Brief Answer:
No antibiotics, think post-viral, reflux, allergy.

Detailed Answer:
Hi,

Thank you for your query.

1. The images show:
a. A mild congestion (prominent blood vessels), However the colour is normal, healthy.
b. A mild Granular Pharyngitis (pale lymphoid tissue granulations on the back of the throat, more on the sides). This usually signifies a chronic irritation of the throat due to a post nasal drip, allergy, reflux or dryness.
c. Tonsils (both sides) have a prominent Crypta Magna, but are normal in appearance.
d. Visible tongue is normal.
e. White spots on the palate. These may be Fordyce's Spots which do not require treatement or this may be a mild yeast (fungal) infection.
f. Dental issues (related to acid reflux, salivary issues and oral hygiene/dryness due to snoring and sleep apnea).

2. Your BMI (Body Mass Index) is very high (more than 40). Your throat appears fine as per the Friedman Mallampati Classification for Sleep Apnea Scoring.

3. If you are diabetic, this will make you prone to repeated sore throats.

4. Right now, further antibiotics are not required. Get a throat swab sent for bacterial, fungal culture and sensitivity.

5. Take anti-reflux medication such as Rabeprazole 20 mg early in the morning half an hour before breakfast and a pro-kinetic such as levosulpiride 25 mg once a day. (Check with your doctor for interactions with other medications). An anti-allergic, mucolytic will help and steam inhalation through the nose and mouth will help (including the ear discomfort). Use a medicated gargle such as Betadine (diluted).

If you have any more questions I will be available to answer them.

Regards.

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Brief Answer:
Waterbrash, cough (Reflux). Topamax & Phenteramine (drug induced).

Detailed Answer:
Hi,

Thank you for writing back.

1. After looking at the images, this may be a post infection phase at the most (raised liver enzymes).

2. With the additional details, I would consider these throat symptoms to be due to Sleep Apnea and reflux (waterbrash).

3. The medications that I have suggested are prescription medicines. You will have to discuss these with your doctor and get a prescription.

4. Topamax and Phenteramine can also lead to such throat symptoms as side effects (non-specific nasopharyngitis and Xerostomia/dryness).

If you have any more questions I will be available to answer them.

Regards.

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Brief Answer:
Meds have side effects. Repeat Liver enzymes. Waterbrash explained.

Detailed Answer:
Hi,

Thank you for writing back.

1. Topamax and Phenteramine will add to the current symptoms as the side effects are similar. Your doctors will have to weigh the benefits against the side effects to decide whether you should take these medications.

2. As per current guidelines, the five days of an acute upper respiratory tract infection are considered as viral, the five as a post-viral and beyond ten days as an acute bacterial infection. The time after the successful treatment with antibiotics is considered as a post infection recovery phase. Chronic infections are those that persist beyond four to eight weeks in spite of treatment.

3. Liver enzymes are often mildly raised during viral infections and after treatment with antibiotics as these medications are metabolized in the liver. Repeat the tests before planning any treatment. Mild or borderline increase in liver enzymes is common and not a cause for concern.

4. Waterbrash is a single word that describes your throat symptoms. It is seen in GERD. A build up of sour or almost tasteless saliva like a post nasal drip, irritates the throat, forces swallowing and retching, vomiting, indigestion and discomfort in the chest and stomach.

5. The medication I have suggested will be fine with your current medication. However you should inform your doctor and get a prescription. The medicines will reduce your symptoms and discomfort.

If you have any more questions I will be available to answer them.

Regards.

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Brief Answer:
Yes, these medications ahve many side effects.

Detailed Answer:
Hi,

Thank you for writing back.

1. Topamax (Topiramate), Phentermine and Alli (Orlistat/sibutramine) are bad for the heart, liver and kidneys.

2. Since you are taking Lexapro (Escitalopram) you should not take these medications.

3. Fatty liver will show up on an Abdomen Ultrasound (USG).Yes, your liver enzymes may be increased due to non-alcoholic fatty liver disease, however, you must rule out viral hepatitis.

If you have any more questions I will be available to answer them.

Regards.

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Brief Answer:
Good to hear that hepatitis test was negative. Weight loss for liver.

Detailed Answer:
Hi,

Thank you for writing back.

1. It is good to hear that you have tested negative for hepatitis.

2. There are no foods or supplements to help the fatty liver.
a. You must try to achieve some weight loss.
b. Diet control is required.
c. Exercise will help further.
d. Avoid experimental remedies, supplements and treatments.
e. Other co-morbid conditions such as Diabetes, Hypertension, High Cholesterol levels must be treated to help the liver to recover.

If you have any more questions I will be available to answer them.

Regards.

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Brief Answer:
These are all related to obesity.

Detailed Answer:
Hi,

Thank you for writing back.

1. These are all related to obesity.

2. Insulin (diabetes), hormones (PCOS) are related to the fat metabolism pathway. Cholesterol metabolism is only a part.

3. Hypertension, which was mostly considered of unknown cause is now linked to Sleep Apnea due to obesity.

4. You need to concentrate on weight loss. The rest of your symptoms will reduce in tandem.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.

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