40 yr Male came with Chief Complaints Weakness of Body Since 1month

This is an updated blog done by taking reference from:

https://vinilreddynallamdompallyrollno101.blogspot.com/2023/12/40-m-co-weaknesses-of-body-since-1-month.html?m=1

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

40 yr male Pt came to the opd with C/o weakness of the body since 1 month 

HOPI : 

pt was apparently asymptomatic 4 yrs back then he developed headache and weakness of body . So , he went to the local doctor and was diagnosed as hypertension. But patient was not taking any medication. So, he again developed weakness of the body since 1 month . 

Weakness is associated with the the dizziness and sweating . 

No H/0 nausea , vomiting , burning micturition, constipation . 

Past H/o : 

k/C/o HTN since 4yrs but not taking any medication 

N/k/C/O DM , Asthama , TB , epilepsy, cva , cad ,thyroid. 

General examination: 

pt is conscious, coherent and cooperative moderately built and well nourished. 

No pallor , icterus,cyanosis, clubbing,pedal edema , no lymphadenopathy

Vitals 

Temp- afebrile 

PR - 90 bpm

BP- 170/100mmHg

RR- 16CPM

Systemic examination:

CVS- S1,S2 heard,no murmurs

RS - BLAE, NVBS  

Per abdomen - Tenderness present in the epigastric region and left lumbar region 

CNS : NFND 

Treatment: pt. Was advised to take home bp monitoring machine. 

Initially pt was advised to take Telmisartan 40 mg but his bp readings did not improve . So , we advised patient to take telmisartan 80 mg . Still his bp readings did not improved . 

So, we added amlodipine 5 mg then his bp readings were improved and we asked the patient to continue amlodipine 5mg

Daily Bp monitoring:

Meals taken:

Breakfast:

Lunch:

Dinner:

PaJR Group discussion log:

10/11/23, 10:54 am - You created group "40M, with hypertension since 4 years Telangana PaJr "

10/11/23, 10:57 am - You changed the group description

10/11/23, 10:57 am - DR.PCL YADAV 😏😎: <Media omitted>

10/11/23, 11:02 am - DR.PCL YADAV 😏😎: After breakfast sir

10/11/23, 11:03 am - Odissa Htn 178/100: Lemon rice

10/11/23, 3:33 pm - DR. BISWAS Sir GM 💱: Thanks.

Well done

Please continue to update

Hourly activities also

BP ten readings once a week

10/11/23, 3:55 pm - DR.PCL YADAV 😏😎: Ok sir

11/11/23, 7:47 am - Odissa Htn 178/100: <Media omitted>

11/11/23, 8:45 am - Odissa Htn 178/100: <Media omitted>

11/11/23, 8:46 am - DR. BISWAS sir GM 💱: 👆👍

11/11/23, 8:48 am - Odissa Htn 178/100: <Media omitted>

11/11/23, 8:48 am - Odissa Htn 178/100: After breakfast

11/11/23, 10:44 am - DR.PCL YADAV 😏😎: Ok sir

11/11/23, 11:47 am - Odissa Htn 178/100: <Media omitted>

11/11/23, 11:49 am - Odissa Htn 178/100: Can I eat chicken,cold drink, can I have coffee weekly two times?

11/11/23, 11:50 am - DR.PCL YADAV 😏😎: Please avoid them for one year

11/11/23, 4:29 pm - DR. BISWAS sir GM 💱: Chicken, coffee: yes

Cold drink: No

11/11/23, 4:30 pm - DR. BISWAS sir GM 💱: This is how everyone has to eat 👇

https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/

11/11/23, 4:33 pm - DR. BISWAS sir GM 💱: This is how most of our PaJR patients eat👇

https://medicinedepartment.blogspot.com/2023/10/variety-of-diet-plates-shared-in-pajr.html?m=1

11/11/23, 4:34 pm - DR. BISWAS sir GM 💱: Please ask your patient to share your food plates daily

