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Suggest Remedy For Severe Depression In An Elderly Person With Fatigue
Question: My mom is 80. She seems to be having depression. She is complaining about her throat hurting so bad she can't swallow. Last week she said the Dr. Said her Cholesterol was out of sight.... Though she isn't taking anything for it. She has ZERO energy. She is in Ohio, I am in Ky... I am worried.
Brief Answer:
I recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I understand your concern and would explain that the difficulty swallowing and the hurting throat seem to be related to an infection.
Does she have any other symptoms like fever, sneezing, cough, running nose?
A psychological factor related to difficulty swallowing do to paradoxical dysphagia can not be excluded.
Her cholesterol levels are not related to this clinical situation.
I recommend consulting with her attending physician for a careful physical examination, a pharingeal discharge bacterial culture and a complete blood test coupled with inflammation tests (PCR, sedimentation rate).
Regarding her mood and humor changes, I recommend consulting with a psychiatrist, to examine better her emotional and psychological situation and choose the best treatment choices.
Hope to have of help!
Feel free to ask any other questions whenever you need!
Greetings!
Dr. Iliri
I recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I understand your concern and would explain that the difficulty swallowing and the hurting throat seem to be related to an infection.
Does she have any other symptoms like fever, sneezing, cough, running nose?
A psychological factor related to difficulty swallowing do to paradoxical dysphagia can not be excluded.
Her cholesterol levels are not related to this clinical situation.
I recommend consulting with her attending physician for a careful physical examination, a pharingeal discharge bacterial culture and a complete blood test coupled with inflammation tests (PCR, sedimentation rate).
Regarding her mood and humor changes, I recommend consulting with a psychiatrist, to examine better her emotional and psychological situation and choose the best treatment choices.
Hope to have of help!
Feel free to ask any other questions whenever you need!
Greetings!
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I just spoke to her and she said that sometimes she gets a sharp pain from under left arm. She is thinking it could be her gallbladder. She also said that she is thinking it may be stemming from her colon/digestive system. Does any of that make sense?
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello again!
The difficulty swallowing is not related to the sharp pain under the left arm.
It is necessary to perform a careful differential diagnosis regarding the sharp pain under her left arm:
-it may be a pinched nerve in the arm or originating from a backbone disorder in the cervical level. A nerve conduction study and a cervical column X ray study are necessary to exclude this possibility.
-a cardiac ischemia. Does she has chest pain, shortness of breath? A resting ECG and a cardiac ultrasound are necessary to examine her cardiac function
-a musculo skeletal pain. Does her pain change during respiration or body movements? this would indicate a musculo skeletal pain
How long does her pain in the arm last? Could you please precise the location of the pain? Does is spread in her chest or neck?
Pain originating in the left arm doesn't seem to be related to any digestive system disorders.
Regards!
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello again!
The difficulty swallowing is not related to the sharp pain under the left arm.
It is necessary to perform a careful differential diagnosis regarding the sharp pain under her left arm:
-it may be a pinched nerve in the arm or originating from a backbone disorder in the cervical level. A nerve conduction study and a cervical column X ray study are necessary to exclude this possibility.
-a cardiac ischemia. Does she has chest pain, shortness of breath? A resting ECG and a cardiac ultrasound are necessary to examine her cardiac function
-a musculo skeletal pain. Does her pain change during respiration or body movements? this would indicate a musculo skeletal pain
How long does her pain in the arm last? Could you please precise the location of the pain? Does is spread in her chest or neck?
Pain originating in the left arm doesn't seem to be related to any digestive system disorders.
Regards!
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The pain last for a few minutes. A couple weeks ago she said, over the phone "my chest gets tight and I feel like I can't breathe. I called her and said I will find a doctor up there, make an appointment, and will plan on taking her myself. She has agreed. Her doctor just retired. What kind of Doctor would you suggest I take her to? She has great insurance, so that isn't a problem.
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello again!
Thank you for the additional information provided.
You should know that when symptoms like chest tightness and shortness of breath are present, taking in consideration also her age, raise high suspicions for a possible coronary artery disease or cardiac arrhythmia.
So the first thing to do is consulting with a cardiologist for a careful physical examination, a resting ECG, cardiac enzymes and a cardiac ultrasound.
Further tests may be needed to establish the diagnosis:
-stress echo for possible coronary artery disease. A coronary angiography would be the test of choice for the diagnosis.
-a 24-48 hours ECG monitoring would be needed for the diagnosis of possible cardiac arrhythmia.
If all the above tests result normal, a cardiac disorder could be excluded.
In such case, other causes of chest pain should be investigated, like:
- pulmonary disorder. A chest X ray study and respiratory function tests would help to examine her pulmonary function.
-a musculo skeletal pain. Inflammation tests would help investigate for possible inflammation.
- esophageal spasms or a hiatal hernia could also be the cause of chest pain. A fibrogastroscopy would help to exclude these disorders.
Besides, anxiety should also be taken into consideration as a cause of this clinical scenario, if all the above tests result normal.
You should discuss with her attending physician on the above issues.
Hope you will find this answer helpful!
Best wishes!
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello again!
Thank you for the additional information provided.
You should know that when symptoms like chest tightness and shortness of breath are present, taking in consideration also her age, raise high suspicions for a possible coronary artery disease or cardiac arrhythmia.
So the first thing to do is consulting with a cardiologist for a careful physical examination, a resting ECG, cardiac enzymes and a cardiac ultrasound.
Further tests may be needed to establish the diagnosis:
-stress echo for possible coronary artery disease. A coronary angiography would be the test of choice for the diagnosis.
-a 24-48 hours ECG monitoring would be needed for the diagnosis of possible cardiac arrhythmia.
If all the above tests result normal, a cardiac disorder could be excluded.
In such case, other causes of chest pain should be investigated, like:
- pulmonary disorder. A chest X ray study and respiratory function tests would help to examine her pulmonary function.
-a musculo skeletal pain. Inflammation tests would help investigate for possible inflammation.
- esophageal spasms or a hiatal hernia could also be the cause of chest pain. A fibrogastroscopy would help to exclude these disorders.
Besides, anxiety should also be taken into consideration as a cause of this clinical scenario, if all the above tests result normal.
You should discuss with her attending physician on the above issues.
Hope you will find this answer helpful!
Best wishes!
Dr. Iliri
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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