MY JOURNEY AND EXPERIENCE IN GENERAL MEDICINE IS STARTED WITH HUGE INTENSION OF---------- MBBS DOCTOR should have general medicine (Physician Skills ) and (Psychologist skills) to be Inculcated in the BLOOD, Irrespective of Whatever branch ,we are going to Opt in the Post Graduation.
So that ,One can become PRO HEALER ,GREAT DOCTOR by complete sense .
Simply ,General Medicine is the Subject ,(Universally to be known ) by Each and Every Doctor , Irrespective of Branch (PG) .
I said ,Should have Psychologist Skills , To Save our Patients from landing in Psychiatric Conditions .(one of the greatest qualities ,Every doctor should have - That's Our Responsibility) .
UNIT DUTIES - 1st 15Days ::::: Worked Really Hard with honest Intention that - IF AN INTERN DO THEIR JOB PROPERLY, EACH AND EVERYONE (Literally ) Can acknowledge the Case ,from their Home Place through mobile even without visiting to Hospital and As we have Direct approach to Patients , we can Help them by taking care of them. TRIED TO DO IT WELL .
New to the Department ,every single day was a great Experience .
Shared lot of things ,through different Charting( GRBS ,BP ,Apraxia ) according to the Patient Condition.
Prepared Case Reports of Following Patients (Loved doing it ,As their Data going to Remain with us forever ,when the Patient gets Discharged / Leave the Hospital )
Prepared PaJR for each and every Patient for whom I prepared Case Report Links ,Since again I loved the Concept of PaJR ,as we can Provide Long term benefits to the Patient .
https://supriyakammari53.blogspot.com/2022/12/63yr-old-female-with-bl-pedal-edema.html?m=1
https://supriyakammari53.blogspot.com/2022/12/16yr-old-male-patient-with-nose-bleeding.html?m=1
https://supriyakammari53.blogspot.com/2022/12/35yr-old-male-patient-with-abdominal.html
https://supriyakammari53.blogspot.com/2022/12/a-60yr-old-male-patient-with-diabetic.html
https://supriyakammari53.blogspot.com/2022/12/is-online-e-log-book-to-discuss-our.html
https://supriyakammari53.blogspot.com/2022/12/60yr-old-female-with-focal-seizures.html
Learning Points and Discussion around different cases were done in Respective PaJR groups.
PERIPHERALS ( NEXT 15 DAYS ) :
FIRST 5 DAYS : NEPHROLOGY:
MY IDEA OF MAKING BLOG IS - WHY ONLY THEM NOT EVERYONE AFFECTED WITH KIDNEY DISEASE :
SO, I THOUGHT OF SHARING NEPHROLOGY PATIENTS -DAILY ROUTINE , DIETARY HABITS , ENVIRONMENTAL FACTORS AND FAMILY HISTORY( so that this data could be useful to anyone to find the outcome ) INSTEAD SHARING RESPECTIVE PATIENTS CASE REPORT LINKS ,AS MOST OF THEM PRESENTED WITH SAME COMPLAINTS ( SOB with varying grades and pedal edema ) associated with K/C/O HTN /DM or HEART FAILURE .
SO I LEARNT , MMRC Grading : ( Modified Medical Research Counsil Scale for Dyspnoea )
EDEMA (pitting ) Grading :
DONE RESPIRATORY EXAMINATION (On patient in AMC ):
Patient examined in sitting position
INSPECTION:
-Chest appears bilaterally Symmetrical and Elliptical in shape
-Respiratory movements appears equal on both sides and it's Abdominothoracic type
-Trachea -Central in position
-Nipples - In 4th Intercostal space
-No scars ,Sinuses , Engorged veins and visible pulsations
No signs of Volume loss
PALPATION :
-All inspectory findings confirmed
-Trachea -Central in position,No deviation
-Apical Impulse - In Left 5th ICS , 1cm Medial to the Mid clavicular line
- cricosternal distance : 3 finger breadth
PERCUSSION:
Right Left
Supra Clavicular : Resonant Resonant
Infra Clavicular : Resonant Resonant
Infra mammary : Resonant Resonant
Axillary : Resonant Resonant
Infra axillary : Resonant Resonant
Supra scapular : Resonant Resonant
Inter scapular : Resonant Resonant
Infra scapular : Resonant Resonant
AUSCULTATION :
Right Left
Supra Clavicular : NVBS NVBS
Infra Clavicular : NVBS NVBS
Infra mammary : NVBS NVBS
Axillary : NVBS NVBS
Infra axillary : NVBS NVBS
Supra scapular : NVBS NVBS
Inter scapular : NVBS NVBS
Infra scapular : NVBS NVBS
( NVBS - Normal Vescicular Breath Sounds )
No Fine / Coarse Crepitations heard .
