21-10-2025
THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED ATER 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.
Age - 48
Gender - Female
Unmarried
Profession - Teacher
*Key Problem:*
Chronic pain in the right lower abdomen since her hysterectomy surgery (laparoscopy) in April 2020.
*Current Status:*
The pain persists throughout the day, mostly mild, but tends to increase before bowel movements and subsides after. It pains when the area is pressed.
A local doctor's physical examination revealed swelling and hardness in the area, suggesting a CT scan. An ultrasound (USG) was done, but it didn't reveal any abnormalities.
The patient recently visited CMC Vellore, where doctors also recommended a CT scan. However, she's hesitant due to radiation concerns.
*Medical History:*
- Gallbladder removal (laparoscopy) on May 9, 2019
- Hysterectomy (laparoscopy) on April 18, 2020 - pain started post-surgery; surgery was complex and prolonged
-Gastrointestinal and piles issues
- Diabetes, hypertension, and cholesterol issues since June 2021 (on medication)
- Ayurvedic piles operation (Chandsi) on March 4, 2024
[21-10-2025 20.41] PA: The pain is in the area she is pointing to with her right hand.
[22-10-2025 12.27] PPM 2: Thanks, is the pain associated with anything else such as Nausea? Bloating, flatulence? Bowel disturbances?
[22-10-2025 06.58] PPM 1: Well done history 👏👏
On first evaluation of the data (pasted again below for our team members added later), it appears to be a bowel motility problem often associated with autonomic bowel plexus involvement due to diabetes as well as without diabetes.
The palpable swelling on ultrasound appears not to be correlated although other clinicians appeared to have suggested CT abdomen meaning they may have felt the swelling to be clinically significant.
Would like to know more about the patient in terms of hourly deidentified activities as in what is in our template here: https://userdrivenhealthcare.blogspot.com/2024/08/template-for-pajr-user-driven-history.html?m=1
Questions for the patient advocate:
Please describe your patient's hourly routine over 24 hours when she was perfectly alright
Next please describe what happened to her hourly 24 hour routine once the disease took hold on her life
Please mention specifically which part of the patient's hourly routine was disrupted
History currently available:
Age - 48
Gender - Female
Unmarried
Profession - Teacher
*Key Problem:*
Chronic pain in the right lower abdomen since her hysterectomy surgery (laparoscopy) in April 2020.
*Current Status:*
The pain persists throughout the day, mostly mild, but tends to increase before bowel movements and subsides after. It pains when the area is pressed.
A local doctor's physical examination revealed swelling and hardness in the area, suggesting a CT scan. An ultrasound (USG) was done, but it didn't reveal any abnormalities.
The patient recently visited CMC Vellore, where doctors also recommended a CT scan. However, she's hesitant due to radiation concerns.
*Medical History:*
- Gallbladder removal (laparoscopy) on May 9, 2019
- Hysterectomy (laparoscopy) on April 18, 2020 - pain started post-surgery; surgery was complex and prolonged
- Gastrointestinal and piles issues
- Diabetes, hypertension, and cholesterol issues since June 2021 (on medication)
- Ayurvedic piles operation (Chandsi) on March 4, 2024
[22-10-2025 08.56] PA: এটা একটু বলে দে[22-10-2025 10.14] PA: It does pain when she has pressure in her abdomen for any reason - it can be stool passing or flatulence or bloating. She didn't feel nausea generally even though she has frequent acidity and gastrological problem.
She can feel the hardness in the area when standing and checking with her hand.
She was posted in a very remote village on the outskirts from 2009 to 2022.
Her surgery phase started at 2019 but this was her normal daily routine throughout her this job posting:
A Normal School Day
On a normal school day, she would wake up by 5 a.m. in the morning and would drink warm water with lemon. She would have a bowel movement and take a shower, followed by Yoga for 30 minutes to 1 hour, usually 1 hour.
After that, she would make herself a cup of tea with milk and sugar and have it with biscuits.
Then she would cook for herself—either a mixed khichdi (with lentils, rice, and vegetables) or rice and a vegetable soup separately. She would have this for breakfast and pack some muri (puffed rice with either a boiled potato or the soup she had made).
She would leave for school by 10 a.m. and reach there by cycling. The school was very near where she stayed; it would only take 2 minutes by bicycle.
