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Diabetic neuropathy,treatment,on tegretol - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Diabetes
Answered by

General & Family Physician
Practicing since : 2009
Answered : 594 Questions
Doctor :   Hello
Doctor :   ok
Doctor :   Please proceed further
User :   Hello. I need some medical advice. My mother is 54 years old and has been smoking for 30 years now. Is over-weight is 163 cm tall and weighs about 85 kg
User :   She suffers from Depression, Anxiety, Asthma, high colesterol, high blood pressure and type 2 diabetes
Doctor :   ok, I understand
User :   She is medicated for Depression & Anxiety, she takes Lerigan Forte, Sobril 10 mg, Stesolid 10 mg, Zoloft 200 mg, Blood pressure Amlodipin Accord 5 mg
User :   Insuline injections Insulatard 60 units in the morning and 60 units in the evening
Doctor :   ok
User :   Her recent illness is that she has this tingling sensation in her hands
Doctor :   ok
User :   stabbing, severe pain, sometimes they go numb and can't feel a thing. Cannot hold objects for a long time and often they fall out of her hands because they feel weak
Doctor :   I understand her problem
User :   loses movement in her legs and she falls underneath her knees and has dark patches on them, her knees
User :   often wakes in the middle of the night becuase of the pain which she has been having for 10 days now
Doctor :   I understand
Doctor :   How is her physical activity otherwise?
User :   some kind of nerve pain and muscle
User :   she has always been very active, even when she is over-weight. Very energetic
Doctor :   That is good to hear
User :   cannot stand still or just sit around and do nothing. In is not in her personality
User :   she doest workout or anything like that
User :   but she does things around the house
User :   etc
User :   what do you think Dr?
Doctor :   Your mother is quite young, she is 54 years old, right?
Doctor :   ok
Doctor :   It seems to me like she is on quite a lot of medications
User :   correct
Doctor :   And she is having a bit of health issues also
Doctor :   Yes, I do agree and it is required for her
Doctor :   yes, sure
User :   she is indeed but they were given to her by professionals
User :   not something she wants to take but must for different reasons
Doctor :   May I know her last readings of Blood sugar and Blood pressure?
Doctor :   ok
User :   shes not the kind of person that ├é┬┤complains and is sick physically. Its very seldom when she does go sick, fly or virus something like that
User :   her blood sugar is regulated. Its around 7-9
Doctor :   Do you mean to say Glycosylated Hb as 7 to 9?
User :   her blood pressure fluctuates
User :   she was given a few days ago Amlodipin in the e.r
User :   not sure
User :   what you mean
Doctor :   What are these values 7 to 9, are these her blood sugar levels?
User :   I check it for her and it reads sometimes 7 sometimes 9 or 11
Doctor :   ok
Doctor :   ok
User :   correct
Doctor :   Yes, I would suggest definitely
User :   has terrible migrains also
User :   so what you reckon Dr.?
Doctor :   Her problems seems to be more of a nervous weakness due to the medications as well as due to Diabetes
User :   suggest what?
Doctor :   She is having generalized weakness in her muscles
Doctor :   It happens sometimes due to more CNS medications also
User :   shes has
Doctor :   ok
User :   shes only had diabetes for 2-3 years
Doctor :   But still Diabetes can have effects on the nerves faster
Doctor :   Drugs used in Central nervous system
User :   CNS medications?
Doctor :   It is unlikely to be degerative in nature considering her age
User :   is it degenerating that could worsen?
Doctor :   I suggest you to get her blood glucose levels tested in the lab
Doctor :   Also do get your mothers' blood pressure checked
Doctor :   ok
User :   The thing is that I took her to a hospital in the emergency room. They took some blood tests and the Dr. on call said that it is not spinal
Doctor :   As far as I see it, your mothers' health concern is not an emergency
Doctor :   It actually needs detailed clinical examination by a neurologist in the OPD
User :   no bad cirulation cuz she has warm hands. According to him, the cardoologist, he thinks it might be Diabetic Neurophaty
Doctor :   That is fine, she can continue on it
User :   he has given her a referal to a Neurologist but given her Tegretol Retard 200 mg
Doctor :   Her nervous system examination has to be done in a detailed manner
Doctor :   Also get her blood sugar tested in the lab
Doctor :   Most likely, it seems like Diabetic neuropathy
Doctor :   Is she on any nuerotropins?
Doctor :   ok
User :   she only takes what he gave her
Doctor :   OPD is out patient department
User :   the regerol retard 200 mg
User :   what is OPD
Doctor :   You can discuss with your doctor about adding neurobion forte to her current medications
User :   so I'll need to explain it for them or what?
User :   so what do I need to say to the neurologist
Doctor :   She will be fine do not worry
User :   ok
User :   yes but I dont want some wishy-washy neurologist to give her "half ass" examination if you pardon my french
Doctor :   Please do get her thoroughly examined by her neurologist
User :   what do I have to say and do to make sure that he or she does her job right?
