02/03/2026
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.
[11:34 am, 02/04/2026] PaJR Health: Namaste! Thank you for signing up with PaJR Health and we welcome you to this group. This group has been created to discuss and manage your patient's clinical concerns. Feel free to share any relevant data - this is a conversational platform. Let us learn together to care better!
[11:34 am, 02/04/2026] PaJR Health: To help us better understand the situation, please follow these instructions:
1. Describe the sequence of events that led to the current problems, starting from when the patient had no problems at all.
2. Describe the patient's normal 24-hour hourly routine when they were perfectly alright.
3. Describe how the disease has disrupted this 24-hour routine.
4. If we could give a single medicine, which specific problem would you prefer it to address?
5. Please post clinical photos as demonstrated in this link:
https://userdrivenhealthcare.blogspot.com/2024/08/template-for-pajr-user-driven-history.html
[12:50 pm, 02/04/2026] PPM 1: I wonder why the patient advocate wasn't added here automatically @PPM2
I've added her manually here now
[12:50 pm, 02/04/2026] PPM 1: Namaste! Thank you for signing up with PaJR Health and we welcome you to this group. This group has been created to discuss and manage your patient's clinical concerns. Feel free to share any relevant data - this is a conversational platform. Let us learn together to care better!
[12:50 pm, 02/04/2026] PPM 1: To help us better understand the situation, please follow these instructions:
1. Describe the sequence of events that led to the current problems, starting from when the patient had no problems at all.
2. Describe the patient's normal 24-hour hourly routine when they were perfectly alright.
3. Describe how the disease has disrupted this 24-hour routine.
4. If we could give a single medicine, which specific problem would you prefer it to address?
5. Please post clinical photos as demonstrated in this link:
[12:52 pm, 02/04/2026] PA: Thank you 🙏
[1:11 pm, 02/04/2026] PPM 2: Maybe the AI agent didn't parse the number correctly. Will check backend.
[1:43 pm, 02/04/2026] PA: 2020 was the first time heel pain started in left heel.
This aggravated to knee pain and X-ray was performed diagnosis of osteoarthritis
This further aggravated to back pain and lead to surgery in December 2022.
Rehabilitation for 1 year with physio and back and knee was stable
2024 Jan heel pain in right heel. Kept aggravating month over month. Jan 2025 got a steroid injection in the heel.
Still the pain didn't reduce
Meanwhile triglycerides and cholesterol are also high.
July 2025 onwards first time right knee pain started
Last 8 months severe pain and inflammation is causing more pain.
Heel pain is settling slowly but the knee is paining badly
[1:45 pm, 02/04/2026] PA: Daily routine
Morning 8 am Herbal hot water with saunf amla ajwain cinnamon
Tea with egg 930 am
11 am 1 egg
Lunch 2 pm Daal sabji roti
Evening 6 pm tea
Dinner 7 pm Daal sabji roti
Sometimes snacks at night.
[1:53 pm, 02/04/2026] PA: I have XRay and MRI
Shall I share that?
I also have blood report, can remove name and share
[12:33 pm, 03/04/2026] PPM 1: 👆Yes you just need to ask your patient to share an image like this one for the abdomen and arms as shown in the guided link shared here above
[4:14 pm, 02/04/2026] PA: Can we have a round of introduction and next steps of engagement
[4:25 pm, 02/04/2026] PPM 1: This overall sounds like a spondyloarthropathy since 2020 beginning with planter fascitis.
The knee pain is likely to be a ligamental enthesitis rather than an arthritis.
The back pain was likely again due to sacroileitis.
Can you share an image of both knees of the patient from front back and sides?
Also please share an image of the patient's arms and abdomen from sides as shown in the link above.
More than the blood lipids that you shared approximately, it's the abdominal adiposity that is more useful to assess for her associated metabolic syn related comorbidities.
Once we are sure that the knee pains are ligamental rather than synovial or cartilaginous, we can move to the next step in deciding the best course for the ligamental inflammation.
[4:27 pm, 02/04/2026] PPM 1: Share the films of the sacro iliac joint or x-ray lumbo sacral spine AP view
Can remove the identifiers and share the other reports of the patient that you have.
[10:24 pm, 02/04/2026] PPM 2: Hi. Thanks so much for sharing and joining our project. My name is Dr. PPM2, I'm an Endocrinologist in the UK.
I'm the director for PaJR Health and I hope we will be able to help you through your medical journey
[10:25 pm, 02/04/2026] PPM 2: What does the patient do? When was she absolutely normal in herself and when did she first start noticing symptoms in her life?
