Brief Answer:
Continue treatment as I had suggested to your query on 15th May

Detailed Answer:
Dear XXXXXXX

Thank you for trusting me with your health concerns again.

The ECG shows some insignificant changes, if you had got it done on 15the itself and showed me, I would have suggested you to do Troponin-I, Troponin-T and CKMB levels to rule out heart attack.

There is no point of doing any of those tests now as the time of them being elevated and being detectable has already passed.

That said, I would not consider T inversion in just one chest lead to be very significant.

Keep a check on your blood pressure and blood sugar levels every 3 to 6 month once.

As far as the treatment goes, I would request you to please continue the treatment as suggested by my answer to your query posted on 15th May. That is, Capsule. Pan-D, twice a day before food, Syrup. Sucrafil-O 10 ml thrice a day before food, Syrup. Mucaine Gel, 10 ml thrice a day before food. All these to be taken for a duration of at least 15 days.

The current blood sugar level in your report is normal.

I wish you all the best dear XXXXXXX (I think you like XXXXXXX more than XXXXXXX correct me if I am wrong).

Have a nice day ahead.

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Brief Answer:
Continue treatment as I had suggested to your query on 15th May

Detailed Answer:
Dear XXXXXXX

Thank you for trusting me with your health concerns again.

The ECG shows some insignificant changes, if you had got it done on 15the itself and showed me, I would have suggested you to do Troponin-I, Troponin-T and CKMB levels to rule out heart attack.

There is no point of doing any of those tests now as the time of them being elevated and being detectable has already passed.

That said, I would not consider T inversion in just one chest lead to be very significant.

Keep a check on your blood pressure and blood sugar levels every 3 to 6 month once.

As far as the treatment goes, I would request you to please continue the treatment as suggested by my answer to your query posted on 15th May. That is, Capsule. Pan-D, twice a day before food, Syrup. Sucrafil-O 10 ml thrice a day before food, Syrup. Mucaine Gel, 10 ml thrice a day before food. All these to be taken for a duration of at least 15 days.

The current blood sugar level in your report is normal.

I wish you all the best dear XXXXXXX (I think you like XXXXXXX more than XXXXXXX correct me if I am wrong).

Have a nice day ahead.

---

Brief Answer:
Relax dear XXXXXXX you are fine, don't worry about the coronavirus.

Detailed Answer:
Dear XXXXXXX

Thankonce again for trusting me with your health concerns.

As you know by now, I am very straightforward when I discuss health issues of my patients and I do not tell you to relax if I suspect even a minor issue.

Yes, I did see all the attached reports you sent me, the blood report is of blood sugar levels, and it is quite normal.

What I would have liked to see is your blood pressure reading.

Yes, the ECG is slightly abnormal. In one of the chest leads the wave is inverted, which could be due to you being a woman (some times in women, the T wave is inverted normally).

Whenever we have any doubt, we always ask for Troponin I and Troponin T levels if the patient comes to us within hours or one or two days after the onset of chest pain.

If you do not have any chest pain, then it is safe to ignore this T wave inversion in only one chest lead.

Once this coronavirus situation gets better, we can discuss this issue further and decide to get an angiogram done to be absolutely sure that you do not have any block in the coronary arteries (blood vessels supplying the heart).

Apart from that, what I honestly think is, you are very stressed due to the current virus situation and hospitals refusing to see patients. You are probably thinking, what will I do if something happens anyone in the family and the hospitals still refuse.

Let me reassure you, if anything serious happens, the hospitals will definitely admit you and treat you. They legally can not refuse to treat you if you have something serious.

Alprazolam is a good medication for controlling anxiety and if you feel very frieghtened constantly, then taking one tablet at that is advisable.

And please stop worrying, nothing will happen to you. Please take the medicines I advised you.

I will always be available in case you need to discuss anything and will do my best to help you with your health related questions ( At time I may take some time as I usually have too much work, but I will certainly answer as soon as I can)

Take care dear XXXXXXX

Warm regards

---

Brief Answer:
Relax dear XXXXXXX you are fine, don't worry about the coronavirus.

Detailed Answer:
Dear XXXXXXX

Thankonce again for trusting me with your health concerns.

As you know by now, I am very straightforward when I discuss health issues of my patients and I do not tell you to relax if I suspect even a minor issue.

Yes, I did see all the attached reports you sent me, the blood report is of blood sugar levels, and it is quite normal.

What I would have liked to see is your blood pressure reading.

Yes, the ECG is slightly abnormal. In one of the chest leads the wave is inverted, which could be due to you being a woman (some times in women, the T wave is inverted normally).

Whenever we have any doubt, we always ask for Troponin I and Troponin T levels if the patient comes to us within hours or one or two days after the onset of chest pain.

If you do not have any chest pain, then it is safe to ignore this T wave inversion in only one chest lead.

Once this coronavirus situation gets better, we can discuss this issue further and decide to get an angiogram done to be absolutely sure that you do not have any block in the coronary arteries (blood vessels supplying the heart).

Apart from that, what I honestly think is, you are very stressed due to the current virus situation and hospitals refusing to see patients. You are probably thinking, what will I do if something happens anyone in the family and the hospitals still refuse.

