A 61 yr old man suffering from severe wt. loss

 NOTE: THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT.

PATIENT HISTORY: Pt is a 61 yr old male, a retired school teacher by profession. In 1972, at the age of 11 yrs, he was taken to Dr. by his father (who was a pt with hemorrhoids) in fear of the same, on his way for a follow-up for his own case. Pt. had no complaints of pain or bleeding pr. Dr. diagnosed internal hemorrhoids (in a very early stage). Recommended Sx. Hemorrhoid banding tech. used. 

When in class 9-10, started having digestion problems (loose stool 3-4/day, acidity occasionally, rarely abd. pain). In 1972, due to the unavailability of water filters, pt and his family used ground water that was rich in iron. Had to boil water for drinking purposes. Pt. suspects that could have led to his gastric problems. Dr. prescribed medicine that would resolve the issues for 10-12 days, then again the same problems. Pt. continued like this without further medical interventions.

In 1977, after completing his primary education in the village school; he joined a high school 15 km far away from his home. He had to travel 3km in a cycle, then 12km by bus to reach his school. It used to become very late at night by the time he returned home after completing his lab. classes. During the rainy season, often he would get drenched in rain while returning home. He often would fall ill with cough and cold, sometimes dry cough, sometimes with sputum and SOB. No treatment was done until 1983. In 1983, he started doing pranayam and other forms of yoga for 2 yrs, which resolved his SOB and breathing problems (cough, cold, nasal congestion).

Then in 1979, his father from his friend prepared a homemade water filter (using sand, stones, and gravel in an earthen pot). After using that filter (which reduced iron content; measured by looking at the iron deposit in utensils after boiling water), he claims that his digestion issues resolved to a certain bit. His neighbors started following his father's technique.

In 1990, after selling off his village home shifted to town

In 1982, joined as a temporary teacher in high school. In 1985 promoted to a permanent teacher. 

In 1986, during a summer vacation went to Assam to take part in a  yoga center for 10-12 days. They taught him various yoga techniques. For his digestion issues, he was told to drink lemon water on an empty stomach, put a pipe via his mouth to reach the stomach, then try to vomit out stomach content by contracting abd. muscles, and then eat after 2 hrs. He felt his indigestion problem reduced significantly after doing this. He would do this once a wk. Another thing he did occasionally was putting in a nasal tube and taking it out via mouth to clean his nasal passage. After getting married in 1988, his wife (who is a nurse by profession) forced him to stop these.

In 1996, also started during private tuition, apart from school work. Claimed that due to hectic lifestyle, lost wt from 52 kg to 47kg within a yr; apart from weakness. Went to Kolkata, for consultation, and tachycardia was detected. He has been prescribed Inderal 10 for tachycardia apart from other medications which improved his wt. (from 47kg to 57kg in 2 yrs). 

In 2005, while playing volleyball at school broke his rt. hand scaphoid bone. Plastered for 56 days. Dr. recommended taking rest for 2-3 months. But, had to join school since his leaves were getting over. Once while trying to catch a moving bus, got his lower back sprained. With time along with pain in the lower back, started feeling a tingling sensation in his rt. leg. Took medicine on the recommendation of a neurologist for 1.5 yrs. Pain decreased. but Dr. recommended continuing medicines. So, visited another Dr. for a second opinion who suggested he stop medicines immediately. But due to fear of withdrawal syndromes, he consulted a pharmacist, who recommended he stop the medications but start taking Inderal tab. in a sequence of 10mg then 5mg then 2.5mg then gradually stop. He followed that.

In 2010, once while returning home at night, noticed as if he is seeing a circle around the street lights. The ophthalmologist said he is having glaucoma in rt. eye. His rt. eye pressure was noted to be high. A Sx was done in 2011. Eye drop Dorzox T and Lumigan 0.01 (both still continuing) were prescribed and advised to measure eye pressure once in 4 months. Eye pressure normal since Sx. 

