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Loss of balance,MRI test analysis,chest pain and high cholesterol level - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: General Health
Answered by

General & Family Physician
Practicing since : 2004
Answered : 40 Questions
Doctor :   hi
Doctor :   how can I help you?
Doctor :   Dr. XXXXXXXX here.
Doctor :   please proceed with your health query
User :   Can you tell me a bit about yourself
Doctor :   I am a qualified and registered general medical practitioner
User :   Ok
User :   Do you have a MD/MS degree
Doctor :   I have a MBBS degree, and I believe I can help you within my expertise and If required I shall recommend a specialist.
Doctor :   please proceed with your symptoms
User :   Makes sense. How long have you been in practice ?
Doctor :   six years
User :   My condition is a bit complex
Doctor :   please describe your symptoms in detail.
User :   Here is the history , 49 year old male , past smoker, 6 ft wt 194 lbs (Gave up smoking in 89)
Doctor :   please provide your age, gender, location, occupation, marital status, height, weight, details of past medical illness if any.
Doctor :   ok
User :   ,,,, Married, Software programmer
User :   Last year I had loss of balance failed rombergs test , went for MRI which showed spots in deep white matter. did spinal tap, MS tests all negative, PCP suspected it to be of vascular in origin
Doctor :   ok
User :   Cholesterol is 200 with ldl around 129 and hdl around 38
Doctor :   do you have the MRI report with you now? if yes could you type the impression here?
Doctor :   ok
User :   Two weeks back , I hired a trainer and he pushed me for a high intensity exercise and when I stopped I felt I was going to faint , I just walked and drank water and it subsided after few minutes. MY heart rate was around 151
Doctor :   ok
User :   I also had a stress with ECHO in November 2009 which came normal with normal EJF
Doctor :   ok
User :   Two days back .. after lunch I had a pressure in my chest which did not go away and in the evening I went to the ED and they put me on oxygen and Nitro since they suspected that I may be having a Heart attack. They put me on observation and discharged me the next day . The pressure in my chest eased as soon as I lay down or had oxygen I do not know which. The cardiac enzymes test after 4 hrs and 8 hrs were normal and so was my ekg
Doctor :   ok
Doctor :   what were the symptoms that you had before the MRI, and then before the ECHO and stress test?
User :   Loss of balance i.e . While walking I get pushed to one side , I sway when I close my eyes
User :   I also believe I has some memory issues
User :   Which is unlike me ?
Doctor :   what symptoms are you having at present ?
User :   I have a mild discomfort in my chest more of fullness
Doctor :   ok, is it present all the time?
User :   Yes seems like it
Doctor :   what are your eating habits? do you have other symptoms like chset discomfort with sour sensation in throat, or mucus in throat, burning sensation in chest, nausea?
User :   I had GERD a mild hiatal hernia at the junction of stomach. Now I do not have sour sensation or burning or nausea
Doctor :   do you have burping, belching, flatulence? especially after a heavy or fatty or spicy meal?
User :   When I had the symptom tow days back I was burping frequently ?
Doctor :   when was the GERD problem diagnosed? is it completely cured?
Doctor :   what medications do yuo take at present?
Doctor :   *you
User :   Tow years back .. Not completely cured . I do not eat full meals andtake care of my dier . Currently I am on baby aspirin
Doctor :   ok. what other symptoms do you have at present?
User :   That's all midl chest discomfort that does not seem to increase due to exertion
Doctor :   are they more pronounced when you have a longer gap between meals? or when you are stressed out?
User :   Difficult to say.. I cannot say I am not stressed out ? I am trying to relax
Doctor :   was endoscopy done for you two years back when GERD was diagnosed?
User :   Yes it was done and they discovered H Pylori for which I took medications
Doctor :   ok, was any esophagitis or reflux detected?
User :   It was reflux with burning and a bloted stomach (key symptoms)
Doctor :   was hiatus hernia detected with the endoscopy?
User :   Yes
Doctor :   ok, what did they do about it? was any surgery done to correct it?
