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48-Year-Old Man with Heart Issues: Should He Stop Medications?

Dr Karthiyayini

Dr Karthiyayini Mahadevan  |1146 Answers  |Ask -

General Physician - Answered on Jul 09, 2024

Dr Karthiyayini Mahadevan has been practising for 30 years.
She specialises in general medicine, child development and senior citizen care.
A graduate from Madurai Medical College, she has DNB training in paediatrics and a postgraduate degree in developmental neurology.
She has trained in Tai chi, eurythmy, Bothmer gymnastics, spacial dynamics and yoga.
She works with children with development difficulties at Sparrc Institute and is the head of wellness for senior citizens at Columbia Pacific Communities.... more
Nazir Question by Nazir on Jun 27, 2024Hindi
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Sir, i am 48 years old and working in gulf country since 1997, almost 27 years, 2 years before i had heart issue, and doctor did the heart catrization procedure and they put the one stent, i continue taken the BP, calostrol and sugar mediation. i have hi potential, other than no issue, i need to stop the other medicine but doctor told me i have to continue, every day i am taken 5 medicine. please advise

Ans: To get out of the supportive medication, you need to strictly follow certain disciplines in yourlifestyle
1.Timely meals-Atleast early dinner by 6 pm
2.Periodic fasting(varies with your ability and will) , maybe once a fortnight
3.Regular exercise according to your ability, safest-walks 30 mts five days a week
DISCLAIMER: The answer provided by rediffGURUS is for informational and general awareness purposes only. It is not a substitute for professional medical diagnosis or treatment.
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Ans: Hello. These are good questions and a lot of people go through the same stages. Cholesterol levels are generally genetically determined and don't change much from dietary or lifestyle changes. It can be reduced by medications. However if it is the only risk factor for heart disease/stroke, then it need not be corrected unless it is very high, LDL> 160. On the other hand the B blocker, if it was taken only for BP, may be stopped if BP comes down and remains normal. A closer monitoring may be required for that. If BP stays normal or low on taking the medicine, reduce the medicine and recheck, if it still stays low or normal, stop and see. Take it slow.

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Hello sir I am mbbs graduated from russia in 2020,n passed with my fmge exam in india in 2021, I want to ask if i want to practice medicine or work as doctor in uk ? Is it necessary for me to pass plab exam exam? Or if i get sponsorship from any uk i will be able to work there and simultaneously i will give plab exam?? Please guide me i m so confused?
Ans: Hi, I understand that you pursued a medicine course in Russia (a non-European country) and, since you are from India, you have completed the FMGE. Now you want to practice or work in the UK as a doctor?

Based on your question, you are eligible to practice in India after completing your internship (which you haven't mentioned, but I assume you have completed it). The FMGE is essentially a licensure exam for Indian students who have completed their medical studies abroad, so you are eligible to practice in India only.

If you want to practice medicine in the UK, you need to complete the PLAB test, as you are from outside the UK/Switzerland/European countries (Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland).

