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.
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