User :   yes
Doctor :   Just ask the doctor to include a neurotropin in the medications
User :   ok. Well my mother says that she does feel better becuse of the new drug Tegretol
User :   but I still want her checked out. Will she have to take these drugs all her life or will it pass with time this affliction
Doctor :   She will have to continue on these medications
User :   ok
Doctor :   yes, it is lifetime
User :   ?
User :   always
User :   and as long as she takes them, the condition will not worsen or degenerate?
Doctor :   Degeneration starts only after 70 years, she is too young for it now
User :   nothing to be worried about???
Doctor :   Yes, she will be fine
User :   that sounds assuring
Doctor :   Continue her medications, Also she can go in for physiotherapy
User :   great. Another question that doesnt involve this
Doctor :   Yes, sure go ahead
User :   I have this recurring pain in my shoulder blades. It hurts like hell and I've had inflammation before
Doctor :   I understand.
Doctor :   Is it on both shoulders or one of them?
User :   They get all swollen and stiff.
User :   I try with Ipren cream and tablets. Its changes, once its on the left and then on the right
Doctor :   ok
Doctor :   It should be a sprain in the shoulder blades due to stress
User :   the pains goes away for a few hours but to releif the pain I have to take 8 tablets a day to be pain-free
User :   then my stomach hurts from the medicine
User :   physical terapy I cannot manage now becuase of the pain
Doctor :   Why don't you try some ice packs locally
Doctor :   also some shoulder exercises should help
User :   on the area that hurts
User :   ?
User :   ok
Doctor :   Please do get an X-ray done
User :   but why does it come back, it is clinical stress?
User :   will it show? I mean, I think the x-ray will show only if its damaged or injured right?
Doctor :   X-ray will show changes in the joint due to wear and tear
Doctor :   Also it shows any fracture
User :   I'm not questioning your expertise or anything Dr.
Doctor :   It also says about the calcium status of the bone grossly
User :   I see
User :   what else should I do
User :   ?
Doctor :   You do not need anything much other than an X-ray
Doctor :   Do take simple analgesics for the pain
Doctor :   May I know your age please?
User :   analgesics. Ofcourse 34 years old female
Doctor :   ok
Doctor :   Most likely it seems to be of muscular origin
Doctor :   I feel you should be fine with some rest and pain killers
User :   i see.
Doctor :   You need not worry about calcium deficiency as you are still young
User :   but its recurring. It comes and goes but it hurts like a sonavvabitch! Pardon for writing that
Doctor :   I understand the pain
Doctor :   Do not strain your shoulders much
Doctor :   Yes sure, they can
Doctor :   You can go to a massuese
User :   do you think a massuese or chiroproctur can help me?
User :   ok
Doctor :   It would be better than a chiropractor
Doctor :   yes
User :   really?
Doctor :   You just need some relaxation of the shoulder muscles
Doctor :   Exactly
Doctor :   Also see an orthopedician with the X-ray
User :   so get a x-ray, go to a messuse, do not strain the shoulder blades, put ice on it
User :   can my house doctor do an x-ray or will I need to go to the hospital for that?
User :   what is that?
Doctor :   An orthopedician is a doctor who specializes in diseases of the bones
Doctor :   For sometime now
User :   but will I have to medicate the pain for it to stop comming back again? I see, ok
Doctor :   Inflammation starts in the joint as the stress on the joint increases
User :   how does the inflammation start?
User :   is it something cause by me???
Doctor :   When you use your shoulders more than they can actually handle, there is strain in the joint cavity, various cytokines are released into the joint causing pain and inflammation
User :   whats the best medication for the pain and inflammation do you think?
Doctor :   Ice packs locally are very very good
Doctor :   Are you understanding what I am saying to you?
Doctor :   You can ask me again if you do not follow
User :   i see
User :   every word
Doctor :   Thank you
Doctor :   Please proceed
User :   Thank you for being so kind but I understand you 100% Dr.
Doctor :   Heat actually worsens the inflammtion
User :   I asked a nurse about it and she said that heat does wonders, like being in a sauna, taking a hot shower
Doctor :   I do not suggest heat therapy for inflammations
User :   etc, is that true?
Doctor :   So, as more and more cytokines are released, the joint gets swollen
User :   I'm always suspicious about Swedish doctors and nurses and I was right in doing so. (smiles)
User :   so no heat
Doctor :   Fluid is secreted into the joint cavity and hence swelling and pain in the joint
Doctor :   Please do not apply heat
User :   ok
Doctor :   I do not recommend it
User :   i wont then
Doctor :   Nice to see you smile
User :   and what medicins do you reccomend for the pain
Doctor :   You can take simple analgesics like Paracetamol, it should suffice
Doctor :   Thank you too
Doctor :   Is there anything else I may help you with?
User :   thank you...
Doctor :   Not really, do not take very hot showers
User :   should i stay away from hot showers?
User :   seriously?
Doctor :   Better would be lukewarm water
Doctor :   Thank you for consulting me
Doctor :   You too have a great day
User :   i see. Ok Dr. thank you so much for your time and your valuble advice. Have a great day and take care
Doctor :   Wishing you and your mom a very healthy life
User :   thank you kindly
Doctor :   Bye for now
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