41M Low back ache 7 years, Abdominal Pain 1 month WB PaJR

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The PHR, patient journey record PaJR transcripts below reflect the therapeutic uncertainties around the patient and their resolution through team based learning :

Here's the rest of the discussions not yet updated in the case report 👇

[10/19, 11:19 AM] PaJR Coordinator: রোগীর অ্যাডভোকেটের জন্য প্রশ্ন;

অনুগ্রহ করে আপনার রোগীর ঘটনাগুলির ক্রম বর্ণনা করুন যা বর্তমান সমস্যার দিকে পরিচালিত করেছে। আপনার রোগীর একেবারে কোন সমস্যা না হওয়ার সময় থেকে ঘটনাগুলির ক্রম শুরু করুন। 

অনুগ্রহ করে আপনার রোগীর 24 ঘন্টা ধরে তার প্রতি ঘন্টার রুটিন বর্ণনা করুন যখন সে পুরোপুরি ঠিক ছিল 

এর পরে অনুগ্রহ করে বর্ণনা করুন যে একবার রোগটি তার জীবন ধরে নেওয়ার পরে তার প্রতি ঘন্টা 24 ঘন্টার রুটিনে কী ঘটেছিল 

রোগীর প্রতি ঘণ্টার রুটিনের কোন অংশটি ব্যাহত হয়েছে তা বিশেষভাবে উল্লেখ করুন 

আমাদের কাছ থেকে রোগীর বর্তমান প্রয়োজনীয়তাগুলি কী যেমন আমরা যদি তাকে একটি ওষুধ দিতে হয় তবে তারা কোন সমস্যাটি সমাধান করতে পছন্দ করবে?

অনুগ্রহ করে রোগীর পেট এবং বাহুর পেশীর ক্লিনিকাল ফটো পোস্ট করুন যেমনটি নীচের ছবিতে দেখানো হয়েছে:

https://userdrivenhealthcare.blogspot.com/2024/08/template-for-pajr-user-driven-history.html?m=1

এবং অন্য কোনো সমস্যাযুক্ত শারীরিক অংশের ছবি পোস্ট করুন যাতে রোগীর পরিচয় প্রকাশ না হয়

PaJR দলের জন্য কাজ:

অগ্রাধিকার অনুসারে রোগীর সমস্যা তালিকা এবং অনুভূত প্রয়োজনীয়তার তালিকা প্রস্তুত করুন 

তালিকাভুক্ত প্রতিটি সমস্যার প্রয়োজনীয়তার জন্য একটি পরিকল্পনা প্রণয়ন করুন

তারা কীভাবে একটি ডায়নামিক কেস রিপোর্ট (EHR) তৈরি করতে পারে সে সম্পর্কে আরও এখানে: 

https://sites.pitt.edu/~super1/lecture/lec53671/002.htm

[10/19, 11:19 AM] PaJR Coordinator: Consent taken and shared

[10/19, 4:09 PM] PaJR PHR Moderator: E-mailed?

[10/20, 7:00 AM] PaJR PHR Moderator: 👆

[10/20, 8:48 AM] PA: Good morng sir

[10/20, 8:51 AM] PA: Can i write the complains of patient in Bengali, bcz i am more comfortable in Bengali

[10/20, 8:53 AM] PA: Pt height 5ft 7inch, wt 68kg

[10/20, 8:56 AM] PA: P/c pt suffering from dull pain in rt ileac region & rt ileac fossa, for 10 month

[10/20, 8:59 AM] PA: Where the exact location of pain& where from it coming pt can't elicit it properly for last 8 month

[10/20, 9:00 AM] PaJR PHR Moderator: Please do. We can ask @⁨Meta AI⁩ to translate it here for other team members who don't know Bengali

[10/20, 9:00 AM] Meta AI: I'd be happy to help translate any Bengali text for you. Please go ahead and provide the text you'd like me to translate, and I'll do my best to provide an accurate English translation.

