Symptoms: Seeking Guidance for My Mother's Health Issues

Inquiry

Hello Dr.
Chen,
My name is Ah Xiang, and I would like to inquire about my mother's symptoms.
Currently, her symptoms are described as follows: 1.
She experiences nocturia with elevated blood pressure (155-178 mmHg) and tachycardia (heart rate of 108-118 beats per minute) after urination.
2.
She has difficulty with bowel movements and a tendency towards constipation.
3.
She has experienced weight loss (from 56 kg to 42 kg).

My mother has been diagnosed with the following conditions: 1.
A gastroscopy confirmed the presence of a gastric ulcer, for which she is currently undergoing medication treatment.
2.
Blood tests revealed hypokalemia, and she is being treated with potassium supplements.
3.
Two years ago (in 2014), a blood test showed a thyroid-stimulating hormone (TSH) level of 5.08 (elevated), and no follow-up tests have been conducted since then.

Currently, her gastric ulcer and hypokalemia have improved, but the elevated blood pressure after urination, tachycardia, and constipation symptoms have not alleviated.
Therefore, I would like to ask Dr.
Chen for your opinion on what condition my mother may have and which specialty she should consult for treatment.
Thank you, Dr.
Chen.

Axiang, 30~39 year old female. Ask Date: 2016/02/01

Dr. Chen Zonglin reply Family Medicine

1.
What were your daughter's blood pressure and heart rate before urination? Frequent urination at night can lead to poor sleep quality, which may result in elevated blood pressure.
It is advisable to visit a urology clinic to address the issue of frequent urination.

2.
If there are difficulties with bowel movements and weight loss, it may be necessary to schedule further examinations at an internal medicine or family medicine clinic.

3.
If thyroid-stimulating hormone levels have been abnormal for over a year and have not been monitored, it may be worth returning to the clinic for further evaluation.

Reply Date: 2016/02/01

More Info

Dear Ah Xiang,
Thank you for reaching out with your concerns regarding your mother's health. Based on the symptoms you've described, it appears that your mother is experiencing a complex interplay of medical issues that require careful evaluation and management.

1. Frequent Urination and Blood Pressure Fluctuations: The symptoms of nocturia (frequent urination at night) combined with elevated blood pressure (155-178 mmHg) and tachycardia (heart rate of 108-118 beats per minute) are concerning. These could be indicative of several underlying conditions, including potential cardiovascular issues, renal problems, or even anxiety-related responses. It's important to monitor her blood pressure regularly and consult a healthcare provider to determine if her hypertension is primary (essential) or secondary to another condition.

2. Constipation: The tendency towards constipation can be linked to various factors, including dietary habits, medication side effects, or underlying gastrointestinal issues. Given her history of a gastric ulcer, it is crucial to ensure that her diet is rich in fiber and that she stays well-hydrated. Additionally, certain medications for her ulcer or potassium supplementation could contribute to constipation. A gastroenterologist would be well-suited to evaluate her bowel health and recommend appropriate interventions.

3. Weight Loss: The significant weight loss from 56 kg to 42 kg is alarming and warrants immediate attention. Unintentional weight loss can be a sign of various conditions, including malnutrition, chronic illness, or even malignancy. It is essential to assess her nutritional intake and consider a referral to a dietitian who can help develop a meal plan that meets her needs.

4. Thyroid Function: The elevated TSH level of 5.08 suggests that your mother may have hypothyroidism, which can contribute to fatigue, weight changes, and cardiovascular symptoms. It is advisable to follow up with an endocrinologist for further evaluation of her thyroid function, including free T4 and possibly thyroid antibodies, to determine if she requires treatment.

Given the complexity of her symptoms, I recommend that you consider a multidisciplinary approach to her care. Here are some steps you can take:
- Primary Care Physician: Start with her primary care physician, who can coordinate her care and refer her to specialists as needed. They can also manage her hypertension and monitor her overall health.

- Gastroenterologist: Since she has a history of gastric ulcers and ongoing gastrointestinal symptoms, a gastroenterologist can provide specialized care for her digestive health.

- Cardiologist: Given her elevated blood pressure and heart rate, a cardiologist should evaluate her cardiovascular health to rule out any serious conditions.

- Endocrinologist: For her thyroid function, an endocrinologist can provide insights into her hormonal health and address any thyroid-related issues.

- Dietitian: A registered dietitian can help her with meal planning to ensure she receives adequate nutrition, especially considering her weight loss.

In conclusion, your mother's health issues are multifaceted and require a comprehensive approach. It is crucial to address each symptom systematically while ensuring that her overall health is monitored closely. Encourage her to keep a symptom diary, noting any changes in her condition, which can be helpful for her healthcare providers.
I hope this guidance helps you navigate your mother's health challenges. Please ensure she receives the necessary medical attention promptly.

Best wishes for your mother's health and well-being.

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