26-12-2024
This is an Online E Log Book to discuss our patient's de-identified health data shared after taking his signed informed consent. Here we discuss our patient's problems through series of inputs from available global online community experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.
PPM 1 - OPD encounter with long distance IPD patient admitted yesterday.
Videoed and signed informed consent taken before archiving in the link below thanks to @PPM3.
https://youtu.be/DCVtAXdip_k?feature=shared
Patient is from WB but his problem is something that is often seen in Telangana in terms of etiology of the problem!
His son is an MSc Math in Kolkata while the parents live in a rural area and he appears to have discovered a (new for me) neurological sign! @PPM4 @PPM2 should be able to review the literature on the sign and share here.
Have shared that in the video!
PPM 1 - 👆Picture of the anatomic and etiologic neurological localization in a simple cervical spine x-ray.
PPM 1 - Complete imageology overview of the spine. 👆
Planned for laminectomy and screw fixation but these lateral mass instruments are costing 70,000!👇
PPM 1 - Post operative review day 3.
Today's update.
The patient had a operation to relieve the cervical compression due to his OPLL (hope to see the details of the operative procedure in his EMR) and reviewed him today in the fourth post operative day.
Currently his right upper limb strength has reduced from a previous 4+ to 3- and left upper limb strength has reduced to 4- while the right lower limb strength has improved from 3 to 3+ and left lower limb strength remains as previous at 3+ as also objectively documented in the video here👇
PPM 1 -
This was his previous gait 👇
13-01-2025
PPM 1 - Post operative X-ray.
PPM 1 - 👆 @PPM3 ask the PGs if they ever gave the buprenorphine patch although they have written it everyday in their notes here.
OT notes 👇
PPM 1 - Post operative site.
PPM 1 - Immediate post operative notes. 👇
PPM 1 - @PPM3 please check with the Orthopedic PG when their discharge will be made available as otherwise they may not be able to catch their flight. I shall also ask Professor sir to discharge them.
PPM 3 - Okay sir.
PPM 1 - I have also informed the Professor.
Caretaker - Sir my sister just said that the discharge will happen tomorrow. She spoke with the lady and the Professor sir will come tomorrow.
14-01-2025
Caretaker - Sir, the biggest problem right now is that he can't sleep at night due to severe pain in his hands... even after taking the sleeping tablet last night, he couldn't sleep because of the pain... he was restless all night... but in the morning, he felt somewhat better... so, sir, please check what medicines he might need."
PPM 1 - "After dinner, Paracetamol 650 mg and one hour before dinner, Tablet Amitriptyline 10 mg.
Caretaker - Ok sir.
Sir, after taking the medicine last night, around 12, he had intense pain for about an hour, then it decreased... today he was fine all day, but now the pain is a bit back, and it might get worse at night... so should the patient continue with Paracetamol and Amitriptyline?
Caretaker - Also, sir, we reached home safely.
And sir, will he eat all the food?"
PPM 1 - Yes, Amitriptyline should be taken one hour before dinner.
You can share a picture of his food plate here every day.
He won't eat sugar and refined flour. Biscuit and bread are all refined flour.
Caretaker - Okay sir.
Caretaker - "Sir, when the pain becomes intense, massaging with this helps reduce the pain a bit. So, sir, can I use this, and can I massage with any oil, like mustard oil?"
PPM 1 - This contains diclofenac, so it's better not to use it. Mustard oil is fine."
Caretaker - Ok sir.
Caretaker - Dinner.
PPM 1 - 👍
16-01-2025
Caretaker - Lunch.
Dinner
Caretaker - Sir, the pain in the hands starts at night... sometimes it becomes very intense for about 30 minutes to an hour and then becomes normal again... and during the day, everything is completely fine."
Sir currently both hands are hurting almost all night. Sometimes it hurts a lot for 1 hour then it comes back to normal. And during the day he is completely healthy.
PPM 1 - Is he taking paracetamol 650 mg after dinner? Also add tablet Ultracet 1/2 tablet to it.