LEARNT ABOUT IMPORTANCE OF AV FISTULA:
1) Rule of 6 For AV Fistula:
Flow rate should be more than 600ml/min
Vein diameter should be more than 6mm
Vein depth should be less than 6mm
2) Types of AV fistula : (AV fistula - Surgically Created in the Non- Dominant Hand ) .
Radial - Cephalic Fistula : anastomosis between Radial artery and Cephalic vein in the distal fore arm .
Brachial -Cephalic Fistula : anastomosis between Brachial artery and Cephalic vein in the Proximal Fore arm
Brachial -Basilic Fistula : anastomosis between Brachial artery and Basilic vein in the upper arm .
3) Maturation of AV fistula : requires 4 to 6 weeks , (on an average varies acc to pt from 1 to 4 months
4) Complications of AV Fistula:
Heart Failure is the serious complication of large AV Fistula .
Claudication - due to lack of blood supply to legs
Internal bleeding
LEARNT ABOUT HEMODIALYSIS AND ITS EQUIPMENT: (Session Duration max : 4 Hours ) .
Acid and bicarbonate solutions(specific to hemodialysis ) are used as Dialysate . Its composition varies from patient to patient according to their electrolytes and pt condition.(we can correct Na+ through machine and also through Dialysate) can't correct K+ through Machine but only through Dialysate .
Rule of 7 for Dialysis:
The K+ level in the patient's body and the K+ given through the dialysate should be equal to 7 (on adding both) .(K+ level in the dialysate adjusted acc to the patient K+ level ) .
If patient complaints of SOB during the session ,then we can stop water access ,through the machine , that may decrease the load in patient .
(Or ) can give medications (diuretics ),if it's severe .
Monitored vitals during the session: when patient lands in hypertension ,managed through medications like Nicardia 20mg ,lasix 80mg ,labetalol 10mg acc to pt condition .
Temperature maintained -36.5 °C , Flow rate : 500ml/min .
2ml heparin is diluted with 8ml of NS ,initially 6ml of this solution is given as bolus later during the session ,given as 2ml and 2ml (it's automatically taken by the machine during the session) if not ,can be given manually also .
ASSISTED To Dr .Chandana Ma'am in CENTRAL LINE ( done activities like Cleaning and draping , suturing) and maintained sterile environment while doing it .Learnt about catheterization. (IJV and femoral vein) .
Monitored vitals of patients in CKD ward ,on daily note and Managed their Hypertension and DM (According to their GRBS values ) .
LIFESTYLE OF DIFFERENT PATIENTS IN NEPHROLOGY (BEFORE THIS EVENT) :
(Daily Routine, Dietary habits , Environmental Factors ,Family History )
1) 47YRS OLD MALE PATIENT from choutuppal ,Lorry driver by Occupation ,diagnosed with AKI ON CKD
K/C/O HTN since 1 year (on Medication)
H/O CVD 1year ago (stenting done )
Daily routine :
As he is lorry driver by Occupation, goes to work for 15-20 days to long distances , wakes up at 4:00 AM ,have tea frequently with one hourly duration,No habit of having breakfast in the morning , he cooks his own food with ingredients (brought from home ) and have his meals at around 3 PM , have Drinking water only (not preferred other source of water ) and travels asusual and have dinner at around 10PM .