You also inquired about sponsorship. Here is the information related to sponsorship for practicing medicine in the UK.
(Extracted from general medical council, uk org. )Applying for registration using sponsorship
If you apply through sponsorship, you will have to satisfy the sponsor that you possess the knowledge, skills and experience required for practising as a fully registered medical practitioner in the UK. Each sponsor has their own scheme which we have pre-approved. If you can satisfy the requirements of their scheme, they will issue you with a Sponsorship Registration Certificate (SRC) which you will need for your application with us. Please ensure this is a Sponsorship Registration Certificate for GMC registration, as we can’t accept UK visa sponsorship certificates for your application for registration.
Please note that a core part of all sponsors' criteria is that a doctor applying for an offer of sponsorship must have been engaged in medical practice for three out of the last five years including the most recent 12 months. If you cannot meet these minimum criteria, it is unlikely that you'll be able to supply sufficient evidence to support your application for sponsorship.
Doctors applying through sponsorship are required to demonstrate their English language skills by achieving our current minimum scores in the academic version of the IELTS test or the OET (medicine version).
• Alder Hey International Fellowship Scheme (Anaesthetics)
• Betsi Cadwaladr University Health Board - BCUHB IMG Sponsorship Scheme
• BAPIO Training Academy Ltd – BTA International Fellowship Scheme
• BAPIO Training Academy Ltd – International Training Programme for Postgraduate Doctors
• BAPIO Training Academy Ltd - BTA International Fellowship Scheme – Internal Medicine with interest in Oncology with MSc in Oncology
• Barking Havering and Redbridge University Hospitals NHS Trust - BHRUT Sponsorship Scheme for Overseas Doctors in Clinical Radiology
• Birmingham and Solihull Mental Health NHS Foundation Trust - International Medical Fellowship Programme in Psychiatry (Birmingham)
• Birmingham Women’s and Children’s Hospital – Birmingham Women’s and Children’s International Medical Graduate sponsorship scheme
• Bradford District Care NHS Foundation Trust - International Medical Fellowship in Psychiatry
• Cambridge IVF, Cambridge University Hospitals NHS Trust – IVF Senior Clinical Fellowship Scheme
• Cambridge University Hospital – Senior Clinical Fellowship Scheme in Intensive Care Medicine/Anaesthesia
• Canterbury Christ Church University
• Cumbria Northumberland Tyne and Wear NHS Psychiatry Fellowship Programme
• Derbyshire Healthcare NHS Foundation Trust - International Medical Fellowship Programme in Psychiatry
• Dudley Group NHS Foundation Trust
• East Lancashire Hospitals NHS Trust - Clinical Fellowship in Urology or Ophthalmology
• East Lancashire Hospital NHS Trust - Specialist Clinical Fellowship in Pain Management
• East London NHS Foundation Trust (ELFT) – ELFT Advanced International Fellowship in Psychiatry
• East Suffolk and North Essex NHS Foundation Trust – ICENI Centre Fellowships Programme
• Edge Hill University and Wrightington, Wigan and Leigh NHS Trust – International Training Fellowships in MCh programmes
• ENT UK – Royal College of Surgeons
• Essex Partnership University NHS Foundation Trust – EPUT Advanced Fellowship in Psychiatry
• Frimley Health NHS Foundation Trust – International Fellowship in Regional Anaesthesia combined with MSc in Principles of Regional Anaesthesia at the University of East Anglia
• Great Ormond Street Hospital International Fellowship Programme
• Guy's and St Thomas' Hospitals NHS Foundation Trust – Critical Care
• Guy’s and St Thomas’ NHS Foundation Trust – International Clinical Fellowship Programme (ICFP)
• Guy's and St Thomas' Hospitals NHS Foundation Trust – Obstetrics and Gynaecology
• Guy’s and St Thomas’ NHS Hospitals Foundation Trust – Oncology Specialty Training
• Guy's and St Thomas' NHS Hospitals Foundation Trust – Specialty Training in Anaesthetics
• Harefield Hospital, Royal Brompton and Harefield NHS Trust – Anaesthesia and Critical Care
• Hertfordshire Partnership University NHS Foundation Trust
• Hull University Teaching Hospitals NHS Trust – International Fellows at Hull University Teaching Hospitals NHS Trust
• Humber Teaching NHS Foundation Trust - Sponsored International Fellowship Scheme in Psychiatry
• Imperial College Healthcare NHS Trust – Emergency Medicine
• Imperial College Healthcare NHS Trust – Haematology
• Imperial College Healthcare NHS Trust – International Anaesthesia Trainees
• Imperial College Healthcare NHS Trust – Intensive Care Medicine
• Imperial College, London - Clinical Research
• King’s College Hospital NHS Trusts – International Critical Care Fellowship
• King’s College Hospital NHS Trusts – Paediatric Critical Care Fellowship
• Lancashire & South Cumbria NHS Foundation Trust - Psychiatry specialty Fellowship Scheme