[10/20, 9:00 AM] PaJR PHR Moderator: Was he absolutely alright before 10 months?

[10/20, 9:03 AM] PA: From last 2 month pt felt that pain in inner aspect of rt ileac creast, pain fell when he move, o sitting to standing up

[10/20, 9:03 AM] PA: Yes sir

[10/20, 9:18 AM] PA:  Sometimes pt fell pain in appedectomy region& Mc bur point will tender when pressed by finger, last two month after taking a metronidazole 400 course there was no pain& tendeness felt in Mc Bys poin

[10/20, 9:20 AM]PA: Pt done appendectomy 6 to 7yrs ago,that time biopsy report will be normal

[10/20, 9:24 AM] PA:  Pt done CECT abd, report normal, usg report normal

[10/20, 9:25 AM] PA: Presently

[10/20, 9:26 AM] PaJR PHR Moderator: What happened 7 years back that led to his appendectomy?

[10/20, 9:26 AM]PA: Pain abd

[10/20, 9:26 AM] PaJR PHR Moderator: Can he share a picture and point a finger at the site of his pain?

[10/20, 9:27 AM] PA: Ok sir

[10/20, 9:27 AM] PaJR PHR Moderator: Does he remember the details of that event?

[10/20, 9:27 AM] PaJR PHR Moderator: Was he absolutely alright after his operation?

[10/20, 9:31 AM] PA: After a long time suffering from mild pain in abd occationally, near abt 16ys, pain in rt ileac fossa only and it will be subside by homoeo med

[10/20, 9:34 AM]PA: 7Yrs back pain was more severe &need to be admit in hospital 1 to 2 times,

[10/20, 9:35 AM] PA: Usg done 4 to 5 times, endoscopy done report will be normal, that time

[10/20, 9:36 AM] PA: Lastly diagnosed by usg it will be recurrent appendicitis

[10/20, 9:43 AM]PA: Yes sir, bt some times low backache arises

[10/20, 9:46 AM] PA: Lastly done colonoscopy bt report normal except small inernal piles

[10/20, 9:54 AM] PA: Last 7 yrs two times severe backache happened, done X ray reveal osteophytes seen in L4,L5 region, MRI done also, treated by allopathycally and regular exercise subside the complaints

[10/20, 10:04 AM]PA: Only one tab Nucoxia mr, & vibact ds 10 night, lead help to subside the complain

[10/20, 10:06 AM] PaJR PHR Moderator: I guess the image is laterally inverted in the selfie and hence become difficult to correlate realistically! But it's okay we can make out from the previous conversations that its just above the right iliac crest although it looks like the left iliac crest

PA: 

[10/20, 10:07 AM] PaJR PHR Moderator: Same location above right iliac crest?

[10/20, 10:11 AM] PaJR PHR Moderator: I'm guessing that the first episode of this patient's low backache was 7 years back before his appendectomy?

Can he describe that first and subsequent episodes of low backache in detail starting from 7 years back?

He can begin by sharing his approximate hourly activities in 24 hours, seven years back and then describe each episode of his pain mentioning what activities he was engaged in at that time and how were those activities disrupted after the pain began.

PA: 

[10/20, 10:12 AM] PaJR PHR Moderator: His current pain appears to be related to his backache as this pain is likely to be musculoskeletal as the patient's advocate described above that it worsens with movement. Likely to be an enthesitis of the abdominal ligaments attached at the iliac crest

[10/20, 10:14 AM] PA: Presenlty fell exactly as u describe

[10/20, 10:16 AM] +PA:  7: 2 month ago pt can't elicite where from the pain was coming, &where it the exact location of pain

[10/20, 10:17 AM]PA: Pt have regular bowel habit, clear stool urine

[10/20, 10:19 AM] PA Pt has a history of mumps metastasis to lt testis 20 ysr back &atrophied lt testis,ct done last yrs seen feeble artery circulation +ve in that, same condition arises his little brother also

