargles thrice a day. Have Calpol (Paracetamol) if she develops any fever only. If sore throat worsens or persists then she will need to start Azithromycin 500 mg once daily for five days after breakfast with an Antacid like Pantoprazole 40 mg before breakfast for five days. If she develops any shortness of breath or severe symptoms then needs to visit a local doctor for checking. Even if it is COVID -19 then it is harmless in the majority of the individuals. However, she should take all the precautions.

Regards.

Patient's Query

Hello doctor,

Today in the morning, I had slight vertigo along with a feeling of nausea. Then I immediately took Vertin 16 mg and measured by BP using Omron digital BP machine, and my BP was 159/91 mmHg. I generally take Olmezest AM 20 for BP, but my BP was relatively high, so I took Olmezest CH 40 today. Now I am taking a rest. My vertigo disease was diagnosed a few years ago. The doctor who examined me prescribed me some vertigo exercises for a year, then I stopped. After that, my vertigo did not recur, and then after years, it has recurred today, and my BP is also high. Do I need any other medications now? I am agitated as it is a lockdown period and many medical facilities are not available outside. Please suggest what I should do now.

Thank you.

Hello,

Welcome to icliniq.com.

Firstly, you should focus on BP, and after controlling BP, if vertigo persists, you need to be started on Vertin (Betahistine ) 16 mg for five days. You may perform those exercises if dizziness persists after BP is controlled.

Now you should monitor your BP frequently, say three times a day for a week. You should continue with Olmezest AM 20 mg once daily in the morning and add Tab Amlodipine 5 mg in the evening. Alternatively, suppose you don't have access to amlodipine. In that case, you may continue with Olmezest AM in the morning and have half a tablet of Olmezest (Olmesartan Medoxomil) CH 40 in the evening. Monitor BP during this time. Do not have more than 40 mg of Olmesartan in 24 hours.

Regards.

Patient's Query

Hello doctor,

My vertigo has not recurred yet after that day. But you know, after my vertigo incident, in these two days when I took Olmezest AM 20, there was a certain discomfort in my body. I feel my head will start reeling and my hands start shivering, and I start sweating. What should I do now? Should I continue with Olmezest AM 20, or will you change this drug for me? My BP was 117/74 mmHg, and my pulse was 84. Will I start my vertigo exercises?

Thank you.

Hello,

Welcome to icliniq.com.

These may be related to anxiety or the primary ear problem, which had given rise to vertigo. You should continue to have Olmezest AM (Olmesartan Medoxomil and Amlodipine) and keep measuring your Blood pressure frequently for rising. If BP shows a rise of more than 140 mmHg, add half tab Olmezest 40. This probably should settle in a day or two. You may restart your vertigo exercises now.

Regards.

Patient's Query

Hello doctor,

Thank you for your response.

I will continue with Olmezest AM 20. But you know I think that this feeling of my may be due to consumption of Rabeprazole daily on an empty stomach. I have been taking Olmezest AM since a long time, but this feeling never occurred before. So will you please change Rabeprazole for me and prescribe any other drug in place of Rabeprazole 20 mg? Another thing I want to ask you, the doctor that is in this period of the pandemic, if we stay indoors is it possible to protect ourselves from Covid-19? Is it safe to go to the terrace of our house? Is it necessary to wear a mask when we go to the terrace?

Thank you.

Hello,

Welcome to icliniq.com.

I suggest you change Rabeprazole 20mg to Pantoprazole 40 mg, an equivalent dose. So change and see the response. Yes, you will be able to protect yourself if you stay indoors. Also, if the terrace is isolated and not close to other terraces, it is safe. Even if it is surrounded by other terraces, then you should avoid going to the terrace if other terraces are occupied by individuals. Otherwise, it is acceptable to be on the terrace.

Thank you.

Patient's Query

Hello doctor,

Thank you for your response.

I have stopped using Rabeprazole. But you know now, when I get up in the morning, have tea, and start reading the newspaper, I feel as if my vertigo will start. Can this be because of my eye power change? I use eyeglasses and have a bifocal lens, but I cannot remember my eye power. It has been a long time that I haven't checked my eye power because of this ongoing pandemic. Should I go and get my eyes checked, or should I consult with an eye doctor online? I take tata tea, gold tea, black tea without sugar in the morning with bakery biscuits and then read the newspaper. After 10 minutes of reading the newspaper, I feel that my vertigo will start. I take only one medicine daily, that is Olmezest AM 20, and no other treatment. Please suggest what I should do. Can this feeling of mine be due to sodium or Potassium imbalance? It has been a long time since I got my blood test done due to this ongoing pandemic. I am also scared to get my blood test done as we dont know who is carrying the virus in the body. Would you please give me your advice on this?

Regards.

Hello,

Welcome to icliniq.com.

Yes, it is likely to relate to the eyes issue. This may be related to either change in refractive power or reading may precipitate vertigo even otherwise. There is a connection between the eyes and the ear (which is a cause for vertigo). Vertin acts on-ear and stabilizes it, and doing a good reading or other fine activities may precipitate dizziness. You may take online ophthalmologist consultation, but ultimately you will need a visit for eye testing, which in my opinion, may wait and not be an emergency. However, if it precipitates vertigo, you may have Vertin (Betahistine) for a few days. It is unlikely to be related to sodium or potassium issues, so this may wait as well.

Regards.

Patient's Query

Hello doctor,

Thank you for your response.

I will consult with an ophthalmologist online. Another thing I want to ask you is that my daughter has been having a little cold for the last few days. There is no fever or cough, or throat pain. Rest all her symptoms are fine. She has a good appetite and can smell and taste food. Can she use nasivion nasal spray? She is allergic to certain drugs like Norflox, Nortini, Pan-D, Cifran CT. Though my daughter does not have any throat problem, can I still keep Azithromycin 500 mg at home

Regards.

Hello,

Welcome back to icliniq.com.

Yes, she may use Nasivion (Oxymetazoline) nasal spray. For cold, she could have tablet Allegra 120 mg once daily bedtime. If it persists for another day or two, or develop any fever then may need Azithromycin. You may keep it available.

Patient's Query

Hello doctor,

Today I had slight vertigo, then I measured my B.P, and it was 158/96 mmHg. So, I took Vertin 16mg, and as my B.P. is relatively high today, so I took Olmezest CH 40 for B.P. Doctor, I did not tell you that I recently changed my B.P. medication to Telmikind 40. I changed my B.P. medication from Olmezest AM to Telmikind 40 as Olmezest drugs were enhancing my sugar level. After taking Telmikind 40, my sugar level has come down to 106 in fasting, but Telmikind 40 is ineffective in reducing B.P. Can you change my B.P. medicine for me and prescribe me a new B.P. medicine? What should I do now regarding my vertigo? Should I continue with Telmikind 40? I also had this vertigo experience before, but it has again recurred today.