11/11/23, 4:34 pm - DR.PCL YADAV 😏😎: Ok sir

11/11/23, 6:51 pm - Odissa Htn 178/100: <Media omitted>

12/11/23, 8:56 am - Odissa Htn 178/100: <Media omitted>

12/11/23, 8:59 am - Odissa Htn 178/100: <Media omitted>

12/11/23, 11:25 am - DR. BISWAS sir GM 💱: Also mention the medicine with timing

12/11/23, 12:08 pm - DR.PCL YADAV 😏😎: He is not using any kind of medicine sir

12/11/23, 7:05 pm - You added Dr.Dinesh Datta Sir

12/11/23, 8:49 pm - DR. BISWAS sir GM 💱: Any serum creatinine test done for him?

Ask him to meet me in the opd asap

12/11/23, 9:01 pm - Odissa Htn 178/100: I'm sorry sir

12/11/23, 9:02 pm - Odissa Htn 178/100: I'm at metting tommoro i will send

12/11/23, 9:15 pm - Odissa Htn 178/100: Ok sir i will come next Monday

12/11/23, 9:16 pm - Odissa Htn 178/100: Thanks 🙏🙏

12/11/23, 9:16 pm - DR.PCL YADAV 😏😎: No sir he didn't got any tests

13/11/23, 3:21 pm - +91 87908 89907 joined using this group's invite link

13/11/23, 9:30 pm - Odissa Htn 178/100: <Media omitted>

14/11/23, 9:43 am - Odissa Htn 178/100: <Media omitted>

15/11/23, 8:25 am - Odissa Htn 178/100: <Media omitted>

15/11/23, 8:28 am - Odissa Htn 178/100: <Media omitted>

15/11/23, 1:37 pm - Odissa Htn 178/100: <Media omitted>

15/11/23, 1:44 pm - Odissa Htn 178/100: <Media omitted>

15/11/23, 4:26 pm - DR. BISWAS sir GM 💱: We need to check your patient's serum creatinine

Was it ever done before?

15/11/23, 4:54 pm - DR.PCL YADAV 😏😎: No sir

15/11/23, 4:55 pm - DR.PCL YADAV 😏😎: Informed sir, for that he will come to hospital on Monday sir

15/11/23, 6:59 pm - DR. BISWAS sir GM 💱: Ask him to prepare to be admitted for a few days

15/11/23, 7:00 pm - DR.PCL YADAV 😏😎: Ok sir

15/11/23, 7:04 pm - DR. BISWAS sir GM 💱: Here in the ward you and the other interns will validate this BP instrument by taking hourly readings with our manual instrument while he takes with this one once he's admitted

15/11/23, 7:04 pm - DR.PCL YADAV 😏😎: Ok Sir

15/11/23, 8:16 pm - Odissa Htn 178/100: Can I eat age once in a week

15/11/23, 8:17 pm - DR.PCL YADAV 😏😎: You deleted this message

15/11/23, 8:20 pm - Odissa Htn 178/100: Sorry agg can I eat

15/11/23, 8:21 pm - DR.PCL YADAV 😏😎: Yes sir you can

15/11/23, 8:21 pm - Odissa Htn 178/100: <Media omitted>

15/11/23, 8:26 pm - Odissa Htn 178/100: Today s dinner

15/11/23, 8:27 pm - Odissa Htn 178/100: <Media omitted>

15/11/23, 8:40 pm - DR. BISWAS sir GM 💱: More vegetables needed in this plate

16/11/23, 7:50 am - Odissa Htn 178/100: <Media omitted>

16/11/23, 8:52 am - Odissa Htn 178/100: <Media omitted>

16/11/23, 8:52 am - Odissa Htn 178/100: <Media omitted>

16/11/23, 8:52 am - Odissa Htn 178/100: After breakfast

16/11/23, 8:56 am - DR. BISWAS sir GM 💱: More salads and vegetables needed

16/11/23, 12:35 pm - Odissa Htn 178/100: Ok sure sir

16/11/23, 2:05 pm - Odissa Htn 178/100: <Media omitted>

16/11/23, 2:41 pm - Chitla Swagath Sir Kims joined using this group's invite link

