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Suffering for psoriatic arthritis, immuno suppresents not effective. Ways to reduce inflamation? - Online Doctor Chats

Date : 12-Jun-2013
User rating for this question
Very Good Posted in: Arthritis
Answered by

General & Family Physician
Practicing since : 2002
Answered : 106 Questions
User:hi i am suffering for psoriatic arthritis
Doctor:Go ahead with your query
Doctor:Are you there?
User:i have tried immunosuppresents earlier but now their efficacy if poor
User:i hope you an immunologist
Doctor:I am a general physician
Doctor:I can help you within my expertise.
User:thanks doctor but i guess i would need a rheumatologist or immunologist
Doctor:Then you can post a query on the website.
Doctor:A specialist will be able to help you with it.
User:however can you sugest me afew ways to get sound sleep to keep my inflamation low
User:i am not able to sleep due to pain and this also affects my psoriasis
User:i sleep for no more than 4 hours a day
User:id want ot have sound sleep for at least 61/2 hrs
Doctor:and the only reason is pain?
Doctor:If pain is the reason then you need adequate pain control with medicines.
Doctor:There are some high potency medicines available that can be prescribed to control pain.
User:i am on painkillers with antacids , i need to improve my sleep
User:i use indocap sr and pantop D
Doctor:I will ask a few questions to be better able to help you
Doctor:Can you tell me the timings of your sleep?
User:i go to bed at 10:00pm but can sleep til 1am then i get some sleep but wake up at 4:30 am
Doctor:You may try a few things.
Doctor:Before going to sleep you may take your pain-killers
Doctor:Stop all brain work at least 1 hour before sleep
Doctor:And then go to bed
Doctor:Make sure that the room is dark and noise free
Doctor:For some days a sleep medicine can also be prescribed
Doctor:But it should not be taken for more than a few days
User:im on tryptomer is it a sleep medicine or for relaxing the cervical spine
User:i take it occasionally just to make sure i dont get used to it
Doctor:It is an anti-depressant
User:are there any safe sleeping pills
Doctor:It needs to be taken daily for few weeks for any effect to be seen
User:one that do not cause death
Doctor:Anti-depressants are not addictive
Doctor:Sleep medicines are addictive
User:but i've noticed when i take tryptomer i sleep better
Doctor:Yes, options are available but need to be taken under the guidance of a psyciatrist
Doctor:Early morning awakening can be related to stress
Doctor:tryptomer can relieve the stress feelings and give you good sleep
User:my doc told me told me that tryptomer will ensure you sleep well
User:how can one have stress whilst sleeping
User:what stress are we talking of anyways
User:i pray and meditate for 10 mins before going to bed at 10:00 pm
Doctor:That is a good thing
User:i make sure im destressed
Doctor:Actually anything can cause stress and resultant early morning awakening
User:thng is my XXXXXXX clock is kinda disturbed says my dietician
User:no i wake up early by choice so that i can go swimming for 1 1/2 hr
Doctor:The main concern is that you are not able to go to sleep in time
Doctor:It is better that you take your sleep.
Doctor:Iknow swimming is good, but adequate rest is also important
User:i want to sleep from 10:00pm to 4:25am thats 6/12 hrs
Doctor:tryptomer is usually prescribed to take care of stress
Doctor:That is just about changing the clock then
Doctor:It is something like coming out of a jet lag
Doctor:It takes a few days
Doctor:You need to go to bed early
User:actually wanted to ask you , if i swim fro bout 1 hr, cycel for 45 mins and work out in gym for 90 mins every day, how many hrs sleep is good sleep especialyy to build muscles and give rest to body
Doctor:Even if you do not sleep, still your time of sleep will change slowly
Doctor:Usually 6-9 hrs should be sufficient
User:i been trying to go to bed for bout 02 weeks at 10:00 pm its helped a bit but i feel drowsy through the day
Doctor:You should wake up when you feel refreshed
Doctor:I think it will take a few more days
User:i dont feel tired when i wake up, but i sleep in short spells
Doctor:then the timing will set for 10 o clock
User:infact i wake up every 02 hrs dont know why
Doctor:It can be many reasons like inadequate dinner
Doctor:Since you are exercising a lot. you need adequate calories as well
Doctor:I think you should try for a few more days.
Doctor:Focus on good sleep hygiene
Doctor:Take a good meal at night
Doctor:If it does not work, then you may resort to medicines.
Doctor:Do you have a question here?
User:ma'am, i dont want to get used to sleeping pills hence i work out and do bout 3 hrs of physical activity each day so taht i may sleep better
User:i need ot suggest few diets which may help me sleep better
Doctor:Yes I can see that
User:Actually i want to just switch off as soon as i get in bed
Doctor:It is normal to just lie for about half an hour
Doctor:Everyone takes some time to go to sleep
Doctor:In some people it can be longer for many reasons
Doctor:When the causes are addressed the person is better able to sleep
User:i know a lot of my health concerns are because i don't sleep too well. Also i tried drinking milk as my dietician suggested but didint help
Doctor:Thus sticking to proper sleep hygiene and relaxation help most
Doctor:What health concerns do you have?
