PW Health Clinic

[s55]

Pain for rheumatoid arthritis(RA) if not controlled by methotrexate then next step in management is to move to anti-TNF inhibitor class of drugs. Either added with methotrexate or alone. But they are quite expensive.

If anti-TNF fails we can move to anti-CD20 mab, which have shown to be effective.

Regarding drug adjustment and changes please discuss what I have told with your physician and best if he is a rheumatologist. If you need a rheumatologist tell I can advise accordingly.

It might work nigella sativa oil as it is on pubmed but problem is finding it in pure form, get it imported from abroad like US, UK, AUS, Canada, Saudia arabia. But what I have experienced with osteoarthritis patients the natural remedy that works brilliantly is consume 1 tablespoon of tugh malanga aka tughm-e-balanga aka chia seeds 2- three times a day. Procedure is to soak 1 tablespoon in water for 20-25min. and then consume it. So far what I have read it should work for RA as well.

Thank you! Will be trying tugh balanga 3 times a day for 2 weeks and then will see a doctor. Is it fine to put tugh balanga in honey mixed in water? also giving kalonji with honey mixed in water.

Also, do you know if Hijama (wet cupping) would be beneficial for RA?

[Glioblastoma]

Doctor, My HBsAg, Uric acid and HCV found to be in normal range, my BMI is 28.4 I smoked regularly back in 2006-2012~
Should I donate blood to control my HB?

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So as I suspected mild obesity. There is nothing that can reverse NAFLD, so best thing is to control it, you have stopped smoking that is positive, more importantly try to bring your BMI in range of 19-25. Ideal would be around 22-23. So start exercising regularly about 1hr daily, then control your diet along with exercise. Also camel's milk might benefit you.

You can donate blood to decrease your HB, it's your choice, but I feel HB is not that high . Make sure you go to a reputed organization.

[Glioblastoma]

Thank you! Will be trying tugh balanga 3 times a day for 2 weeks and then will see a doctor. Is it fine to put tugh balanga in honey mixed in water? also giving kalonji with honey mixed in water.

Also, do you know if Hijama (wet cupping) would be beneficial for RA?

Do not know about chia in honey and water. If you are giving hondy with kalonji then no point mixing it with chia seeds. Give chia seeds with water separate. I prefer this.

Hijama is beneficial have heard a lot of good things about it. Where I used to work a doctor used to do hijama at his private clinic. If you are in karachi I can tell you about him.

Also camel milk has anti-inflammatory properties so that can be tried as well.

[nasirjavaid]

Hi doc, Yesterday went to Clinix for purchasing some medicines. There I saw they were doing free Bone Densitometry test using SONOST3000 as shown below.

So I also gave it a try and the guy doing test was also amazed to see that my reading was in top red part which says "presence of osteoporosis". So he advised one tablet of cac1000 daily and Indrob D. twice a month via oral path.

I also have kidney stones (2mm-6mm) which keep forming and dissolving with time so can I use these medicines without much fear that they will aggravate stones formation?

Don't know the type of stones as never caught any for analysis. Also my uric acid was borderline as per last tests a year ago.

Note: My mother was also diagnosed Rhumatoid Arthritis in her 50s.

Thanks.

[shaikh229]

Assalamoalaikum. Dr my wife has complaint of difficulty in breath and her blood pressure also drops to 90/60 approx. even lower than that at the time when she complains of difficulty in breathing. Her CBC test is normal. Plz suggest any good dr in karachi and also wat u think might be the problem. Also she has bone enlargement at nostril from one side. Is low blood pressure related to it in any way? (Sorry for my gulabi english)

[faheemakbar18]

thank you doc.
my father's reading for blood pressure is finally good 120/80
however blood sugar was slightly lower side 88mg/dl.

ps. which glucose meter should i buy for him. some say codefree, some accuchek

[jawwad.farooq]

Best doctor to treat with the disease of Uric acid?

[Glioblastoma]

Hi doc, Yesterday went to Clinix for purchasing some medicines. There I saw they were doing free Bone Densitometry test using SONOST3000 as shown below.

