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Diagnosed with Osteoarthritis of hip, knee and ankle. Subclinical hypothyroidism. Measures to be taken?

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My mother-in-law has been diagnosed with the following
Osteoarthritis of hip, knee, ankle
Subclinical hypothyroidism
Hyperlipidimia
Type 2 diabetes
Chronic Kidney Disease Stage 2
She had her legs swollen - mainly near ankles - for nearly ten days. And, recently her face - near nose - was swollen a bit for 2 days: on the day (by evening) her BP reading was consistently 140/90. From that day, nearly 10 days now, we have been taking reading using Digital BP meter at home. Couple of occasion it was at 143/92.. Mostly, in 130s/90s range with quite a few occasion at 112/65.. Her pulse has been regularly at 90s. What could be the reason for these? What measures need to be taken?

FYI - Reading taken at 4:15 p.m today, when was absolutely relaxed but sweating a lot, was 111/65. Her pulse was 98.
Posted Wed, 16 Oct 2013 in Hypertension and Heart Disease
 
 
Answered by Dr. Sukhvinder Singh 35 minutes later
Brief Answer:
please see details.

Detailed Answer:
Dear sir/ madam
The blood pressure fluctuates as per the level of mental and physical activity or stress,, through out the day. Hence a large number of variations are normally because of change in level of stress. Intake of tea/ coffee also increases the blood pressure.
A generalized swelling can be due to protein loss in urine in association with diabetic nephropathy, due to certain BP lowering drugs like amlodipine, due to heart failure, due to over hypothyroidism or due to sudden deterioration of renal functions. The last one would be associated with decrease urine output in majority of cases.
A definite cause need to be established before any measure to prevent it can be taken.
Sweating can have multiple reasons. If it is persistent & associated with other serious symptoms like chest pain, shortness of breath or listlessness you need to consult the emergency room.
Hope this helps. Feel free to discuss further.
Sincerely
Sukhvinder
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with Osteoarthritis of hip, knee and ankle. Subclinical hypothyroidism. Measures to be taken? 52 minutes later
Which range is considered to be NORMAL systolic and diastolic pressure.. When is the warning signal?

And, my main concern is about her pulse that seems to be regularly at 90s, even at rest..
 
 
Answered by Dr. Sukhvinder Singh 40 minutes later
Brief Answer:
please see details.

Detailed Answer:
Dear Sir / Madam
1. The Goal BP for a diabetic person being treated for high blood pressure is 130/80 mmHg. If most of the readings, over a period of time, are above this level action is required. Non medicinal means to have better control of blood pressure include daily supervised exercise, optimal weight (BMI~23), low salt diet, no added salt, no smoking, moderation of alcohol intake & a diet XXXXXXX in vegetables, fruits, legumes but low in fats. A sudden fall of blood pressure by more than 25% is considered significant or any fall which is symptomatic (associated with symptoms attributable to lower BP) is important and warrants medical attention.
2. The heart rate is governed by many things and is a secondary response rather than a primary event. For example when we run the heart rate increases, when we are anxious, when we have fever, when we suddenly wake up from sleep, when we take certain anti-asthma or blood pressure lowering medications, when we have low hemoglobin the heart rate increases. Hence we have to find out the cause for increase in heart rate. However, heart rate in 90s may be normal for an individual. My main focus will be on
a. To ascertain the cause of swelling.
b. secondarily, to ascertain the cause of increased heart rate (with lesser priority).
Hope this provides more insight into the issue.
Sincerely
Sukhvinder
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with Osteoarthritis of hip, knee and ankle. Subclinical hypothyroidism. Measures to be taken? 1 hour later
Thanks for the detailed response..

Hers had crossed 130/80 most often, in the last 1+ week and there had been instances of 111/65 range.. What shall we infer, as we take reading almost every day? As 130/80 is upper limit what shall be the lower limit for a diabetic?

Also, what should be the normal range of pulse for men and women?
 
 
Answered by Dr. Sukhvinder Singh 14 minutes later
Brief Answer:
please see details.

