22-07-2025
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 HEALTH 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.
[22-07-2025 16:17] PPM 1: Thanks @PA for sharing this very well done history, which I'm resharing here again below for the benefit of our other team members:
Before 3 years she was involved in agricultural activities along with her husband.
Last 3 years she left agricultural work to take care of her grandson.
Recently she again started going for agriculture work.
After 4 days her Knee pain has started.
When she sits on the floor and is trying to get up she experiences lot of pain.
Inspite of her current pain below is her daily routine:
Wake up - 6 AM
Freshup - 6:00 - 6:30 AM
Household activities like vessel cleaning & washing clothes manually on floor- 6:30 - 8:00 AM
Breakfast preparation & having it - 8:00 - 9:00 AM
A cup of milk - 9 :30 AM
Cooking - 10Am -12
Lunch time -12:30 -1:30 PM
2 - 4 pm: A small nap/Sleep.
5:00 PM: Any Fruit/ little snack
4-6: Little household works if any.
7:00 - Get fresh and Pooja
8-8:30 - Speak with Children on phone
8:30-9:30 - Dinner time
10:00 PM - Go to bed. She will sleep in 90 percent cases. In rare cases she will be awake till 3:00 AM and get sleep around 3AM
[22-07-2025 16:19] PPM 1: So @PA since when is she having the knee pains? 4 days or 1 week?
[22-07-2025 16:22] PPM 1: 👆 Consuming these medicines since 4 months!
It's danger for the kidneys!
Also this suggests that her knee pain is since 4 months?
So in her history she may have started agricultural labour 4 months back and developed pain since then?
[22-07-2025 16:22] PPM 1: 👆Not evidence based. Can be stopped
[22-07-2025 16:23] PPM 1: Again dangerous! How many injections does she need per week??!!
[22-07-2025 16:23] PPM 1: Non evidence based. Can be stopped
[22-07-2025 16:23] PPM 1: 👆Non evidence based. Can be stopped
[22-07-2025 16:24] PPM 1: Those good results are only due to aceclofenac and piroxicam and they are slowly damaging her kidneys
[22-07-2025 16:25] PPM 1: Please let us know when was anemia noticed in this patient and how
[22-07-2025 16:27] PA: Hysterectomy surgery done 20 years back
That time noticed
[22-07-2025 16:30] PA: Around 9 grams at present sir
[22-07-2025 16:30] PPM 1: So is she having anemia for 20 years!?
Can you share some of her hemogram reports since then?
Why was hysterectomy done at the age of 36?
@PPM4 @RS1 @RS2 hysterectomy is a very important issue in India and you all may want to explore this angle here further by even some telephonic discussion through @PPM5 or @PPM3
[22-07-2025 16:31] PPM 1: Please share the complete hemogram for us to understand the cause of her anemia
For example an iron deficiency anemia would have microcytic hypochromic picture, which needs to be confirmed with serum ferritin
[22-07-2025 16:33] PA: From past 5 months
[22-07-2025 16:33] PA: Ok sir...will do
[22-07-2025 16:33] PA: Which tests required
[22-07-2025 16:34] PA: CBP
S ferretin
[22-07-2025 16:34] PPM 1: Yes
[22-07-2025 16:34] PPM 1: But above its written she's on pain killers since 4 months
[22-07-2025 16:37] PA: Ok sir. Will do and send reports sir
[22-07-2025 16:40] PA: Yeah. She is having this issue since 5-6 months.
Around 15 days she ignored it. Later she took it seriously and consulted a doctor in KPHB, Hyderabad. He suggested some physical exercises and some medicines. Whenever she uses medicines she is fine. Later pain resumed.
Later she went to her hometown from Hyderabad and consulted another doctor in Narasaraopet. Above are the medicines suggested by Narasaraopet doctor. She is continuing these from past 4 months.
[22-07-2025 16:41] PPM 1: Please share a close up of her knees and particularly mark the area with the maximum pain
[22-07-2025 16:41] PA: Understood Sir.
[22-07-2025 16:42] PA: Sure, will share the image sir
[22-07-2025 16:46]PA: Gradually pain coming in the front side knee circle part.
[23-07-2025 10:09] PPM 1: Is the pain only in her right knee and not her left?
[23-07-2025 11:17] PA: Right knee only
[24-07-2025 16:38] PA: Samples given for these two tests.we will get reports by tomorrow. As soon as received I will post it here..
