I have shortness of breath and pain in shoulder. Can you give any suggestions?

Hello,

Welcome to icliniq.com.

Your ECG (electrocardiogram) shows changes (attachment removed to protect patient identity) that indicate some form of heart damage, possibly due to ischemia, hypertension, or other causes. You mentioned undergoing angiography, which showed only 30 percent blockages. Have you had an echocardiogram to rule out other causes? If not, you should consider getting one.

Additionally, you mentioned shortness of breath, which can occur due to heart dysfunction visible on an echocardiogram or may be related to low hemoglobin levels. Have you ever smoked? Smoking can cause lung damage and lead to shortness of breath.

Regarding your shoulder and body pain, this is commonly associated with low vitamin D levels or cervical spine issues. Do you also experience neck pain, tingling, or numbness in your arms, which may indicate a cervical spine problem?

It is important to maintain a healthy lifestyle by avoiding fatty, oily, and high-calorie foods. Follow a low-salt diet and monitor your blood pressure regularly. Engage in regular exercises, such as brisk walking or jogging, for at least 30 minutes a day, five days a week.

Overall, please provide more information, such as the results of your echocardiogram, any history of smoking, and details about tingling or numbness. You should also have your vitamin D and hemoglobin levels tested. Lastly, you mentioned Ezetimibe; could you clarify if it contains Atorvastatin?

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Regarding your shortness of breath, it is likely due to age-related changes in your airways, which are causing the symptoms of shortness of breath, cough, and phlegm. You should continue with symptomatic therapies, and intermittent antihistamine tablets may be helpful.

Secondly, this pain is likely related to cervical issues rather than cardiac problems; however, you should have an ECG (electrocardiogram) done by a local doctor to be sure. Additionally, it would be best to have a local doctor examine you for signs of an active infection in the chest, etc.

Regards.

Hello,

Welcome back to icliniq.com.

I suggest you continue with the same medicines. Also, you may use a pain relief gel and do hot fomentation for pain relief.

All the best.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Alprazolam is used for sleep and anxiety, while Torsemide (a diuretic) may help reduce chest congestion, particularly in patients with systolic or diastolic dysfunction. If your echocardiogram shows any of these conditions, it may be helpful for cough and breathlessness.

Severe bouts of cough, breathlessness, and pain suggest an infection rather than congestion due to heart issues. Pain associated with infection is usually pleuritic in nature, meaning it is sharp and increases with deep breathing or coughing. Chronic cough and phlegm commonly occur due to airway diseases related to age, former smoking, and air pollution. It is also beneficial to practice yoga and meditation regularly.

Regards.

Hello,

Welcome back to icliniq.com.

Your echocardiogram is fine. It shows some age-related changes, but nothing significant or worrisome. Therefore, it is clear that your symptoms are not related to the heart; they are related to your lungs and airways.

Firstly, regarding fatigue, please note if it increases after taking Levocetirizine and Montelukast, as it can cause some sedation or fatigue as a side effect. Otherwise, you should consider getting some blood tests done. It would also be beneficial to have a routine or comprehensive check-up at any laboratory, which should include a hemogram with ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), blood sugar, lipid profile, thyroid profile, vitamin D, etc. If you have had these tests recently, it may not be necessary to repeat them.

You will need additional nebulizations with Seroflow twice daily for airway stabilization for a few weeks. To help clear phlegm, you may use syrup Levosalbutamol, Ambroxol hydrochloride, and Guaiphenesin. Additionally, practicing yoga can be beneficial. This problem is usually not worrisome and may persist for a few weeks to months after an infection.

Try to identify any triggers, such as certain foods or exposure to dust, that could exacerbate your symptoms. It would be a good idea to have a local doctor or pulmonologist examine and auscultate you to be sure. You may also need a pulmonary function test if you are experiencing shortness of breath.

Thank you.

Hello,

Welcome back to icliniq.com.

What is the exact reason for immobiliaztion? In psychological causes, psychiatrist will be helpful. Anyway, you may get psychiatrist opinion as well, but if you think you feel good in mind, no depression, anxiety or sad mood then psychiatrist will not be helpful and then neurologist will be helpful. Do you also have symptoms like tremors, forgetfulness, difficulty in initiating movements etc. If yes, then you should visit a neurologist. Low Vitamin D, hemoglobin or thyroid issues can cause fatigue and tiredness. So these should be ruled out. So, overall, I think neurologist would be the better option in your case.

