My aunt has pacemaker and gets swelling in her feet for the past few days. Is this due to cardiac medications?

Hi doctor,

My aunt is 89 years old. She has a pacemaker and chronic bronchitis. She is complaining of swelling on both feet with more swelling on the left foot. It gets better when she exerts herself less. She has anxiety due to this. Also, she has a lot of phlegm, especially at night, which makes her wake up. Meanwhile, due to the COVID-19 situation, she will not step outside of her house to see a doctor nor do blood works. Her current medications are Metolar 25 mg, Cardace 5mg, and Water pill 5 mg in the morning. And Cardace 5 mg, Telma 40 mg, Warfarin 5 mg, Aspirin 75 mg, Atorvastatin 10 mg, Nebulizer Duolin Respules, and Budecort in the evening. She would like to know what is causing the edema to her ankles? Is it any medicines? How to ease her phlegm problems?

Thank you doctor,

Does she need anything to boost her immunity and build her strength? Sometimes the coughing makes her tired. Does she need anything to go with her antibiotics, like prebiotics? She was regular at doing electrocardiogram (ECG) etc. but is now reluctant to go outside the house due to COVID-19.

Dr. Prabhu Prasad: Good morning! I’m updating you regarding my auntie – Mrs. Janet Jacob. 1)She has completed her medication regimen as prescribed by you: Tab.Amoxycillin/clavulanate 1gm twice daily for 7 days. Tab.Prednisone 30mg once daily for 5 days. Tab.Frusemide 10 mg morning for 7 days. 2)She has some relief from her cough and phlegm but not completely gone. She is checking if there is anything that can get rid of her phlegm completely. She finds relief after nebullisations in the night but wakes up to clear the chest soon after, thus disturbing her sleep. Do you recommend adding 1 nebullisation treatment during the day as well? They think that this can help her to clear her secretions while she is awake, more effectively. Or any other recommendation? 3)Both ankles continue to be swollen. No visible improvement. Do you recommend a higher dose than the 10 mg Frusemide that you prescribed? Also she keeps looking at her swollen ankles all the time and does not feel good about it. 4)She is happy and feels much better after taking Ensure and providac. Along with this do you recommend anything more to supplement her nutrition? 5)Her 94 year old husband tells me that she has started getting forgetful and has to be reminded where to find things which she previously managed well. Is there anything that can be done about it? Just for your information, her current medications are : Morning: Metolar 25 mg; Cardace 5mg; water pill 5mg. Evening: Cardace 5mg; Telma 40mg; Warfarin 5mg; Aspirin 75mg; Atorvostatin 10mg; Nebulizer Duolin Respules; Budecort. Medical history: fitted with pacemaker; chronic bronchitis. Look forward to hearing from you. Thank you.

Good morning, Dr. Prabhu Prasad: Thank you for your response. Since my auntie is advanced in age, her husband does not want her to step out of the house under the current COVID situation. Therefore no sputum testing could be done. Regarding the prescription, she has asked me to clarify with you whether the following is the right way to take the medication: Tab.Levoflox 500mg once daily for 7 days (without sputum testing). Tab.Dytor plus once in the morning for 15 days. Nebullisation duolin 3 times a day within 8 hour gap. Must she add Mistabron nebullisation 2ml q 8h along with duolin i.e. take Mistabron and duolin nebullisation together at once 3 times a day? Or take Duolin nebullisation separately and Mistabron nebullisation separately? Tab.ABFLO-N twice daily I am forwarding pictures of legs taken on 5th Jan, for review. Look forward to your reply. Thank you.

Good afternoon Dr. Prabhu Prasad. I’m updating you regarding my auntie – Mrs. Janet Jacob. She is feeling much better after taking the medication you prescribed. But she could not continue with Mistabron nebullisation as well as Tab ABFLO-N as she did not tolerate the two medicines well due to some reactions. 1)She has completed her medication regimen as prescribed by you: Tab.Levoflox 500mg once daily for 7 days. Tab.Dytor plus once in the morning for 15 days. 2)The swelling on both her ankles and feet subsided for 3 weeks but the swelling has come back on her right ankle / foot. 3) Does she need to take any water pill / steroid on a long term basis? Just for your information, her current medications are : Morning: Metolar 25 mg; Cardace 5mg Evening: Cardace 5mg; Telma 40mg; Warfarin 5mg; Aspirin 75mg; Atorvostatin 10mg; Nebulizer Duolin Respules thrice daily. Medical history: fitted with pacemaker; chronic bronchitis. Look forward to hearing from you. Encl. leg pictures

Hi Dr. Prabhu Prasad: Just updating regarding my auntie. She has started having swelling to her left foot with less swelling to the right foot. This is giving her mobility issues. Please advice what to do to get rid of the swelling. Thank you.