In 2012, during a regular health checkup, HTN was detected. Since then Amlodac 5mg started. Also, in 2012, he noticed blood with hard stool. This happened 3 times in 6 months. Dr. said his internal hemorrhoids are still there. Was given an ointment using which his bleeding stopped.

In 2016, one day because of feeling a generalized body weakness for the past few days, he decided to check his wt. and found he had lost wt. (from 59kg to 55kg). Did TFT. TSH lvl. 12.5mlU/L. The report said he was hypothyroid. But he went to Kolkata to repeat the test, which showed his TSH lvl 6mlU/L. His Hb lvl was 6g/dL. He c/o of abd. pain and vomiting. He went to Hyd. for a consultation about wt. loss and low Hb. lvl. Colonoscopy was done to rule out internal bleeding. A blood test detected iron deficiency anemia. Started on Feronia XT. His PPBS was found to be 160Was given iron infusion and Feronia XT. His Hb lvl rose to 10g/dL and abd. pain and vomiting reduced significantly. 

In 2017, his TSH lvl. 14mlU/L. Started Thyrox 37.5. At present, TSH is 3.3mgU/L. 

In 2019, he visited a Dr. in Siliguri and was told he is suffering from IBS and advised to avoid milk. Does not drink milk since then.

In 2020, he again started having abd. pain which increased in intensity and vomited (2-3times/month), especially whenever he ate spicy foods or fast foods.

In 2022, He joined an online Yoga center, thinking it will cure his pain and digestion problems. The Yoga center used to monitor his diet regularly and prescribed their own protein powder, it. herbal tea and also taught yoga techniques. He started doing yoga 1-1.5 hrs daily. After 15 days, his wt reduced from 55kg to 52kg. Within 1-2 months wt. reached 49kgs and Hb 8.4g/dL. He stopped immediately. But, wt. did not improve.

In 2022 March, during a regular checkup, BP was found to be low, hence stopped taking Amlodac 5mg. Now, normal BP.

He does not smoke, is non-alcoholic. Rarely, (1-3 times during occasions) eat paan and nutmeg.

CURRENT CHIEF PROBLEMS  AND PATIENT'S REQ.: Pt. c/o episodes of abd. pain and vomiting the whole day that occurs at least twice a  month, even if he eats a small amount of spicy food or some foods from outside.

On 23rd July, there was an occasion in his house. He ate only veg. items but from the next day morning vomited 1-2 times. So, skipped lunch. 

Pt. is not able to increase his body wt. from 49kg.

Because he suffers from gastric problems (abd. pain, vomiting) whenever he eats some spicy foods and since he had been previously diagnosed with IBS, he started taking an Ayurvedic herbal tonic for digestion on his own accord for 1 month. He feels his hunger has increased.

25.01.23

[9:16 am, 26/01/2023] Pt: Yesterday's stool color before flashing. Today's morning is also the same.

[9:17 am, 26/01/2023] Pt:  Last ten years have never seen such type of bloody stool.

[9:21 am, 26/01/2023] Pt: From 2000 to 2013, yearly thrice or more times It occurred. then never seen

FAMILY HISTORY: Father used to suffer from indigestion. Mother had no health issues.

Maternal grandfather had DM.

Brother has HTN

Sister aged 56 - HTN and hypothyroidism. 10 yrs ago gallstone Sx.

PATIENT's DIET PLAN (for the past 4 months):

REPORTS:

 

 DAILY UPDATES (Source - copy pasted from pt's diary)

Date:28/06/2022

6.30am -woke up from bed, Brush my tooth & Went to the washroom then  Had a glass of lukewarm water. Taken Medicine Thyrox 37.5 .(dose)7 a.m_ morning walk for 35 minutes and took rest for 10 minutes.

7.45- had breakfast  with  banana,sattu, dates

8.30= had dry fruits (small amount of almond,cashew, pesta etc )

After that got engaged in my studies at my computer table.

10.30= two pieces of Roti, Dahi(curd), and one boiled egg with vegetables. 

After that spent time with my grandson .

