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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6545
Experience:  14 years as clinician in the field of Family Practice
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If my pcp wont see me what do i do

Customer Question

If my pcp wont see me what do i do
Submitted: 1 year ago.
Category: Health
Expert:  Anthony Bray, MD replied 1 year ago.

Anthony Bray MD :

Hello again,

Anthony Bray MD :

Well let clear up something >> you had a Dr. A that would not see you or would not prescibe a new antibiotic after the Augmentin allergy declared itself.....

Anthony Bray MD :

Then you had a Dr. B that prescribed you the Cipro... right??

Anthony Bray MD :

Are you unable to get Dr. B to see you??

Anthony Bray MD :

If neither A not B will see you then you may need to opt for another doctor OR urgent care OR ER as your options. I would advise you to get follow up on this Monday or tuesday at least unless you show remarkable improvement what you have described today....

Anthony Bray MD :

I hope this helps. Let me know if you have further concerns or questions! Take Care!

Anthony Bray MD :

Anthony Bray MD

Customer: replied 1 year ago.
Dr a is my pcp who took me off the augmentin and wouldnt rx me something else. Hes also the one who told me i had to wait 2 weeks before hed see me for this since he feels its viral. Dr b rxd me the cipro
Expert:  Anthony Bray, MD replied 1 year ago.

Hi again,

 

I see... Well, I would recommend that you follow up with Dr. B whom prescribed the Cipro if I were in your shoes..

 

It sounds that Dr. A may be too dismissive of you....

 

I hope this helps. Let me know if I may be of further help to you!

 

Take Care,

 

Anthony Bray MD

Customer: replied 1 year ago.
Are you certain that its not viral
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Yes I am pretty certain that it is not viral. Viral respiratory infections do not usually cause fever in adults (with the main exception being the influenza virus and certain others...)

 

Most respiratory viral infections tend to be relatively short lived and would be expected to improving inside a week. Antibiotics do not impact the course of a viral infection... (OK with the notable exception of EARLY anti-viral treatments for influenza...)

 

When a viral infection causes a fever it will generally be at the front end of the illness and not a later development of yours...

 

Your course of illness has all the trademarks of a bacterial illness >> most definitely in my opinion!

 

I hope this helps. Let me know if you have further... Take care!

 

Anthony Bray MD

 

Customer: replied 1 year ago.
I dont want to go the dr
If theres no reason
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,I realize that you must be sick of seeing doctors !! I really understand where you are coming from on this. You could wait a but I think and see how things are tomorrow but if not better by Tuesday then I would strongly advise follow up. I feel that follow up tomorrow would be a good idea and the careful and cautious thing to do but not an absolute necessity>> so I think that tomorrow or Tuesday would be reasonable for you to follow up with this infection presuming that you did not feel improved. If you feel improved then I think this would alleviate the need for you to follow up. Your symptoms today and recurring fever I take as concerning signs at this point though.I hope this helps. Let me know if you have further questions or concerns. Best regards XXXXX XXXXX!Anthony Bray MD
Customer: replied 1 year ago.
Have you heard of the cinnamon challenge? One of my teens tried it and she said her throat feels scratchy
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Cinnamon challenge ?? No I am afraid I am not familiar with that >> fill me in>> I am lifelong student!! Always learning new things... So if you want let me know more about this Cinnamon challenge then fill
me in or send me a link and I'll be happy to read up on this. At this point however I can't really comment on it....is this intended for weight loss ???

Let me know and I'll get back with you!! Take care!

Anthony Bray MD
Customer: replied 1 year ago.
https://www.google.com/search?q=cinnamon+challenge&ie=UTF-8&oe=UTF-8&hl=en&client=safari#itp=open1
Expert:  Anthony Bray, MD replied 1 year ago.
Hello,

I'm trying to look up your link now >> hold on >> I'll be back in a few minutes...
Customer: replied 1 year ago.
Ok
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!!

