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Suggest Treatment For Stomach Discomfort, Recurrent UTI And Anxiety
Question: My mother, who lives in XXXXXXX is about 75 years old. For the past 20 years she has been taking blood pressure medicine and also cerepax for sleeping. The doctor had prescribed cerepax to help her sleep and all these years she has been taking a tablet in the afternoon and at night for sleeping. She never had an anxiety, panic or depression disorders.
During April 2014, one night her blood pressure went up and she had a severe nosebleed. She was taken to the hospital, and released the next day. A few days later she started getting a strange feeling and pain in her stomach, so she was admitted to the hospital again. It was found that her SODIUM LEVELS WERE CRITICALLY LOW. Her sodium levels returned to normal after about one week. However, the strange feeling and pain in her stomach became even worse.
She was admitted to the hospital again and all the tests were done. These tests included ECG/ EKG, Upper GI endoscopy, full ultrasound, CT scan, fecal and all routine blood and urine tests test. All the results were normal and the treating physician in XXXXXXX concluded that the issue was psychological. He changed the medication from cereprax to lozep. With this, she would be okay for a few hours after she took the medicine, and then have the strange feeling in the stomach again. Her tests have been repeated a number of times, including H. pylori, and all the results are within a normal range. Her appetite is normal, and her bowel movements are also normal.
The doctors have tried altering the dosage of the lozep. They also tried changing the medication, but without much success. Currently, she is taking lozep (MD) 0.25mg twice a day, and 0.5 mg at night. In addition, she has also been prescribe ventab. Since she has chronic UTI, she is on a regular antibiotic medication for the UTI also.
In spite of all the medications, her level of discomfort and anxiety have not improved. She feels better for a few hours after taking the antidepressant, but once the effect starts wearing off, she becomes extremely uncomfortable and suffers from body pains again. The effect of the medicine lasts for only four to five hours. This has been her condition for the past one and a half year without any periods of continued normalcy. My concern is that she will need an increased dosage over time. Is there something I could do to reduce her extreme discomfort and body pain? Could the issue be something other than depression/ anxiety? (All the tests have been repeated recently in XXXXXXX and the doctors have not found anything abnormal)
During April 2014, one night her blood pressure went up and she had a severe nosebleed. She was taken to the hospital, and released the next day. A few days later she started getting a strange feeling and pain in her stomach, so she was admitted to the hospital again. It was found that her SODIUM LEVELS WERE CRITICALLY LOW. Her sodium levels returned to normal after about one week. However, the strange feeling and pain in her stomach became even worse.
She was admitted to the hospital again and all the tests were done. These tests included ECG/ EKG, Upper GI endoscopy, full ultrasound, CT scan, fecal and all routine blood and urine tests test. All the results were normal and the treating physician in XXXXXXX concluded that the issue was psychological. He changed the medication from cereprax to lozep. With this, she would be okay for a few hours after she took the medicine, and then have the strange feeling in the stomach again. Her tests have been repeated a number of times, including H. pylori, and all the results are within a normal range. Her appetite is normal, and her bowel movements are also normal.
The doctors have tried altering the dosage of the lozep. They also tried changing the medication, but without much success. Currently, she is taking lozep (MD) 0.25mg twice a day, and 0.5 mg at night. In addition, she has also been prescribe ventab. Since she has chronic UTI, she is on a regular antibiotic medication for the UTI also.
In spite of all the medications, her level of discomfort and anxiety have not improved. She feels better for a few hours after taking the antidepressant, but once the effect starts wearing off, she becomes extremely uncomfortable and suffers from body pains again. The effect of the medicine lasts for only four to five hours. This has been her condition for the past one and a half year without any periods of continued normalcy. My concern is that she will need an increased dosage over time. Is there something I could do to reduce her extreme discomfort and body pain? Could the issue be something other than depression/ anxiety? (All the tests have been repeated recently in XXXXXXX and the doctors have not found anything abnormal)
Brief Answer:
As her tests came normal so anxiety is most likely cause of her symptoms
Detailed Answer:
Hello thanks for asking from HCM for your health related queries
I can understand your concern. She is 75 years old and was taking Cerepax since years for sleep and medicines for blood pressure. Cerepax is a benzodiazepine drug and is a safe drug. After the episode of nose bleed because of severe hypertension she developed symptoms like strange feeling in stomach and she was taken to hospital again and her serum sodium was low which was managed well. But her symptoms like strange feeling in stomach became worse and persisted.