Thank you.

Hello,

Welcome to icliniq.com.

In my opinion your vertigo is probably related to high blood pressure as its correlating with high BP. If its persist after treating high blood pressure then you may have Vertin (Betahistine) thrice daily for few days. You are having low dose of antihypertensive. Olmezest 40 is equivalent to Telmisartan 80 mg. Also, you were having Amlodipine component as well. So, you should change medications to Telmikind (Telmisartan) AM and may need to change it again as well if BP remains elevated. It is usually the CH component which causes high blood sugar. Anyways have Telmikind AM from tomorrow.

Regards.

Patient's Query

Hello doctor,

Thank you for the reply,

Today, after I took Olmezest CH 40 in the morning, and my B.P. was high, then I again took Telmikind 40mg at night. I measured my B.P. in the night before dinner, my B.P. was still quite high to 157/95. I am really scared. Is this something to worry about? My vertigo has not yet recurred since morning. Doctor, will I die? Sorry to ask you these questions, I am really very scared and nervous regarding my health condition. Do I need to perform any medical tests now? Now, there is online form verification going on at my College and I am sitting in front of laptop for hours. This is going on since last four days and this has made me stressed.I have not taken any painkillers recently.

Hello,

Welcome back to icliniq.com.

No, this is worrisome. Blood pressure is mildly elevated and this does not kill anyone. These medications take time to act, while Amlodipine acts faster. So do not worry about it and keep track of bp regularly three times a day. You need to have medications with amlodipine component, so either have Telmikind AM 40/5 mg or even previous Olmezest AM (both are similar medications). Keep Amlodipine 5 mg available for emergency purposes, to be taken if blood pressure is elevated.

Patient's Query

Hello doctor,

I have been consulting with you for quite a long time. Today I will be consulting with you about my brother-in-law. He is 65 years old and is both diabetic and hypertensive. For the last few days, he has been having chest pain. This pain increases when he does brisk walking or when he has to climb stairs. At that time, his pulse rate even increases to about 148. After taking medicine, his B.P. generally lies in the range 132/79 pulse rate 69. One day his B.P. came down to 103/48 mmHg and pulse rate 81. He then took the salt sugar mixture in water, and then his B.P. became normal. He takes the following medicines daily:

  1. Injection Lupisulin M30/70, 20 units in the morning and ten units at night.
  2. Telvas CT 40 every day in the morning on an empty stomach.
  3. Metocard XL 50 once daily.
  4. Aztor ASP 75 once daily.
  5. Gluformin G2 twice daily.

My sister-in-law is dead and being childless. My brother-in-law stays alone in his flat. We are tense regarding his health. Both my husband and sister-in-law died due to diabetes a few years back. If you would like to alter his medicines, he would follow them. We have faith in your treatment. Apart from this, it will be of great help if you prescribe a proper diet plan for him. I am attaching herewith his recent medical reports for your reference. Would you please give me your valuable opinion?

Thank you.

Hello,

Welcome to icliniq.com.

Firstly regarding reports, his Echocardiogram and Electrocardiogram (attachments removed to protect the patient's identity) are acceptable. However, his uric acid is elevated, for which he should have medication like Tab Febuxostat 40 mg once daily in the morning after breakfast for four weeks. He should also have a healthy diet like avoiding fatty, oily, and high-calorie food. Have a light dinner, avoiding non-veg as much as possible if consuming. And he is avoiding all sweets. Plenty of green vegetables and salads. He should avoid pain killers as much as possible to prevent worsening of kidney function. Also, sugar should be tightly controlled for the same reason. His fasting sugar was too elevated, so sugars should be monitored at home, and the insulin dose needs to be adjusted. Also, the CT component in Telvas CT may raise uric acid, so it's better to have plain Telvas 40 mg instead of Telvas CT.

Regarding his symptoms, it is likely due to cardiac blockages. Diabetes is a vital risk factor. So he should continue his daily activities and routine walk but avoid heavy activities that precipitate the symptoms. The dose of Aztor (Atorvastatin) should be 150 instead of 75, as it is likely a coronary artery disease. He will need angiography to see the extent of blockages. If he does not want to undergo it, then alternatively may undergo CT coronary angiography.

Thank you.

Patient's Query

Hello doctor,

Thankyou for your response.

Today I would like to tell you about my daughter's health issue. Whenever she goes on a long journey by bus or car, she vomits. This mainly occurs whenever we go on tours in hilly areas. The steep roads and continuous turnings taken by buses make her vomit a lot. As a result, other tourists start complaining about her, which becomes embarrassing. She takes Avomine tablet one hour before the journey, but yet she vomits. Avomine does not work for her. A few days ago we went to a place 4 hours from our house by car. My daughter took meclizine 25mg tablet one hour before the journey, yet she vomited twice in the middle of the trip. She tells me that she starts feeling nausea as soon as she gets into the car. Both meclizine 25mg and Avomine tablets are unable to control her vomit during long journeys. So, will you please prescribe a strong vomit-controlling medicine for my daughter, which she will use during tours and long journeys? It will be of great help to her. She is allergic to certain drugs like Norflox, Nortini, Pan-D, Cifran CT.

Regards.

Hello doctor,

Thank you for your response.

She should do some behavioral modifications while traveling, like avoiding reading, using mobile, or focusing on any near work. She should preferably sit at the window and fix the site over the distant objects, which appear static. Avoid using AC in private cars. She should have such ginger candies during travel. Avoid oily and spicy meals, have light meals before the trip. Now in medications, she should use Tab Dimenhydrinate 25 mg three to 4 times a day on the travel day and begin the first dose atleast 4-6 hours before travel. But the issue is that this can cause sedation, so if there is no excessive sedation, then the dose may be increased to 50 mg three to four times a day, depending upon the travel duration. She should also take antacids in the morning before breakfast, like Capsule Cyra-D or Pan-Dsr once only. Also, frequent travel may gradually resolve this issue, so she should try to travel frequently for few times.

Regards.