EMR SUMMARY
Age/Gender : 56 Years/Male
Address :
Discharge Type: Relieved
Admission Date: 25/12/2024 11:15 AM
Date of Operation
3/1/2025(C3-C7 POSTERIOR SPINAL STABILIZATION+C3-C7 LAMINECTOMY)
Diagnosis
C3-C7 CERVICAL MYELOPATHY WITH L5-S1 MILD LUMBAR CANAL STENOSIS
Case History and Clinical Findings
56 YEAR OLD MALE CAME TO OPD WITH COMPLAINT OF NECK AND LOWER BACK PAIN SINCE 5 YEARS
WEAKNESS OF RIGHT LOWER LIMB SINCE 5 YEARS WHICH IS SPONTANEOUS IN ONSET , GRADUALLY PROGRESSIVE IN NATURE AGGRAVATED ON MOVEMENTS AND RELIEVED PARTIALLY WITH REST AND MEDICATION. NOT ASSOCIATED WITH ANY RADIATING PAIN OR TINGLING SENSATION
NO H/O TRAUMA / FEVER/BURNING MICTURITION/BLADDER AND BOWEL INCONTINENCE NO COMORBIDITIES
O/E
PATIENT IS CONSCIOUS COHERENT CO-OPERATIVE GC FAIR
AFEBRILE BP:130/90MMHG PR:72/MIN
LOCAL EXAMINATION OF SPINE- SWELLING ABSENT
SKIN NORMAL
LOCAL RISE OF TEMPERATURE ABSENT
TENDERNESS- DIFFUSE MIDLINE OVER C-SPINE, LS-SPINE TONE-SPASTIC
POWER- LEFT -
SHOULDER-5/5 ELBOW-5/5 WRIST-5/5 HAND GRIP-5/5 HIP-5/5
KNEE-5/5 ANKLE-5/5 EHC-5/5 FHC-5/5
SENSATIONS-INTACT REFLEXES-
BICEPS-EXAGGERATED TRICEPS-EXAGGERATED SUPINATOR-EXAGGERATED KNEE-EXAGGERATED ANKLE-EXAGGERATED PLANTAR-EXTENSOR RIGHT-
SHOULDER-5/5 ELBOW-5/5 WRIST-5/5 HAND GRIP-5/5 HIP-5/5
KNEE-5/5 ANKLE-5/5 EHC-5/5 FHC-5/5
SENSATIONS-INTACT REFLEXES-
BICEPS-EXAGGERATED TRICEPS-EXAGGERATED SUPINATOR-EXAGGERATED KNEE-EXAGGERATED ANKLE-EXAGGERATED PLANTAR-EXTENSOR
Investigation
NameValueNameValueBLOOD UREA25-12-2024 11:38:AM
28 mg/dl
SERUM CREATININE
25-12- 2024 11:38:AM0.8 mg/dl
SERUM ELECTROLYTES (Na, K, C l) 25-12-2024 11:38:AMSODIUM139 mmol/LPOTASSIUM4.1 mmol/L
CHLORIDE99 mmol/L
LIVER FUNCTION TEST (LFT) 25-12-2024
11:38:AM
Total Bilurubin0.65 mg/dl
Direct Bilurubin0.17 mg/dl
SGOT(AST)25 IU/L
SGPT(ALT)32 IU/L
ALKALINE PHOSPHATASE138 IU/L
TOTAL PROTEINS7.0 gm/dlALBUMIN4.25 gm/dl A/G RATIO1.55HBsAg-RAPID25-12-2024 11:38:AM
Negative HBsAg-RAPID28-12-2024
09:37:PM
Negative Anti HCV Antibodies - RAPID28-12-2024 09:37:PMNon Reactive BLOOD UREA28-12-2024 09:37:PM19 mg/dl SERUM CREATININE28-12-2024 09:37:PM0.9 mg/dl SERUM ELECTROLYTES (Na, K, C l) 28-12-2024 09:37:PM SODIUM138 mmol/LPOTASSIUM4.2 mmol/LCHLORIDE101 mmol/LPHOSPHOROUS28-12-2024 09:37:PM2.7 mg dl LIVER FUNCTION
