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.
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FAMILY HISTORY: 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:
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Congratulations @SE 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.
🙏🙏🙏
[12-08-2025 08.01] PA: Sokale patient aar taar family ek sathe chini chara red tea, shonge shohara,raisin, cashew, small amount jaggery, walnut, raw turmeric root, khoi
[12-08-2025 08:12] PA: https://youtu.be/Qnkz56DlX2Y?si
=TOBgWtFCDbzORVRV
Shonge ei Rabi Thakur er gaan o chilo
[12-08-2025 09:21] PPM 1: Which raga is this?
[12-08-2025 11:52] PA: The raag you are asking about is Pilu.
[12-08-2025 14.34] PA: Lunch at office
Bikaler snacks
Oi relative er barite 8.30 pm e ekcup laal cha ekta meri biscuit kheye chilo.
[13-08-2025 07.59] PA: Today morning
PPM 1: 👍
[14-08-2025 08.22] PA: Morning
[14-08-2025 20:33] PA: Aajke office e khubi baysto ter jonnyo photo tola jaynaai, lanch e chilo , aalu diye potoler torkari, koi mach aalu diye , vat, shonge shosha aar khejur 2 piece.
6.30 pm e laal cha , muri , pore 1. ekta kola , 8 ter shomoy ekta shobri kola kheyeche.
[15-08-2025 08.41] PA: Jera vejano jol, shonge laal cha, shohara khoi almond walnut cashew resins.
Kaal raate 11.30 e ghumiyechilo, pore sokal 4 ter shomoy urine er pressure ashe pore urine kore abar shua holo, ekta ghum ghum vab chilo, pore ek ghume 7.30 ta. Uthte ichhe korchilo na patient er. ekhon thik ache.
[15-08-2025 14.45] PA: Lunch, Daal, kachu baata, shosha, chitol mach, chichinga vaja, mocha ghonto, vat 17.45: Bikale
22.08: Daal, mach, mocha ghonto vaat
[16-08-2025 11.19] PA: Orhor daal , lau, aalu dherosh vaja
[16-08-2025 11.30] PPM 1: 👍
[16-08-2025 11.42] PA: Purota khete paarlen na, pet vora laagche, sokale potty hoyeche normal, mone hochhe je arektu jodi hoy tobe ektu aaram pabe.Nicher abdomen e ekta halka chap moto ashe.
[16-08-2025 14:31] PA: Ekhon patient er emon ek obostha je hoy bomi na hoy poty ekta hole aram pabe, kintu kichui hochhe na, folswarup pet er vitor ekta khubi oshubidha, ebong dupurer khabar er icheo nei , khideo nei , ei obosthay ektu gorom jol shonge halka lobon diye khelen.
[16-08-2025 14:57] PPM 1: Eta aer aageo kokhono hoyeche unar?
[16-08-2025 15:02] PA: Ha, 2-2.5 bochor aage hoyechhilo ekbar.
[16-08-2025 17:21] PA: Ek dinei 4-5 ghorer modhey bomi start hoy, tarpor loose stool with fever chilo.
[16-08-2025 20:46] PPM 1: Tarpor koto din chilo?
[16-08-2025 21:04] PA: 1-2 dui din chilo.pore aste aste thik hoye jay.
Aajke sokaleer jol khabar por patient er poty er ekta halka chap ashe, pore giye bosen, eer por normal stick type poty holo, taar mone hoyechilo arektu hobe pore aar hoy ni, jaihok pore tini snan kore pujo dite dite chinta korchilo je sokal 11 ta baje ekhono khide pachhe na keno, emotabosthay tini 11.30 ter shomoy sokaler oi khabar kheye oshubidha ta ( mone hoy nijer theke) deke ane. Folswarup ei problem.
Ekhono khide payni . Tini ekta homeopathic medicine bikale kheyechen, aar sara din jol kheye achen, kichu yoga pose kore body ke nije theke niyontron korer chesta chalachen, ashakori tini valo hoye jaben. Ei sokal bela poty na hole oner mone akta anxiety hoy je, rasta ghate jodi chap ashe.
[16-08-2025 21:31] PA: Sokale e khawa hoyeche, tarpor shudhu jol i khawa hoyeche,ekhon ki olpo vat khawa jabe, khide payni.
Sokale onekta normal poty hoyeche, shorir ekta halkavab o weakness onubhob hochhe
[17-08-2025 10:24] PPM 1: Goto kaal er oniyom er jonno
[17-08-2025 10:47] PA: Sir,eta aajke sokale kheyeche. Mixed vegetable with khichuri
Pore masala chara aalu diye chicken soup, mukhi kochu, shosha
[18-08-2025 08:20] PA: Gotokal dinner
Bikale akta kola muri pore ekcup lal cha kheyeche.