So I also gave it a try and the guy doing test was also amazed to see that my reading was in top red part which says "presence of osteoporosis". So he advised one tablet of cac1000 daily and Indrob D. twice a month via oral path.

I also have kidney stones (2mm-6mm) which keep forming and dissolving with time so can I use these medicines without much fear that they will aggravate stones formation?

Don't know the type of stones as never caught any for analysis. Also my uric acid was borderline as per last tests a year ago.

Note: My mother was also diagnosed Rhumatoid Arthritis in her 50s.

Thanks.

This test is not that accurate. Hence the results are not reliable. If you want do a DEXA scan from a reputed hospital or lab. DEXA scan is the most accurate test for osteoporosis.

Starting cac1000 and indrob D with history of kidney stone disease can be tricky as it may aggravate the condition.

So best advice get a DEXA scan done, meanwhile consume only milk one glass daily. Do not use these medications until DEXA results are available. If DEXA also shows osteoporosis or osteomalacia, go to a specialist.

[nasirjavaid]

This test is not that accurate. Hence the results are not reliable. If you want do a DEXA scan from a reputed hospital or lab. DEXA scan is the most accurate test for osteoporosis.

Starting cac1000 and indrob D with history of kidney stone disease can be tricky as it may aggravate the condition.

So best advice get a DEXA scan done, meanwhile consume only milk one glass daily. Do not use these medications until DEXA results are available. If DEXA also shows osteoporosis or osteomalacia, go to a specialist.

Thanks sir. I also heard white spots on nails show calcium deficiency. I have on right first finger.
From where I can get this dexa test and any idea how much its charged?

[ehhaq]

Dear Bro.. following are reports of my Mom. She have gall bladder stone (without having any symtom) also HCV. Please see and suggest which one to treat on priorty..

Thanks

[ehhaq]

AT report

[Glioblastoma]

Assalamoalaikum. Dr my wife has complaint of difficulty in breath and her blood pressure also drops to 90/60 approx. even lower than that at the time when she complains of difficulty in breathing. Her CBC test is normal. Plz suggest any good dr in karachi and also wat u think might be the problem. Also she has bone enlargement at nostril from one side. Is low blood pressure related to it in any way? (Sorry for my gulabi english)

Yes lowering of blood pressure can be related to difficulty breathing, but not to bone enlargement of nostril.

So this difficulty breathing can be due to many causes. First give a detailed history:

Patient age?
Is it related to exertion?
Is it continuous or episodic? If episodic how many episodes in a day? How long an episode lasts?
Anything that relieves the condition?
Anything that makes the condition worse?
Is there any swelling of the feet?
Does it occur at any particular time of day like morning, evening, night?
Is there any fever?
Is there any rash?
Is there any cough? If yes is it productive or dry? If productive how many tablespoon of balgham? If balgham present any blood with it?
Is there any weight loss?
Is there any decrease in appetite?
Any history of allergies?
Any history of GERD(please see internet for meaning)?
Any history of blueing or reddening of fingers?

CBC wouldn't tell much. Before going to any doctor at least get a chest x ray done tell lab to do AP and Lateral view(go to a good reputed place with digital x ray machine). Also get an ECG done. Also get a spirometry also called pulmonary function test done. This spirometry is only available in AKU, Liaquat national or south city. Or you can get spirometry done free of cost if you have contacts at civil hospital.

Looking like most probably an allergic condition like asthma as there is history of nasal bone enlargement which mostly is a polyp.

For good doctors go to:

General medicine: Aga khan hospital (Dr. sara sajid, Dr. sobia ghazali), south city hospital (Dr. junaid patel),

Chest specialist: Aga khan hospital (Dr. Ali bin sarwar zuberi, Dr. Murtaza Kazmi), South city hospital (Dr. javed husain), Liaquat National (Dr. Syed Arsalan)

General Medicine and Chest Specialist: National Medical center (Dr. Salahuddin Afsar)

[Glioblastoma]

Thanks sir. I also heard white spots on nails show calcium deficiency. I have on right first finger.
From where I can get this dexa test and any idea how much its charged?

Shaukat khanum will definitely have it also try ittefaq or doctors hospital. It is only available at big tertiary care hospitals. for cost no idea.

