18-08-2025
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.
[21-08-2025 11:50] PPM 1: @PPM3 can you have a telephonic session with the patient advocate here to collect an event timeline as well as the clinical and investigation images at a time of mutual convenience?
[21-08-2025 12:02] PA: I will be free "tomorrow between 7-10 in the morning and post 6PM in the evening "to provide the required information.
[21-08-2025 14:40] PPM 3: will do sir
[21-08-2025 14:40] PA: Noted
[29-08-2025 08.04] PA: This is the report 2 days before coming to the hospital
[29-08-2025 08:08] PA: Symptoms before Carbimazole
1. Dull pain in stomach while standing or sleeping (October)
2. Pain got increased at nights after having beef for consecutive 4days, blood after stool (November)
3. Started going to washroom 2-4 times a day with pain in the intestine
4. Lost weight from 62 to 50
5. Feels dizzy and exhausted all the time
6. Used to play cricket for hours without even having food now can't even play 10 mins at any moment
7. Sweats a lot even after any simple work
8. I feel like resting on the bed after standing 3-4 mins
9. Heartbeat increases after any little work, and is usually high while resting
10. Can't stand for a few mins
11. Pain in the knees while standing, climbing or getting down on stairs
[29-08-2025 08:09] PA: Relief post usage of Carbimazole
[29-08-2025 08:14] PA: 1. Not feeling exhausted
2. No sweating
3. Pain in stomach reduced to almost 70-80%
4. Wait gained from 50(06/08/2025) to 52kg (26/08/2025)
5. Stool frequency has decreased from 3-4 times a day to 1-2 times a day, rarely 3 times
6. Reduced joint pains
7. Thickening of Hair
8. Eyes balls that don't pop out
9. Heartbeat decreased (Patient could notice his heart racing before using carbimazole, he could see it through and hear it when he plugs in earphones)
10. No palpitations if he does a bit of jogging
[29-08-2025 08:16] PA: Things that still need to be changed
1. Still couldn't sleep before 1:30 or 2:30 and wake up by 5:30 or 6 (but the quality of sleep has increased as in he doesn't get up in his sleep as much as he used to)
[29-08-2025 08:19] PA: Noticed side effects of Carbimazole (Not sure if it's because of Carbimazole but it did occur during the usage)
1. Sensitivity to sunlight - Patient got mildly itchy whenever he steps out or if there's a change in the environment
2. The whole body got unbearably itchy only one for day 4 days back (22/08/2025) (he took an avil and the itchiness went never returned in these 4days)
[29-08-2025 10:13] PPM 1: Very well described 👏👏
Your patient is lucky to have you as an advocate and I suppose he too is sharing his symptoms meticulously with you👍
[29-08-2025 10:13] PPM 1: @CR let's collate everything into a case report so that the shared information can be analysed further here using Web 2.0-3.0 approaches
[29-08-2025 10:15] PPM 1: This report may have another page where it mentions the total leucocyte count.
Please share the thyroid function test report of T3, T4 , TSH
[29-08-2025 10:17] PPM 1: While you have shared your patient's events very well, please go through our official template here
to see if you can add more.
[29-08-2025 11:00] PA: Sure. T3, T4 TSH Values before Carbimazole
CBC Before Carbimazole
[29-08-2025 11:08] PPM 1: The total leucocyte count is same in both reports
[29-08-2025 19:49] PA: Hi Doctor
Can I start going to the gym again?
[29-08-2025 20:55] PPM 1: Yes if your patient wants to start exercising again please keep sharing his hourly routine including his diet plates here
Check out how this is done by our other patients here 👇
[30-08-2025 01:18] PA: Sure Will do
[03-09-2025 23:03] PA: Day 1 - 3rd Sept 2025
5:30 AM - Woke up
6:15-7:15 - Work out
8:00 - Breakfast
9:00 AM - 1:00 PM- Office
1:00 PM -2:00PM Lunch
2:00 PM -6:00PM Office
6:00 PM -8:30PM Leisure
8:30PM - Dinner
9:15 PM-10:30PM - Office work
10:30 - 11:00 Listened to Music
[03-09-2025 23:05] PA: Breakfast
4 Boiled Eggs (With Ghee and Red Chilli powder sprinkle)
1 Banana
Lunch - Potato and Dal curries Rice and curd
Dinner - Chicken Curry and Rice
PPM 1: 👍
[05-09-2025 08:11] PA: Day 2 - 4th Sept 2025
5:30 AM - Woke up
6:15-7:15 - Work out
8:00 - Breakfast
9:00 AM - 1:00 PM- Office
1:00 PM -2:00PM Lunch
2:00 PM -6:00PM Office
6:00 PM -7:30 leisure
Slept By 8PM
Woke up in btn at 2, slept and Woke up again at 5:30
[05-09-2025 08:12] PA: Breakfast
4 Boiled Eggs (With Ghee and Red Chilli powder sprinkle)
3 Idly
Lunch - 3 Roti, Dal, Bhindi Curry, Carrot Beetroot fry and curd
Dinner - Chicken Curry and Rice
[05-09-2025 08:12] PA: Couldn't Send yesterday as I was asleep by 8
[-5-09-2025 21.09] PA: Day 3 - 5th Sept 2025
5:40 AM - Woke up
6:25-7:25- Work out
8:00 - Breakfast
9:00 AM - 1:00 PM- Office
1:00 PM -2:00PM Lunch
2:00 PM -6:00PM Office
6:00 PM -7:30 Meeting
7:30-9:00 cooked and had food.