[18-08-2025 08:25] PA: Gotokal rater 10 ter modhye dinner hoye jay, taarpor 11 ter dike shober shomoy nicher dike abdomen e pain hochhilo, pore aste aste kome jay o tini ghumiye poren.
Sokal 5.30 e ghum venge jay shorir maj maj korchilo , bathroom kore aber ektu shuye thake, pore 7.30 tai uthen buker baam pasher niche ekta chap hochhe, poty normal hoy, ei chap ekbar pither dike ghure kome giye abar peter dike namche. Shorir e ekta chibano vab ache.
[18-08-2025 08:50] PPM 1: Patient er problem ta intestinal motility sonkranto mone hocche.
Amader anek PaJR participants ekhane amra amader dinner 6:00 PM er modhye shere ni.
Taate amra anek bhalo achi hoito
[18-08-2025 09:14] PA: Thanks sir
[18-08-2025 10:27] PPM 1: Local daktar ke dekhiye ekta ECG kore ekhane share korte paren
[18-08-2025 16:56] PPM 1: 👍
[19-08-2025 07.42] PA: Aaj sokale yoga korer por khubi khide peyeche,
[19-08-2025 08.28] PPM 1: Bhalo 👏(Reports)
[19-08-2025 10.32] PA: Aalu diye potol vaja, mushur daal, potol posto, alu begun diye mourala macher torkari, tokdoi kola,
Lunch at office 14.38
21.53
[20-08-2025 07.57] PA:
[21-08-2025 10.28] PA: Mocha ghonto, aalu vaja, musur dal, doi, kola, pepe, shosha
[23-08-2025 10.42] PA: Bhat vaja dim torka pore ekta rut koekta shoshai
Gotokal raate patient er barir loker hotel theke motton kosha khawer ichhe hoyechilo, ek piece motton , mach, chichinga vaja, daal, alu potol, alu sedho
[23-08-2025 11.32] PPM 1: 👍
Gotokal raate patient er barir loker hotel theke motton kosha khawer ichhe hoyechilo, ek piece motton , mach, chichinga vaja, daal, alu potol, alu sedho
[23-08-2025 11.32] PPM 1: 👍
[23-08-2025 15:30] PA: Dupurer khabar er photo tola hoyni, vat, alu quash er torkari, musur daal, katol mach, shosha, koekti choto tukro kora aakh.
[23-08-2025 19.35] PA: Khub khide peyeche patient er,
Aajke tar wife taal er bora o dudh diye taaler khir ( chini chara, eita oboshyo patient kaben na) kora cholche, tini aajke khubi chape achen, taar kache rater khabar chawa thik hobe na, ogotya olpo khoi diye taaler bora ( olpo chini ache) khachen,
[23-08-2025 23:04] PA: Aaj rate vat, musur daal,aalu kosh er torkari, aar mach khawa hoyeche
[25-08-2025 10.28] PA: Prothome korlam vaja diye bhat khawa hoyeche, tarpor chal kumro, aalu potol , musur daal, shasha, pepe, doi vat
Lunch at 2.30pm
[26-08-2025 10.17] PA: Koash ghonto, daal , lebu, aalu vaja, doi diye vat, mach vaja
[28-08-2025 14:33] PPM 1: 👍
তিনি যে রাজ্যের সরকারী কর্মী, তার রাজ্যের রাজ্য সরকার ক্যাম্প খাটিয়ে প্রতিটি দপ্তরের কর্মীদের একসাথে কোনো এক মাঠের মধ্যে বা স্কুলের মধ্যে ক্যাম্প তৈরি করে সরকারী সুবিধাগুলো সমাজের প্রতিটি স্তরের জনগণকে পৌঁছে দেবেন। সেই ক্যাম্পে তিনিও এসেছেন ভূমি দপ্তরের কিছু সুবিধা জনগণকে বিতরণ করবেন।
সেই খানে এই খাবারের ব্যবস্থা করা হয়েছে। যাইহোক তিনি এই খাবার কোনো একজন অভুক্ত কে দিয়ে দিয়েছেন এবং নিজে বাড়ির তৈরি করা খাবার খেয়েছেন
দুপুরের খাবার
[29-08-2025 15:51] PPM 1: 👍
[29-08-2025 16:25] PA: Aaj office e ekta conference chilo, sekhane dupure khabar bayboshtha chilo, tini sekhane Lunch korechen, vat,daal, kouash diye badha copy, aalu vaja, chicken 2 piece.