Ok I am a bit more up to speed now... It appears to be a stupid stunt type thing! AHHHHH !! Why teens are so reckless ????!!!! ( I have two now teens and one older...)

It looks like this is just a stunt or gag. If your patient had a scratchy throat and nothing worse then this is probably a good thing. It is reported to cause a variety of potential health problems up to pneumonia. A scratchy throat would be expected with this stunt and she is fortunate not to have worse.

I hope this is helpful for you. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
I have 3 teenangers and they are all for trying stupid stuff
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!!

I'm sorry ---they must worry you to death then!! Sorry to hear that they are worrying you so much! That age group with their sense of immortality can really be stupid unfortunately!!

Let me know further details if you need more specific help with any if them....

Take care,

Anthony Bray MD
Customer: replied 1 year ago.
Im still having pretty significant epigastric pain
Expert:  Anthony Bray, MD replied 1 year ago.
Hello,

I sorry to hear that ... I wish that you felt better.... I think your stomach will be better able to heal after you clear the respiratory infection. The respiratory infection is a stress factor for you that would tend to nastily rally worsen the stomach issues...

Hang in there,

Anthony Bray MD
Customer: replied 1 year ago.
No more fever
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

Well that is encouraging!!

How do you feel otherwise ??

Hope you recover soon!!

Anthony Bray MD
Customer: replied 1 year ago.
Still hAve cough and chest discomfort
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

I would expect that your resolving of the cough to be gradual over the next 2-3 weeks steady improvement typical but a severe bronchitis ( possible pneumonia??) may take weeks as the cough eventually taper down to zero... It would be likely to be less productive and less intense ( less likely to wake you up at night) . I hope this helps. Let me know if you have further questions.

Take care,

Anthony Bray MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6545
Experience: 14 years as clinician in the field of Family Practice
Anthony Bray, MD and 2 other Health Specialists are ready to help you
Customer: replied 1 year ago.
My pulse is fastagain though. Its 132
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!!

Well that is concerning... Keep at watch on this as well!! Have you taken your beta blocker today?? How long has your pulse rate been elevated like this? Do you think that you might be dehydrated? You had the nausea and vomiting ... I suppose this has been better today?? You haven't mentioned that symptom today...

Are you dizzy or short of breath? These symptoms plus rapid heart rate would be alarming!!

Let me know if you have further details >> take care!!

Anthony Bray MD
Customer: replied 1 year ago.
I have a question. We have an 8 day old downs baby. His cbc is crazy. His WBC today was 16 yesterday wa 14 (normal 12). His platelets today were 75 yesterday it was 100 (normal 130). His cbc had
Other abnormalities. I asked the dr why and he said downs babies can be born with leukemia. Is this true why is that
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

I would NOT leap to any conclusion of leukemia based on the high white count and low platelets !! I suspect a combination of infection and ITP would be more likely. Down's children do have a set of potential health concerns but I am not familiar with leukemia being one of these. If leukemia were suspected then the child should be referred to a hematologist for further evaluation. I would advise that she be checked for anti-platelet antibodies, ultrasound for evaluation of her spleen ( often enlarged spleen may be related to low platelets) , blood smear for pathologist to review ... Evaluation should include checking for possible sources of infection such as a urinalysis for UTI... Checking her respiratory tract clinically...

I hope this helps! Let me know of you have further questions!

Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
I know you cant juml to conclusion. I just never hear of a link between downs and leukemia. This kid was born with a high wbc, he had blood cultures drawn that showed nothing
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

I agree with you! I do not know everything of course and I constantly strive to learn. I am not aware of an association between Downs and leukemia either. The child in question may have a chronic condition leading to the high white count ... How old is he??

Best for now>>

Anthony Bray MD
Customer: replied 1 year ago.
Hes 8 days old
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Oh Ok -- the child being a neonate makes a difference . He would have had a sepsis work up from the sounds of this situation. Is he full term?? It sounds that the next step would be to follow his counts over a period of time....

