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.
[10-04-2025 11.09] PPM 1: OPD right now 48M with history of cough and shortness of breath as well as left loin pain since last 5 months and bipedal edema since two weeks.
Also has hypertrophied latissimi indicative of his occupation which is toddy tree climbing. Another, our campus sign? @~PPM3 @~PPM4, He's also a toddy drinker as well as drinks other kinds of alcohol, chews tobacco often and his last drink of a quarter was two days back! Three months back he was admitted in another hospital ICU and a CT pulmonary angiography found multiple filling defects @~PPM5
[10-04-2025 11:10] PPM 1: 👆step 1 of toddy tree climbing and prominent latissimi
[10-04-2025 11:10] PPM 1: 👆Step 2 of toddy tree climbing and prominent latissimi
[10-04-2025 11:34] PPM 6: 1. Acute Pulmonary Thromboembolism
2. Left Pyelonephritis
3. Urinary Tract Infection (UTI)
4. Prominent Left Latissimus Dorsi (likely due to toddy tree climbing)
PPM 1: 👍
[10-04-2025 16.22] PPM 1: Afternoon session:
[11-04-2025 09:40] PPM 1: Pleased to add our PGY1 and great to see his interest in this direction @PPM 2 Let's hope he becomes another mover and shaker emerging out of the Narketpally syndrome![14-04-2025 07:59] PPM 1: @PPM7 would you and @PPM 8 :) @PPM 4 like to take the complete history details of this patient on a con call for another potential integrative case report? His advocate is regularly updating me his prowess and I'm hoping he will also share here
[14-04-2025 08:20] PPM 4: Sir language?[14-04-2025 08:42] PPM 1: @PPM 7 will help to translate during the con call
[14-04-2025 13:09] PPM 7: Yes sir
[24-04-2025 11:56] PPM 1: [14/04, 07:59]pm: Share his update in his group here👇https://chat.whatsapp.com/Jr9JKNMo2NsEmbXH8XSLot
[15/04, 09:16] Patient Advocate Narketpally: Is there any need to meet you sir about him
[15/04, 09:25]pm: Share his daily energy Inputs (food plates) and hourly energy outputs (activities) in his PaJR group
[15/04, 21:21] Patient Advocate Narketpally: Ok sir
[24/04, 11:37] Patient Advocate Narketpally: Hai sir good morning
[24/04, 11:37] Patient Advocate Narketpally: He don't have any swelling
[24/04, 11:39] Patient Advocate Narketpally: But some time he getting ankle pain
[24/04, 11:41] Patient Advocate Narketpally: And truly he did not put efforts on food
[24/04, 11:41] Patient Advocate Narketpally: Daily he eat rice +one curry
[24/04, 11:41] Patient Advocate Narketpally: That's it
[24-04-2025 12:07] PA: Ok sir.
[07-05-2025 11.27] PPM 1: Reviewing him now in OPD:
48M with past history of bike accident in 2012 with persistent right knee pain and left lumbar pain since then and a right knee operation for ACL tear was done in March 2024 and during the immediate post operative period they also gave a transforaminal paravertebral injection to relieve his left lumbar pain.
After 2 months of that progressive cough, shortness of breath and persistent left lumbar pain made him hospitalized at LBN. Following which they did CTPA and documented multiple pulmonary arterial filling defects.
On April 10 we reviewed him and added Hfpef and metabolic syn to his diagnosis and he's still on once daily rivoroxaban 15 mg once daily.
His case report is archived by @CR here: https://pajrcasereporter.blogspot.com/2025/04/48m-pedal-edema-pulmonary-embolism.html?m=1 and may need to be updated with the current documents and this addition to his history.
His pedal edema had reduced with diuretics but now has left lower limb pain, which has returned along with unilateral edema!
[07-05-2025 11.42] PPM 1: At that time he was also labeled pyelonephritis in view of an incidental left bulky kidney
Will get a review ultrasound in view of suspected left renal vein thrombosis that may have caused his symptoms at that time along with pulmonary embolism.
[10-05-2025 11.51] PPM 1: @PPM7 remember he came to the OPD that day and you asked for venous Doppler to investigate his past pulmonary embolism?
@PPM8 they have again changed the report after your phone call now saying there's no thrombus in the popliteal vein!
[10-05-2025 14:27] PPM 8: They have doubt of thrombus unfortunately first year have written it in the final report ..they thoroughly rechecked again and said that there is no thrombus sir
[10-05-2025 14:27] PPM 8: After sending him second time.
[10-05-2025 14.28] PPM 1: 👍
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