Patient's Query

Hello doctor,

This is to inform you that I have been taking Cilacar 10 mg since last month. In the beginning, my B.P. was 134/83 mmHg. But today, my B.P. is a bit high to 150/90 mmHg after taking Cilacar 10 mg. I have also been suffering from constipation for the last few days. I think my B.P. is elevated due to constipation. Will you change my B.P. medication and prescribe me a stronger dose of my B.P. medicine? Previously, I was on Olmezest drugs, but I stopped taking them as they increased my blood sugar levels. I was once put on Telmikind drugs but they caused tremendous vertigo, so I stopped taking them. I am very scared now regarding my elevated B.P. level in spite of taking Cilacar (Cilnidipine) 10 mg. I feel that this drug is quite light and I need stronger medicine to control my B.P. I am unable to take Asomex 5 mg as it caused swelling of legs. I have changed my B.P. medicine several times before as most of them did not suit me well. Now I feel it is necessary to change my B.P. medicine. So, will you please change my B.P. medicine and even suggest me a medicine for my constipation.

Thank you.

Hello,

Welcome to icliniq.com.

Such fluctuations may occur in BP from time to time. So you will need dose adjustments. It is marginally high. As of now, you should increase the dose of Cilacar (Cilnidipine) to 10 mg twice daily instead of once daily. This will control your blood pressure and later reduce the amount of BP that goes down. You should have good fruits and green leafy vegetable intake. Avoid excessive salty products like pickles or salted chips. You may have syrup Cremaffin plus (sugar-free) 2 teaspoon bedtime whenever needed for constipation. Alternatively, you may have Bisacodyl 10 mg at rest whenever necessary. Have walking for atleast 30 min a day. Increase intake of salads, cucumber, bananas.

Regards.

Patient's Query

Hello doctor,

Thank you for your response.

I am now taking Cilacar 10 mg regularly. Today my B.P. was 136/87 mmHg in the morning. But you know my sugar level was a bit high in fasting. It was 124 in the fasting. Now, my College is closed, and I am entirely at home. Though I am doing some work at home, like cooking, my sugar level has gone up. I am worried about this. Will you prescribe me any medicine for my increased sugar level?

Thank you.

Hello, You may continue with cilacar, however you may add additional 5 mg in the evening. Best BP readings are between 110 to 130 systolic. So adjust medication dose according to BP. For sugar you should have Tab Metformin 500 mg once daily after breakfast. You should also get 2 hour post lunch sugar level done, so as to know the maximum sugar level.

Patient's Query

Hello doctor,

Today I will be consulting with you regarding my brother-in-law's health as I had told you earlier that he is both diabetic and hypertensive and was on insulin. His age is 65 years. A few days ago, he suddenly became unwell as his uric acid level was relatively high above 8. At that time, he had swelling of his legs and extreme pain in his toes, for which he was even unable to move for a few days. Then he visited a local nephrologist, and somehow that problem was cured. Now, he is under the supervision of that nephrologist who has prescribed him certain medications, and he is taking them regularly. He is currently taking Nexosvas 20mg for hypertension. But you know, he told me that after taking Nexosvas 20mg, there is swelling of both of his legs and even the growth of rash in his body. Would you please change this B.P. medication? I am sending you the images of his prescription where there is a list of the medications he takes regularly. You may change the medicines if you find it necessary. I am also sending you the images of his recent medical reports.

Thankyou.

Hello,

Welcome to icliniq.com.

As he is not tolerating Nexovas, it should be changed. And also considering his albuminuria issue, he should be on ARB like telmisartan. These medicines prevent the progression of albuminuria. So he should have Telma CT (40/12.5 mg) instead of Nexovas (Cilnidipine). Also, monitor BP frequently as the dose might have to be increased subsequently if BP remains high. Preferably his kidney function test like Urea Creat Sodium Potassium should be tested after 2 weeks of starting this medicine, to see his potassium is not rising. His Vitamin D is also low, so he should have supplements for it as well, like Tab Uprise (Vitamin D3 ) D3 or calciferol sachet 60,000 units once a week with milk for 8 weeks.Regards.

Patient's Query

Hello doctor,

Today I will be consulting with you regarding my health. As I had told you earlier that I am prediabetic, so about four months ago, I had performed my HBA1 C test, fasting blood sugar test, and a few other blood tests. But you know my blood reports did not signal I am being prediabetic. I am attaching herewith my blood reports for your reference. As I performed these tests about four months ago, do I need to complete my diabetes blood test again? Another thing I want to ask you, doctor, is that I am hypertensive, and you know all about my other health conditions. Now, my age is 62 years, and in this ongoing pandemic situation, it has become mandatory for everyone above 45 years of age to get vaccinated against COVID 19. So, will it be safe for me to get vaccinated? Can COVID 19 vaccine lead to other health complications in my body? There is a big hospital near my residence, but you know it is a COVID hospital. So will it be safe to get my COVID 19 vaccine from there, or will I look for any other COVID-free hospital for my vaccination?

Thank you.

Hello,

Welcome back to icliniq.com.

Yes, your blood reports do not show any evidence of pre-diabetes so just continue with precautions. Your cholesterol was bit elevated, so you should take precautions regarding that too like avoiding fatty oil meals, walk as much as possible and have light dinner. Whenever you ll repeat blood tests, ask them to add fasting lipid profile as well to see the trend and efficacy of diet modifications. Your ESR (erythrocyte sedimentation rate) was elevated during that last time. Were you having any symptoms of any infection like fever, weakness or other symptoms at that time, and did you take any treatment for it? And it should be repeated once to confirm that it has normalised now. So you need to ESR (erythrocyte sedimentation rate) and CRP (C- reactive protein) now.

Your hemoglobin is on lower side too. So you should undergo serum iron profile, Vitamin B12 and folic acid level as well, in order to confirm the cause and starts treatment. Yes, you can take covid vaccination, but risk of acquiring infection in the hospital will always be there. But you can minimise the risk by taking all said precautions. So get above mentioned blood tests whenever possible for you. All the best.

Patient's Query

Hi doctor,

Thanks for your advice.

Another thing I would like to ask you is that in this ongoing pandemic situation, our local corporation office is also giving vaccines at free of cost. So, will it be authentic to take these vaccines which are free of cost from our local municipal office? I actually wanted to avoid the hospitals for vaccination as you know that now they are very much prone to COVID 19 infection and I am now a senior citizen and even hypertensive. Can the vaccines given in local municipality be as effective as those given in hospitals? My daughter is now 28 years old and in the news we can see that after next month, COVID 19 vaccines will be mandatory for citizens above 18 years. My daughter is allergic to certain drugs like Norflox, Nortini, PAN D, Cifran CT. So, will she be able to tolerate COVID 19 vaccine? Can COVID 19 vaccine cause any allergic reactions to her body?