Best regards XXXXX XXXXX>>>

Anthony Bray MD
Customer: replied 1 year ago.
He was born at 36w5d. We are following his counts.
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well that sounds reasonable to me at this point. I would agree that this first priority would be the sepsis work up and then to follow the cell counts over the first weeks of life. It may normalize within a short time ( ESP the white cell count I would suspect) I think that the low platelets might end up being an ongoing issue ... The baby is just short of the 37 weeks gestation so this is not that bad at all...generally babies of this gestation do fine ....

Certainly if I followed an infant with persisting low platelets and/or unexplained elevated white cell count then I would have a low threshold to consult a hematologist ( they would usually be consulted for cases if ITP as well)

I hope this helps ! Let me know if you have further questions!
Take care,

Anthony Bray MD
Customer: replied 1 year ago.
Work has just sucked lately. We have a little 2.5 year old with stage four neuroblastoma. A 6 year old with alveolar rhabdomyosarcoma, who has relapsed for 3rd time. Im sick of these really sick kids. It hard to see them struggle
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

I know what you mean... There is NOTHING more tragic than a child with a life threatening illness such as these. Usually kids when sick bounce back quickly but the really sick children as you describe are heartbreaking. This aspect of working in the health field is quite difficult...

How are you feeling physically?? I guess that your respiratory symptoms have settled down? I presume this is probably the case since you have returned to work....

Take care,

Anthony Bray MD
Customer: replied 1 year ago.
My respiratory symptoms have settle down slightly
Expert:  Anthony Bray, MD replied 1 year ago.
Hi again,

I see, well hopefully you will stay on the path of recovery then. I think that is most likely the case that you have turned the corner on your respiratory infection and will continue to improve.

Let me know if you should have further questions,

Anthony Bray MD
Customer: replied 1 year ago.
Is there a better medication than atenolol for tachycardia. I tried 50 mg metoporol but it didnt help my pulse at all. The atenolol for the most part keeps my pukse down but it also lowers my bo a lot. And the atenolol makes me so tired
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

Well with the beta blockers we do have to individualize these some. An individual can seem to have nuances if effect/ side effect profile with a particular drug so that no one choice fits all. Certainly there are several options that may be tried. The baseline of your heart rate should be established by a good average of at least 10 15 numbers ( I strongly prefer and recommend this approach rather than simply looking at a few numbers on in office MD visits that may be skewed)

The addition of a beta blocker for treatment should then be monitored for effect by again checking an average of 10 - 15 or so readings of pulse rate and BP. ( these should be after resting for ten minutes and checked in sitting position )

Bisoprolol is a usually mild medication in terms of blood pressure reduction. This may be a good option for you.

All beta blockers could have lower BP and fatigue as potential side effects though. The fatigue is usually mild in nature and may be something that you would adjust to. Low dose here would be key for you it sounds to me.

Of interest if your heart rate gets too fast then this can itself cause a drop in BP. The cardiac output would in general rise as the heart rate goes up by everyone has a max rate of efficiency and above this rate may decrease filling time of the ventricles enough to drop cardiac output back down... The point is that the physiology of your BP is complicated and the use of the beta blocker does have effects to reduce heart rate and USUALLY BP but if rate is very high ( say 150 for example ) then such a high heart rate being controlled may actually cause support if blood pressure. ( beta blockers alleviate diastolic dysfunction of the heart)

As I recall , you have mentioned the tachycardia but no specific diagnosis has been given as far as I remember.... This may be sinus tachycardia?? Sick sinus syndrome?? Let me know if you have further details...

I hope that this is helpful. Let me know if you have further questions! I will be happy to get back with you! Take care!