He worked as Labourer in fields with Iron as Constituent at Karnataka for 1 year (2006 year) @2 months at a stretch without going to his home place , According to patient ,working in those fields ,affected his health and made him physically weak . So Stopped it and continued as Lorry driver
Daily routine,when he is at Home for 15 days (when worked as Lorry driver)
Wakes up at 7:00AM -have tea ,at around 10AM - have Roti and Tea ,he takes rest and spends with family and friends (this whole 15days ) at around 1PM - have meals and tea ,at around 5PM - have tea at around 8PM - have meals /roti , at 10PM - he Usually sleeps .
Dietary habits - Mixed (Non allergic to any food)
-Have water @ 1 litre / day
-occasional alcoholic
- smoker : 1 Pack of Beedi /day since 25 years
Environmental factors: from Choutuppal, Nalgonda district ( tropical region )
Family History: No H/O any Kidney disease in family but H/O DM and HTN present .
2) 60 YRS OLD MALE PATIENT from Suryapet ,Merchant by Occupation since 15 years , previously he was farmer ,Diagnosed with AKI on CKD
K/C/O HTN (DENOVO DIAGNOSED 1 month ago ) - On medication .
On dialysis
Daily Routine:
wakes up at 7AM - Usually have tea and snacks in the morning and goes to work ,at around 2PM - have meals , around 5PM - have tea ,at around 9:30PM - have dinner (meals ),and sleep .(when he was farmer used to wake up at 6 AM , and used to have meals at 9AM and goes to farm ).
Dietary habits : Mixed diet (not allergic to any food)
Have water @ 2 litres /day
Non alcoholic
Non smoker
Environmental factors: from Suryapet ( tropical region)
Family History: No H/O kidney diseases in the family but H/O HTN+
3) 60YRS OLD MALE PATIENT,from Mothkur , labourer by Occupation, diagnosed with CKD on MHD
K/C/O HTN since 2 months (On medication)
K/C/O CKD since 6 months (on dialysis)
Daily routine :
Wakes up at 6AM - have tea ,at around 9AM - have meals and goes to work , at around 2PM- have meals ,takes rest for sometime then goes to work again and returns home and at around 8PM have meals and at 10PM he usually sleep .
Dietary habits : Mixed diet (non allergic to any food
-Have water @ 3 litres /day
Occasional alcoholic
Smoker : 4-5 beedi /day since 20 years
Environmental factors: from Mothkur (tropical region )
Family History: No H/O any Kidney disease and No H/O HTN and DM
4 ) 70YRS OLD MALE PATIENT, from Choutuppal,POT MAKER by Occupation, Diagnosed with CKD
K/C/O HTN and DM since 2 years (On medication)
On dialysis
Daily routine:
Wakes up at 6AM ,have tea goes to work and 10AM -have meals and goes to work ,at around 2PM in the afternoon - have TODDY and sleeps and most of the time he directly wakes up in the next day morning, occasionally wakes up in the night and have dinner (meals )
Dietary habits - Mixed diet (non allergic to any food
Have water @ < 1 litre/day
Occasional alcoholic (regular toddy drinker )
Smoker : 1 pack of Beedi /day since 20years
Environmental factors : from Choutuppal, Nalgonda district (tropical region)
Family History: No H/O kidney diseases,HTN ,DM
5) 50YRS OLD MALE PATIENT, from Kaeshvarigudem , Farmer by Occupation, diagnosed with CRF
K/C/O HTN since 1 year (On medication)
On dialysis
Daily routine:
Wakes up at 5AM and Goes for prayer and at 6AM have tea and at around 8AM have meals and goes to farm and at 1PM have meals and takes rest for sometime and goes to work again and returns home at around 6PM and have dinner (meals ) at 8PM and goes to bed after dinner .