Detailed Answer:
Respected sir/ madam
1. Normal range of heart rate is from 60-100 beats per minute for both men and women. Rates less than 60 or more than 100 are not always abnormal. Each individual and circumstances in which he/she is being examined are different.
2. If she is frequently crossing 130/80 mm Hg in a relaxed state, without having any pain/ irritation/ stress, without having coffee/ tea in last one hour of examination, then you must discuss this with your cardiologist. He will try to ascertain any cause for this. If there is no apparent provocative factor, he will increase the drug dosage.
3. There is no set lower limit for a given patient. As I told you in my last response also, that a sudden decrease of ~25% or any symptomatic fall is important. As a thumb rule, a systolic (the higher of the two readings) blood pressure of <100 mm Hg should alert you and at <90 mm Hg one should always consult a doctor. However BP higher than this may be lower for a given patient in certain circumstances. Symptoms of low blood pressure may be decrease urine output, cold clammy skin, excessive sweating, listlessness & inattentiveness.
4. Unless specifically instructed by your doctor, BP can be checked in 2-3 days, almost at same time of day, without any stress and with precautions as mentioned above. Normally for BP readings just outside the range, we wait for 2-3 weeks before intervening.
Hope that helps.
Sincerely
Sukhvinder
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with Osteoarthritis of hip, knee and ankle. Subclinical hypothyroidism. Measures to be taken? 13 hours later
Thanks for the clarification.. Though it may sound repetitive, considering all her ailments (hypothyroidism, diabetes, osteoarthritis, CKD) which is the optimum level of BP, pulse to maintain (higher-lower range)?

And, 4 days ago - over the dusk.. she had unpleasantful moment for couple of hr. During that time, her left eye closed and she had severe pain on left leg. She couldn't sleep until 1 A.M. What could have been the reason then?
 
 
Answered by Dr. Sukhvinder Singh 2 hours later
Brief Answer:
please see below.

Detailed Answer:
Dear sir/ Madam
1. The higher limit for blood pressure is 130/90 mm Hg. There is no set lower limit but a systolic BP of less than 90 mm Hg is alarming and needs evaluation by a physician. If patient has symptoms or trouble, even a value less than 100 mmHg would be sufficient to take action. We also look for symptoms of low blood pressure in assessing the situation.
2. As I tried to explain you that we do not control or maintain optimal pulse in day to day life, we just look at the factors affecting the pulse, If we find it too abnormal. Otherwise theoretically the range is 60-100 beats per minute.
3. Difficult to comment on the episode you mentioned without having examined her at that time. A leg pain and closed left eye are not usual concomitant symptoms. If at all they were together, it may be a neurological problem but its just a vague guess. If you can come up with more details, i may be able to throw more light on the episode. Like what exactly u mean by closed eye, was she conscious , speaking well, how does the pain felt like. how was it being provoked etc.
Sincerely
Sukhvinder
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with Osteoarthritis of hip, knee and ankle. Subclinical hypothyroidism. Measures to be taken? 30 hours later
She was very much conscious. She has this problem of excitement, deep focus making her left eye becoming smaller i.e., droopy eyelid.. On that for some reason she was emotionally disturbed.. At that time, her left eye was closed by 75% and she had pain on the whole left leg - more at knee and below - for nearly 3-4 hr., and could sleep by 2:00 A.M only..

What does this mean? Otherwise, she was normal, speaking well.. With all these explained in this query and follow-ups, do you suggest EKG for her? Or, anything else we need to do?
 
 
Answered by Dr. Sukhvinder Singh 1 hour later
Brief Answer:
please see details

Detailed Answer:
Dear Sir
1. A droopy eyelid and leg pain do not go hand in hand. They are possibly two different process at the basic level. The leg pain can be neurological in origin as it is involving whole of the limb. This usually occurs secondary to involvement lower spine in old age. It will not be possible for me detail more on this issue.
2. No, I will not recommend an ECG. She requires a detailed and complete examination by a good internist (medical specialist). He will assess the possible reasons for her complaints and will guide you about further investigations and referrals. She will possibly require opinion of an orthopedician / neurophysician/ cardiologist.
Hope this helps.
Sincerely
Sukhvinder
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with Osteoarthritis of hip, knee and ankle. Subclinical hypothyroidism. Measures to be taken? 14 hours later
Thanks for all the response.. Would examination by internist require hospitalization? Do we have internists in India, especially in Chennai - city we reside at?
 
 
Answered by Dr. Sukhvinder Singh 50 minutes later
Brief Answer:
please see below

Detailed Answer:
Dear Sir
Internist is a specialist in XXXXXXX medicine, what we commonly call as
"MD (medicine)" in India. There are many such specialist in Chennai.
There is no need of admission for a detailed examination. However, if required, she may be advised admission after examination.
Sincerely
Sukhvinder
Above answer was peer-reviewed by
 
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