52F Varicose veins 15 years, piles, obesity Telangana 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.

Our patient is 52 years old female who has shared her problems that she started noticing the Varicose Veins problem about 15 years ago. 

Early indications started after second delivery which was a C-Section in late 1990. Patient was aged 19 at the time. After delivery patient started gaining weight. Between 2008 - 2010 slowly the back of the legs started bulging while standing for long times, especially during cooking. It comes to normal while sitting or sleeping. This is when weight reached to around 70kgs.

Patient started walking daily to reduce weight. Walking has since become a habit but weight hasn't reduced much. Off late weight has reached to 76kgs. This happened as patient misses walking for 1 to 2 weeks at a time when grandchildren are at thome and its not possible to go for a walk. 

To bring weight under control, added light exercise to daily routine and reduced food quantity as per suggestion from nutritionist about 4 months ago. Current weight is 73kgs. The diet change includes reducing the quantity of white rice in the afternoon, changing to brown rice occasionally and eating roti in the night.

Below is her daily routine data 👇🏻

*Patient current daily rutine*

4:30 - 5:30 AM - Wake Up & Freshing Up

5:30 - 6:30 AM - Brisk Walking ~3kms (~6000 steps)

6:30 - 7:30 AM - Chores, Light Cleaning of house

7:30 - 8:30 AM - Preparing Breakfast (Standing)

8:30 - 9:30 AM - Breakfast

9:30 - 11:30 AM - Relaxing, Playing with kid etc

11:30 - 12:30 PM - Preparing Lunch (Standing)

12:30 - 1:00 PM - Bathing

1:00 - 2:00 PM - Lunch

2:00 - 5:00 PM - Relaxing, Watching TV (Sitting on bed), Sleeping (not regularly)

5:00 - 6:00 PM - Any chores, playing with kid

6:00 - 7:00 PM - Light exercise for 30 minutes

7:00 - 8:00 PM - Dinner

8:00 - 9:30 PM - Relaxing, Sitting on Sofa, Playing with kid

9:30 - 4:30 AM - Sleep

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

[8/10, 9:54 AM] PaJR Coordinator: Patient complete case history is has to be provided and consent has to be sent

[8/10, 9:54 AM] PaJR Coordinator: In a deidentified format

[8/10, 9:55 AM] PA: Sure! I'm sharing the details now.

[8/10, 9:58 AM] PaJR Coordinator: Always post information by addressing as below

[8/10, 9:59 AM] PaJR Coordinator: Add patient in the beginning just to maintain privacy and anonymity

[8/10, 10:15 AM] PA: *Patient current daily rutine*

4:30 - 5:30 AM - Wake Up & Freshing Up

5:30 - 6:30 AM - Brisk Walking ~3kms (~6000 steps)

6:30 - 7:30 AM - Chores, Light Cleaning of house

7:30 - 8:30 AM - Preparing Breakfast (Standing)

8:30 - 9:30 AM - Breakfast

9:30 - 11:30 AM - Relaxing, Playing with kid etc

11:30 - 12:30 PM - Preparing Lunch (Standing)

12:30 - 1:00 PM - Bathing

1:00 - 2:00 PM - Lunch

2:00 - 5:00 PM - Relaxing, Watching TV (Sitting on bed), Sleeping (not regularly)

5:00 - 6:00 PM - Any chores, playing with kid

6:00 - 7:00 PM - Light exercise for 30 minutes

7:00 - 8:00 PM - Dinner

8:00 - 9:30 PM - Relaxing, Sitting on Sofa, Playing with kid

9:30 - 4:30 AM - Sleep

[8/10, 10:46 AM] PaJR PHR Moderator: In this hourly schedule, when, in which hourly slot, does she feel any discomfort due to her varicose veins?

[8/10, 11:07 AM] PA: Patient feels discomfort between 6:30 to 8:30. During this time legs become stiff while cooking. After sitting for about an hour or so during breakfast legs become normal. While cooking for lunch, 11:30 - 12:30 PM, the issue not that severe as in the morning.

[8/10, 11:09 AM] PA: Patient started noticing the Varicose Veins problem about 15 years ago. Early indications started after second delivery which was a C-Section in late 1990. Patient was aged 19 at the time. After delivery patient started gaining weight. Between 2008 - 2010 slowly the back of the legs started bulging while standing for long times, especially during cooking. It comes to normal while sitting or sleeping. This is when weight reached to around 70kgs.

