22-04-2025
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.
[22-04-2025 21:49] PPM 1: Please describe your patient's sequence of events that led to the current problems. Please begin the sequence of events from the time your patient had absolutely no problems at all. Please describe your patient's hourly routine over 24 hours when he was perfectly alright. Next please describe what happened to his hourly 24 hour routine once the disease took hold on his life
Please mention specifically which part of the patient's hourly routine was disrupted
What are the patient's current requirements from us like if we had to give him a single medicine which problem would they prefer it to address?
[22-04-2025 22:25] PA: The patient was born in March 1994 i.e. presently 31 years old. Since childhood he did not exactly suffer any specific physical disease except being skinny (if that is a disease).
At the age of 10 years old he was hit by stone at the top of his head (scalp) because of which he suffered blood loss and had to take 3 stitches. Post this he had several physical injuries and minor road accidents due to which he suffered several physical injuries and scars. His right hand was also broken in the wrist area (hair line crack) at the age of 15 while playing cricket at school.
Around this age, he started showing up some symptoms of skin flakiness (probably psoriasis as no Dermatologist could confirm the disease). The issue is that small pieces of finger skin comes out like flakes. The same issue was fand in his feet as well, but it was gone within 6 months after showing up and till date it had not been revived in feet. However, the issue remained persistent in both the hands.
Sometimes, mostly in the dry seasons like winter and spring the skin shows some cracks by which blood is visible inside but it does not come out and it gives an uncomfortable feeling.
At the age of 17 he was hit in his chin accidentally by the handle of deep tubewell handpump because of which he suffered bloodloss, however, the x ray showed no cracks. But since this incident, sometimes (once in a month) his chin pains along with the front lobe. Visited many Doctors for the same but nobody could fathom the exact reason behind this frequent pain.
At the age of 18 he got admission in B. TECH, and it is during this time he started having unusual amount of dandruff because of which he visited dermatologist and used some shampoos for the same but that issue is still persisting associated with hair thinning and hairfall since the age of 25.
At the age of 28 he got married post which he was diagnosed with fatty liver (while having regular checkup advised by the Employer company) and polyp in gall bladder. After medication fatty liver was cured but the polyp remains the same as no further ultrasound was taken as the Doctor advised that it was benign.
[22-04-2025 22:26] PA: Recently, in the month of March he undertook blood tests where he was found Pre- Diabetic and the report is attached herewith.
[22-04-2025 22:32] PA: Now coming to the daily routine, the patient is late riser wakes up according to the need of his work. Sometimes it can be 8 am or may be extended to 9.30 AM.
After waking up, he takes a long hour in the bathroom with his phone. Post this he takes his breakfast. As his job most of the time is from home he goes out on need basis. However, he has to travel a lot from cities to cities hence most of the time he has to consume outside foods. He, goes to bed mostly around or before 12 am.
[22-04-2025 22:34] PA: The patient presently requires guidance mainly to protect himself from Diabetes and if the skin issues could have been addressed, it would have been helpful.
[23-04-2025 09:16] PA: The patient woke up at 7:40 AM and did his morning chores. For breakfast the patient is having jowar puffs with cucumber and onions. Also having methi kaadha.
[23-04-2025 09:33] PPM 1: Yes it will be our pleasure to do that.Please ask the patient to download this: https://medicinedepartment.blogspot.com/2025/02/informed-patient-consent-and.html?m=1 consent form, read it and sign it in the language of his choice and share it back along with his full address and mobile phone number.
As a first step although the deidentified patient image in the DP looks apparently alright the ultrasound does mention visceral fat and the image also points to arm muscle sarcopenia all contributing to his pre diabetes and possibly also to the skin flaking.
Would need to verify it again with another similar side view from the other side as well as front and back
[23-04-2025 13:08] PPM 2: This is not pre diabetes and I wouldn't be worried.
