I am 32 years old, 318 pounds, 5'10

Patient : I am 32 years old, 318 pounds, 5'10" and I have type 2 diabetes and high blood pressure. I'm currently taking metformin, insulin, hydrochlorithizide, metoprolol, loratadine, pantoprazole. I recently have been experiencing shortness of breath and Adema in my left leg. I'm breastfeeding my daughter and trying to eat well. I'm concerned about my health. My insurance is lapsed right this moment. Is this a major concern or can it wait?
Doctor :   Hello. Welcome to Ask The Doctor. I understand your concern. I have following diagnosis for you: 1. Cardiac Chest pain. 2. Acid reflux. 3. Muscular pain. It is important to differentiate between the all as the treatment course is entirely different. The Muscular chest pain aggravates with movement. It is dull, diffuse and continuous in nature. However, the Cardiac chest pain is severe and crushing in nature. It increases with activity like walking, exercising. It also radiated to left arm. In such scenario, I would advise an ECG and a Chest X-ray. This will give an idea that pain is cardiac in nature or not. If the ECG and Chest Xray are normal, the pain is probably Muscular or due to Acid reflux. For acid reflux, I would advise you to take a combination of Pantoprazole and Domperidone once a day. I suppose, you should get an evaluation done for Anginal pains. I would advise you following: 1. Treadmill Test 2. Repeat ECHO. If any abnormality is found, then an angiography should be performed. Share my opinion with your Doctor before acting upon it. I hope it helps. Stay Healthy

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