[10/20, 10:21 AM] PA: Marrital history good, pt has two child

[10/20, 10:25 AM]PA: For a long time pt attend 4 clinic regularly, long byke journey ,every day 60 km for a long period for abt 13 yr

[10/20, 10:26 AM] PA: Last 10yrs, limited byking, driving car 60 km weekly 2 days

[10/20, 10:28 AM] PA: Last 7yrs pt sitting on wooden stool daily 10 to 12 yrs in a clinic

[10/20, 10:31 AM] +PA: Befor that he was sitting on revolving chair for 6ys and suffered from low backache

[10/20, 11:01 AM] PA Pt's DAILY ROUTINE : 

Raising from bed at 8:30 am.

Before 9:30 am the pt takes a very little amount of rice (1cup) with 'Dal/Fish/Sabji' and goes to clinic at 10:00 am and works there till 5 pm.    

 In the middle of the working time the pt takes a lite tiffin of water(1liter) and 'Puffed rice' 

 Around 5pm-6pm the pt takes a meal of rice(1cup)+ Dal/Sabji/Fish, And attends the clinic at 6pm and works there till 10:00 pm .  

 From 10:00 pm to 11:00 pm the pt does 'Speedy walk' and 'free hand exercise' in open field , after that takes his dinner around 12:00am and goes to bed at 1:00am.

*sleep:- good 

*The pt also did his namaz 5 times a day.

[10/20, 11:09 AM] PA:  Long time of biking made 3 times RTA. ,

1 time '#' his 10th rib before 10 yrs,  

2 years back in RTA. by bike , '#' finger of left hand and rubtured right tympanic membrane .

 *Lastly did tympanoplasty 10 months ago , after that pain of RIF. arrised.

[10/20, 12:09 PM] PA: Family hstry , Father diabetic pt, Mother Aso titre hight,Ra factor -ve, mother suffering from bodyache treated by homoeopathically, elder brother TG level& uric acid high, pt also suffering from high TG &uric acid afer lockdown period,bcz prolong time sitting in clinic & walking exercise stope during this time

[10/20, 12:14 PM] PA: That time pt total cholesterol level 200, TG 418, uric acid 10.8, after 2 month running regularly & taking completely oil free &high protein diet ,the level comedown to normal limit TG 114, uric acid 5.0

[10/20, 12:23 PM] PA:  After 9mont of this report pt has started Lipikind 10 regularly

[10/20, 12:29 PM] PA:  After taking lipikind 10 one month , bood report

[10/20, 12:32 PM] PA: Pt occatinally suffer from rt knee jt pain, &hell pain, bt subside by taking homoepathy med

[10/20, 12:37 PM] PA: Pt's DAILY ROUTINE : 

Raising from bed at 8:30 am.

Before 9:30 am the pt takes a very little amount of rice (1cup) with 'Dal/Fish/Sabji' and goes to clinic at 10:00 am and works there till 5 pm.    

 In the middle of the working time the pt takes a lite tiffin of water(1liter) and 'Puffed rice' 

 Around 5pm-6pm the pt takes a meal of rice(1cup)+ Dal/Sabji/Fish, And attends the clinic at 6pm and works there till 10:00 pm .  

 From 10:00 pm to 11:00 pm the pt does 'Speedy walk' and 'free hand exercise' in open field , after that takes his dinner around 12:00am and goes to bed at 1:00am.

*sleep:- good 

*The pt also did his namaz 5 times a day. ,*

Sunday pt off day,

[10/20, 3:31 PM] PaJR PHR Moderator: Deleted that report here as the patient's identifiers were visible to protect his privacy

[10/20, 3:32 PM] PaJR PHR Moderator: All these symptoms of the patient since 7 years is pointing towards a diagnosis of Spondyloarthropathy.