Hello, Yes, it would be probably safe to take vaccine from corporation office as well. Because the few same vaccines are being circulated all ove the India, so corporation must be having either of these few vaccines. Just check the brand of vaccine they are using. So i don't think that there would be any issues with it. It will not be mandatory but will be advisable to take. Probability of developing any significant reaction is very less . However it would be advisable to take in hospital set-up where they have a facility to manage anaphylaxis, in. case it happens. All the best.

Patient's Query

Hello doctor,

The pandemic is now spreading in leaps and bounds throughout our country, and it is terrifying. Many people in my locality have even lost their lives due to this ongoing pandemic. In my building, a family of three has tested COVID positive, and we are residing with them on the upper floor as there is no other choice. My daughter and I have developed COVID symptoms like about 100.4 F fever, running nose, cold. Our pulse oximeter readings are 98% and 99%. We haven't been able to get our COVID test done as the local labs nearby have stopped conducting COVID tests. To get our COVID tests done, we will have to go to hospitals, and there is a massive crowd of people, we will have to stand in long queues, their chances of infection will be more. There is no bed available in the hospitals around us, so we take treatment at home. We are taking medicines like tab Zerodol plus, tablet Absolute 3g, Tablet Bifilac, tab augmentin 625mg. We have even purchased a nebulizer machine online as there is an oxygen crisis everywhere. The doctor has advised us to use it with budesonide 0.5mg respules if our pulse oximeter reading goes below 93%. We have now fully quarantined ourselves at home and ordered groceries online. In this way, if God saves us, we will remain alive. As a senior citizen, I have not been able to get my first dose of the COVID 19 vaccine due to a shortage of COVID vaccines in our city.

Today, I want to know from you that the online nebulizer that we purchased functions the same as an oxygen cylinder? How does an online nebulizer accumulate oxygen? I had ordered my B.P. medicine Olmezest CH 20 medicine online but was supplied with Olvance CT 20. Is Olmezest CH 20 and Olvance CT 20 same medication?

Thank you.

Hello, You should book a video consult from any local doctor for medications. The medications which you are taking will not be helpful in covid 19 in any way. So get those optimized. Avoid zerodol plus as much as possible. Get medications prescribed like vit c zinc Doxycycline and Ivermectin instead of Augmentin.. Nebulizer is not an alternative to oxygen cylinder. There is no oxygen reserve in it. It's just used a way of delivering medication to lungs. And you can have olvance CT 20 instead of olmezest ch 20.

Patient's Query

Hello doctor,

In this pandemic era, I was terrified, so I purchased this nebulizer machine as there is a crisis of oxygen everywhere. Another thing I would like to ask you is whether the small portable oxygen cylinders of 6 liters like oxygen 99 or Air 6, which demand to contain 99% oxygen, are safe to use as a substitute for oxygen cylinders? Can I buy oxy99 or Air 6 and use them if my pulse oximeter reading goes below 94 and I cannot get myself hospitalized? Now, I have become relatively stable. My body temperature today is 98.8 Farenheit, my pulse oximeter reading is 98%, pulse rate is 77. My daughter's body temperature now is 100 F, her pulse oximeter reading now is 100%, and her pulse rate is 104. We were unable to get our COVID 19 tests done. As for it, we will have to go to a hospital, and there is a massive crowd of people every day, and dead bodies of Covid-19 patients are lying here and there in those places. So we have now fully quarantined ourselves at home, ordering medicines and groceries online. My daughter has a running nose and a dry cough. She took Allegra 180 for the last two days and garbled with warm salt water, but this running nose is still there. I am much better now and regularly taking Olmezest CH 20 for B.P. I am not taking any other medicine. I wasted my money entirely by buying this nebulizer machine, and I was ignorant of the function. But please let me know whether I will buy oxy99 or air six portable 6-liter oxygen cylinders or not for emergency purposes. In my city, only a few dealers are selling oxygen cylinders. The genuinity of these cylinders is a big question. Please give me your opinion on this.

Thank you.

Hello, I don't think it's worth buying this oxygen cylinder. 6 litre oxygen is nothing and will serve no purpose. If need arises for oxygen then 6 litres oxygen will last for 1-2 minutes only. Instead you can think of buying oxygen concentrator, which is also not absolutely necessary to buy. Because if need for oxygen arises then you ll need to get admitted somewhere and cant be managed at home alone. Your daughter may continue Allegra till rhinitis persists. Betadine gargles instead of warm Saline gargles is a better option. Both of you can take Vit C 500 mg twice daily for 10 days and zinc 50 mg once daily for 14 days. Also, besides these, you can have tab Ivermectin 12 mg once daily for 5 days after lunch and Doxycycline 100 mg twice daily for 5 days. Also, should have some antacids like Cap Cyra D before breakfast in the morning, for five days. All the best.

Patient's Query

Hello doctor,

Yesterday at night, my daughter suddenly started having breathing trouble. A dry cough followed the breathing trouble. I immediately took her pulse oximeter reading, and it was 100%, and her pulse rate came down to 47. I then took her random sugar test, which was 110 mg/dL. I gave her a Clonazepam tablet that she used to take earlier also when she traveled by bus and had this similar breathing trouble. Her B.P. at first was 95/55 mmHg and pulse rate 52. So I gave her ORS water and tricaine antacid. She then sat in the A.C. and was feeling much better. I kept monitoring her pulse oximeter reading, and it was 100% throughout, but the pulse rate fluctuated to 52. She has been taking the antidepressant Stalopam plus for the last few days. Sir, I feel that it is mucous in her chest, thats why she is having this breathing trouble. This is because I have noticed that water is coming out of her nose during her breathing trouble with a dry cough. Today about 30 mins ago, her B.P. was 113/74 mmHg, and her pulse rate was 62. I cannot give her oxygen as her pulse oximeter reading is 100%. I am terrified. The doctor does she need to be hospitalized if her breathing trouble continues? Will I give her oxygen from my air six oxygen bottle I had purchased online if this breathing trouble continues? This breathing trouble happened before also, especially before her exams or when she used to travel by bus. She does lots of panics all the time. Yesterday she saw the news channel, and after that, this incident occurred. She has not eaten anything solid since yesterday because of her breathing trouble. She is still now lying under A.C. and is feeling a bit better. She is allergic to certain drugs like Norflox, Nortini, Pan-D, Cifran CT. Would you please give me your suggestion?

Thank you.

Hello,

Welcome back to icliniq.com.

