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Suggest treatment for fatigue, diarrhea, black stool, swollen legs and insomnia

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Posted on Wed, 20 May 2015
Question: An elderly relative of mine has had (for about 3-4 days) fatigue, loose...black stool, slightly swollen legs, and insomnia. He is 74 years old and has emphysema, he is not far enough to be on oxygen yet, but he does get winded easily. Please advise.
doctor
Answered by Dr. Kaushal Bhavsar (1 hour later)
Brief Answer:
Stop aspirin immediately.

Detailed Answer:
Thanks for your question on HCM.
Your relative is having black stool.
This can be maleana. It is black coloured stool due to gastrointestinal bleeding.
So possibility of GI bleed is high in his case.
Aspirin is having anticoagulant effect along with painkiller effect. So possibility of aspirin induced GI bleed is high.
So immediately stop aspirin.
And get done stool microscopic examination for red blood cells.
If this is positive then he needs upper GI scopy and lower GI scopy to search for the bleeding site.
Since he is also having emphysema, his edema legs suggest possibility of right sided heart failure.
So please let me know if he had 2d echo or not in the past?
Please reply me answer of above asked question, so that I can guide you better.
I will be happy to help you further.
Wishing good health to your relative.
Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar (6 minutes later)
I don't understand your question. What is "2d echo" ? Would this be an emergency, or can he see someone in the morning?
doctor
Answered by Dr. Kaushal Bhavsar (5 minutes later)
Brief Answer:
2d is done for evaluation of heart function.

Detailed Answer:
Thanks for your follow up question on HCM.
2d echo is for evaluation of heart function.
It will tell you whether heart failure is present or not.
Heart failure is one of the cause for edema feet in emphysema patient.
And it requires diuretic drug for treatment.
So we need to rule out heart failure in his case.
And for this 2d echo is needed.
And if he is severely breathless on rest or with minimal exertion then he needs emergency treatment.
Is he taking any inhaler medicine at home? I will be happy to help you further.
Wishing good health to your relative.
Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar (4 minutes later)
No inhaler. He only has breathing trouble when he walks. When he's seated he feels normal. And he doesn't have any pain, which is why he's reluctant to see doctor.
doctor
Answered by Dr. Kaushal Bhavsar (5 minutes later)
Brief Answer:
He need to consult pulmonologist first.

Detailed Answer:
Thanks for your follow up question on HCM.
Since he is not having breathlessness on rest, no need for urgent treatment.
By your history and description he is having untreated emphysema and it's complications.
And inhaled bronchodilators and inhaled corticosteroid are the main stay of treatment for this.
Had he ever consulted pulmonologist?
Had he ever undergone PFT (Pulmonary Function Test)?
Is he smoker?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wishing good health to your relative.
Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar (4 minutes later)
Yes to all your questions. Including yes to being a smoker.
doctor
Answered by Dr. Kaushal Bhavsar (16 minutes later)
Brief Answer:
Does he look pale?

Detailed Answer:
Thanks for your follow up question on HCM.
Is he still smokes?
Does he look pale?
Does he have burning epigastric pain with nausea and vomiting?
Does he drink alcohol?
Possibility of GI bleeding is more in his case as he is having black stools. And this can cause anemia and anemia can also lead to edema feet and breathlessness on exertion.
So, please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wishing good health to your relative.
Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar (10 minutes later)
Yes he still smokes, he does drink alcohol, but he does not look pale or have nausea/ vomiting. I will let him of your advice. And tell him to see doctor in the morning. Any other advice? If not, thank you so much for your help.
doctor
Answered by Dr. Kaushal Bhavsar (4 minutes later)
Brief Answer:
Ask him to quit smoking and consult pulmonologist.

Detailed Answer:
Thanks for your follow up question on HCM.
Thanks for your kind words.
Ask him to quit smoking as soon as possible and consult pulmonologist and get done
1. Clinical examination of respiratory system
2. Chest x ray
3. PFT (Pulmonary Function Test) for the diagnosis of emphysema.
4. Complete blood count to rule out anemia.
5. 2d echo to rule out heart failure.
He needs inhaled bronchodilators and inhaled corticosteroid treatment.
Hope I have solved your queries.
If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly /askdrkaushalbhavsar.
Wishing good health to your relative.
Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Kaushal Bhavsar

Pulmonologist

Practicing since :2008

Answered : 14643 Questions

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Suggest treatment for fatigue, diarrhea, black stool, swollen legs and insomnia

Brief Answer: Stop aspirin immediately. Detailed Answer: Thanks for your question on HCM. Your relative is having black stool. This can be maleana. It is black coloured stool due to gastrointestinal bleeding. So possibility of GI bleed is high in his case. Aspirin is having anticoagulant effect along with painkiller effect. So possibility of aspirin induced GI bleed is high. So immediately stop aspirin. And get done stool microscopic examination for red blood cells. If this is positive then he needs upper GI scopy and lower GI scopy to search for the bleeding site. Since he is also having emphysema, his edema legs suggest possibility of right sided heart failure. So please let me know if he had 2d echo or not in the past? Please reply me answer of above asked question, so that I can guide you better. I will be happy to help you further. Wishing good health to your relative. Thanks.