[23-04-2025 14:03] PA: At 12:30 PM, the patient had a small cup of lassi with salt and stevia.
[23-04-2025 14.07] PA: Lunch at 2:00 PM White rice, Chicken stew with carrot and quash, with cucumber and raw onion.
[23-04-2025 17.16] PA: Patient is having some ripe papaya as evening snack
[23-04-2025 18:52] PA: The patient took a 5KM walk in the evening.
Dinner at 19.20 Millet Khichuri, Oats-Ragi Chila, Chicken Stew with quash and carrot, cucumber and raw onion.
[23-04-2025 21:20] PPM 1: Thanks
[24-04-2025 10:37] PA: The patient woke up at 8:30 AM. Breakfast at 10.39am oats-ragi chila, scrambled eggs, Salad (tomato, cucumber, onion with yogurt) with a cup of whey water.
[24-04-2025 20:31] PA: Patient is going out of station for 3 days.
[24-04-2025 22:40] PPM 1: Wherever the patient goes this PaJR will remain supplying us his diet and regular hourly activities.
[25-04-2025 09:08] PA: The patient woke up at 7AM. He is still travelling in train.
He is having some jowar puffs, roasted makhana and roasted soyabean.
[25-04-2025 09:36] PPM 1: 👍
[25-04-2025 11.14] PA: Breakfast Roti, mixed veg and egg bhurji
[25-04-2025 16.00] PA: The patient is having black tea without sugar and a piece of dry cake.
[25-04-2025 16:15] PPM 1: Pastry and Cakes can be problematic as they are calorie dense and poor in nutrition and one needs to avoid them.
[25-04-2025 20.15] PA: Dinner Roti with egg bhurji
[25-04-2025 20:40] PPM 1: More vegetables needed
[26-04-2025 08:21] PA: The patient woke up at 7:30 AM.
[26-04-2025 08.22] PA: Breakfast Roti, boiled egg, mixed vegetables with kala chana
[26-04-2025 16:52] PA: The patient forgot to take the lunch photo. The patient had 2 roti with chicken curry, cucumber and onions at 3 PM.
[26-04-2025 16.55] PPM 1: 👍
[26-04-2025 22.28] PA: The patient was unable to take a photo of the plate due to attending a formal dinner with clients. For dinner, the patient had plain naan, chicken gravy, mixed vegetables, cucumber, and raw onion.
[27-04-2025 14:19] PPM 1: Also do share your activities.
Here's a sample from another patient:
PaJR patient activities from 6:00 AM to 8:00 AM Sunday April 26, 2025
Experiments in organic gymning amidst middle aged PaJR patients where gymn activities are organically built upon real work activities.
The first picture shows a satisfied dog proud of his PaJR patient father's physical activity (posing with the evidence for the last pruning activity) this morning!
6:00 AM to 7:00 AM After walking the two dogs, started to remove the heavy bags of soil, compost etc from the car and carrying them inside the garden over some distance.
Good resistance to upper arms, shoulders, chest and forearms. Noticed that the abdomen muscles can act as a bag rest and allow oneself to leverage more power with less effort using the upper limbs while lifting and carrying the heavy bags.
7:00 AM-8:00 AM After the heavy lifting and shifting it was time for some heavy pruning of the Nirgundi tree trunks as it was shading the Surinam Cherry and that took some time as the wood is quite hard. Some pruning of the karanj pongamia milletia leaves too that were otherwise encroaching neighbour's garden. Finally lugging all the heavy weight of the tree stems and leaves. Also the remaining stem and branches could become a future bull worker!
https://www.facebook.com/share/p/1EAKm6Fgui/?mibextid=oFDknk
[27-04-2025 15.31] PA: Due to tight work schedule patient couldn’t update anything from morning.
Today patient woke up at 7:30 AM. The patient only had 500 ml of water in morning and skipped his breakfast.