Dietary habits : mixed diet (non allergic to any food)
Have water @ 4litres/day
Non alcoholic
Non smoker
Environmental factors: from Kaeshvarigudem,Nalgonda district (tropical region)
Family History: No H/O kidney disease ,HTN,DM
6) 60YRS OLD MALE PATIENT, from Battugudem , Farmer by Occupation, Diagnosed with CKD 2° to Diabetic Nephropathy
K/C/O DM since 10 years , HTN since 5 years (On Medication ) ,CKD since 1 year
On dialysis
Daily routine :
Wakes up at 6AM , have milk at 8AM , Meals at 9AM as breakfast and goes to farm at 2PM have meals ,and takes rest for sometime and goes to work ,and returns home and have dinner (meals /Roti )at 8PM and sleep .
Dietary habits : mixed diet (non allergic to any kind of food )
Have water @ 2 litres /day
Non alcoholic
Non smoker
Environmental factors: from Battugudem, Nalgonda district (tropical region)
Family History: No H/O Kidney diseases but H/O HTN,DM +
7) 45YRS OLD MALE PATIENT, from Narketpally , Driver by Occupation, diagnosed with CKD ( 4YRS ago)
H/O Chikungunya 4yrs ago (used medication )
On dialysis
Daily routine :
Wakes up at 6AM ,have tea ,at around 7:30 have meals as breakfast and goes to work ,at 1PM have meals and goes to work and returns home at 5PM and have tea ,at around 8PM have dinner (meals ) and at 9PM goes to bed .
Dietary habits : mixed diet (non allergic to any food)
Have water @ 4litres/day
Occasional Alcoholic (Stopped since 4 years )
Non smoker
Environmental factors: from Narketpally,Nalgonda district (tropical region )
Family History: No H/O kidney disease ,HTN ,DM
8) A 40YRS OLD MALE PATIENT, from Veliminedu ,Sub Editor for Competitive Magazines (employee),Diagnosed with CKD (H/O NSAID abuse +nt )
K/C/O HTN (Diagnosed at age of 28yrs) and On medication
On dialysis through same AV fistula (working )since 5 years (as CKD diagnosed 5 yrs ago)
Daily routine:
Wakes up at 5:30 AM and have tea ,reads newspaper and at around 8AM have breakfast (upma/chapathi / dosa /idli) and goes to work and at 1PM have lunch (meals )and goes to work and returns home at 6PM and have tea and at 8PM have dinner (meals ) at 10PM -sleep
Dietary habits: mixed diet (non allergic to any kind of food )
Have water @ 3 litres /day
Non alcoholic
Non smoker
Environmental factors: from Veliminedu (tropical region)
Family History: No H/O kidney diseases but H/O HTN (with High recorded BP values ) in their family - Mother ,Father , Siblings (2 elder sisters and 1 twin sister ) ,Grand Father and Grand Mother
H/O DM - Mother ,twin sister .
SECOND - 5 DAYS - WARD :
CONDUCTED PREFINAL PRACTICALS FOR 2K18 BATCH FOR 5 DAYS : (by preparing their allotment lists etc.........)
Took Histories of 2 Patients : ( During WARD duties) :
WARD
BED 8
46YRS OLD FEMALE ,resident of narketpally .
diagnosis in our hospital: Dimorphic Anemia with Heart failure .
SEQUENCE OF EVENTS :
Feb 2022 ( i.e ...10 months ago ) - She developed Polymenorrhaegea associatied with pain at lower abdomen , which was insidious in onset ,gradually progressive, squeezing type ,non radiating ,no aggravating factors .
went to Govt hospital at Nalgonda i/v/o it .where she was diagnosed with Uterine fibroids ,advised Hysterectomy but it was not done ,as her Hb was 4.6 g/dl .
2units PRBCs transfusion done at that hospital ,and then Hb was improved to 8g/dl and advised to have proper diet and given medication ( Medroxyprogesterone acetate ) , which she used for 2 months on daily basis ,OD
then ,since 8 months ,she used only during menses .( now , only spotting present )
on 15th Dec 22, She developed pedal edema ( pitting type )
on 17th Dec 22 , she developed SOB(Grade 3 ) , cough with sputum ( yellowish ,mucoid in consistency , non foul smelling ,less in quantity) .So ,she went to the hospital at Narketpally and was not relieved on taking medication . (on investigations;Hb - 3.2g/dl )
on 31st dec 22, came to our hospital,with the same presentation, 2 units of PRBCs transfusion done on 3/1/23, 5/1/23 and now her Hb is 8.4 g/dl and appropriate treatment is given .
after 5 days of hospital stay ,her SOB(Grade 3) relieved , pedal edema (pitting type ) resolved , and mild cough present .