I hope this helps.

Thanks and regards.

Hello,

Welcome to icliniq.com.

Firstly, your disability is unlikely to be related to heart. Disease of any organ can cause such disability including heart but since your echo did not show any significant changes and you do not have any symptoms of cardiac disease like chest pain, it is unrelated to heart. However, shortness may occur due to diastolic dysfunction which is there in echo, but I guess shortness of breath is not the reason for your immobilisation. Also, you may get some shortness of breath on exertion due to age and chronic immobilization. Your spinal problem may cause pain and which secondarily can cause immobilization. So, I guess, your diseases at present are well controlled, and in order to achieve good health, you should continue healthy lifestyle like regular walking, healthy low calorie and low fatty diet. Do not let your body gain weight. Along with activities, you should keep your mind fresh so should do Yoga as well. Keep yourself busy in some Or other activities in order to prevent stress and depression, which can hamper your activities.

I hope this helps.

Regards.

Hello,

Welcome back to icliniq.com.

Does this pain increases on deep breathing or is there any cough? These symptoms are suggestive of two possibilities, first is allergic reactions to external agents like whether change or environmental agents or second possibility is of infection in lungs. So, allergic medicine is advisable like tab Montair LC bedtime for 5 days, and you may also need antibiotics for it. However, it is better to get examined by local doctor once and may need Chest X-ray especially if not responding.

I hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

I have gone through your details. Now, any viral infection can worsen phlegm problem and may persist for few weeks. Viral infection combined with Amoxicillin has caused you gastritis which is probable cause for your symptoms including decreased appetite, breathlessness post meals. Also, constipation may aggravate all these symptoms. Constipation is age related and associated with decreased activity and digestive power so you continue to have duphalac accordingly. Now, you should antacid prokinetic combination like Cyra D or Pan Dsr for 2 weeks atleast. Also, to ease with mucus problem, you should have Tab Montair LC bedtime once, and tablet Mucinac 600 mg tablet after meals once or twice a day to soften the mucus and easy expulsion for a week period. You may have steam inhalation three times a day. Try to have small but multiple meals instead of few heavy meals. Try to have to some walk after your meals. You can also try yoga for respiratory problems.

Hope this helps you and get back if you have any doubts.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

I suggest you continue taking with Mucinac (mucolytic agent) and Montair LC (antiallergic) for complete of seven days for complete relief. You can additionally have steam inhalation whenever having severe symptoms. I have gone through your reports. Except ECG, other reports are fine. There are some nonspecific changes in ECG. So, echo is advisable in such scenario if not recently done, to rule out possibility of structural heart disease. Also, let me know if there any history of chest or heaviness or breathlessness on exertion which relieves with rest, any family history of disease?

Kindly update with the answers.

I hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Considering your family history and ECG changes, you should have a cardiac evaluation with echo and further test if necessary after echo. Let me know once echo is done. Also, it is better to start taking a tablet of Ecosprin (antiplatelet) at bedtime as a prophylactic measure till evaluation is complete. All the best.

Kindly consult a specialist, talk with them, and take medicines with their consent.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

I also feel that your symptoms are truly lungs related and allergic rather than infective. With age, lungs get damaged due to external agents especially pollution and gets aggravated with seasonal factors producting more symptoms. These should subside or atleast minimize to some extent with change in season. By asking for CT scan, she just waned to be sure that we are not missing anything and to confirm the findings. So I think, treatment is going on proper line. Also, rather than having oral steroids, it's better to restart and try inhalers which are prescribed to you. Your cough is probably unrelated to inhalers but may occur due to lungs irritation due to medicine in inhalers. So, I would rather go with inhalers which are safer than oral steroids. Should continue steam. Do yoga if possible. Hope this helps you and get back if you have any doubts.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

The swelling in the legs has gone or is it still persistent ? If there is resolution of swelling with the medication, then your elevated blood pressure was probably precipitating the cardiac failure leading to symptoms as high blood pressure puts heart under strain as it needs to pump blood against high pressure. If the swelling is persistent then you need a dose escalation of Dytor (antihypertensive) to relieve limb as well as chest edema. Kindly consult a specialist before taking medications.

Thanks and regards.

