Sunday, December 24, 2023

PaJR jeevan yapan daily activities (energy outputs) and food plates (energy inputs) for different PaJRs from pan India locations

Summary: 

This is an illustration of how some of our PaJR patients share their daily activities in their own PaJR groups.


Post AI era:


[02/06, 08:36]hu2: Can we begin by listing yesterday's hourly activities and pain points?


[02/06, 08:43]hu1: Yes

800 am wake up and herbal water with powder of jeera, cinnamon,. methi and ajwain

Yoga 840 am to 920 am 
egg 2 945 am

Soaked Almonds and walnut 10 am

Travel to hospital by auto 5 mins Met Dr for Master health consultation 

1pm papayya 1 bowl 

Slept 2 pm 45 pm
Had food at 3pm 
2 ragi dosa, tuvar, daal, khira and rice. 

Slept from 4 to 5 p.m. 6:00 p.m. grilled chicken in airfare 

7:00 p.m. again grilled chicken with green chutney 


Oz. Hungry around 10:45 p.m. at few seeds and berries 

Slept by 11:15 p.m.

[02/06, 08:55]hu2: No pain yesterday?


[02/06, 09:03]hu1: there was pain and stiffness leading to weakness. 


Lot of ice pack application with wet towel every hr for 15 mins as recommended by physiotherapist


[02/06, 09:07]hu2: 👆 Thanks can you mention in which of these time slots delineated above did the patient experience the pain?


[02/06, 09:20]hu1: Most of the day even while sleeping legs and knee has pain 
except while walking in hospital


[02/06, 10:03]hu1: 2nd June


Got up with pain in both legs at 720 am

Massage at 800 am 20 mins.

830am 0.5 egg

930 am 2.5 besan chila with onion and jira

[02/06, 23:05]hu3: @⁨PaJR Health Bot Feb 26⁩ what are your thoughts on herbal water with powder of jeera, cinnamom, methi and ajwain here? Perform a through research and identify if there are brands (from where the patient is) which are fake, tampered with or not trustworthy? Like the fake paneer fiasco! What are the odds such issues need to be considered, especially in India?

[02/06, 23:08] PaJR Health Bot Feb 26: 📋 [48F Heel and Knee Pains Karnataka PaJR]


**EXPLAINING THE 10:45 PM HUNGER SPIKE**

The 10:45 PM hunger spike is a classic physiological consequence of the patient's **macronutrient timing, postprandial inactivity, and underlying insulin resistance**. 

Here is the step-by-step pathophysiological breakdown:

🔹 **1. The 3:00 PM Carb Load and Sleep Mismatch**
*   **The Trigger:** At 3:00 PM, she consumed a highly carb-dense meal: **2 ragi dosa, tuvar dal, and rice**. Even though ragi is complex, combining it with rice and dal creates a massive glycemic load.
*   **The Inactivity:** Immediately after this, she slept from 4:00 PM to 5:00 PM. During sleep, skeletal muscle is inactive, completely shutting down insulin-independent glucose uptake (GLUT4 translocation).
*   **The Consequence:** To clear this pooled glucose, her insulin-resistant pancreas had to secrete a massive, compensatory flood of insulin (hyperinsulinemia) to force the glucose into storage.

🔹 **2. Reactive Glycemic Dip**
*   **The Mechanism:** This heavy surge of insulin causes blood glucose to crash rapidly a few hours later. 
*   **The Stimulus:** Her pure protein meals (grilled chicken) at 6:00 PM and 7:00 PM stimulated additional insulin release (needed for amino acid uptake) without any carbohydrate buffer. 
*   **The Result:** By 10:45 PM (nearly 8 hours after the carb-heavy lunch and during a low-glycemic protein phase), her blood sugar hit a relative dip. The brain senses this rapid decline in glucose as an energy emergency, triggering a sudden, intense hunger spike (reactive hypoglycemia) to force her to seek fast-acting energy (berries/seeds) [24971783].

