My mother in law 56 years, 76 kg weight, height 5 ft3 inch, known diabetic for 10 years, hypothyroidism taking thyroxine 100 mg daily ,taking insulin, undergone angiography and single artery standing 1 year back, taking all required medication and regular follow up, takes an anti anxiety medication called depolv 37 (mixture of imiprime plus 2 more drugs].recently did a nuclear myocardial perfusion study, which came out normal. Yet she constantly complaint of pain in upper left chest area and breathless on getting up stairs and on getting up from toilet. No physical activity as she feels exhausted after few rounds of slow walk. Feels drowsy all dsy and remain lie down on bed day long and gets less sleep in night. Consulted all the relevant doctors, who gave same impression of all normal state and advised her proper diet and physical work out. She has weak mental strength so gets panicked easily. So I request for suggestions to get her back to normal state. Please help ?I'm a dental surgeon by profession, so if the below interpretation help you, please go thru. She is already on ecosprin, atorvastatin,metoprolol, nitrocontin,ranulaz500, thyroxine100 mg,Metformin 500 mg twice daily, brilinta90 mg,insulin (mixed 30 twice daily 20 units morning and 12 units night. Antienxiety drug depolv 37 bed time. Her recent lipid profile is normal, so as the renal, liver profiles only the tsh was 21, so increased the does from thyroxine25 mg to 100 mg. As per her treating cardiologist all vitals regarding heart is fine. He gave a impression of psychosomatic pain. As per his suggestion myocardial perfusion test under stress was done which also came normal. Her Hb1AC was 7 and ppbs was 170 mg/dl. Creatinine is within normal range, so as the calcium, CBC and urine findings. Please suggest.
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There are 3 existing issues basing on details that you provided 1. Pain left upper chest 2.Breathlessness on minimal exertion 3.poor quality of sleep. Pain left upper chest can be due to cervical angina ,mean to say that in cervical spondylitis with nerve irritation tha pain can be referred to upper anterior chest. Breathlessness reasons 1.Physical deconditioning due to prolonged rest 2.Check hemoglobin levels and blood pressure. 3.Ejection fraction in 2d echo 4.poor nutrition status{protein intake} sleep disturbace: pain frequent urination at night depression day time sleeping consumption of tea or coffea at evenings muscle cramps/burning feet are the reasons. Also advise to check electrolytes as there is high chance of low sodium in your mother. Will speak to your mother and counsil her if that is ok from you sir. Take care as she i.
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lybrate-user, Thanks for the query. I have gone through the details given and understand your concern. Her diabetes looks under control, which is excellent. Similarly het hypothyroidism also needs to be controlled effectively. Because if she feels tired or gets fatigued, that could be due to high TSH. On treatment it should be < 3 mU/L. Then only all the symptoms related to hypothyroidism are in check. So my suggestion please check her TSH, if it is still above the recommended level then you will have to increase the dose by another 12.5 to 25 mcg per day. Thyroxine should be taken early morning on empty stomach and nothing else should taken for next 1 to 1 and half hour. This has to be strictly adhered to. You will have to motivate her to get up and walk initially at home, in front of the house and later in a near by park. Daily walking for about 30 to 45 minutes will make her feel fresh. She is already on enough medications. Thanks.
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