To some extent this nail spot thing related to calcium deficiency is correct, try to get the test done that is the most accurate way to tell.

For blood test you can get vitamin d levels and calcium levels checked.

[Glioblastoma]

thank you doc.
my father's reading for blood pressure is finally good 120/80
however blood sugar was slightly lower side 88mg/dl.

ps. which glucose meter should i buy for him. some say codefree, some accuchek

Blood sugar 88mg/dl is not low is okay. If it goes below 60 that is dangerous. Buy anyone accuchek, codefree, abbott(optium xceed) all are good.

[nasirjavaid]

Shaukat khanum will definitely have it also try ittefaq or doctors hospital. It is only available at big tertiary care hospitals. for cost no idea.

To some extent this nail spot thing related to calcium deficiency is correct, try to get the test done that is the most accurate way to tell.

For blood test you can get vitamin d levels and calcium levels checked.

Thanks. I will check these hospitals.

[shaikh229]

Age 20 yrs
Exertion no
Episodic. From last 3 days she is complaining more. Abt 1-2 times a day. B4 it was less. Once in 3-4 days.
Sometimes it relieves with use of Calcee sachet.
Worse no
Swelling of feet no
Not any particular time of occuring
No fever no rash no cough
No weight loss
Yes appetite decreased. She eats very little
No history of gerd but sometimes she has digestive problems like motions etc
No history of blueing/redding of fingers.

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[Glioblastoma]

Best doctor to treat with the disease of Uric acid?

Go to shaukat khanum to Dr. Umme rubab syeda or Dr. syed arsalan khalid.

[Glioblastoma]

Dear Bro.. following are reports of my Mom. She have gall bladder stone (without having any symtom) also HCV. Please see and suggest which one to treat on priorty..

Thanks

Nothing can be said about priority both diseases should be treated simultaneously.

Lets start with HepC. So because it has been confirmed it is HepC treatment usually consists of interferon + ribavirin + telaprevir or boceprevir (both not available in pakistan). So our consultants usually use interferon with ribavirin because these two are only available, obviously a specialist can tell way better than me. So go to a specialist hepatologist or gastroenterologist. They are expert in treating it. So go to shaukat khanum Dr. Qayyum khan or Dr. Aasim Yusuf. They will also give you good advice on gallstones.

Regarding gallstones is after visiting these consultants lets see what they say. But many treatment options are available from using drugs to liquify these gallstones to surgical removal of gall bladder. Drugs work rarely and slowly so my sincere advice would be to visit a general surgeon and think about removal of gallbladder, go to shaukat khanum Dr. Aamir ali syed or Dr. Shahid khattak or Dr. Faisal hanif.

[Glioblastoma]

Age 20 yrs
Exertion no
Episodic. From last 3 days she is complaining more. Abt 1-2 times a day. B4 it was less. Once in 3-4 days.
Sometimes it relieves with use of Calcee sachet.
Worse no
Swelling of feet no
Not any particular time of occuring
No fever no rash no cough
No weight loss
Yes appetite decreased. She eats very little
No history of gerd but sometimes she has digestive problems like motions etc
No history of blueing/redding of fingers.

Sent from my SM-G920F using Tapatalk

What about heart rate does it increase during these episodes. If yes and as you are saying calcee relieves it, most probably looking like a panic attack.

But still get all the tests done I told. I have already mentioned physician names, they are competent enough to take of this case. Better if you go to a general medicine doctor first and not directly to chest specialist. If they say then go to a chest specialist.

As I told I am most likely sure it must be allergic condition like asthma or might be a panic attack. But let the test result come and go to the named physicians and lets see what they say.

Also Dr. Shaheen Bhatti is good at Mamji hospital, but there are long lines so you have to take number early morning.

[adilfarid]

Well i am suffering from a issue since last month. My left shoulder and arm kind of get locked. Cant seem to move my arm at all because of excessive pain in muscle not bone. Right now there is still pain but it has shifted to my arm from the shoulder. I cant lift anything, i cant move it properly, i hav taken a movax tablet and artiffen tablet but no use. I hav even taken a decloron injection yeterday and day before yesterday to get some relieve from the pain as it was too much to control. Can someone help me out plz. Thanx