12.30 pm= had fruits  (tangerine)

1.pm- Had a shower 

2.pm_ Had lunch with rice, dal,sabzi, and paneer .and Curd.

2.30- took a nap and rest. read the newspaper and again spent time with grandson.

5.30= almond, cashew, walnut  (small amount)

 7.30pm= tea without sugar and milk. had puffed rice with a bit of oil and half chilly.

Did my studies and made a few calls and did some internet surfing.

10. pm = Had dinner with rice,sabji and egg curry.

By 11.15= hopefully will be asleep.

WT LOSS TREND: 

1995      47 kg

1998      52 kg

2000      55kg

2008      63 kg

2009      61kg

2010      59kg

2011      56kg

2012      57kg

2015      56kg

2016      55 kg

2017      56kg

2018      57kg

2019      55kg 

2020      56kg

2021      55kg

2022      55kg (Jan.28)

2022       49kg(March 15)

2022       48kg(Apr)

2022       48kg(May)

2022       48kg(June)

2022       48kg(July)

2022       49kgs(Aug)

2022       48kgs(Sep)

2022       48kgs(Oct)

2022       48kgs(nov)

2022       49kgs(Dec)

2023       48.3kgs(Jan 21)

BP 

6.10AM 120/77, Pulse 77

8.40AM 116/84, Pulse 82

10.30 A.M 123/79, Pulse 84

11.45A.M 126/76, Pulse 79

1.10PM 109/66, Pulse 74

3.10 A.M. 122/79, Pulse 86

4.30A.M. 113/75, Pulse 74

5.55A.M. 119/82, Pulse 77

7.30PM. 124/81, Pulse 80

8.50PM 129/84, Pulse 78

CDSS (Conservational Decision Support System)

[1/26, 8:38 AM] Pt 61M Weight Loss: গতকাল রাতে পায়খানায় রক্ত দেখলাম। আজ সকালেও শক্ত পায়খানার গায়ে লাগানো রক্ত দেখলাম। অর্শ অনেক আগে ছিল আমার। তবে  গত দশ বছর ধরে কোনও দিন রক্ত পড়েনি

[1/26, 8:39 AM] Pt 61M Weight Loss: Rectumএ সামান্য ব্যথা আছে

[1/26, 8:41 AM] Rakesh Biswas: Hain 

Apnar orsho theke rokto porar aagei chotobelai operation kora hoyechilo (amar dharona unnecessarily ebong oi jonyei eta amar mone chilo) kintu amar eta jana dorkar apnar oi chotobelar operation er por kotobar orsho theke rokto jai ebong apnar last hemoglobin kobe konodin komechilo?

[1/26, 8:50 AM] Pt 61M Weight Loss: রক্ত দশ বছর আগে(2013) পর্যন্ত বছরে তিনচার বার পড়ত। প্রথম রক্ত পড়ে সম্ভবত 2000 সালের পরে। হিমোগ্লোবিন প্রথম কমে 2016 সালে

[1/26, 8:55 AM] Rakesh Biswas: Hemoglobin kotobar koto ta komechilo?

[1/26, 9:09 AM] Pt 61M Weight Loss: 12+ থাকত। 2016 সালে 6এ দাঁড়িয়েছিল। আয়রন ইঞ্জেকশন দেবার পর 10+ হয়েছিল। অথচ তখন রক্ত পড়তে দেখিনি।

[1/26, 9:10 AM] Rakesh Biswas: 2016 chara are kobe kobe komechilo?

[1/26, 9:12 AM] Pt 61M Weight Loss: আর কমেনি। 11+ থাকে। এখনও তাই আছে

[1/26, 9:29 AM] Pt 61M Weight Loss: রক্ত পড়া বন্ধ হবার জন্য কি কোনও ওষুধ খাব

[1/26, 9:39 AM] Rakesh Biswas: Abar rokto porle bojha jabe bondho hoyeche ki hoini

[1/26, 9:40 AM] Pt 61M Weight Loss: ঠিক আছে