I have bad breath, constipation, and blurring of vision for a month. Kindly help me.

Hello,

Welcome to icliniq.com.

I went through all your blood investigation reports done ten months ago, nine months ago, and last month (attachments removed to protect the patient's identity).

1) Your blood levels of C-reactive protein and lactate dehydrogenase (inflammatory marker) are constantly above normal limits. Serum iron percentage and transferrin saturation is low and, in correlation with your complete blood count reports, indicates iron deficiency anemia. Your fasting blood sugar and HbA1c (hemoglobin A1c) are suggestive of impaired glucose tolerance or pre-diabetes. Your blood total IgE (immunoglobulin) is also high.

2) High total IgE is probably due to bronchial asthma, which you suffer from. A high level of IgE is also seen in many parasitic infections.

3) You are currently prescribed Hetrazan 100 mg (Diethylcarbamazine), which is an antihelminthic drug and not an anti-allergic.

4) I will strongly advise you to avoid short-period oral steroids like Wysolone 10 mg without a doctor's advice each time. Taking short-term steroids on and off will decrease your cell-mediated immunity and will put you at risk of suffering from many infections, including parasitic infections. Taking on and off steroids will put you at risk of developing diabetes.

5) I will suggest you get an additional stool test for ova any cyst. Sometimes, your IgE level can get elevated in parasitic infections like hookworm and roundworm infection. These infections can cause associated anemia. In these conditions, their eggs are passed in the stool sample. Do give three samples on three consecutive days for stool ova cyst examination and occult blood.

6) I Have seen your specific allergy panel, which are all negative. Still, I would like to advise you to reduce intake of milk, eggs, fish, vegetables like brinjal and citrus fruits like lemon and orange. Avoid cold food items too.

7) To take anti-parasitic medication (tablet Albendazole 400 mg one tablet once a day for three days, preferably after a fat-rich food meal. Fat helps in better Albendazole activity) after giving a sample for stool examination. Do not start on medication before giving the stool sample for the ova cyst test.

8) I Would like to advise you on an Iron supplement as you are suffering from associated iron deficiency anemia. Start with this medication after stool ova cyst, occult blood test, and after three days Albendazole treatment. Do remember this. Do not take iron supplements with calcium-containing food like milk.

9) There is probably no connection between these and body warts and foot corn.

10) No need to take Absolut 3G Multivitamin tablet for now.

11) During this treatment, I will not advise taking Saaz (Sulfasalazine). You can continue the anti asthmatics as per the doctor's advice who prescribed it.

I hope this was helpful. Please follow up with stool examination.

Hello,

Welcome back to icliniq.com.

1) Laboratories, where you have done your previous tests, will do stool tests too.

2) You can go ahead with Absolut 3G and Iron medication containing Ferrous Fumarate. In such a case, no need to take the Iron supplement suggested by me.

3) I do not recommend Hetrazan for now in this situation. We will decide after your stool examination report to know if you are suffering from any parasitic infections.

4) Your doctor would have suggested this medication based on his differential diagnosis. Hetrazan will help in killing the parasites inside your intestine.

I hope this was helpful.

Hi,

Welcome back to icliniq.com.

I acknowledge your stool occult blood test result and ova or cyst examination result. There are no abnormalities detected in the stool examination. You can follow the advice provided by your physician. You can continue Hetrazan, multivitamin, and iron supplements. You can take Hetrazan in the morning and night as recommended. Take multivitamin and iron supplements in the afternoon after lunch. You can use Systane ultra ophthalmic solution (Polyethylene glycol and Propylene glycol) and Iflomax ointment (Carbomer and Vitamin A) advised by your previous doctor. Take a balanced nutritious diet. Do regular walking and exercise. Do breathing exercise which are recommended for asthma such as deep breathing exercise and pranayama. Do meditation and yoga regularly. Have a cup of green tea twice a day. Have a strict watch over your blood sugar. Avoid certain food items as I previously advised like avoidance of milk, egg, fish, vegetables like brinjal and citrus fruits like lemon and orange for few months. Be calm, stress free and relaxed all the time. Being in the pandemic time, follow the personal protective measures while going out like wearing mask, follow hand hygiene and social distancing. You will be fine soon. Take care.

Hi,

Welcome back to icliniq.com.

1. Do the other two tests for confirmation.

2. It seems to be high IgE. It probably occurs due to some parasitic etiology. Rarely, it can be due to Hyper IgE syndrome.

3. You are going on appropriate treatment. Do not be worried.

4. There is no need to be worried about heart for now. Repeat these tests after six months and have a review. Do fasting blood sugar, postprandial blood sugar, HbA1c (glycated hemoglobin), complete urine analysis, complete blood count with peripheral smear, Total IgE (immunoglobulin E), CRP (C-reactive protein), Hs-CRP (high sensitivity C-reactive protein), ECG (electrocardiogram), chest X-Ray, echocardiogram, pulmonary function test, and stool examination for ova cyst and stool occult blood test.

5. It does not look like sarcoidosis or fungal infection. It looks like parasitic etiology probably.

6. All the vaccines against COVID 19 are safe. You can choose any vaccine of your choices like Covishield or Covaxin.

7. Both you and your husband can take the vaccine safely. Remember to get both doses of vaccines without fail at a recommended interval. Even after vaccination, follow hand hygiene, social distancing, and wear a mask.

Do follow my other advice. Avoid taking unnecessary steroid medication. Follow exercise advice and food advice. Brush your teeth twice a day and use chlorhexidine mouth wash after brushing twice a day to overcome halitosis (bad breath). You can do respiratory exercise with a respirometer. You will be fine soon. Take care.

Hi,

Welcome back to icliniq.com.

I understand your query. The tooth pain might be linked to headaches and swelling of the eyes. You may be suffering from a dental problem like tooth decay. You must visit a nearby dentist and get it treated or else it will lead to some complications. Do not take Zerodol. Go to a dentist and get your dental treatment done. If you are not comfortable with Hetrazan, you can stop taking it with the advice of the physician who prescribed it. You can use Abphylline N (Acebrophylline with Acetylcysteine) and Montair LC (Levocetirizine with Montelukast) for a short duration to control your asthma. There are certain things that control asthma. Do regular breathing exercises with a respirometer, do pranayama and other gentle breathing exercises, do mild exercises. Keep your room and bedsheets dust-free and pollen-free. Do steam inhalation. Take water boiled with herbs like holy basil. Take frequent warm water sips. In this humid climate, you can have steam inhalation for 5 to 10 minutes daily but not too hot steam. Take care.