After finishing his work he had lunch. White sauce pasta with chicken, french beans and bell peppers. The patient has walked 10,000 steps so far
[27-04-2025 19:04] PPM 1: @PPM 2 @PPM 3 @PPM 4 how sure can we be of these mobile phone accelerometer driven data captures?
[27-04-2025 19:19] PPM 2: Broadly the patient walked more. That's good enough
[27-04-2025 19:19] PPM 1: The nitty gritties of the exact numbers may not matter as much.
[27-04-2025 19.28] PA: Dinner Roti, double egg omelette, tandoori chicken
[27-04-2025 21:28] PPM 3: The reliability of mobile phone accelerometer data for step tracking depends on several factors, and while it is generally useful, there are limitations to consider:
### *Factors Affecting Accuracy*:
1. *Device Placement*:
- Accuracy varies if the phone is in a pocket, hand, or bag. Pocket placement typically yields the most reliable results, while carrying it in a bag may overcount steps due to incidental motion.
2. *Movement Type*:
- Accelerometers detect repetitive motion patterns. Activities like cycling, driving, or even typing might be misinterpreted as steps, leading to overcounting. Conversely, slow walking or uneven terrain may undercount.
3. *Algorithm Differences*:
- Step-counting algorithms vary by phone model and app. Some filter out non-walking motions better than others. For example, your sudden jump to 10,540 steps (vs. a 2,155-step average) could indicate either genuine activity or algorithmic overcounting (e.g., phone jostling).
4. *Environmental Context*:
- Consistent phone usage matters. If the phone was left stationary part of the day, steps during that period would not register.
--- ### *Practical Recommendations*:
- *Cross-Verify*: Compare data with a dedicated fitness tracker or smartwatch, which are often more accurate due to specialized sensors and consistent placement.
- *Check Phone Placement*: Ensure the phone is carried consistently (e.g., in a pocket).
- *Review Activity Context*: Reflect on whether the spike aligns with actual activities (e.g., a long walk, workout) or potential false triggers (e.g., travel, phone vibrations).
### *Conclusion*:
While accelerometer data provides a reasonable estimate, treat it as a general guide rather than an absolute measure. Significant deviations (like your 10,540 steps) warrant contextual validation—did you walk more, or could external factors have skewed the data?
[28-04-2025 11:41] PA: The patient didn't have proper sleep last night because he was traveling back to his home.
He reached home at 5:45 AM. After that the patient took a nap and woke up at 10 AM.
[28-04-2025 11:45] PA: The patient had breakfast at 11 AM 2 rava- curd chila, 2 eggs shakshuka
[28-04-2025 15.24] PA: Lunch Millet, sauted cabbage-potato-carrot, paneer-quash-pointed gourd gravy
[28-04-2025 20:39] PPM 1: 👍
[28-04-2025 21.57] PA: Dinner Tandoori Roti, Tandoori Chicken, cabbage-raw onion-carrot salad
[29-04-2025 10:36] PA: The patient woke up at 9:30 AM. Breakfast Half Rawa-Yougurt Chila, Shakshuka
[29-04-2025 17:03] PA: The patient had veg (corn & onion) grilled sandwich and a cup of masala tea at 2 PM. The patient is having chia pudding (no added sugar) with coconut and papaya and black coffee (without sugar)
[29-04-2025 19.54] PA: Dinner Khichdi with carrot-sheem-peanuts, sauted cabbage-aalu and laal shaak
The patient is having a meetha paan after dinner.
[30-04-2025 10.21] PA: The patient woke up at 9:00 AM Breakfast Roasted Makhana and Jowar puffs with salad (cucumber, raw onion, beet root)
[30-04-2025 13.34] PA: Lunch Khichdi with peanuts-carrot-cabbage, laal saag, pointed gourd with paneer.
[30-04-2025 20.53] PA: The patient had a glass of milkshake with dried blueberry and cashew without sugar at 4:00 PM. After that the patient went for a 3 KM walk at 5:00 PM. At 6:00 PM the patient had a small piece of watermelon, raw black chana and raw whole moong.
