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| Bridelia stipularis (Pic wikimedia.org/wiki/File:Bridelia_stipularis) |
Patient's ID: Bridelia731stipularis
This is a de-identified open-online-patient-record with initial information from Doctor's notes, diagnostic test results, as well as patients' voice. Posted here after collecting informed "Patient Consent" (DOWNLOADABLE HERE) by Health Worker DEBASISH ACHARJEE from PIN Code area 731204 for discussion.
This is 53 years old gentleman who faced sudden chocking sensation in sleep on __ September 2019 and __ January 2020 at mid night. Again on __ February 2020 comparatively moderate choking with right hand lack of sensation. No chest pain, No sweating, No syncope, No cough, No fever, No HTN, No T2DM, BP 120/80 mm.Hg and pulse 86 bit/min, Weight 78Kg, SpO2- 98%. Evaluated in ER Dept. nearest local hospital - No immediate issues found. Cardiac evaluations also normal.
Diagnosed: Obstructive Sleep Apnea-Hypopnea Syndrome OSAHS - SEVERE
Using Auto CPAP (Auto Continuous Positive Airway Pressure)
Medications:
1) Fluticasone Furoate 27.5MCG Nasal Spray ( Once daily at 8AM)
2) Inhaler Duova (Tiotropium 9 mcg + Formoterol 6 mcg)
3) Clonafit 0.25 mg Tablet (Clonazepam 0.25 mg)
Medical History:
2005: kidney stone lithotripsy
2005 Inpatient treatment for Jaundice
2015 Slip disk L4- L5 (0.47 as per MRI and Doctor advised surgical treatment, not yet done.
2019 (Aug) Paratyphoid.
Since last 6 months 5-6 times sudden syncope (no fainting).
Allergy: Not known
Family Medical History: Mother HTN and died due to stroke at her age 53 years. and Father slip disk.
Doctor's prescriptions: [CLICK HERE]
Diagnostics Test Reports [CLICK HERE]
Still c/o disturbed sleep - panicked, seeking medical experts advise to recover and lead normal life.
Thank you
Debasish Acharjee
more history - A 54 year old man, working at BPL as an officer, a regular 9 to 5 job with no addictions for alcohol or smoking from Shili Goli, west Bengal was apparently alright till 2005 when he suddenly experienced intense abdominal pain, so severe that he couldn't even stand straight for which he was rushed to hospital for which he was diagnosed to have 2 left renal calculi measuring 8mm & 5mm for which he had to undergo lithotripsy. He was apparently alright for an year after which he again had abdominal pain, lesser in intensity for which he visited a hospital and was diagnosed to have bilateral renal calculi for which he was told that consuming adequate amount of fluids especially lemon juice. In 2010, he suddenly experienced intense lower backache and has apparently had similar episodes since 2005 but he always assumed it to be due to the renal calculi. This time it was so intense that he was rushed to the hospital and on doing an mri spine was told to have l4-l5 disc prolapse with cord compression and advised to get a discectomy and fusion. He continued to have a lower back ache for which he tried to look for a conservative treatment without undergoing surgery. From 2006 to 2014 he had recurrent episodes of abdominal pain and was told to consume adequate fluids as he had only tiny renal calculi. In 2010, he slipped and fell on the ground after which he started to profusely bleed from his nose, he went to the doctor and was found to have deviated nasal septum and hypertrophied turbinate. By 2015 his lower back ache started to radiate to his right thigh and it started to impede his daily regular activities, that is when he decided to undergo surgery. He got admitted to undergo discectomy at L4-L5 but was deferred for sugery as he was told to have trasaminitis and was put on evion, methylcobalamine and pregabalin and was advised to repeat lft after 2 weeks.
ReplyDeleteIn Aug 2019, he had fever for over a week and was admitted in a hospital for parathyroid fever.
more history - In 2019, 20th in the month of July at 2am suddenly felt like someone was choking him and he could feel his hands trembling and had an episode of blurred vision for 2 secs. He assumed it to be an MI and rushed to a local hospital and was told to be perfectly alright. He then visited a cardiology who ran an ecg and 2decho which turned out to have insignificant findings. The cardiologist suggested to visit a pulmonologist. He then visited a pulmonologist who did a pulmonary function test which was normal and even a sleep study which showed REI of 53.3. He started to notice his day time sleepiness and night time insomnia after visiting the pulmonologist he became more aware of his symptoms. The pulmonologist advised CPAP along with tab tiova & montek.
ReplyDeleteHe again visited a cardiologist in 7/10 who did a holter study and told everything was normal and sent him to a pulmonologist who told him about his cheyne stroke breathing pattern, advised CPAP and along with furamest nasal spray. He also advised him to visit an ent specialist as it is the root cause for his obstructive sleep apnea. He visited an ent specialist in 14/10/19 and was told to have Mallanpati grade 3, upper airway narrowing and he advised him to continue CPAP.
In Jan 2nd 2020, he again felt like someone was choking him while he was asleep in the midnight, he also tells that he feels intense thirst during these episodes, he feels it difficult to breath and unable to swallow. Cpap no longer was relieving his symptoms. He then visited his pulmonologist on 3/1/2020 who put him on Diva containing divalproex & valproic acid and clonafit 0.25mg containing clonazepam and was told to have copd with Obstructive sleep apnea. He was even asked to visit a psychiatrist which he decided not to. He again paid a visit to another pulmonologist who asked him to continue Auto CPAP along with monteleukast and Furamest nasal spray.
On Feb 2nd he experienced right arm numbness which gets relieved on massaging and mri spine was done and was told to have cervical spondylosis
Being a Male patient in which osa is more common and he is obese with turbinate hypertrophy, I dont know why he was said to have copd, we need to look into that along with why is he having recurrent renal calculi.
So yeah my diagnosis would be
1) obstructive sleep apnea secondary to turbinate hypertrophy and obesity
2) Recurrent renal calculi ( cause unknown, could be due to hypertriglyceridemia )
3) cervical spondylosis along with lumbar spondylosis