It may not be true breathlessness. Instead, it may be related to a psychological event like panic attacks or even allergies due to cold weather. However, due to associated coughing, we should also rule out other possibilities. However, with saturation being 100 percent, there is no need to give her oxygen. Here she should perform a 6-minute walk test twice daily to see if the oxygen level is going down with activities. Now best here would be to get tested to administer appropriate treatment. Even if not willing for swab, then specific. Now it's no harm to consider it as covid and take essential covid medicine like Vitamin C and Zinc, and even Doxycycline if symptoms persist or worsen. Try to avoid Zerodol SP (Aceclofenac, Paracetamol, Serratiopeptidase) as much as possible, and have plain paracetamol 650 mg alternatively. If you are planning not to get tested, then isolation is essential to prevent transmission to others.

Regards.

Patient's Query

Hello doctor,

Can you please suggest what medications I must be taking now? I cannot get myself and my daughter tested for Covid-19 as the local pathology laboratory nearby is not doing the home collection. Even they are not doing it at their location. My body temperature was 99.2 degrees Fahrenheit, pulse oximeter reading was 99, and pulse rate was 78. So I took one dose each of Calpol 650mg, Amoxicillin 625mg. After a while, I was having slight vertigo and felt quite uncomfortable. So I measured my B.P., and my B.P. was 159/91 mmHg and pulse rate 87. My B.P. stays typically in the range of 122/78 mmHg. I take Olmezest CH 20 every day for B.P. Can you please prescribe what medications I must abide by at this moment? My eyes have turned red and watery. Apart from this, I also have a running nose. I do not have a sore throat or cough. I even do not have body pain and can smell and taste food. Could you please advise me on medications?

Thank you.

Hello,

Welcome back to icliniq.com.

You need not worry about it, as most of the patients do recover from it. If blood pressure remains high, you can take an additional dose of Olmezest ( Olmesartan Medoxomil) 20 mg. If suspected Covid-19, you should avoid taking Augmentin (Amoxicillin Clavulanate) and instead you should have Doxycycline 100 mg twice daily for five days after meals, Ivermectin 12 mg once daily for five days after meals, Vitamin C 500 mg twice daily for five days, and Zinc 50 mg once daily for fourteen days. You can have Tablet Allegra (Fexofenadine) 120 mg once daily at bedtime until symptoms are there for rhinitis. Continue to monitor SpO2, especially after having walked for six minutes. If it drops less than 94 percent or you develop severe symptoms or breathlessness, they should rush to the hospital or at least OPD to start specific treatment.

Regards.

Patient's Query

Hello doctor,

My daughter and I have recovered from Covid-19 and we do not have any symptoms. I took my 1st dose of vaccine this mid-year. The day before my vaccination, out of tension my B.P. became as high as 171/101 mmHg. So I immediately took 1 dose of Olmezest CH 40 at that time along with 1 Digene tablet. In the morning, on the day of my vaccination, my B.P. was 140/85 mmHg, so I took Olmezest CH 20 and went for vaccination. After taking the vaccine, at night, my B.P. was 124/69 mmHg and my pulse oximeter reading was 99%. I had pain in my hand. From the next day of my vaccination, my B.P. began to fluctuate and I am also having indigestion, a feeling of nausea, and little vertigo sometimes. I have been regularly taking Tricaine antacid two teaspoons one time daily after that. Yesterday I also had little vertigo and took Vertin 16mg and tricaine antacid after that. I had taken Olmezest CH 20 at 11 am in the morning yesterday. At night yesterday when I measured my B.P, it was a bit high to 140/83 mmHg and pulse rate 69. My pulse oximeter reading was 99% yesterday. I am not having fever or body pain after vaccination. If my vertigo persists, will I continue taking Vertin 16mg? Will I also increase the dose of my B.P. medicine if my B.P. also fluctuates? Is my condition something to worry about? You know now as it is a season of mangoes so I am taking one daily and they are also causing indigestion in my body. Will I stop taking mangoes, I am very fond of them. Please give me your opinion on this.

Thank you.

Hello,

Welcome back to icliniq.com.

In my opinion, there is nothing to worry about. It would help if you continued to take Olmezest (Olmesartan Medoxomil) CH 20 itself as of now for a few days regularly. After a week or so, BP continues to stay in the range of 140 mmHg or above, so you may need to increase the dose of Olmezest CH to 40 mg. This is because Olmezest CH takes a few days to show the full effect on the body. So we should wait for a complete result.

If you can tolerate and manage indigestion due to mangoes, then you can continue to have them as you like them. There is no absolute need to stop them. If symptoms are too troublesome, then you should stop them.

Regards.

Patient's Query

Hello doctor,

I want to discuss my brother-in-law with you. He is both diabetic and hypertensive, and his age is 66 years. He takes insulin regularly two times for diabetes. He is a widower and issueless and stays alone in his flat. About four days ago, hot water fell over his hands, and he had a severe burn on his fingers. He applied ice and gel over his burn. It has been four days now, but his wounds have not healed yet. What medicines should he use for his injuries? He is experiencing pain in his wounds. I am sending you the images of his wounds. He also complains that his sugar level has come down to 60 mg/dL, and then he sweats a lot and feels uncomfortable. To increase sugar level, he drinks sugar mixed in water at those times. Is that safe for a diabetic patient? What should a diabetic patient take if sugar level falls? Can ORS water be assumed if the sugar level falls? If yes, what proportion must ORS be mixed in water to enhance sugar levels? Please also prescribe a sugar-free antacid liquid for him as he seldom suffers from acidity and indigestion.

Thank you.

Hello,

Welcome back to icliniq.com.

Are those blisters? (attachments removed to protect patient's identity) He should apply silver sulfadiazine ointment thrice a day if it is not improving or worsening from four days. It is better to get it checked once by a local practitioner for dressing and oral antibiotics. He can take Paracetamol 500 mg upto thrice a day according to need for pain relief. Keep it as dry as possible.

Sugar coming down to 60 mg/dL means either he has irregular, inadequate meals or the dose of insulin is more. If his meals are irregular, he should take regular meals and take less insulin if he is skipping the meal or having less food.

If sugar is going low, then it is appropriate to take one to two teaspoons of sugar because low sugar can be life-threatening, not necessarily for ORS.

He can have a tab of Cyra 20 (Rabeprazole sodium) mg before breakfast once daily for acidity and syrup Cremaffin (Liquid paraffin and Milk of magnesia) plus (sugar-free) two teaspoon bedtime whenever needed for constipation.

Regards.

