17F suffering from PCOD

14th October 2022

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.

This is the case of a 17-year-old female, resident of West Bengal, and Grade eleven student. The following history was taken through a telephone conversation. The patient was explained about confidentiality and written consent was taken to create the following case report.

This case report aims to record the patient's journey.

CHIEF COMPLAINTS:-

- The patient complains of hypomenorrhea since the last 7-8 months.

- She also complains about severe acne breakouts (roughly around 7-8 times in a month) as well as severe hair loss for the past 6-7 months.

- There is also increased amount of facial hair growth for the last two years.

- She complains having experiencing insomnia on a daily basis.

- The patient also complains of experiencing throat irritation since 16th November and dry cough since 20th November.

History of present illness:-

The patient did mention being stressed out most of the time. Whenever she feels anxious, she mentions experiencing shortness of breath and chest tightness. She also experiences interrupted sleep patterns (either she experiences complete insomnia or she experiences excessive sleep which can last an entire day). This pattern of interrupted sleep continues presently, with her after effects being red eyes, headache, inability to perform work properly, and experiences tiredness and fatigue. The patient also mentions that it takes time for her to fall asleep. She has been going for therapy for the last 4 years (roughly in the year 2018), with a frequency of once or twice in a month. This has been effective according to the patient.

Roughly in the year 2020, the patient complains of having severe acne and hair loss. She mentions that these acne breakouts occur 7-8 times in a month till date. This condition doesn't worsen before, during or after the onset of her menstrual cycle. The patient isn't aware of any other possible aggrivating factors of this condition. Upon the checkup with the local dermatologist, it has been determined that the patient has oily skin type and was prescribed a medicated cream, to which she mentions that it hasn't worked for her.

The patient complains of having excessive facial hair growth beside her ear, foot, upper lip and neck area.

On January 2022, the patient complains to suffer from throat pain and skin allergy. The onset of this allergy, as the patient describes, was on the year 2021, when an insect bites her. It was precisly during this time, when the occurance of dark patches and itching took place. The patient isn't aware of what triggers the allergy, and the onset of this allergy is abrupt and sudden. She does however mention that the condition worsens once she is exposed to dust or direct sunlight. When the allergy sets in, it consists of itchiness around the eye region, the nose, ear, in front of the throat and below the chin. The patient also mentions wheezing and sneezing uncontrollably. The itchiness of the eye seems to occur every morning till day. The patient mentions after taking Allegra, the symtoms seem to come in control temporarily. The throat pain has a seasonal occurance, it's onset happening only in the winter season. The allergy problem still continues till today.

On February 2022, borderline PCOD has been detected upon general checkup with the local gynaecologist. The report also mentions the patient was suffering with polycystic ovary.

Since May 2022, the patient has been experiencing severe hair loss. The aggrivating factor isn't related to the onset of mentrual cycle Or any other factor according to the patient.

On October 2022, the patient was suffering from severe chest pain and severe breathlessness. Presently, upon excertion, the patient complains of shortness of breath.

The patient complains of gaining weight, especially in the thigh and abdomen region. She also mentions having dark patches in the armpit, forehead and beside lips and chin. There is also stretch marks on her thigh and belly. (Refer History of past illness for variation of weight)

The patient is also currently suffering from throat irritation. She despribes it to be a burning sensation and she was experiencing it for the past one week.

The patient mentions feeling nauseated every morning since 14th of November, precisely during the time when she is travelling in the bus. However, this occurs only sometimes during the evening time.

Every winter season, the patient complains of nose bleed (which consists of dry blood) and it occurs in the early morning and at the middle of the night.

Update (29th November 2022),

The patient complains of having jaw pain for the last week. This occurs occationally and the patient describes it to be hammering and irritating. The cheek muscles become strained and the patient faces difficulty in talking or movement of her jaw. This paun aggrivates during the night time, roughly around 2am according to the patient.

The patient also experiences severe headache the very next day, which the patient attributes it to insufficient amount of sleep. This headache continues thought the day.

The patient also complains of reoccurance of the nose bleed, accopanies with itching around the same time frame. There is increased incidence of sneezing and eye itching, with an increased occurance of 15 to 20 times a day.

History of past illness:-

The patient does not have any history of TB, HTN, DM, Epilepsy and asthma.

But the patient did suffer from mumps and tonsilitis when she was in fourth grade. She also mentions suffering from severe headache around the same time.

On the year 2021 (around the end of July) , the patient suffered from scabies. It's onset was when the patient interacted with a neighborhood dog. It's reoccurance happened on the mid of September 2022.

On July 2022, The patient has suffered from a COVID infection. She has eventually recovered from the infection. Her weight during that time (and even now) is 57kg. Earlier, since 8th grade it was ranging around 61 to 63 kg.

Personal history:-

Water intake:- 1.5 to 2 litres per day

Appetite:- reduced on the morning, increased in the night.

Diet:- mixed

Bowel and bladder movement:- normal

Addictions:- none

Alcohol:- none

Smoking:- doesn't smoke

Allergies:- (as mentioned in the history of presenting illness)

Exercise status:- Does yoga and stair climbing four to five times a day.

Menstrual History:-

The patient started to mentruate when she was of 10 years of age (4th grade).

For the last 7 to 8 months, the patient has noticed that there is decrease amount of blood flow for only for 3 days per month.

She experiences back and abdomen pain.

The patient also experiences white discharge since fourth grade. This occurs one to two days after the onset of her mentrual cycle.

Update on 29th November 2022,

However on 25th November 2022, the patient reports that her mentrual cycle, for the first time in 4-6 months, lasted for 4 days. For the initial two days, there had been a heavy blood flow. And the patient also mentions an increase of her breast size.

Reports:-