Anthony Bray MD
Customer: replied 1 year ago.
I dont have a real diagnosis. They say its tachycardia of unknown origin. On the medication by average pulse is 54. Average bp is 92/60. Without meds average pulse is 130's, Average bp is 104/60s
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

I see-- it sounds to me from your response vs baseline it may do fine for you to have about 50% of current dose ( I am not telling you to change your dose on your own but discuss it with your doctor...)

Was the beta blocker prescribed by your cardiologist?? Do you take this very regular without missed doses??

Let me know and I' ll get back with you! Take care !!

Anthony Bray MD
Customer: replied 1 year ago.
The atenolol was rxd by my pcp. The cardiologist didnt say anything about it. I take it everyday
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well as I said -- based on your heart rate and BP that you report it would seem to me reasonable to consider a drop in dose of the Atenolol as one option. Trying a switch to bisoprolol at 5 mg / day (= mid - range for this one) I think would be a reasonable option that may be tried for you.

I hope this is helpful for you! Take care!

Anthony Bray MD
Customer: replied 1 year ago.
My symptoms were better. Now they are worse again. Right now my bp is 89/60
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again ,

You are on the edge of low end of BP that is tolerated (90 to 100 low end if systolic that would be tolerated by most adults....younger, female and lower in weight individuals may tolerate such lows better....)

If you feel light headed, heart racing, then these plus low BP would increase concern. Increased salt intake along with fluids may help to support your BP.

How are you feeling otherwise?? Respiratory symptoms or fever or other symptoms of concern??

The diastolic if 60 is at low end of that tolerated as well ( 55 -60...)

Let me know if you have further questions or concerns! Take care!!

Anthony Bray MD
Customer: replied 1 year ago.
My respiratory symptoms came back. Confested, produtive cough, hurts to breathe
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

I'm sorry to hear that you are feeling worse again. Hopefully this will be only a minor setback. If your symptoms are serious and of concern to you then you will likely need further follow up -- further clinical evaluation -- chest x ray --- CBC with differential-- sputum collection may be needed.

This will be a judgment call on your part. I know that you are worn out with this illness and tired of doctor visits...if your symptoms are again escalating then further follow up may be needed..

I hope this helps! Let me know if you have further questions. Thank you and best regards,

Anthony Bray MD
Customer: replied 1 year ago.
My pcp is making me feel like a drug seeker. My gi dr told me to schedule an appt with my pcp to discuss a non nsaid for the costchondritis. When i called the schedule my pcp told me "you already have vicodin what more do you want. Im not giving you any more narcotics". I dont want a narcotic
Expert:  Anthony Bray, MD replied 1 year ago.

Hello!

 

I'm sorry that you have had so much trouble! Is this the same doctor that you had so much trouble with before with the antibiotic issue?? It sounds that you may need to find a doctor more responsive to your needs...

 

How are you feeling?? How are you doing with regard to the respiratory infection today?

 

With regard to the costochondritis vs the GI issues I think that Celebrex or Arthrotec may be your better options if you find someone whom is reasonably cooperative for you!!

 

I wish you the best and hope that you feel better soon.

 

Take care,

 

Anthony Bray MD

Customer: replied 1 year ago.
I think it make be a mix of sinus infection and cough(maybe related to allergies)
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Well it would be difficult to distinguish if you may have some component of allergies in the mix>> I think definitely you are in recovery from fairly severe respiratory infection... I suspect you would let me know if you were seriously backsliding with increased cough and shortness of breath and fever which might indicate worsening again of the lower respiratory infection...

 

I hope that you do get good care from your physicians...Let me know if I may be of further assist. Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
I broke out in hives
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Oh no! Not again!! You need to take Benedryl 50 mg and call your doctor in the AM. Stop the Cipro if you have this remaining...

Any other NEW meds??

Let me know!! Yikes!

Anthony Bray MD
Customer: replied 1 year ago.
http://m.flickr.com/#/photos/94762849@N06/8702729823/


Look like hives? Last dose of cipro is tomorrow am, no other new meds
Expert:  Anthony Bray, MD replied 1 year ago.
again,

I tried the link but I can't seem to get thorough >> it said no photos matched address.. I believe that I typed it was as above.. you can double check ...