🔹 **3. Leptin and Circadian Clock Dysregulation**
*   **Circadian Decoupling:** In healthy physiology, the satiety hormone **leptin** rises nocturnally to suppress appetite during sleep. 
*   **Leptin Resistance:** Chronic hyperinsulinemia (driven by insulin resistance) directly impairs leptin transport across the blood-brain barrier. The brain is "blind" to leptin's satiety signals, resulting in late-evening cravings.
*   **Circadian Disruption:** Feeding late, sleeping late, and napping twice a day dampens the amplitude of metabolic clock genes (such as *CLOCK* and *BMAL1*), which are critical for coordinating appetite and glucose tolerance [31548244].


**HOW THESE SPIKES FEED THE INSULIN RESISTANCE LOOP**

These late-night hunger spikes are both **downstream symptoms** and **upstream drivers** of worsening insulin resistance:

1.  **Late-Night Eating Blocks Fat Oxidation:** Consuming seeds and berries at 10:45 PM, right before sleeping at 11:15 PM, triggers a nocturnal insulin spike. Insulin is highly lipogenic—it completely halts lipolysis (fat-burning) and stimulates hepatic de novo lipogenesis [27832862]. This directly feeds into her high triglycerides (292 mg/dL) and abdominal adiposity.
2.  **Nocturnal Glycemic Variability:** Late-night snacking leads to a higher fasting glucose the next morning (compounded by the dawn phenomenon) [37566445].
3.  **Worsening Receptor Desensitization:** Constant, round-the-clock insulin stimulation (from 9:45 AM eggs through 10:45 PM seeds) means her insulin receptors never get a "fasting window" to rest and upregulate, cementing her chronic insulin resistance.


**CLINICAL RECOMMENDATIONS FOR THE PATIENT ADVOCATE**

1.  **Restructure the 3:00 PM Meal:** She must avoid combining rice and ragi dosa in the same meal, especially before a nap. Replace the starch with non-starchy vegetables (like cucumber or cooked greens) and protein.
2.  **Eliminate the Post-Carb Nap:** If she must nap, she should do it *before* the meal, or take a 10-minute light walk (ankle pumps, light steps) after eating to help clear glucose before sleeping.
3.  **Establish a Satiating Dinner:** Instead of two separate chicken snacks at 6:00 PM and 7:00 PM, consolidate them into a single, well-rounded dinner at 7:30 PM with healthy fats and fiber (e.g., chicken with a large portion of khira/salad) to carry her comfortably to bedtime without the 10:45 PM crash.


**REFERENCES**

1. Chung H, et al. Time-restricted feeding improves insulin resistance and hepatic steatosis in postmenopausal obesity. *Metabolism*. 2016;65(12):1743-1754. PMID: 27832862

2. Costantino D, et al. Role of D-chiro-inositol in glucidic metabolism alterations, decreasing weight gain and nocturnal hypoglycemia responsible for hunger attacks. *Minerva Ginecol*. 2014;66(3):281-91. PMID: 24971783

3. Jakubowicz D, et al. Reduction in Glycated Hemoglobin and Daily Insulin Dose Alongside Circadian Clock Upregulation in Patients With Type 2 Diabetes Consuming a Three-Meal Diet. *Diabetes Care*. 2019;42(12):2171-2180. PMID: 31548244

4. Jospe MR, et al. Dawn Phenomenon and Morning Preprandial Glucose Levels in Type 2 Diabetes. *JMIR Form Res*. 2023;7:e46034. PMID: 37566445


[03/06, 08:41]hu1: What are the best timings to distribute meal and sleep for her condition?


[03/06, 08:42] PaJR Health Bot Feb 26: **OPTIMAL DAILY TIMELINE**

07:30 AM - Wake up & Hydrate
Drink warm water or her home-prepared herbal water (fenugreek and cumin). Avoid tea first thing in the morning, or have it completely unsweetened. 

08:30 AM to 09:00 AM - Breakfast
Make this a protein-rich start (such as eggs or a high-protein cheela) to keep her full. Do not consume any mid-morning snacks (like fruits, biscuits, or nuts) after this.