[8:22 am, 03/04/2026] PA: 2019 was last completely normal
2020 March was first heel pain
[8:38 am, 03/04/2026] PPM 3: Thanks I am Dr. PPM3, pajr volunteer, can you elaborate your pain..? What is your daily routine(describe in hourly slot) and how your pain impacted your daily routine...?
[9:44 am, 03/04/2026] PA: There is no great structure as recently quit job and doing a course. A rough timeline is as below
Get up 730 to 8am
Hot water 2 cups with saunf amla haldi pepper and powdered cinnamon methi
Tea 830 am
Boiled egg 1, 9 am
MWF Yoga 30 mins 9 am to 930 am
Lunch dal sabji roti 2pm
Tea 530 pm
Dinner 630 pm same dal sabji roti
Sleep 1.30 am (working on this to change)
In between at random
Walk :- knee hurts so may be 2k steps max
Cycle
Dry fruits eating
Tea 2 times
[9:48 am, 03/04/2026] PA: Before 2020
15k Steps daily
Balanced diet
Done 10K walkathon events
Avid dancer and traveller.
Very high energy level at job
How pain impacts
If slightly more walk or activity done pain becomes unbearable
Can't take stairs even 2 or 3 stairs
Take support while getting up
Impacted job due to heel pain and knee pain. stress leading to aggravated pain
Why is her sleep so delayed? How much time does she spend on her phone?
[12:57 pm, 03/04/2026] PPM 2: Past PaJR knee images
[1:02 pm, 03/04/2026] PPM 1: 👆@PPM2 the same images don't seem to have reached this new automated site: https://pajrpublications.gadelab.com/
[1:04 pm, 03/04/2026] PPM 2: Hmm. We have at the moment left the blogger blog as is and the new conversational logs to be logged to the new website.
Maybe I will try importing after I'm back from my trip.
[8:50 am, 04/04/2026] PPM 1: Other than bilateral knee osteoarthritis (apparently right more than left in this picture), due to her metabolic syn I would clinically wager that her current pains are also contributed to by her past spondyloarthropathy although the other interesting possibility is an overlap between the two!
[9:29 am, 04/04/2026] PA: As per doctor patient's osteoarthritis is more in left knee since 2020 end. She has worked with ankle weights to reduce pain and strengthen in 2023 as a part of her back surgery rehabilitation
[9:37 am, 04/04/2026] PPM 1: Which knee pains more for the patient?
I guess you are using the patient's forwarded text but better to address it in the third person to protect the patient's confidentiality in team based learning ecosystems such as these
[9:38 am, 04/04/2026] PA: Currently right knee has more
[9:38 am, 04/04/2026] PPM 1: We need to know more about this patient's backache and the events that led to the decision for her back surgery
[9:38 am, 04/04/2026] PA: Which knee pains more for the patient?
Yes it's a forward from patient
[9:39 am, 04/04/2026] PPM 1: Currently right knee has more
That's what was visible in the current clinical image. It's possible that it was more in the left during 2020
[10:00 am, 04/04/2026] PA: History of back surgery
2020
Heel pain
2020 end knee pain
Lot of travel in 2021
2022 May first time sciatica pain
May to December travel + Physio
2022 Dec sudden increase in pain
Foot fall occurred with left foot
Urgent Surgery 27th December 2022
Rehab for entire 2022
Back exercise and knee exercises till December 2023
Again 2024 onwards work travel and personal travel started
Heel pain started
Rest is what is highlighted till right knee pain
[10:12 am, 04/04/2026] PPM 1: Can you describe her back pain instead of calling it sciatica pain (thus bringing premature thought closure as @42MPA @PPM3 are wary of) and describe the events surrounding that pain when it was noticed for the first time?
Generally when an event is acute, patients are able to remember it well, else we call it a gradual onset event.
Let's begin by her relating particular incidents from the month of May 2022 when the back pain was first noticed by the patient.
[10:16 am, 04/04/2026] PA: It was left side lower back pain radiating throughout her left leg and made the pain unbearable over 5 months even though some exercises were going on.
Regular muscle relaxant etoshine MR and nerve relaxant Gabantin was taken
In December when she met Doctor in Bangalore she was asked to walk on toes and her left foot could not sustain standing
Finally as per doctor surgery were done removing disc l5s1 and screws were put
[10:23 am, 04/04/2026] PPM 1: What was her pain like? Was it dull aching or tingling with burning and current like sensations?
[10:23 am, 04/04/2026] PA: Tingling
[10:24 am, 04/04/2026] PPM 1: Would be interested to know the clinical examination details at that time other than the fact that she was unable to stand on her left toe. Does the patient think she had reduced power in her left toe compared to her right?
[10:31 am, 04/04/2026] PA: Yes very less power and severe all time tingling in toe
Even now tingling not completely gone for left toe
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