I suspect that you as a nurse in Peds would probably KNOW hives when you see them though....

So I would hold OFF on last dose of Cipro ( I would hesitate to generalize this as an allergy to the whole class but I would be careful to watch for any similar reactions if you should need to take a quinolone class med in the future... Avelox as an example...) ( I would avoid using this class unless there was an over-riding need to try this. )

The REASON that allergies to antibiotics are so common is that you are adding a strange compound at a time when you immune system is very active. If you notice allergies to antibiotics are the most common type of medication allergies...

I hope that this helps. Good luck >>

Anthony Bray MD
Customer: replied 1 year ago.
http://m.flickr.com/photos/94762849@N06/8702729823/lightbox/




Heres a different link
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

I tried but the whole address just leads me to m.flicker page>> options then to go "shutterstock" or "dreamstime" >> it may be that I do not have subscription>>???

I seem to get to a point that it asks me for a password and then stops ... I don't belong and don't have a password.. that might be problem??

I tried to type in the address as above but it did not lead me to any specific pic page... I have been so directed by other customers on the site... I have had it work and other times not work as so far tonight... not sure why....

Let me know what you wish me to try next...

Anthony Bray MD
Customer: replied 1 year ago.
Have you heard of using prednisone for costchondritis
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again!

 

Yes >> prednisone would be stronger in anti-inflammatory effect>> this may be good choice in light of your hives as well !!

 

I would worry a bit I suppose of it weakening your immune response but your bacterial infection is probably essentially beaten down after 9 days of the Cipro....

 

Let me know if you have further questions. Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
Ill be on it for 4 weeks
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

I see. I hope that helps. It should help to settle the inflammation of the costochondritis. Let me know if I may be of further assistance.

Take Care,

Anthony Bray MD
Customer: replied 1 year ago.
Last time i took prednisone my fasting blood sugar was 136
Expert:  Anthony Bray, MD replied 1 year ago.
Hello !!

It is often an issue with prednisone that this will cause problems with close glucose intolerance. If it pushed fasting blood sugar to 130 range then this is still not that bad ( diabetics goal is to keep fasting blood sugars controlled to less than 150..)

It is short term but still it would be best to keep the dosing of the prednisone down low and the duration short ....

I hope this helps. Let me know if you have further questions! Take Care,

Anthony Bray MD
Customer: replied 1 year ago.
Its not as high of a dose as last time. Its 20 mg for 14 days then 10mg for 7 days and then 10 mg every otger day
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

That is not that bad of dose then. I think that you will do OK with that>> you could opt to drop the dose >> and opt to take only 10mg /day if you wish.. not critical either way I would say.. short time only if you do take the 20 mg for 14 days...

I hope this helps! Let me know if you have further questions! Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
Can being sick make me miss a period
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

Yes it can >> the stress of an acute illness can very well have enough impact on your hormones to cause you to skip a menstrual cycle.. yes this is indeed very possible...

I hope this is helpful>> Take care,

Anthony Bray MD
Customer: replied 1 year ago.
Is it typucal to rx prednisone for costchondritis without actually touching the pt?
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

No that would not be typical. I would want to confirm the diagnosis by demonstrating tenderness of the cartilage segment(s) involved adjacent to the sternum.

Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
He didnt even touch me. When i saw the 2nd gi dr he said i had it but that was a while
Ago. And despite what the 2nd gi dr thought, my symptomd are from reflux not costchondritis
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Well you may certainly have both conditions as being possible... Your history with regard to the GI issues I agree that these are not solely due to costochondritis though...

