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Dr. Andrew Rynne

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Suggest treatment for running nose, congestion and muscle weakness

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Dr. Praveen Tayal

Orthopaedic Surgeon

Practicing since :1994

Answered : 10868 Questions

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Posted on Mon, 25 Aug 2014 in Back Pain
Question: Dear doctor,

My father (77 yrs old) has been vaccinated Pneumovac   & Influvac yesterday. Thanks for your valuable guidance of the doctors in heathcaremagic.com, to each of whom I give my sincere thanks.

There is one small issue (stated under 'E' below & continues thereafter ) for which I seek your kind guidance :

Request you to first go through his history, profile & present medicine regime as stated ( under 'A' to 'D' below ) :

A. PAST HISTORY :
COPD is a history of the past which since last 10 yrs xrays have confirmed that it is not there. A mild borderline case due to weather may not be ruled out.
His Echo cardiogram (heart) & ECG
  shows normal. But ECG shows slight right axis, which though cardiologist negated saying it has been stated by automated machine but graph does not show right axis in the true sense at all. 
He has gallbladder  adenomyastatis which doctors have said seemed harmless / beningn & no operation needed at this stage
He has E.COLI, Puscell (urinary  track infection). Prior to detection, his blood TC was 20k above, CRP 8, High neutrophill, repeated bacterial infection attacks. Since previous 6 months till now, COMPLETELY CONTROLLED.
He has bit of hand trembling since last 25 yrs ( though not parkinson in real sense), very hypertensive, since past 1 year loosing bit of confidence in walking (without a stick).

B. INVESTIGATIONS :

(1)Latest blood tests done four days back. Hb Tc DC ESR CRP Lipid Profile CPK CPKMB LFT Urea Creatine Amylase Lipase Uric Acid Vit D3 D Sugar F HBA1C Electrolytes Calcium Phosphorous T3 T4 TSH.   Except TSH 6.4, slightly Low Calcium, low  borderline D3, all other parameters NORMAL.    (incl. TC 7000, ESR 4 all normal).
(2) Urine : E.Coli count less than 20k. Pus cells 6 hpf
(3) USG abdomen (8 months back) : normal (except gall bladder)
(4) Chest PA (8 months back) : clear
Echo cardiogram heart ( 8 months back) : normal
(5) ECG (4 days back) : Normal limits. But slight right axis (as printed), which though cardiologist negated saying it has been stated by automated machine but graph does not show right axis in the true sense at all. 
(6) Brain CT (8 months back) : no abnormality.

C. PRESENT MEDICINES : Pneumovac & Influvac injections administered yesterday. Present Medicines : Pantodac 20: once daily, Thyronorm 25 once daily, Surbex XT : once daily, Tab CCM once daily, Sorbiline twice daily, Septilin twice daily, Liv 52 twice daily, Carmozyme once daily, Levofloxacin (alevo) 500 : one tab only on Mon & Fri each week, Martifur MR 100 one tab alternate days (maintenance dose)

D. ALLERGY IN : Azithyromycin

E. PRESENT AREA OF CONCERN :

I would like to add further that since the previous 3 to 4 months he has been having "running nose" especially during the time of eating. Since the previous month, the "running nose" is almost for all the time. Also, in general, he feels uncomfortable in cold, cannot tolerate airconditioner, and has low immunity level. Also, at present, when occassionally coughing, I find a watery sound of thick mucus coming from the chest region.

My family doctor, when checked him with stethoscope, could not find anything much in chest except borderline COPD but commented on congestion around throat & vocal chord region. (However, although I hear the sound coming from chest region when he is coughing). He prescribed gargle and solvin expectorant. But this is having not much effect. About running nose he commented on possibility of an allergic outcome.

Sinus Xray taken a few months back showed maxillary sinus.

He also has spondylitis & is bent from dorsal D6 to shoulder, lacks confidence in walking, walks slow with slight sideways gait & bit unsmooth way. Forgetful memory ( though not acute). Feels lethargic & tired soon (may be due to thyroid + lifestyle). MUSCLE WEAKNESS (particularly, waist, full legs from thigh onwards). Sedentary life style pattern.

Reading on the internet shows :
1. The most probable cause of running nose at age above 70 yrs is allergic rhinitis / perennial rhinitis due to thin lining of nose membrane, etc. Suggested treatment is to use nasal spray atropin.
2. Another possibility of running nose is for people using dentures (which he does) which may be pressing a nerve.

My QUESTIONS are :

1. What could be the possible cause of running nose & the treatment ? If you suggest atropin or any other medicine (please suggest name, dosage & duration) and that whether it may be in conflict with any of his present medications as written above.
2. Please suggest effective medicine for maxillary sinus & chest congestion, dosage, duration ?
3. How to boost general body immunity & resistance power in him ?
( he generally has a very balanced diet with cereals, fruits, egg, vegetables, little fish & chicken, drinks tea about 4 to 6 times, 2.5 to 3 litres of water; etc..... in general please also suggest names of particular food / health drinks / immunity medicine/ any other thoughts ).
4. How to strengthen muscle (his bones are very fragile). Also,:any other thoughts, please feel free.

( HE IS ALLERGIC TO AZITHROMYCIN).

Best Regards,
XXXX
doctor
Answered by Dr. Praveen Tayal 4 hours later
Brief Answer:
Details below.

Detailed Answer:
Hello,
Thanks for posting your query.
1. After going through the detailed history I feel the cause of running nose is allergic rhinitis with mild infection in the sinuses like maxillary sinus.
It is commonly associated with rainy season but may be seen all the year round. Symptomatic relief can be found with use of
a) Steam inhalation using warm water and menthol three times a day
b) Topical saline nasal drops - 2 drops instilled into each nostril
c) Antihistamines like cetrizine one tablet daily and Atropin nasal spray..
d) Avoiding dust and allergies
e) Adequate rest; proper nutrition and plenty of fluids.
He can take these with the current medicines and on regular basis as long as the symptoms persist.
2. Steam inhalation will help. Antibiotics can only be given after proper culture from the sinus washings.
3. Poor diet and low iron contents causing anemia may cause lack of essential nutrients which may make the body less fit to fight germs. Eating a healthy, balanced diet and hydrating the body with plenty of water can help his immune system be stronger.

Give him more of vitamin C which is a general anti-allergy supplement. It helps stabilize mast cells so they are less likely to release histamine. You can give him a diet rich in vitamin C like citrus fruits, oranges, papaya, grapefruit, raspberries, blueberries, cranberries, and pineapple.

Let him be involved in more physical activities,outdoor activities than indoor activities.This builds immunity.
4. I suggest you to consult an endocrinologist and get prescribed vitamin D and magnesium supplements. The muscle weakness and other symptoms should improve with that. Also eat magnesium rich foods like bananas, beans, chickpeas, fish, nuts, soybeans, spinach etc which are natural sources of magnesium.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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