Hello doctor, I have a few problems with my body. Since last year I was under work pressure. I could see my blood sugar gone up to 289 mg/dL on post prandial (PP) last month and reduced to 175 on PP and 109 on fasting last week. In the meantime, for the past two weeks, I suffer from fissure. I am a case of vitiligo and epilepsy for 20 years and under medication with Valproic acid 500 mg (reduced to 250 mg for the last 10 months) and Clonazepam 0.5 mg. I have been noticing that my penis skin is shrinking for the last eight months and now narrowed down to 8 mm opening on the penis forehead skin. For the last three months, I am suffering from back muscle spasm. After consulting MD medicine, I am taking a sitz bath for fissure, continuing Valproic acid 500 mg for epilepsy and back pain, following a strict diet for blood sugar, and no medication for vitiligo. He suggests circumcision as the only option for penis skin problem. I request your second opinion.
Hello.  I understand your concerns. I have checked all the attached reports thoroughly (attachments removed to protect patient identity), and here are my notes: 1. Repeated high post prandial sugar above 200 means that you are diabetic and need to start therapy. Do you have polyuria (frequent urination)? do you drink water more than usual? 2. Repeated cholesterol level above 200 along with fatty liver grade 2 means dyslipidemia that requires management. 3. Stress ECG shows some changes that could mean some cardiac ischemia. Do you feel any chest pain especially with efforts? if yes, could you describe it?  4. All other investigations are within normal limits. Advice: 1. Healthy life style that includes daily 30 minutes walk, a healthy diet with low sugar, starch, and oily foods. 2. Metformin 500 mg after meals plus Glimepiride (Amaryl) 2 mg before breakfast (for diabetes). 3. Rosuvastatin 10 mg once per day (for high cholesterol). 4. A retinal fundoscopy and urine analysis for microproteinuria are required. Continue other medications you have. Follow up after one week. Regarding the penis problem, I agree with circumcision. I hope this helps.