16/11/23, 6:56 pm - Odissa Htn 178/100: <Media omitted>

16/11/23, 7:47 pm - Odissa Htn 178/100: <Media omitted>

16/11/23, 7:51 pm - DR. BISWAS sir GM 💱: 👍 Add salads

16/11/23, 7:58 pm - Odissa Htn 178/100: Ok sir

17/11/23, 8:28 am - Odissa Htn 178/100: <Media omitted>

17/11/23, 8:48 am - Odissa Htn 178/100: <Media omitted>

17/11/23, 8:49 am - Odissa Htn 178/100: <Media omitted>

17/11/23, 8:49 am - Odissa Htn 178/100: After breakfast

17/11/23, 8:49 am - Odissa Htn 178/100: 🙏🙏

17/11/23, 10:28 am - DR. BISWAS sir GM 💱: 👍

18/11/23, 9:35 am - Odissa Htn 178/100: <Media omitted>

18/11/23, 9:37 am - Odissa Htn 178/100: <Media omitted>

18/11/23, 10:31 pm - DR. BISWAS sir GM 💱: More salads needed

19/11/23, 6:52 pm - Odissa Htn 178/100: <Media omitted>

19/11/23, 6:58 pm - Odissa Htn 178/100: Shall I come tomorrow

19/11/23, 6:58 pm - DR.PCL YADAV 😏😎: Yes sir

20/11/23, 10:39 pm - Odissa Htn 178/100: <Media omitted>

21/11/23, 7:15 am - DR. BISWAS sir GM 💱: @919052565354 Is he admitted in the wards?

What about the hourly BP charting from our side and the corresponding readings from his machine?

21/11/23, 7:18 am - DR.PCL YADAV 😏😎: null

21/11/23, 7:18 am - DR.PCL YADAV 😏😎: USG with grade 2 fatty liver

21/11/23, 7:19 am - DR.PCL YADAV 😏😎: You deleted this message

21/11/23, 7:20 am - DR.PCL YADAV 😏😎: Sir in 2d echo

21/11/23, 7:21 am - DR.PCL YADAV 😏😎: Left ventricular hypertrophy is seen sir

21/11/23, 7:22 am - DR. BISWAS sir GM 💱: Looks like metabolic syndrome causing hypertension with early target organ changes (although these concepts are in a flux)

Share his Echo ultrasound videos as that would be one of the anatomical essentials to learn deeper about the metabolic adipocyte driven problem

21/11/23, 7:22 am - +91 93817 51553 joined using this group's invite link

21/11/23, 7:22 am - DR. BISWAS sir GM 💱: Ecg?

21/11/23, 7:24 am - DR.PCL YADAV 😏😎: No ECG was not done sir

21/11/23, 7:40 am - DR. BISWAS sir GM 💱: How about preparing his case report as demonstrated by your batchmates here 👇

https://likhitamaddula.blogspot.com/2023/07/60-year-old-male-patient-with.html?m=1

21/11/23, 7:41 am - DR. BISWAS sir GM 💱: Let's get it done today

21/11/23, 7:47 am - DR.PCL YADAV 😏😎: Informed to come to hospital sir

21/11/23, 7:50 am - Sreeja Madam Kims joined using this group's invite link

21/11/23, 7:56 am - DR. BISWAS sir GM 💱: Oh so he didn't get admitted yesterday?

21/11/23, 10:16 am - DR.PCL YADAV 😏😎: Yes sir, because he didn't his BP monitoring machine

21/11/23, 7:59 am - DR. BISWAS sir GM 💱: Not very necessary

He may be missing out on his work. You never told us more about what he does from morning till evening?

