Question to general practitioner Maarten: Stomach problems, diuretics and pulmonary embolism
Maarten Vasbinder lives in Isaan. His profession is general practitioner, a profession that he mainly practiced in Spain. On Thailandblog he answers questions from readers who live in Thailand and writes about medical facts.
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Dear Martin,
I am 65 living in Thailand since 2004. Married, had a stressful period, and a 4 bypass in 2015. Was told that I should take a water pill 3 times a day, in addition to other known substances, for the rest of my life. I have not always lived up to this, and (it is said!) suffered a pulmonary embolism (nam tuam phot) as a result in 2017, I narrowly survived.
Three days ago admitted again via emergency with the same (milder) diagnosis after an x-ray result. Sitting on a bed for two days. no drip, no extra medication, was allowed to go home after a second x-ray, with medication for my stomach problems that I absolutely do NOT have. Surprised pharmacy, surprised fellow doctors, but now (albeit less intense) breathing problems, with the slightest effort.
Age 65, weight 108 kg, 1,82 tall. Medication:
- Lipitor/platogrix
- Vastrel
- alprazolam (o.25) 2
- caretes
- Tramadol (accident related) 50.mg 3 times daily 1
- dominex……domperidone
- simethicone
My question is short, are these stomach related drugs relative? And would you advise me to request a third opinion? I find it very strange that I didn't actually receive any treatment but could just go home, fear prevails at the memory of 2017.
Regards,
H.
Dear Henk,
Slightly unclear story. I doubt the diagnosis of pulmonary embolism and rather think of pulmonary edema (fluid in the lungs). This can occur, among other things, with pulmonary hypertension. (PAH)
A pulmonary embolism is almost impossible to detect on a simple X-ray, and a milder form is certainly not. Moisture, on the other hand, you can see and hear immediately.
Which water tablets did you have to take? What are the doses of the other pills like?
Why you have to take Vastarel (trimetazidine) after 4 bypasses is also not entirely clear to me, unless the operation failed or was not performed.
The means for your stomach are superfluous. Moreover, there are much better means.
Your weight is too high and I wouldn't be surprised if some of that is fluid. Do you ever have swollen feet?
More information would help give better advice. Why the bypasses? Blood pressure. Smoking. Alcohol. etc.
Sincerely,
Dr. Maarten
Dear Dr Maarten
Just for the record I have noticed that the last 6 months I regularly suffer from 'blanks' or undefinable holes in my memory, but that aside. First of all many thanks for your response and obviously this is a pulmonary edema, one that almost killed me 2 years ago, just in time at the state hospital, 9 days ICU a week recuperating. NOW starting form of fluid behind / in the lungs diagnosed last Sunday.
Compulsory admission, but no follow-up, something that is rare here in NongKhai. I generally have good experiences with general hospital nongKhai. After a new x-ray I was able to leave, but have to come back September 16th. Still have breathing problems.
I do not smoke or drink, not a drop of alcohol for 15 years, stopped smoking immediately after bypass. Overweight, yes should normally be around 90.
Cause Bypass: Multicultural Marriage (Laos) Autistic Son (now 15) and Business Decisions That Hardly Affected Me.
Then the follow up in Khon Kaen where the bypass took place. First year no problem, the SR cardiologist was the point of contact, but after a year (2016), he retired and I had to deal with upcoming doctors, usually all with their own ego and poor communication. I speak reasonable Thai, but I am short on medical specialists.
2017: After testing PSA every 5 months for 3 years, a TURP and a number of biopsies, a mild form of prostate cancer was diagnosed. In the meantime also irradiated in KKU (Srinagarind), but erection problems left, very frustrating.
November 28, 2017: pulmonary edema. Just arrived at the trauma ward, absolute nightmare. Went well, but then the evil genius pill for me in this story. Water tablets. I was expected to take 3 pill 1 times a day, became completely dehydrated and could hardly take a step without having to urinate. After consultation in Khon Kaen, brought back to once a day and taking in little fluids. Doesn't seem to work though. Why this drug or not, can not be discussed. Thai doctors not 1 except in MY experience do NOT appreciate asking questions, I do anyway and that also brings tension, or sometimes even conflict.
List of medicines from khon kaen:
- Atorvastatin Sandoz 40 mg 1 tablet s'avons after meals
- Careten 6.25 mg 1/2 tablet morning and evening after meals
- Clopidogrel 75 mg 1 tablet in the morning after a meal
- Vastarel 35 mg 1 tablet in the morning and 1 tablet in the evening after a meal
- Alprazolam 0.5 mg as needed at bedtime (often insomnia) (not during the day)
- Furosemide 40 mg…….3 tablet 1 times a day
Every 3 months blood tests for both prostate and heart issue. Prostate now 1.3 psa. blood values normal.
Regards,
H.
Dear h.
You have experienced some things.
My first advice is indeed, see another doctor.
If necessary, have yourself tested for pulmonary hypertension (PAH). That can cause the fluid in your lungs.
Pulmonary hypertension can develop if the right ventricle of the heart is enlarged.
If there is PAH, the medication must be changed essentially. For example, you could be prescribed Tadalafil (Cialis).
PAH is quite rare so it won't be the first thing they look at.
The left ventricle of the heart can also be enlarged, which can cause shortness of breath. Very common and can have many causes, such as high blood pressure and valve problems.
Valve problems can be diagnosed with an echocardiogram, and a stethoscope virtuoso can often hear them too.
The heart contours can be seen on a simple chest X-ray and with a CT scan one can view the entire heart.
The vessels can be clearly seen with catheterization.
As far as your medication is concerned, you could switch from Caraten (Cardivolol) to Nebilet (Nebivolol). The latter does not dilate the vessels.
The Vastarel (Trimetazidine) also sounds a bit obsolete to me. That is a remedy for Angina Pectoris.
3 × 40 mg Seguril per day seems a bit much and moreover does not appear to work sufficiently. You could possibly combine it with Spironolactone. This is also good for the electrolyte (K and Na) balance.
However, in my opinion, a full cardiac examination, including catheterization, is necessary. Medication changes or other therapy can be implemented based on the results.
It won't be easy. Much depends on the doctor.
Good luck and success,
Sincerely,
Dr. Maarten