Patient's Query

Hello doctor,

I would like your opinion regarding my daughter's health. For the last few days, she has been experiencing extreme pain in one of the toes of her left leg. It is the region of the toe just next to the nails. The part has swelled up a little and has become red. The pain increases as she walks. This has been happening for a few days. I can not understand whether it is an allergic reaction to her shoes or slippers. She is experiencing pain on touching that region or when she walks. Every day she takes only two Glutathione capsules and Stalopam plus tablets for depression. I am sending you some images of my daughter's toes for your reference. Would you please suggest some treatment? My daughter is allergic to certain drugs like Norflox, Nortini, PAN D, Cifran CT. Can my daughter take Arnica for the pain?

Thank you.

Hello,

Welcome back to icliniq.com.

It is likely a bacterial infection, and the whole toe appears swollen. You should take her to the nearby doctor for examination once and get prescribed antibiotics soon to prevent worsening. Avoid Arnica and she can take Paracetamol 500 mg upto 3 times a day for pain. If this is not helpful she can get other pain killers prescribed like Naproxen or Aceclofenac. I advise you to consult a nearby doctor for examination and antibiotics prescription. Lastly, avoid frequent contact with water.

Thank you.

Patient's Query

Hello doctor,

Thank you for the reply,

I am consulting with you after quite a long time. A few days ago I performed some of my medical tests like ECG, ECHO, blood. My ECHO report did not come well doctor. The report showed certain problems like concentric LV hypertrophy, Aortic sclerosis, Grade 1 diastolic dysfunction. These things have made me quite tensed now. Doctor is my heart condition really very serious, will I die soon? Please tell honestly how much time I have in my hands to survive. I am a widowed woman now with one unmarried daughter aged 29. If I die soon, no one will take care of my daughter. I have become quite tensed now seeing my ECHO report. Is there no cure Sir to my heart disease? I am attaching herewith all my medical reports for your reference. As you know that I am a patient of hypertension and regularly take olmezest CH 20 for my B.P. Apart from these I do not take any other medications. My B.P. nowadays stays normal 124/74. I am also suffering from constipation nowadays. I take two spoons of Softovac in warm water on weekends but still no improvement in my constipation.

Can you please prescribe me medication for constipation. Apart from this in my USG report there is a cyst in my lever. Is it worrisome? You know I did my ECHO test last two years back before pandemic and at that time it was mild concentric LV hypertrophy. But now it is concentric LV hypertrophy in my ECHO report. It means that my disease is getting enhanced. Doctor I do not have much knowledge about medical Science I am fully dependent on your advice and trust you. Please help me. Please also suggest what other medications I must take apart from Olmezest CH 20. Please also prescribe me a medicine for my constipation problem. My name is Sumita Das, my age is 63 years. It will be of great help if you can provide me with an online prescription. If you face difficulty in reading my reports then kindly let me know and I will send them to you again. My platelets doctor is also a bit low now.

Hello,

Welocme back to icliniq.com.

I have gone through your reports and overall they show minor derangements only. There are no serious or worrisome abnormalities. Echo had mild concentric hypertrophy only and mild AR, LVDD I, which can be an age or hypertension related change. These are not worrisome issues. You should continue to take monitor blood pressure and try to keep systolic blood pressure below 140 mmHg. However you should get echo repeated after every two to three years. Your ECG (Electrocardiogram) is normal. Another minor abnormalities are slightly elevated LDL (low density protein) cholesterol, low vitamin D and hemoglobin. You should have healthy lifestyle like avoiding fatty oily and high calorie food. Have regular walk and light dinner. You should get is repeated after three to six months of healthy lifestyle. For low vitamin D, you can take Tablet Uprise D3 (or Calcirol sachet) 60,000 units once a week with milk for eight weeks. Your hemoglobin is slightly low, so should undergo serum iron profile to ascertain the cause for low hemoglobin. You might need iron supplements like Fericip XT once daily after lunch. Eat iron rich food like green vegetables. For constipation, you can take syrup Cremafffin plus, two teaspoon bedtime, whenever need. All the best

Patient's Query

Hi doctor,

Thank you for the reply.

Today I will be consulting with you regarding my brother in laws health. My brother in law is a widower and childless. He stays alone in his flat. He is now 66 years old and is both diabetic and hypertensive. He takes the following medicines regularly : Lupisulin M 30/70, morning 20 units and 10 units at night. Tablet Nexovas 20, Tablet CTD 6.25, Tablet Metocard L 50, Tablet Astor Asp, Tablet Triglynase 2, Tablet Ubexa 40, Tablet Ondesmet and one more tablet. His recent problem is that about ten days ago, he was experiencing chest pain. The pain was occurring when he was trying to sleep or was lying down or when he was changing sides during sleeping. The pain was at the left side of chest near heart. The pain was not there when he was doing work or while moving up and down the stairs. After this incident, he had consulted with the local General Physician who prescribed him two new medications of which one is a panic related medicine which my brother in law did not take. He has performed his PP sugar test and ECG of heart in these days.

I am attaching (attachment removed to protect the patient's identity) herewith the ECG report, PP sugar report and the prescription of the local General Physician my brother in law had consulted. Doctor kindly let me know if my brother in law needs any more medical tests to be performed like ECHO, urine or any other blood tests. If you want you can make changes in the medicines he takes. Is my brother in laws condition now really worrisome? Actually he stays alone and seldom tells me that his sugar level falls very often and at that time he sweats, his heartbeat increases and he eats sugar instantly during that time. Today he told me that his sugar level was 99 in fasting in the morning which he measured in his one touch sugar machine. Kindly give your suggestions on his chest pain.

Hello,

Welcome back to ciliniq.com.

Can you attach ECG (echocardiography) tracing? Firstly regarding chest pain, now being a diabetic and hypertensive predisposes one for heart disease. So such patients should be evaluated for cardiac diseases. Now his chest pain was probably non cardiac as he did not have any chest pain on exertion. Cardiac pain usually worsens on exertion and does not usually changes on bodily movements like change in position. The written ECG (echocardiography) report does not suggest any abnormalities, however it is not reliable always. So he should go for Echo and if echo is normal then he should go for stress test like Treadmill test or CT (computed tomography) coronary angiography. These tests can reliably rule out possibility of cardiac disease. He can continue his current medications. His blood pressure was mentioned to be high in prescription, so he should monitor it frequently at home and antihypertensive might need to be hiked up if BP (blood pressure) is high even at home.

Regarding sugar, low sugar can be life-threatening so all precautions should be taken to avoid such episodes. For that matter, diet should be regular and if he is not having full meal on particular day then he should reduce the dose of insulin on that day. If his diet is good and regular then he should reduce the dose of insulin by 2 units both morning and evening, keep monitoring sugars.

Regards

The Probable causes

The probable cause is diabetes mellitus

Patient's Query

Hello doctor,

Thanks for your reply.

