Brief Answer: You seem to be undergoing mental stress Detailed Answer: Hello Mr. Chow, Thanks for your query. I wish that you had furnished more details regarding your problem. From the information provided, I feel that you are passing through acute anxiety. If that is so, try to control your emotions, think positive and, if required, a short course of an anti-anxiety drug will give you significant relief. Persistently high BP is just a minor problem. Your doctor will increase the dose of your BP medicines on Monday. BP will come down to normal range. Regarding nutrition, you can easily meet your body's nutritional requirements by taking a nourishing semi-liquid diet, till you have your dental problem sorted out. If required, and your dentist recommends dentures, go ahead with it. To remain physically fit, just adhere to the following advice :- 1. Take a nutritious, well-balanced diet (Low Calories, Low carbohydrate, Low fat and high Protein diet; reduce your salt intake; ensure that your Blood sugar levels remain within the desirable range; stop alcohol and smoking (if applicable); reduce your weight to ideal level of BMI less than 25; do regular exercises (jogging, gym, brisk walks, cycling, swimming etc.). Consult your doctor and apprise him of my opinion. I am certain that he will agree with my opinion; order required tests, and- based on the reports- will arrive at a certain diagnosis and prescribe suitable treatment as advised. Perhaps, you would like to elaborate further on your problems. Hope I have addressed to your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Fond regards and have a nice day, Col (Dr.) Rakesh Karanwal

---

Brief Answer: More information is required Detailed Answer: Hi Mr. Chow, 1. Medicine for BP is started at a lower dose and gradually increased till the BP is controlled. This is because some people are very sensitive to medicines. I presume that your doctor has prescribed a drug, the effect of which lasts for 12 hours. So, you don't need to take it more often. Consult your doctor once a week, who will keep on increasing the dose till BP is controlled. 2. Please do NOT worry at all. I WILL HELP YOU AS MUCH AS POSSIBLE. Describe in more details, the feeling of "head all stuffed up". Do you feel depressed, tired, get headaches, low appetite, feel like crying, confused, do not sleep well at night, cannot concentrate, have blocked nose, etc? 3. Also provide the names and doses of ALL medicines for Blood pressure, blood sugar and cholesterol; your blood sugar readings and all test reports. Rest assured that, on receiving the required information, I will be able to diagnose the cause of all your problems. Waiting for the requested information. Take care, Dr. Rakesh Karanwal

---

Brief Answer: Your symptoms are suggestive of mental depression Detailed Answer: 1. Firstly, you are on correct medicines, though you have not mentioned the doses. 2. In about 90% cases, Blood pressure has no cause and hence, called Idiopathic or Primary Hypertension. It may be familial or due to abnormal lifestyle. Reduce your weight to desirable/ideal level, reduce your fat and salt intake to minimum, do regular exercises and eat a well-balanced diet in order to control blood pressure and diabetes. 3. Form the information provided, you seem to be either under mental depression; have an underlying undiagnosed thyroid problem; or, have a low blood sugar. Repeat your blood sugar to detect low levels and, get Thyroid Function test to detect/rule out thyroid problem. If both are normal, then consult a Psychiatrist who will evaluate you and put you on a regular course of anti-depressants, which will bring your life back to normal. Lastly, everyone passes through a temporary phase of depression at some stage in life. It is just a temporary phase. There is nothing to be worried about: take it at its stride and a course of anti-depressants which will be stopped once you are back to normal. Take care Dr. Rakesh Karanwal

---

Brief Answer: I will be following your case eagerly Detailed Answer: Hi Mr.XXXX I was, after all, on the right tract, regarding thyroid problem. I will be keenly following up your case. Do keep me updated with the outcome of your meeting with the cardiologist. Fond regards and all the best, Dr. Rakesh Karanwal

---

Brief Answer: BP and sugar control should be first priority Detailed Answer: Hello XXXX 1. Your TOP priority should be to control your blood sugar and blood pressure. Clonidine is a good drug. Do not be influenced by the potential side effects mentioned in the brochure. as such, ALL drugs for BP can cause dizziness. 2. Seizure cannot be directly attributable to high Blood Pressure. However, extremely high blood pressure can rupture small vessels in the brain, causing mild hemorrhage. MRI Brain and EEG will detect the exact cause of seizure. 3. Yours symptoms suggest that the dose of Levothyroxine needs to be increased, so as to maintain TSH level to 1.0 or less. Take care, Dr. Rakesh Karanwal

---

Brief Answer: Wait till thyriod report is received. Detailed Answer: Dear XXXX It's good to know that your fasting blood sugar and BP are coming down towards normal. Fasting blood sugar is IDEAL. Do NOT increase the dose of Levothyroxine UNTIL the report comes. Let me know the TSH value. I feel that heaviness in the head is due to anxiety. Take an anti-anxiety drug, such as Alprazolam or Clonazepam, along with an anti-depressant drug, as per your doctor's advice. I am sure your heaviness will go. Take care Dr. Rakesh Karanwal

---

Brief Answer: Take medicines strictly as prescribed Detailed Answer: Dear XXXX I understand your concern regarding fluctuating BP. But you need not worry, as the BP fluctuates every moment : it comes down to minimum at rest, but fluctuates with physical activity. It may even go up to 200 after jogging. Further, every drug has a duration of action. The effect of Losartan lasts for 12 hours, while that of Atenolol lasts for 6-8hours. BP starts rising in the evening as the effect of morning dose wanes off. Therefore, there is no cause of worry. PLEASE TAKE THE DOSE AND FREQUENCY OF THE PRESCRIBED DRUGS, STRICTLY AS PRESCRIBED. Do NOT take more than the prescribed dose; it will be adjusted by your doctor, based on the BP readings. Just relax and have patience. Let your doctor deal with your BP. It takes time to reach to the ideal dose to stabilize the BP. Medical ethics demand that I should not interfere with your doctor's judgment, sitting thousands of miles away from you. Your doctor is the BEST JUDGE. Lastly, you are feeling bad due to mild depression + anxiety. HAVE FAITH IN ME and start treatment for these conditions and you will CERTAINLY start feeling happy/cheerful again. Rest assured that I will always be available to guide and advise you, as and when required. Fond regards, Col (Dr.) Rakesh Karanwal

---

Brief Answer: Intimate dose/frequency of all BP drugs you take Detailed Answer: Dear XXXX its good to know that your BP is finally stabilizing. PLEASE LET ME KNOW THE DOSE OF EACH DRUG AND THE FREQUENCY AT WHICH YOU ARE TAKING. I will adjust the doses, so that ideal BP levels are maintained throughout the day. But I will still insist that you take a 3-6months' course of anti-depressants +anti-anxiety drugs. Wish you a speedy recovery. Fond regards, Col (Dr.) Rakesh Karanwal

---

Brief Answer: Intimate morning + evening doses of drugs Detailed Answer: Dear XXXX 1. As mentioned earlier, the effect of Losartan + Atenolol lasts for 12 hours. But in reality, the effect comes down significantly by 9-10 hours. Hence, drugs should be taken EXACTLY at 12 hours interval. For example, at 7:00 AM and 7:00PM. 2. High blood pressure in morning as well as evening means, that your MORNING and EVENING doses need to be INCREASED. 3. I AM SORRY, I WILL NOT BE ABLE TO HELP YOU FURTHER, IF YOU DO NOT INTIMATE ME THE MORNIGN AND EVENING DOSES OF ATENOLOL AND LOSARTAN as requested by me. 3. You will need prescription for anti-depressant drugs. Take care, Dr. Rakesh Karanwal

---