OCTOBER 15, 2022
THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HER 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.
PATIENT HISTORY
Patient is a 61-yr old female, homemaker.
First pregnancy in 1985 (normal delivery) uneventful.
In 1990 the patient noticed white discharge during menstruation along with menstrual bleeding (normal, no pain). Doctor diagnosed it to be a uterine tumor and Sx done. Soon after she got pregnant, but her menstrual cycles did not stop, bleeding for 1 day per cycle, with no discharge. After six months into the pregnancy, doctor reported fetus had died and was aborted.
In 1993, got pregnanat for the 3rd time. This time also menstrual cycles did not stop. Bleeding for one day only per cycle and had normal delivery.
In 2005 due to continuous extreme abdomen pain, went to doctor who diagnosed it to be due to uterine cysts. Hysterectomy and bilateral salpingo-oophorectomy were done.
In 2009 February, patient fell down from ladder almost 10ft and #L1 vertebra. Recovery with medicine, bed rest and physiotherapy.
In 2010, c/o severe epigastric and hypogastric pain and agitation. Endoscopy and colonoscopy done. Medicine prescribed (Rabeprazole 20 mg, Levosulpiride, Omeprazole {continued till 2013, then since 2021 till date})
Since 2011 Jan, started Clonazepam 0.5mg , because at that time her husband had recently died and her daughter was still unmarried. Now, takes only when she c/o trouble sleeping or anxiety. Takes 2-3 times per month.
In 2015, c/o continuous lower back pain and elbow pain lat epicondyle (?tennis elbow). Dr advised wearing a belt again (which provides relief) for back pain and gave injections(?steroid) in painful area of elbow, which resolved elbow pain.
In 2016, while on a follow-up for the abdomen pain a lot of tests were done. TSH lvl was 6 mlU/L. Did not prescribe any medications.
In 2017 May, due to a persistent high fever she was asked to do blood and urine tests which detected UTI and her TSH lvl was 8 mlU/L. Medicine Thyronorm 50 was prescribed.
In 2018, for 3 months c/o itchy red rash in the thigh and above elbow jt. Resolved with medicines and ointment. Around that time on a separate occasion c/o persistent fever, for which blood tests were done. DM was detected. Medicine prescribed Glycomate 500 SR.
In 2018, she c/o headache, dizziness, nausea and weakness in getting up from bed. After 1 month, she was taken to a Dr. who did an cervical X ray (report not available) and prescribed medications, taking which she recovered within days. Thinking the headache was due to eye problem she was also taken to Opthalmologist that time.
In 2020, again c/o abd pain in epigastric and hypogastric regions. Colonoscopy and endoscopy done. Erosive gastritis with gastric polyps were detected of which 2 polyps were removed later on 2021 via endoscopic polydectomy. Colonoscopy detected small internal piles.
While on a regular checkup for DM, Dr. prescribed he to take
For the past one month, c/o lower abd. pain, heartburn, throat burning constipation. Dr diagnosed it to be IBS. Prescribed medicine for 3 wks, taking which reduced her symptoms to certain extent.
Pt is diabetic and on medication.
Addiction of eating Paan 3-4 times per day for the past 20 days.
CHIEF COMPLAINT AND Pt REQ.:
Pt wants a update about her gastric polyps and what further treatment can be done
c/o lower abd. pain, heartburn, throat burning constipation and an uneasy feeling in the epigastrium.
Wants to know if so many tablets are actually needed to treat her DM and also for cholesterol.
FAMILY HISTORY:
Mother - similar c/o GI problems
Father - heavy smoker, used to cough a lot and also similar c/o GI problems
HER NORMAL ROUTINE;
She wakes up by 5.30 - 6am. Drink two glasses of water. Then goes for a morning walk for 20 min. Then takes bath and has red tea and two biscuits. Then does puja.
Does cooking, eat some rice and vegetables, sour curd, puffed rice and banana at 11am.
After finishing household chores, eat lunch (rice, fish, vegetables, dal, sour curd) at 2.30pm.
Sleep from 3.30pm to 5pm.
Take a short walk in the evening.
Have red tea and biscuits at 6pm.
Then from 7pm to 9pm lie down and watch TV.
Drink diabetic horlicks at 8.30pm.
