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What Is The Specific Treatment For Loose Motions And Why Is My Mother Unable To Bear Cold With Rheumatoid Arthritis?

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Posted on Tue, 21 Jan 2014
Question: In recent tests for my mother, we got the following results. RBC count 3.2, Heamoglobin 8.2, Haematocrit 27.1, MCH 25.6, MCHC 30.3, ALP (p-NPP, Kinetic) 143, SERUM ALbumin (BCG-Dye) 3.0, ALB/GLOB (A/G) Ratio 0.9, Total Iron(FERENE) 14, Total Iron Binding Capacity-152, TRANSFERRIN SATURATION (Calculation) 9.2, SERUM FERRITIN (ECLIA) 184.5. ESR- We are pure vegetarians by Diet. She takes (FERRUS SULPHATE+ FOLIC ACID)FEEFOL but she is getting loose motions and had to stop it. She is unable to bear the winter cold and restricted by physical activity. She also has Rheumatoid Arthiritis for the last 14 Years. What is the specific treatment or a test that needs to be done to improve her ability
doctor
Answered by Dr. Anshul Varshney (37 minutes later)
Brief Answer: Rule out Ulcers and Kidney problems Detailed Answer: Dear Friend Anemia in your mother can be because of following reasons : 1. Etodolac induced Gastric/Duodenal Ulcer , causing blood loss - Get her Stool for occult blood (Off Iron for 7 days) 2. Etodolac Induced Kidney problem - Get her Kidney Function Test. 3. She might have taken steroids for Rheumatoid Arthritis , that can again cause severe gastritis and ulcers causing blood loss. 4. Nutritional Deficiencies. Vegetarian diet has been implicated by some theories for Vitamin B12 Deficiency anemia. So , that can not be your case. Now about Serum ferritin - A normal ferritin blood level, referred to as the reference interval is determined by many testing laboratories. The ranges for ferritin can vary between laboratories but are usually between 30–300 ng/mL for males, and 15–200 ng/mL for females. So i assume you lab references are same , so her ferritin is normal. But her TIBC and Transferrin Saturation is Low , which goes in favour of iron deficiency anemia. Her Serum Albumin is also low , means either her liver is not producing enough of it or her kidney's are unable to retain them - Get her Liver Function Test and Urine Routine and microscopy. Once the reports are there , we will be able to tell exactly her problems. And how to treat them. Rheumatoid Arthritis problem increases in winters , a lot of joint pain and stiffening patient feels. I personally prefer to give intramuscular shot of Injection Depomedrol to my patient during episodes of acute flares. You may discuss with your doctor about that. I hope i am able to solve your query , still if you have any query , ask me.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Anshul Varshney (3 days later)
Doctor I have uploaded the very recent lab report for my mother. Please look into the report and let us know if we have to add/modify any medication? Do you suggest any other follow up tests that would help identify the root cause for the weakness? Her energy levels are OK when she gets up but towards the evening, she has very little or no energy left in her. Based on the condition, Is there a good pain killer that will help her. Is ETODOLAC good for her in this condition. Currently she is unable to sustain without a painkiller on a daily basis.
doctor
Answered by Dr. Anshul Varshney (16 hours later)
Brief Answer: Detail follows Detailed Answer: Hi, Thanks for your query. It seems she has iron deficiency. .. she should continue iron supplements. . She should avoid Etorodolac... And can take tarmadol ir flupirtine.. She should get evaluation by Endoscopy and Stool for occult blood If you have any other question you may please ask me , else close the query and rate it.
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Anshul Varshney (7 hours later)
The occult blood test was also part of the report. Kindly look into it. Also suggest a good multi-vitamin for her in case it is required. Just to inform you that she has her gall bladder removed and weak on digestion. Sometimes taking FEEFOL (IROn + FOLIC Acid) casues lose motions. Please suggest a right supplement for her? Any specific food that she needs to add to the diet or any specific foods that she should avoid. Is there a brand name for tarmadol ir flupirtine? What is the dosage that she should start with.? The Endoscopy report is as follows. OESPHAGUS-NORMAL, STOMACH-NORMAL, DUODENUM-NORMAL, IMPRESSION-NORMAL.
doctor
Answered by Dr. Anshul Varshney (7 hours later)
Brief Answer: Detail follows Detailed Answer: Dear Friend. . It's good her endoscopy is normal. For females a good multivitamin is "Multivitamin Women" once a day. For anemia I prefer to use Fefoz-Z twice daily , modified according to Hb levels. Flupirtine is not tramadol , it's available with the same of Katadol 100 mg , should br taken on as required basis and under your treating physicians care. Tramadol is also safe comparatively but has addictive potential and causes nausea also. Hope she gets well soon.
Note: Do you have more questions on diagnosis or treatment of blood disorders? Ask An Expert/ Specialist Now
Above answer was peer-reviewed by : Dr. Prasad
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Dr. Anshul Varshney

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What Is The Specific Treatment For Loose Motions And Why Is My Mother Unable To Bear Cold With Rheumatoid Arthritis?

Brief Answer: Rule out Ulcers and Kidney problems Detailed Answer: Dear Friend Anemia in your mother can be because of following reasons : 1. Etodolac induced Gastric/Duodenal Ulcer , causing blood loss - Get her Stool for occult blood (Off Iron for 7 days) 2. Etodolac Induced Kidney problem - Get her Kidney Function Test. 3. She might have taken steroids for Rheumatoid Arthritis , that can again cause severe gastritis and ulcers causing blood loss. 4. Nutritional Deficiencies. Vegetarian diet has been implicated by some theories for Vitamin B12 Deficiency anemia. So , that can not be your case. Now about Serum ferritin - A normal ferritin blood level, referred to as the reference interval is determined by many testing laboratories. The ranges for ferritin can vary between laboratories but are usually between 30–300 ng/mL for males, and 15–200 ng/mL for females. So i assume you lab references are same , so her ferritin is normal. But her TIBC and Transferrin Saturation is Low , which goes in favour of iron deficiency anemia. Her Serum Albumin is also low , means either her liver is not producing enough of it or her kidney's are unable to retain them - Get her Liver Function Test and Urine Routine and microscopy. Once the reports are there , we will be able to tell exactly her problems. And how to treat them. Rheumatoid Arthritis problem increases in winters , a lot of joint pain and stiffening patient feels. I personally prefer to give intramuscular shot of Injection Depomedrol to my patient during episodes of acute flares. You may discuss with your doctor about that. I hope i am able to solve your query , still if you have any query , ask me.