saikiran's elog
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.
This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.
Here is a case that I have seen.
A 20 year old man presented with the chief complaint of weakness in all 4 limbs. In early November, while settling down for a grand dinner with his family, the patient reported to have had a heartful meal and when he was finished he noticed that he had some difficult in getting up from a seated position on the floor. Dr. Zain and I are interviewing him and at this point we asked if this was the first time he ever felt weak and he recollected that he felt weakness in his toes earlier than this event and he reported that his footwear was slipping off from his feet. Reasoning it to his allegedly poor diet, he ignored this symptom, however on the day he couldn't get up from the floor, he realised his weakness wasn't improving inspite of taking an improved diet and that led him to consult a doctor in Hyderabad. At that point he had some difficulty in walking, getting up from seated positions and a difficulty in playing cricket which led him to abandon the sport. He did not report any difficulty in rolling in bed, getting up from bed in the morning or any weakness in his upper limbs. He reported a vague tingling sensation, restricted to his feet at that point. After seeking consultation with a neurologist, he got some tests done which revealed a 'nerve problem'. He reported that his sensory symptoms vanished with the drug the doctor prescribed. He also reported a mild improvement in his weakness at that point but a complete resolution wasn't attained. With a slightly improved functional ability he was able to get back to his daily activities, however playing cricket remained elusive. He changed his footwear to sandals and he says since then slippage of footwear stopped. On direct questioning he still reported a vague weakness in his toes and feet.
Over the next few months, the patient started to have progressive weakness of his lower limbs which have now resulted in a significant impairment in walking. He also says that since the lockdown began, he has been having tingling sensation in his feet, which gradually progressed to his knees. With schools and colleges indefinitely suspended and having to stay at home and playing cricket remaining elusive, the patient was distressed. The concerned parents were also worried about the progressive weakness. When asked how he felt while walking, the parents and the patient alike reported that his weakness progressed from March to June to a point where he had buckling of his knees. At this point in May, they felt that a neuro consult was warranted, however the lockdown was in full effect and getting medical care proved cumbersome. In mid June, when the lockdown eased, the patient sought a neuro consult. At this point he reported to us that he couldn't hold his phone, he had difficulty in mixing food with his fingers and holding mug while taking a bath. When asked if he ever had instability of gait, the patient recalls that one night in March, when he woke up in the night to drink water, he felt instability of his stance in the dark. He says that since that moment, his weakness has worsened and even daily activities were now becoming difficult. He also said that the same tingling he felt in his legs, he also felt in his hands, just above the wrists on both sides. He also required assisted living with help needed to get him up from bed, making him stand and helping him along to the bathroom.
A Neuro consult taken on 23rd June reaffirmed the same thing - He had a 'nerve problem'. Distressed and with no solution in sight, the patient presented to us in this current state.
He is the youngest of 2 children (both boys) to his parents. He is currently a final year student, pursuing B.com. His past history is significant for allergic sinusitis and rhinitis. He also reported having an abdominal surgery for an intestinal problem. He also got operated for a nasal polyp at age 12. He said that since the last 8 years, he hasn't been having any allergic symptoms.
There is no significant family history.
Drug history includes Gabapentin 300 mg for 2weeks and tab wysolone 30 mg tapered over 2weeks.
From our interview, we gauged that the patient has a good understanding of his disease and is eager to learn more about it. Just before we are finished, he longingly asks Dr. Zain if there is any solution in sight. Zain reassuringly puts his hand on his shoulder and platonically says "Everything will be alright".
The interview ends. The examination begins. Both Zain and I reflect on his problems and hope to get a deeper understanding of the person and the disease.