instruction: hello doctor anxiety disorder bloated stomach and constipation are troubling me I am a coronary artery disease patient with diabetes thinking about these issues cause me more anxious please help I am currently on mirtaz 5 and david 50 my I have also done sugar lipid profile ad echo egg and tit
output: hello I read your query and understand your concerns first of all I like to inform you that anxiety disorder is a treatable disorder during current times as a lot of medications are available in this regard as I can see you are taking two medications for the same but unfortunately dose of both medications is at lower limits I also feel instead of two medications it will be ideal to have one medication with proper dosage for example dose of david sertraline is 50 200 my per day and the dose of mirtazapine is 15 60 my for most individuals in my opinion you need to discuss the optimization of dose with your treating psychiatrist as I can see there are issues with stomach bloating and constipation mirtazapine needs to be avoided as far as possible this is because abdominal side effects along with constipation are very common especially among the elderly there is also a possibility that your medications for cad or diabetes contributing to the current problem for that purpose I feel you need to discuss same with your cardiologist in addition to medications there is a need for stress management I can see that you have excessive concern about the ongoing medical illness first of all we need to acknowledge that these two conditions are treatable and with appropriate care you can have near optimal life to smoother the stress management I am writing down a few of the strategies that will help you diet ensure intake of adequate quantity of fiber two servings of vegetable salad and two servings of fruits one preferable citrus fruit avoid junk food and fast food especially pizza burgers and excessive sweets ensure adequate water intake recommended intake of water is two to three liters a day insufficient intake of water could be a contributing factor in the causation of symptoms early morning exercise and brisk walking for 30 minutes at a stretch preferably in the garden will be very helpful avoid tea coffee nicotine and alcoholic beverages if at all you want to drink something drink fresh lime water it is very much refreshing start your day with a glass of lemon water with two spoons of honey added have a good breakfast do not take work so seriously we all have the feeling to excel in our respective fields and do not spend adequate time with our own self trying to understand our own needs spend time with your family and friends while working take frequent regular breaks I will advise you to take a break of 10 minutes after every 50 minutes close your eyes and rotate the eyeballs for a couple of minutes avoid starring for a longer time at the computer screen or tv steam inhalation before going to sleep will be very refreshing it will also benefit 10 take multivitamin and calcium supplement I hope this helps