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Sleeping and breathing difficulty in one with arthritis and hypertension - Online Doctor Chats

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

General & Family Physician
Practicing since : 2004
Answered : 1722 Questions
Doctor :   hi
User :   hi
Doctor :   Dr. XXXXXXXX here.
Doctor :   please proceed with your health query
User :   Dr. I am XXX
User :   its about my father
Doctor :   ok. please proceed
User :   he is arthritc from past 40 years
User :   and hypertensive from past 15 years
Doctor :   ok.
User :   The problem started from last 15 days
User :   he was unable to sleep
User :   he was restless.
User :   in meantime he had cold which blocked his nose
User :   he was unable to sleep for 7 days on trot
Doctor :   ok
User :   I brought him to XXX for further tests and was admitted to XXX
Doctor :   what other symptoms did he have?
User :   He told me when he tried to sleep, he felt breathlessness
User :   and used to sit up
Doctor :   ok
Doctor :   what further tests were done for him?
User :   He was tested for his heart , ECG, Echo cardio and lungs
User :   the report were fine except that he had mild regurgitaion
Doctor :   ok for lungs was chest x-ray and PFT (pulmonary function test) done?
User :   which was detected a year and halg ago
User :   yes
User :   he was there for a day and was dischrged
User :   after coming home he was fine for two days, slept fully
Doctor :   ok
User :   and on third night he again complained of restlessness, breathlessness and some kind of strage feeling in his head ( like some pressure)
User :   and collapsed
Doctor :   ok. is his blood pressure controlled?
User :   I took him to nearby Heart hospital think that it was a heart attack
Doctor :   was EEG and ECHO found normal?
User :   but the ECg and ECHO did not show any of the thigs
User :   they were agin normal
User :   a pulmonologist was called in the morning and he treated him for allergic rhinitis
User :   He also told him that my father has sleep apnea
User :   and did a sleep test
Doctor :   ok.
User :   The rports are yet to vcome
User :   They discharged him again
Doctor :   ok. was allergen test done for him to identify the allergy causing substance?
User :   yes
User :   he was tested for IGE serum
User :   which was negative
User :   I though because of his sleeplessness he might be having some acute psychosis
User :   and called in a psychiatrist
User :   he prescribed cipralex 5mg anitdipressant and rivtrol 0.5mg
Doctor :   ok
User :   he slept well yesterday
User :   but after getting up in the morning he had the same ymptoms
User :   mild breathlessness, eyelids become heavy and some strange feeling inside his head
Doctor :   ok. what is the frequency of the new medications prescribed?
User :   which transients from his forehead to top and back of his head
Doctor :   ok
User :   one each in night
Doctor :   ok. so you mean to say that he is having symptom control in night now due to medication use but not during the day time?
User :   He also taking Telma-h for his hypertension( in the morning after breakfast)
Doctor :   ok
User :   no
User :   the symptoms are persisting
User :   even after taking the drugs
User :   he started the drugs yestrday only
Doctor :   but you said he slept well after taking the drugs, hence I asked if his symptoms are fine at night after drug use?
User :   yes
Doctor :   ok. wait for another 2 days, the drugs will take some time to take proper effect
Doctor :   if even after 3 days of drug use his symptoms persis during daytime also
User :   does he have some neurological
Doctor :   then he will need re-evaluation and change of dosages or medication that can give him 24 hour relief from his symptoms.
User :   his blood gas report sugessted that he has mild hypoxia (guess this is the right word for less oxygen in blood) his PO2 is 70 mmHg
Doctor :   yes it is the right word.
User :   PH 7.4, PCO2 35, HCO3 22, ABE -2 and O2 sat 94%
Doctor :   but is oxygen saturation is good
Doctor :   *his
User :   even with oxygen administration he had the same symtopms, hence i ruled out carbon dioxide retention
Doctor :   even if with oxygen administration he is having the symptoms, then it suggests psychological effect
User :   can the symptoms persists even after good sleep?
Doctor :   also his symptoms were betteer as you said after first dose of new medications
Doctor :   after a good sleep usually symptoms should not persist unless he has some exertion.
User :   shall i see a neurplogist to rule out some neurological problem
User :   *neurologist
Doctor :   a psychologist or a psychiatrist would be better, wait for the sleep test result to come
User :   ok
Doctor :   and then based on the reports it can be decided what next should be done
User :   thank you doctor
Doctor :   is there anything else I can help you with?
User :   i think i will wait for the reports tommorrow and will decide
User :   how can i contact you again online after getting my results
Doctor :   yes, that is better. you can also discuss with his treating doctor about a good referral to psychologist
Doctor :   to help him out
Doctor :   overcoming the symptoms
User :   i mean i cannot explain all this things again to a new doctor who comes online
Doctor :   you can come online and ask for me. I am available between 9am-4pm IST
User :   ok thank you for your advice
Doctor :   even otherwise your discussion will be saved in your account
Doctor :   and when you come to discuss again, the doctor can go through your previous discussion and guide you further
User :   ok
Doctor :   you will not need to re-type everything again
Doctor :   have you followed what i said?
Doctor :   is there anything else I can help you with?
User :   yes
User :   no doctor, thanks once again for your time
Doctor :   thanks for consulting me. bye for now.
User :   bye
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