• Lancashire Teaching Hospitals NHS Trust - Overseas Registrar Development and Recruitment (ORDER)
• Leeds Teaching Hospitals NHS Trust – International Fellowship Programme
• Leicestershire Partnership NHS Trust – International Medical Fellowship Programme in Psychiatry
• Lincolnshire Partnership NHS Foundation Trust – CESR Fellowship in Psychiatry or Sponsored Fellowship in Psychiatry
• Lysholm Dept of Neuroradiology – National Hospital for Neurology and Neurosurgery, UCL
• Manchester University NHS Foundation Trust – International Fellowship Programme
• Midlands Partnership NHS Foundation Trust
• Ministry of Defence – International Military Clinical Fellowships
• Modality Partnership - Modality Primary Care International Fellowship Scheme
• NAViGO Health and Social Care CIC – International Medical Fellowship in Psychiatry
• NHS England, East of England - East of England International Office GMC Sponsorship
• NHS Fife – CESR Fellowship Programme in Psychiatry
• NHS Grampian – Psychiatry CESR Fellowship Programme
• NHS Grampian – Multi-specialty SAS Fellowship
• NHS Wales Shared Services Partnership (NWSSP) – All Wales International Medical Recruitment Programme
• Norfolk and Suffolk NHS Foundation Trust (NSFT) - Advanced Clinical Fellowship in Psychiatry
• North Lincolnshire and Goole NHS Foundation Trust (NLAG) Sponsorship Programme
• Northampton General Hospital – Clinical Fellowship in Regional Anaesthesia
• Northampton General Hospital NHS Trust - International Clinical Fellowship in Regional Anaesthesia, Vascular Anaesthesia, or Peri-operative Medicine
• Northamptonshire Healthcare NHS Foundation Trust – International Clinical Fellowship Scheme
• Northamptonshire Healthcare NHS Foundation Trust – International Clinical Fellowship Scheme (Psychiatry)
• Northern Care Alliance – NCA International Medical Fellowship Scheme
• Oxford University Hospitals NHS Foundation Trust – Oxford Eye Hospital
• Oxford University Hospitals NHS Foundation Trust – Oxford Intensive Care Medicine (OxICM) Sponsorship Scheme
• Oxford University Hospitals NHS Foundation Trust – Oxford University Hospitals Sponsorship Scheme
• Oxford University Hospitals NHS Foundation Trust – The Oxford International Neonatal and Paediatric Fellowship Programme
• Rotherham Doncaster and South Humber NHS Foundation Trust - Sponsored International Fellowship Scheme in Psychiatry
• Royal College of Anaesthetists – Global Fellowship Scheme (Anaesthesia or ICM)
• Royal College of Anaesthetists – MTI Scheme
• Royal College of Emergency Medicine
• Royal College of Obstetricians and Gynaecologists – MTI Scheme
• Royal College of Ophthalmologists
• Royal College of Paediatrics and Child Health – International Paediatric Sponsorship Scheme
• Royal College of Paediatrics and Child Health – MTI Scheme
• Royal College of Pathologists
• Royal College of Physicians of Edinburgh
• Royal College of Surgeons of England
• Royal College of Physicians of London
• Royal College of Physicians and Surgeons of Glasgow
• Royal College of Psychiatrists – MTI Scheme
• Royal College of Radiologists – Clinical Radiology
• Royal College of Radiologists – Clinical Oncology
• Royal College of Radiologists – RCR Specialty Training Sponsorship Scheme
• Royal College of Surgeons of Edinburgh
• Royal Devon and Exeter NHS Trust
• Royal Papworth Hospital NHS Foundation Trust – Senior Clinical Fellowship Programme in Anaesthesia and Critical Care
• Royal Wolverhampton Trust – Clinical Fellowship Programme
• Sheffield Children’s NHS Foundation Trust - Rotational Clinical Fellows in Paediatrics, Trauma and Orthopaedic International Fellows, and Subspeciality Fellows in Paediatrics
• Sheffield Health and Social Care NHS Foundation Trust - International Medical Fellowship in Psychiatry
• Somerset NHS Foundation Trust – Somerset Overseas Doctors Sponsorship Scheme
• Somerset NHS Foundation Trust – Psychiatry Overseas Doctors Sponsorship Scheme
• South Warwickshire University NHS Foundation Trust - GMC Multispecialty Sponsorship Scheme
• South West Yorkshire Partnership NHS Foundation Trust – International Fellowship in Psychiatry
• Southmead Hospital, North Bristol NHS Trust – International Obstetrics and Gynaecology Training Programme
• St Bartholomew’s Hospital, Barts Health NHS Trust – St Bartholomew’s Critical Care Fellowship
• St George’s University Hospitals NHS Foundation Trust – International Anaesthetics Fellowship Programme
• St George’s University Hospital NHS Foundation Trust (Dr Nirav Shah) – International Intensive Care Medicine Trainees
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• University Hospitals Birmingham NHS Foundation Trust - UHB LED Fellowship Programme
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KINDLY NOTE: If your sponsor is not on this list then you cannot apply using sponsorship.
If you have any further questions, please visit the GMC website for more information.