Let's start him on tablet Telmisartan 40 mg once in the morning and recheck 10 readings coming Sunday

21/11/23, 8:46 am - Odissa Htn 178/100: <Media omitted>

21/11/23, 8:46 am - Odissa Htn 178/100: After breakfast

21/11/23, 10:21 am - DR.PCL YADAV 😏😎: Ok sir

21/11/23, 6:27 pm - Odissa Htn 178/100: <Media omitted>

21/11/23, 8:57 pm - Odissa Htn 178/100: <Media omitted>

21/11/23, 8:58 pm - Odissa Htn 178/100: Dinner

22/11/23, 8:27 am - Odissa Htn 178/100: <Media omitted>

22/11/23, 8:28 am - DR. BISWAS  sir GM 💱: 👆@Yadav Has he started his antihypertensives as suggested here?

22/11/23, 8:44 am - Odissa Htn 178/100: Good morning sir,I am walking twice a day, not taking oily food,I'm eating dry fruits every morning.

Can I drink tea, coffee in morning?

Will I eat any medicine?

22/11/23, 8:49 am - DR. BISWAS sir GM 💱: Without sugar yes

22/11/23, 8:50 am - DR. BISWAS sir GM 💱: This is how everyone has to eat 👇

https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/

22/11/23, 8:51 am - DR. BISWAS sir GM 💱: Share the images of your patient's daily food plates and share his hourly activities daily

22/11/23, 3:56 pm - DR.PCL YADAV 😏😎: You deleted this message

22/11/23, 3:59 pm - DR.PCL YADAV 😏😎: From Tommorow he will start sir

22/11/23, 8:59 pm - Odissa Htn 178/100: Sir nowadays I'm running and doing some manual work like holding spade for digging soil so that I'm filling fever what shall I do

22/11/23, 9:01 pm - Odissa Htn 178/100: <Media omitted>

22/11/23, 9:05 pm - Odissa Htn 178/100: <Media omitted>

22/11/23, 9:37 pm - DR. BISWAS sir GM 💱: Please share your patient's activities hourly since morning till night

https://pdevendrareddyrollno115.blogspot.com/2023/10/daily-routine-format.html?m=1 <This message was edited>

22/11/23, 9:37 pm - DR. BISWAS sir GM 💱: Taken at what time?

22/11/23, 9:41 pm - Odissa Htn 178/100: After breakfast

22/11/23, 9:42 pm - Odissa Htn 178/100: Thank you so much sir

23/11/23, 8:26 am - Odissa Htn 178/100: <Media omitted>

23/11/23, 8:26 am - DR. BISWAS sir GM 💱: Vegetables and salads needed

23/11/23, 8:28 am - Odissa Htn 178/100: Ok sir

23/11/23, 8:32 am - Odissa Htn 178/100: <Media omitted>

23/11/23, 1:36 pm - Odissa Htn 178/100: <Media omitted>

24/11/23, 12:01 pm - Odissa Htn 178/100: <Media omitted>

25/11/23, 9:43 am - Odissa Htn 178/100: <Media omitted>

25/11/23, 9:46 am - DR. BISWAS sir GM 💱: Increase this dose to 80 mg once daily

25/11/23, 6:12 pm - Odissa Htn 178/100: <Media omitted>

25/11/23, 9:23 pm - DR. BISWAS sir GM 💱: Morning dose was 40 mg or 80 mg today?

25/11/23, 9:36 pm - DR.PCL YADAV 😏😎: 40 sir

25/11/23, 9:38 pm - DR. BISWAS sir GM 💱: Ask to take 80 tomorrow

25/11/23, 9:54 pm - DR.PCL YADAV 😏😎: Informed sir

26/11/23, 8:26 am - Odissa Htn 178/100: <Media omitted>

26/11/23, 8:27 am - DR.PCL YADAV 😏😎: Sir did you get the 80 mg tablet

26/11/23, 8:28 am - Odissa Htn 178/100: Good morning sir

26/11/23, 8:29 am - DR.PCL YADAV 😏😎: @odissa Htn ☝🏻

26/11/23, 8:31 am - Odissa Htn 178/100: I have not brought but i ate two tablets which is 40mg

26/11/23, 8:32 am - DR.PCL YADAV 😏😎: Bring them today and send the reading after using tablet at tomorrow morning

26/11/23, 4:15 pm - Odissa Htn 178/100: <Media omitted>

26/11/23, 6:36 pm - Odissa Htn 178/100: <Media omitted>

27/11/23, 8:53 am - Odissa Htn 178/100: <Media omitted>

27/11/23, 9:42 am - DR. BISWAS sir GM 💱: Taken 80 mg yesterday?