Hello,

Welcome back to icliniq.com. The probable cause for your symptoms was fluid overload which was worsened by elevated BP. The likely cause for both fluid overload and elevated bp was steroid course which may lead to these events in some individuals. So, the precautions would be to avoid future steroid intake unless very essential. Also, since your bp usually stays in lower range, the elevated bp is detrimental to your heart. so measure bp frequently and especially when such symptoms arise. You should avoid excess salt and water especially when such symptoms ensues. Also, it is better if you can monitor weight at home.

I hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Yes, this should get better with change in season. However, in your next visit to nearby doctor, I want you to discuss regarding increasing dose Dytor to 10 and 5, which would help to prevent episodes of cardiac failure. Also, you should get prescribed some inhalers like Asthalin for such worsening. If you are taking Telma in the morning then you may have in the afternoon time so that it will prevent morning low bp and control evening elevations. Also, during winter many patients need to be started on additional medicines like Montair LC bedtime which is anti allergic and Abphylline to prevent bronchoconstriction due to cold. BP rise may occur as a response to pain. If your rash is still present then you should get it checked from nearby doctor.

I hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Firstly, Ivabradine may be used in normal or low ejection fraction patient. However it has been found to be most beneficial in patients with ejection fraction less than 35 percent. Ivabradine is given in you to lower the heart rate, however I do not think it is absolutely necessary for you. So, you may discuss your cardiologist regarding need and if it can be stopped especially if heart rate is staying low. However, no harm in having it. Resting pulse rate more 50 is enough for you, so nothing to worry about it. Regarding constipation, you should have high fibre diet like fruits, cucumber, papaya, green leafy vegetables. Avoid refined flour products. Try to mobilise yourself like walking as much as possible at least at home. You may use Duphalac two teaspoons in half glass of water bedtime whenever needed. These respiratory problems may worsen in winter. So, you should continue with steam inhalation as much as possible. I would also advise you to have regular either inhalers or tablets. Alternatively, you may have tab Abphylline 200 mg once a day for few months. If there is good relief with Montair LC then continue it. It can be taken over long term basis or you may use it intermittently. You should continue to have respiratory exercises or yoga for lung function improvement.

I hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Heart rate around 60 is fine. So, you may continue with similar dosage. Intermittent high heart rate readings may be artefactual and is not reliable on activity tracker. You need Holter monitoring to confirm it. Dytor reduces fluid in a lungs which occurs due to cardiac cause and helps in relieving shortness of breath. So, it helps in relieving shortness of breath due to cardiac cause. Now, you also have lungs problem likely chronic bronchitis, which causes both shortness of breath by causing narrowing of airways and increased phlegm by inflammation. So, there are two components. Montair LC helps to some extent to reduce inflammation so it is reducing shortness of breath but not enough to reduce phlegm production by damaged airways. So, you will need some other medicines to reduce it. So, in my opinion you should also use inhalers like Foracort to reduce inflammation. You may seek pulmonologist opinion for this. This lungs problem are frequently aggravated by cold, environmental pollution etc. Also, try to identify factors which increase this lungs issues.

I hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Phlegm production basically occurs in response to any kind of irritation like allergens, pollution or acid. So, I have some patients who has had severe respiratory symptoms like breathlessness or phlegm production due to gastroesophageal reflux. So, you may be having acid as a trigger for phlegm. Now, it may not be always symptomatic or noticeable, and also many a times it occur as gradual and continuous process which is called as silent aspirations. It is worth trying a response to antacids. So, in a nutshell, it may be a trigger.

I hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Heart burn is a symptom for acid reflux, but absence of symptoms does not rule out reflux. It's possible that it's intensity has gone down to extent of not causing symptoms, or internal mucosal sensitivity has changed with time so not giving same symptoms as that previous. So, still reflux may be there. Also, relief with antacids support this possibility. Hyperactive airways are sensitive to any kind of irritation be it environmental like pollution, infection, allergens or acid. So, symptoms may be aggravated by acid.

I hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Firstly, BP may go up in winter and this does not mean heart failure. occasional high readings are fine and if frequently going up then may need dose optimisation of antihypertensive. Now, loss of appetite is not a disease per say but a symptom of underlying disease. Now various possibilities are gastritis, worsening constipation or other gastric issues, some kind of infection. Even lack of activities can precipitate this. Sompraz D unlikely to cause it. The cause is not evident from your description, but it may be likely related to gastritis only. So you should wait for a day or two, if does not improve then its better to get yourself examined by local doctor. Regarding leg pain, since your NCV was normal and it started after chilling, I am considering possibility of vasoconstriction induced pain is a likely cause. Ultimately, vasoconstriction causes decreased blood supply to legs tissue and nerves only, which ultimately may pain. So, final answer to this can be obtained from neurologist only or on repeat NCV. Let's see the response of using socks and shoes. If there is good response then it may indicate, cold was culprit. Nose issue and phlegm are a part of same disease. You may use Nasoclear for the same.

I hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Probably, you should be able to continue like this in winter. Have you noticed any significant weight loss during last few months? You should get examined by local doctor once for weight loss. However, it's not uncommon to individuals to experience decreased appetite in winter. This is partly due to decreased activity, constipation, decreased bowel movements in winter. Also, too many medicines further causes gastritis which decreases appetite. Engaged yourself in some indoor or outdoor activities so as to keep body moving. You should also do yoga involving abdomen. Also, take care of constipation. I am noticing here that there is no medicine for phlegm here. Mucinac may help to clear phlegm but it does not reduces phlegm production. Since you are having inflammation in lungs, which is causing increased phlegm production, you should take some medicine to reduce inflammation. In my opinion, you should continue to have Montair LC and should use should use some inhalers like Budecort or Seroflow. So you can get more advice on this from pulmonologist. Also, regularly do yoga and meditation. Urine issue may be due to prostate and get evaluated for that with ultrasound pelvis and have medicine prescribed like Urimax etc. Have less fluid in the evening or near bedtime so as to reduce frequency of night urination.

Hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

It can be a prostate issue and prostate can be troublesome at night. So, it is worth evaluation. Now, with weight loss, I would advise you to visit local doctor and get yourself checked. Discuss if your local doctor feel the need for ultrasound of abdomen and pelvis for both prostate and loss of appetite. As I mentioned, phlegm production basically occurs due to damaged lung (called as chronic bronchitis). And there are various aggravating factors like pollution, smoking (active or passive), acid reflux etc. And this may be multifactorial in you. So, treating reflux will certainly decrease it is production, but can be reduced beyond certain extent and it will persist to some extent. So, to further reduce it, you may need inhalers. Once a day for Montair LC is enough. Diastolic dysfunction may aggravate phlegm production and more commonly it can cause fluid in the lungs. Now to be specific, inflammation causes phlegm production from airways of lung while diastolic dysfunction may cause sputum production from alveoli (different part of lung). So, there are minor differences. So you basically have multiple causes for lungs trouble.

Hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

I have a few questions.

1. Is your constipation cured?

2. Have you started inhalers?

To simplify, you have a diseased lung which responds by increasing phlegm and coughing to any kind of irritation like gastric issues and cold. You should treat your disease from all sides, that is avoiding triggers and stabilisation of lung through inhalers and medicines. Being on gastric medicines does not prevent all episodes of reflux, acid production etc. Gastric issues cause problems by bloating and elevating diaphragm which makes breathing difficult. You should increase dose of laxatives in order to reduce constipation. You should avoid heavy meals and have small meals multiple times. More the amount of food stagnates in the stomach, more will be the issues like reflux, bloating. Reduces amount of spices in the food. Have walk for 15 to 20 minutes after each meal. Elevate your head end of the bed while sleeping. Consume warm water rather cold one. Also, perform breathing and abdominal exercises/ yoga. Winter worsens gastric as well as lung issues directly. So, these are expected to go down after winter. You should also get examined by local doctor and request for ultrasound of abdomen or other relevant tests based on examination findings. Continue Sompraz D, Montair LC, steam inhalation, Sucral O or Gelusil SOS, additional dose of Rantac 150 if necessary at night.

Kindly consult a specialist, talk with them, and take medicines with their consent.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Firstly, airways is a general term which includes pharynx, larynx, trachea, bronchi etc. Phlegm is mainly produced by bronchi and bronchioles and by trachea to some extent. So, things are intermingled. You have a diseased lung which has tendency to produce phlegm. Even without any cause, it will continue to produce phlegm. Winter aggravates it, acid reflux aggravates it. Also, winter aggravate gastric issues. So, controlling these factors would lead to reduction in phlegm production. Now, what inhalers does is directly act on phlegm producing mechanism (glands in airways) leading to reduction in phlegm production and relief of symptoms. Now kind of stress say increased phlegm production or inadequate sleep due to it may again worsen gastric issues leading to vicious cycle. So, controlling one thing may lead to control in other. So may continue with medicines advised by pulmonologist. She has also prescribed antibiotics to deal with infection if any. Regarding BP, systolic is more important. Diastolic may go down with age. In some individuals, it may go below 50. So systolic is important and should be focused upon. Regarding heart rate, its better to reduce dose of Ivabradine to 2.5 mg twice daily from 5 mg twice daily, as its responsible for low heart rate.

I hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Firstly, it may not be an infection which caused your worsening entirely. There is predominantly an allergic component. Elevated IgE supports this possibility. Controlling allergy with medicines may bring it down. Infection can certainly aggravate symptoms but usually associated with fever, purulent expectoration etc. Some component may be there of infection, but relief on the next day itself suggest that relief is likely due to antiallergic medicines and inhalers. Antibiotics takes time to act and some difference may be seen after 48 hours. Infection may not be catched in test always, so negative test doesn't help to rule it out either. Antibiotics are given just to cover the possibility of infection. I hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

There is some decline in digestive capacity with age, but you do not appear to have a significant decline at present. Constipation is quite common in winters. Low temperature and cold water intake reduces bowel movements. Also, gastric symptoms in you contributed to some extent by lungs problem and medicines. You adjust dose of Duphalac according to need or may shift to some other laxative. Chest pain for 15 days is unlikely to be related to heart, but it's probably a chest wall pain as you are getting relief with hot compacts. However, I can't be certain online. so either get examined by local doctor or get an ecg done. Chest pain may also occurs due to respiratory problems or acid reflux. Regarding heart rate fluctuations, first it may be artefactual or may be true fluctuation. In case of true fluctuations, it can be sinus (which is normal phenomenon and not dangerous) or may be arrhythmic like atrial fibrillation which needs treatment. If it is sinus then ivabradine may control the peak heart but it will also reduce lowest heart rate putting you at risk of bradycardia so important to consider lowest heart rate before ivabradine dose escalation. If it arrhythmic then ivabradine will not control it. So, reliable way is to obtain Holter monitoring which will give answers. Also, Ivabradine does not have much effect on BP, so unlikely to be a cause for it. BP elevation is probably due to other factors like diet, water intake or internal body changes etc.

Hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

As I mentioned, lungs are the culprit. There is primary problem in the lungs and various other aggravating factors. Lungs are damaged and produces phlegm even without any trigger. Other factors like weather and digestive disturbances worsen it. So, even if all other factors are under control, still lungs would produce phlegm as they are damaged and damaged lungs have tendency to produce it. Also, cold whether tend to slightly worsen phlegm production as compared to summer. This is not related to rhythm disturbances. Heart rate increase with activities may be a normal and sinus type, which is expected. Now, if this phlegm is not tolerable or too much troublesome then dose of Inhalers may be hiked up or can add some oral medicines as well. You should also do some yoga. These symptoms are likely to get better as winter passes away.

Hope this helps you and get back if you have any doubts.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Firstly regarding your fatigue, it is probably related to deconditioning. As you did not go out for long time, the habit of walking is not there. Usually, walking inside is not as much as you walk outside and also walking outside is different from inside, where environmental conditions are different. So you gradually resume your outside activities. Also, you should measure your bp once as low bp or even low pulse rate can cause similar fatigue. Regarding your inability to lie down on back, you mentioned you are able to manage it, if not then you may try escalating dose of diuretics for days and see if it is helpful. Regarding back pain, it is probably related to disc prolapse only, however there may be some component of hip joint abnormalities which can occur with age. Such problems are more prominent after period of some rest. Also, that dizziness may be related to same issue. So you should have some support your back with belt so as minimize these troubles. Also, you should be careful about your diet as dietary derangments may lead to worsening acidity and reflux, which can worsen your symptoms.

Hope this helps you and get back if you have any doubts.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

You may discontinue Sompraz D and see the response. However, considering your history and multiple medications, you are expected to have some acidity. So it is better if you can be on some milder antacids. A-fib may be picked up on pulse oximeter but it is not an accurate way of estimating. You should have an ECG for it as treatment would change after diagnosis. You may continue using inhalers.

Hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

The problem of acidity is not curable, but can be kept under control. So, once Sompraz D is stopped and also due to dietary changes, acid reflux has probably came back. Ranitidine is weaker antacids. And there is relation between acid reflux and phlegm production in you. So, if you can manage acidity with ranitidine and other changes, then continue the same or else restarts Sompraz D. Lying flat or particular positions increases acid reflux for obvious reasons. Dizziness has two reasons, one is due to slow heart rate, which is due to ivabradine and it can be solved with dose reduction or stopping it. In this case, pacemaker will not be necessary if it heart rate recovers after dose modifications. Another reason for dizziness is postural hypotension which occur while immediately getting up from sleeping position. This occurs due to fall in blood pressure momentarily after getting up due to gravity factor. This will not be helped by pacemaker. Here, you need to do behavioral changes like getting up slowly, wearing compression stockings. Also, you need to reduce to dose of Dytor slightly. This would increase your blood pressure and also solve your dizziness issue. If you are on antihypertensive, then dose might have to be reduced before Dytor.

Hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

So it is good that you are having less symptoms. So, you might continue all your medications as of now. You should vary dose of Ivabradine according to need. So target should be to keep resting heart rate at least above 50.

Hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

The probable reason for breathing difficulty was fluid accumulation in the lung as it responded well to increase in Dytor dose. So, stay on current dose of Dytor. Also, do not drink excessive water or another fluids like juices and all, however you may continue with current status of fluid intake as we have increased the dose of Dytor. In future is you noticed breathlessness then should stress of further fluid restriction. Also, monitor weight at least 2 times a week as weight gain occurs usually a week before an episode of such severe breathing difficulty, so modifying doses would help to prevent it. Also, have steam inhalation intermittently in order to keep phlegm soft. Now urine difficulty is likely a prostate problem. It usually troubles at night. So you should undergo ultrasound of pelvis to confirm it and also undergo PSA level once to see how it has progressed. Meanwhile you may have some medications for prostate like tablet Urimax D 0.4 mg bedtime and should monitor bp frequently during its initiation as sometimes it may temporarily reduce bp. Also, you should avoid fluid intake or coffee/tea 2 hours prior to sleep. Also, prepone the dose of Dytor to 3 pm. Now regarding dizziness, there are two aspects one is bp and other is pulse rate. Either low may cause dizziness, pulse rate is less than 60, then better to taper off ivabradine and if bp is low then it is a trade between the Dytor dose and bp. However, if dizziness is occurring even on lying down position or neck movements then its related to internal ear problem,

Hope this helps you and get back if you have any doubts.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Sompraz D is more effective if taken before breakfast instead of night. And avoid heavy and spicy meals, have some walk after meals, dinner should be light. You may have Mucaine gel according to need.

All the best.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Now lungs are damaged and has baseline tendency to produce phlegm, which is aggravated by allergens and aspirations. As there is clear cut association of gastric upset with worsening of symptoms, we can safely assume that precipitating factor here is acid. Constipation worsens gastritis which in turn worsens lung issues. Your constipation should be adequately treated as well. You may increase the dose to Duphalac itself, which may be taken three times a day. Avoid Fybogel as it contains fibre which may increase bloating. Focus on activities like walking, may be within home. It's more important to have good walk after meals and continue to have light meals. You should avoid eucalyptus oil inhalation as it may irritate the lungs leading to excessive phlegm production. Also, if you do not get adequate relief with above steps then should increase the dose of Dytor by 5 mg.

Hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Reason for relief is probably multifactorial. Inhaling herbs may irritate the mucosa leading to increase in production of secretions and water from the respiratory lining which may lead to thinning of phlegm and easy clearance. But these may be harmful sometimes by causing allergy and increase in production of phlegm. So safest is steam inhalation which may be done as many times as you want. Coming days may be good, again it is a trade between the allergies, which may be a bit severe during these months and cool environment, and time will tell which one dominates.

Hope this helps you.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Firstly this is not a sick sinus syndrome at all. Sick sinus syndrome would not cause such symptoms, but it is a term used for low heart rate which would cause dizziness, loss of consciousness, etc, but not choking sensation. This is exacerbation of the respiratory issues and as you mentioned it was associated with belching, so probable reason for exacerbation was gastric reflux. However it can also be exacerbated due to multiple other factors like weather changes, dust exposure, subtle change in quality of air etc etc. Once this has happened, Mucaine gel will not be helpful. It has got preventive role. Now to tackle this, besides other factors to keep acidity under control, you should use inhaler on a regular basis. And you should keep nebulizer or another inhaler for emergency purposes, after such episodes for immediate relief.