TEST (LFT) 28-12-2024 09:37:PM Total Bilurubin0.60 mg/dl Direct Bilurubin0.18 mg/dl SGOT(AST)18 IU/LSGPT(ALT)18 IU/LALKALINE PHOSPHATASE124 IU/LTOTAL PROTEINS6.4 gm/dlALBUMIN3.8 gm/dl A/G RATIO1.46COMPLETE BLOOD PICTURE (CBP) 28-12-2024 09:37:PM HAEMOGLOBIN12.1 gm/dl TOTAL COUNT6500 cells/cummNEUTROPHILS37
%LYMPHOCYTES50 %EOSINOPHILS06 %MONOCYTES07 %BASOPHILS00 %PLATELET COUNT2.20SMEARNormocytic normochromic COMPLETE URINE EXAMINATION (CUE) 28-12- 2024 09:37:PMCOLOURPale yellowAPPEARANCEClearREACTIONAcidicSP.GRAVITY1.010ALBUMINtraceSUGARNilBILE SALTS Nil BILE PIGMENTS Nil PUS CELLS3-4EPITHELIAL CELLS2-3RED BLOOD CELLS Nil CRYSTALS Nil CASTS Nil AMORPHOUS DEPOSITS Absent OTHERS Nil COMPLETE BLOOD PICTURE (CBP) 03-01-2025 09:40:PMHAEMOGLOBIN13.6 gm/dl TOTAL COUNT16000 cells/cummNEUTROPHILS91 %LYMPHOCYTES06 %EOSINOPHILS01 %MONOCYTES02
%BASOPHILS00 %PLATELET COUNT2.96SMEARNormocytic normochromic with neutrophilic leukocytosis
Treatment Given(Enter only Generic Name)
56 YEAR OLD MALE CAME TO OPD WITH PAIN OVER NECK AND LOWER BACK SINCE 5 YEARS.CLINICORADIOLOGICALLY DIAGNOSED DIAGNOSED WITHC3-C7 CERVICAL MYELOPATHY WITH L5-S1 MILD LUMBAR CANAL STENOSIS.AFTER PAC AND INFORMED CONSENTC3-C7 POSTERIOR SPINAL STABILIZATION+C3-C7 LAMINECTOMY DONE ON 3/1/2025.POD 2,5,10 DRESSINGS WERE DONE.POST OPERATIVE PERIOD WAS UNEVENTFULL
1 INJ MAGNEX FORTE 1.5 GM IV BD
2 INJ AMIKACIN 500MG IV OD
3 INJ METROGYL 100ML IV TID
4 INJ NEOMOL 100ML IV TID
5 INJ PAN 40 MG IV OD
6 INJ ZOFER 4MG IV OD
7 INJ TRAMADOL 50 MG IN 100 ML NS SLOW IV SOS
8 IVF 1. RL AND 1.NS @75 ML/HR
Advice at Discharge
1. TAB CEFTAS CL 200MG PO BD X 5 DAYS
2. TAB PAN 40MG PO OD X 5 DAYS
3. TAB SHELCAL CT PO OD X 15 DAYS
4. TAB LIMCEE 500MG PO BD X 15 DAYS
5. TAB EVION LC PO OD X 15 DAYS
6. TAB.TRIGABANTIN 300MG PO H/S X 1 M0MTH
7 TAB AMLONG 5MG PO OD TO CONTINUE
8 BUPINORPHINE PATCH FOR LOCAL APPLICATION IF PAIN
Follow Up
REVIEW AFTER 15 DAYS TO ORTHO OPD OR SOS
When to Obtain Urgent Care
IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR ATTEND EMERGENCY DEPARTMENT.
