NOTE: 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.
A 65-year-old man, raised in Palivada from a consanguineous marriage, had a typical childhood. He completed his education up to the 10th standard. During his schooling, he and his friends once got into trouble, leading to them failing their exams. At 18, he chose farming over a potential career as a police officer. He now owns 4 acres of land and is married to his sister-in-law, with whom he has three children. His eldest son, an engineering graduate, is currently unemployed in Hyderabad. His second son works as a mechanic in Nalgonda due to a congenital heart defect, while his daughter pursued B.E.D. Over the last three years, he has experienced knee pain, forcing him to sell his cattle. His daily routine involves waking up at 6 am, working on the farm, and returning home at noon for lunch and a nap. In the evening, he socializes with fellow villagers before retiring for the night. Recently, he developed symptoms such as pedal edema, decreased urine output, and shortness of breath, despite no history of hypertension, diabetes, or other major health issues. His personal habits include moderate alcohol consumption twice a week, with no smoking history.
TEMP-98.6F
PR- 86 bpm
RR- 18cpm
BP- 110/80mmhg
CVS-S1S2 NO MURMUR
R/S- BAE NVBS
P/A- SOFT NT
CNS- NFND
22/04/2024
ABG
PH-7.39
Pco2-34.5
Po2-80.3
Hco3-22.0
So2-96.3
RBS-157 mg/dl
PT-18sex
INR-1.3
APTT-37sed
HB-14.7gm/dl
TLC-8,500 cells/cumm
PLT-2.60 lakhs/cumm
CUE
Colour- pale yellow
Appearance- clear
Reaction- acidic
Sp gravity- 1.010
Albumin-+
Sugar- NIL
Bile salts- NIL
Bile pigments- NIL
Pus cells- 3-6
Epithelial cells- 2-4
Red blood cells- NIL
Crystals- NIL
Casts - NIL
Amorphous deposits- absent
Others- NIL
RFT
UREA- 20mg/dl
S CREATININE- 0.9mg/dl
SODIUM-134mmol/L
POTASSIUM-3.2 mmol/L
CHLORIDE-98 mmol/L
CALCIUM IONIZED- 0.80 mmol/L
LFT
Total bilirubin-1.89 mg/dl
Direct bilirubin/ 0.50 mg/dl
SGOT-21 IU/L
SGPT- 28 IU/L
ALP- 140 IU/L
TP - 6.6 gm/dl
ALB- 4.1 gm/dl
A/G RATIO- 1.68
DIAGNOSIS
HEART FAILURE WITH PRESERVED EJECTION FRACTION
HYPERVOLEMIC HYPONATREMIA
BENIGN PROSTATE HYPERTROPHY
TREATMENT
1)INJ LASIX 20mg IV/BD
2)INJ PAN 40mg IV/OD
3) TAB URIMAX D PO/OD
THEMATIC ANALYSIS
1. Rural Lifestyle and Agriculture: The individual’s life is deeply rooted in rural living and agriculture. He chose farming over a potential career in law enforcement, indicating a strong attachment to his land and lifestyle.
2. Family Dynamics and Relationships: The family structure is notable, with the man marrying his sister-in-law and having three children. Each child’s educational and professional path reflects the challenges and opportunities they encountered.
3. Health Challenges and Aging: The individual faces health challenges associated with aging, such as knee pain, which has impacted his ability to engage in strenuous activities like farming. Additionally, recent symptoms like pedal edema and shortness of breath suggest emerging health issues that require attention.
4. Daily Routine and Social Interaction: The routine of the individual revolves around farm work, family meals, and socializing with peers in the community.
5. Personal Habits and Health History: Despite a generally healthy lifestyle with regular bowel movements and moderate alcohol consumption, the individual is experiencing health issues that warrant medical attention. The absence of major chronic conditions like hypertension or diabetes is noteworthy.
Case 4
### Thematic Analysis of the Case
#### 1. **Coding:**
- **Early Life:** Typical rural upbringing, failed exams, choice of farming over other careers.
- **Health Issues:** Knee pain, pedal edema, decreased urine output, shortness of breath.
- **Lifestyle:** Farming, moderate alcohol use, socializing.
- **Family Dynamics:** Unemployment of eldest son, second son's heart defect, daughter's education.
#### 2. **Categorization:**
- **Physical Health:** Knee pain, edema, shortness of breath.
- **Family and Social Life:** Farming, children’s challenges.
- **Lifestyle Choices:** Alcohol use, daily routine.
#### 3. **Theme Identification:**
- **Transition from Active to Limited Mobility:** Knee pain significantly impacts his farming work and social activities.
- **Chronic Symptom Management:** Recent development of concerning symptoms despite no history of major health issues.
- **Family Responsibilities Amid Health Challenges:** Balancing personal health with family concerns.
#### 4. **Theme Representation (Learning Points):**
- **Importance of Mobility in Rural Farming Communities:** Knee pain leading to reduced productivity emphasizes the need for early intervention.
- **Monitoring Emerging Symptoms in Aging Populations:** Symptoms like pedal edema and decreased urine output may signal underlying health concerns even in the absence of chronic conditions.
- **Managing Family Stressors While Addressing Health:** Balancing the health of aging parents with the needs of children facing unemployment and health issues.
Review literature
Diastolic heart failure AKA Heartfailure with preserved ejection fraction
Hypervolemic Hyponatremia secondary to CHF
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