24F Exam stress depression years WB PaJR part 3

My patient shared her problem of depression and anxiety for the first time . The case report link is here 👇🏻

http://24fpatientblog.blogspot.com/2024/06/pajr-patient-advocate-driven-phr.html

She shared her problems for the second time that she is suffering from ill health like fever and paining.

The report link of that case is shared here 👇🏻

http://24fpatientblog.blogspot.com/2024/08/24f-exam-stress-depression-years-wb-pajr.html

[8/17, 1:03 PM] Patient Advocate: My patient is having throat pain.. and can't not sing properly.. 

She is recalling her past years and watching her previous recordings .. can't sing smoothly for voice soar.. 

She already mentioned about her throat problem in this group but that problem is not curing properly still...

And can't sing the high notes like previous days.. 

From 1.5 years she is feeling this problem..

She needs guidance to cure her voice

[8/17, 1:04 PM] +91 85199 76747: One thing that works for me to sing high notes is,

[8/17, 1:04 PM] Patient Advocate: If she does rewaj after 1 hour of practicing she can't talk properly Because of voice paining... She didn't give attention to it before... But from two days her mother noticed

[8/17, 1:05 PM] Patient Advocate: That after practicing she can't talk properly, her voice starts sound like split voice... And it pains

[8/17, 1:05 PM] +91 85199 76747: But go into a sound proof room and shout loudly for 3.5 minutes

[8/17, 1:05 PM] Patient Advocate: What is that

[8/17, 1:06 PM] +91 85199 76747: Whatever you want to shout, shout loudly

[8/17, 1:06 PM] Patient Advocate: She already did that.. and on that protest procession that happened in 15th ayg 11.55 pm night... She shouted on that procession "we want justice" 5-6 times but after coming home she could not speak

[8/17, 1:07 PM] Patient Advocate: She is now really worried about her voice .. she is thinking will she never sing like before again? From 1.5 years this is happening with her

[8/17, 1:08 PM] +91 85199 76747: There are no short cuts

[8/17, 1:08 PM] Patient Advocate: For this reason the local doc prescribed her that steroids

[8/17, 1:08 PM] Patient Advocate: Ok she will try

[8/17, 1:09 PM] +91 85199 76747: Steroids for what?

[8/17, 1:10 PM] Patient Advocate: That doctor gave her steroids to repair his throat ( as the doc said) 

But after 7-8 days she went to that doc to stop that medicine

[8/17, 1:11 PM] Patient Advocate: Because of her weight was increasing very fast after taking that medicine

[8/17, 1:11 PM] +91 85199 76747: Strange....Rakesh Sir should comment on this

[8/17, 1:12 PM] Patient Advocate: I mentioned it before

[8/17, 4:53 PM] PaJR PHR Moderator: I can't recall this having been mentioned although I do recall that she had a problem of weight gain

Her voice issue simply needs voice rest and proper voice usage with caution

[8/17, 4:55 PM] PaJR PHR Moderator: Steroids are anti inflammatory and often used by some practitioners wherever they suspect any inflammation. I wouldn't recommend it for shouting induced hoarseness of voice as appears to have been given in this patient

[8/17, 5:05 PM] Patient Advocate: She had lost the prescription... But that doctor said it was mild

[8/17, 5:07 PM] Patient Advocate: She already gave her voice rest for 6 months and now she doesn't practice singing daily .. she practices it once or twice a week.. 

And when she teaches students in home tuition,she doesn't shout..

[8/17, 5:07 PM] Patient Advocate: Still not curing

[8/17, 8:21 PM] PaJR PHR Moderator: 👆this may have destroyed months of voice rest

[8/17, 8:24 PM] Patient Advocate: Before this she also observed the changes of her voice but didn't give attention to it

[8/17, 8:24 PM] Patient Advocate: Because she was not practicing it daily

[8/17, 8:27 PM] Patient Advocate: Tomorrow there is a singing program from a respected organisation in her town and she was invited to give judgement of singing competition , she felt very happy for this . But she felt sad also because she can't sing properly like before... For this she mentioned it to tell here in this group today.

[8/17, 9:25 PM] Patient Advocate: All these problems she is facing from all these days ... From 1.5 years.. after joining the teaching profesion... She can remember.. 

when she joined as a teacher 1.5 years ago after completing college. one day in a program she sang a song with her students while taking class and then she had cough, then she felt pressure in her voice .. she has that video of last singing of her without any problem, 

After that singing class she had another class.. and she taught her students in a high pitched voice , 

Then she felt voice paining, she thought it will cure, and it was normal voice paining for cough.. 

But from that day she never can sing smoothly till now... And everyone keeps asking what happened to your voice ..