Doctor:Psoriasis is one
Doctor:Apart from that
User:Psoriatic artristis is another
Doctor:Maybe I can help you with the concerns
Doctor:In any type of pain including arthritis, it is a must to get proper pain-control through medicines
Doctor:Otherwise proper sleep will not be possible
User:i do take indomethacin and pantop when the pain is unbearable
Doctor:You may also try drinking clean water as it may help with reduction of other concurrent infections
Doctor:I know indomethacin is usually not taken for a long time
User:i do drink ro treated water daily
Doctor:I was thinking of adding codiene in your pain-killers
User:i take it in spells of 15 days and then give a break for bout same time
User:docter where from are you ? Meaning India? or abroad
Doctor:I am from Canada but currently in India
User:If India, then would be be ok to concur with my doc from hinduja hospital
Doctor:Sorry I did not understand what you meant
Doctor:I am in Bangalore
User:i meant taking an opinion with my rhematologist at hinduja hospital who has been handling my case for bout 02 years
Doctor:Yes I understand what you mean
User:or would it help if is sent yuo the scanned copy of my prescription
Doctor:But it is more appropriate if you discuss your options with the doctor directly
Doctor:Yes you can send me a scanned copy
Doctor:Address it to my name
User:i discussed with my doc he says take tryptomer often, i afraid i kinda got dependant on it then
User:hence all these questions.
Doctor:You may ask him for two or three alternatives
Doctor:I know
Doctor:You may take then according to the severity of pain
User:would it be possible to mail me a few tips ( dietary) to induce good sleep on YYYY@YYYY
Doctor:For example a brufen may be taken if the pain is mild
Doctor:I have taken a note of it and I will send it as soon as possible
User:actually ive been advised to not take painkillers for prolonged duration. moreover i can mange with slight pain. but i ned to get my sleep inorder ASAP to make sure i dont cause damage to my muscles due to lcak of sleep
Doctor:Why have you been advised against pain-killers?
Doctor:Because of acidity?
User:my doc says and i too have read that they can lead to cardiac arrests, for acidity i take pantop D an antaacid with the painkillers
Doctor:How bad is the acidity?
User:i dont have any acidity issues
Doctor:Actually D means domperidone and it should be taken if vomiting is present
User:in fact when i wake up i drink 02 litres of water every day
Doctor:Actually NSAID-induced gastritis can happen but only in some patients
Doctor:Most people take NSAIDs for life without much problems
Doctor:I think you should discuss in detail about your medicines with your doctor
User:no actually the doc prescribed pantop 40 and Pantop D as well but he did so jus to make sure no aciity probs
Doctor:Quality of life should not be affected because of inadequate medicines
Doctor:I understand
Doctor:But you are having issues because of inadequate pain-control
Doctor:You may get a whole list of pain-killers that you can use
User:ma'am appreciate your veiws but, i was looking forward to seeking some help on other issues such as sleep and food which basically can keep me healthly
Doctor:I will send you a diet chart and sleep hygiene on your email id
User:As of now teh pain isnt so severe, the pain is kinda cyclical, it goes through its high and lows, i can do cardio and swimming whch means it isnt that bad
User:by the way how are general physicians different from other doctors
Doctor:I was only worried about your pain coming in the way of your sleep
User:actually when should one contact a general physician?
Doctor:General physicians have done graduation like MBBS
User:coz i have visited one in 3 years
User:sorry if i sounded rude
Doctor:If he thinks that a specialist is needed then he may send you to one
Doctor:It is ok
User:But with all ortho, immuno and other docs around i was told mine is an auto immune disorder
User:hence i frequented only these docs
User:Ma'am, i appologise if you felt offended, that wasnt my intention
Doctor:No I am ok
Doctor:I just sent you a diet chart that you may refer
Doctor:I will send you something on sleep hygiene too
Doctor:Usually I do not advise something for post-dinner but you may take milk, etc before sleeping to help you with the sleep
Doctor:Are you there?
User:can i take health supplements with milk
User:like protienex or Amul pro
Doctor:Actually supplements are only advised for conditions causing weight loss
User:actually from my height 177 cm im 75 kgs
Doctor:Yo may take multivitamins though
Doctor:I do not think you need nutritional supplements
User:i intend to build muscle groups to reduce the load on my knees and ankles, and upper body to strengthen my shoulders
User:is revital ok
Doctor:weight of 75 kg is ok for 177 cm height
Doctor:Yes you may
Doctor:Mostly if sleep is getting disturbed you may take a hearty dinner so that you do not wake up because of hunger
Doctor:Any other question?
User:doc im kinda taking more of your time, can we discuss this later ( if need be) . Was really nice talking to you.
User:appreciate the prompt response and for being patient with me
Doctor:You can always login again to chat with a doctor 24/7
Doctor:If you do not have more questions, I will close the chat window now.
Doctor:No problem
User:yeah but i guess it woudl be soem different doc and i'd have to type the whole storyagain
Doctor:I am here to address your concerns
Doctor:You can ask for me specifically
Doctor:You can also talk to me on phone
Doctor:You just need to ask the customer care team to put the call across to me
User:that'd be great coz i would not have to go through he drill of telling bout it again and again.
User:meanwhile doc do you practice outside of the tele support
Doctor:Currently I am not practicing
Doctor:It was nice talking to you
Doctor:I will close the chat window now.
Doctor:I will also send you the email on sleep hygiene
User:thanks anyways was really great talking to you, actually kinda got me distressed
Doctor:Take care
User:thanks ma'am, bye for now
Doctor:Do not worry
Doctor:Bye for now
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