Finish dinner by 10.30pm
Go to sleep at 11pm.
Eat jarda paan 4 or 5 times a aday
Love to eat sweet or sour things like khurma, rosogolla, nimki, chana chur and singara.
Details of the medicines that she takes every day.
1. Metformin 500mg + Sitaglipin 50mg (b.d before breakfast and dinner)
2. Metformin hydrochloride 500mg + glimepiride 2mg (o.d before breakfast)
3. Rabeprazole 20 + Domperidone (o.d, empty stomach in the morning)
4. Chlordiazepoxide (5mg + Amitriptyline 12.5mg o.d after dinner)
5. Propranolol 10mg (t.d after breakfast, lunch and dinner)
[01-06-2025 11:20] PA: Sir,
Patient er pet bytha nei,
Kintu ekta pet fule jache, gas gas vab, khete hobe tai khache, khabar seirokom ichhe nei,kaalke aar aajke sokale ghum theke uthe bomi koreche, ghum thiki ache,
Delhi theke ghure eshe egulo bolche last 15 din theke,
[01-06-2025 11:29] PPM 1: When was her last fasting blood sugar, 2 hours post breakfast, lunch and dinner done?
If there's no such recent values of blood sugar available, we may need to get it done with the patient's glucometer and share here
[01-06-2025 11:43] PA: Ei sob report gulo gotokal korano hoyeche.
Eer 1.5 month aage report kora hoyechilo.
Sadharonoto report gulo last 1 year theke 1 month por por Lab theke korano hoy.
[01-06-2025 11:47] PPM 1: Aajke sokal theke ghum theke othar por ghontai ghontai unar activities ebong subjective feelings jaante parle bhalo bhabe bojha jeto unar koshto ta
[01-06-2025 12:06] PA: Sir,
আজকে সকালে আমি ৬ টাতে উঠে দেখি তিনি উঠে পড়েছেন। ঘর পরিষ্কার, ফুল তোলা, তার মধ্যে আজ আবার জামাই ষষ্ঠি। তিনি আজ ব্রত করবেন বলে ঠিক করেছেন। সকালে স্নান সেরে , ঠাকুর ঘর পরিষ্কার করেন, তা আমি জিগ্গেস করলাম আজকে কেমন আছ, বলেন যে পেট টা কেমন গুম করে আছে , তুই আমাকে একজন ডাক্তার দেখা, আরো বলেন যে দিল্লি, বৃন্দাবন তে তিনি যখন ছিলেন তখন সেখানে শুধু আতপ চালের ভাত জল দিয়ে লবণ মেখে খেয়েছেন, ওগুলি খেয়েই তার এই অবস্থা, আমাকে এতদিন কিছু বলেনি যদি আমি রেগে যাই, যাই হোক সকালে আজ লাল চা, আর আখরোট, কাজু, কিসমিস, কাঠ বাদাম এগুলো আমরা একসাথে চায়ের টেবিলে বসে খেয়েছি, তারপর পুজো দিয়ে ঘরের কাজ দৌড়াদৌড়ি করে চলছে, এখন একটু আগে পেঁপে,শসা, এগুলো খেলো, এখন নিজের জন্য ডালিয়া করবে দুপুরে খাবে, আমাকে দেখলেই বলছে যে বাবা আমাকে কালকে একটু ডাক্তার দেখাশ, আমি বললাম যে ঠিক আছে দেখাবো , খুব খুশিতেই আছেন এখন, আমার স্ত্রী সাগু ভিজিয়ে রেখে দিয়েছে, রাতে সাগু ও ফল খেতে বলেছেন , কাজ হাঁটাচলা করছে বিরাম নেই , আমি সামনে থাকছিনা, আমাকে সামনে একা দেখলেই আবভাবে বোঝায় যে শরীর ভালো নেই অথচ কাজ করেই চলছি।
[01-06-2025 12:19] PPM 1: Khub bhalo description. Aebhabe update deete thakle khub sohoje bojha jaabe
[01-06-2025 12:30] PPM 1: @CR let's update her mirror case report borrowing from initial one in the description box and add her updates from last year August and today's updates 👇
[14/08/2024, 08:39] 61F Patient Advocate:
Patient
Glycomet 500(3 times before food)
Glimperide 1.5 mg(before breakfast)
Thironorm 50 khachen
Tini
5.3 am e ghum theke uthe
Tarpor ghorer kichu kaaj koren
7 am er modhye snan, potty complete kore suger free red tea with muri khoi
Kheye puja den.
