57F Meralgia paeresthetica Hypothyroidism, Hypertension, 4 yrs Recent Giddiness weakness WB PaJR

This is an online E log book 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 series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.

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

[8/31/2024, 1:38 PM] PaJR Coordinator: Questions for the patient advocate:

Please describe your patient's sequence of events that led to the current problems. Please begin the sequence of events from the time your patient had absolutely no problems at all. 

Please describe your patient's hourly routine over 24 hours when he was perfectly alright 

Next please describe what happened to his hourly 24 hour routine once the disease took hold on his life 

Please mention specifically which part of the patient's hourly routine was disrupted 

What are the patient's current requirements from us like if we had to give him a single medicine which problem would they prefer it to address?

Please post the patient's clinical photo of abdomen and arm muscle as demonstrated below in the image here:

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

and post the photo of any other problematic bodily area taking care such that it doesn't reveal the patient's identity

Task for PaJR team:

Prepare the patient's problem list and perceived requirements list in order of priority 

Formulate a plan for each one of the problem requirements listed

[8/31/2024, 1:38 PM] PaJR Coordinator: I will collect the consent form

[8/31/2024, 1:41 PM] PaJR Coordinator: Already shared with patient advocate

[9/1/2024, 10:25 AM] pajr doc 2: These two medicines are taken when the problem of vertigo arises.

[9/1/2024, 5:44 PM] pajr doc3: There are identifiers in this. Please delete.

[9/1/2024, 7:09 PM] PaJR PHR Moderator: Well done history 👏👏

@⁨pajrtrainee⁩ please archive this once @⁨PaJR Coordinator⁩ shares the signed informed consent

[9/1/2024, 7:12 PM] PaJR PHR Moderator: Tablet thyronorm ebong Tazloc choluk

Baki shob oshudh bondho korle bhalo hoi. Oshudh er side effect er jonye unar recent obosh ebong weakness lagte pare.

Matha ghoranor jonye Tablet Avomine 25 mg dine teen bar jedin matha ghorabe shudhu sei diner jonye nite paren

[9/1/2024, 7:33 PM] pajr doc2: Ok sir

[9/1/2024, 7:34 PM] pa: Sir 

Neck er xray report e ki onar sondalysis er problem ache mone hochhe?

[9/1/2024, 7:55 PM]pa: Ami change kore pathiye dichhi

[9/1/2024, 8:03 PM] PaJR PHR Moderator: Otar chobi ta dekhe bola jabe

[9/1/2024, 8:16 PM] PaJR PHR Moderator: This looks fine

[9/1/2024, 8:21 PM] pa: Tahole sondalysis er problem nei?

[9/1/2024, 8:33 PM] PaJR PHR Moderator: Hoito otar jonye noi unar matha ghurano ta

[9/1/2024, 8:35 PM] PaJR PHR Moderator: Unar mone kemon thake?

Kokhono kokhono unar ki khub mone kharap mone hoi roj?

[9/1/2024, 8:45 PM] PA: Achha

[9/1/2024, 8:48 PM] PA:  উনি খুবই ভূলে যান। বেশি কিছু মনে রাখতে পারেন না।  

এবং বাবা মারা যাওয়ার পর ( লাস্ট ৪ বছর) উনি একটু বেশিই একা একা চিন্তা করেন। এবং মন খারাপ করেন।

[9/9/2024, 2:55 PM] PA: Sir

এই প্রবলেম গুলোর জন্য ওনার কি অন্য কিছু সমস্যা হচ্ছে।

[9/9/2024, 4:37 PM] PaJR PHR Moderator: Thyroid medicine er bortoman dose ta koto?

[9/9/2024, 4:37 PM] PAjr doc2: 88

[9/9/2024, 4:38 PM] PaJR PHR Moderator: Last thyroid report ta share korte parben?

[9/9/2024, 4:39 PM] PaJR PHR Moderator: Aeguno depression er jonye mone hocche.

Dr @⁨~pajrdoc4 ke add korlam. Unake apni phone kore aei byapare janate paren

[9/9/2024, 4:39 PM] PaJR PHR Moderator: 👆Date?

[9/9/2024, 4:41 PM] pajrdoc2: 30 August

[9/9/2024, 4:46 PM] PaJR PHR Moderator: Thik achhe. Thyroid aeo hote pare tabe report dekhe bojha jacche tar jonye noi.dr4 ke ekbar appointment niye phone korte paren

[9/9/2024, 4:54 PM] pajrdoc2: Ok sir

[9/9/2024, 5:29 PM] pajrdoc2: Thyroid er power ta 88 e continue korbo..

[9/9/2024, 7:05 PM] PaJR PHR Moderator: Hain

[9/9/2024, 7:05 PM] pa: Ok sir

[9/11/2024, 10:26 AM] pa: Dr. Rajkumar sir,

Please give me an appointment to contact you to discuss some issues.

[9/11/2024, 10:43 AM] +pajrdoc4: Please call me at 2pm today

[9/11/2024, 11:57 AM] pa: Ok sir

[2/16, 10:54 PM] pa: Recent problem:

বেশি ক্ষণ দাঁড়িয়ে থাকলে left পা এর থাই এর একটা পোরশন e তে বার্নিং sensetion টা খুব বেশিই শুরু হচ্ছে। 

এখানে লোকাল একজন অর্থোপেডিক কে দেখানো হয়ে ছে। উনি কিচ্ছু x ray and medicine দিয়ে ছেন। আমি প্রেসক্রিপশন টা পাঠাচ্ছি।

[2/16, 10:56 PM] pa: Sir ektu suggest korun । Ei medicine gulo ki sab দরকার আছে ?