Trying to sleep by 9:30
Breakfast - 4 Boiled Eggs (With Ghee and Red Chilli powder sprinkle)
1 Banana and an orange
Lunch - Brown rice, Drumstick tomato curry, Sambar
Dinner - Rice and Aloo curry
[06-09-2025 23:00] PA: Day 4 - 6th Sept 2025
10:00 AM - Woke up
10:20 - Breakfast
11:00-02:00 Attended a Session
2:00 PM Lunch
2:45 PM to 3:30 PM Laundry
04:00 PM to 06:00 PM - Went out
06:00 PM to 08:00 PM slept
08:00PM Had Dinner
9:30 PM Scrolled for a while
11:00PM - Trying to sleep
Breakfast - 4 Boiled Eggs (With Ghee and Red Chilli powder sprinkle)
Smoothie -1 Banana, 50gm Oats, 15gm Peanut butter
Lunch - Chicken Curry rice and Curd
Dinner - Chicken Curry and Rice
[07-09-2025 09:39] PPM 1: One egg per day is a better idea. Please share the food plate images of the patient for us to evaluate better.
[07-09-2025 12.50] PA: Noted Doctor
[07-09-2025 12:52] PA: This is what patient generally use to track and make his own meals
[07-09-2025 12:53] PA: Suggest changes if required
[07-09-2025 12:54] PA: This is made by the patient himself and has been using it for the last 4 years excluding Jan to July end 2025
[07-09-2025 12.56] PPM 1: 👆@PPM3@PPM2 @PPM5@PPM6 please check out the nicely done work of this patient's advocate here as far as quantitative documentation of his diet energy inputs are concerned
[07-09-2025 16:19] PPM 2: Fantastic work! Would love to see pictures of food plates though.
[07-09-2025 16:20] PPM 2: Hopefully one day our sensor will be able to pick how much salt the foodplate has and how many micro nutrients etc.
[07-09-2025 17:23] PA: Will share starting tomorrow morning
[07-09-2025 18:33] PPM 5: Brilliant!!
[07-09-2025 18:33] PPM 5: What is the patient advocate using to compute this from the patient's food plate? Any app?
[07-09-2025 19:05] PA: The patient weighs the ingredients before cooking so that it is easier to track macro nutrients. Nutrition facts of each ingredient are gathered from either food labels or through a Google search,
Once obtained
According to patients knowledge Each Carb and Protein is multiplied by 4 as 1gm of carb / protein = 4 calories
And Fat is multiplied by 9 as 1gm fat = 9 calories
[07-09-2025 19:08] PPM 5: Superb! What a patient we have!!
[07-09-2025 19:14] PPM 2: Great work and insights.
[07-09-2025 19:14] PPM 2: I'm curious, why is the patient meticulously tracking these?
[07-09-2025 19:18] PA: Patient is
1. Focused towards long-term health
2. Does workouts (started in 2020 Age 17)
3. Also into Martial Arts So important to maintain weight while getting stronger
[07-09-2025 20:21] PPM 2: Excellent. We should consider changing the title of this PaJR group then.
[07-09-2025 20:27] PPM 1: Suggest a new title!
[07-09-2025 20:50] PPM2: 22/M Health Journey with Graves' Disease
[07-09-2025 21:32] PPM 1: Duration of disease would be useful upfront in the title
[08-09-2025 07.51] PA: Patient converts ingredients in the plate, into a shake using water only, and consume it after Having eggs
[08-09-2025 07:58] PPM 1: I should have taken a side profile of the patient when met him at the time with weight loss etc because now I'm sure that if I see him again he'll look more like a body builder!
[08-09-2025 08:01] PA: Patient has pictures/videos of before the weightloss and after the weightloss
[08-09-2025 08:03] PPM 1: Here are some transformative images of another past patient from may to November 2023. Will try to gather recent ones to update there 👇
[08-09-2025 08:03] PPM 1: Please share in the lateral view as demonstrated above after deidentification.