Preventive Care
AVOID SELF MEDICATION WITHOUT DOCTORS ADVICE,DONOT MISS MEDICATIONS. In case
of Emergency or to speak to your treating FACULTY or For Appointments, Please Contact: For Treatment Enquiries Patient/Attendent Declaration : - The medicines prescribed and the advice regarding preventive aspects of care ,when and how to obtain urgent care have been explained to me in my own language
SIGNATURE OF PATIENT /ATTENDER
SIGNATURE OF PG/INTERNEE SIGNATURE OF ADMINISTRATOR SIGNATURE OF FACULTY
Drugs
Drug-Dosage Drug-Dosage Drug-Dosage
10ML SYRINGE (LIFELONG)- 2ML SYRINGE (LIFELONG)- 3WAY 100CM EXTENSION(VEIN-O-LINE)-
ABSORBENT COTTON - 400 NETT- ALINFEC - 500MG - INJ(AMIKACIN)- AMLOHOM - 5MG TAB(AMLODEPIN)-
AQSILK-1-0 R/C AM5037- AQSOLVE -1 R/C- 2421 - ATROMED - INJ (ATROPINE)-
ATRYPEX - 25MG TAB(AMITRIPTYLINE)- BLOOD SET (LIFE LINE)- BUPRIGESIC 5MCG -PATCH-
CALVIC -D TABLET(CALCIUM)- CARLY 200MG - TAB(CEFIXIME)- CORTIBEST -100MG INJ(HYDROCORTISONE)-
DISPOVAN SYRINGES - 5 ML- DYNOPLASTER ( MEDIGRIP) )- ENDOTRACHEAL TUBE - 7.0 (ROMSONS
)-
ENDOTRACHEL TUBE - 7-5 SIZE - MEDIKIT- EVIKEM - LC TAB(L-CARNITINE -VIT -E)- EVMOL - 650MG TAB(PARACETAMOL)-
FENT -2ML INJ [FENTANYL]- FOLEYS CATHETER - 14 (POLYMED)- GABAKEM - 300MG TRIO- GABA &METHYLCOBALAMIN)-
HYDROGEN PEROXIDE - 100 ML- IGNIUM - 1ML INJ(NEOSTIGMINE)- IO DRAPE-MEDIUM ID-3025-
IV CANNULA -18G- MEDIKIT- IV DNS -500ML (PUNISKA)- IV NS - 500ML (PUNISKA)-
IV NS 100ML -PUNISKA- IV RL - 500ML - (PUNISKA)- IV SET - MEDIKIT-
JODDY PLUS GEL(DICLOFENAC GEL)- LIMCEE CHEW TAB- MEZOLAM - 10 ML-
NEOROF 1 % - 20 ML(PROPOFOL)- NEOVEC - 4MG - INJ- OXYGEN MASK ADULT - (LIFE O LINE)-
PANRAS - 40MG TAB(PANTOPRAZOLE)- PAPER PLASTER -1/2'- PETCRYL - 1-0 R/C 2534-
PIMET - POVIDONE IODINE SOLUTION - 100ML- PYROLATE - 1 ML- Q-METH -40MG INJ(METHYLPREDNISOLONE)-
REVERSEE- 2ML - INJ(SUGAMMADEX )- ROLLER BANDAGES - 6'- ROMOVAC SET - NO. 14-
SHERCEF - 1GM INJ(CEFTRIAXONE)- SKIN STAPLER (AQMEN )- SPONDYLOSIS COLLAR -LARGE -0101-
SPONGILUS GELSPON - STERILE WATER - 10 ML- SUCCITHEM - 10ML(SUCCINYLCHOLINE)VAIL-
SUCTION CATHETER - NO:14 [ROMSONS]- SURGICAL BLADE - NO. 11 - SURGICAL BLADE - NO. 22-
SURGICAL BLADE NO-15- SURGICAL GLOVE - NO:7-0 [SURGICARE]- SURGICAL GLOVE -7.5 -AQMAX)-
SURGICAL SPIRIT - 100 ML- TRAXAMAK - INJ - 5ML (TRANEXAMIC)- TUCIN - AM - 100ML SYRP-
URINE BAG ADULT - MEDIKIT- WAXOCARE - BW810- ZOSTUM -1.5G INJ(CEFOPERAZONE&SULBACTAM)-
Discharge Date
Date:14/1/2025
Ward: MOW Unit: ORTHO I
16-01-2025
Caretaker - Yes sir as you said, he is taking paracetamol after dinner.
Sir Ultracet should be taken after dinner?
17-01-2025
PPM 1 - Yes.
Caretaker - Okay sir.
The patient was much better yesterday night than the previous night.
PPM 1 - 👍
Caretaker -
Breakfast.
Lunch
Dinner.
PPM 1 - He may need to reduce the quantity of rice and add more salads and fruits
Can follow this patient's PaJR to see how it's done 👇
Caretaker - Okay sir.
18-01-2025
Caretaker - Dressing time. Sir is it ok?