Patient started walking daily to reduce weight. Walking has since become a habit but weight hasn't reduced much. Off late weight has reached to 76kgs. This happened as patient misses walking for 1 to 2 weeks at a time when grandchildren are at thome and its not possible to go for a walk. 

To bring weight under control, added light exercise to daily routine and reduced food quantity as per suggestion from nutritionist about 4 months ago. Current weight is 73kgs. The diet change includes reducing the quantity of white rice in the afternoon, changing to brown rice occasionally and eating roti in the night.

[8/10, 11:35 AM] PaJR Coordinator: Please keep posting food plates daily 3 times

[8/10, 11:40 AM] PaJR PHR Moderator: Very well shared history by the patient's advocate 👏👏

@⁨PAJR_TRAINEE please see if you can get the patient's signed informed consent through @⁨PaJR Coordinator⁩ to prepare her Case report

[8/10, 11:52 AM] PaJR Coordinator: Ok sir I have sent reminder

[8/10, 12:31 PM] Patient Advocate: Ok

[8/12, 4:08 PM] PaJR Coordinator: Please start sharing patient food plate every day with out fail

[8/12, 4:09 PM] PaJR PHR Moderator: The hourly activities are also important

For example here 👇

https://userdrivenhealthcare.blogspot.com/2024/02/pajr-telugu-guidelines-for-sharing.html?m=1

[8/15, 12:48 PM] PaJR Coordinator: Hi is there is not much activity for more than a week we will remove the account

[8/15, 12:48 PM] PaJR Coordinator: Doctors time is valuable next time when you need help 2000 per consultation for 20 minutes 🙏

[8/15, 12:57 PM] PaJR Coordinator: 🙏

[8/15, 8:05 PM] PaJR PHR Moderator: 👆The history was very well shared 👏👏

[8/15, 8:13 PM] PA: Patient Meals - 15th Aug 2024

10:00 AM - Breakfast - 1 1/2 Dosa, 5 tablespoon Peanut+Coconut Chutney

1:30 PM - Lunch - White RIce 300gms, Cucumber Curry 1 cup, Curd 1 cup

7:30 PM - Dnner - Rice 300gms, Cucumber Curry 1 cup, Curd 1 cup

Water - ~2 1/2 litres

[8/15, 8:19 PM] PaJR PHR Moderator: 👆This remained same in 14th August?

Any small changes in the routine since 10th August?

[8/15, 8:23 PM] PA:  Today's breakfast got delayed due to additional cleaning and other works for tomorrow's festival. Additional work was between 7 AM - 10 AM. Other than that rest of the routine remains same.

[8/15, 8:24 PM] PaJR Coordinator: Kindly keep sharing food plate if possible it give good information

[8/15, 9:35 PM] PaJR PHR Moderator: What was the additional work? How was it different from what was shared on 10th August?

[8/17, 9:08 PM] PaJR Coordinator: ☝️

[8/17, 9:42 PM] PaJR PHR Moderator: 👆

[8/17, 10:14 PM] PaJR Coordinator: We need to get informed consent it is still pendit

[8/17, 10:52 PM] PA:  Apologies for the delayed response. Patient has Varalakshmi Vratham on 16th August. Patient was involved in cleaning the house, making arrangements for vratham, replacing all washed curtains, sofa covers etc. Patient also informed that she didn't go for a walk as well on 15th August. Even the 5 AM - 7 AM time was spent in making necessary preparations for the vratham.

[8/17, 11:21 PM] PA: Patient Routine - 16th August 2024

5 AM - 9 AM: Prasadam preparation for Vratham (5 different items), Chores

9 AM - 10 AM: White Rice (200gms), Curd

10 AM - 12 AM: Managing Grandson

12 AM - 12:30 AM: Bathing

12:30 AM - 1:30: Sitting for Vratham

1:30 - 2:00 PM: Lunch - Pulihora 100gm, Sweet Pongal 50gm, Curd Rice, 100gm, Sweet Bonda 2

2:00 PM - 5:00 PM: Sleeping

5:00 PM - 8:00 PM: Cleaning, Entertaining few guests who came for Vratham

8:00 PM - 8:30 PM: Dinner Pulihora 100gm, Sweet Pongal 50gm, Curd Rice, 100gm, Sweet Bonda 1

