37M w/c/o Anxiety, Gastric Problems

 

October 11, 2022

NOTE: THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT. 

PATIENT HISTORY: Pt is a 37-yr old male, govt employee by profession, and also enjoys doing tuition. 

In 2004 Feb, started smoking cigarettes (3-4/day, occasionally 1-2 bidis) while in college due to peer pressure. In 2005, smoked 6-7 cigarettes/day. 

In 2006, during the graduation exam c/o rt side chest pain and dry cough. Dr. gave medications. Since exams were going on he took an overdose of Ambrolite D (felt good) thinking it will help him recover faster. Within a few days, symptoms resolved. For 3 months he stopped smoking due to health concerns.

Due to exam fear (desire to score highest) since childhood, he c/o abd cramps and urgency to defecate. Mucus-laden loose stool during exam time. Sometimes, would take Metronidazole before going to the exam. He noticed taking milk and milk products aggravated the symptoms. So, stopped taking milk products. 

He stressed a lot about the exam outcomes and had negative thoughts. After scoring better than expected, he was over-excited and c/o palpitation and shivering. After taking rest for a day, he became alright.

He also did take homeopathy medicines whenever he had c/o abd cramps, mucus laden stool, which used to resolve the symptoms temporarily.

In 2007, during the final exam, his c/o abd cramps, mucus-laden stool, and borborygmus increased multi-folds. Dr. prescribed Ofloxacin and Ornidazole. He developed an ulcer on his glans penis and mucosae of upper and lower lips as a side effect, which was resolved by stopping the O2 tab. Afterward, whenever he takes O2 tablets the same side effects reappear. 

Since 2007, his dental issues started resulting in 6 tooth extraction and 7 RCT to date.

While doing Masters in 2007, continuous c/o abd cramps, mucus-laden loose stool, sometimes abd bloating, and borborygmus. Dr. suggested doing a colonoscopy and endoscopy whose reports were normal and prescribed medications that have him temporary relief. Did not seek further treatment. Sometimes took Metronidazole and ORS when symptoms were aggravated by study-related stress and overthinking.

In 2009, the death of his father caused a lot of frustration (derailed his plan to study further, his sister was still small and unmarried). He got his father's govt. job which he did not want to do. He started doing pushups and situps but was inconsistent and lacked motivation. Started doing tuition, which resulted in skipping meals or untimely meals. He noticed eating roti causes acidity. So, he gave up roti, and maida, and prefers only rice. His students use to complain of a sour odor form his mouth.

In 2014, after marriage started c/o dull or burning pain in the epigastric region that reduced after meal, steatorrhea, and feeling weak after defecation. A colonoscopy detected a gastric ulcer with erosive duodenitis. He realized via surfing the internet that smoking could be one of the reasons for his developing ulcers. Since his symptoms improved with medication he decided to continue smoking beside continuing medications. He was unable to give up smoking because of job dissatisfaction, his sister's responsibilities, unable to give time and attention to family members properly because of work pressure. 

In 2015, diagnosed with proctitis. Took medicine Mesalazine 400 mg.

In 2018, he finally gave up smoking after realizing its negative health impact by studying extensively on the internet. He went to AIG and did a colonoscopy and endoscopy after which he was prescribed Sompraz L. He reports he felt very mentally satisfied with taking medicines and his symptoms subsided.

In 2021, during the lockdown, he became anxious about his health and c/o stress, panic attacks due to negative thoughts, and palpitation. He frequently consulted different Dr. for the next 3 months. Dr. prescribed Clonazepam, Inderal which he discontinued after a week because he was concerned about its side effects. Another Dr. prescribed O-Anxit, which he stopped after 1 month because he c/o painful ejaculation and passing hard stool after taking O-Anxit. 

In 2021 Nov, again c/o of diarrhea (triggering factor - pt was under a lot of stress due quarrel with a close relative). Dr. prescribed O-Anxit and Lactobacillus. He became alright. 

In Jan 2022, he c/o rt side eye pain. Dr diagnosed it to be a corneal ulcer. Eyedrops and Doxycycline were given. After taking Doxycycline he c/o hard stool and abd bloating. He started Sompraz on his own accord for 20 days.

In March 2022, his colleague's father died of throat Ca. He panicked and started having fear of death, c/o a Globus sensation. ENT doctor said nothing was wrong and referred him to a Psychiatrist. The psychiatrist prescribed him Clonazepam and FXT 10. But after taking antidepressant medicines he started c/o itchiness and burning sensation in the anus after defecation.

On April 2022, he did homeopathy treatment for his GI problems which gave him temporary relief.