WARD
BED 4
31YR OLD FEMALE ,Resident of Sajjapuram came to OPD with chief complaints of
fever ,associated with Chills ,Rigors ,Head ache ,Joint pains and generalised weakness since 2 months
patient was apparently asymptomatic 2 months ago , then developed fever associated with chills ,rigors ,head ache ,joint pains and generalised weakness ,went to local hospital , (on investigations , WIDAL positive , ESR raised (26mm ) ,CRP -6.01 ,K+ 2.9 , Na+ 133 , ON USG ,Cystitis and Grade 1 fatty liver found )
diagnosed as Typhoid fever and given medications ( unknown ).
her symptoms were not relieved on taking medication. So, she came to our hospital for further management .
burning micturition present
No H/O nausea ,vomiting ,loose stools
No H/O cough ,cold
Not a known case Of DM ,HTN ,asthma ,epilep
SEQUENCE OF EVENTS :
In 2019 -(i.e .., 3yrs ago ) She developed fever ,which was sudden in onset ,low grade , intermittent type , lasted for 2 months duration , which was diagnosed as typhoid fever, relieved on taking medication .
but fever recurrs every 8 months ,since then .
In 2020 ,( i.e 2yrs ago ), she developed headache ,which was sudden in onset , lasted for 1hr duration , in the parietal region radiating to neck ,increased in intensity on exposure to loud sounds (phonophobia) , went to the hospital at Miryalaguda ,took medication for 20days ,and headache got relieved for few months .
then ,associated with fever ,which reccurs every 8 months .
In October 2022,(i.e ..,2months ) She developed joint pains ,which involves large joints and Spine .( small joints not involved ) . Intensity increases during night time, and lasts till 1 hour after wake up in the morning ,and relieves on performing daily chores , associated with fever.
Above History taking of 31 year Old female patient -------> lead to the case report link and PaJR group preparation ---
https://supriyakammari53.blogspot.com/2023/01/31yr-old-female-with-reccurent-puo.html
My Personal experience on Exposure to Patient and idea Of Helping Patients and Healing them through Deeper Sense ,Made me to THINK OUT OF THE BOX and I Personally RE INVENTED PSYCHOSOCIAL COMPONENT and I Came Up with an Idea of BIOPSYCHOSOCIAL MODEL and I implemented on the Same 31 YR OLD Patient -------->>>>>>Gave an OPPORTUNITY To Present this Case On JAN 25th CME .
I Can Proudly Say ; I earned that Opportunity through My Previous 40 DAYS WORK and MY BIOPSYCHOSOCIAL MODEL .( DR. RAKESH BISWAS SIR and DR .RAJ KUMAR SIR ---- Encouraged me alot to Present My Idea On Jan 25th CME ).
EARNED IT
ICU DUTIES: ( LAST 5 DAYS ) :
Most of the ICU duties of mine are Night duties --- those are the horrible night duties ,where 2 patients are on Mechanical Ventilator and remaining patients in ICU are serious patients ,who requires Hourly monitoring .
Nights are soooo calm in the ICU ,where only Apparatus Sounds are audible ,and Some irritable Patients makes noise in between ,where we are continuously aware of, in dimmed lights .
1st Death in internship ,i witnessed On ICU 3rd Night duty --- though continuous monitoring was done and appropriate treatment and care was given,we were unable to save him --- That day ,I was freezed with my mixed emotions ..........( Unexplainable .......) .I was not in a Position to do CPR ,since ,it was my first experience in witnessing death but CPR was done by Dr.Raveen Sir , Dr. kranthi Sir , Dr. Bharath Sir vigorously for 1 hour , Since the time his BP was Unrecordable and Pulse became feeble i.eee,,,(5AM ) in the morning to (6AM ) and also ventilated him through ambu bag -- but of no use ,we declared death at 6:15 AM .