[2/17, 9:45 AM] PaJR PHR Moderator: @⁨pajrtrainee⁩ do we have her case report link?

[2/17, 9:45 AM] PaJR PHR Moderator: Shob dorkar nei

[2/17, 9:48 AM] PaJR PHR Moderator: 👆the history is very well presented here only problem is how to translate and link it in case reports similar to that available here https://pajrcasereporter.blogspot.com/?m=1

[2/17, 9:50 AM] PaJR PHR Moderator: Unar beshikhon dariya thaka ta kabe theke ebong oi shomoy uni ki koren?

Translating for other team members:

What does she do when she is standing for a long period? How long does she stand before she starts feeling that burning sensation in her thigh?

[2/17, 9:52 AM] pa: Ok sir, I am translating it and post in this group...

[2/17, 10:45 AM] pajrtrainee: No I'll make it today

[2/20, 9:53 PM] pajr doc2: Recent Problems: 

Problem 1:

Since last five months, if the patient standing for a long time (more than 20 minutes) at a stretch for any type of home activity (like cooking etc..) a serious burning sensation will start for a particular portion of her left thigh only. 

Problem 2:

Sometimes while doing movement, the left knee feels loose.

Here she has visited an orthopedic surgeon, the doctor advised cryotheraphy one time and heating pad one time. After that, use volitra- APS. A number of X- rays and medications are prescribed. 

Presently she taking (i) Thyronorm 88 and (ii) Tazloc-Beta 25 (Telmisartan (40mg) + Metoprolol Succinate (25mg)

[2/20, 10:02 PM] pajr doc1: X ray please

[2/20, 10:03 PM] pajr doc1: I have post here...

[2/20, 10:03 PM] +pajr doc1 : Please see the images...

[2/20, 10:04 PM] pajr doc1: Indicate👆🏻

[2/20, 10:06 PM]pajr doc4: 2 image don't open

[2/20, 10:09 PM] pajr doc1: Poor image but L2-3 seems lost. Lumbar Disc Disease. Not meralgia

[2/20, 10:10 PM] pajr doc1: Injection locally with Exercise may help

[2/20, 10:10 PM] pajr doc1: Meet a pain physician or Physiatrist locally

[2/20, 10:25 PM] PaJR Coordinator: Thiamnnot able to download could you kindly repost these 🙏

[2/22, 9:56 AM] PaJR PHR Moderator: After it starts within 20 minutes of standing how long does that sensation last?

[2/22, 11:25 AM] pajr doc2: After seating, the burning sensation is reduced...

[2/22, 11:25 AM]pajr doc2: I have already reposted the images of x ray plates

[2/22, 4:25 PM] PaJR PHR Moderator: Were they held against a white lighted background like a whitelighted computer desktop screen?

[2/22, 4:26 PM] PaJR PHR Moderator: So is it her routine strategy now to sit once after the pain starts every 20 minutes of standing?

[2/22, 4:27 PM] PaJR PHR Moderator: What happens to the pain if she's walking?

[2/22, 4:28 PM]pajr doc2: No sir, I think the quality of the X Ray is very bad.

[2/22, 4:31 PM] pajr doc2: No, she will try to avoid continuous standing as a preventive measure.

[2/22, 4:33 PM] pa: Na sir, uni chesta koren jate ektana besikhon na dariye thakte hoi. 

Normal hata chola korle problem ta hoi na. Kebolmatro desikhon ektana dariye thaklei problem ta suru hoi.

[2/22, 8:30 PM] pa: Sir

Eta ki problem,  

R kon medicine gulo lagbe?

[2/22, 9:31 PM] PaJR PHR Moderator: Lumbo sacral strain

Medicine is back strengthening exercises

[2/22, 9:34 PM] pajr doc1: And static abdominal strengthening

[2/22, 10:20 PM] pa: Onar kono lowar back pain nei ..

[2/22, 10:26 PM] pajr doc2: Sir 

Please inform me the requirements of these medicines. 

Which types of exercises are needed?

[2/22, 10:28 PM] pajr doc1: Need to review...

[2/23, 9:17 AM] PaJR PHR Moderator: It's postulated above as a hypothesis that the origin of thigh symptoms currently labeled as a sensory nerve symptom (aka meralgia paresthetica) is from the back although they could also originate from the thigh itself.

Why did this back origin hypothesis come about for her symptoms? Perhaps because of the fact/data that standing is worsening her symptoms.

[2/23, 9:18 AM] PaJR PHR Moderator: Will be looking forward to it

[2/23, 11:34 AM] pajr doc2: Ok sir, I little bit understand about the problem.

Please suggest, whether the prescribed medication are required? 

I also request you to guide in this matter.

[2/23, 11:40 AM] PaJR PHR Moderator: In my opinion they are not required.

We can guide if we are informed about the patient's hourly activities here daily.

Here's a patient who is informing us daily about her pain in the leg (scroll down to the bottom) as well as her daily hourly activities 👇

https://pajrcasereporter.blogspot.com/2025/01/33f-with-post-traumatic-headache.html?m=1