WISH YOU ALL THE VERY BEST.

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Hi Sir, I follow your articles regularly and your detailed assessment is really awesome.I am 47yrs Male with wife, 20&18 years kids, elder one is in B.Tech and younger one is 12th. My wife is a home maker. Coming to financials. I have 4 houses including the one residing worth 10cr(total) and getting rental income of 70k per month, invested in stocks and MFs worth 60L, have foreign stocks of worth 1.7cr, accumulated pf around 1.3cr. I have farm lands worth 5cr. Have 1.2cr loan and salary of ~4L (net). current sips in equity 70k/month, have 5Cr term plan, health insurance for family 50L. How do I plan my retirement at 52-53years assuming 80 years life expectancy. Don't want to depend on kids and need regular income ~3-4L per month.
Ans: Asset Evaluation
Real Estate:
You own four houses worth Rs 10 crore, generating Rs 70,000 monthly rental income. This is a solid base for passive income. However, real estate can have fluctuating maintenance costs, tenant issues, and varying rental yields over time.

Stocks and Mutual Funds:
Your Rs 60 lakh investment in stocks and mutual funds is a commendable step. Active mutual funds offer professional fund management and can outperform index funds over time.

Foreign Stocks:
Your Rs 1.7 crore portfolio in foreign stocks adds geographical diversification. Monitor currency exchange fluctuations and global market trends.

Provident Fund (PF):
With Rs 1.3 crore in PF, this is a reliable retirement corpus. The fund provides fixed returns and tax benefits, adding stability.

Farm Lands:
Farm lands worth Rs 5 crore are an illiquid but valuable asset. They might not generate consistent income unless leased or developed.

Loans:
A loan liability of Rs 1.2 crore needs prioritised repayment. Focus on loans with higher interest rates first.

Insurance Coverage:
A Rs 5 crore term plan is robust. Your Rs 50 lakh health insurance is sufficient for unexpected medical emergencies.

Retirement Goals
You need Rs 3–4 lakh monthly for 27–28 years post-retirement.
The portfolio must generate steady, inflation-adjusted returns.
Action Plan for Retirement
Debt Management
Prepay High-Interest Loans:
Use a portion of your surplus income to prepay loans. This reduces interest outflow and increases your cash flow.

Avoid New Loans:
Focus on reducing existing liabilities instead of taking on new ones.

Portfolio Restructuring
Real Estate:
Retain essential properties. Sell underperforming or non-essential properties to reduce concentration in real estate. Invest proceeds in mutual funds or debt instruments for diversification.

Mutual Funds (MFs):
Increase SIPs in actively managed funds. They outperform direct funds due to guidance from Certified Financial Planners and MFDs. Regular funds offer better tracking and professional assistance.

Stocks:
Monitor direct equity investments closely. Consider reallocating underperforming stocks to mutual funds for better management.

Debt Instruments:
Invest in high-quality debt funds or fixed-income securities for stability. These instruments balance equity volatility and ensure steady returns.

SIP Strategy
Increase SIPs from Rs 70,000 to Rs 1 lakh/month.
Allocate 70% to equity funds for long-term growth.
Invest 30% in debt funds for stability and liquidity.
Emergency Fund
Maintain a 12-month expense reserve in liquid funds or fixed deposits.
This covers unexpected expenses without disturbing investments.
Income During Retirement
Systematic Withdrawal Plan (SWP)
Use SWPs in mutual funds to generate regular income.
Withdraw 6–8% annually from your mutual fund portfolio for a steady income stream.
Rental Income Optimisation
Review property rents regularly.
Invest part of rental income in equity or debt mutual funds for compounding.
Dividend Stocks
Retain high-dividend-yield stocks for regular income.
Reinvest surplus dividends for long-term growth.
Tax Efficiency
Equity Funds Taxation:
Long-term gains above Rs 1.25 lakh are taxed at 12.5%. Short-term gains are taxed at 20%.

Debt Funds Taxation:
Both short- and long-term gains are taxed per your income slab.

Real Estate Capital Gains:
Use exemptions under Sections 54 or 54F to save tax on property sales.

Inflation Protection
Allocate 60–70% of your portfolio to equity investments.

Equity provides inflation-adjusted returns over time.

Debt funds and fixed instruments safeguard against equity market volatility.

Estate Planning
Draft a will to allocate assets transparently among family members.
Use nomination and joint ownership to avoid legal complications.
Consider a family trust for farm lands to avoid disputes.
Periodic Review
Review your financial plan every six months.
Adjust investments based on market conditions, goals, and needs.
Consult a Certified Financial Planner regularly for updates.
Finally
A well-diversified portfolio ensures financial independence post-retirement. Focus on debt repayment, portfolio balance, and tax-efficient withdrawals. Your assets can comfortably generate Rs 3–4 lakh monthly income, adjusted for inflation.

