Question to general practitioner Maarten: Would you like to look at my medication use?

Maarten Vasbinder lives in Isaan for 1½ years. His profession is general practitioner, a profession that he mainly practiced in Spain. On Thailandblog he answers questions from readers and writes about medical facts.

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Dear Martin,

Is a flu shot necessary in Thailand? I am 72 years old, had a heart bypass in 2002, treated type 1980 diabetes with metformin since 2 and levemir 2012 EH per day since 70, which has now been reduced by using Minidiab 5 mg per day and insulin now 52 EH per day.

In addition, I suffer from neuropathy in the legs according to my GP last visit in 2007, but walking is no longer possible for a hundred meters and then I have to stop because of the pain.

I regularly have an ECG and a lung X-ray taken every 6 months, also a blood test HBA3c every 1 months, where my sugar is between 6-8, but my kidneys are 28, so they are not good.

I am taking the following medications, Levemir 52 EH, Minidiab 5mg. Imdex 5mg, HCT 25mg half, Bestantin 40mg, Alapine 10mg, Asperin 160mg, madipot 20mg, Utrached.

Can you also look at this drug use please. I am uninsured here in Thailand and have had a regular doctor in a small hospital in Chiang Mai for years which keeps my costs low. Buy the medicines cheaper at Pharmacy Choice.

Thanks in advance.

B.

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Dear B,

The flu shot: in principle, it is now more or less the end of flu season in Thailand. The flu starts here in the rainy season. So you should get vaccinated next year in May/April. In your case I would.

• ECGs as a check say nothing and lung x-rays are not necessary either.
• Try to keep your HBA1c between 6 and 7. As for your kidneys, I assume it's urea. In that case it is a bit high. It is better to request a clearance (GFR = Glomerulus Filtration Rate). Sometimes 24 hours of urine is used for this. It can also come from the blood. This test says something about the speed at which the kidneys work. 60 or larger is good.

Medication

• I would only change the insulin based on the sugar level. You have to regulate that yourself. Maybe add short-acting insulin. That means more injections.
• The Minidiab (Gilipizide) can, I think, be better replaced by metformin. That gives less chance of hypos and has fewer side effects, such as vision problems.
• Imidex (Arimidex) 5mg, if that's what you mean, is actually contraindicated, but well-being is also important.
• HCTZ is a water pill. Maybe necessary for your heart, but watch out for drying out. The kidneys don't like it either.
• Try to drop the Filetin to 20mg. The question is whether it is necessary, given the latest insights.
• Alapine is, I suspect, a vitamin preparation. Don't take too much of it.
• Aspirin can be reduced to half. Take after breakfast. For sale here as Aspent-M. It's about the decoagulation. More is not better in that case. Research shows that 38mg per day is enough.
• The Madiplot (Manidipine) (take in the evening) is a calcium blocker, which lowers blood pressure and dilates the vessels somewhat. However, an ACE inhibitor is better for your kidneys, such as Enalapril or Ramipril. In addition, Madiplot can increase the urea value, which is 28 with you.
• Ultrachet is a painkiller, if I remember correctly, a mixture of Paracetamol and Tramadol (an opiate). If it helps with the pain, just take it, but not too much.

The pain in your legs can also be caused by bad blood vessels. Sometimes something can be done about that. However, that is expensive.

General: Check your feet every day, including between the toes, to immediately detect and disinfect any wounds. This is especially important in neuropathy.

Discuss any changes with your doctor.

If everything is not clear, do not hesitate to contact us again.

Yours faithfully,

Maarten