Kaal raate ekta meeting chilo, bari firte raat 10.30 beje jay,raater khaber olpo vat, quash er torkari, dui piece choto mach,diye khan ,raat 12 ter shomoy ghuman, ek ghume sokal 7 ta, taar por prato kormo o yoga koren. Alu jhinga posto, ghi, daal, alu vaja
[02-09-2025 22:36] PA: Aajke sokal theke patient er abdomen e ekta spasm, o gas move korchilo, mone hoy je gas ba poty hole tini aram pabe.sokale ghum vangle bichana tei tar poty peye jay,aajkeo eki rokom, valo poty hoyeche.Lanch er por abar hoyechilo, shondhyar por theke start hoe aar kome ne, ekhon aar tar valo lagche na dekhe meva sr ekta kheyeche. Eer aage tini eta khai ni.aajke first.
[03-09-2025 08:37] PPM 1: How is he now?
[03-09-2025 08:53] PA: Sokale khub valo poty hoyeche, bytha ta move korchilo ekber bukeer niche , aber right side abdomen er niche, aber middle abdomen diye niche , mone hochhe ekta gas ber hole aram pabe, sokale tini ekta antacid kheyechen, taarpor yoga korechen , taarpor sokaler khabar kheyechen , ekhon bytha ta middle abdomen e, Tobe aager theke onek kom.
[03-09-2025 08:56] PA: Ek ek shomoy ek ek jaygay move kore, dariye thakhle ekrokom, boshe thakhle onek kom mone hoy
[03-09-2025 10:17] PA: Patient er eer aageo badam theke gas hoyechilo,
ei plate tar jonno ki pet bytha hote pare.
[03-09-2025 12:26] PPM 1: Hote pare but it's still healthy
[03-09-2025 12:26] PPM 1: Sounds like IBS
[03-09-2025 20:29] PPM 1: 👍
[04-09-2025 07:51] PPM 1: 👍
Lunch
[14-09-2025 08.32] PA: Aajke .
Gotokal ek relative er barite lanch o dinner kora hoyeche.
Lanch e chilo vat, orhor daal, chal kumro posto, alu koash er torkari , ool kochu ghonto, tok doi.
Raater menu te eki jinis Tobe tok doi er poriborte aalu vaja.
📚
“Teacher, I’ve read so many books… but I’ve forgotten most of them. So what’s the point of reading?”
That was the question of a curious student.
The teacher didn’t answer. He just looked at him in silence.
A few days later, they were sitting by a river. Out of nowhere, the old man said:
“I’m thirsty. Bring me some water… but use that old strainer lying there on the ground.”
The student looked confused. It was a ridiculous request.
How could anyone bring water in a strainer full of holes?
But he didn’t dare argue.
He picked up the strainer and tried.
Once.
Twice.
Over and over again…
He ran faster, angled it differently, even tried covering holes with his fingers.
Nothing worked. He couldn’t hold a single drop.
Exhausted and frustrated, he dropped the strainer at the teacher’s feet and said:
“I’m sorry. I failed. It was impossible.”
The teacher looked at him kindly and said:
“You didn’t fail. Look at the strainer.”
The student glanced down… and noticed something.
The old, dark, dirty strainer was now shining clean. The water, though it never stayed, had washed it over and over until it gleamed.
The teacher continued:
“That’s what reading does. It doesn’t matter if you don’t remember every detail. It doesn’t matter if the knowledge seems to slip through, like water through a strainer…
Because while you read, your mind is refreshed.
Your spirit is renewed.
Your ideas are oxygenated.
And even if you don’t notice it right away, you’re being transformed from the inside out.”
That’s the true purpose of reading.
Not to fill your memory…
but to cleanse and enrich your soul.
[21-09-2025 08.41] PA: Arek cup cha khoi muri shoho, aaj Khub vore othay khide peye jay,
Sokaler Khabar ekhono ready hoini tai.
👍
[23-09-2025 18.09] PA: Lunch
[23-09-2025 18.09] PA: Bari fire ekhon
[12-10-2025 22.01] PA: Aaj bikaler photo dea hoi ni,
[13-10-2025 07.44] PA: 
[13-10-2025 08.14] PPM 1: Tarpor asha kori shere giyechilo?
[12-10-2025 22.01] PA: Aaj bikaler photo dea hoi ni,
Bikale lal cha o khoi chilo, eta khabar 1 ghonta por taar sneezing start hoy, eer phole tar golar kache kichu mucus ashte thake, sei
gulo saur taste.
[13-10-2025 08.19] PA: Hain kome jay,
[15-10-2025 08.03] PA: Goto one week theke patient anus er jaygay ekta halka pain onubhab koren, pain ta ekdom halka bikal, raate shober shomoy aar shokaler dike onubhab ta hoy,potty normal hochhe, pain potty korer shomoy hoy na, tini regular yoga er sathe molashan niyomito koren, majhe koekdin gorom poray rate shober shomoy AC use korechilen, AC te ki anus e problem hote pare, karon tini khubi niom kore choler chesta koren , Aar byke run ta dine 50km hoy ei jonno ki probhab pore naki, aar ghum theke sokale uthle komore ekta bytha ashe potty korle onekta kome jay.tini sitz bath o nichhe.