[24-07-2025 16:44] PA: Ok sir
[24-07-2025 16:44] PPM 1: Now more importantly to address her knee pain and obvious metabolic syndrome visible through the abdominal and arm images we need to have every food plate that she consumes shared here daily. Also her hourly activities needs to be logged daily.
We can add you to other similar patient groups if you desire so that you can better understand the workflow.
However @CR has archived many such patients here 👇
[24-07-2025 16.45] PA: Ok sir
[24-07-2025 16:48] PA: I will share food plate..
Generally she will have breakfast like Idli, dosa, poori kindly breakfast.
Two times rice afternoon and night. South Indian meal I can say
2 cups rice, daily 1-2 curries like dal, any veg curry, sometimes boiled egg along with curry, A cup of butter milk.
Monthly once or twice Nonveg she will take like Chicken curry, few times mutton or Fish..
[24-07-2025 16:49] PA: I will capture and share images tonight and tomorrow
[24-07-2025 16:49] PPM 1: What about sugar and maida consumption?
[24-07-2025 16:50] PPM 1: Yes every plate and glass images
[24-07-2025 16:50] PPM 1: Also hourly activities
[24-07-2025 16:51] PA: Maida she won't take..
Sugar very little only I can say..monthly once or twice 1-2 sweets on avg
[24-07-2025 16:51] PA: Sometimes with Upma breakfast she will add little sugar.
[25-07-2025 08:03] PA: Plz find the blood reports as attached
[25-07-2025 20:36] PPM 1: She's not on iron tablets I guess.
We may need to add that.
She can stop all other medicines and start cap-tablet livogen which
contains Ferrous Ascorbate (152mg)+ Folic Acid (1500mcg) once daily
For her knee pains, a safer medicine would be tablet Ultracet half tablet every six hours for 2 days a well.
Please share her daily hourly activities and food plates
[25-07-2025 20:38] PPM 1: 👆Serum ferritin is quite low because of which she may need captab livogen as detailed above.
[25-07-2025 20:39] PPM 1: Serum Ferritin 3.7ng (lab normal is 10-291)
[25-07-2025 20:40] PPM 5: @PA When is a good time to talk to you.. I would like to take a detailed history. Please give me a time tomorrow.
[25-07-2025 20.46] PA: Sure. We will discuss at 11 AM in the morning
[25-07-2025 20:46] PA: Is it fine for you?
[25-07-2025 20:48] PPM 5: Sure.
[25-07-2025 20:48] PPM 5: If it is possible, can we make at 12?
[25-07-2025 20:49] PA: Yeah, that's ok for me. We can talk at 12
[25-07-2025 20:58] PA: Ok sir. From tomorrow will start .
1.Livogen tabs. 30.
Daily 1.
2.ultracet tab. 10
Daily 1/2 tab.
[25-07-2025 21:10] PPM 1: Ultracet tablet half every six hours in a single day for only two days a week
[25-07-2025 21:11] PA: Ok. Sir. Sure👆
[25-07-2025 21.53] PA: Today's dinner plate. Along with this a cup of curd rice.
[26-07-2025 11:22] PPM 5: Just stepped out of my home.. Let's connect at 1 or I will call you directly..
[26-07-2025 12:08] PA: Ok fine
[26-07-2025 12:09] PA: You can call me whenever it works for you today or tomorrow. I am available at any time
[26-07-2025 14:00] PPM 5: @PA -- You can correct me if I am wrong. Please send to me personally the requested images, I will have to deidentify them before sharing. Thank you so much.
Appreciate sharing the data to us. Please continue it.
[26-07-2025 14:41] PA: A small correction in it. Initially for a period of 10 days( not 10 months)
[26-07-2025 14:41] PA: Yeah, will share sir. Tq
[26-07-2025 14:42] PPM 5: Sorry.. my mistake
[26-07-2025 14:42] PA: No issues. Seems type mistake. That's ok..
[26-07-2025 14:43] PPM 5: Dear team..
Thank you so much for the all work around the patient...
There are some changes to the initial history which I have found out after talking to the patient.
Patient started suffering from Knee pain from last five months. Initially for a period of 10 days, she didn't give much attention to it but she was suffering was so much that she was not able to get up on sitting on a flat surface but was able to sit on chair and bed.
So, they visited a consultant in Hyderabad who has taken a X-Ray (requested) and also given her medications. (Requested) and physical exercises. Her pain subsided after taking thes
[26-07-2025 14:43] PPM 5: Updated with the typo correction..
[26-07-2025 14:48] PA: I tried to share the X-Ray and other medication suggested by the doctor. Bt accidentally we missed those things booklet & prescription as well..