 

Let me know if you have further >>

 

Anthony Bray MD

Customer: replied 1 year ago.
When i see the gi dr on the 15th um going to tell them to go ahead and make the referral to the mayo clinic. But idk what tests theyd do since ive had a lot of tests done. Ive been scoped, swallowed the mini camera, done tge 24 hour ph/motility, upper gi series, hida scans, and gastric empting studies
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Right > well the first thing for them to do of course would be to review your prior test results. For the most part these studies would not need to be repeated. I think that the endoscopy may need repeating >> depending on how you are doing by that time... the mucosa of the esophagus and stomach may change with time is the reason that I think that this test may need to be repeated. You may be clear of any erosions or ulcers and a year later this could be different for example...

 

I hope this helps. let me know if you have further questions! Take Care >>

 

Anthony Bray MD

Customer: replied 1 year ago.
What ither tests could be done?
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

I did not perceive that you lacked any necessary tests in what you have had done to date! I think that you stand well in this regard. I do think that you need to maintain good nutrition to heal and maintain healthy mucosa tissue of your stomach and esophagus. I think that you probably need healthy diet and continued Protonix as the main aspects of your treatment...

 

I hope that this is helpful. Let me know if you have further questions! Take Care,

 

Anthony Bray MD

Customer: replied 1 year ago.
Can i take advil with prednisone
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

No I would not do that >> I think that you raise your side effect profile too much relative to benefit... Prednisone's mechanism of action reduces inflammation but chemically at a higher point in the chain of events>> Prednisone inhibits both production of inflammatory prostaglandins and leukotrienes>> Advil inhibits prostaglandins... So then both are not really necessary .. both together would increase your tendency to have GI problems such as ulcer...


I hope this helps. let me know if you have further questions. Take care,

Anthony Bray MD
Customer: replied 1 year ago.
Stabby firey pain in epigastric region
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

With pain in the epigastric region the stomach would be most likely culprit. So this sounds like you may have some worsening of your problems with GI (gastritis or ulcer >> continue Protonix , if you still have some Carafate may add this for several days at least and see if this helps, be more careful with diet...)

I hope this helps. Let me know if you have further questions. Take Care,

Anthony Bray MD
Customer: replied 1 year ago.
Im already watching my diet
Expert:  Anthony Bray, MD replied 1 year ago.

Hi again,

 

Well that's good. I hope that you feel better soon...

 

Let me know if I may be of further help. Best regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
Can anemia cause fatigue
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Yes of course it can. Fatigue is classic symptom of anemia ....

Let me know if you have further questions .... Best regards!

Anthony Bray MD
Customer: replied 1 year ago.
What can i do about the fatigue if it is from anemia. My last hgb was 10.7
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well the most common cause if anemia in young females may relate to heavy periods as a common reason. This causes iron deficiency as well. So supplemental iron usually helps this type . Your iron level , folate and B12 may be checked in connection with your anemia. Periodically the blood counts should be checked to make sure that has corrected to normal and not become worse. Your GI history of problems could be a factor with anemia too --- this could cause internal bleeding if you had ulcers...so this may need further attention as well..

I hope that this helps. Let me know if you have further questions.

OTC option to treat iron deficiency would be ferrous sulfate 325 mg/ day and it helps absorption to take with vitamin C 500 mg...

Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
I did a FOB at work today and it was positive
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

I see. ... You need follow up on the occult blood ... It sounds likely that you may have ulcers again. They will probably repeat the upper endoscopy when you visit the Mayo clinic. In the meantime do what you can to protect your stomach ---Protonix , Carafate, diet....I would advise taking the iron with vitamin C ( but note that some timing here may be needed as the iron and vitamin C may be irritating to the stomach ---

Let me know if you have further questions. Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
I think im just going to live on a clear liquid diet
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

You need good nutrition for ulcers to heal and or to maintain good health of the stomach and GI tract mucosa. You could need a clear liquid diet if you have nausea / vomiting and for this I would advise clear liquids for 12 hour period BUT in the long run you need NUTRITION to promote good health of your GI health!!