[08-09-2025 08:03] PA: Sure
[08-09-2025 15:45] PPM 1: Mango?
[08-09-2025 16:38] PA: Yes
[08-09-2025 23:46] PA Day 6- 8th Sept 2025
5:30 AM - Woke up
06:00 AM to 07:00PM workout
08:00 AM - Breakfast
09:00 AM to 1:30 PM Office
1:30 PM Lunch
2:00 PM to 6:30PM office
08:00 Rested
08:30 to 9:30PM office related work
9:30 PM Dinner
12:00PM - Trying to sleep
[09-09-2025 07:51] PA: Couldn't find picture references as required
[09-09-2025 07:51] PA: But could get something closer for a rough estimation
[09-09-2025 07:55] PPM 1 @CR we can archive all these very well done image timeline
[09-09-2025 22:28] PA: Day 7- 9th Sept 2025
5:30 AM - Woke up
06:00 AM to 07:00PM workout
08:00 AM - Breakfast
09:00 AM to 1:30 PM Office
1:30 PM Lunch
2:00 PM to 6:30PM office
08:00 Rested
08:30 Dinner
11:00PM - Trying to sleep
[10-09-2025 06:22] PPM 1: 👆What time could the patient sleep on 8th?
[10-09-2025 06:23] PPM 1: Canteen?
[10-09-2025 06:24] PPM 1: 👆 Approximately how much time from 11:00PM may have the patient taken to fall asleep? Half an hour or an hour?
[10-09-2025 06:41] PA: Slept before 10:40
[10-09-2025 06:41] PA: +/- 5 minutes 12:00
[10-09-2025 06:51] PPM 1: The patient mentioned trying to sleep at 11:00 PM
[10-09-2025 06:53] PA: It's a typo trying to sleep "by" 11:00
[10-09-2025 09:25] PA: Dal and Salad is from Canteen, Rest prepared by patient
[10-09-2025 09:27] PPM 1: Patient often uses a canteen kind of plate design during lunch?
[10-09-2025 09:28] PA: No, only when there's a time constraint
[11-09-2025 22:35] PA: Day 8- 10th Sept 2025
5:30 AM - Woke up
06:00 AM to 07:00PM workout
08:00 AM - Breakfast
09:00 AM to 1:30 PM Office
1:30 PM Lunch
2:00 PM to 6:30PM office
08:00 Rested
08:30 Dinner
Slept by 9:15
Breakfast and Dinner Remained same while Lunch was Rice, 1 Roti, Dal and Curd
[11-09-2025 22:39] PA: Day 9- 11th Sept 2025
5:30 AM - Woke up
06:10 AM to 07:10PM workout
08:00 AM - Breakfast
09:00 AM to 1:30 PM Office
1:30 PM Lunch
2:00 PM to 10:15 PM office
Snacks at 6:30- Sunny side up (only one egg - no other ingredients)
9:15PM - Dinner
Trying to sleep by 11:00 PM
As Usual Breakfast and Dinner -for Lunch zeera rice, Sweet Corn, Sambar and Curd
[11-09-2025 22:40] PPM 1: 👍
[12-09-2025 22:26] PA: Day 10- 12th Sept 2025
5:30 AM - Woke up
06:10 AM to 07:10PM workout
08:00 AM - Breakfast
09:00 AM to 11:00 AM office
11:30 Had early lunch from outside
2:00 PM Flight to Mohali
5 PM reached Mohali and the stay
6:30 PM - 9:30 PM Client work
9:30PM Dinner - From outside
10:15 PM - Back to the Hotel
Will try to sleep by 11:00
Snacks at 6:30- Sunny side up (only one egg - no other ingredients)
9:15PM - Dinner
Trying to sleep by 11:00 PM
As Usual Breakfast and Dinner -for Lunch zeera rice, Sweet Corn, Sambar and Curd
[12-09-2025 22:31] PA: Today is also a month on Carbimazole
[12-09-2025 22:31] PA: 32 days to be precise
[12-09-2025 22:43] PA: 1. Quality of sleep has increased a bit more
2. In the past few days patient hasn't slept after 12:00 at night, which in case before patient was (from the past few months to 1-1.5 weeks on Carbimazole) unable to sleep till 1:30 or 2:30
3. Increased energy levels
4. 0 to no Sweating observed even during workouts
5. No pulsating in stomach at all
6. No joint pains - but there's a sense of discomfort while doing squats
7. No Palpitations while resting or standing or walking or jogging, they only come if patient push past my limits and go away in 10-15 secs of rest
8. No Headaches
[12-09-2025 22:57] PA: Stool frequency remained at 1-2 times a day
A bit anxious at times
Tremors
[12-09-2025 23:02] PA: No sensitivity to sunlight observed during the last 10 days
Nor any amount of itchiness
[13-09-2025 07:12] PPM 1: I guess it would still be prudent to get his hemogram checked monthly as carbimazole can be notorious in reducing the neutrophil count.