Majhe kotha bolte bolte voice e mucus chole asche, Erokom keno hoy.
Tini aajke Annovate cream use korechen.
[15-10-2025 08.37] PPM 1: @Meta AI @PPM4 what could be the possible evidence based answer to this interesting question from the patient's advocate?👇
Goto one week theke patient anus er jaygay ekta halka pain onubhab koren, pain ta ekdom halka bikal, raate shober shomoy aar shokaler dike onubhab ta hoy,potty normal hochhe, pain potty korer shomoy hoy na, tini regular yoga er sathe molashan niyomito koren, majhe koekdin gorom poray rate shober shomoy AC use korechilen, AC te ki anus e problem hote pare, karon tini khubi niom kore choler chesta koren , Aar byke run ta dine 50km hoy ei jonno ki probhab pore naki, aar ghum theke sokale uthle komore ekta bytha ashe potty korle onekta kome jay.tini sitz bath o nichhe.
Tini aajke Annovate cream use korechen.
[15-10-2025 08.37] Meta AI: Based on the details provided, here’s an evidence-based perspective on the possible causes and considerations for the patient’s symptoms:
1. *Anal Discomfort and Pain Timing*:
- The mild, localized pain near the anus, which worsens at specific times (e.g., evening, early morning), might indicate *muscle fatigue or strain*. This could stem from prolonged or repetitive activities like cycling (50 km daily), which may exert pressure on the pelvic region.
- It could also be related to *minor anal fissures, irritation, or hemorrhoids*, especially if there has been any strain during bowel movements or prolonged sitting.
2. *Impact of AC Usage*:
- Using air conditioning itself does not directly cause anal pain. However, prolonged exposure to cold air or sitting in one position for extended periods might lead to *muscle stiffness* or affect circulation, potentially causing mild discomfort in the pelvic area.
3. *Yoga and Bowel Movements*:
- Regular yoga and molashan practice are beneficial for bowel health and circulation. The fact that the patient’s bowel movements are normal and pain-free during defecation reduces the likelihood of severe anal pathology (e.g., fissures or infections).
- However, certain yoga poses that stretch or engage pelvic muscles excessively might sometimes lead to discomfort.
4. *Morning Lower Back Pain*:
- The lower back pain upon waking, which improves after bowel movements, could suggest *muscle stiffness* or even mild *sacroiliac joint dysfunction* (common in cyclists). This might be unrelated to the anal pain but could be linked to posture during cycling or sleeping position.
5. *Sitz Bath and Annovate Cream*:
- Sitz baths are generally effective in soothing minor anal pain or irritation. The use of Annovate cream suggests the possibility of hemorrhoids or anal irritation, but its effectiveness can vary depending on the underlying cause.
### Key Considerations:
- *Cycling-related Pressure*: Prolonged cycling can sometimes lead to *perineal compression*, affecting nerves or muscles in the pelvic region. A proper cycling posture and padded seat might help reduce this.
- *Dietary and Hydration Factors*: Ensure adequate hydration and fiber intake to maintain soft stools, as straining can worsen symptoms.
- *Rule Out Other Causes*: If the pain persists or worsens, it would be prudent to rule out conditions like *proctalgia fugax* (episodic anal muscle spasms) or *levator ani syndrome* through a clinical examination.
Has the pain improved after using the Annovate cream or sitz baths?
[15-10-2025 08.38] PPM 1: @Meta AI can you share perplexity styled evidence based links to your statements above?
[15-10-2025 08.38] Meta AI: Here are the evidence-based references, styled in a "perplexity" format, to support the statements in the earlier response:1. *Anovate Cream Uses and Effectiveness*:
- Anovate Cream is used for managing anal fissures, hemorrhoids, and related symptoms like pain, itching, and swelling. It combines active ingredients like Beclomethasone (anti-inflammatory), Phenylephrine (blood vessel constrictor), and Lidocaine (local anesthetic) to provide relief.
(link unavailable) (link unavailable)
2. *Side Effects and Precautions*:
- Common side effects include burning, redness, and skin irritation at the application site. Overuse can lead to skin thinning or allergic reactions. Avoid prolonged use without medical supervision.
(link unavailable) (link unavailable)
3. *Cycling Impact on Pelvic Pain*:
- Prolonged cycling can lead to perineal compression, potentially causing discomfort or irritation in the pelvic and anal regions. Adjusting posture and using a padded seat may help.
(link unavailable).
4. *Sitz Bath Benefits*:
- Sitz baths are effective for soothing anal discomfort, improving blood flow, and reducing irritation in conditions like hemorrhoids or fissures.
(link unavailable).
Let me know if you'd like further clarification on any point!