I hope this helps! Let me know if you have further questions! Take care ,

Anthony Bray MD
Customer: replied 1 year ago.
Everything hurts my stomach!
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

I'm sorry that you have this pain and discomfort--- I think that you have problems with recurrent ulcers or gastritis. I think that you need to continue the Protonix, Carafate if you still have it, and diet to avoid further stomach issues.

Best regards ,

Anthony Bray MD
Customer: replied 1 year ago.
My heart is beating extremely hard. I can feel it by putting my hand on my chest. Is this normal
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

No I would not say that that sensation is normal. The sense if pounding of the heart is probably a sign if stress... The anemia can be a factor in this or acute illness...

Hopefully this will settle down by AM. Let me know if you have further questions. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
I am ill. Temp if 101.2, a lot of pain in the epigastric region and extremely nausious
Expert:  Anthony Bray, MD replied 1 year ago.

Hello!

 

I am sorry to hear that you are sick again!! You can't seem to catch a break!!

 

With the combination of your fever plus epigastirc pain I feel that you need to see doctor again for re-evaluation...

 

Your history to me with the epigastric pain suggest probable problems with gastric ulcers... I think that the fever may be separate problem... I suspect perhaps this may be due to resurgence of your prior respiratory infection BUT other causes are certainly possible...

 

With abdominal pain plus fever it is important to rule out acute abdomen causes.. need to make sure that you do not have an acute intra-abdominal infection such as acute cholecystitis for example ( infected gall bladder) Need to ensure that you do not have more serious problem such as perforated ulcer or pancreatitis ( pancreatitis may cause all three symptoms of fever/ abdominal pain and nausea...)

 

UTI may be potential cause of fever plus nausea...

 

Bottom line is that you need to be checked out further I'm afraid... I know that you hate this need to return again to doctor but you need to ....

 

Urgent care or ER are options or to see your primary doctor tomorrow>> urgency may be in large part determined by the degree of the abdominal pain...

 

I hope this helps. Let me know if you have further questions and I will be happy to get back with you!!

 

Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
It feels ulcery
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

As I said I do suspect that your stomach pain and nausea are probably due to ulcer disease. I suspect that your fever is due to separate issue but I can't tell you that for sure >> you need further evaluation >> if abdominal pain is not severe than it may wait until tomorrow but use your best judgment in this...

 

I hope this helps. Let me know if I may be of further help .. ( I will be offline shortly until about 830 PM..)

 

Best Regards,

 

Anthony Bray MD

 

Customer: replied 1 year ago.
I will let you know then how i feel
Customer: replied 1 year ago.
Ive lost 2.5 pounds since this am
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again!

 

Have you not been drinking?? Do you have diarrhea?? A weight loss of 2.5 pounds is not that much in the whole scheme of things but seems a rapid rate of change... same scales?? Different scales could itself potentially account for 2.5 pounds... otherwise look at fluid changes...

 

I hope this helps. Let me know if you have further questions. Take Care,

 

Anthony Bray MD

Customer: replied 1 year ago.
10 oz of fluid. My tummy is just really sensitive right now. Same scale
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

I see>> I think you have probably just reduced your fluid intake too much. I would try to GENTLY increase your fluid intake with things like Gatorade, soups, tea, jello, etc..

 

I would start probably with full liquid diet and then advance if tolerated to bland diet..

 

I hope this helps! Let me know if you have further questions! Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
It physically hurts to drink
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Well do it slow with frequent sips >> you HAVE to have fluid intake though and you KNOW THIS!!

 

In the long run you need nutrition in order to heal the stomach!! So try to do the best you can with the gradual oral intake... Otherwise it will need to be the hospital and IV fluids... I know that you don't want that!!

 

Hang in there >> I hope that you feel better soon! Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
I know this. Last time i had ulcers i couldnt eat/drink either
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

I realize that you know the drill... try your best >> you know that your stomach healing does require nutrition and that your body demands fluids!! I just ask you to do your best to take care of yourself to get through this !!