In May 2022, he c/o recurrent left lower abd pain which lasted for 2-3 days. Dr. diagnosed it as IBS. Medicine provided relief from symptoms. After taking medicine for 1.5 months he stopped because his sister practicing homeopathy warned him of the side effects. After stopping the medications he started c/o palpitation after waking up, tremors of rt. hand. On taking antidepressant medicines Inderal 10, Amixide H, and Mirtaz his symptoms resolved. At the same time # the little finger of rt hand by falling from the bike. Healed with treatment.

Doing yoga since Aug 2022. Sometimes C/o left side lower back pain.

No history of DM/HTN

No alc consumption

Currently under no medications. Having peaceful deep sleep.

CHIEF COMPLAINTs and PATIENT REQ.: Pt c/o being forgetful, absent-minded, negative thoughts (always expecting the worst outcome) causing stress, palpitation on climbing stairs, rt side chest pain while talking continuously, anal itching, sometimes GI problems (loose motion, abd cramps, bloating). Also, c/o motion sickness. Wants a dental checkup. 

FAMILY HISTORY: Great great grandfather - h/o stomach ulcer

Grandfather - c/o dysentery, 1 episode of heart attack

Grandmother - Diptheria

Aunt - takes antidepressant medications (c/o stress, anxiety, depression)

Mother - c/o palpitation, IBS, hypothyroidism

Sister - hypothyroidism

most of 1st degree and second-degree relatives have dental problems.

REPORTS:

Congratulations @Narmeen Shah and the rest of our team who have been looking after this patient's PaJR for this note acknowledging your positive contribution to their life:

"Yesterday, Narmeen Shah madam asked how I was doing. Based on that, I wrote a story about my current life situation and translated it into English with the help of Google Translate."

Over the past two and a half years, I have noticed a profound transformation in myself. Now, I no longer let weak thoughts control my mind so easily. I don't know whether I have become good or bad—I simply follow the path shown by the great souls who came before us.

I have learned that there is no law requiring me to be like everyone else. If I feel anger toward someone, I can forgive them easily, but that doesn’t mean I won’t criticize them when necessary. I have understood that by controlling emotions, one can overcome great obstacles. However, that doesn’t mean circumstances will always be in my favor. Sometimes, I will have to create an entirely new path for myself, even if it requires a bit of strategic thinking.

It doesn’t feel good; sometimes, I feel afraid. But I strongly believe that as long as the worst hasn’t happened yet, nothing truly terrible will happen. Perhaps the universe has already set everything in place.

It feels like being summoned to a battlefield to save my country during a crisis. I was completely unprepared, but I had no choice but to go. At first, I fought by running and dodging, but eventually, I came face-to-face with the enemy. I was captured—purely by fate (if fate exists). Then, by some divine intervention, I met a few enlightened beings who taught me battle strategies. In the end, I emerged victorious.

But now that I have learned to fight, I realize that every day is a new battle, and I must continue fighting—with myself or with my circumstances.

I have learned to understand that whatever we think gets transferred through our mind to different parts of our body, causing changes that the body then signals back to us. The best way to control this process is through proper mindset training, which I try to practice regularly.

How do I do it? Through pranayama, deep breathing, yoga, and, most importantly, by being mindful of the food we eat.

Every day, I try to follow a healthy diet. In the morning, I start by drinking two glasses of warm water after waking up. Then, I have a light meal, such as puffed rice or muri, along with almonds, cashews, pistachios, raisins, and various seeds. Finally, I drink red tea—always without sugar.

All of us in the family—my wife, son, mother, and I—sit together at the table to have this morning meal. Initially, my mother and son didn’t want to eat it, but I continued eating mine silently. After a few days, seeing that I was consistent, they also started eating, and now it has become a habit for them too. We completely avoid sugar and refined flour.

Throughout the day—whether it’s breakfast, lunch, evening snacks, or dinner—we try to include a balanced mix of proteins, carbohydrates, vegetables, fruits, and probiotic foods like yogurt.

I do yoga for 15-30 minutes in the morning, and apart from office hours, I have a habit of reading books on two to three different topics daily. I also make an effort to maintain the boundaries of my family, tell my son a story every day, work on improving my weaknesses, ensure 7-8 hours of sleep, spend time with my family on holidays, and keep learning new things.

I personally prepare the morning meal for everyone. My English was once a weakness, but I have improved a lot—though I still use Google Translate for assistance when writing.

If I don’t have a proper bowel movement, I feel a little down, but I manage to deal with it. If someone speaks harshly to me, I feel hurt, but then I remind myself that they are not like me, just as I am not like them.

Honestly, compared to before, I feel much better now. I am living a more planned and conscious life, enjoying every moment with greater awareness.

🙏🙏🙏