I had contacted with my brother in law and I can understand that now in his present health condition ECHO test is quite necessary. But as you can see the hike now in the COVID 19 cases in India now and in my city Kolkata, there a partial lockdown has already been announced. So my brother in law being a comorbid patient and senior citizen is quite scared now to go to the hospitals and get ECHO done. But I do have one of his old ECHO reports with me, which was done by him. I am attaching herewith that old ECHO report of my brother in law. Regarding his B.P. level, yes it is quite high. He informed me that his B.P. was 170/88 and pulse rate 78 today, which he measured in his omron B.P. machine. He takes daily two medicines for B.P. Metocard L 50 and CTD 6.25. Kindly prescribe some medicines for him to lower his B.P. level. Please also prescribe an antacid for him as he seldom suffers from acidity and gas related problems. Regarding his sugar level I have told him to reduce his insulin by 2 units both in the morning and at night as you have prescribed. Regarding his ECHO test, he will surely perform it after this pandemic situation now gets a bit normalized. Kindly prescribe his B.P. medicines and an antacid.

Hello,

Welcome back to icliniq.com.

His echo was fine, and get it done after lockdown is over. He can have Capsule Rabeprazole, Domperidone (Capsule Cyra D) 20 mg before breakfast once daily for acidity. For blood pressure, he should have Metocard AM instead of Metocard XL (I guess you wrongly mentioned Metocard L there). Besides have low salt diet, regular walk (may be in a house). Regards

Patient's Query

Hello doctor,

Today I will be discussing with you my daughter's recent health issue. She is a patient of PCOD and quite overweight. Her weight is now 73.5kg. To reduce weight, she follows a peculiar diet chart. Every day in the morning, in an empty stomach, she takes oziva apple cider vinegar (oziva matcha) in lukewarm water. After that, she takes two besan chilla with green chutney or poha or egg chowmein or Maggi. In the mid-afternoon, she takes seven almonds, four walnuts, and four dates. Every day she takes her lunch quite late, at 6 pm in the evening. After that, around 12 pm night, she takes two apples and an oziva nutritional meal shake. She is now pursuing her B.Ed course online. This diet chart she has been following for the last two months, but there is very little weight loss. She does not exercise daily. Today at about 5 am in the morning, she was feeling nausea, and had cramping pain in her upper abdomen, followed by acidic belches. She then had loose motions about six times since 5 am morning, followed by the pain in her stomach. I gave her a Cefixime IP tablet once in the morning. She has also taken three glasses of ORS water and two biscuits since morning and nothing else. In spite of taking the Cefixime IP tablet once, her loose motion is not stopping, and also, there is a pain in her stomach. Doctor, I am really tense now about my daughter's health. As you know that the third wave of COVID is now active, and it will not be possible for me to hospitalize my daughter easily. She does not have a fever but has a little running nose. Please suggest what medications my daughter must take now to stop her loose motions, stomach pain, and acidic belches. She is allergic to certain drugs like Norflox, Nortini, PAN D, and Cifran CT. I am attaching herewith some of her recent medical reports for your reference. What must she eat now? Her age is 29 years old.

Hello,

Thank you for the reply.

The third wave is quite rampant now, although milder. Considering the association of running nose, this can be a covid infection. Another possibility of gastroenteritis.

She should continue to take ORS solution, 200 ml, with each stool passed. Also, Cefixime 200 mg twice daily may be continued for five days. In order to stop stools, she can have tab Racecadrotil 100 mg, whenever needed (can be taken up to three times a day) up to stools are stopped. Also, she can tab Rabeprazole 20 mg or Ranitidine 150 mg twice daily for five days.

For effective weight loss, calorie restrictions along with exercises are necessary. She should calculate the calorie content and adjust the amount of food accordingly. She can have a good breakfast with light lunch and may skip dinner. Diet should include salads and green leafy vegetables in the meals. Regular exercises are equally important. She can reduce the consumption of supplements, as these can predispose her to gastritis.

Patient's Query

Hello doctor,

Thank you for the reply.

It is been a long time that I had consulted with you. As you know that I am hypertensive and non diabetic. I regularly take three medications:

  1. Tablet Olmezest CH 20
  2. Tablet Nexpro RD 40
  3. Tablet Rozavel 5

About one week ago I slipped on the floor and hurt my hips. There was pain so I had consulted local orthopaedic doctor and he prescribed me two painkillers namely Tab Tendocare Forte and Tab Hefinac. Two days ago, after taking first dose of the medicines I started feeling quite uncomfortable, then I had vertigo. At that time I measured my B. P. and it rose to 180/100. At that time I immediately took Olmezest CH 40 and Vertin 16 tablet. Sir my B. P. did not come down much. The next morning I again took one dose of Olmezest CH 40 and took one dose of Olmezest CH 20 in the evening. My B. P. at night was 170/98. Yesterday another problem started, I started having loose motions from the morning. There was acidity and I vomitted twice yesterday and loose motions was 6 times. My B. P. was very low yesterday about 107/74 and pulse rate was high to 115. Yesterday night I immediately consulted local doctor and he prescribed me Tab Bifilac and prescribed some blood tests. After taking Tab Bifilac, today my loose motions and vomiting has stopped. Today my B.P is normal to 115/78 and pulse rate 88. I am taking ORS water in between. Today in the morning my blood tests have been performed but the reports are not good. My urea, creatinine level has gone high, my uric acid is high, sodium, potassium level is low, ESR is high, Uric acid is high. I am quite tensed now Sir. My blood tests were performed one month ago and at that time everything was normal, but now after taking the painkillers everything is abnormal in my blood report. Sir do I need to be admitted to the hospital? I had cramps in my leg during my illness. I will send you both my last and recent blood reports for you to compare. Can this be due to painkillers? What medications I must take now? Do I need to perform more medical tests? I am attaching here with both my last and recent medical reports. I am quite tensed now. Was it a stroke? Kindly help

Hello,

Welcome back to icliniq.com.

Your ESR (erythrocyte sedimentation rate) was elevated last time as well. Now these problems like deranged kidney function are likely precipitated by pain killers with subsequent extra doses of antihypertensive (Olmezest in higher doses can cause kidney function derangement) and also loose motions. Loose motions cause dehydration and can reduce blood supply to kidneys leading to derangement of kidney function. You could have taken Amlodipine for it. These derangements are reversible and will likely come to normal level. However, it needs to be monitored regularly. So, you should repeat these tests now to see for improvement. You should get admitted for monitoring kidney function or at least be in close follow up with any general physician. The general measures include:

  1. Avoiding further consumption of pain killers.
  2. Have a high potassium diet (like coconut water, fruits) and a high salt diet till sodium recovers. Sodium, potassium needs to be repeated now.
  3. Avoid Olmezest till creatinine recovers to normal and Amlodipine may be taken if blood pressure rises. Monitor BP frequently.
  4. You should also get ESR and CRP (C-reactive protein) repeated to see if there is any decline in these inflammatory parameters.