Hope this helps you.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Intermittently gastric issues may worsen due to excessive acid production, which may occur due to internal body changes, dietary change, sleep disturbances, stress etc. Body may not react similarly every time to the same stimulus, there might be some residual effect of lung medications (less inflammation) or pollution level may be less this time compared to last year.

Hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Now BP is certainly low due to dehydration. So you may reduce the dose to half. However, one more possibility should be considered is chest infection, which is causing worsening of chest symptoms and low blood pressure. So if possible, visit nearby doctor or pulmonologist and get some investigations done like chest X-ray, Complete blood count and renal function test. If its still low then have some salt-sugar water. Till you visit the doctor, you should start the antibiotics, which you were prescribed previously (or alternatively may have Augmentin 625 mg three times a day).Also, continue using an inhaler and initiate steam inhalation 3 to 4 times a day. Be careful on diet and try to have heavy meals especially at night. You should also buy some rapidly acting inhaler like Duolin which you may have three times a day till this episode resolves. All the best.

Hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Numbness part is probably related to neuropathy or nerve compressions at the spinal level which may be dealt later. So in a nutshell, we need to rule out possibility of chest infection first. You should continue using all measures like inhalers, steam and antacids. All the best.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

The likely cause for the worsening was lung infection. From lungs point of view: 1. Use regular inhalers to keep lungs inflammation under control.

2. Inhaler Duolin to be used in emergency cases.3. Continue antiallergic Montair LC, steam inhalation. If you could practice or yoga or other form of chest physiotherapy then it may be helpful.

4. Continue gastric medications.5. The arm pain and swelling is likely related to nerve pinching and unlikely to be related to heart, however only way to confirm is an ECG.

6. Do some walking, may in the home at least. Avoid taking nap in the daytime.

Hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

You may increase the water intake or initiate ORS intake slightly or reduce Dytor dose. All have same effect of keeping rehydrated. All the best.

Hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Regarding jaw and neck pain, it is probably non cardiac as angiography did not show significant blockages. Cardiac pain classically occur on exertion and relieves with rest. You can also check if there is any tender spots over the jaw or near the dentures and if its increasing on jaw movement, if yes then likely due to non cardiac cause. Neck pain is probably cervical only. You should consult an orthopedic surgeon for the same.Fatigue is largely related to low BP. Now phlegm is a chronic problem. Besides your mentioned medications, you may add nebulization or inhalers. Some patients report good relief with yoga as well. So you may try it.

Hope this helps you.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

I have gone through your reports (the attachments removed to protect the patient's identity).

Your echo was fine except for diastolic dysfunction and angiography showed minor blockages which would require medications only. CT showed pneumonia which must have been resolved by now with the help of medications. Your triglycerides and total cholesterol were also elevated and Ecosprin AV will help it. Some images were blur like TSH report etc. Vitamin D was also low, so I guess you must have been supplemented. Yes, constipation can worsen respiratory issues by multiple mechanisms, and you should be laxatives on regular basis, so as to avoid constipation. Constipation can also worsen belching, acid reflux etc. Now what exactly do you mean by disturbed sleep on right side? Are you talking about gastric disturbances or other issues? Now sleeping on right side has less favorable effects on digestion, acid reflux is more, lymphatic drainage is hampered. Also, whichever side one sleeps on, lung on that side comparatively becomes less functional due to splinting effect of body weight. So its possible that right lung is more important for you or its due to gastric disturbances due to right sided position. Now you should be on following class of medications in order to keep homeostasis.

1. Regular nebulisation or inhalers on long term basis, one of which should be steroid so as to keep inflammation down. Also previous anti allergic should be like Montair LC should be continued.

2. Strong antacids pro kinetic combination.

3. Diuretics and regular weight monitoring. Rapid weight gain suggests fluid accumulation and precedes the worsening of symptoms. Your lung showed haziness in both lower regions of both lungs, which also suggests the possibility of fluid accumulation.

4. Regular steam inhalation.

5. Some physical activities especially post meal.

6. All meals should be light and dinner should be the lightest.

7. Yoga and respiratory exercises for lungs rehabilitation.

8. If your TSH is even mildly deranged (i could not read it as image is blur) then should get medications prescribed as you are symptomatic and medication will help.

I hope this helps.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Please keep all the instructions in mind.

Thanks and regards.