Anovate Anovate Anovate Anovatewww.practo.com www.truemeds.in pharmeasy.in www.netmeds.com
[15-10-2025 08.55] PPM 4: Of course. This is an excellent and detailed question from a patient advocate. Here is a possible evidence-based answer, breaking down each component of the patient's situation.
[15-10-2025 08.55] PPM 4: Of course. This is an excellent and detailed question from a patient advocate. Here is a possible evidence-based answer, breaking down each component of the patient's situation.
### Executive Summary for the Healthcare Provider
Based on the described symptoms, the most likely diagnosis is **Pelvic Floor Muscle Tension or Levator Ani Syndrome**, with contributing factors from prolonged cycling. It is less likely to be a primary anal fissure or hemorrhoids, given the absence of pain during defecation and bleeding. The AC use is a coincidental factor, not a causative one, but may point towards muscle tension.
---
### Detailed Evidence-Based Analysis
Let's break down the patient's history point by point.
#### 1. The Nature of the Pain: Pointing Away from the Lining of the Anus
* **Symptom:** "Halka pain," not during bowel movements, normal stool, worse in the evening/morning.
* **Evidence-Based Analysis:**
* Pain during bowel movements is the hallmark of **anal fissures** (a tear in the anal lining) and thrombosed external **hemorrhoids**. The absence of this makes these conditions less likely.
* Pain that is dull, aching, and described as a "pressure" or "heaviness" that worsens with sitting and is better after a bowel movement is classic for **Levator Ani Syndrome** or **Proctalgia Fugax**. This involves spasm of the pelvic floor muscles that support the rectum and anus.
* The fact that the pain is relieved by a bowel movement is a key indicator. Passing a stool can temporarily stretch and relax these spasming muscles.
#### 2. The Impact of Cycling: A Major Contributing Factor
* **Symptom:** "Byke run ta dine 50km hoy."
* **Evidence-Based Analysis:**
* **This is a highly significant detail.** Prolonged pressure on the perineum (the area between the anus and genitals) from a bicycle saddle is a well-documented cause of:
* **Pudendal Nerve Irritation/Compression:** The pudendal nerve provides sensation to the anal and genital regions. Compression can cause pain, numbness, or a burning sensation in the perineum and anus.
* **Muscle Strain and Tension:** The constant positioning and pedaling can lead to hypertonicity (excessive tightness) in the pelvic floor muscles, including the levator ani.
* Fifty kilometers daily is a very high volume that significantly increases the risk of these issues. The pain being worse in the evening aligns perfectly with the cumulative effect of a long cycling session.
#### 3. The AC Connection: A Coincidence, Not a Cause
* **Symptom:** "Majhe koekdin gorom poray rate shober shomoy AC use korechilen."
* **Evidence-Based Analysis:**
* There is **no physiological mechanism** by which sleeping in an air-conditioned room can directly cause anal pain.
* However, a possible indirect link exists: Cold temperatures can cause muscles to contract and become tense. If the patient was already predisposed to pelvic muscle tension (from cycling, yoga, or stress), sleeping in a cold room could potentially exacerbate general muscle tightness, which might be perceived in the sensitive pelvic region. This is speculative but biologically plausible. The AC is more likely a "red herring" than the root cause.
#### 4. The Morning Backache & Relief with Activity
* **Symptom:** "Ghum theke sokale uthle komore ekta bytha ashe potty korle onekta kome jay."
* **Evidence-Based Analysis:**
* Morning stiffness and pain in the low back/buttock region that eases with movement is a classic sign of a **musculoskeletal issue**. It suggests that the muscles and ligaments have tightened up overnight.
* The pelvic floor muscles are intimately connected to the core, gluteal, and low back muscles. Tightness in one area often affects the others. This symptom strongly supports the diagnosis of a muscular problem like Levator Ani Syndrome.
#### 5. Yoga and Mula Shodhana (Anal Cleansing)
* **Symptom:** "Regular yoga er sathe molashan niyomito koren."
* **Evidence-Based Analysis:**
* **Yoga:** Generally beneficial for pelvic health. However, certain intense poses or improper engagement could potentially contribute to muscle strain in a susceptible individual.
* **Mula Shodhana (or any vigorous anal cleansing):** While hygiene is important, overzealous or aggressive cleansing can irritate the sensitive perianal skin and potentially cause minor abrasions or nerve irritation. It is a less likely primary cause but could be a contributing irritant.
#### 6. Use of Anovate Cream
* **Symptom:** "Annovate cream use korechen."
* **Evidence-Based Analysis:**
* Anovate is a combination cream containing a corticosteroid (to reduce inflammation) and a local anesthetic (to numb pain).