She would mostly teach Maths and the Physics portion of Physical Science to classes 9 and 10.
The tiffin break was at 1:30 p.m. Since she wasn't hungry then, she would monitor the midday meal procedure and student activities during the break hour instead of eating her lunch.
She would have her light lunch (muri and boiled potato/vegetable soup, or sometimes a vegetable from the midday meal) at around 3 p.m.
She would leave from school by 4:45 p.m. after making sure everything was properly closed.
On returning, she would have milk tea with sugar again, with biscuits.
Sometimes she would visit the market to buy her daily supplies and would have fried snacks like pakoda, etc.
In the evening, she would do her yoga again for another 1 hour.
She would make a fresh batch of rice and have it with the leftover soup from the morning, if any, or she would make a fresh one. She would finish her dinner by 7:30 p.m.
Then she would do some reading or check the students' notes.
She would go to sleep by 10 p.m.
Weekends
On Saturday, she would leave for home after school at 2 p.m. It was a 6-hour journey. She would cycle 6 km to the bus stand first. Then she would return home by bus. Her father would pick her up by bike for the last 5 km of the journey.
On the weekend, she continued her yoga both morning and evening. She had a variety of vegetables and sometimes fish in her meals.
Note:
She has a strong connection with a spiritual Ashram that also operates an orphanage.
She donates most of her earnings there and lives a very minimalist life.
Also she often prefers a vegetarian diet.
[22-10-2025 10.43] PPM 1: Very well done event timeline before her problems started. 👏
Please now fit in her various symptoms in these workday and weekend time slots that you mentioned
[10:43 am, 22/10/2025] PPM 1: Please now fit in her various symptoms in these workday and weekend time slots that you mentioned
[12:48 pm, 22/10/2025] PA: In May 2022, she was posted to her hometown, which is a calm village with good air quality.
Now her school is 7 km away from her home, and she lives with her elderly parents.
Her New Daily Routine
In the morning, she wakes up by 5:30 a.m., has a bowel movement, and takes a shower. Then she performs her yoga, but the time is now reduced to 30 minutes.
She then boils water with black pepper, cinnamon, cloves, and basil seeds. She will add tea to this and drink it whenever she wants tea, which is usually twice in the morning and once in the afternoon. This tea is without sugar and milk. Sometimes, she skips this recipe and has black tea with bay leaves instead.
After drinking tea, she starts cooking. Here, she needs to cook multiple vegetables separately and prepare roti for her father.
After cooking, she gets ready for school and has her breakfast, consisting of rice, multiple sabjis (vegetable dishes), and sometimes fish (as she needs to cook fish more often here for her parents).
She packs her lunch for school - mostly muri and a vegetable, and sometimes roti that she prepared for her father.
She leaves for school by 10:30 a.m. Now, instead of a bicycle, she rides a Moped, and it takes 20 minutes to reach school.
The school routine is as usual. She takes her lunch at 3 p.m., as before. She leaves school at 5 p.m.
After coming back home, she prepares tea for herself as well as for her parents.
She then goes for an evening walk for 30 minutes. After returning home, she again performs her yoga and prayers for 30 minutes.
Then, she cooks again. She has her dinner, consisting of rice again, by 9 p.m.
After dinner, she often needs to do some official work for her school, usually on her mobile.
She goes to sleep by 10:30 p.m.
On the weekends, she goes to market sometimes.
[1:00 pm, 22/10/2025] PPM 1: Very well narrated. 👏
@Meta AI @PPM3 what are the differences in the two routines described here?
[22/10, 10:36] Patient Advocate 2: She was posted in a very remote village on the outskirts from 2009 to 2022.
Her surgery phase started at 2019 but this was her normal daily routine throughout her this job posting:
A Normal School Day
On a normal school day, she would wake up by 5 a.m. in the morning and would drink warm water with lemon. She would have a bowel movement and take a shower, followed by Yoga for 30 minutes to 1 hour, usually 1 hour.
After that, she would make herself a cup of tea with milk and sugar and have it with biscuits.
Then she would cook for herself—either a mixed khichdi (with lentils, rice, and vegetables) or rice and a vegetable soup separately. She would have this for breakfast and pack some muri (puffed rice with either a boiled potato or the soup she had made).
