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Suggest Treatment For Chronic Epigastric Pain

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Posted on Mon, 27 Apr 2015
Question: I have been experiencing quite a bit of pain in my epigastric region, just about 2-3 inches under my xiphoid process. I take Lebetalol in the morning and do drink some coffee, and have always attributed the symptoms to that. It has seemed to go away after I have a bit to eat, but it has been hurting quite a bit over the past couple of days. I work in a health-related field and have just enough knowledge to overreact and worry over the worst case scenarios. I have taken some antacids and acid blockers, but am still experiencing the gnawing pain. What steps might I take next to treat my symptoms, what symptoms would warrant making an appointment with my physician?
Please cancel. I meant to ask a new question. This one has been answered. Now I have a new concern with severely swollen ankles.
doctor
Answered by Dr. Heera Lal Poonia (5 hours later)
Brief Answer:
visit cardiologist, it looks like related to your heart ailments

Detailed Answer:
Dear XXXX, welcome to HCM and thanks for choosing us.

I have gone through your medical history (and you are also working in the health field), based on that I would like to know some more details about the current problem
1 duration of ankle swelling
2 nature of swelling (pitting or nonpitting)
3 time of the day when swelling is maximum
4 other symptoms like difficult breathing, cough , current state of palpitations and blood pressure, frequency of micturition (passing urine)
5 any injury or exertion

I would be able to help you in better way with these details. However in my opinion your ankle swelling is related to your heart ailments. So its better to visit your doctor for better assessment of your heart condition and treatment.

I hope my reply will help you. Please write to us for follow up queries. I wish you good health. Thanks
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Heera Lal Poonia (27 minutes later)
I have visited a cardiologist. I have had stress tests, holter monitor's and they always say nothing alarming. One of the resting 12-lead ECG's said that it could not rule out an infarction and according to the ECG tech, there was an extended ST segment. However, nothing has been said about that. I have been in Bigeminy and they pretty much said that was fine. I have been struggling with alcohol since my husband and I have gotten together. I have been under quite a bit of stress with my job and have been drinking too much, so I am really concerned about my liver, but nobody asks me about that even when I mention drinking too much. I have some minor swelling here and there, but my feet and ankles just blew up like balloons today. I have been getting up at 3:00 a.m. to work on my job and working until I go to bed, I might have some swelling, but never like this. I don't pass much urine without my diuretic, but apparently all of my blood work is very normal. There have been times that I have felt winded lately -- like the feeling one gets when they are a child and have the breath knocked out of them. I have gone to the doctor over all of these things, but am treated with humor and was told that "I was so healthy that it just wasn't funny." That doesn't make sense to me. Without my medication, but blood pressure has reached over 170/120, I have heart palpitations, I have just gained about 9 pounds in less than a month, I weigh over 200 pounds -- I was always a thin young person. I have a five-year old and want to be around for him, but they just keep telling me that I am fine and sending me home. I guess maybe I am just crazy and should quit trying to get help :) Thank you for taking the time to try to help me.
doctor
Answered by Dr. Heera Lal Poonia (2 hours later)
Brief Answer:
go for ECHOCARDIOGRAM and liver function test

Detailed Answer:
Dear XXXX, welcome again and thanks for the details you have provided.

I share your concerns as you have been suffering from ankle swelling and not able to get doctor's attention and finally relief from it. Your heart ailments have not yet been ruled out for this ankle swelling. Prolonged ST segment requires further investigations like ECHOCARDIOGRAM to know about the damage to heart wall due to your high blood pressure.

If these reports come negative, you need to visit a gastroenterologist because you have been taking alcohol for long. Liver problems disturb the metabolism and can cause swelling in ankles and fluid collection in abdominal cavity. You need to go for a liver function test and ultrasound scan of abdomen to look for all organs in abdomen like liver, spleen, kidneys, blood vessels, pancreas and intestine.

I hope my reply will help you. Please write to us for follow up queries. Kindly provide a feedback on this reply. Thanks
Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
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Follow up: Dr. Heera Lal Poonia (11 hours later)
Hello,

I am guessing that my LFT's were fine. I was told that everything was perfectly normal. When I was in the office with my doctor, he mentioned them and looked at them, but didn't say anything. I quite honestly have not talked to him about the alcohol because I have been too embarrassed about my struggle with it. I had an echocardiogram last April and was told that there "were things, but nothing glaring." He listed the results as normal with my physician.

I contacted my physician this morning and he didn't want to see me, but instead told me to double the Lasix to 40 mg/per day.

I do feel pressure in my back on the right side and wonder if it is due to an enlarged liver. I am a college professor and have been working extremely hard, with very long hours on my computer. I have been just trying to make it through the last few weeks of the semester in order to deal with the problem. I hope that I haven't reached the point of no return with this. I know it sounds crazy that I keep doing what I have been doing.
doctor
Answered by Dr. Heera Lal Poonia (8 hours later)
Brief Answer:
do echo again. ankle swelling can be due to prolonged sitting

Detailed Answer:
Dear XXXX, welcome again and thanks for the feedback and follow up queries.

If your heart and liver are functioning normal or tests have come within normal ranges, then in my opinion your prolonged work is causing this swelling in ankles. But you had your echocardiogram one year back, that can not be considered now, please get it done again. You can also discuss with your doctor about the need of furesemide, it is generally given in heart ailments.

Long time standing or sitting can cause swelling but that swelling disappears in morning or when you get up from sleep. You don't require furesemide for that. You can judge accordingly. Do jogging or running, you will feel relived.

Pain in back on right side is , in my opinion not related to liver. Liver related problems cause pain in front side (anterior). In my opinion it is due to your prolonged work with computer to achieve your targets of your profession.

I hope I have answered your queries. Please feel free to contact for follow up queries. Kindly rate this conversation. I wish you good health. Thanks
Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.

Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
Answered by
Dr.
Dr. Heera Lal Poonia

General & Family Physician

Practicing since :2008

Answered : 506 Questions

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Suggest Treatment For Chronic Epigastric Pain

Brief Answer: visit cardiologist, it looks like related to your heart ailments Detailed Answer: Dear XXXX, welcome to HCM and thanks for choosing us. I have gone through your medical history (and you are also working in the health field), based on that I would like to know some more details about the current problem 1 duration of ankle swelling 2 nature of swelling (pitting or nonpitting) 3 time of the day when swelling is maximum 4 other symptoms like difficult breathing, cough , current state of palpitations and blood pressure, frequency of micturition (passing urine) 5 any injury or exertion I would be able to help you in better way with these details. However in my opinion your ankle swelling is related to your heart ailments. So its better to visit your doctor for better assessment of your heart condition and treatment. I hope my reply will help you. Please write to us for follow up queries. I wish you good health. Thanks