9.30 am abar red tea ( suger thake)
With biscuit
11 am e chhana ,kola , khoi abar kokhono daliyar khichuri Khan.
2 -2.30 pm vat, mixed veg, nach) mangsho/ egg, tok doi diye kola vat mekhe , fruit khan
4 pm to 5.30 pm bed rest, majhe ghumiye nei.
6 pm lal cha with biscuit
7 pm oats chhila/ muri diye shosha gajor chanachur makha/ chana/ chola seddho
10- 10.30 pm vat daal shobhi
11 pm ghum
Maaj rate ghum theke aar uthen na.
Tobe oner khubi positive energy.
Jemon uni vaben je oner suger bole kono rog i nei, amra dayitto niye eshob korai, oni oner cheleke khubi Vorsha koren, chele ache Mane kono rog nei,
Orthat patient eishob rog ke patta dey na.tar moner jor khubi beshi.
[14/08/2024, 08:57] cm: Khub bhalo 👏👏
[31/05, 20:49] 61F Patient Advocate:
Patient er routine shomporke onekdin theke kichu likchina,
Patient er daily medication
Glycomet 500 daily 3 times khabar aage
Glimperide 1.5mg sokal 9 ta
Eltroxin 50 empty stomach
Amixide H ( khub proyojon hole raate shober shomoy 1 ta dei)
Patient ei medicine gulo 2022 er November theke khachen. Blood sugar levels er range tokhon theke ei rokom i ache.
Tini 6 am e ghum theke uthen, jol khan,taarpor ghor porishkar kore ful tulte ber hon, taarpor snan complete koren, 7.30-8 am e tini ek bati khoi /muri, 2 ta shohara, 3 ta almond, 2 ta kaaju, 10-12 ta kismish, ek tukro kancha holud,shonge without suger lal cha kheye pujo den, pujo dite dite onek shomoy uthe chole ashen je taar cheler wife ki ranna korche, ghorer kaaj korer didi thik thak kaaj korche kina ei sob porjobekhon koren, majhe majhe tader kaajer shomolochna koren ei na oivabe kaaj korte hobe, ei korte korte 9.30 am e lal cha duto biscuit shohoj khan, tarpor ghorer kaaj kora , er por hatachola cholchei, mone ja kotha ashe kono china vabna na kore bole kharap howa, kintu ete taar kono provab ashe na, 11 am e sokaler khabar jmn vat daal shobji ei guloi khaan, taarpor doinik ek kotha aajke pet valo na, kaalke komore bytha, kono din paaye bytha, egulo bolen aami ba amar wife ektu bokajhoja kori,dupur 1.30 e abar snan kore, 2.30 pm e vaat, daal, shobji, mach, tok doi, kola, salad ( egulo daily khan), kheye dupure ghuman bikal 4 tar shomoy kajer didi ashen tini bashon majen, taar shamne regular boshe thake jate bashon thik maja hoy, taar por TV dekhte thaken, 1 month aager theke mobile e reels dekhen jmn gaan shonen, purano hindi ba bangla, swami premanand er bani shonen, aar negative kichu chinta regularly koren , je aamar vai ba aamar bon ra kewi valo na, shondeho kore je aamake aamar chelera bidh hoy dekhbena ultapalta kotha , taar nati taar bichanai boshle rege jay , shuchi batik ache, naati jodi taar kono jinis dhore taake boka onek shomoy kaan mola o khay , aabar naatir sathe deke golpo koren, mobile e duijon boshe reels dekhe, eksathe tv dekhe, kintu oi matha gorom holei bipod, jay hok amra ei nei mani guchiye cholchi, raat 10-10.30 pm e khabar kheye 11 pm e ghum, majhe raate aar uthen na.
[31/05, 20:50] 61f Patient Advocate: Suger baad diye ei test gulo 2 years por kora holo,
[31/05, 20:55] 61F Patient Advocate:
Patient koek din aage 1 month er jonno eka eka delhi, brindavan, mothura ghure ashchen, koekdin theke bolchen je shorir week laage, majhe pet bytha kore , homeo medicine nuxvom 30 diyechi one week pet batha nei , kintu week vab ta ache, Tobe manoshik jhor onek .
[31/05, 21:22] 61F Patient Advocate: 6pm e kono din,
Chanachur muri, makhna diye chola muri, konodin oats chila, abar shagu diye pepe, shosha kola makha , aar laal cha biscuit khan
[01/06, 11:20] 61F Patient Advocate: Sir,
Patient er pet bytha nei,
Kintu ekta pet fule jache, gas gas vab, khete hobe tai khache, khabar seirokom ichhe nei,kaalke aar aajke sokale ghum theke uthe bomi koreche, ghum thiki ache,
Delhi theke ghure eshe egulo bolche last 15 din theke,
[01/06, 11:29]cm: When was her last fasting blood sugar, 2 hours post breakfast, lunch and dinner done?
If there's no such recent values of blood sugar available, we may need to get it done with the patient's glucometer and share here
[01/06, 11:43] 61F Patient Advocate: Ei sob report gulo gotokal korano hoyeche.
Eer 1.5 month aage report kora hoyechilo.
Sadharonoto report gulo last 1 year theke 1 month por por Lab theke korano hoy.
[01/06, 11:47]cm: Aajke sokal theke ghum theke othar por ghontai ghontai unar activities ebong subjective feelings jaante parle bhalo bhabe bojha jeto unar koshto ta
[01/06, 12:06] 61F Patient Advocate: Sir,
আজকে সকালে আমি ৬ টাতে উঠে দেখি তিনি উঠে পড়েছেন। ঘর পরিষ্কার, ফুল তোলা, তার মধ্যে আজ আবার জামাই ষষ্ঠি। তিনি আজ ব্রত করবেন বলে ঠিক করেছেন। সকালে স্নান সেরে , ঠাকুর ঘর পরিষ্কার করেন, তা আমি জিগ্গেস করলাম আজকে কেমন আছ, বলেন যে পেট টা কেমন গুম করে আছে , তুই আমাকে একজন ডাক্তার দেখা, আরো বলেন যে দিল্লি, বৃন্দাবন তে তিনি যখন ছিলেন তখন সেখানে শুধু আতপ চালের ভাত জল দিয়ে লবণ মেখে খেয়েছেন, ওগুলি খেয়েই তার এই অবস্থা, আমাকে এতদিন কিছু বলেনি যদি আমি রেগে যাই, যাই হোক সকালে আজ লাল চা, আর আখরোট, কাজু, কিসমিস, কাঠ বাদাম এগুলো আমরা একসাথে চায়ের টেবিলে বসে খেয়েছি, তারপর পুজো দিয়ে ঘরের কাজ দৌড়াদৌড়ি করে চলছে, এখন একটু আগে পেঁপে,শসা, এগুলো খেলো, এখন নিজের জন্য ডালিয়া করবে দুপুরে খাবে, আমাকে দেখলেই বলছে যে বাবা আমাকে কালকে একটু ডাক্তার দেখাশ, আমি বললাম যে ঠিক আছে দেখাবো , খুব খুশিতেই আছেন এখন, আমার স্ত্রী সাগু ভিজিয়ে রেখে দিয়েছে, রাতে সাগু ও ফল খেতে বলেছেন , কাজ হাঁটাচলা করছে বিরাম নেই , আমি সামনে থাকছিনা, আমাকে সামনে একা দেখলেই আবভাবে বোঝায় যে শরীর ভালো নেই অথচ কাজ করেই চলছি।
[01/06, 12:19] cm: Khub bhalo description. Aebhabe update deete thakle khub sohoje bojha jaabe
[01-06-2025 23:10] PA: Patient Dupure 2 tate sagu kola olpo suger diye kheyeche, taarpor 3 tar theke 5.30 obdi ghumiyeche ,6.30 pm e laal cha with biscuit 2 ta kheye chayer bashon meje mobile dekhte bosheche, aamra aaj bari chilam na, ekhon firlam ,TV ta kharap hober jonno youtube reels dekhe ratre shomoy katiyechen, kichu phone call korechen,jiggesh korlam ki khele bollo daliya kheyechi, aamar sathe olpo golpo korlo ,ekhon ghumiyechen, pet baytha shomporke kichu bollen na, aamiyo aar jiggesh korini
[02-06-2025 07:40] PPM 1: Khub bhalo
[02-06-2025 22:29] PA: Aajke shokal 6 am e uthe eki vabe ghor poriskar, ful tola, snan kore puja diye, sokale khoi muri mixed, shohara, kismish, kaju, akhrot, almond sugar free tea, ranna kore aamake office e pathiyechen, sokale 11 tai daal vat dheosh vaja,aamar wife aaj barite na thakay sob ghorer kaaj korechen, taarpor 2.30 pm e tini vat, macher torkari, mocha ghonto, tok doi, kola,
Taarpor bikal 5.30 pm porjonto ghum, bikale puja diye , mobile dekha, ami bari fire 7 pm e cha kore dilam shonge khoi muri kola aar biscuit kheyehen, taarpor cup plate dhuye mobile e phone kora , youtube dekha, ekhon abar vat khachi shonge loal Rui mach ,daal, mochar torkari diye.