SOME OF THE PROCEDURES , i have done in ICU :
-Ryles Tube Insertion and given feeding and medications after checking position of Ryles tube .
-Foleys Catheterization.
-Many ABG Samples took for different patients ( Radial and Femoral )
-Venous sampling done .
- IV cannula :
-Dressing with Neosporin Powder for Bed Sores :
-Platelet Transfusion done
- Assisted In LUMBAR PUNCTURE: under ( Dr.VAMSI SIR ) :
--->>Managed Hypotension of Nephro patient in ICU through NORAD infusion (through infusion pump),Started from 6ml/hr given up to 0.5ml/hr and then stopped and monitored vitals thoroughly.
PSYCHIATRY Postings ( Next 15days ) :
- Learnt What is Psychiatry
- Learnt about what are the different cases ,we come across in Psychiatry.
- Learnt about Approach to case --> diagnosis through Scales ,ICD 11 ----> Treatment
- During My Psychiatry postings --> CME 2023 on Jan 25th , Where Dr. Rakesh Biswas sir Mentioned ,She explained her Case as a Psychiatrist.
That's how My Psychiatry postings ended .
UNIT :::: ( LAST 15 DAYS ) : Implemented BPS model over every case ,I came across and Prepared Case report links and PaJR groups as usual .
https://supriyakammari53.blogspot.com/2023/02/18-yr-old-female-with-ho-fall-aw-loc.html
https://supriyakammari53.blogspot.com/2023/02/is-online-e-log-book-to-discuss-our.html
BIOPSYCHOSOCIAL MODEL OF 2 PATIENTS IN THE WARD :
75year Old Male ,from Jangareddygudem ,farmer by occupation came with the Chief complaints of SOB , Cough with Sputum since 15days .
C/O weakness of B/L UL and LL since 5days .
BIOLOGICAL COMPONENT:
Patient was apparently asymptomatic 15days ago , then he developed SOB (Grade II - MMRC ) , No H/O Chest pain, Palpitations, PND , Orthopnoea .
C/O cough with sputum since 15days ,which was white in color ,moderate in quantity, no odour ,no blood in the sputum , No H/O cold ,fever .
C/O tingling , numbness of B/L UL and LL during the episode of Shortness of Breath .
K/C/O DM-2 since 8years and is On medication.
K/C/O HTN since 4years and is On medication.
H/O Hernioplasty done for Indirect Inguinal Hernia 9years ago .
H/O Hernioplasty done for Umblical Hernia 4years ago .
Mixed diet , Occasional alcoholic,Non smoker .
PSYCHO- SOCIAL COMPONENT:
75 year old male patient ,who is a farmer by Occupation ,is uneducated but can read telugu newspaper , he got married at the age of 28years , where his wife age was 17years .
He worked really hard in the fields,Since Childhood ,as his Father got expired at the age of 5years and built their own house at the age of 30years and they have their own agriculture land of 5 acres area now.
H/O trauma to the Left eye ,while working in the fields - Lost his left eye vision - but never stopped working in the fields .
He had 2 Children ,after 10years of his Marriage, Prayed to various Gods regarding their child birth - they had their 1st Child - Son - Now his age is 40years -Stays at their native place ,- he has 2 children - daughter and son .
and his 2nd Child is - Daughter - Now her age is 36years - She has 2 daughters - Stays at Kodhada ,he was given 3 Acres of land to her as Dowry .
He stopped working in the fields at the age of 60years .
His Mother expired at the age of 63years .
His son ,who works in his land and stays in his house but has no respect and love towards them and always scolds them regarding 3acres of land given to their daughter as Dowry ,even watching TV also bothers his son , never cared about their well being and wont give money for their expenses --- his son visited only once to this hospital ,since his admission ,Though his daughter family loves them so much ,this couple refused to stay at their daughters house .( they Cried and became emotional while explaining about their Son ) .
