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STROKE with DIABETES, HYPERTENSION, HYPERLIPIDEMIA. Treatment.

Resolved Question:

Doc,
Patient history of strokes with diagnosis of type 2 diabetes, hypertension, hyperlipidemia. drugs currently take are glipizide 10mg po daily, HCTZ 25mg daily, Atenolol 25 mg po daily, hydralazine 25 mg qid, simvastatin 80mg daily, verapamil 180mg CD daily. Do you think you would modify the current drug treatment or provide any alternative treatment option for the patient on the given data above?
Thank you very much.





Category: ENT Specialist

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Category: ENT Specialist
Dr. Sunil Jalan is online now

Expert:  Dr. Sunil Jalan replied 4 Days.

Hello Andy,
Thank you for your query at DoctorSpring.com
The yellowish mucus indicates a super added bacterial infection, which is common in chronic sinusitis cases.
Since the antibiotic is not responding ( you might have used the same antibiotic before too ), you can start taking Avelox ( Moxifloxacin ) which is also a good alternative for upper respiratory tract infections.
In such recurrent sinusitis cases, it is better to get them removed through procedures like FESS. That is the only alternative in patient with recurrent cold and sinusitis.
Along with Avelox, you should also take Tab. Levocetrizine 5 mg once daily at bed time for 5 days, till you continue the antibiotic. Also you can do steam inhalation to ensure that whatever secretions are blocked can come out, reducing the nidus of infection.
Hope this was helpful,
Regards.


Patient replied :

Thanks for your reply. It was starting to get better yesterday, while still taking the Amoclane. Today I didn't have any colored mucus comming from my nose anymore. Only from my troat a little.. So maybe the amoclane antibiotics were working after all. But it's not completely gone, so I guess the threatment for 7 days was not long enough? Today I started Avalox antibiotics, but why do I need to take the Levocetrizine 5mg exactly? It's a medecinde for allergies, isn't ?
Second question:



When I'm having yellowish mucus comming from my nose. Usually a couple days later my sens of smell is completely gone. I find this very frustrating... It usually takes very long before this gets better. At this very moment I'm unable to smell anything..
Last time I saw my ENT doctor I asked about it and she said that it must be because of the infection. She said some people have the same problem even with a common cold. It'll get back she said.
I don't understand, why exactly is my sense of smell gone? Is it because mucus might be blocking air to the 'smell-sensors' in my nose or something? Or could it be that those "smell sensors" are infected and not working well because of it? I don't know what could be the cause...
And is there anything that I can do to get it back faster?
If it could be because of mucus blocking air to the sensors. Is there any medicine that I can take to make this mucus weaker or something, so it gets out of the way faster?
My wife always sais I should take "Sinutab Forte". She sais it makes mucus weaker so it might help.
I have never tried it and never bothered to ask my doctor about it. But I find it very frustrating that I can't smell anything at all so if there's a thing that I could try. I would like to try it now :)
Kind regards,
Andy


Expert:  Dr. Sunil Jalan replied 3 Days.

Hello,
Thank you for your follow up at DoctorSpring.com
To answer your query why levocetrizine 5mg? Levocetrizine is an antihistamine, you are right in your understanding that it is a medication used to control allergies. It will help provide symptomatic relief from the runny nose that you are experiencing which is in part produced by the effects of histamine. The medication you inquired about, sinutab forte contains chlorpheniramine which is also an anti-histamine and serves the same purpose. Whichever medication you chose to take (only one and not both), they will provide symptomatic relief and not cure your sinusitis.
Your doctor is right in her explanation that anosmia (loss of smell) is frequently associated with the common cold, sinus infection, allergic rhinitis and non-allergic rhinitis. The anosmia associated with your sinusitis is temporary. I understand it can be discomforting but it is caused due to irritation or destruction of the mucous membranes of your nose which occurs with each episode of sinusitis. Unfortunately there is no medication which can revert the anosmia until the sinusitis subsides.
You can add mometasone nasal spray two times daily for 6 weeks to provide further symptomatic relief.
Hope this helps, feel free to discuss further


Patient replied :

Thanks for the clarifications.


The last couple of days I don't have a runny nose at all. But I don't smell a thing, not even things that should smell very hard :) Absolutely nothing...
The mucus comming from my nose today is clear (not yellowish color). I didn't need much tissues at all trougout the day. I guess this is good news? But the mucus is thicker than I'm used to see. So I'm not sure if I should do something about it? I would guess that it would be better if it was less thick (So it could get out easier. Especially since I still had yellowish mucus comming from my nose yesterday.).

I did only take 1 Avelox pill in the morning. I didn't (yet) take anything else like sinutab forte or something...
If you think I should take something else (because the clear mucus is thicker), then please advice :)

Kind regards,
Andy


Expert:  Dr. Sunil Jalan replied 2 Days.

Hello,
Thank you for your follow up at DoctorSpring.com
Well, your episode is expected to become better within days of starting medication, the clear mucus and need for fewer tissues is definitely a good sign.
Aside from the medication, I have suggested above, the best way to remove thick mucus is to do steam inhalation. When done in the proper way this technique works most effectively in clearing mucus. For the first few days, do steam inhalation upto 5 times in a day (each time, inhaling steam while your entire head and neck is covered for 5-10 minutes, breathe only through your nose)
Hope this helps, feel free to discuss further


Patient replied :

Hello,

I have been doing a couple of steam inhalations the last couple of days but I don't notice anything happening when doing that? Should I expect something to happen, like mucus comming out?
I don't need much tissues the lately, but when I do need one the mucus comming out is sometimes clear and other times it still has a yellow color. Lighter than before, but certainly not clear.
I also started taking the Sinutab Forte because I'm told it will make it easier for the mucus to come out. I'm taking these for 2 days now, 2 times a day. Both days I noticed that I started to cough after taking the Sinutab Forte tab and little mucus was comming out while coughing. Today I also took the sinutab fort tab but no more coughing...
I also noticed that when I take the sinutab forte It feels like there is a change in pressure in my ears. It feels a little weird, compareble to how it feels like in an airplane...
What I also noticed is that the last days I have no more popping sound in my right ear. I usually hear popping sound in my ears when I swallow. I have been talking to my ENT doctor about this before but she said this is normal and is related to the eustachius tube not functioning properly. But nothing had to be done about it if I had no other symptoms.
Since I started taking the sinutab forte I feel change in pressure and now when I swallow only my left ear pops like before but in my right ear I don't hear that poppsing sound anymore.
I hope this is all good news? Hopefully things are changing now in the good direction?
Is there anything else I should do? Or should I just continue with the Avelox + Sinutab Forte?


Expert:  Dr. Sunil Jalan replied 1 Day.

Hello,
Yes with the mucus coming out, and after taking Sinutab Forte, the secretions are also coming out, these are good signs showing that you're recovering.
For the time being continue with the steam inhalation and the medicines. Primarily because it will ensure faster recovery and also steam inhalation will make the much thinner, making it easier to come out. It will aid the medicine in recovery mainly.
Regards.


Dr. Sunil Jalan
Category: ENT Specialist
Experience: 
DAA (Diploma in asthma and allergy) : Christian Medical College, Vellore, 2012
D.N.B (ENT), 2011
Residency - M.S. (Master post graduate degree in otorhinolaryngology),  Christian Medical College, Vellore, 2009
D.L.O. (Diploma in otorhinolaryngology) - Christian Medical College, Vellore, 2007
Medical School - M.B.B.S, S.P. Medical college, Bikaner, 2004
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