[30-04-2025 20.54] PA: Now the patient is having dinner. Rice and moong dal khichdi with carrots and cabbage. Parwal-quash gravy, laal shaak and egg bhurji.
PPM 1: 👍
[01-05-2025 21.48] PA: Due to some unavoidable circumstances the patient could not provide the timely details today.
Today's food details are mentioned below.
The patient woke up at 9:30 AM. Last night the patient slept around 2:30-3:00 AM, as he was not feeling sleepy.
Breakfast at 10:30 AM
Chia pudding with papaya and dry fruits. Egg-Ragi upma.
[01-05-2025 21.51] PA: Lunch at 2:00 PM
Brown bread sandwich with home made hung curd spread, raw cucumber and raw onion, Chicken curry
Post lunch the patient had a home made meetha paan with coconut, fennel seeds and gulkand.
The patient had a plate of mutton biryani with a piece of mutton kosha and raita and zero sugar pepsi at 8 PM
[-2-05-2025 14.31] PA: The patient woke up at 9:30 in the morning and had his breakfast at 10:30 AM.
Breakfast - Chicken curry and millet upma with tofu. Lunch White rice, til bata, shim bata, moong dal with tofu and carrots
[02-05-2025 15:12] PPM 1: 👍
[02-05-2025 18:35] PA: The patient took a small walk of 3KM and some push ups
[02-05-2025 21:13] PA: The patient had half Raj Kachori and a small cup of milk tea in the evening.
At 9:00 PM the patient had his dinner. 2 ragi rotis, cucumber-onion-curd salad, Moong Dal with carrot, parwal and tofu.
[03-05-2025 15.21] PA: The patient woke up at 9:00 AM. The patient had his breakfast at 10:30 AM
Whole wheat bread sandwich (fresh cream, cucumber, onion) and one boiled egg.
[03-05-2025 15:24] PA: The patient had some chana with cucumber and onion at 2:00 PM.
Lunch 2 ragi rotis, moong dal with parwal and tofu, chichinga with potato sauted, 1 boiled egg and curd.[03-05-2025 16:49] PPM 1: The only real whole wheat bread in the world is chapati. All other breads are largely colored maida
[04-05-2025 20.49] PA: The patient woke up at 9:00 AM. The patient had his breakfast at 10:30 AM
Home made urad dal, moong dal idlis with peanut chutney.
[04-05-2025 20.51] PA: Lunch Millet upma with dry fruits and bhindi, aaloo sabji.
[04-05-2025 2053] PA: The patient had some idli chaat made with urad dal, moong dal, with beet root, curd, pomegranate, roasted peanuts and some bhujia at 6:30 PM. The patient took a small walk of 3KM.
[04-05-2025 20.54] PA: Dinner at 8:30 PM Millet upma with dry fruits, egg bhurji and bhindi, aaloo sabji.
[05-05-2025 09.14] PA: The patient woke up at 8:15 AM.
[05-05-2025 09.24] PA: Breakfast Jowar puffs, bhindi-aaloo sabji, millet upma with eggs and dry fruits, black grapes
[05-05-2025 20.06] PA: Lunch at 1:00 PM. 2 roti, dhokar dalna with parwal, chicken stew with carrot and potato, cucumber and raw onion salad with curd. The patient took 3 KM walk in the evening.
[05-05-2025 20.10] PA: Dinner at 7:30 PM. The patient had some idli chaat made with urad dal - moong dal, with beet root, curd, pomegranate, roasted peanuts, grapes and some bhujia. Also home made watermelon drink made with watermelon, lime, pudina with some salt.
[05-05-2025 20.49] PA:
[07-05-2025 20.30] PA: At 3:30 PM the patient had 2 roti, beans fry, bhindi fry, a bowl of chana dal, a bowl of kabuli chana and egg bhurji.
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