58M Hypertension, DM, post CABS

Introduction

2011

He was asymptomatic 14 years ago. He was diagnosed with Malaria when he found out he was diabetic too. He is on medicine ever since till he met a ayurvedic practitioner and is eating a leaf (which promises to cure diabetes in 8 days forever). He was having pain in abdomen and chest. He was feeling uncomfortable and consulted a doctor. When they suggested to have an Angiogram, he refused to have one as he was not sure if it was safe. He consulted a homeopathy practitioner later. The symptoms were relieved and he continued to take them for 8 years. He was having a usual lifestyle of a middle aged man(he used to drink alcohol, smoke cigarette and eat meat and junk food).

2021

He then suddenly stopped taking homeopathy medication as they were not relieving the symptoms anymore. 2 moths later he experienced pain in abdomen and gripping pain chest region along with episodes of vomiting. He had episodes of Vomiting. He consulted a doctor and they suggested an angiogram. He was prepped for angiogram, but as the place seemed shady, he was worried about safety and panicked. He had an episode of vomiting just before they were gonna start the procedure. He left the hospital and consulted another reputed doctor where he felt safe. He was diagnosed with IHD(Ischemic Heart Disease) and TVD(Triple Vessel Disease).

He underwent CABS(Coronary Bypass Surgery).

Present

He has no present Complaints.

HISTORY

Medical History

Diabetes Mellitus (since 2011)

• Glynase MF(glipizide 5mg, Metformin hydrochloride 500mg)

Hypertension (since 2023)

• Clinidipine 20 mg PO OD morning

Post op CABS (2021)

• Rosuva Gold 20 PO OD at night (composition: Rosuvastatin 20mg, Aspirin 75mg and Clopidogrel ~75mg) Capsules

Personal and Social History

He has Lift business. He feels tension sometimes due to his work.

Water Intake	~3 Liters a day
Appetite	Normal
Diet	Mixed diet, Whole grains
Bowel Movement	Normal
Bladder Movement	Normal
Alcohol	-
Smoking	-
Allergies	-
Exercise Status	Moderate activity

*eats rice and curry for lunch, eats mixed grains chapati for dinner.

Daily:

6:00	Wakeup, drink 1 liter water + tea
6:30	poop
9:00	Job(lift business)
18:00 - 19:00	get off job(lift business)
19:00	Dinner*
19:30	Hotel business
22:30	get off of Hotel business
22:30	Dinner*
23:00	sleep

*Dinner - eats at either 19:30 or 22:30 o’clock

Investigations/ Findings

2021

2023

Cardiometabolic Phenotype

Conclusion

After the surgery in 2021, his life has took a turn. He started eating healthy. Stopped alcohol and Cigarette. Became aware of financial independence. He is asymptomatic.

Critical Appraisal of the Case Report:

[24-05-2024 23:13] : 58M DM Hypertension post CABS

case report link:

https://thevodee.notion.site/58M-Hypertension-DM-post-CABS-48ea7f8c64124a96b74c939a07e31320?pvs=4

group invite:

https://chat.whatsapp.com/EguwtXPQRw6JraQpDeuiCX

[25-05-2024 07:01] Dr Rakesh Biswas KIMS: Amazing introduction :

Quoting :

"58M Hypertension, DM, post CABS

Introduction

2011

He was asymptomatic 14 years ago. He was diagnosed with Malaria when he found out he was diabetic too. He is on medicine ever since till he met a ayurvedic practitioner and is eating a leaf (which promises to cure diabetes in 8 days forever). He was having pain in abdomen and chest. He was feeling uncomfortable and consulted a doctor. When they suggested to have an Angiogram, he refused to have one as he was not sure if it was safe. He consulted a homeopathy practitioner later. The symptoms were relieved and he continued to take them for 8 years. He was having a normal lifestyle of a middle aged man(he used to drink alcohol, smoke cigarette and eat meat and junk food)."

Unquote 

Let's change the word "normal lifestyle" to "usual lifestyle"?

[25-05-2024 07:04] Dr Rakesh Biswas KIMS: Quoting :

"2021

He then suddenly stopped taking homeopathy medication. 2 moths later he experienced pain in abdomen and gripping pain chest region along with episodes of vomiting."

Why sudden stoppage?

[25-05-2024 07:06] Dr Rakesh Biswas KIMS: "He was prepped for angiogram, but as the place seemed shady, he was worried about safety and panicked. He had an episode of vomiting just before they were gonna start the procedure. He left the hospital and consulted another reputed doctor where he felt safe. He was diagnosed with IHD(Ischemic Heart Disease) and TVD(Triple Vessel Disease).

He underwent CABS(Coronary Bypass Surgery)."

Unquote 

Liked the term cabs (which may provide some hint of travel) instead of the more prevalent terminology cabg (pronounced cabbage giving nightmarish thoughts of a vegetative state)!

[25-05-2024 07:09] Dr Rakesh Biswas KIMS: In the slot marked, 

Medical History

Diabetes Mellitus, 

Hypertension 

There's no mention of duration, how diagnosed first what medication, what control? 

Essentially we need a lot more history here!

[25-05-2024 07:15] Dr Rakesh Biswas KIMS: Quote :

"Personal and Social History

He has Lift business. He feels tension sometimes due to his work."

Tell us more about it! Since when is he in this business? What's the exact nature of his business? What does he do all day in 24 hours divided into hourly slots as illustrated here :

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

[25-05-2024 08:36] deekshith.vodela: @Dr Rakesh Biswas KIMS thankyou for the inputs sir.

[25-05-2024 08:45] Dr Rakesh Biswas KIMS: @+91 79799 05942 Start your case report journey by reading the above as well as this case report https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453268/ by another ET @+880 1733-506870 which may appear to be an antithesis of Deekshith's current case report although again it's too early to say as Deekshith's case report thesis still needs to be developed and Vivek's BMJ published version linked above could go a long way to develop that

[25-05-2024 09:37] +91 79799 05942: Okay sir,Thank you 🙏

[25-05-2024 09:41] Dr Rakesh Biswas KIMS: Also check out the current patient's case report in ICI bed 1 who is very similar to @Deekshith 's case although again it appears to be developing into it's antithesis

[25-05-2024 09:53] +91 79799 05942: Yes sir