She would leave for school by 10 a.m. and reach there by cycling. The school was very near where she stayed; it would only take 2 minutes by bicycle.
She would mostly teach Maths and the Physics portion of Physical Science to classes 9 and 10.
The tiffin break was at 1:30 p.m. Since she wasn't hungry then, she would monitor the midday meal procedure and student activities during the break hour instead of eating her lunch.
She would have her light lunch (muri and boiled potato/vegetable soup, or sometimes a vegetable from the midday meal) at around 3 p.m.
She would leave from school by 4:45 p.m. after making sure everything was properly closed.
On returning, she would have milk tea with sugar again, with biscuits.
Sometimes she would visit the market to buy her daily supplies and would have fried snacks like pakoda, etc.
In the evening, she would do her yoga again for another 1 hour.
She would make a fresh batch of rice and have it with the leftover soup from the morning, if any, or she would make a fresh one. She would finish her dinner by 7:30 p.m.
Then she would do some reading or check the students' notes.
She would go to sleep by 10 p.m.
Weekends
On Saturday, she would leave for home after school at 2 p.m. It was a 6-hour journey. She would cycle 6 km to the bus stand first. Then she would return home by bus. Her father would pick her up by bike for the last 5 km of the journey.
On the weekend, she continued her yoga in both the morning and evening. She had a variety of vegetables and sometimes fish in her meals.
Note:
She has a strong connection with a spiritual Ashram that also operates an orphanage.
She donates most of her earnings there and lives a very minimalist life.
Also she often prefers a vegetarian diet.
[22/10, 12:48] Patient Advocate 2: In May 2022, she was posted to her hometown, which is a calm village with good air quality.
Now her school is 7 km away from her home, and she lives with her elderly parents.
Her New Daily Routine
In the morning, she wakes up by 5:30 a.m., has a bowel movement, and takes a shower. Then she performs her yoga, but the time is now reduced to 30 minutes.
She then boils water with black pepper, cinnamon, cloves, and basil seeds. She will add tea to this and drink it whenever she wants tea, which is usually twice in the morning and once in the afternoon. This tea is without sugar and milk. Sometimes, she skips this recipe and has black tea with bay leaves instead.
After drinking tea, she starts cooking. Here, she needs to cook multiple vegetables separately and prepare roti for her father.
After cooking, she gets ready for school and has her breakfast, consisting of rice, multiple sabjis (vegetable dishes), and sometimes fish (as she needs to cook fish more often here for her parents).
She packs her lunch for school - mostly muri and a vegetable, and sometimes roti that she prepared for her father.
She leaves for school by 10:30 a.m. Now, instead of a bicycle, she rides a Moped, and it takes 20 minutes to reach school.
The school routine is as usual. She takes her lunch at 3 p.m., as before. She leaves school at 5 p.m.
After coming back home, she prepares tea for herself as well as for her parents.
She then goes for an evening walk for 30 minutes. After returning home, she again performs her yoga and prayers for 30 minutes.
Then, she cooks again. She has her dinner, consisting of rice again, by 9 p.m.
After dinner, she often needs to do some official work for her school, usually on her mobile.
She goes to sleep by 10:30 p.m.
On the weekends, she goes to market sometimes.
[1:00 pm, 22/10/2025] Meta AI: Let's break it down.
The main differences between her old routine and new routine are:
Location: Her new school is 7 km away from home, whereas her old school was just 2 minutes away by bicycle.
Yoga time: She used to do 2 hours of yoga daily (1 hour in the morning and 1 hour in the evening), but now she does 1 hour (30 minutes in the morning and 30 minutes in the evening).
3. Diet: In her new routine, she cooks multiple vegetables and roti for her father and sometimes has fish, whereas in her old routine, she mostly had khichdi or rice and vegetable soup.
4. Transportation: She now rides a moped to school, which takes 20 minutes, whereas she used to cycle to her old school.
5. Evening routine: She now goes for a 30-minute evening walk, which wasn't part of her old routine.
6. Sleep schedule: Her sleep schedule has been delayed by 30 minutes in her new routine, and she now does official work on her mobile after dinner.
7. Family responsibilities: She's now living with her elderly parents and takes care of their meals, which wasn't the case in her old routine.
These changes reflect her new responsibilities and living situation.