PPM 1 - Yes.
Dinner.
PPM 1 - 👍
19-01-2025
Lunch
Dinner
PPM 1 - 👍
20-01-2025
Caretaker - 
PPM 1 - 👍
Caretaker - Sir both feet and hands are swollen since two days. Sir, will there be any problem?
PPM 1 - Is he walking well?
Caretaker - Yes sir.
A little better than before.
Sir just like you saw in the hospital.
PPM 1 - And his upper limbs?
Caretaker - Sir he has some strength in his left fingers but no strength in his right arm.
But both hands can't lift up. Arm hurts when trying to lift. Sir he can move both hands.
Lunch
Dinner
21-01-2025
Caretaker - Dinner 👇
Lunch 👇
Caretaker - Sir, the pain has reduced a lot. Arm hurts when trying to lift.
So sir, will he continue to take paracetamol and amitriptyline?
PPM 1 - Can stop the paracetamol.
Caretaker - Okay sir.
22-01-2025
Caretaker -
Dinner
Lunch
PPM 1 - 👍
23-01-2025
PPM 1 - 👍
26-01-2025
Caretaker - Lunch
Dinner
27-01-2025
PPM 1 - 👍
29-01-2025
Caretaker - Sir the x-ray reports after 15 days 👆 Sir is it okay?
Sir currently the feet are better than ever. Walking has been a little better than ever.Sir it is not walking balance for the weakness of the hand.
The left foot is just as good as before the operation.
But the right foot has been a little better than that was bad before the operation.
The left hand now can lift up fairly, the power has arrived roughly. The left finger is still a lot of weakness but being a little better than ever.
The lower part of the right hand has been much better, can lift up, but the upper part is still much less power and could not lift up.
Sir it hurts when he tries to lift and down the hands.
Sir currently running Gabakem-300 trio, Bp tablet and amitriptyline.
Sir will require more drugs?
PPM 1 - Thanks
Good to hear that he's getting better.
Looks good.
Will share with the surgeon.
Caretaker - Yes Sir I have already shared to him.
PPM 1 - 👍
Caretaker - Thank you sir.
Sir will he continue to take amitriptyline?
PPM 1 - Yes one hour before dinner.
Caretaker - Okay sir.
01-02-2025
Caretaker - Lunch
02-02-2025
Caretaker - 
PPM 1 - 👍
PPM 1 - 👍
What were his hourly activities from morning to evening today?
Caretaker - Sir at 8 am he woke up then he brushes and eats breakfast and then he took BP tablets. Then he did a little walk and the hand exercise for 15 minutes then he sat down and sometimes walk a little. At 12 noon he took a bath and lunch . After lunch he took EVION LC, then he resting for a while. In the aftetnoon he walked again and took some fruits.In the evening he again exercise the hand for 15 minutes and then sat down. At 7 pm he took AMITRIPTYLINE then at 8 pm he took dinner and after dinner he took GABAKEM-300.At 9 pm he fell asleep.
PPM 1 - 👍
05-02-2025
Caretaker - Sir just like this day ۔۔۔۔ just slept 1 hour at noon.
Sir can we do physio at home ??
PPM 1 - 👍
caretaker - Sir what kind of physio will do?
PPM 1 - Show a local physiotherapist once.
Caretaker - Okay sir.
Caretaker - Patient had breakfast with poha and curd.
He woke up at 8 am. Then brushed and then a little walking and exercising the hand for 15 minutes and now eating breakfast.
PPM 1 - Share deidentified videos of his current hand exercise routine if possible.
You can take the deidentified video and then host it in your own YouTube channel and share the link here as shown here 👇
Caretaker - Okay sir.
PPM 1 - But also keep your channel deidentified as others may be able to identify the patient if they can identify that it's your channel.
Caretaker - Okay sir.
Caretaker - https://youtu.be/Tx59CsejRt0?si=xdokjniUkyrdx2vt
The Current Situation Of the patient & The Exercises. 👆
Sir a physiotherapist came and just massaged the patient. the patient is doing the exercised shown in the above video.
Sir is there need for more exercises?
Sir currently he took bp tablets after breakfast, Evion LC after lunch and amitriptyline 1 hr. before the Dinner.
