PaJR Case Reports: 63M, Weight Loss, Crohn's Label WB PaJR.

A 61 Yr old man suffering from severe wt loss.

25-07-2022

This is an online E Log book to discuss our patients de-identified health data shared after taking his signed informed consent.

Patient History

The patient is a 61yr old male retired school teacher. In 1972 at the age of 11 the patient was diagnosed with internal hemorrhoids where his father was also a patient of hemorrhoids. The patient had no complaint of any pain or bleeding before he was diagnosed. Recommended SX. Hemorrhoid banding tech.used.

When he was in class9-10, he experienced digestive problems like acidity, abdominal pain and loose stools. Due to unavailability of water purifiers they had to boil water for drinking as the water was rich in iron. The patient feels this as one of the reason for his problems.

In 1977 after completion of his primary education, the patient joined a high school 15kms away from home. He travelled 3km by cycle and 12km by bus to school. Traveling late in the night from school to home and getting drenched in the rainy season he would become sick with cold and cough.

He practised Yoga for 2yrs and got relief from breathing problems and SOB.

In 1979 the patients father made a homemade water filter which helped in resolving his digestive problems to some extent. In 1986 the patient went to Yoga center in Assam and was taught some techniques of cleansing his stomach by taking lemon water on empty stomach and insert a pipe into his stomach and vomit out all the content of his stomach by contracting abdominal muscles. He felt relief and continued this process for some time once in a week. The other process he followed was cleansing his nasal passage by inserting a pipe in the nose and taking out through his mouth.

In 1996 due to hectic schedule, he lost 5kg weight within a year and felt very weak. He was diagnosed with Tachycardia and was prescribed Inderal 10. His weight gain was better by 10kg

(47-57) in 2 yrs.

In 2005 the patient broke his right hand scaphoid bone while playing volleyball at school. He had bandage for 56 days, and went to work. One day while trying to catch a moving bus, he got his lower back sprained. Later with the pain he felt a tingling sensation in his right leg. He continued medicines prescribed by a neurologist for one and half year. Inspite of recovering from the pain he was asked to continue the medicines. On the advice of another physician he was asked to stop the medicines immediately, but again consulted a pharmacist and was prescribed Inderal tablet in a sequence of 10mg-5mg-2.5mg and then stop accordingly.

In 2010 he was diagnosed with glaucoma in the right eye. In 2011 he was prescribed eye drops Dorzox T and Lumigan 0.01 and was advised to check eye pressure once in 4 months. In 2012 he was detected with HTN , and Amlodac was prescribed. The same year he noticed blood with hard stools, 3 times in 6 months due to hemorrhoids and was advised an ointment to control bleeding.

In 2016 he lost weight from 59 to 55 kg and was diagnosed with hypothyroidism with TFT, TSH IvI.12.5/U/L. Later he got the tests done again and found TFT, TSH,IvI. 6m/U/L, Hb IvI- 6g/dL. For abdominal pain vomiting, for consultation of wt.loss and low Hb.IvI. colonoscopy was done to rule out internal bleeding. He was detected with anemia and was on Feronia XT. His PPBS was found to be 160 and was given iron infusion and FeroniaXT. His HbIvI rose to 10g/dL and abdominal pain and vomiting reduced significantly.

In 2017 his TSH IvI.14m IUL , was prescribed Thyrox 37.5. Now TSH is 3.3mgU/L.

In 2019 he was diagnosed with IBS and was advised no milk at all.

In 2020 his abdominal pain intensity increased and vomited 2-3 times in a month. Was intolerant to spicy foods.

In 2022 he joined an online Yoga and was advised some protein powder and some Yoga techniques. After 15 days his weight reduced from 55- 52kg. In 2 months he came down to 49kg and Hb 8.4g/dL. Discontinued Yoga. He is a teetotaller and does not smoke, sometimes pain and nutmeg.

CURRENT CHIEF PROBLEMS AND

PATIENT'S REQUIREMENTS:

The patient with episodes of abdominal pain and vomiting throughout the day, twice a month, was intolerant to spicy food.

23-07-2022

Even with veg home made food, he experienced vomiting. The patient is not putting on weight more than 49kg. Earlier when he was diagnosed with IBS, he tried Ayurvedic herbal tonic for digestion on his own, after which his hunger improved.

26-01-2023

PA- Yesterday's stool color pic and today morning the same. Since last ten yrs the patient have never seen this type of stools.

From 2000 - 2013 , the above problem occurred yearly thrice or more.

FAMILY HISTORY

Father used to suffer from indigestion .

Mother was healthy, Brother has HTN and maternal grandfather had DM. Sister aged 56 had HTN, Hypothyroidism and ten years ago had gallstone SX.

PATIENT'S DIET PLAN

8am- Breakfast , Curd, flattened rice,

1 banana, 1 date.

9-10.30am- Dry fruits (raisin,cashew,

almond mixed.

11am- 1st meal- 1scoop rice, 1 boiled egg

and dal.

2 pm - Lunch- 3 scoops rice, fish, dal and

mixed vegetable.

6-7.30pm - Sugarless black tea,

Sometimes dry fruits.

9-9.30pm- Dinner- 2 scoops rice, fish, dal

Mixed vegetable.

28-06-2022

UPDATED FROM PATIENT'S DIARY

6.30AM- Wake up and get fresh. Has

Thyrox 37.5 with lukewarm

Water.