34 Yr Old male ,from west bengal came with the chief complaints of weakness of left LL since 7 months .
Tingling sensation of left foot since 3 months
Decreased sensations in both right and left lower limbs since 2 months .( where left is more affected than right ) .
BIOLOGICAL COMPONENT:
Patient was apparently asymptomatic 7 months ago ,
In JULY 2022 ,i.e.., 7 months ago - he developed weakness of left lower limb ,which was insidious in onset ,gradually progressive ,then he went to govt hospital at their native place and took medication .
inspite of taking medication , his weekness was not relieved and then , he went to Private hospital In August2022 ,where On investigations- his MRI was Normal and used medication .
He took complete rest for one month by staying at home i.ee in September 2022 but his weekness was not relieved on taking rest and medication.
He Continued his work ,as Auto driver and farmer simultaneously despite of weekness of his left LL ,and he was not on medication .
In OCT 2022 ,i e..,3 months ago ,he developed tingling sensations of Left foot
In NOV 2022, he developed decreased sensations in the left LL,and in the right LL ,where he took ayurvedic treatment but was not relieved .
On Feb 4th 2023 ,i.e...,4 days ago, He came to our hospital - for further management .
There is H/O difficulty in getting up from Squatting position .
H/O increased tingling sensations on walking .
H/O head trauma ,10years ago - Pain associated with trauma ,was relieved on taking medication .
Not associated with LOC, Vomitings ,bleeding at trauma site and ENT bleed .
No H/O fever ,recent trauma , speech abnormalities ,involuntary movements ,irregular bowel and bladder movements, deviation of mouth and diplopia , burning micturition .
N/K/C/O DM2 ,HTN ,CAD ,Asthma ,TB ,epilepsy ,Thyroid disorders .
He is Occasional alcoholic, Consumes tobbacco.
PSYCHO SOCIAL COMPONENT :
34year Old Male ,who discontinued education from 8th Class ,as his father got expired at the age of 12years ,He worked as daily wage labourer , in Construction site at Kerala for 5years .
Where ,his Mother and Siblings,used to stay at their native place .
He lost his Mother at the age of 15 years .
He returned to his native place from kerala ,after death of his mother and started working as Auto driver and farmer simultaneously.
He has 2 siblings - Elder brother - His age is 40yrs now - he has 5 Children - 4 Girls and 1 Boy
he has elder sister - Her age is 38years now -She has 2 children .
He got married at the age of 22years - His wife is supportive and caring women .
His 1st Child was Son - Expired at the age of 1 year - after 3months of hospital stay ,Spent nearly 80,000Rs but couldn't save him .
He has 2.5 year Old female child now .
His agricultural land and own house was given by his father , where his Brother and himself shared their land and started farming .There are small disputes in their family regarding land .
During Conversation, Eye to eye contact maintained and PMA -Normal .
https://supriyakammari53.blogspot.com/2023/02/34yr-old-male-with-co-loose-stools.html
Went through this case ::::
https://nikitha0510.blogspot.com/2022/03/dermatomyositis.html?m=1
PSYCHOSOCIAL COMPONENT:
A 36 Year Old Female , from Choutuppal,House wife ,Muslim by Religion ,who was one among 7 daughters ,she also has one Brother .Their family was decent ,Happy at their own pace ,Non alcoholic family who followed Islam ,his father used to visit Mosque on daily basis.
She was married at the age of 18years ,where her husband age was 20years ,who is Vegetable vendor by Occupation , initally Non alcoholic ,Later after 3 years of Marriage,transformed into Alcoholic
Life after Marriage ------------>>>>
She was married to Person ,who has 5 Brothers ,one Elder brother and 4 Younger Brothers.
His Edler Brother is Unmarried ,So she became the female head of family ,after her Mother in law .She looked over all her younger brother- in- laws and made their marriages by taking lead.
Her Mother - in- law ,was orthodox person ,who
limited her freedom by listening to words of her 3rd Son .They both restricted her in everything, but she became a Good women ,since 8 years after getting to know about her son and his thoughts ,and his behavioural change after his marriage.