[1:01 pm, 22/10/2025] PA: Not sure how to do it.
It would be great if @RS2 could have a call in Bengali with the patient and ask everything needed.
@RS2, can you let us know your convenient time for a call?"
[1:02 pm, 22/10/2025] PA: Her dinner time has changed from 7.30 P.M. to 9 P.M.
[1:04 pm, 22/10/2025] PA: The patient wants to know if a CT scan is absolutely necessary or is there any alternative or she can wait.
[1:08 pm, 22/10/2025] PPM 1: Also @PPM4 if anyone of them is free
[1:09 pm, 22/10/2025] PPM 1: This question is difficult to answer unless we get to palpate her abdomen ourselves
[1:10 pm, 22/10/2025] RS2: Ok.. I'm free at 5 pm
[1:11 pm, 22/10/2025] PPM 1: 👆@PA can you ask the patient if she feels these changes in her routine are significant enough to correlate with her current problems?
[1:13 pm, 22/10/2025] PPM 3: Of course. This is an excellent case study for comparing lifestyle routines and their potential impacts. The two routines describe the same person's life before and after a significant relocation and change in her living situation.
Here is a detailed breakdown of the key differences between her two routines:
### Summary of the Core Difference
The fundamental shift is from a *solitary, self-focused, and highly disciplined minimalist routine* to a *family-integrated, caregiving-oriented routine with shared responsibilities.* Her new life is less about personal ritual and more about domestic management.
---
### Detailed Comparison of Differences
| Aspect | Routine 1 (Remote Village, 2009-2022) | Routine 2 (Hometown, 2022-Present) |
| :--- | :--- | :--- |
| *1. Living Situation & Environment* | *Solitary:* Living alone in a remote area. | *With Family:* Living with elderly parents in a calm village with better air quality. |
| *2. Commute* | *Short & Active:* 2-minute bicycle ride. Very near. | *Longer & Motorized:* 20-minute Moped ride. 7 km away. |
| *3. Morning Schedule* | *Earlier & Longer:* Wakes at 5:00 AM. Yoga for 60 min. | *Slightly Later & Shorter:* Wakes at 5:30 AM. Yoga for 30 min. |
| *4. Beverages (Tea)* | *Simple & Sweet:* Milk tea with sugar and biscuits (twice daily). | *Complex, Spiced & Unsweetened:* Herbal tea with spices (black pepper, cinnamon, etc.), no milk/sugar. Sometimes black tea with bay leaves. |
| *5. Cooking & Diet* | *Simple & Solo:* Cooks single-pot meals (khichdi) or simple rice & soup for herself. Primarily vegetarian. | *Complex & For Family:* Cooks multiple separate dishes (sabjis, roti, fish) for her parents and herself. Diet includes fish more frequently. |
| *6. Breakfast* | *Light & Early:* Eats cooked breakfast (khichdi/rice) at home before school. | *Hearty & Later:* Eats a larger, multi-item breakfast (rice, sabjis, sometimes fish) after cooking for the family. |
| *7. Evening Routine* | *Yoga-Centric:* Returns home, has tea, does 1 hour of yoga. | *Walk & Yoga/Prayer:* Returns home, makes tea for family, goes for a 30-min walk, then does 30 min of yoga & prayers. |
| *8. Dinner Time* | *Early:* Eats by 7:30 PM. | *Late:* Eats by 9:00 PM. |
| *9. Post-Dinner Activity* | *Leisure/Work:* Reading or checking student notes. | *Official Work:* Often does school-related official work on her mobile. |
| *10. Weekend Routine* | *Travel-Focused:* Long 6-hour journey to visit family, involving cycling and bus rides. | *Local & Domestic:* Stays at home, goes to the market sometimes. Focus is on household and parents. |
| *11. Implied Stressors* | *Isolation & Minimalism:* Potential loneliness and the physical challenge of remoteness. | *Caregiver Burden & Time Pressure:* Responsibility for elderly parents, longer commute, more complex cooking, and official work intruding on personal time. |
---
### Key Takeaways from the Differences
1. *From Independence to Interdependence:* The most significant change is her role. She has transitioned from being responsible only for herself to being a primary caregiver for her aging parents. This adds a layer of domestic and emotional labor.
