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Suggest Treatment For Severe Headache While On Obimet And Telma

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Posted on Fri, 17 Feb 2017
Question: After your advise I have started taking Cordarone in consultation with Dr XXXXXXX Manthravadi who is MRCP and Phd in Electrophsiology from UK. I have was given a loading Dose of 200 1-1-1 for 10 days followed 1-0-1 for 15 days and there after 1-0-0 as maintenance dosage.The Palpitations disappeared even after the first two days.After five weeks I took another Holter test and Dr XXXXXXX found that I was fine and asked me to continue Cordarone 100.
At this point of time when I met my Cardiologist for a follow up he told me to stop cardarone as my palpitations were not there and that the other drugs is good to handle the palpitations.I had no problem for 15 days but then I started getting some Palpitations,now and then.
I visited Dr XXXXXXX and reported the matter who asked me to start cardarone 200 1-0-0 for 10 days and 100 1-0-0 there after.In between he has aske d me to get a test done.The test reports are attached for your advise.The palpitations has been controlled well.
My present problem is that My BP is fluctuating 140/80 to 180/75 for the last 20 days and my Physician has been treating me with Concor AM 5 at night in place of Concor 5. I am able to recognise the rise in BP, by my eye burning and head ache and I invariable it is 150-160/70-80 on the digital BP meter.At this time I have visited the Hospital to check the BP when the readings was slightly higer or near about the same.At each of this time an ECG wsa taken and found normal/no change.
My follow up visit to my Physician( MD Internal Medicine) has asked me to take Telma 40 in place of telma 20 in the morning and has replaced Concor AM 5 to Concor 5 in the night. He has also added thyronorm 25 1-0-0 as my T3 and T4 was normal but TSH was high.
I do not get sleep for the last 25 days because of the headache(perhaps due to increase in BP)/or some other reason and I am taking Zolfresh 5mg daily for the last 25 days.
I am going for walks in the morning regularily for abour 3-4 Km.and I go to work as usual and carry other other normal duties.
I want your help and advise for the fluctuating BP,headache with sligh dissiness and sleeping without the aid of Zolfresh.Do you suggest any other test which needs to be done to diagonise my health problem.
The medicines I take now:
1. Brillanta 1-0-1,Telma 40 1-0-0,Ecosprin75 0-1-0,Concor 5 0-0-1,Thyronorm 25 1-0-0
2. Glix 60 MR 1-0-0, Obimet 1Gm SR 1-0-0,Obimet 500 mg 0-0-1
3. Zolfresh 5 0-0-1

Thanks and regards
C XXXXXXX XXXXXXX
doctor
Answered by Dr. Dr Sameer Maheshwari (1 hour later)
Brief Answer:
Please see detailed answer

Detailed Answer:
Hi,
This is Dr Sameer, cardiologist from Fortis Hospital.
I went through all your reports & noticed that you had a angioplasty done in 2013. In the holter report you have a run of Atrial Fibrillation. And you have a labile hypertension.
We generally keep the patient on single antiplatelet drug (ie Ecosprin) after a year & stop the 2nd one (Brillinta) as after a year stent becomes a part of body & continuing 2 antiplatelet drugs increases risk of bleeding.
For AF, we also recommend a blood thinner in other form (mostly Vitamin K antagonist).
For this labile BP, I'll recommend taking Tab Telma 40mg once a day in morning & Tab Concor - AM 5mg once daily at night. This will keep your bp under control. Concor will also help keep your heart rate & palpitations under control. Cordarone can be taken along with it if you still feel palpitations.
Coming to Zolfresh, this is a good medicine. It helps in continuing sleep & do not help in initiation of sleep. So if you have problem initiating sleep, it is not of much use. This medicine can be weaned off easily without any side effect.
You can continue taking rest of the medicines for sugar.
So in next follow up with your doctor do remember to ask him about stopping Brillinta & taking some other blood thinner for AF.
I hope i answered your query. If you have any more question, feel free to ask.
Thanks
Take care

Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Dr Sameer Maheshwari (1 hour later)
I had a second angioplasty in July 2017.After 6 months,the doctor has stopped Brillinta & Ecospirin & started me on clopitab AS 150.

I was taking Telma 40 for a few weeks, however since I had a high systolic pressure on & off for the last 3 weeks, my doctor has changed the pressure medicines.

My current problem is constant headache with my eyes burning all the time. I was told it is because of the high BP, however, the headache is persistant even when my pressure is normal.Can you suggest a solution for this problem. Nobody seems to have an answer.My present Medication is given below

1.Clopitab AS 150 1-0
2.Crestor 20 0-1
3 XXXXXXX 80 0-1
4.ctd 6.25 1-0
5.Concor 5 0-1
6.Benitowa 4 1-0

The reports of the recent blood test is attached.Recently I found that my fasting Sugar is 75- 90 and PP is 140 - 210.The higher value of PP is on those days when I have Rice based Breakfast.My HBA!c has also come down to 7.1 from 7.6.
I have been walking regularily for 3-3.5 Km almost every day for the last six months( after the Recent Angioplasty),except for the last 3 days.

Shall appreciate your reply.