27/11/23, 3:30 pm - Odissa Htn 178/100: Yes

27/11/23, 3:31 pm - Odissa Htn 178/100: I did eat

27/11/23, 3:31 pm - Odissa Htn 178/100: <Media omitted>

27/11/23, 8:25 pm - DR. BISWAS sir GM 💱: The 80 mg telmisartan doesn't appear to have started working.

After a few more days if the BP remains same we shall add a diuretic @Yadav

27/11/23, 8:26 pm - DR.PCL YADAV 😏😎: Yes sir

28/11/23, 6:44 am - Odissa Htn 178/100: <Media omitted>

28/11/23, 6:49 am - DR. BISWAS sir GM 💱: Yesterday's telmisarta28/11/23, 6:44 am - Odissa Htn 178/100: <Media omitted>

28/11/23, 6:49 am - DR. BISWAS sir GM 💱: Yesterday's telmisartan at what time?

28/11/23, 6:51 am - Odissa Htn 178/100: I at morning 80clock

28/11/23, 6:52 am - Odissa Htn 178/100: After breakfast

28/11/23, 8:46 am - Odissa Htn 178/100: <Media omitted>

28/11/23, 9:11 am - DR. BISWAS sir GM 💱: Last Telma 80 at 8:00 AM?

28/11/23, 10:11 am - DR.PCL YADAV 😏😎: Yes sir

29/11/23, 10:44 am - Odissa Htn 178/100: <Media omitted>

29/11/23, 5:01 pm - DR. BISWAS sir GM 💱: When is your patient finishing all these tablets?

29/11/23, 5:01 pm - DR. BISWAS sir GM 💱: How many tablets are left?

29/11/23, 8:19 pm - Odissa Htn 178/100: <Media omitted>

29/11/23, 8:26 pm - DR.PCL YADAV 😏😎: 15 sir

29/11/23, 8:49 pm - DR. BISWAS sir GM 💱: All 40 or 80 mg?

29/11/23, 8:49 pm - DR.PCL YADAV 😏😎: 80 mg sir

29/11/23, 8:49 pm - DR. BISWAS sir GM 💱: Let's add tablet Amlodipine 5 mg once daily

29/11/23, 8:49 pm - DR.PCL YADAV 😏😎: Ok sir

30/11/23, 10:35 am - Odissa Htn 178/100: <Media omitted>

30/11/23, 11:21 am - Odissa Htn 178/100: <Media omitted>

30/11/23, 1:52 pm - Odissa Htn 178/100: <Media omitted>

30/11/23, 1:58 pm - DR. BISWAS sir GM 💱: More vegetables less rice required 👍

30/11/23, 2:12 pm - Odissa Htn 178/100: Thank you sir

30/11/23, 5:26 pm - Odissa Htn 178/100: <Media omitted>

30/11/23, 5:36 pm - DR. BISWAS sir GM 💱: Did your patient also take the telmisartan 80 mg today?

30/11/23, 5:36 pm - DR.PCL YADAV 😏😎: No sir

30/11/23, 5:36 pm - DR. BISWAS sir GM 💱: Okay

01/12/23, 8:15 am - Odissa Htn 178/100: <Media omitted>

01/12/23, 8:33 am - DR. BISWAS sir GM 💱: Amlodipine 5mg at what time?

