Brief Answer:
Bariatric surgery and airway evaluation
Detailed Answer:
Hello again Mr XXXX!
Thank you for asking. As you have borderline galaucoma pressures and the CNS stimulants and anorexiants may worsen that so you need further monotoring while using it. Here is the list of adverse effects These Qsymia can have
>10%
Paresthesia (4.2-19.9%)
Dry mouth (6.7-19.1%)
Constipation (7.9-16.1%)
URI (12.2-15.8%)
Metabolic acidosis (6.4-12.8%)
Nasopharyngitis (9.4-12.5%)
Headache (7-10.6%)
1-10%
Insomnia (5-9.4%)
Dysgeusia (1.3-9.4%)
Dizziness (2.9-8.6%)
Increased serum creatinine (2.1-8.4%)
Sinusitis (6.8-7.8%)
Nausea (3.6-7.2%)
Bronchitis (4.4-6.7%)
Back pain (5.4-6.6%)
Diarrhea (5-6.4%)
Blurred vision (4-6.3%)
Fatigue (4.4-5.9%)
UTI (3.3-5.2%)
Hypokalemia (persistent) (0.4-4.9%)
Cough (3.3-4.8%)
Depression (2.8-4.3%)
Anxiety (1.8-4.1%)
Irritability (1.7-3.7%)
Alopecia (1.7-3.7%)
Hypoesthesia (0.8-3.7%)
Disturbance in attention (0.4-3.5%)
GERD (0.8-3.2%)
Extremity pain (2.1-3%)
Musculoskeletal pain (0.8-3%)
Muscle spasms (2.8-2.9%)
Dyspepsia (2.1-2.8%)
Sinus congestion (2-2.6%)
Rash (1.7-2.6%)
Pharyngeal pain (1.2-2.5%)
Dry eye (0.8-2.5%)
Gastroenteritis (0.8-2.5%)
Hypokalemia/ Low potassium (acute) (0.4-2.5%)
Palpitations (0.8-2.4%)
Eye pain (2.1-2.2%)
Neck pain (1.2-2.2%)
Oral paresthesia (0.2-2.2%)
Decreased appetite (1.5-2.1%)
Nephrolithiasis (0.2-1.2%)
Dysmenorrhea (0.4-2.1%)
Chest discomfort (0.2-2.1%)
Thirst (1.8-2%)
Nasal congestion (1.2-2%)
Postmarketing Reports
Phentermine
Allergic: Urticaria
Cardiovascular: Increased blood pressure, ischemic events
CNS: Euphoria, psychosis, tremor
Reproductive: Changes in libido, impotence
Topiramate
Dermatologic: Bullous skin reactions (eg,
erythema multiforme,
Stevens-Johnson syndrome,
toxic epidermal necrolysis), pemphigus
Gastrointestinal: Pancreatitis
Hepatic: Hepatic failure (including fatalities), hepatitis
Metabolic: Hyperammonemia, hypothermia
Ophthalmic: Maculopathy
Now the Obesity issue. Mr XXXXXXX as you mentioned you last 20 sedentary years of lifestyle has made it difficult further to lose weight. You need to reduce your energey expenditures. and use conventional diets like
Low-fat diets - Eg, the Ornish diet
Low-carbohydrate diets - Eg, the XXXXXXX diet
Midlevel diets - Eg, the Zone diet, in which the 3 major macronutrients (fat, carbohydrate, protein) are eaten in similar proportions of 30-40%)
Joslin Why WAIT diet for diabetic patients - 40-45% carbohydrates, 20-30% protein, less than 35% fat
Sign up to some weight-loss programs, such as those advocated by XXXXXXX XXXXXXX Weight Watchers, Take Off Pounds Sensibly (TOPS), and Overeaters Anonymous (OA).
You can try Reduced ΜΆ portion size diets.portion control can be achieved by participation in structured weight loss programs (eg, XXXXXXX XXXXXXX Nutrisystem) or by the purchase of products such as meal-replacement shakes, bars, prepackaged meals, and frozen entrees (eg, Slim-Fast, Glucerna, Lean Cuisine, Healthy Choice, Smart Ones) Also Alcohol, sodas, most fruit juices, and highly concentrated sweets are generally calorie dense and nutrient deficient (so-called empty calories). Consequently, these are generally prohibited or reduced to a minimum.
Drink cold water 10 ml per kg before every meal. As study has shown that people who consumed 500 mL of water prior to each daily meal had a 44% greater decline in weight over 12 weeks than did individuals on a hypocaloric diet without premeal water consumption.
You need behavioural changes and exercises. As you mentioned disability then i think you should consider the Option of Bariatric surgery. They are the only solution of losing weight And proved effective but again age of 57 would be a little impediment for that. Any ways seek the Docotrs opinion for bariatric surgery.
Now the snoring i mentioned once you lose weight it will be gone, and otorhinolaryngologist will evaluate airways to find if there is any thing else other than obesity as a factor for snoring. Lets focus on the weight loss first and snoring will resolve with it.
Mr XXXXXXX Hope i was of some service. Kindly dont forget to close the discussion and rate the answer if you have no more queries for me.
have a very good rest of the day.
Yours sincerely
Dr S Khan