Brief Answer:
Please attach the report

Detailed Answer:
Hello XXXX, thanks for coming to HealthCareMagic. Unfortunately, something has gone wrong with the report attachment you have mentioned. I have no access to it. So upload it when you get a chance and I will be happy to go over it with you

As for the Blood sugar reports you have typed in, They look quite good for a person who is on lantus insulin. Has he had an HbA1C test done recently?

It's always good to treat a patient as a whole person rather than just looking at reports. So can you give me any details on your father current medical condition? Does he have any complaints or symptoms that are troubling him?

Looking forward to your reply.

Vin

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Brief Answer:
Lab results overall OK, some suggestions below

Detailed Answer:
Hey XXXX, Thanks for following up. Have gone over both reports you have uploaded. Will go over these first, then, taking into account your Dads gastric issues we can formulate a plan to optimize his health.

Lets discuss his Ferritin and TSH report first. His Ferritin levels are normal so that tells me he has an adequate amount of iron in his diet. In spite of this, i would not see the harm in starting a multivitamin supplement to make sure that he has the necessary vitamin B in his diet to absorb iron properly (you need Vit B to absorb Iron from food).

His TSH (Thyroid Stimulating Hormone) is borderline high, since he has no symptoms of Hypothyroidism, I'm not inclined to worry about this right now. I would suggest that he get another screening in 6 months to see if the TSH levels are trending any higher, if they are, we may need to start working him up for hypothyroidism.

To the next report. The first thing that jumps out at me is his HbA1c report. 6.8 is not bad, not ideal, but not bad. I would suggest that your Dad look at what he is eating to control his sugars a bit better. We have a dietician service if you would like to use it for him. That might also help with his gas and loose stool issues, it sounds like he is not getting enough fiber in his diet. I see that he takes Razo-D for acidity issues already, the D in Razo-D stands for a drug called "Domperidone", now this drugs has the side effect of causing loose stools. so you may want to talk to his prescribing doctor about getting that stopped.

As to the A1c, diet can help and maybe a change in insulin dosage if diet is not enough. Make sure he is following up with his Diabetologist / Primary Doc.

His Tryglyceride levels are very high and this is curious. I'm guessing the Concor that he takes is not doing the job, I would suggest he follow up with his doctor and see about either changing to a Statin drug like Rosuvastatin or adding it on. That should help. The rest of his Lipid profile is fine though, so this is not an urgent thing.

Going through the rest of his labs seems easy enough, his liver and kidney functions
are normal for his age. His cell counts are good and his Hemoglobin levels are good. So All of that is excellent.

Given his acidity and related gastric issues. I think that a change in the medication he is taking ay be in order, a myriad of other Proton Pump Inhibitors and prokinetic agents that will help him better. Also make sure that his diet is low on spicy foods and oil. If he drinks caffeine (coffee, etc), try and switch him to lower caffeine blends. The darker the roast of the coffee bean, the less caffeine it will have.

So those are my recommendations given what I have seen. Let me know if there is anything I missed or anything you want me to comment on or clarify. I look forward to your reply.

Vinay

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Brief Answer:
Fibre rich foods and gastric issues

Detailed Answer:
Hello again! Thanks for following up. My apologies for the delay in answering this. There are two types of fiber that should be present in our diet. Soluble and Insoluble. Depending on what kind of diet your father prefers to take, there are many sources. In a typical South XXXXXXX diet, your best sources of fiber are unpolished rice and minimally boiled vegetables. In some cases it's very tough to get the needful fiber from these sources. At those times I suggest that the patient take a spoonful of Psyllium Husk with two glasses of water before bed. It has both types of fiber. Psyllium is a plant product that does not get broken down by the digestive tract, so it is safe for diabetics and non-diabetics alike.

Now, the issue with the Razo-D was the D part right? The Domperidone, a prokinetic agent for the gut (speeds up the gut). You mentioned that your Dad was having loose stools. In my opinion, the two could be related. In such cases, taking plain Razo (plain Rabeprazole) should solve the issue.

I'm not 100% sure that the concor should be stopped. In these cases I normally ADD a Statin class drug called Rosuvastatin to the patients medications and then re-evaluate in 6 months with another Lipid profile.

Before you make these changes though, you need to talk to the doctor who originally prescribed these meds. There may be exigencies that I'm not aware of from the brief info that I have gotten here.

Make sense? I will make sure i answer your questions in a more timely manner. My apologies again.

Vinay

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