[26-07-2025 14:49] PA: Sorry to say this..But we missed those.
[26-07-2025 14:50] PPM 5: It's okay. No problem
[26-07-2025 14:56] PA: Regarding patient hourly activities
She usually wakes up at 6. She will do household works (washing,vessel cleaning and sweeping in her home,etc) in her home..Fresh up and have breakfast Idly (5)/Upma (Medium cup of Upma)/dosa (3 medium size) around 9 Am daily. She will do cooking. Later at 12:30-1:30 she will have her Lunch ( white rice, curries: Dal/any curry and a cup of curd rice). Same she used to have it in dinner as well bt some wt little quantity during dinner at 9:30 pm. Afternoon she will sleep around 1 hr. Around 4-5 a fruit/any snack like Bajji/Pakodi she will have. Around 10-10:30 she will go to bed and sleep.
[26-07-2025 14:57] PA: 90 percent the routine is same on each day. No major differences we can see here from day to day..
[28-07-2025 10:24] PA: We started these two
[28-07-2025 10:25] PA: As part of treatment anything we need to follow like medicines/etc/food habits/any
[28-07-2025 10:26] PA: Plz suggest. She will start
[28-07-2025 11:32] PPM 1: Keep sharing her hourly activities and daily food plates and we shall be able to guide
[28-07-2025 11:32] PPM 1: Please share the image of the medicines she's taking
[28-07-2025 11:33] PA: Livogen, Ultracet
[28-07-2025 11:34] PA: All other medicines she stopped
[28-07-2025 11:35] PA: 6 AM - woke up
7-9 household activities she did
9-10 Am: freshup & breakfast Upma she taken
[28-07-2025 11:35] PA: Meal plate I will share
[28-07-2025 11:38] PA: 11:30 she taken Ultracet half tablet
[28-07-2025 11:38] PA: Today only she started Ultracet
[28-07-2025 11:38] PA: Last ni8 only we started Livogen (1) she taken
[28-07-2025 11:38] PA: Now she is dng cooking
[28-07-2025 11:39] PA: Hope you have enough information about patient day schedule. Plz let me know if anything do I need to add here
[28-07-2025 21:01] PPM 1: 11:00-12:00PM
12PM-1:00PM
1:00 PM-2:00PM
3:00 PM-4 PM
4:00PM-5PM
5:00 PM -6 PM
6 PM -7 PM
7PM-8PM
8PM -9PM
9PM-10PM
10PM-11PM
[28-07-2025 21:23] PA: Meal plate today. Dal & Bitter guard fry. A small cup of curd rice. Ok will reply shortly
[28-07-2025 21:59] PA: 11:00 -12:00PM - Cooking
12:00 -1:00 PM - Cooking
1:00 -2:00 PM - Having Lunch
2:00 - 3:00 PM - Sleep
3-00 - 4:00 PM - Sleep
4:00 -5:00 PM - Washed clothes folding
5:00 - 6:00 PM - Spending time with Grandson
6:00 -7:00 PM - Rice preparation
7:00 -8:00 PM - Fresh up and do Pooja
8:00 -9:00 PM - Spending time with family & talking in phone with children
9:00 -10:00 PM - Having Dinner
10:00 -11:00 PM - Taking medicine & go to bed..
[29-07-2025 07:24] PPM 1: Well done 👏👏
[29-07-2025 09:13] PA: Tq. Plz suggest the Medicines or anything that patient needs to follow as part of this treatment.
[29-07-2025 09:23] PPM 1: The most important way to healing the root cause in her case which is trunkal obesity, is life style modification.
We can share how to modify it daily if she continues to share her daily energy inputs and outputs as demonstrated here: https://medicinedepartment.blogspot.com/2023/12/pajr-daily-activities-energy-outputs.html?m=1
[29-07-2025 13:07] PA: Can you plz explain it clearly. What she needs to..
[29-07-2025 13:14] PPM 6: Just like you shared about her daily schedule
Also Take pictures of food She is having daily
Like a Picture diary.
So that we can advise and balance her diet.
[29-07-2025 13:18] PPM 6: Ex:
Lunch at 1 pm - Attach a pic of Food
just like how you shared 2 pics prior
Also about lifestyle modification:
That is
1. Balanced Food the patient takes
2. Daily physical activity she does
3. Managing Stress (Emotionally) via meditation or yoga or pooja as she does.
4. Sleep - uninterrupted - 7 -8 hrs
[29-07-2025 13.31] PA: Lunch
No comments:
Post a Comment