We would need to see this patient's x-ray sacroiliac joints

[10/20, 4:06 PM]PA: Ok sir

[10/20, 5:30 PM] PA: After one month taking lipikind 10, test report

[10/21, 8:54 AM] PaJR PHR Moderator: Yes this was shared here earlier too and we think it's not important to focus on the blood levels of cholesterol which was insignificantly raised anyways and has nothing to do with this patient's actual issues. This was just an incidentaloma that was unfortunately generated by the patient's approaching a health system where getting unnecessary tests is currently not discouraged easily.

@PAJR_TRAINEE⁩ or even @⁨~PA dr⁩ can you prepare a priority wise list of this patient's current issues?

[10/29, 12:16 AM] PA: Sir to day done

[10/29, 12:26 AM] PA: 20 days back orthopaedic given following med,pt takes med tab Nucoxia mr 5 days& digestive problem arises than stope tab Nucoxia mr,& continue other 2 med

[10/29, 12:29 AM]PA: Lastly prescribe zerodol mr, bt pt should not take this med

[10/29, 12:47 AM]PA: 4 month ago general surgeon who done patient's appendectomy7yrs back, prescribe this med , patient should not take this medicine bt every test will be done& report found normal

[10/29, 9:35 AM] PaJR PHR Moderator: Thanks for sharing this.

Appears to be hopefully a non inflammatory backache since 7 years.

@⁨PAJR_TRAINEE can you share the snippets from your case report around a similar 55F with low backache where we finally diagnosed trunkal muscle weakness and lumbo sacral strain. Share the portion with the YouTube link to the patient's trunkal power testing and see if you can ask this patient to do the same

[10/29, 9:50 AM] PA:  http://24fpatientblog.blogspot.com/2024/08/55f-back-pain-6-years-telangana-pajr.html

[10/29, 9:52 AM] PaJR PHR Moderator: Well done 👏👏

Also please guide this patient to do the same power testing and share here

[10/29, 10:02 AM] PA: Sir , pls adv me written, which test require presently for the pt?

[10/29, 10:05 AM] PaJR PHR Moderator: Copy pasting from the above similar patient case report link shared above and prepared by @⁨PAJR_TRAINEE

Please go through it and check if you can do it yourself DIY for your own patient 👇

8/7, 10:07 AM] PaJR Coordinator: Appears to be a paraspinal muscular pain

Can you test her trunkal muscle flexion as instructed in this video linked below and take a deidentified video of the patient's trunkal muscle test and share it in your own link here?

Standard trunkal/back muscle power testing👇

https://youtu.be/H3AxTxLP7zE?feature=shared

[8/7, 10:07 AM] Patient Advocate: Good Idea but the patient needs to cover the entire face and head for deidentification perhaps

[8/7, 10:07 AM] PaJR Coordinator: Excellent work @⁨Pajr_member⁩ 👏👏

@⁨PaJR Coordinator⁩ @pajr_member please hire him as our trainee volunteer if he agrees. 

He has the potential to be a great patient advocate to many more patients one day.

The videos and the event timeline that you finally shared for us has made it so much easier to nail the diagnosis for her backache!

It's likely to be due to lumbosacral strain, which is often exacerbated with injury and muscle weakness along with spondylotic changes.

So to reverse her current issues we need to work on her back muscle strengthening as well as prevent further back injury.

Wish her videos could be shared widely if not for our patient deidentification clause as the videos are showing her face although again if the patient provides signed informed consent we can prepare the case report accordingly.

@⁨pajr_trainee⁩ is our top case reporter who is also likely to embark on a PhD in "user driven healthcare" soon. It's a name we have given to this entire process. Can check her work in her learning portfolio here:

https://24fpatientblog.blogspot.com/?m=1 and if you agree she can guide you as to how to prepare your patient's case report.

[10/29, 10:05 AM] PA: Sir have you seen anything abnormal in rt sided sacroiliac jt?

[10/29, 10:06 AM] PaJR PHR Moderator: No that's the reason I feel this is a non inflammatory backache likely due to lumbosacral strain rather than sacroileitis. 

Will be looking forward to this patient's deidentified muscle testing videos