Dinner with roti, leafy dal and sabji at 8pm.
13-02-2025
Caretaker - Lunch
PPM 1 - 👍
PPM 1 - Thanks.
Video Well done 👏👏
Good to see that he's recovering so well.
Continue the same physiotherapy and we too shall suggest a few more.
I've added Prof for that. I thought he was already in this group and realised just now that he wasn't.
Prof please go through his case report in the description box and let us know your thoughts.
Professor - 👍
15-02-2025
Professor - Very good exercises. Need to add on Occupational Therapy now. List the Activities of Daily Living (ADL) as possible/not possible👇🏻
1. In and Out of Bed
2. Walking inside/outside
3. Toilet routine
4. Stairs/Slope
PPM 1 - @Caretaker please answer if 1,2,3,4 routine action points aka ADL above are possible for this patient or not.
From the data already shared in the patient's evolving videos my hunch is that 1,2,3 should already be possible although the quality of it is important to discern while I am not sure about 4.
Professor - Perhaps 3 may not be even if 4 possible.
I need details of 3.
अमिताभ बच्चन का सिनेमा याद कीजिए - रोटी, कपड़ा, और मकान - हमें प्राथमिकताएं बताता है
Feeding, Dressing, Residential activities are in line of priority
PPM 1 - Perhaps he's using a chair based toilet like this one 👇
But will need to confirm with @Caretaker.
Caretaker -
1. Sir he can sleep on bed alone but if help is there it's better as he cannot get up from the bed as he has very less strength in his hands.
2. He can walk alone inside the house or outside but needs a walking stick for some help as he cannot balance properly to start walking after sitting or lying down een for a short time.
3. Sir there are few stairs at the toilet and someone has to help him. Already used the toilet chair and can sit alone in the chair and needs someone to clean the chair.
4. He can't climb or go down the stairs alone.
He can eat alone with both hands as the right hand cannot be lifted. He was advised by the surgeon to not bend forward for three months so he was fed. Some foods he can eat by himself. He needs help in dressing clothes as his hands are very weak.
Okay sir, we will take a physio center in two days.
Caretaker - Sir he uses this chair 👆
Professor - Ask for Occupational Therapist, if available. PT can't solve those issues.
PPM 1-
Occupational therapists are not even availability in our hospital! I wonder why? Is there a dearth of occupational therapists in India?
Caretaker - Ok sir will try.
26-02-2025
Caretaker - 56M current situation.
56/M . Current Situation After 54 Days Of Surgery.👇
Sir, The Upper Limbs have been better than ever. The left hand is fairly free and the right hand is better than before. The phisio therapy by a therapist and the exercise are contineuing.
But, after all the medicine are stoped the right leg is just getting sick as before the surgery and left leg is just as okay as before.
And Sir one more thing to note is that in sleeping time the lower limbs are pulled by themselves and this problem is increasing day by day.
Sir just amitriptyline is continuing.
PPM 1 - Alright so this means he is somewhat back to the same position that he was prior to the surgery?
We know that the lower limbs getting pulled by themselves (aka flexor spasms due to UMN spinal cord involvement) was there earlier before the operation but was it less for few weeks after his operation?
Caretaker - Yes sir.
This problem has begun since all sort of medicine stopped.
PPM 1 - Which problem? The flexor spasm?
How long was it reduced on medicines?
While there aren't many medicines for it, we may have given him baclofen in the past and that may have reduced the flexor spasm slightly but please share since how many days were these flexor spasms not noticed and what medications was he on during that time.
Caretaker - Sir Yes the flexor spasm and sir the right leg is a littile weak also.
Sir this problem being from 5/6 days.
And before 5/6 days he took Gabakem-300 trio after dinner & Evion LC after lunch.
And After breakfast BP tablets also.
PPM 1 - Has he stopped his BP tablets also.
Caretaker - Yes sir
PPM 1- 😮
Gabakem is for tingling pain. It will not help in preventing weakness
Evion is a placebo and will not help.
Please share his BP recordings hourly today asap.
How is his urination?
Caretaker - Sir urination is normal. That's good.
Okay sir.
Sir need any medicines now.
PPM 1 - Share his BP recordings hourly.