01:00 PM to 01:30 PM - Lunch (The Main Meal)
This should be her largest, most satisfying meal of the day (including whole grains, cooked vegetables, and dal). This replaces her previous 4:00 PM heavy meal. Do not snack on peanuts or makhana in the afternoon.

01:45 PM to 02:15 PM - Rest (The Only Nap)
Limit daytime resting to this single, short 30-minute window. Do not sleep after 3:00 PM. This is critical to building up enough sleep pressure for the night.

04:00 PM - Afternoon Tea (Optional)
A single cup of unsweetened tea. No snack with it. This must be her last caffeine intake of the day.

07:00 PM to 07:30 PM - Dinner
Keep dinner light but nourishing (vegetable soup, light dal, or stir-fried greens). All eating must be completely finished by 7:45 PM. No late-night seeds, berries, or munching.

10:30 PM - Sleep Onset
Wind down by 10:00 PM and aim to be asleep by 10:30 PM. This allows her body to secrete natural melatonin and growth hormones during the peak anti-inflammatory hours (11:00 PM to 3:00 AM).


**WHY THIS STRUCTURE IS CRITICAL FOR HER**

1. **Reversing the Grazing Pattern**
Moving from 6 to 7 eating events a day down to 3 square meals allows her insulin levels to drop to baseline. This signals her body to burn belly fat rather than store it, which is crucial for reducing belly-fat driven inflammation.

2. **Protecting Night Sleep Pressure**
By cutting out the late afternoon nap (4:00 PM) and limiting the post-lunch rest to just 30 minutes, her brain will build up the natural drive to sleep deeply at 10:30 PM. Fragmented daytime sleep is the main reason she struggles to fall asleep before midnight.

3. **A Clear 13-Hour Fasting Window**
Finishing dinner by 7:30 PM and eating breakfast at 8:30 AM creates a clean 13-hour overnight fast. This gives her liver ample time to clear circulating fats, keeping her triglycerides safely below 150 mg/dL without relying solely on medication.


[03/06, 10:25]hu1: Yesterday 

2nd June


Got up with pain in both legs at 720 am

Massage at 800 am 20 mins.
830am 0.5 egg
930 am 2.5 besan chila with onion and jira

1230 pm muskmelon

230 pm chhole chawal with butter milk 

No nap or sleep 

Buttermilk again at 4pm

730 pm 
2 ragi dosa with grilled paneer 

10 pm a few berries and seeds



[03/06, 10:25] PaJR Health Bot Feb 26: **YESTERDAY'S ANALYSIS (JUNE 2)**

🔹 **THE WINS**


* **Zero Daytime Naps:** Outstanding. Cutting out the daytime naps entirely is a massive win for building sleep pressure for the night.

* **Great Dinner Timing:** Dinner was at 7:30 PM with solid, complex carbs and protein (ragi dosa and grilled paneer). 

* **Early Pain Management:** Using a 20-minute massage at 8:00 AM to manage early morning stiffness/pain rather than reaching for NSAIDs is a highly positive step.

⚠️ **THE DEVIATIONS**


* **Split Breakfast:** Eating half an egg at 8:30 AM and then 2.5 besan chila at 9:30 AM creates two distinct insulin spikes within an hour. 


* **Grazing/Snacking:** Muskmelon at 12:30 PM, buttermilk at 4:00 PM, and berries/seeds at 10:00 PM. This means she had **7 separate eating events** throughout the day. 


* **Broken Fasting Window:** The 10:00 PM snack of berries and seeds restarted her digestion and broke the overnight fasting window, which raises nocturnal insulin and stalls metabolic recovery.


💡 **CLINICAL NOTE**


Consolidating meals is her biggest hurdle. While the food choices themselves are mostly excellent (ragi, paneer, eggs, seeds), consuming them in a "grazing" fashion throughout the day keeps her insulin levels persistently elevated. This prevents her body from entering the fat-burning state needed to reduce belly-fat inflammation. 