[02-06-2025 23:11] PA: Ekhon ghumalo, aami jiggesh korlam je aaj sara din pet er ki khobor, bollo je aaj ashubidha hoi ni, Tobe majhe majhe weak laage.
Achha sir weak Haemoglobin kom thakar karone hochhe.
[03-06-2025 08:46] PPM 1: Hemoglobin ta tahole ekbar porikkha kora jete pare are nahole apnar ebong unar palmar surface of the hand er pasha pashi chobi pathaleo bojha jabe
[03-06-2025 09:19] PA: Eita last Saturday te kora hoyeche
[03-06-2025 09:24] PPM 1: Thanks
[03-06-2025 09:27] PPM 1: Eta mone hocche blood loss er jonye iron deficiency
Arekta test serum ferritin korle aro bojha jeto jodio unar olpo infection o chilo tai oi somoi serum ferritin korle hoito bojha jeto na.
Etar jonye iron tablets nite paren jemon Tablet Livogen 120 mg once daily
[03-06-2025 09:29] PA: Infection er jonno ki medicine nite hobe
[03-06-2025 09:51] PPM 1: Infection ta bortoman hourly activities shune asha korchi are nei.
Thakle kothai ache sheta janar jonye abar hourly activities ebong shei hourly activities er bhitor ki ki koshto sheta jaante parle bojha jabe
[03-06-2025 10:16] PA: Thik ache sir.
Aajkeo oi aki vabe sokal porjonto cholche, majhe ekbar puja kore eshe shuye porlo, ta ami jiggesh korate bollo mathata jhim jhim korche, weak laagche, pet er kotha bolate bollo je peter vitor gas ba konorokom asthirota nei, khabar ruchi ache, aber kichukhon por uthe kajkormo start kore diyechen.
[09-06-2025 09:36] PA: Sir ,
Patient er komor theke paa porjonto khub bytha hochilo aar pet bytha ta chilo ,tai petient request er jonno ekhane local doctor dekhai, doctor babu aager suger er jonno je sob medicine nito segulo change kore diyeche, doctor babu ke aami bollam patient 2022 theke ei medicine gulo khachhe ebong aager prescription gulo dekhai, tini bollo je PP ta kom ache aar onake oner moto kore treatment korte dite, bollen je 1 month ei medicine kheye onake aber dekhate, oni aro kichu test diye chilen segulo niche dilam.
Eer modhye 2 din holo, Veloz 20, Algaba m75 start korechi
[09-06-2025 09:54] PA: Suger jonno je medicine diyechen ebong others medicine sei gulo ki start kora jabe.
Ekhon pet bytha ba gas er problem hochhe na, Tobe paa theke komor porjonto ekta obosh vab ache, mone hochhe je shue thakle valo, kintu tobuo tini tar doinik kaajkormo jemon sokale otha, ghor poriskar, hata chola, khabar shothik time e khawa egulo chalie jachhe.
[09-06-2025 10:47] PA: Ekhon bolche je shorire ekta jala jala vab
[09-06-2025 21:52] PPM 1: PP ta kom thakle glimiperide 1.5 mg jeta nicchen sheta 1 mg kore dewa jete pare
[09-06-2025 22:36] PA: Thik ache sir
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