Check out one of our other patients of Grave's disease hemogram trends here: https://pajrcasereporter.blogspot.com/2025/03/32f-pregnancy-associated-graves-disease.html?m=1
[13-09-2025 08:03] PA: Got it, will do as said.
[13-09-2025 18:59] PA: Hemogram as of 13th Sept 2025 - 33 days on Carbimazole
[13-09-2025 19:00] PPM 1: Looks good
[16-09-2025 22:10] PA: Day 11 13th Sept 2025
03:50 AM – Wake up, wash
04:00 – 06:30 AM – Deep work (urgent reports, presentations)
06:30 – 07:00 AM – Shower + quick breakfast
07:00 – 09:30 AM – Emails + prep for meetings
09:30 – 12:30 PM – Back-to-back office calls/meetings
12:30 – 12:40 PM – Lunch
01:00 – 06:00 PM – Project work + client deliverables + team sync
06:00 – 09:00 PM – Finalize documents, follow-ups
09:00 – 09:30 PM – Dinner
09:30 – 12:30 AM – Extra office work (catch-up, strategy)
12:30 – 03:50 AM - sleep
Day 12 - 14th sept 2025
04:00 AM – Wake up
4:30 – 07:00 AM – Focused deep work (analysis, reports)
07:00 – 07:30 AM – Shower + breakfast
07:30 – 10:30 AM – Calls + client discussions
10:30 – 01:00 PM – Team reviews + urgent emails
01:00 – 01:30 PM – Lunch
01:30 – 07:00 PM – Non-stop project execution (presentations, Excel, docs)
07:00 – 07:30 PM – Dinner
07:30 – 11:30 PM – Work on delayed tasks / strategy work
11:30 – 01:15 AM – Review reports, plan next day
01:25 – 04:15 AM - sleep
Day 13 (15th Sept 2025)
04:30 AM – Wake up
04:45 – 06:30 AM – Prepare decks, write emails, urgent deliverables
06:30 – 07:00 AM – Shower + quick bite
07:00 – 11:00 AM – Marathon meetings (client & internal)
11:00 – 12:30 PM – Documentation + follow-up tasks
12:30 – 01:00 PM – Lunch
01:00 – 07:00 PM – Project execution (tight deadlines + syncs)
07:00 – 07:30 PM – Dinner
07:30 – 11:00 PM – Office backlog clearing + emails
11:00 – 03:30 AM - sleep
[16-09-2025 22:17] PA: Day 14 (16th sept 2025)
03:30 AM – Wake up, get ready
04:00 – 05:20 AM – Client meeting (early start)
05:40 – 07:30 AM – Travel to airport, quick breakfast on the go
07:30 – 09:30 AM – Flight to Hyderabad
09:30 – 10:30 AM – Commute from airport + quick catch-up calls
10:30 – 01:00 PM – Client meetings in Hyderabad (presentations, discussions)
01:00 – 01:30 PM – Working lunch with team/client
01:30 – 05:30 PM – Project execution + follow-up tasks
05:30 – 07:00 PM – Team sync / additional client touchpoints
07:00 – 07:30 PM –Dinner
07:30 – 10:30 PM Liesure
Will try to sleep by 11
Lunch - Day 11. Chole bhature Day 12. Dal chawal Day 13. Chicken burrito bowl
Day 14. Veg Pulao with Raita (couldn't take reference pictures)
Dinner - Chicken Ketsu with rice - Dinner for all 4 days
[17-09-2025 22:15] PA: Day 15 (17th sept 2025)
06:30 AM – Wake up, get ready
09:00 – 01:30 PM – office
1:30 - PM Lunch
2:00 PM to 6:30 PM office
08:00 PM - Dinner
08:30 – 10:30 PM Liesure
Will try to sleep by 11
[17-09-2025 22:16] PA: Breakfast remained same. Lunch entirely from the canteen.
[18-09-2025 08:01] PPM 1: 👍👍
5:30 AM - Woke up
06:00 AM to 07:00PM workout
08:00 AM - Breakfast
09:00 AM to 1:30 PM Office
1:30 PM Lunch
2:00 PM to 6:30PM office
08:00 Rested
08:30 to 9:30PM office related work
9:30 PM Dinner
Trying to sleep by 11:15PM
Breakfast and Dinner as usual
Lunch - Tamarind Rice with dal
No comments:
Post a Comment