Best Regards,
K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in
https://www.youtube.com/@HolisticInvestment

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I am the eldest sibling in our families and aged 51. Normally, whenever anyone in the family has a problem - financial, mental, psychological, issue with people or anything else, they come up to discuss with me and share. Well, many would say I am lucky as people look up to me when they are in any kind of a problem. But that is not the case. Sadly no one is around with whom I can discuss or even think to share my issues, my problems. I do not have any friends. Sadly, yes, that is a fact and at my age, I dont expect that here we have a culture where we can get to making friends, at least the kind of friends with whom you can confide, share your feelings, problems. I tried and failed. Maybe because I am introvert or maybe I am too cautious. To make it more complicated, I dont work in the regular kind of job. I am a lone person who works as a freelance from home. This limits my outreach when it comes to interacting with real people. I have clients, business contacts, but I cannot get personal with them. It will never be a good choice. My wife is busy with her job + we do not have any relation beyond the daily matters related to household and it has been more than 10 years now that we live this way. Tried to sort out things with her but she just does not have time and interest (after all who wants to add on to tensions, stress). My daughter is after all my daughter - I cannot share these with her, and definitely at 10 she is too young to be one to discuss such stuff. I am not sure how far this issue can be fixed but I am hopeful to find some path here.
Ans: Dear Kevin,
Starting small can be helpful. Consider connecting with people through shared interests or hobbies, either online or in person, where the pressure to immediately open up is minimal. Online communities, local meetups, or volunteer activities can create low-stakes opportunities to connect with like-minded individuals. The goal isn’t to instantly find someone to confide in but to slowly build a sense of belonging and companionship.

Your relationship with your wife appears to be another significant source of emotional distance. While her lack of interest in deep conversations may seem like a barrier, it’s worth exploring other ways to reconnect—perhaps by spending time together in shared activities or revisiting moments that once brought you closer. Sometimes, relationships stuck in routines benefit from new experiences or even professional counseling to navigate the underlying dynamics.

Regarding your daughter, while it’s clear she cannot shoulder your emotional burdens, she can still be a source of joy and connection. Investing time in activities with her can provide a sense of fulfillment and grounding that counters loneliness.

Above all, remember that reaching out for professional support, such as therapy, is not a sign of weakness but an act of self-care. A therapist can provide a safe space to express your feelings and help you develop strategies to foster deeper connections and manage emotional isolation.

You deserve to feel supported and connected, and even if the journey to finding that seems long, every step you take toward opening up or seeking out others is a move toward a more fulfilling and less lonely existence.

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Top4 sips with 15k amount suggest me
Ans: Here’s an updated strategy for your Rs. 15,000 SIP allocation, replacing the sectoral/thematic fund with a small-cap fund for better long-term growth potential.

Suggested SIP Allocation (Rs. 15,000)
Large-Cap Fund

Allocation: Rs. 4,000/month
Objective: Stability and steady growth by investing in India’s top 100 companies.
Why Choose: Provides consistent returns and low volatility in your portfolio.
Flexi-Cap Fund

Allocation: Rs. 4,000/month
Objective: Diversified exposure across large, mid, and small-cap stocks.
Why Choose: Offers balanced risk and returns with flexibility during market cycles.
Mid-Cap Fund

Allocation: Rs. 3,500/month
Objective: Tap into the growth potential of medium-sized companies.
Why Choose: Higher returns with manageable risk compared to small caps.
Small-Cap Fund

Allocation: Rs. 3,500/month
Objective: Focus on fast-growing small-cap companies.
Why Choose: High-growth potential over the long term, though with higher volatility.
Why Include Small-Cap Funds?
Long-Term Growth: Small-cap companies have immense potential to grow significantly over time.
Diversification: Adds exposure to an underrepresented segment, complementing large and mid-caps.
High Returns: Potential for higher returns compared to other categories, albeit with higher risk.
Key Considerations
Investment Horizon: Stay invested for at least 7-10 years to mitigate short-term volatility.
Active Fund Management: Avoid direct or index funds to leverage professional expertise.
Regular Monitoring: Review fund performance periodically with a Certified Financial Planner.
Tax Implications
Equity Funds:
LTCG above Rs. 1.25 lakh/year taxed at 12.5%.
STCG (held less than 1 year) taxed at 20%.
Final Insights
This updated allocation ensures a mix of stability, moderate risk, and high growth. With consistent SIPs and periodic reviews, you can achieve robust wealth creation over the long term. A Certified Financial Planner can assist in optimising your investment strategy.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in
https://www.youtube.com/@HolisticInvestment

...Read more

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DISCLAIMER: The content of this post by the expert is the personal view of the rediffGURU. Investment in securities market are subject to market risks. Read all the related document carefully before investing. The securities quoted are for illustration only and are not recommendatory. Users are advised to pursue the information provided by the rediffGURU only as a source of information and as a point of reference and to rely on their own judgement when making a decision. RediffGURUS is an intermediary as per India's Information Technology Act.
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