 

I hope that you feel better soon! Take Care,

 

Anthony Bray MD

Customer: replied 1 year ago.
I have been tryig my best. It is not working
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Well try things such as the YUCKY Boost or Ensure or even milk shakes for nutrition..

 

If you have too much trouble then see your doctor or otherwise get help via ER if you have to...

 

Actually milkshakes are pretty good for this situation , cool and the milk is an excellent buffer of acid as well..

 

I hope this helps! Take Care!!

 

Anthony Bray MD

Customer: replied 1 year ago.
Im down 4.1 pounds since yesterday morning
Customer: replied 1 year ago.
My urine shows im dehydrated. Soecific gravity is 1.30 and 3+ ketones
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Yes I'm afraid that is more evidence of your nutrition suffering and dehydration worsening... you need to improve your fluid and nutritional intake...

 

 

If you are unable to do this on your own then you may need further medical attention...

 

I hope that you feel better soon! If you would please start a new thread as this one has grown quite long... Thank You and Best Regards,

 

Anthony Bray MD

 

PS >> you may visit my profile page and ask question from there or just address Q to me >> Page is >>http://www.justanswer.com/medical/expert-anthonybraymd/

 

Customer: replied 1 year ago.
Last thing and i will close this page. I dont think i can physically eat. My stomach hurts too bad
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

OK > it sounds that you need help if this is the case.. You may try first taking some Carafate and wait 20 minutes and then sip some soup or milkshake.. this approach may be of some help to you, I hope!

 

Take Care,

 

Anthony Bray MD

Customer: replied 1 year ago.
Gi dr wants to scope me on friday. ive lost a little over 9# since monday
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again ,

I would agree that you need to be scoped again at this time. You may need to be hospitalized due to dehydration with the short term drop in weight that you have had. Try to have better intake of fluids.

I hope that you feel better soon! Take care,

Anthony Bray MD
Customer: replied 1 year ago.
Gi dr out me on a clear liquid diet
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

That is standard with the problem of vomiting >>> I usually recommend that you keep on clear liquids until you have had no vomiting for 12 hours. Then if this has been tolerated then gradually advance to full liquids and layer to bland diet. Your being scheduled for EGD will impact what is allowed to consume prior to this test too.

One tip>> water is considered by most to be the most benign to the stomach with your type problem but it is not!! Water is the most dilute liquid ( it has nothing dissolved in it) the osmotic difference between the stomach lining and the fluid will cause the stomach lining to absorb more free water to try and balance the osmolality... This effect may cause the stomach tissue to Swell and this may make you feel worse!! So liquids with increased solute/ salts dissolved in them are actually better. When the fluid intake is closer in concentration of dissolved salts the the stomach lining will not be as prone to swell. This is much if the reason that chicken soup had been a favorite for stomach illness for decades at least !! Soups are salt and have a higher osmolality >> this means less of a problem with injured stomach absorbing free water and causing swelling.. ( if the salt content is high then the close balance of the concentration with the stomach tissue makes swelling of the stomach lining less likely to take place.

Salty items such as Saltine crackers may be helpful for this same reason. Gatorade has helpful electrolytes which may help( still Gatorade is fairly dilute)

I hope that this information helps. Let me know if you have further questions! I wl be happy to get back with you! Please start a new thread due to the excess length if this one, thank you and best regards ,

Anthony Bray MD
Customer: replied 1 year ago.
Very last question then im going to bed. Can ulcers cause back pain
Expert:  Anthony Bray, MD replied 1 year ago.
I see you opened new thread ....I will answer your question both here and on new thread if possible,.... I saw Dr Brims had answered other...

Yes it is certainly possible for ulcers to have radiation of pain to the back. This is not extremely common for ulcers but it does occur at times. Other abdominal sources tend to have radiating to the back such pancreatitis for example.

I hope this helps. Let me know if you have further questions. Best regards,

Anthony Bray MD

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