Her Father -in- Law is alcoholic ,who stays at Mumbai ,Daily wage labourer by Occupation, visits their native place every six months and stays in their home for one month .He is ALCOHOLIC ,and behaves very rudely with everyone,shouts bigger , after consuming alcohol ----> that created a strong feel of fear inside her ,soo deeply ,as she belongs to Non alcoholic family ,before marriage.
She lost her Parents after her 9 years of marriage.
She cannot give Birth to Child ,as Confirmed after one year after marriage, couple tried manyways by visiting different hospitals ,both of them used different medications ( allopathy ,ayurvedic ) but of no use .She doesnt have kids now .
Her Husband put her Gold in finance and started Business ,He lost whole money and her gold ,but she never complained about and never scolded him regarding this .
He started consuming alcohol after 3 years of Marriage, on a regular basis (only stops ,when he doesnt has money ) .
He is an introvert ,never shares his inner feelings and emotions to anyone ,even his wife ,he never travels to any place(Relatives house ,functions etc..) with his wife and even he wont come to hospitals but he is a Nice Person ( according to Patient ) .
She came with her Neighbour to Hospital ,Earlier she used to travel with her Mother in law to everywhere but her brother in laws wives restricted her ,by saying ,why you always take her with you ,you can go with your husband no ----- She felt bad ,by thinking that - im in a position in life - to listen to their words, who are younger than me -- as they are pointing out me.
She mentioned that ,im sharing this with you
only madam ,as she never shared her feelings with anyone ,even with her 6 sisters and Brother ,as she thought ,it may degrade the value of her Husband and her family .
Problem Statement :::
She Cried alot ,nearly 20 minutes long duration,by saying I dont have children ,i like them soo much but i cant give birth ,which hurts me lot . Everyone has Children . No one is there to look after me and serve me during my illness and
Second thing is- Her husband is Alcoholic,Since 15 long years - Which is the most difficult part to her to deal with ,as she never went through those aspects before her marriage,where they followed Islam and was most devotional ,who never into alcohol .
During Conversation - Eye to Eye Contact maintained, PMA - Normal .
Advised her to have a view of her life ,through
another ways - by explaining problems associated with raising Children and their mindset in Modern generations .
Advised that ,Her Husband requires Counselling - Needs Follow up
GRATITUDE:
Thankful to MY SRs - Nikitha Ma'am ,Aashitha ma'am ,Abhinaya ma'am ,Sushmitha Ma'am ,Zain Sir
Vamsi Sir - First person , who encouraged me in my journey --- will never forget him forever
DK sir -- My companion forever
Charan Sir , Pradeep Sir , Raveen sir ,Vinay sir always encouraged me ,throughout my Journey .
Chandana ma'am - my Nephro PG , loved to work with ma'am .
MY UNIT and WARD PGs -- Nishitha Ma'am ,Narasimha Sir ,Keerthi Ma'am ,Deepika Ma'am Govardhini ma'am ,Vivek Sir ----- My Constant Support System --- Gave me Home like Environment in the work place .
Thanks to ALL MY PGS and My CO INTERNS of GM Department.
Got an Overview of General Medicine,Approach towards Different patients and will for sure reach the depths of General Medicine in Future (through my further studies ) .
GENERAL MEDICINE POSTING --- GIVEN ME DR.RAKESH BISWAS SIR (HOD) and DR. RAJ KUMAR SIR ( PSYCHOLOGIST ) FOR LIFETIME TILL MY LAST BREATH (THEIR BELOVED STUDENT FOREVER ) .
Got My Little Brother For Lifetime ---
SAPTARSHI SAHA .
Best Compliments received :
Going to such depths to understand the biological, psychological and social profile of a patient is not easy. Wonderful execution of the skills of an exceptional medical doctor in the making👏👏👏
Wish Supriya Could teach them ,as Her Future Students will be very happy .
Great Job by Dr.Supriya ,we need more Docs like her in the Academia .
Dr . Supriya is irreplaceable ,Just like anyone else .
THANK YOU
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