8:30 PM - 9:30 PM: Managing Grandson

9:30 PM - 5:00 AM: Sleeping

[8/17, 11:29 PM] PA: Patient Routine - 17th August 2024

5 AM - 6 AM: Fresh up

6 AM - 7 AM: Walking

8 AM - 9 AM: Preparing Food

9 AM - 10 AM: Sweet Pongal 100gms

10 AM - 12 AM: Managing Grandson

12 AM - 12:30 AM: Bathing

12:30 AM - 1:30: Preparing Lunch

1:30 - 2:00 PM: Lunch - White Rice 300gms, Alu tomato Curry 1cup, Leafy Vegetable Dal 1cup, Curd 1cup

2:00 PM - 5:00 PM: Sleeping

5:00 PM - 7:00 PM: Playing with Grandson

7:00 PM - 8:00 PM: Relaxing

8:00 PM - 8:30 PM: Dinner - White Rice 300gms, Alu tomato Curry 1cup, Leafy Vegetable Dal 1cup, Curd 1cup

8:30 PM - 9:30 PM: Managing Grandson

9:30 PM: Sleeping

[8/17, 11:48 PM] PA : Patient informed that her legs didn't feel stiff whenever she skps walk. Even after working for long on 16th August it wasn't tiresome and legs also didn't feel stiff. 

But after going for a walk on 17th August and cooking after that, legs feel stiff. When asked if this is regular, patient agreed. When when working after a walk, legs feel stiff and discomfort is the most. When not going for a walk discomfort in the legs is manageable.

Walking has become more of a habit to reduce weight. But, that also seems to be causing most of the discomfort.

[8/18, 8:40 AM] PaJR PHR Moderator: Excellent event history shared that is providing more insights about this patient.👏👏

Now the narrative is taking us toward what is medically termed as "ischemic claudication pain" 

We need to further evaluate with a limb vessel (both arterial and venous) as to where exactly is vascular anatomical localisation of the ischemia if at all

[8/18, 8:41 AM] PaJR PHR Moderator: Please get that ASAP.

I'm excited to get it archived by @⁨Pajr_trainee⁩ as this is a remarkable PaJR case report, particularly as the patient advocate @⁨PA Vaddepally⁩ has shared such good data

[8/18, 1:09 PM] PaJR Coordinator: Sir I got the informed signed consent by mistake I reported that I did not get it I will send the consent

[8/18, 1:09 PM] PaJR Coordinator: 🙏

[8/18, 1:09 PM] PaJR Coordinator: Today patient advocate called and confirmed about consent

[8/18, 1:09 PM] PaJR Coordinator: My mistake

[8/18, 1:27 PM] PaJR PHR Moderator: Also email it here:

informedconsentpajr@gmail.com

along with the current PaJR link and title.

Check out the email I sent of another similar form minutes back

[8/23, 9:55 AM] PaJR Coordinator: Please keep posting daily food plate and medications taken if any 🙏

[8/23, 9:58 AM] PaJR PHR Moderator: And activities and experiences of pain

[8/23, 10:51 PM] PaJR Coordinator: If account is not active for a week doctors will shift our focus to other patients

[8/24, 7:59 AM] PaJR PHR Moderator: No doctors always focus on patients who require them. 

Sharing patient's daily activities along with the daily challenges the patient faces in his her journey makes the PaJR team respond to them quickly.

The PaJR team is always focused on their patients

[9/2, 2:04 PM] PaJR Coordinator: Hi there is no activity in the group

[9/2, 2:04 PM] PaJR Coordinator: Shall we close it down

[9/2, 3:14 PM] PaJR PHR Moderator: Please prepare the case report of this patient after obtaining signed informed consent ASAP

[9/11, 9:51 PM] PaJR Coordinator: Sir consent sent

[9/11, 10:08 PM] PaJR PHR Moderator: @⁨PAJR_TRAINEE

⁩

[9/11, 10:12 PM] Patient Advocate: Ok.. I'll start to make the case report ASAP

[9/11, 10:13 PM] PaJR PHR Moderator: @⁨PaJR Coordinator⁩ any recent update?

[9/11, 10:13 PM] PaJR PHR Moderator: Check and confirm the email

[9/11, 10:18 PM] PAJR TRAINEE: Can you please send it to my inbox?

[9/11, 10:18 PM] Patient Advocate: I can't find it in mail box

[9/13, 1:53 PM] PaJR Coordinator: I will check and send it sir