Brief Answer:
Lts discuss it out like we did, regarding heart issues.

Detailed Answer:
Hi,
XXXXXXX hope you are fine and had a great Easter,


Thanks for writing back,



I do remember you, your history and even the meds you take, we recently had a great discussion and I am pleased that spreading lopressor did work for you I would suggest you to make it 7am,11:30am,4pm,7:30pm and see if things stay good, with this timing I believe lopressor level in your body will stay even better,

if after using the med at this timing you feel thay 7,10,4:30,7:30 controlled heart rate better , you can switch back to it, bu for the time being i would suggest to keep the timing i suggested just to cover up the 6.5 hour gap between 10am and 4:30 .

Now we come to your recent problem, here we can make few things clear.

1) You have no acid burn.

2) No pain just compression i throat after spicy meal.

3) Burping off an on specially after meal.

Now tell me ,

1)How often you use fizzy drinks?

2)Do you feel excess acid in stomach ever?

3) Does burping settle down as time passes by after food intake?

4) Was using Nexium a good experience or it worsened you issue? or did it correct some issues and didn't work for some? What is your experience with it?

5) Is your digestion ok? any history of constipation?

6) Do you feel heaviness in stomach often?


Waiting for your response i am gland to hear from you again.

Regards :

Dr.Muhammad Ahmad.

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Brief Answer:
It's a pleasure helping you

Detailed Answer:
Hello XXXXXXX

Thanks for writing back in such detail,

your kind words and appreciation really mean alot, it really pays off the effort i make to help you understand your issues. You could find meds list from internet ,or some book , or someone could tell you meds like your sister did,

But for me it is really important that my patients UNDERSTAND what is happening and why.



It's indeed a wonderful feeling that I can benefit so many people sitting thousand of miles away from them , their smiles and overwhelmingly kind feedback is all what make my efforts worth.

I am so pleased that i could help you manage your heart rate issue just by changing the way you took your med , fun part is that we didn't change the dose and still the results are awesome, all it needs is to know the med and to know your patient's life style.



And if it's a patient like you , who is this much vigilant plus comitted to have a better health, things get much easier.

I told you the timing to 7 and 4 to keep almost equal time turation between doses plus I also considered your every day routine before advising you the timing, as you said, you are fine but you are willing to make it even better, so I thought we should try medically more appropriate dosing time,

if it doesn't work that well, then we always have the option to run back to previous dosing time which have been working great for you lately.

In my opinion Nexium wouldn't have helped with heart rate much but it does save your stomach from acidity after coffee and spicy meals.

You are right in that," I will say I am trying to fix my issue but no gloom and doom. So there may be a touch of anxiety from a fast pace but my focus is on correcting and fixing the issue."

Yes there must be touch of anxiety but I won't say "anxiety is causing this" , infact in my opinion this might be causing a bit of anxiety.

But here I would like to say one thing, when you are much concerned about something, human mind starts focusing on it and amplifying it's effect so a little pain which you won't otherwise feel would get amplified and felt.

It reminds me of a Paulo Coelho's writing in which a man enters a shopping mall, full of noises ,kids laughing women gossiping ,video games ,music and all, from some distant corner his ears catch sound of a violin played, and his ears start amplifying it and after 5 minutes that violine is all he could hear , world around him is nothing but silent.

So don't fall into such thing, keep trying to get better health , but don't make small things, your nightmare.

Now i will start describing your symptoms:

1)Burping:

There are many reasons of it like :

a) Bad digestion.

b) Acidity in stomach , when there is acid in stomach and food with salt and spice(basic) is taken , acid base neutralizes and gas is produced.

c) There is air gathered in stomach, when food enters stomach's mouth opens to take it in and at exactly that time air escapes through the opened sphincter.

d) Food stays in stomach for longer periods of time acid keeps dissolving it and acid base reactions produce gas which result in burping often.

2)Lump in throat:

Acid and spice irritate lower end of esophagus which in turn get spasmed and harden up temporarily , this is felt as lump, it's rather a compression in uper part of chest.

You take an antacid and it eliminates acid >>the lump (spasm of esophagus) is gone.

3) Butterflies :

They can be stomach spasms you don't have to worry about them much but yes making them better is what we are going to try.

4)Last night event:

Well you ate something and it didn't get digested this is the simplest answer to that issue,

You ate it, it irritated your gut, and the gut kept pushing it out as a defence and when it got empty you slept fine and got up havig no issues.

What best you can do about it? Don't worry about it and forget the event for good :)

You asked me if it's ok to take nexium in night and zantac in noon i will suggest you to take nexium in morning half hour before breakfast empty stomach, and take zantac in night ,, this is one method for extended cover , Nexium in morning will cover up for the acid produced by your morning coffee cups.

Or you can take zantac in morning and nexium in night but i would like you to keep it the second option.

I agree with your sister that digestive enzymes sometimes help alot in case of indigestion and heavy stomach with occasional bloating.


Prokinetics like motillium can help too it keeps the gut working so stomach doesn't get really heavy and problems get reduced.

Not having daily walk can also make stomach heavy it's always good to have a 20 minute walk after dinner, this walk shouldn't be effort or brisk walk just normal calm walking for 20-30 mins keeps your gut moving.


Lets try a strategy for this.



1) Increase fibre intake , fibre supplements can be used too . the organic ones they make digestion better.

2) Use nexium in morning half hour before breakfast and zantac after dinner.

3) Walk after dinner .

4) Don't take heavy spicy food in dinner prefer it in lunch but if it must be for dinner, then take your dinner a bit early, like at 7pm so that your stomach gets 3 hours to get emptied.