Let me reassure you, if anything serious happens, the hospitals will definitely admit you and treat you. They legally can not refuse to treat you if you have something serious.

Alprazolam is a good medication for controlling anxiety and if you feel very frieghtened constantly, then taking one tablet at that is advisable.

And please stop worrying, nothing will happen to you. Please take the medicines I advised you.

I will always be available in case you need to discuss anything and will do my best to help you with your health related questions ( At time I may take some time as I usually have too much work, but I will certainly answer as soon as I can)

Take care dear XXXXXXX

Warm regards

---

Brief Answer:
ESR alone is not very good indicator of illness, could be due to leg pain.

Detailed Answer:
Dear XXXXXXX

Thank you for updating me with the CBC report.

1. I have gone through it carefully and I agree with you that the ESR is elevated, and ESR is not a very good indicator of anything specific, it can be elevated in all conditions that result in some amount of inflammation in the body.

High ESR in your case is likely due to the leg pains you are having from 3 months.

I would like to know more about these leg pains. Where exactly do you get the pain? Is in the knees, or claf, or feet?

And when do you experience the pain? Is it present througout the day or is it present when you wake up.

Does the pain start in the morning and get better as you go through your routine?

Does the pain get worse as the day goes by?

Or does the pain start in the evenings and gets worse?

Do you feel pain if you touch the part that is painful?

Does walking make the pain worse?

When you walk, do you feel pain in the calf or in your knee joints?

Are your knees swollen?

Dear XXXXXXX please forget about oxygen levels, if you do not have breathlessness or wheezing your oxygen levels will be absolutely fine.

Your haemoglobin level is indeed perfectly fine and that is indication that you do not have any major chronic illness. With that good haemoglobin, the body will get enough oxygen without any issue.

And don't be so stressed about this coronavirus issue, it is a self limiting viral illness just like common cold, most of the world will get this illness and it will subside on its own without any treatment in 99% of people.

Stop beleiving everything you hear on news and politicians, they have no idea what they are doing or saying.

Don't check temperature so often, you are just fine, you are very afraid of the coronavirus, honestly this much fear is not good, it will make your life very difficult to live.

Please trust me, you are fine.

Coming back to leg pain, I suggest you apply ice to the part that is painful. (Apply ice every 4 hours for 10 to 15 days) and see if it gets better.

Apart from that I would like to know the ANA, AntiDsDNA, Rh Factor (Rheumatoid factor), ASO titres, HLA B27 Marker and CRP levels to rule out rheumatoid arthritis or osteoarthritis and other common arthritis problems.

Also an X-Ray of both knees will be very useful.

Apply ice and see XXXXXXX let us hope it is nothing significant.

You can also alternate ice applicaion with applying hot water bag to the painful area too. That will also help.

Please do write back to me with further details about your leg pains, I will try my best to guide you further.

Warm regards.

Take care and stop worrying so much.

---

Brief Answer:
ESR alone is not very good indicator of illness, could be due to leg pain.

Detailed Answer:
Dear XXXXXXX

Thank you for updating me with the CBC report.

1. I have gone through it carefully and I agree with you that the ESR is elevated, and ESR is not a very good indicator of anything specific, it can be elevated in all conditions that result in some amount of inflammation in the body.

High ESR in your case is likely due to the leg pains you are having from 3 months.

I would like to know more about these leg pains. Where exactly do you get the pain? Is in the knees, or claf, or feet?

And when do you experience the pain? Is it present througout the day or is it present when you wake up.

Does the pain start in the morning and get better as you go through your routine?

Does the pain get worse as the day goes by?

Or does the pain start in the evenings and gets worse?

Do you feel pain if you touch the part that is painful?

Does walking make the pain worse?

When you walk, do you feel pain in the calf or in your knee joints?

Are your knees swollen?

Dear XXXXXXX please forget about oxygen levels, if you do not have breathlessness or wheezing your oxygen levels will be absolutely fine.

Your haemoglobin level is indeed perfectly fine and that is indication that you do not have any major chronic illness. With that good haemoglobin, the body will get enough oxygen without any issue.

And don't be so stressed about this coronavirus issue, it is a self limiting viral illness just like common cold, most of the world will get this illness and it will subside on its own without any treatment in 99% of people.

Stop beleiving everything you hear on news and politicians, they have no idea what they are doing or saying.

Don't check temperature so often, you are just fine, you are very afraid of the coronavirus, honestly this much fear is not good, it will make your life very difficult to live.

Please trust me, you are fine.

Coming back to leg pain, I suggest you apply ice to the part that is painful. (Apply ice every 4 hours for 10 to 15 days) and see if it gets better.

Apart from that I would like to know the ANA, AntiDsDNA, Rh Factor (Rheumatoid factor), ASO titres, HLA B27 Marker and CRP levels to rule out rheumatoid arthritis or osteoarthritis and other common arthritis problems.

Also an X-Ray of both knees will be very useful.

Apply ice and see XXXXXXX let us hope it is nothing significant.

You can also alternate ice applicaion with applying hot water bag to the painful area too. That will also help.

Please do write back to me with further details about your leg pains, I will try my best to guide you further.

Warm regards.

Take care and stop worrying so much.

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