**HOW TO REFINE TODAY**


1. **Combine breakfast:** Eat the egg and the besan chila together at 9:00 AM. 
2. **Shift the fruit:** Move the muskmelon from a standalone snack to the end of her lunch as a dessert.
3. **Firm limit at 8:00 PM:** Absolutely nothing but water after her 7:30 PM dinner. Lock away the seeds and berries for the night.

Pre AI era 


Daily hourly Activity from the PaJR patient linked below:


Hourly activities:

7.30am Get Up then household activity like bed & floor cleaning for 15 mins


7.45am Taking Bath & washed own regular dress ... still now she believes in self service.


8.15am Doing pranayam & meditation for 20 mins.


9am Taking breakfast & medicine Monit GTN 1 tab.


9.30am Doing puja for 15 mins after that went to bathroom but was not able to pass Urine, then started uneasiness, pain with burning sensation in lower abdomen & urinary passage. Almost 2-3 hours it continued. She tried to take rest but failed.


10.30am She took a glass of water.


11.30am She couldn't lie down or sit comfortably. There was uneasiness.


12.30pm She couldn't lie down or sit comfortably. There was uneasiness.

1.30pm Took Musambi (fruit 1pic)

2pm She completed her lunch then took rest. She felt very tired.

3pm Attend 1 hour online Gita class.

4pm Uneasiness continue.

5pm Took medicine Flavoxate 200 (1tablet).

5.40pm Relived after lot of Urination.

6pm Took rest.

7pm Watched t.v sat on the bed.

8pm Watched t.v sat on the bed.

8.30pm Completed dinner & took medicine.

9.30pm Started discomfort.

10.30pm Playing Ludo with her grand daughter.


11.30pm She took Revotril half tablet, went to toilet & passed little bit urine.

July 2025 Telangana:

[28/07, 11:35] Patient Advocate 56F Metabolic Syn Knee OA: 

6 AM - woke up

7-9 house hold activities she did

9-10 Am : fresh up & breakfast Upma she taken

[28/07, 11:35] Patient Advocate 56F Metabolic Syn Knee OA: 

Meal plate I will share

[28/07, 11:38] Patient Advocate 56F Metabolic Syn Knee OA: 

11:30 AM she taken Ultracet half tablet

[28/07, 11:38] Patient Advocate 56F Metabolic Syn Knee OA: 
Today only she started Ultracet

[28/07, 11:38] Patient Advocate 56F Metabolic Syn Knee OA: Last ni8 only we started
 Livogen (1) she taken

[28/07, 11:38] Patient Advocate 56F Metabolic Syn Knee OA: Now she is dng cooking

[28/07, 11:39] Patient Advocate 56F Metabolic Syn Knee OA: Hope you have enough information about patient day schedule. Plz  let me know if anything do I need to add here

[28/07, 21:01]cm: 11:00-12:00PM

12 PM -1:00PM

1:00 PM-2:00PM

3:00 PM-4 PM

4:00 PM-5PM

5:00 PM -6 PM

6 PM -7 PM

7 PM-8PM

8-9PM

9PM-10PM

10PM-11PM

[28/07, 21:23] Patient Advocate 56F Metabolic Syn Knee OA: Ok will reply shortly

[28/07, 21:59] Patient Advocate 56F Metabolic Syn Knee OA: 

11:00 -12:00PM - Cooking

12:00 -1:00 PM - Cooking

1:00 -2:00 PM - Having Lunch

2:00 - 3:00 PM - Sleep

3-00 - 4:00 PM - Sleep

4:00 -5:00 PM - Washed clothes folding 

5:00 - 6:00 PM - Spending time with Grandson

6:00 -7:00 PM - Rice preparation 

7:00 -8:00 PM - Fresh up and do Pooja

8:00 -9:00 PM - Spending time with family & talking in phone with children

9:00 -10:00 PM - Having Dinner

10:00 -11:00 PM - Taking medicine & go to bed..

