60 Y female with joint pains

19th July 2023

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 60 year old female, an agricultural laborer by occupation (stopped working 4 years ago) and resident of Guramguda. The following history was taken with the patient in person. 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:-

-pain in both knees since 4-5 years, 

-facial swelling since 2-3 months, 

-pedal edema since 1 week.

HISTORY OF PRESENTING ILLNESS:-

The patient was apparently asymptomatic 4-5 years ago. She then started developing pain in both her knees which is aggravated on walking and standing, relieved on resting and medications (painkillers). She stopped working due to the pains.

2-3 months ago, she developed facial puffiness which was insidious in onset and gradually progressive in nature. It appears maximally in the mornings and gets relieved by the end of the day. 

1 month ago, she had a tooth extraction on the left side and still has facial puffiness on the left side.

1 week ago, she had pedal edema upto her ankles which was pitting in nature. This also appears maximally in the morning and subsides by the end of the day. Her edema greatly subsided by itself after a week.

She came to the hospital now to find a working solution for her joint pains and to find out about why her pedal edema appeared and disappeared.

DAILY ROUTINE:-

The patient wakes up in the morning at 5:30 and begins household chores, eats breakfast at 8:00. She smokes tobacco at this time.

She then passes her time by talking with family members or guests till 11:00, when she cooks her lunch and eats lunch late, around 3:00-4:00pm

She has tea occasionally in between, when she visits family. She spends time sleeping or talking with friends and family in person or on the phone.

At night, she doesn't feel hungry. She may or may not smoke tobacco again. She then sleeps at around 10:00pm.

This has been her routine since 4 years, after she stopped working.

PAST HISTORY:-

Not a known case of diabetes, hypertension, CVA, CAD, TB, asthma

FAMILY HISTORY:-

Not significant.

TREATMENT HISTORY:-

The patient has a history of using NSAIDS 3-4 days a week since 4 years for the joint pains, suggested by and RMP.

PERSONAL HISTORY:-

Appetite: normal

Diet: mixed

Sleep: adequate

Bowel movements: regular

Micturition: normal

No known allergies

Addictions: Smokes tobacco once or twice a day everyday

MENSTRUAL HISTORY:-

Attained menopause 20 years ago. 

GENERAL EXAMINATION:-

The patient is conscious, coherent, cooperative and well-oriented to time, place and person.

The patient is moderately built and well-nourished.

No pallor, icterus, cyanosis, clubbing, koilonychia, lymphadenopathy

Pedal edema present in right foot. 

Vitals:-

Temperature: Afebrile

Blood pressure: 120/80mm Hg

Pulse rate: 82 bpm

Respiratory rate: 18cpm

INVESTIGATIONS:-

19.07.23

Ultrasound:-