* If the problem is muscular (nerve or muscle spasm), a topical steroid cream will have **little to no effect**. Its lack of efficacy would be a further clinical clue that the issue is not on the skin surface or in the anal canal lining, but deeper in the muscles.
---
### Probable Diagnosis & Recommended Next Steps for the Patient
**Most Likely Diagnosis:** **Chronic Pelvic Pain Syndrome, specifically Levator Ani Syndrome or Pudendal Neuralgia, exacerbated by high-volume cycling.**
**Action Plan for the Patient Advocate to Discuss with the Doctor:**
1. **Formal Medical Evaluation:** The patient must see a **Proctologist or a Gastroenterologist** with an interest in pelvic floor disorders. A **Colorectal Surgeon** or a **Pelvic Health Physical Therapist** would also be an excellent choice.
2. **Physical Exam:** The diagnostic gold standard for Levator Ani Syndrome is a **digital rectal exam**. The physician will palpate the levator ani muscles for tenderness and reproduce the pain, confirming the muscular source.
3. **Modify Cycling Regimen:** This is critical.
* **Immediate reduction** in cycling distance and frequency.
* Invest in a **properly fitted bicycle** and a **quality, split-nose or pressure-relieving saddle**.
* Ensure proper cycling form and take frequent breaks to stand on the pedals.
4. **Pelvic Floor Physical Therapy:** This is the cornerstone of treatment. A specialized therapist can teach the patient:
* **Relaxation techniques** for the pelvic floor (not just strengthening).
* **Internal and external soft tissue mobilization.**
* **Stretches** for the hips, glutes, and hamstrings.
* **Biofeedback** to gain conscious control over pelvic floor muscles.
5. **Review Yoga and Hygiene Practices:**
* Focus on yoga poses that promote relaxation and stretching of the pelvic region (e.g., Happy Baby Pose, deep squats).
* Avoid aggressive anal cleansing; use gentle patting with moist wipes if necessary.
6. **Continue Supportive Measures:** The **sitz bath** is an excellent idea, as warm water can help relax spasming muscles. They should continue this 1-2 times daily.
By systematically evaluating the evidence from the patient's history, we can steer away from less likely causes (like fissures or AC) and focus the diagnostic and treatment efforts on the most probable source: the musculoskeletal system, heavily influenced by the patient's athletic pursuits.
[15-10-2025 09.38] PA: Some additional information has been provided by the patient,
patient feels pressure-like pain in the lower back after walking for a long time. The pain improves only after taking rest for some time.
He gets relief when doing yoga postures like Happy Baby Pose and Child’s Pose.
Using Annovate cream does not give much pain relief.
If he sits for a long time with one leg crossed over the other, he feels pain in the pelvic region.
In the morning, he feels the urge to pass stool soon after waking up, but the stool does not come out easily. He often needs to spray water on the anus to help pass stool.
However, whenever he feels anxious or tense, he suddenly gets the urge to pass stool easily.
[15-10-2025 09.56] PPM 1: Very useful. Deep seek I presume.[15-10-2025 10.41] PPM 1: @PPM3 your current inputs on this PMR issue 👇
[15/10, 08:55] Deep seek: Of course. This is an excellent and detailed question from a patient advocate. Here is a possible evidence-based answer, breaking down each component of the patient's situation.
### Executive Summary for the Healthcare Provider
Based on the described symptoms, the most likely diagnosis is **Pelvic Floor Muscle Tension or Levator Ani Syndrome**, with contributing factors from prolonged cycling. It is less likely to be a primary anal fissure or hemorrhoids, given the absence of pain during defecation and bleeding. The AC use is a coincidental factor, not a causative one, but may point towards muscle tension.
---
### Detailed Evidence-Based Analysis
Let's break down the patient's history point by point.
#### 1. The Nature of the Pain: Pointing Away from the Lining of the Anus
* **Symptom:** "Halka pain," not during bowel movements, normal stool, worse in the evening/morning.
* **Evidence-Based Analysis:**
* Pain during bowel movements is the hallmark of **anal fissures** (a tear in the anal lining) and thrombosed external **hemorrhoids**. The absence of this makes these conditions less likely.
* Pain that is dull, aching, and described as a "pressure" or "heaviness" that worsens with sitting and is better after a bowel movement is classic for **Levator Ani Syndrome** or **Proctalgia Fugax**. This involves spasm of the pelvic floor muscles that support the rectum and anus.
* The fact that the pain is relieved by a bowel movement is a key indicator. Passing a stool can temporarily stretch and relax these spasming muscles.
#### 2. The Impact of Cycling: A Major Contributing Factor
* **Symptom:** "Byke run ta dine 50km hoy."
* **Evidence-Based Analysis:**
* **This is a highly significant detail.** Prolonged pressure on the perineum (the area between the anus and genitals) from a bicycle saddle is a well-documented cause of:
* **Pudendal Nerve Irritation/Compression:** The pudendal nerve provides sensation to the anal and genital regions. Compression can cause pain, numbness, or a burning sensation in the perineum and anus.