User :   No it was a mild hiatal hernia and they suggested to take small meals etc
Doctor :   sometimes the hiatus hernia can present wil atypical symptoms like in your case with only chest discomfort and mimic a mild heart attack
Doctor :   i would recommend you to go ahead with a repeat endoscopy to see what is the present state of it, and if there is more damage to the esophagus as compared with your previous report
User :   According to doctors here they suspect blockage and would like me to get a diag XXXXXXXX done as soon as possible since I am supposed to have all the risk factors
Doctor :   in the meantime continue to take small meals and other precautionary measures
User :   OK
Doctor :   if the repeat endoscopy comes back negative, then go ahead with a diagnostic angiogram or XXXXXXXX
Doctor :   to see if there is really any block
Doctor :   the MRI brain should also be repeated since 1 year is over, to see what is the present state of the white spots that were seen in earlier MRI
User :   I have had 3 MRI 1 at start and another at 6 months - In Jan 2010
Doctor :   start with home remedies for your cholesterol levels that are on higher side of normal
User :   Ok
Doctor :   this will help you to reduce your cardiac risk
Doctor :   1) take less fatty food, avoid saturated fat altogether
User :   I know the drill
Doctor :   2) take pomegranate juice without sugar on empty stomach atleast 2-3 times a week
User :   ok
Doctor :   3) soak cumin seeds in water overnight and drink that water in morning on empty stomach
Doctor :   4) take 3-4 cloves of raw garlic every morning on empty stomach
User :   OK
Doctor :   these are known to reduce your cholesterol levels to optimal extent
Doctor :   what did the repeat MRI's show?
User :   No changes .. The spots are same
Doctor :   did the white spots progress or did they regresses?
Doctor :   which area of brain were they found to be more concentrated?
Doctor :   could you type the 'impression' given in the MRI reports if you have a copy of them?
User :   The neurologist said that there was no change . he suspected MS but the evoked potential came back normal
Doctor :   if not, please send it across later to YYYY@YYYY for me to have a look at it to understand better
Doctor :   what you rae facing
Doctor :   *are
User :   Let me see if I can type that
Doctor :   ok, that wil be great, if you can type the report
User :   High signal intensities in the deep white matter suggestion of de myelination such as ms , or small vessle ischeamic disease
Doctor :   ok, so after this report, were blood parameters checked for you to see if there was any chance that you could ajve abnormal bleeding?
Doctor :   *have
User :   Yes whole blood work up was done everything came back normal . They suspected Sarcioidosis after spinal tap came nagative . They did a CT scan .. Incidentall the CT scan came negative for sarcoids but the radilogist indicated that mild calcification of coronaries detected
Doctor :   ok
User :   After all this the PCP suspected this could be vascular in origin and suggested that I get onto aspirins and Statins
Doctor :   are you feeling better with the aspirins and statins?
User :   I have not started the statins , have started to take aspirin few days back .. too early to notice any difference
Doctor :   ok.
Doctor :   i would suggest you these steps at this junction
User :   Ok
Doctor :   1) continue to take the medications as prescribed for atleast 2 weeks and see if they make your symptoms better, go for a follow up check,
User :   ok
Doctor :   go early if you feels that symptoms are worsening, do not wait.
User :   ok
Doctor :   2) take a repeat gastro consult and endoscopy to see what is present state of your hiatus hernia and esophagus
User :   ok
Doctor :   3) start with acid suppressors like Prilosec or Omez daily to control the GERD symptoms
User :   ok
Doctor :   4) continue to follow the home remedies as suggested above
User :   ok
Doctor :   5) Take a second opinion on the Ct scan and the MRI scan
User :   ok
Doctor :   in short, you require a combined approach of cardiology, gastroenterology and neurology to solve your problems
Doctor :   6) if the endoscopy comes back negative, then consider a diagnostic XXXXXXXX or angiogram
User :   ok
Doctor :   7) avoid straining exercises and any other activity that worsens your symptoms
User :   Ok
Doctor :   in teh meantime
User :   ok
Doctor :   you can get back to me once you finish doing the tests or take help from our specialist panel to decide on what shold be your next step
User :   Ok
Doctor :   you can see my recommendations on the right hand side of the chat window
User :   Ok I can see that
User :   Probably I will do so some other time thanks
Doctor :   ok
User :   bye for now
Doctor :   have you followed what I have said?
Doctor :   is there anything else I can help you with?
User :   Nope thanks
Doctor :   Thanks for consulting me. Bye for now. Please chat with our doctors 24/7 for medical queries. Please refer your friends to our service.
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