35 yr male with c/o of lower back pain, pain in rt iliac fossa, feeling of weakness on rt side and no appetite

 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 35 yr old male, who works as a civil contractor.

Pt had no health issues before getting married.

12 yrs ago, pt got married. 1 month later started c/o severe body weakness, weight loss, and passing white loose stool for 3 months. Did Ayurvedic treatment which restored his normal bowel movement and stool color. But he noticed a lot of mucus in his stool. Did not seek further treatment.

In 2019, went to Hyderabad for his brother's checkup and reported about this mucus to the Dr. Medication was prescribed after which his condition improved. For the past 2 yrs, he only notices mucus in his stool when he eats spicy, protein-rich foods.

A few months later after returning from Hyderabad, he started c/o slight migratory pain in the right lower quadrant of abd. The pain lasted for 15-20 mins and happened 2-3 times a day, 2-3 times a week. It was of migrating type which sometimes migrated from peri umbilical region to rt. iliac fossa. Pt scored pain severity 3/10. The pain was not felt while working (reason sighted - his mind was occupied with work), but after returning home, while sitting or lying down he would feel the pain. He also noticed that on chewing beetle nuts or eating fruits like apples, grapes, oranges, or cashew nuts he has to run to the washroom for defaecation (loose consistency), also started c/o borborygmi, bloatedness, sour burps, reduced appetite (since 2019 to 2022, body wt reduced from 55kgs to 48 kgs), flatulence, but no abd. cramps before defecation. Dr. did an endoscopy whose report was normal. He prescribed him medicines, taking which reduced his gastric symptoms but his right lower abd pain did not resolve. He made dietary changes (does not eat spicy or oily foods, consumes significantly less amount of chicken, egg, only fried fish not curry). He claims maintaining this strict diet helped him restore normal bowel movement, no loose motion, except flatulence, sometimes bitter taste, sore throat, and heartburn. He is taking antacids on his own accord every day. He reports taking antacids regularly helps (he can stay without antacids for max 7 days).

3-4 months later, since his abd pain did not resolve, he visited another Dr. On doing USG chronic appendicitis was diagnosed. Dr. prescribed medications that resolved the pain for 6-9 months. 

6-9 months later he again c/o lower right quadrant migrating abd pain. and general body weakness. Dr. again did USG, which detected chronic appendicitis. Medication relieved the pain for a few months. 

1-2 months later, he started c/o a sudden sharp pain in the rt side of the chest, SOB. At that time was suffering from a cough and cold with sputum production. He visited a Dr. to consult his chest pain and also told him about his rt side abd pain. After doing USG, medication was prescribed which resolved the pain temporarily for a few days.

In 2020, he visited a homeopathy friend. Pt was told that he is lacking "mineral", he fed him 2 drops of "mineral" and tried to do some body maneuvers (pt was made to stand and put his hands backward, while the friend stood on his hand with full body weight and pulled him backward) to prove the strength of homeopathy mineral. While doing so, he heard a cracking sound from his back. After that, he started c/o pain in the right lower back. The pain would initially resolve for 5-7 days after taking medicine. 

In 2020, pt c/o neck pain only on the right side which got resolved with medication.

For the past 2 months, c/o continuous pain in rt lower back scored 7/10. Consulted a neurologist, who prescribed medications. For 1 wk no pain with medications. Sometimes while walking or riding a bike the pain migrated to the front lumbar region and sometimes migrated to the right shoulder. 

No history of DM or HTN. 

Very rarely smokes cigarette due to peer pressure (within 1 hr c/o bloating and loose motion).

Chew tobacco for the past 20 yrs, 2-3 gm/day. For the past 1.5 yrs gutkha (a type of chewing tobacco) once daily.

PRESENT HISTORY: For the past 2 months, c/o neck pain first only on the right side. For the past 2 weeks continuous pain(8/10) in the whole neck.

For the past 1.5 months, he feels a lack of strength/weakness on the whole right side of his body with a tingling sensation, only when sitting for long or lying down. But, no sensory loss, and no problem in daily activities. While trying to get up from bed on the right side he says it would take him some time (cannot lift his right leg easily). But after moving around for a bit, no more weakness felt.

For the past 1 wk, almost no appetite for food at all. Feels like vomiting on seeing food.

CHIEF COMPLAINT AND PATIENT'S REQUIREMENT: 

1) Pain in rt lower abdomen (2-3 times/ day a week)

2) Continuous pain in rt lower back for the past 2 months

3) Feeling of weakness while lying down or sitting on rt side of the body with a tingling sensation

4) No appetite for any food

5) Neck pain

6) Excessive flatulence

7) sometimes c/o general body weakness

FAMILY HISTORY

Father - no health issue reported

Mother - DM for 2 yrs

Brother - all his joints became stiff, which improved temporarily with treatment and physiotherapy, but later died

Sister - Blood Ca