* **Muscle Strain and Tension:** The constant positioning and pedaling can lead to hypertonicity (excessive tightness) in the pelvic floor muscles, including the levator ani.
* Fifty kilometers daily is a very high volume that significantly increases the risk of these issues. The pain being worse in the evening aligns perfectly with the cumulative effect of a long cycling session.
#### 3. The AC Connection: A Coincidence, Not a Cause
* **Symptom:** "Majhe koekdin gorom poray rate shober shomoy AC use korechilen."
* **Evidence-Based Analysis:**
* There is **no physiological mechanism** by which sleeping in an air-conditioned room can directly cause anal pain.
* However, a possible indirect link exists: Cold temperatures can cause muscles to contract and become tense. If the patient was already predisposed to pelvic muscle tension (from cycling, yoga, or stress), sleeping in a cold room could potentially exacerbate general muscle tightness, which might be perceived in the sensitive pelvic region. This is speculative but biologically plausible. The AC is more likely a "red herring" than the root cause.
#### 4. The Morning Backache & Relief with Activity
* **Symptom:** "Ghum theke sokale uthle komore ekta bytha ashe potty korle onekta kome jay."
* **Evidence-Based Analysis:**
* Morning stiffness and pain in the low back/buttock region that eases with movement is a classic sign of a **musculoskeletal issue**. It suggests that the muscles and ligaments have tightened up overnight.
* The pelvic floor muscles are intimately connected to the core, gluteal, and low back muscles. Tightness in one area often affects the others. This symptom strongly supports the diagnosis of a muscular problem like Levator Ani Syndrome.
#### 5. Yoga and Mula Shodhana (Anal Cleansing)
* **Symptom:** "Regular yoga er sathe molashan niyomito koren."
* **Evidence-Based Analysis:**
* **Yoga:** Generally beneficial for pelvic health. However, certain intense poses or improper engagement could potentially contribute to muscle strain in a susceptible individual.
* **Mula Shodhana (or any vigorous anal cleansing):** While hygiene is important, overzealous or aggressive cleansing can irritate the sensitive perianal skin and potentially cause minor abrasions or nerve irritation. It is a less likely primary cause but could be a contributing irritant.
#### 6. Use of Anovate Cream
* **Symptom:** "Annovate cream use korechen."
* **Evidence-Based Analysis:**
* Anovate is a combination cream containing a corticosteroid (to reduce inflammation) and a local anesthetic (to numb pain).
* If the problem is muscular (nerve or muscle spasm), a topical steroid cream will have **little to no effect**. Its lack of efficacy would be a further clinical clue that the issue is not on the skin surface or in the anal canal lining, but deeper in the muscles.
---
### Probable Diagnosis & Recommended Next Steps for the Patient
**Most Likely Diagnosis:** **Chronic Pelvic Pain Syndrome, specifically Levator Ani Syndrome or Pudendal Neuralgia, exacerbated by high-volume cycling.**
**Action Plan for the Patient Advocate to Discuss with the Doctor:**
1. **Formal Medical Evaluation:** The patient must see a **Proctologist or a Gastroenterologist** with an interest in pelvic floor disorders. A **Colorectal Surgeon** or a **Pelvic Health Physical Therapist** would also be an excellent choice.
2. **Physical Exam:** The diagnostic gold standard for Levator Ani Syndrome is a **digital rectal exam**. The physician will palpate the levator ani muscles for tenderness and reproduce the pain, confirming the muscular source.
3. **Modify Cycling Regimen:** This is critical.
* **Immediate reduction** in cycling distance and frequency.
* Invest in a **properly fitted bicycle** and a **quality, split-nose or pressure-relieving saddle**.
* Ensure proper cycling form and take frequent breaks to stand on the pedals.
4. **Pelvic Floor Physical Therapy:** This is the cornerstone of treatment. A specialized therapist can teach the patient:
* **Relaxation techniques** for the pelvic floor (not just strengthening).
* **Internal and external soft tissue mobilization.**
* **Stretches** for the hips, glutes, and hamstrings.
* **Biofeedback** to gain conscious control over pelvic floor muscles.
5. **Review Yoga and Hygiene Practices:**
* Focus on yoga poses that promote relaxation and stretching of the pelvic region (e.g., Happy Baby Pose, deep squats).
* Avoid aggressive anal cleansing; use gentle patting with moist wipes if necessary.
6. **Continue Supportive Measures:** The **sitz bath** is an excellent idea, as warm water can help relax spasming muscles. They should continue this 1-2 times daily.