But she thought it will be cured soon... But today she doubted "is it not too long!?"

[8/17, 9:29 PM] Patient Advocate: After 4-5 months of this problem she felt desperate and without his father's permission she went to a local ENT and he gave her that steroids , she questioned that doctor "is it safe to take" that doctor said "obviously,it will cure your voice soon " 

Then after 7-8 days she gained weight 68 kgs to 73 kgs then she told her mother and her mother took her to that doctor again and requested him to stop this medicine,

[8/17, 9:31 PM] Patient Advocate: Then she went to a homeopathy doctor.. he gave her medicines .. and for some days voice paining stopped but voice was not smooth like before...

But she thought it was cured.. she was not practicing singing daily , due to give her voice to take rest..

She thought it will be cured soon..

All these days she was not giving attention to her voice but today she thought it is too long

[8/17, 9:32 PM] Patient Advocate: Then she did thyroid test

[8/17, 9:46 PM] Patient Advocate: Yes.. that's why patient and her mother is worried.. why it is not curing properly

[8/17, 9:59 PM] PaJR PHR Moderator: 👆

[8/17, 10:25 PM] Patient Advocate: She is not following all of these.. she talks a lot and she thought only not practicing music is called voice rest... From today she will maintain all of these.

[8/17, 10:26 PM] Patient Advocate: At night before sleeping she takes vapour as the homeopathy doc suggested and he also said not to gurgle as it gives pressure to the voice...

[8/19, 8:34 AM] Patient Advocate: Patient er Gotokal rat theke prochondo gola byatha hoeche ... Vocal cord e ..ar jiver goray...goromer moddheo golay chador jorie ghumieche... Kotha bolte kosto hocchilo sondhya theke .. vapour newar por ektu komechilo kintu sei byatha ta aj sokale ghum theke othar por o ache

[8/19, 9:28 AM] PaJR PHR Moderator: Ask her to take Tablet paracetamol 650 mg every 6 hours for 1 day

[8/19, 9:42 AM] Patient Advocate: Ok

[8/19, 9:58 AM] Patient Advocate: Golar sathe sathe jiver gorateo byatha ache...dhok gilte kosto hocche. Mone hoi gan ba jore kotha bolar jnno pressure poreche

[8/19, 9:58 AM] Patient Advocate: Tarpor theke emn hocche

[8/19, 10:21 AM] PaJR PHR Moderator: Oshudh nile aasha korchi aajke kome jabe

[8/19, 10:31 AM] Patient Advocate: Kintu gola vanga awaj ta ki thik hbe??

[8/19, 10:31 AM] Patient Advocate: Ektu gan korlei bose jacche

[8/19, 10:31 AM] Patient Advocate: Seta ki kora jay

[8/19, 11:18 AM] PaJR PHR Moderator: Kichu din rest nile thik habe

Nahole laryngoscopy kore dekhte habe vocal cord a kono nodule ache kina

[8/19, 11:19 AM] Patient Advocate: Accha

[8/20, 10:36 AM] Patient Advocate 2: Dear @⁨Patient Advocate⁩ Golar somosaa niye ami o vugchi. Voice rest a thakle ami sei abar amar misti sor fire pai specially katha bolar somoy. Jani tumi akjon teacher. Amar to class a chechiye poranor ovves chilo. Seta o change korar chesta korchi. R amra holam bangali, lekha pora o sikhechi tai sab bisoy a amader kichu na kichu motamot to thakbei seta prokash kora amader swavabjata.Aguno obossoi dorkar seta hoyto amra likhe janate pari. Amar music teacher khub choto kore gan gaite bolechen jate golay chap na pore r class a poranor somoy spekar bebohar jeta kina news anchor ra koren. 

You are versatile. Kichu din ganer bodole nach o korte paro ❤️

[8/20, 10:39 AM] Patient Advocate: Gan ta ekrokom bondhoi royeche...eta thik bolecho @⁨Patient Advocate 2⁩ karon amar teaching job suru korar por i emn problem suru hoeche poranor flow te jore kotha bolate may be chap pore gechilo...seta ar kono vabei recover hocche na jnno khub chintay... Sombhoboto michile chitkar korar jnno ekhoner gola byatha ta abar bereche... Aj golar sathe sathe dan diker mukher vetore mari teo khub byatha ..dhok gilte kosto hocche ..tai doctor babur kotha moto paracetamol nicchi... R joto ta para jay voice rest nie dekhi kodin

[8/20, 11:17 AM] PaJR PHR Moderator: Paracetamol 650 kota newa hoyeche unar?