From a Telangana PaJR accessible here: 



Below is another daily hourly activity from another PaJR here: 


[29/07, 10:26] Pt Mb 62M metabolic syn GAD: 

Aaj 29/07/2025:- 

06 a.m.:- 

Last night ghum bhaloi holo. Arektu ichchha chilo ghumanor. Kintu dolchhara hobar bhoye bichhana chhere fresh hoye beriye porlam.
Ager routine wise hanta sesh kore bari phire elam. Tarpor snan ityadi sere cha-muri khete² chorer panchalitao dekhe nilam. Oh, akta paka kolao kheyechhi.
Reyaz e boste giye dekhlam report lekha hoyni. Aaj B.P.Chart ready kore ratre pathabo. Last night BP chhilo 149/79 - 74.


[29/07, 10:33] Pt Mb 62M metabolic syn GAD: Probably moida r sweets  ekhane culprit.  Should have taken the curry with muri. Dekhechhi luchi/paratha 100%atta diye banale khaoar por kono samasya hoy na.


[29/07, 11:21] Pt Mb 58M GAD: One thing more I forgot to mention. I have been facing a problem of going to toilet for 02 to 04 times every day. Seems bowels will be cleared, but doesn't happen likely so though there is a tremendous pressure of the work to be done immediately. Sometime it is quite okay.


[29/07, 12:04]cm: Sounds like an overactive bladder.

I'm assuming that the patient is passing a normal volume of urine output daily


[29/07, 12:20] Pt Mb 58M GAD: Yes, daily urine output is normal. But the  frequency is after every 02 hours in the day time. And once in the sleeping hours at night mainly at around 4/5a.m.


[29/07, 12:22]cm: And does the stream of urine also come like a thread, very thin stream? Does the urine fall near?


[29/07, 12:33] Pt Mb 58M GAD: Flow is normal and easy.

[29/07, 13:27] Pt Mb 58M GAD: Forgot to mention that sometimes last 2 to 3 drops of urine even
fall on the trousers while course of   urination is likely to be completed.
This droppings occur when there is tremendous unbearable pressure for release of urine. Otherwise it's okay.

[29/07, 16:57]cm: This sounds normal because of the bulbocavernosus muscle


[29/07, 17:16] Pt Mb 58M GAD: Continued :- (29/07)
12 noon: 6/7 qua kanthal
12.30a.m:- lunch ready. Forgot to take photo of the dish. Aajker menu :
1. Jhinga, alu diye chholar dal 
2. Alu-peper dalna
3. Alu-sqash
4. Kankrol bhaja
5. Ak pc. Pabda machh
6. Ak pc. ilish machh
7. Bhat kom kore
8. Amer chaatni
    9.  Lebu

[29/07, 17:19] Pt Mb 58M GAD: 👆Contd. 
2p.m:-01pc aam khelam
5p.m :- ak cup laal cha
[30/07, 00:18] Pt Mb 58M GAD: 29.07.2025 evening:
At around 6 p.m ektu uneasy feel korchhilam. Ghonta dhore B.P. Chart toiri hochchhe. Kintu B.P.tao barchhe. 
Bujhte parchhi je, aaj ei samasyatar janya bhul khabar nirbachan dayee. Buk jwala korchhe, kan matha alpa garam hoye galo. dekha jak ki hoy. Samne sara raat achhe

[30/07, 08:58]cm: BP 'r kono oshudh khacchilen?

[30/07, 09:01] Pt Mb 58M GAD: Sakale akta kore TELMISARTAN-20 khachchhi.

[30/07, 09:13] Pt Mb 58M GAD: Aj sakal theke amader dui chest er majhe je gorto mato achhe tar thik dui angul upore harer upor ektu chap dile light pain hochchhe. Morning walk er samay temonta bojha jayni. 
Last night dinner e khub olpo millet rice (Sama rice) bivinno sobji fele kheyechhi. Ghum aste khub deri holo. Eta factor noy. Kintu khub aswasti hochchhilo bole akta  Rabiprazole 40 kheyechhilam. [Bhoye]

[30/07, 09:36]cm: Rabeprazole bhoi peye khawar hoito dorkar nei keno ki ota kokhonoi pran rokkha korena. Khele borong side effect er bhoi thakte pare


[30/07, 09:37]cm: BP chart a aei information ta time somet otyonto joruri

[30/07, 09:38]cm: Harer pain ta costochondritis mone hocche. Again doesn't appear to be a cardiac pain

[30/07, 09:39]cm: However to be sure if the pain is non cardiac or not a local clinical examination is necessary by a local doctor

[30/07, 10:09] Pt Mb 58M GAD: Thik achhe

[30/07, 10:11] Pt Mb 58M GAD: Etao jana hoye galo.