01/12/23, 5:38 pm - Odissa Htn 178/100: <Media omitted>

02/12/23, 8:01 am - Odissa Htn 178/100: <Media omitted>

02/12/23, 8:02 am - Odissa Htn 178/100: Before breakfast

02/12/23, 8:16 pm - Odissa Htn 178/100: <Media omitted>

03/12/23, 7:40 am - Odissa Htn 178/100: <Media omitted>

03/12/23, 7:42 am - DR. BISWAS sir GM 💱: Add tablet Aten 25 mg once daily

03/12/23, 7:43 am - Odissa Htn 178/100: Ok sir

03/12/23, 10:45 am - Odissa Htn 178/100: <Media omitted>

03/12/23, 6:16 pm - Odissa Htn 178/100: <Media omitted>

03/12/23, 6:28 pm - DR. BISWAS sir GM 💱: Was tablet Aten added to Amlodipine today

03/12/23, 6:39 pm - Odissa Htn 178/100: Yes sir

03/12/23, 6:41 pm - Odissa Htn 178/100: Sir today I will bring the 25 mg medicine or not

03/12/23, 7:00 pm - DR. BISWAS sir GM 💱: No let's continue to take more readings on tablet amlodipine alone

03/12/23, 7:03 pm - Odissa Htn 178/100: Ok sir thank you so much

04/12/23, 10:53 am - Odissa Htn 178/100: <Media omitted>

04/12/23, 11:09 am - Odissa Htn 178/100: <Media omitted>

04/12/23, 11:10 am - Odissa Htn 178/100: When I checkup another time then I will got this bpm

04/12/23, 3:23 pm - Odissa Htn 178/100: <Media omitted>

04/12/23, 4:29 pm - Odissa Htn 178/100: <Media omitted>

05/12/23, 9:09 am - Odissa Htn 178/100: <Media omitted>

05/12/23, 9:14 am - DR. BISWAS sir GM 💱: Only Amlodipine 5mg appears to be working well 👍

05/12/23, 9:42 am - Odissa Htn 178/100: 🙏

05/12/23, 9:19 pm - Odissa Htn 178/100: <Media omitted>

06/12/23, 8:15 am - Odissa Htn 178/100: <Media omitted>

06/12/23, 10:28 am - +91 83091 13758 joined using this group's invite link

06/12/23, 2:02 pm - DR. BISWAS sir GM 💱: 👆@Yadav Was this patient on any medicine on this day?

06/12/23, 2:02 pm - DR. BISWAS sir GM 💱 changed the group description

06/12/23, 2:12 pm - DR.PCL YADAV 😏😎: No sir

06/12/23, 3:38 pm - +91 96760 70013 joined using this group's invite link

06/12/23, 4:18 pm - DR. BISWAS sir GM 💱: 👆This day his BP was well corrected without medicine! Any reason, any special event that day or the day before that ?

06/12/23, 4:22 pm - Vinay Kims joined using this group's invite link

06/12/23, 4:28 pm - DR.PCL YADAV 😏😎: That day before he took

 fast food Sir

06/12/23, 4:35 pm - DR. BISWAS sir GM 💱: Is that known to be beneficial for BP?

Which fast food?

06/12/23, 4:35 pm - DR.PCL YADAV 😏😎: He said biryani Sir

06/12/23, 4:37 pm - DR. BISWAS sir GM 💱: Did he feel very happy after taking it?

08/12/23, 7:34 am - Odissa Htn 178/100: <Media omitted>

08/12/23, 7:34 am - Odissa Htn 178/100: I was absent

08/12/23, 7:40 am - Odissa Htn 178/100: <Media omitted>

08/12/23, 4:53 pm - Odissa Htn 178/100: <Media omitted>

09/12/23, 9:25 am - Odissa Htn 178/100: <Media omitted>

09/12/23, 7:55 pm - Odissa Htn 178/100: <Media omitted>

09/12/23, 8:07 pm - DR. BISWAS sir GM 💱: @Yadav Can you ask the patient to share his daily food plates at least for one whole day that can be updated to the case report as a representative sample?

Also what about his hourly activities?

09/12/23, 8:07 pm - DR.PCL YADAV 😏😎: Ok sir