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Dr. Andrew Rynne

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Suggest treatment for persistent weight gain and tennis elbow

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Dr. Shanti Vennam

OBGYN

Practicing since :1989

Answered : 7350 Questions

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Posted on Fri, 31 Mar 2017 in Women's Health
Question: Female 40 yr old, height 5’3” weight: 78 kg.
Brief History which may be the reason for ill physical and mental health condition:
Married for 16 years experienced a difficult marriage since early days and continued there seeing my 10 yr old son but since last 1 yr separated and staying alone with my son, never been properly assessed for my health; My father died of colon cancer last year and there are several cases of cancer in my parental sides and myself feeling little depressed and feeling of emptiness and at times leaving everything and going somewhere is arising, other way I am very happy person with a good sense of humour, which no one can figure out my exact stress level.
Health issues:
1.     Overweight 78kg Female 40 yr old, height 5’3” Sudden increase in weight from 65 to 78 in last 1 yr (Thyroid normal)
2.     Headache-backache-stress-anxiety condition-Mood disorder
3.     Tennis elbow condition in right hand
4.     Normal Periods: 3 days cramping periods with heavy flow.
5.     Palpitation at times when panic on thinking about something, settles up within 30 mins.
6.     Breathlessness at time s while talking walking or doing household chores.
7.     Vitamin D deficiency
8.     Hair fall, Strict diet plan though eating 5-6 portions includes salads, oat, soup.
9.     Right tennis elbow.
10.     History of miscarriages, after 6 yrs of marriage conceived and blessed with a baby boy.
11.     Sleep deprival.
12.     Dust allergy, nasal congestion
13.     Swelling in legs, hand (observed when I sit down for long or stand for long it happens and swelling goes away of its own on rest for sometime), Pain in toe.
14.     Father died of colon cancer
15.     UTI history is there earlier (5-6 yrs back) where I had good dose of antibiotics that time.
16.     Undergoing marital discord with son now at times feeling of loneliness, irritation and at times felling of going somewhere else leaving behind everyone, though I try to be happy and got a good sense of humour people around cant figure out that there are so much going inside my head.
Note: I am also on verge of remarriage and planning to conceive once again, Pls let me know if I can go ahead with existing health condition if so what precautionary measures/medicines to be taken.
Please let me know if anything can be figure out from above written problems at times I feel I am a bundle of ailments which need to be address, though I have started diet and 1 hrs walk a day 1 hr morning and 1 hr evening, feeling little light and energetic.
Note: Despite all these I can walk for 1 hr easily w/o any complication can independently d all my household chores.
Please advise to undergo required test for diagnosing any ailments I am going through specifically for swelling overweight breathlessnes (Cardiac or Pulmonary) though my diet is very little and restricted, severe headache at times, as there is cancer history in past I am having that concern too.
Appreciate the esteemed doctors to kindly help me out of this situation and health condition and assist me in getting me back to my normal medical condition.
Thanks
doctor
Answered by Dr. Shanti Vennam 59 minutes later
Brief Answer:
Detailed below.

Detailed Answer:
Hello,

Thanks for writing to us.

I have gone through your query and understood the concern. I have noticed a point in your presentation. All your current symptoms are likely to have stemmed from the marital discord and it's subsequent happenings.

As far as your clinical condition seems to be, I do not think you should be having any serious problem. You are overweight and this could be causing some difficulty. Please try to reduce some weight through exercise and this will help you regain confidence.

For a family history of cancer, it should suffice to have regular screening procedures. It is not necessary that everyone in the family is affected.

You can see a physician for a general evaluation and take treatment for any medical condition needed.

I would suggest a counselling session with a good counselor to help you cope up with the separation. Please remember that persistent mental trauma and depression can mimic several disease patterns. You can also try meditation, joining similar groups and pursuing your favourite hobby.

You can think of remarriage once you are able to steady yourself. I do not think you should be unfit physically. Make yourself independent financially and communicate with your family.

Hope I have clarified your query. Please feel free to contact for further information. I will be happy to help.

regards,
Shanti.V.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Shanti Vennam 1 hour later
Appreciate your detail answer.

Like to apprise you with that for weight loss regime I am in touch of a dietician and following her up alongwith daily 2 hr brisk walk morning and evening. Trying to setup my garment designing boutique and try to keep myself engaged.

At times felt breathlessness which was there in family to my father (Asthma), as mentioned he has suffered colon cancer too so a bit conscious on that part, as my divorce things has settled up and planning to marry my childhood friend but worry on my 10 yr old Sons part how it is going affecting him how to communicate and all and these things are really kept my mind chattering all the time.

Till what age one could plan a baby I am 40 yr old and thinking of planning a baby by next 1-2 year span do I need special care or medication before planning conception, About swelling thing please suggest some of your views why this is happening and what could be the reason (Any indication of Kidney problem) earlier I use to have frequent urination and feeling of full bladder and my abdomen use to be tighter but since the day I started walk and drinking water 3-4 litres My urination is controlled and my abdomen too feel little light.

Can you please advise some medication for:
a. Severe headache at times.
b. Severe back ache and elbow joint muscle pain at times.
c. Swelling/water retention
d. At times severe pain in heel (Here One doc has said not to wear shoe, so I usually wear sandle
)

As I have never been exposed to any blood; Several test is been advised by one of family doctor is mentioned underneath, Pls confirm rather these tests are required or any missing tests which can be addedd alongwith it.

1)     CBC with ESR
2)     Blood Grouping
3)     Electrolytes
4)     Routine Urine and microscopy
5)     B12
6)     Uric acid
7)     Iron studies
8)     Fasting sugar
9)     Ferritin
10)     Vitamin B9
11)     Toxic elements
12)     CA-125
13)     BILLIRUBINDHEAS
14)     17-ALPHA HRDROXY PROGESTERONE (17-OHP)
15)     HBA1C
16)     CORTISOL 24 HR URINE
17)     PAULA's Test
18)     IHC-CARCINOEMBRYONIC ANTIGEN (CEA)
19)     Prolactin
20)     Thyroid profile,
21)     Vit D, Vitamin D total
22)     Iron deficiency Profile
23)     Calcium
24)     lipid profile,
25)     LFT
26)     Kidney Function Test
27)     Ultrasonography of whole abdomen.

Kindly see if above test is required or not.

Thanks.



doctor
Answered by Dr. Shanti Vennam 22 minutes later
Brief Answer:
Detailed below.

Detailed Answer:
Hi,

Thanks for writing back.

I have gone through your query and have some suggestions:

1. Please continue with your weight loss regime as it is beneficial in several ways. Also, it is good that you are trying to prove yourself without losing heart.

2. I would ask you to speak to your son and make him understand why you should marry again. If the person you wish to marry is ready to accept the boy, it would be better for both of you. You can take the help of a counselor.

3. Asthma can be a cause of your breathlessness. You can get evaluation and management from a pulmonologist.

4. As far as reproductive function is concerned, chances of natural conception diminish at your age, especially if your partner also is beyond 40 years. You have to opt for assisted reproduction if you fail to conceive within a six month span. Preliminary investigation like AMH titres and antral follicular count help to know the status.

5. Your family doctor has suggested investigations that would encompass all your doubts. I would suggest taking the opinion of a physician for further evaluation. You can get assessment of all profiles like hormone, blood, kidney, heart and liver etc.

6. I would like to know the cause of the swelling and pains before prescribing any medication. Yet, simple analgesics like paracetamol often help.

Hope your query has been answered. Please get back if you need anything else. I will be happy to help.

regards,
Shanti.V.

Above answer was peer-reviewed by : Dr. Nagamani Ng
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