5) In heavy people when they sleep, abdominal pressure pushed stomach up towards chest so one feels heavy in stomach , if you keep losing weight with time you will feel the difference.

Last but not the least Burping 5-6 times after a meal is normal , if the meal is much spicy and salty this normal limit goes up to 10 times, so when you have to see your progress do consider what are your eating.

I will advise you to take simple meals and have a cheat day after every 3 days when you can have your favourite food, on that day you can take motillium along with other acid reduction meds.


6) Enzymes would be last resort of things don't settle then you can use enzymes, but natural digestion is always advised.

I hope your visit to XXXXXXX Clinic proves to be great, I feel you are doing quite well now on the same med and same doses, but I would like you to take a paper and write down what would you want to ask your doctor. any concerns, future strategy, if any test if required and about your progress, just write down what you would like to ask so that you don't miss anything . I am quite sure your doctor would be pleased to see how you are doing.

I hope i covered up all your concerns in my response if you have more feel free to discuss.

Stay blessed.

Dr.Muhammad Ahmad
Hi, I have provided some attachments. Please review them.
Hello Dr. XXXXXXX

Feeling great these days thanks to you. I still think that the stomach is causing some of the issues. Since taking Nexium and a zantac all my symptoms appeared to correct itself. I am get a little diarrhea that before but it may be the acid reduction not breaking down food enough. Even relations with wife my pulse was at 75-80 after 5-10 min. Do you think I have some acid reflux or irritated vangus nerve? When I take a rolaid drink it really calms things down.

Anything I should ask the specialist about? Any tests to take? I have attached a few charts including blood. It seems my blood looks pretty good. The Tri count needs improved, probably from not doing much exercise.

You have been absolutely a great person to help me. Hopefully this is good. I will pay in a month a special question request just to update you on my progress. I will have my actual stress test paperwork you could review. Again thank you for being there and being so detailed. I truly wish you health and happiness. I also wish you happy holidays for you...

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Brief Answer:
Weight it is..

Detailed Answer:
Hi,

Thanks for writing back and kind words XXXXXXX

Sorry for a delayed response , it happened to be a really busy yet great weekend at my side.

I hope you too had a great weekend.

I just reviewed your reports closely and now I will get to your blood reports first,

Everything from your blood to liver to kidney is perfect.

Yes you are right you need some imporvement in your lipid profile but for me that would needed more in your HDL , then come triglycerides.

If you notice in the report, they have provided you with HDL/Cholesterole ratio,

It might clearly tell you, how important it is to keep your HDL high when your total cholesterole is normal. It reduces risk of heart issues big time.

You were right in saying that you would need some physicial activity, it's interesting to know that the first thing which goes in your benefit when one exercises is HDL increase, then there are foods which are HDL enriched or help in increasing the HDL, for example

1)Cod liver oil is really beneifitial.



2)Lose weight:

Losing even a few pounds can improve your HDL level, . For every 6 pounds (2.7 kg) you lose, your HDL may increase by 1mg/dl (0.03mmol/L).

3)Exercise:

within two months of starting, frequent aerobic exercise can increase HDL cholesterol by about 5% in otherwise healthy sedentary adults. You can break up your daily
activity into three 10 minute segments if you're having difficiulty finding time to exercise.

4) FOODS with good fats:

Monounsaturated and polyunsaturated fats.

Olive,

peanut and canola oils.

Nuts,

fish and

foods with omega-3 fatty acids .

Infact you know what XXXXXXX

Even if it's your heart , lungs or your blood works,

Every thing in the end would need a weight reduction,

So why not take this thing seriously, ? I know you already have done a wonderful job reducing 25 pounds , but lets do it as religiously as you care about your meds and
I know you care about your medication more than most patients, so why not consider weight reduction a medicine and make it your mission :)

Now it's your heart we talk about,

Have you started taking the med on my suggested timings? did it work for you?

I am pleased that you heart rate is in beautiful control, During relation with wife heart rate till 150 is super normal, and it used to me 90-100 5-10 minutes later before we changed your dose strategy, If it has dropped to 70 , it means that everything is doing great.

You asked be about relevant questions with your doctor,

Well XXXXXXX you are doing great on simple meds, Do tell him how you are using them and how they are helping you and see what he has to say about that.

Ask him about the butterflies if he considers them cardiac or die to stomach in your case,

Ask him if you need anything tested regarding stomach issues or just medication is required.

Ask him if he wants to change any stomach meds or anything.

Ask him about exercise how much heart rate you can go to... how much you can push yourself, and how much exercise is safe for you.

Do sit and make a list of questions which you would like to ask, a list always helps.

YOUR CALCIUM SCORE:

Calsium score is done with the help of CT scan it just detects if there is any calsium deposit in any coronary. Why would you detect calcium? because athrosclerotic placs have calcium in them so one just gets a clue how big a clot is.

You calcium score for all coronaries is 0 it means they have no problems but in one artery it is ~24 it means there is mild narrowing in arteries,

Untill you are taking medicines and taking care of life style this won't get worse and untill you aren't running any marathons this narrowing won't affect you, it's no way dangerous but it has to stay there, this will happen by taking care
of you HDL, cholesterole and staying active physically.

Here I want to mention that Cholesterole alone is NOT a derterminant of safety ,,, you have to have a low cholesterol and active life style in combination to stay safe..

END NOTE:

I wont make it long I would just say , start some physcial activity and lose your weight nothing else is needed :) simple enough ?:) well needs hardwork but not a bad deal if it makes you look good and saves your health too .

Stay blessed,

Wish you the best of health.

If you have any further thing to discuss I'm ears, (all eyes rather).

Regards.

Dr.Muhammad Ahmad.

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