[8/20, 11:17 AM] PaJR PHR Moderator: Good inputs 👏

[8/20, 12:25 PM] Patient Advocate: Hyan ..uni nicchen jnno byatha ta ektu kom...aj sokale dan dike marir dike byatha hocchilo ..

[8/20, 12:36 PM] PaJR PHR Moderator: Marir byatha ta na komle ekbar Dental opinion nite hobe

[8/20, 12:36 PM] Patient Advocate: Thik date noy...gola theke eksathe dan dike

[8/20, 12:37 PM] Patient Advocate: Golar jnnoi feel hocche marite byatha ta ..gilte kosto hocche

[8/20, 12:59 PM] PaJR PHR Moderator: Tahole ENT

[8/20, 1:00 PM] PaJR PHR Moderator: Kichu patient er golar bhitorer chobi endoscope diye tule dekhte parle bhalo bojha jeto.

[8/20, 1:07 PM] Patient Advocate: Endoscopy ki je kono hospital e hoi?

[8/20, 2:08 PM] PaJR PHR Moderator: Most ENT set ups these days should be able to do their own video endoscopy (laryngoscopy and pharyngoscopy) but this patient's issues appear to be acute since a few days (except the voice driven hoarseness) and should subside soon

[8/20, 2:28 PM] Patient Advocate: Ok

[8/21, 12:19 PM] Patient Advocate: Amar patient tar UGC net exam dite siliguri te eseche... Tar baba boleche Aj k vabche test gulo kore jabe . Ki ki test korte hbe

[8/21, 12:21 PM] Patient Advocate: Ar kono special instruction kichu thakle bola jabe ENT k

[8/21, 12:23 PM] Patient Advocate: Jekhane test gulo kora hbe onara prescription chaiche

[8/21, 12:26 PM] PaJR PHR Moderator: Sheta ENT daktar er bibechonar upor chere dite habe

Test guno simply a way of doing a meticulous local examination of the throat and vocal cords using technology such as a video endoscope

[8/21, 12:26 PM] Patient Advocate: Ok tai bola hobe onake

[8/29, 11:20 AM] Patient Advocate: My patient is worried about his throat... Also she is asking How many days she has to stop singing? 

Every night she feels throat pain, she takes vapour... Still feeling pain

[8/29, 12:42 PM] PaJR PHR Moderator: I tried to check this patient's case report for her ENT problem data but due to the volume of her previous data it's not opening due to a slower connection in the OPD!

Can you split her data into different posts by the problems discussed (aka EMRs) and have one post for an overall EHR which will have all the links to her separate EMRs

[8/29, 12:46 PM] Patient Advocate: Ok..

[8/29, 6:45 PM] Patient Advocate: http://24fpatientblog.blogspot.com/2024/08/24f-exam-stress-depression-years-wb-pajr.html

[8/29, 6:45 PM] Patient Advocate: This is the update of july month of my patient

[8/29, 7:06 PM] PaJR PHR Moderator: Good month wise separating is also a good idea

[8/29, 7:07 PM] PaJR PHR Moderator: I guess her hoarseness discussion started from August?

[8/29, 7:34 PM] Patient Advocate: No it was from 1.5 years.. but she mentioned it before... But she thought it will be cured.. so she didn't took it seriously 

But it was not recovering so she decided to take treatment so she started here

[8/29, 7:41 PM] +91 63096 50921: 1.5 years?!

[8/29, 7:41 PM] Patient Advocate: Yes

[8/29, 7:42 PM] +91 63096 50921: Sir what's ur say?

[8/29, 7:44 PM] Patient Advocate: Sometimes it was little, sometimes it was more and sometimes there was no pain...but the problem she is facing from july 2023

[8/29, 7:45 PM] Patient Advocate: After joining as a teacher..and may be for too much pressure in the voice

[8/29, 7:50 PM] +91 63096 50921: Teacher's nodules? @⁨PaJR PHR Moderator⁩ @⁨Meta AI⁩

[8/29, 7:50 PM] Meta AI: For clarity, I believe you meant to ask "What are teacher's nodules?"

Teacher's nodules, also known as singer's nodules or vocal cord nodules, are growths that develop on the vocal cords due to repeated strain and overuse. They are common among individuals who use their voice extensively, such as:

- Teachers

- Singers

- Public speakers

- Actors

These nodules can cause:

- Hoarseness

- Breathy voice

- Vocal fatigue

- Pain or discomfort while speaking or singing

Prevention and treatment strategies include:

- Vocal technique training

- Rest and voice conservation

- Hydration

- Avoiding loud or prolonged speaking/singing

- Medical treatment (in severe cases)

If you have further questions or concerns, please feel free to ask!