7 am- Walking for 35 min.

7.45am- Breakfast- Banana, sattu

Dates.

8.30am- Dry fruits (almond, cashew,

pista). On computer

10.30am- 2 pieces roti, curd, boiled egg

with vegetables.

Quality time with grandson.

12.30pm- Fruits(tangerine)

1 pm. - Shower

2 pm - Lunch- rice, dal, sabzi, paneer

and curd.

2.30pm- Nap, newspaper and quality

time with grandson.

5.30pm- Dry fruits (almond, cashew,

walnut)

7.30pm- Sugarless black tea and

puffed rice with a bit of oil

and chilly. After that attended

a few calls, internet surfing

and studies.

10 pm- Dinner- Rice, sabzi and egg curry

11.15pm- Sleep time.

WEIGHT LOSS TREND

1995 - 47 Kg

1998. - 52 kg

2000 - 55kg

2008 - 63kg

2009 - 61kg

2010 - 59kg

2011 - 56kg

2012 - 57kg

2015 - 56kg

2016 - 55kg

2017 - 56kg

2018- 57kg

2019- 55kg

2020- 56kg

2021 - 55kg

2022- 55kg (Jan 28)

2022- 49kg (March 15)

2022- 48kg (April)

2022- 48kg (May)

2022- 48kg (June)

2022- 48kg (July)

2022- 49kg (August)

BLOOD PRESSURE

6.10 am. 120/77. Pulse 77.

8.40 am. 116/84. Pulse 82

10.30am 123/79. Pulse 84

11.45am 126/76. Pulse 79

1.10pm. 109/66. Pulse 74

3.10am. 122/79. Pulse 86

4.30am 113/75. Pulse 74

5.55am. 119/82. Pulse 77

7.30pm. 124/81. Pulse 80

8.50pm. 129/84. Pulse 78

CDSS ( Conservationnal Decision

Support System)

26-01-2022

PA- 8.38am The patient noticed blood in the closet last night. Today morning also he could notice on the hard closet. The insurgency was mild long ago. But for the last ten years there has been no blood.

PPM 1- 8.41am Good morning. I am inquiring about the outcome of your blood transfusion procedure following the severe injury ( which I thought was unnecessary) could you please provide the following information

How many units of blood were transfused after the operation.

What was your last hemoglobin level?

How many units did it decrease by?

When did it decrease?

Has your blood pressure become normal?

PA- 8.50 am- Blood fell 3 times a year until ten years ago(2013). The first blood fell probably after 2000. Hemoglobin was first reduced in 2016.

PPM - 8.55am- Hemoglobin koto bar ta komechilo?

PA- 9.09am- 12 + lived. Stand at 6 in 2016. It was 10+ after the iron injection.

Although I did not see blood falling then.

PPM - 9.10am- 2016 Chara are kobe kobe komechilo?

PA- 9.12am- No more, contains 11+

Do you take any medicine to stop bleeding

PPM- 9.39am- Abar rokto parle botha owner bonhomie hoyeche ki hoini.

PA 9.40am - There is.

19-09-2024

PA- Medication for the period Nov 2023 to Feb 2024

1. Steroid thrice daily for one month. Twice daily for second month and once daily for third month.

2. Ezoran 25

3. Thyrox 25

4. Pantasa 1g.

Medication for the period March 2024 to May 2024

1. Thyrox 25

2. Ezoran 50

3. Pantasa ( 1g/ day)

4. FeroniaXT

5. Folvite 5

Medication for June 2024- August 2024

1. Thyrox 25

2. Ezoran 75

3. FeroniaXT

4. Folvite 5

Medication for present week

1. Thyrox 25

2. Ezoran 75

3. Folvite 5

4. Colospa X( for 10 days twice daily,

SOS)

5. Peptamen food supplement.

Above are the medication from the patient's present Doctor. Since Jan2023 to October 2023 the patient's previous Doctor tried with Pantasa 2 g and Ezoran without steroid. As a result the patient's CBC result worsened. So skipping this Medication the patient took second opinion from Manipal hospital who is presently supervising him.

PA- Patient's daily routine updated

6. am Wake up. No morning walk as he was underweight. Light physical exercises and walk short distance for daily needs.

6.30am- Breakfast, Idly, dosa, banana and sour curd. Sometimes puffed rice.

7.30am- Going to market for an hour.

Being a creative writer spends time in writing and literary studies.

10 am- Papaya or watermelon. He was advised strict low fiber diet.

12 pm- Bath

1 pm- Lunch rice, low fibre vegetables, dal

Fish and chicken once or twice in a month.

Evening- Light snacks.

Dinner- Rice with vegetables and dal.

10 pm- Go to bed.

PA- Physically the patient is fine , but for a mild pain in the naval area, mostly on empty stomach. Finds relief after taking food.

PPM- The patient appears to be doing well. Eventually I guess the PA will incorporate all these into his case report so that the doctor team would come to know.

PA- The patient has to follow only low fibre diet, daily the same. Hence did not share the pics of food plates.

Crohn's Disease Activity Index. (CDAI)

Instructions- Signs, symptoms and history should be based on the past 7 days. Note for abdominal pain and general wellbeing ratings this calculator uses an average rating per day over the past 7 days. For stools use the total number of soft liquid stools over the past 7 days.