Thanks XXXXXXX XXXXXXX
doctor
Answered by Dr. Dr Sameer Maheshwari (24 minutes later)
Brief Answer:
May be side effect of some medication

Detailed Answer:
Hi Mr XXXXXXX
Welcome back.
Thanks for telling about your recent angioplasty. As it was done recently, it is advisable to Tab Clopitab AS which you are already taking.
I must also say that you have been prescribed the latest Drug, Benitowa.
Persistent headache despite controlled bp can be a side effect of some medications. Benitowa & XXXXXXX are among those. They can cause light headedness. So we tell the patients to take them at night & take adequate water along with the medication & keep yourself properly hydrated. So you can shift tab Benitowa in night.
I will also advice you to a neurologist advice for this headache as it could be something like a cluster or tension headache.
I appreciate that your HbA1c is coming down, but it is still high. Try to bring it till 6.5. Because a very important cause of recurrent Coronary Disease is uncontrolled Diabetes.
Its good that you are exercising regularly. Keep that up.
One more important thing i wanted you to know is Tab CTD causes frequent dyselectrolytemia (loss of sodium or potassium). So remember to check it routinely at least once every 3 month.
Be happy, eat healthy & exercise regularly and you will be fine.
I hope i answered your query.
Wishing you a happy & healthy life.
Thanks
Take care
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Dr Sameer Maheshwari (1 hour later)
Dear Dr XXXXXXX
Thanks for your prompt reply and advise.I wish to inform you that the medicines as below,except concor and Crestor has been started one two days back.
1.Clopitab AS 150 1-0
2.Crestor 20 0-1
3 XXXXXXX 80 0-1
4.ctd 6.25 1-0
5.Concor 5 0-1
6.Benitowa 4 1-0

I have been taking telma 20 1-0-0 ,concor 5 0-0-1,T.G Goal 145 0-0-1 with ecosprin 75 along with other medicines for Diabeties after my first angioplasty in 2013.
Since my preasure was fluctauting in the last 3 weeks I was put on Telma 40 by my Family Physician (MD Internal Medicines) Crestor 20 F was started after my second angioplasty in July 2016.
Since there was no relief from the Headache,burning eyes and increased systolic,I met my Cardiologist, who has done the angioplasty,who has put me on this new drug regimen.I have also started thyronorm 25 a week ago because of my TSH was high though T3 and T4 was normal.Can this also create headache,burning eyes.
My Blood test reports has been attached. More over my Cholesterol is 108 , Triglyceride is 90,Cholestrol/HD ratio 2.51 and LDL/HDL is 1.09.
Is this okay?
I want a solution for my present problem of Headache and burning eyes and hope the new medicines control my BP.
Please advise.
Thanks and regards XXXXXXX XXXXXXX


doctor
Answered by Dr. Dr Sameer Maheshwari (39 minutes later)
Brief Answer:
Please see detailed answer

Detailed Answer:
Hi Mr XXXXXXX
Welcome back.
Telma, concor or crestor generally do not cause any headache nor does hypothyroidism or thyroid medication. I hope these new medicine combination will definitely keep your bp in control. Remember to keep yourself hydrated & check electrolytes regularly as i said earlier. I hope you must also be taking low salt in diet, so keep that up.
I don't think this headache of yours is due to bp. So as i recommended you earlier, please see a neurologist to see for alternative diagnosis like Tension headache. Also meet a Eye specialist because sometimes raised intra occular tension (pressure of fluid in eye) can also cause headache & burning eye or it can be simply because your eye might be getting weak. So please meet them both.
Your lipid profile is absolutely fine & is within ranges.
Actually the real culprit for every heart patient is uncontrolled sugar. So keep that in good range which i believe you must be doing great.
And finally, its been great to see you give such a detailed history & wise attachments. In XXXXXXX patients generally want to know everything without telling anything. So thanks for this help.
I hope i answered your query. If you have any more question, I'll be more than happy to help.
Thanks
Take care
Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
Answered by
Dr.
Dr. Dr Sameer Maheshwari

Cardiologist

Practicing since :2010

Answered : 818 Questions

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Suggest Treatment For Severe Headache While On Obimet And Telma

Brief Answer: Please see detailed answer Detailed Answer: Hi, This is Dr Sameer, cardiologist from Fortis Hospital. I went through all your reports & noticed that you had a angioplasty done in 2013. In the holter report you have a run of Atrial Fibrillation. And you have a labile hypertension. We generally keep the patient on single antiplatelet drug (ie Ecosprin) after a year & stop the 2nd one (Brillinta) as after a year stent becomes a part of body & continuing 2 antiplatelet drugs increases risk of bleeding. For AF, we also recommend a blood thinner in other form (mostly Vitamin K antagonist). For this labile BP, I'll recommend taking Tab Telma 40mg once a day in morning & Tab Concor - AM 5mg once daily at night. This will keep your bp under control. Concor will also help keep your heart rate & palpitations under control. Cordarone can be taken along with it if you still feel palpitations. Coming to Zolfresh, this is a good medicine. It helps in continuing sleep & do not help in initiation of sleep. So if you have problem initiating sleep, it is not of much use. This medicine can be weaned off easily without any side effect. You can continue taking rest of the medicines for sugar. So in next follow up with your doctor do remember to ask him about stopping Brillinta & taking some other blood thinner for AF. I hope i answered your query. If you have any more question, feel free to ask. Thanks Take care