2. *Dietary Sophistication and Compromise:* Her diet has become more varied and nutritious (multiple vegetables, fish) but is also less controlled by her personal preference (she cooks and eats fish for her parents). Her beverages have shifted from simple, sweet comfort drinks to complex, health-focused, unsweetened concoctions.
3. *Shift in Physical Activity:* While she still practices yoga, the total time has been halved. The short, active bicycle commute has been replaced by a longer, passive moped ride. The addition of an evening walk is a new form of exercise, possibly to compensate for the reduced yoga and active commute.
4. *Time and Schedule Pressure:* The new routine appears more time-pressured. She wakes later but has more tasks (cooking for three). Dinner is significantly later, and work often spills into her personal time after dinner. The long, dedicated weekend travel is gone, but her daily routine is more demanding.
5. *Spiritual Practice Integration:* In the first routine, her spiritual connection was mentioned as a separate note (donations to an ashram). In the second, it's integrated into her daily routine as "prayers" combined with her evening yoga.
In conclusion, while her move to her hometown offers the comforts of family and a better environment, it has come at the cost of her highly disciplined personal routine, introducing new responsibilities and time constraints that have reshaped her daily life profoundly.
[1:14 pm, 22/10/2025] PA: All her problem started during the previous routine phase itself. The previous very same routine phase existed from 2009 to 2022. Her surgeries were done at 2019, 2020. Diabetes, BP medicine started at 2021
[1:17 pm, 22/10/2025] PPM 1: Is the problem intensity similar in both the phases?
[7:02 pm, 22/10/2025] PA: Yes
[9:43 pm, 22/10/2025] PA: সে সকাল সাড়ে পাঁচটায় ঘুম থেকে উঠে,গরম জলে অর্ধেক পাতি লেবু মিশিয়ে ( নুন চিনি বাদে) খেয়েছে।ব্রাশ করে,পায়খানা করে স্নান করে মুড়ি চা( লবঙ্গ, দারুচিনি,গোল মরিচ ও তুলসী মঞ্জরী মিশিয়ে),৬.৪৫ এ খেয়েছেও বাড়িতে সবাই কে দিয়েছে। তার আগে সুগারের ও প্রেসারের ওষুধ খেয়েছে। আধ ঘন্টা হেঁটে এসে রুটি বেলেছে।ও নয়টায একটা রুটি আলু ভাজা ও কলা খেয়েছে
[9:56 pm, 22/10/2025] PA: ব্যাথা অল্প অল্প সারাদিন ই মাঝে মাঝে অনুভব হয়,পাইখানার আগে একটু বেশি চাপ লাগে, হয়ে গেলে একটু রিলিফ লাগে। কখন ও কখন ও ব্যাথার অনুভূতি থাকে না। নড়াচড়া বা ঝুকলে লেগে যায়। টিপলে ব্যাথা লাগে।
[10:33 pm, 22/10/2025] PA: Tried translating it with Gemini, it's pretty accurate:
That is a detailed description of someone's morning routine!
Here is the translation:
"She woke up at half-past five in the morning and drank warm water mixed with half a lemon (without salt or sugar). After brushing her teeth, having a bowel movement, and taking a bath, she had puffed rice (muri) and tea (mixed with cloves, cinnamon, black pepper, and holy basil blossoms/manjari) at 6:45 AM, and also served it to everyone in the house. Before that, she took her medicine for sugar (diabetes) and blood pressure. After walking for half an hour, she rolled out rotis (flatbreads). And at nine o'clock, she ate one roti with fried potatoes (aloo bhaja) and a banana."
[10:34 pm, 22/10/2025] PA: Gemini:
Here is the translation of the second passage:
"The pain is felt slightly, intermittently, throughout the day. There is a little more pressure/strain before a bowel movement, and she feels some relief after it is over. Sometimes, there is no feeling of pain. It (the pain) is triggered by movement or bending. It hurts when touched/pressed."
[6:23 am, 23/10/2025] PPM 1: Thanks! Well done 👏
It would be great if Gemini can provide us with a graphical representation of the 24 hour routine events and the pain events in this patient although the given data doesn't cover 24 hours.
When we say the pain is slightly felt intermittently throughout the day what is the time gap between each bout of pain assuming that this gap is variable and what are the other events or activities related or unrelated just before she perceives these pains?
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