47 yr old woman with weight gain, neck pains, indigestion and depression

August 12, 2022

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: She's a 47-year-old woman working as a professional dealing with a lot of people and helping them to manage their business accounts and lately she has also begun professional photography for which she has to travel frequently

Since childhood, she started c/o constipation (no passing of stool for 2-3 days, resulting in flatulence, abd. swelling, and tenderness). Did Ayurvedic treatment but only got temporary relief. On 2000, finally got admitted to a yoga center and learned some yoga techniques. Doing those yogasana every day resolved her problem of constipation. Pt. noted that if she stops doing yogas for 20 days, constipation will reemerge.

As a child, she was emotional and would take scolding very seriously. She used to c/o migraines.

Since childhood, she frequently has to use the washroom for micturition and had noticed that there would be a burning sensation on passing urine only if she drinks less water. No discharge.

Since childhood till the age of 28, she was suffering from severe dust allergy (almost 2 times a wk), which gradually went away on its own after this age and would reoccur very very occasionally.

At the age of 13, since hitting puberty, she c/o dysmenorrhea, with normal bleeding and frequency. In 2002, she started c/o menorrhagia with dysmenorrhea. Periods were regular. On consultation with Gynecologist, USG was done which detected uterine fibroids. On taking the prescribed medication, the bleeding was a little less, but the pain was of the same intensity. Continued like this till 2013. No further treatment in between.

Since age 14; while standing for long hours(2-3 hrs) severe pain starts from the right hip joint and spreads to the ankle. The pain was so intense that the pt won't be able to walk. Pain used to go away with complete rest/sleep for 4-5 hrs.

In 2014, the bleeding increased even more (would bleed for even 10 days) with pain during periods. No treatment was done. In 2016, the bleeding would not stop at all. It would continue even after periods ended. Her Hb was reduced to 6.2 gm/dl 2-3 times. The gynecologist diagnosed uterine polyps. In 2018 May, Sx done to remove polyps and a few of the larger fibroids.

In 2017, got married at the age of 42. Pt. reported her dysmenorrhea went away after having sexual intercourse and never reappeared again. She became single in Jan 2021.

From May 2018 to July 2019, her periods were normal and she became completely alright. In July 2019, again heavy bleeding started, which won't stop at all. A gynecologist recommended a Hysterectomy. Because she contracted covid (twice, both during first and second wave; both times mild fever, cold, recovered, was in home quarantine), she delayed the surgery. In Oct 2020, a hysterectomy was done. She became alright.

In 2015, for the first time she c/o cervical spondylitis (possible etiology - 13-15 hrs sitting with laptop). Since 2019, its frequency increased. It would occur 4-5 times monthly and the neck pain would stay for 5-6 days. She c/o neck stiffness and pain, headache, followed by blurred vision. Also. c/o acidity. Wearing a cervical collar helped relief pain. Yoga and swimming also helps her relief pain.

In Nov 2020, shifted to a new home in a new locality. Since then started having digestion issues (diffused abd. tenderness after eating). Had 6-7 episodes of food poisoning (nausea, vomiting, diarrhea). She was eating homemade food only. She used to get somewhat relief from digestion problems by drinking buttermilk. She complained that her house is supplied with hard water. She suspects that the cook of her house did not prepare food in a hygienic way.

She had gained 10kgs (from 55-62kgs to 72kgs) between Jan 2021 to July 2022. She occasionally indulges in swimming, morning walks and eats healthy foods. She had somewhat decreased her food intake because of digestion problems and wt. gain.

CURRENT CHIEF PROBLEMS AND PATIENT'S REQ.:

Her hip joint pain about which she started c/o since childhood now a day starts even after standing for 1 hr and is felt over both hip joints.

She is feeling depressed and demotivated sometimes (possibly due to loneliness after she left her partner, a hysterectomy, and the thought of aging).

7 months ago, once while doing photography, while rising from a sitting position, she heard a pop sound from her knees, and since then occasionally c/o knee pains if standing for long hrs.

For the past 2 months, she feels extremely hungry in the morning. And she had noticed on eating something sweet (ladoo, kheer, etc) she would feel nauseous.

After returning home via flight recently, she is feeling nauseous. She had a sandwich in flight, which according to her increased her nausea and headache.

FAMILY HISTORY:

FATHER: He was a heavy consumer of tobacco (100gm/day), and paan masala. In June 2018, terminal Pancreatic Ca was detected. In Sep 2018, at the age of 72 died because of Ca.

MOTHER: In 1988, got operated on for ectopic pregnancy. A blood transfusion was needed. She contracted Hep C because of a blood transfusion, for which symptoms started appearing in 2013. She also used to complain of episodes of food poisoning.

SISTER: also c/o wt gain and pain in the foot

REPORTS: