Brief Answer: You need to undergo relevant tests Detailed Answer: Hi Mr. XXXXXXX Thanks for your query. Your symptoms of abdominal cramps and severe bloating, are suggestive of aspirin + smoking- induced gastritis (inflammation of the stomach with increased acid formation) along with stomach + intestinal infection (due to either, H.pylori bacteria and/or ameba and worms). Neck stiffness associated with chest pain and mild headache are apparently due to a condition called Cervicalgia (including cervical spondylosis, spasm of neck, shoulder, chest and head muscles). At the same time, given the history of chronic smoking with elevated triglyceride levels, silent ischemia (silent hear disease) needs exclusion. You should therefore undergo breath test for H.pylori, stools test for ameba, ova/cyst and blood, if any; TMT and stress Echo to rule out/detect silent heart disease. Consult your doctor and apprise him of my opinion. I am certain that he will agree with my opinion; order required tests, and- based on the reports- will arrive at a certain diagnosis and prescribe suitable treatment for your problems. Hope I have addressed to your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Have a nice day, Col (Dr.) Rakesh Karanwal

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Brief Answer: Answers to your queries are given below Detailed Answer: Hello Mr. XXXXXXX Nice hearing back from you. Additional details are quite informative. 1. Pain in right upper abdomen can be due to Gastritis (as already highlighted), associated with, Non-Alcoholic Fatty Liver Disease (NAFLD). 2. Sticky, loose and dark colored stools raise the possibility of Non-alcoholic Steato-Hepatitis (NASH), a condition in which Fatty liver is associated with deranged absorption of food leading to the nature of stools as mentioned by you. (I presume that you do not take alcohol). 3. Chronic, advance problem of Pancreas (which produces enzymes responsible for digestion of fats, proteins and carbohydrates present in ingested food) too manifests in the similar manner. An ultrasound and CT scan of upper abdomen (to include Liver, Gall Bladder and Pancreas), along with Liver Function Tests and Serum Amylase will provide valuable information on the involvement (if any) of Liver and Pancreas. 4. The damage to lungs, already caused by smoking, will NOT revert back by giving up smoking! Damage to the lungs due to chronic smoking are irreversible. Hence, you should get further evaluation of Lungs structural and functional status, done. Chest X-ray and Pulmonary Function Test (PFT) will give accurate information on the status. 5. In view of history of chronic smoking and elevated Triglyceride levels, evaluation of the heart condition is also essential. An ECG, 2-D Echo and TMT should be done to rule out/detect silent heart disease. 6. Ecosprin is NOT indicated at present. Several studies have shown that preventive Ecosprin has no role. However, Ecosprin would be invaluable in heart disease. 6. I would recommend that a combination of Rosuvastatin (Rosulip) + Fenofibrate be taken- instead of Rosulip alone-, as Fenofibrate specifically lowers Triglyceride levels. It should be taken daily at Bedtime, after dinner. 7. A 7-10 days' course of a combination of Ibuprofen + Paracetamol + Chlorzoxazone will give substantial relief from pain due to Cervicalgia. Lastly, it may be appreciated that your treating doctor- who has examined you and is fully conversant with your complete medical history- is the BEST JUDGE. Consult him and apprise him of my opinion. I am sure he will agree with me and guide you further. Take care, Col (Dr.) Rakesh Karanwal

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