By systematically evaluating the evidence from the patient's history, we can steer away from less likely causes (like fissures or AC) and focus the diagnostic and treatment efforts on the most probable source: the musculoskeletal system, heavily influenced by the patient's athletic pursuits.
[15/10, 09:38] 37M Staphysagria Patient Advocate: Some additional information has been provided by the patient,
patient feels pressure-like pain in the lower back after walking for a long time. The pain improves only after taking rest for some time.
He gets relief when doing yoga postures like Happy Baby Pose and Child’s Pose.
Using Annovate cream does not give much pain relief.
If he sits for a long time with one leg crossed over the other, he feels pain in the pelvic region.
In the morning, he feels the urge to pass stool soon after waking up, but the stool does not come out easily. He often needs to spray water on the anus to help pass stool.
However, whenever he feels anxious or tense, he suddenly gets the urge to pass stool easily.
[20-10-2025 10.46] PA: 14shak, aluvaja, koash alu torkari, shosha,[20-10-2025 16.02] PPM 1: 👍
[4:03 pm, 20/10/2025] PPM 1: That small green patch contains fourteen varieties of shaag/leaves?
[4:26 pm, 20/10/2025] PA: একজন শাক বিক্রেতা প্রায় ১৬-১৭ রকমের শাকপাতা নিয়ে বাজারে বিক্রি করছিলেন। তিনি প্রতিটির কাণ্ড বা লতা থেকে পাতা আলাদা করে ১০ বা ২০ টাকায় বিক্রি করছিলেন। শাকগুলো রান্না করার পর দেখা গেল, পরিমাণে একেবারেই অল্প হয়ে গেছে। সেই মিশ্রণ থেকে খুব সামান্য অংশই নিয়েছিলেন, ফলে সম্ভবত এই মিশ্রণে ১৪টিরও কম শাক হয়তো থাকতেও পারে।
[20-10-2025 17.01] PPM 1: Lunch today with a modified Bengali choddo shaak recipe from our garden edibles in Telangana. I got an image only of the final cooked product on the plate that looks like traditional Telangana annam (70% is actually fox tail millets and not annam) and pachdi.
1) Notey shaak amaranth
2) Poi pui shaak
3) Ash gourd leaves:
Benincasa hispida, the wax gourd, also called ash gourd
4) Boerhavia diffusa punarnava
5) abutilon indicum
6) Achyranthus aspera
7) Acalypha indica aka biralhanchi/biralkanduni (বিড়াল হাঁচি/বিড়ালকান্দুনি) in Bengali
8) premna latifolia, aka Pedda Nelli in Telugu
9) Celosea Argentea
10) Asystasia Gangetica
11) Commelina bengalensis
12) insulin plant
13) cranberry hibiscus leaves
14) Antigonon leptopus, a species of perennial vine in the buckwheat family commonly known as coral vine or queen's wreath. https://en.wikipedia.org/wiki/Antigonon_leptopus
15) Moringa
16) Sesbania
[21-10-202519.51] PA: তিনি মুড়ি, খই, কলা খাচ্ছেন।অন্যান্য সদস্যদের ফুচকা খাবার খুব ইচ্ছে হয়েছে তাই তারা ফুচকা খাচ্ছে।
[25-10-2025 11.07] PA: Begun bhaja, pepe bhaja, aalu ful copy, lau diye mash kolaier daal, fol
[25-10-2025 14.46] PA: Lunch
Ful kopir torkari, pepe vaja, doi, shosha, lau diye daal.
[25-10-2025 22.24] PA: Dinner e aalur torkari ,bok ful er bora ache, daal lau diye,[10:45 am, 26/10/2025] PPM 1: Aet moddhyeo bokfuler bora royeche mone hocche?
[12:01 pm, 26/10/2025] PA: Na sir,
Koekti kismis, walnut 1 ti, 2 ta sohara, muri , lal cha,
Ghum theke 6-6.30 am e uthe taar khubi khide pay, dui glass jol kheye free hoye tini half -1 hour yoga koren, last koekdin aage rectum e problem hoyechilo tokhon tini homeo medicine kheye thik hoye jan, ekhon root chokra balancing kichu ashon ( molashan, child pose, plow pose, butterfly pose, sholder stand pose,cobra pose,pawanmuktashon,
Kichu mudra with anus movement, pranayam koren,)
Majhe abdomen e gas hole tini butterfly pose aar mudra kore anus movement e khubi Aram pan.
[28-10-2025 10.44] PA: লাও ঘণ্ট মাছের মাথা দিয়ে, মুশুর ডাল, আলু সিম দিয়ে পালং শাক, মাছ, মিষ্টি কুমড়া ভাজা, লাউয়ের চোচা ভাজা
[01-11-2025 20.48] PA: Implant done today
Khichdi with badha copy
Ghi alu koash diye gola vat, begun vaja, badha kopy
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