So in a nutshell, it is likely reversible, however it needs to be monitored. So, you need to stay in close follow up with a local treating doctor. If ESR remains elevated then you need to be evaluated further for it like any underlying infection etc.

Hope this helps you. Feel free to ask if you have any further queries.

Thank you.

Patient's Query

Hello doctor,

Thank you for your advise, it gave me much relief.

Kindly prescribe a B.P medicine having composition Amlodipine. Can ORS water enhance sodium, potassium level? Will I continue taking ORS water? I will soon follow up with my recent medical reports.

Hello,

Welcome back to icliniq.com.

Yes, ORS (oral rehydration solution) will do and also have a high potassium rich diet for a day or two. If loose motions are still there, then possibility of further derangement will be there, as loose motions can cause loss of sodium and potassium in the stool. Then IV (intravenous) supplements will be required. It is important to keep watch over these blood abnormalities. In such a scenario, any brand containing Amlodipine may be taken whenever blood pressure goes above 140 systolic. So, you should discuss all these issues with a local treating doctor.

I hope this information will help you. Please revert in case of further queries.

Thank you.

Patient's Query

Hello doctor,

Thank you for the reply.

I have undergone my blood test, and in the recent reports, my creatinine, urea, and uric acid have decreased, which has provided me with relief. However, my hemoglobin and platelet levels have also decreased, while my ESR has significantly increased. Is there any way to address my elevated ESR level? Today, my morning blood pressure was measured at 130/85, with a pulse rate of 88. I am currently taking three medications: Cilacar 10 for blood pressure, Rozavel 5, and Esoz D 40, as prescribed by a local doctor. Should I continue with these medications? I must mention that I cannot tolerate iron tablets; I experienced nausea and indigestion when I was prescribed Orofer XT tablets, which also caused my blood pressure to rise. Can you recommend a milder iron supplement to increase my hemoglobin? I have attached my recent blood reports for your reference.

Hello,

Welcome back to icliniq.com.

That is a good thing about kidney function; however, the ESR value is a bit concerning. For iron supplements, you can try a syrup or cap Cheri once daily, which is better tolerated by many patients. You can continue with the medications prescribed to you, and the dose of Cilacar (Cilnidipine) may be increased in the future if your blood pressure rises. Regarding the high ESR, it is important to rule out underlying causes such as infection. In addition to starting iron supplements, I would suggest visiting a local hematologist and a reputable general medicine doctor for a prompt evaluation of your elevated ESR. Proper assessment should include additional tests and x-rays after a thorough examination. Consult your specialist doctor, discuss with them, and take the medicines with their consent.

You can always come back and reach me at icliniq.com.

Thank you for consulting me.

Patient's Query

Hello doctor,

Thank you again for your time; I greatly appreciate it.

As you know, i am non-diabetic and hypertensive. I take the following medications regularly:

  1. Benitowa 4 for blood pressure.
  2. Rozavel 5.
  3. Esoz 40.
  4. Livogen XT.

A few days ago, I experienced a nosebleed, and at that time, my blood pressure was in the range of 160/93. I consulted with you, and you advised me to see an ENT specialist. The next day, before taking my evening medication at 6 pm, I checked my blood pressure, and it had risen to 190/105, with a high pulse rate of 115. Concerned, I immediately took Olmezest CH 40. Subsequently, I experienced frequent urination at intervals of 15 to 17 minutes throughout the night. Despite taking Benitowa 4 later that night, I could not sleep due to anxiety. After urinating around 30 times, I checked my blood pressure in the morning, and it had started to decrease. By 7 am, my blood pressure was 150/95, and by 11 am, it had further reduced to 139/90, along with a decreased pulse rate. I consulted a local doctor on next day, who prescribed various medical tests, and the reports revealed a low potassium level and high CRP. The doctor advised taking Olmezest 40 for blood pressure and Zaiper 0.25 mg for anxiety at night. Additionally, I was recommended to consume coconut water daily for low potassium.

After taking Olmezest 40 for the last two days, my blood pressure has reduced to 124/80, with a pulse rate of 85. However, I experienced a fever of 101 F after two nights, for which I took Calpol 650. Last night, I had back pain and took Calpol 650 again. Today, my body temperature is 99.4 F. Should I continue taking Calpol 650? I am currently feeling very weak, and I am not sure about the cause of my symptoms. Despite negative results for Dengue, malaria, and typhoid, I would like to know if I should continue with Olmezest 40. How long should I take the anxiety medication, and when should I undergo my next blood test? How many more days should I consume coconut water, and are additional medical tests necessary? I am also uncertain about the duration for taking Livogen XT.

Hello,

Welcome back to icliniq.com.

Your electrocardiogram (ECG) is fine. In the blood reports, hemoglobin is marginally low, and although the white blood cell (WBC) count is within the normal range, the distribution of various components with the WBC count indicates the possibility of infection (neutrophil count is relatively higher than normal). Considering the ongoing fever and a history of frequent urination, there is a possibility of a urinary tract infection. Therefore, it is advisable to undergo a urine routine examination as a priority. Additionally, you should consult a general medicine doctor for an evaluation of the fever. You can take Calpol (Paracetamol) as needed for fever.

Furthermore, it is important not to overly worry about blood pressure fluctuations. Anxiety can contribute to an increase in blood pressure and pulse rate. Elevated blood pressure is not immediately threatening unless it is very high, exceeding 180, for example. Regarding anxiety medication, in my opinion, it can be tapered off once blood pressure is stabilized, and your anxiety has decreased. Rechecking potassium levels is advisable, and if they are normal, you may consider discontinuing coconut water. Livogen (a combination of ferrous fumarate, folic acid, and zinc sulphate) is an iron supplement, and you may need to continue taking it for a few months to replenish iron stores. In a nutshell, there is a possibility of infection, most likely a urinary tract infection, for which further tests such as a urine routine examination and a consultation with a general medicine doctor are necessary. Repeat potassium testing is recommended. You can continue with Olmezest (Olmesartan) 40 for now.

I hope you are satisfied with my answer. For further queries, you can consult me at icliniq.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Sagar Ramesh Makode
Dr. Sagar Ramesh Makode

Cardiology

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