Tests of heart, blood, stomach were done and nothing significant found. Tests were repeated and everything came normal. The cause of her symptoms was provisionally made to be psychological. She is currently taking Venlafaxine and CLonazepam. Clonazepam is causing the relief but for short time only.
A lot of individuals at her age develop anxiety and distress. Changes in hormones and neurotransmitters with advancing age are the probable reasons. Some individuals present with somatic symptoms and the symptoms she is showing like discomfort in stomach are probably due to somatic symptoms. Though the Lozep in doses of 0.25-0.5 mg can help to reduce the symptoms but this is not the definitive treatment. She was taking Cerepax on regular basis for years and now she is on 0.75 mg Clonazepam. Though you haven't mentioned the dose of Cerepax she was taking but reduced equivalent dose could be the reason for her persistent symptoms. Slight increase in dose of Lozep can help but considering her age I'd not advise this.
Other anti anxiety medicines like SSRIs especially Sertraline or Paroxetine can be used for her symptoms. Both these medicines cause sedation and thus will help in sleep also. These are relatively more efficacious for anxiety as compared to Ventab and would control her symptoms effectively. Along with these medicines other medicines like Pregabalin or Gabapentin can also be used. These medicines will reduce her anxiety and she would feel relaxed. These are relatively safer in elderly and will ameliorate the need to increase the doses of Lozep. Please discuss with her doctor and ask for the changes in the therapy I've mentioned and this should help her.
As her all tests came normal so I don't think there is need to fear from some serious medical conditions. So no need to worry.
Thanks, I hope this helps you. Please dont hesitate to ask again for more doubts.
Take care
As her tests came normal so anxiety is most likely cause of her symptoms
Detailed Answer:
Hello thanks for asking from HCM for your health related queries
I can understand your concern. She is 75 years old and was taking Cerepax since years for sleep and medicines for blood pressure. Cerepax is a benzodiazepine drug and is a safe drug. After the episode of nose bleed because of severe hypertension she developed symptoms like strange feeling in stomach and she was taken to hospital again and her serum sodium was low which was managed well. But her symptoms like strange feeling in stomach became worse and persisted.
Tests of heart, blood, stomach were done and nothing significant found. Tests were repeated and everything came normal. The cause of her symptoms was provisionally made to be psychological. She is currently taking Venlafaxine and CLonazepam. Clonazepam is causing the relief but for short time only.
A lot of individuals at her age develop anxiety and distress. Changes in hormones and neurotransmitters with advancing age are the probable reasons. Some individuals present with somatic symptoms and the symptoms she is showing like discomfort in stomach are probably due to somatic symptoms. Though the Lozep in doses of 0.25-0.5 mg can help to reduce the symptoms but this is not the definitive treatment. She was taking Cerepax on regular basis for years and now she is on 0.75 mg Clonazepam. Though you haven't mentioned the dose of Cerepax she was taking but reduced equivalent dose could be the reason for her persistent symptoms. Slight increase in dose of Lozep can help but considering her age I'd not advise this.
Other anti anxiety medicines like SSRIs especially Sertraline or Paroxetine can be used for her symptoms. Both these medicines cause sedation and thus will help in sleep also. These are relatively more efficacious for anxiety as compared to Ventab and would control her symptoms effectively. Along with these medicines other medicines like Pregabalin or Gabapentin can also be used. These medicines will reduce her anxiety and she would feel relaxed. These are relatively safer in elderly and will ameliorate the need to increase the doses of Lozep. Please discuss with her doctor and ask for the changes in the therapy I've mentioned and this should help her.
As her all tests came normal so I don't think there is need to fear from some serious medical conditions. So no need to worry.
Thanks, I hope this helps you. Please dont hesitate to ask again for more doubts.
Take care
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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