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History Of Diabetes, Hypertension, Dyslipidemia, Bloated Abdomen, Pain Below The Breast. What Can Be The Pain Due To?
Question: 84 year old female with a history of diabetes, hypertension, gerd, dyslipedemia, with pain beneath the right breast over the rib cage. The pain radiates to the back. No fever.
There abdomen seems to be swollen or enlarged as in bloated.
There abdomen seems to be swollen or enlarged as in bloated.
Hi there,
Thank you for writing in to Health Care Magic.
I am a cardiologist and read your mail with diligence. Though, symptoms are produced in here because of GERD, in my opinion most important silent illness is Diabetes Mellitus. Dyslipidemia and Hypertension the two life style diseases usually accompany Diabetes and these merit treatment nonetheless.
Diabetes Mellitus contributes to symptoms of pain beneath right rib cage radiating to back by aggravating and facilitating spillage of gastric contents into oesophagus due to gastroparesis. Therefore, proper monitoring of Diabetes is essential. Investigation wise whenever there is change in drugs or diet, as per doctor's advice Fasting Blood Sugar is the investigation of choice. However, when diabetes is stabilised on oral hypoglycemic agents (Metformin, Glimiperide and other drugs) with or without insulin, a three monthly monitoring with glycosylated hemoglobin (HbA1C)is mandatory, it is usually done 3 monthly when trying to improve and six monthly once you have achieved very stable levels.
Hypertension depending upon severity can be controlled with Diuretics with Ace Inhibitors or Angiotensinogen Receptor Blockers.
For dyslipidemia of diabetes there is greater benefit with Fenofibrate. A combination of rosuvastatin and fenofibrate is usually effective in maintaining an appropriate lipid profile, which should also be periodically monitored.
Coming to GERD (gastro esophageal reflux disease): Spillage of acidic stomach contents into oesophagus leads to heart burn and other symptoms. The risk factors namely alcohol, obesity, smoking to be avoided. Others like hiatal hernia and scleroderma should be investigated for and drugs to be avoided are anticholinergic for example for motion sickness, calcium channel blockers for hypertension, oral bronchodilators for bronchospasm and as far as possible sedatives for insomnia and anxiety and antidepressants, nonsteroidal pain killers like aspirin and ibuprofen. This is the list of drugs which are commonly needed at this age.
Antacids available OTC can be taken, one should remain in upright position especially after Dinner for lying down helps to spill the contents by gravity alone. Your doctor can prescribe prescription drugs which act slowly but give longer relief. Two important drugs in this list are Proton Pump Inhibitors like pentoprazole, H2 blockers like cimetidine.
Anti reflux operations like fundoplication in an 84 year old lady is ultimate option when life style changes and drugs completely fail to act.
Last but not the least in a 84 year old lady we have to consider polypharmacy when we are prescribing so many drugs for these 4 problems. As far as possible combination therapy ought to be used and total number of preparations patient has to take and their frequency ought to be kept minimum or else supervised.
I hope I have answered all the questions arising out of this multisystem problem. I shall be only too happy to take any follow up query if there is any.
With Best Wishes.
Dr Anil Grover
MBBS, MD(Medicine), DM(Cardiology)
WWW.WWWW.WW
Thank you for writing in to Health Care Magic.
I am a cardiologist and read your mail with diligence. Though, symptoms are produced in here because of GERD, in my opinion most important silent illness is Diabetes Mellitus. Dyslipidemia and Hypertension the two life style diseases usually accompany Diabetes and these merit treatment nonetheless.
Diabetes Mellitus contributes to symptoms of pain beneath right rib cage radiating to back by aggravating and facilitating spillage of gastric contents into oesophagus due to gastroparesis. Therefore, proper monitoring of Diabetes is essential. Investigation wise whenever there is change in drugs or diet, as per doctor's advice Fasting Blood Sugar is the investigation of choice. However, when diabetes is stabilised on oral hypoglycemic agents (Metformin, Glimiperide and other drugs) with or without insulin, a three monthly monitoring with glycosylated hemoglobin (HbA1C)is mandatory, it is usually done 3 monthly when trying to improve and six monthly once you have achieved very stable levels.
Hypertension depending upon severity can be controlled with Diuretics with Ace Inhibitors or Angiotensinogen Receptor Blockers.
For dyslipidemia of diabetes there is greater benefit with Fenofibrate. A combination of rosuvastatin and fenofibrate is usually effective in maintaining an appropriate lipid profile, which should also be periodically monitored.
Coming to GERD (gastro esophageal reflux disease): Spillage of acidic stomach contents into oesophagus leads to heart burn and other symptoms. The risk factors namely alcohol, obesity, smoking to be avoided. Others like hiatal hernia and scleroderma should be investigated for and drugs to be avoided are anticholinergic for example for motion sickness, calcium channel blockers for hypertension, oral bronchodilators for bronchospasm and as far as possible sedatives for insomnia and anxiety and antidepressants, nonsteroidal pain killers like aspirin and ibuprofen. This is the list of drugs which are commonly needed at this age.
Antacids available OTC can be taken, one should remain in upright position especially after Dinner for lying down helps to spill the contents by gravity alone. Your doctor can prescribe prescription drugs which act slowly but give longer relief. Two important drugs in this list are Proton Pump Inhibitors like pentoprazole, H2 blockers like cimetidine.
Anti reflux operations like fundoplication in an 84 year old lady is ultimate option when life style changes and drugs completely fail to act.
Last but not the least in a 84 year old lady we have to consider polypharmacy when we are prescribing so many drugs for these 4 problems. As far as possible combination therapy ought to be used and total number of preparations patient has to take and their frequency ought to be kept minimum or else supervised.
I hope I have answered all the questions arising out of this multisystem problem. I shall be only too happy to take any follow up query if there is any.
With Best Wishes.
Dr Anil Grover
MBBS, MD(Medicine), DM(Cardiology)
WWW.WWWW.WW
Above answer was peer-reviewed by :
Dr. Shanthi.E
Yes, Thank you Doctor. I have made an appointment with her XXXXXXX medicicne doctor for monday. I was just afraid because the pain was intense and she did not want to go to the ER. I concur and will get her seen.
Hello,
You did the right thing. If you are referring to burning pain on right side of chest, antacids both chew-able and liquid, which are available as over the counter medicines should give her some relief. Time these antacid, one and three hours after meals.
If there is any other query I will be happy to answer.
Best Wishes
Dr Anil Grover
You did the right thing. If you are referring to burning pain on right side of chest, antacids both chew-able and liquid, which are available as over the counter medicines should give her some relief. Time these antacid, one and three hours after meals.
If there is any other query I will be happy to answer.
Best Wishes
Dr Anil Grover
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Prasad
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