Did he have any problem with his urination earlier?
Caretaker - Sir, will bp tablets turn on?
No sir.
PPM 1 - Check his BP hourly and share it here.
Caretaker - Sir we have no sphygmomanometer and we live in a village. that's the problem sir.
But We try it once in a day.
PPM 1 - Electronic BP measuring instruments are available and can be ordered. They are simple to check with just a single press button.
PPM 3 - Urine force, time to pass it, complete passing all are important.
Caretaker - Okay sir.
PPM 1 - Since how long has the patient noticed this flexor spasm and for how many days was it absent and not noticed recently after the operation?
PPM 3 - Can you count pulse?
PPM 1 - He can easily learn that.
Caretaker - Yes sir.
PPM 3 - Please count for full 15 sec and get back.
If pulse oximeter of COVID time is at home, it is better.
Caretaker - Sir after operation it was greatly reduced. But from last 5/6 days that was noticed and he cannot say. He was sleeping.
No sir.
PPM 1 - Noticed how many times in the last 5 days?
Caretaker - Sir especially at night and it was continuing.
Sir after 5/6 minutes interval.
Sir Urine Force is a little too much it was same as before the operation.
PPM 3 - Good👍🏻
Caretaker - Sir 16 times/ 15 sec.
PPM 3 - Good👍🏻
01-03-2025
Caretaker - Today's BP - 140/80 after breakfast.
Patient had dinner with Pulka, dal and sabji.
PPM 1 - 👍
[04-04-2025 14:54] Caretaker: https://youtu.be/QIF-VN-ZAvs?si=Qb7weKKzCQUskEuo
[04-04-2025 14:55] Caretaker: Sir currently he is far better. His physiotherapy and exercises are going on and sir his bp and sugar are normal.
[04-04-2025 14:56] Caretaker: Sir all the medicines are now stopped from 15 days. Sir now a big problem is specially when he is sleeping at night the lower limbs pulls towards himself as you watch in the video and this problem continues for the whole night and he is not able sleep properly. And one another problem is sometimes the fingers of upper limbs pull towards himself.
And with all these reasons his lower and upper limbs are paining and the right foot, the fingers of upper limbs have become weak. He has no balance in the body for walking.
[04-04-2025 14:56] Caretaker: Sir when he took medicines the problems have reduced and he was far better. Sir when he stops the medicine, the problems are increasing.
[04-04-2025 14:57] Caretaker: Sir last time he took Trigabantin 100 at night and Evion Lc at afternoon.
[04-04-2025 15:00] Caretaker: Good after noon sir. Please see the situation.
Sir I also sent this to the surgeon.
[04-04-2025 16:41] PPM 1: These are flexor spasms.
When did he start taking Trigabantin 100 at night and Evion Lc at afternoon and after how many days did the flexor spasm stop? After how many days of stopping the trigabantin and evion did the flexor spasms return?
[04-04-2025 16:43] PPM 1: 👆Please YouTube and archive these "flexor spasms through the blanket" too similar to how you have youtubed his current progress here 👇
Is it that cold now that he still needs that kind of a blanket or was this video taken earlier?
[04-04-2025 16:48] PPM 1: https://youtu.be/GgdquAH6lOQ?feature=shared
[04-04-2025 17:28] Caretaker: Sir the medicine( Trigabantin 100 & Evion lc ) started 30 days ago and took for 15 days.
Sir the flexor spasms is not completely closed but it is reduced within two days after taking medicine.
Sir the flexor spasms is slowly increasing from the next day when the medicine stopped .
[04-04-2025 17:29] Caretaker: Sir the blanket video is current.
Sir last night i captured the video.
There are a still light cold night in our village.
[04-04-2025 17:31] Caretaker: Sir now the surgeon suggest to take tab pregaba m at night time for 1 month.
Sir, will it(pregaba m ) continue ??
[04-04-2025 18:49] PPM 1: Can restart same medication of Trigabantin and evion as it appeared to have worked earlier.
After that instead of stopping them together first we will try stopping Evion
[04-04-2025 19:16] Caretaker: Okay sir
[04-04-2025 19:16] Caretaker: Thank u sir 🙏
No comments:
Post a Comment