[30/07, 10:24] Pt Mb 58M GAD: Eta angul diye harta tiple tobei byathar anubhuti hocchhe. Otherwise bazarer bag carry / long walking e kono problem hoyni.

[30/07, 11:37]cm: More suggestive of costochondritis

[30/07, 23:18] Pt Mb 58M GAD: 

Aaj 30th July 2025:- 

Sudhu dinner er chhobi pathalam. Lunch eo same menu songe mung daal r chalkumrar akta tarkari. Seshe tok doi.
Aaj khub bhalo achhi.




B. P. Chart aajo ready kore pathalam

[30/07, 23:23] Pt Mb 58M GAD: 

B.P. Chart on 30.07.2025



Previously published details of our UDHC PaJR workflow :



https://pubmed.ncbi.nlm.nih.gov/40674544/


The patient's case report details are published by our intern in the link below :


PaJR daily activities (energy outputs) 

November 2023

সাধারণভাবে পাঁচটা থেকে সাড়ে পাঁচটায় ঘুম থেকে উঠে পড়ি। তারপর ওয়াশরুম থেকে ফিরে নদীতে যাই অল্প কিছুক্ষণ সাঁতার ও স্নান করে ফিরে আসি। তারপর সামান্য ব্রেকফাস্ট করে হাঁটতে চলে যাই এবং সেটা খোলা হাওয়ায় নদীর পাড় ধরে। ফিরে এসে বাজারে যাই। সেখান থেকে ফিরে এসে ভোরের কাগজ পরি। দশটা নাগাদ দুপুরের খাবার  খেয়ে নেই।  তারপর একটু বিছানায় গড়িয়ে নেই। তারপর বাইরের কিছু কাজ থাকলে করি অথবা বন্ধুর উপন্যাসের অথবা কম্পিউটারে কিছু কাজ থাকলে করি। আবার তিনটে নাগাদ নাগাদ কিছু স্ন্যাকস বা টিফিন জাতীয় খাবার খাই। বিকালের দিকে কখনো কখনো আবার হাঁটতে যাই অবশ্য সেটা  সঙ্গী সাথী পেলে। ফিরে এসে ফল খাই তারপর আবার বাইরের কাজ থাকলে করি অথবা কম্পিউটার বা অন্যান্য কিছু কাজ থাকলে সেগুলো করি। তারপর দশটা নাগাদ রাতের খাবার খেয়ে নেই। তারপর রাত এগারোটা থেকে বারোটার মধ্যে শুয়ে পড়ি এটাই দৈনন্দিন জীবন।

১৩/১১/২০২৩

সকাল সাড়ে পাঁচটা পেশেন্ট ঘুম থেকে উঠে তারপর ছটা নাগাদ ছোলা ছাতু কাঠবাদাম চীনাবাদাম খেজুর মুড়ি খেয়ে হাটতে বেরিয়ে যায়। 

সকাল সাড়ে আটটা নাগাদ দুধ ফল নিউজ পেপার ইত্যাদি  বাজার নিয়ে বাড়ি ফেরে।

কিছুক্ষণ পেপার পড়ে তারপর ছোট্ট সবজি বাগানে কিছুক্ষণ কাজ করে নদীতে স্নান করে এসে সারে এগারোটা নাগাদ দুপুরের খাবার খেতে বসে। 

তারপর বেলা সাড়ে বারোটা পর্যন্ত সংবাদপত্র এবং পুজোর সংখ্যা ম্যাগাজিন পড়ার পর সামান্য ঘুমাতে যায়। 

বেলা দুটায় ঘুম থেকে উঠে পাশের বাড়িতে একটু কম্পিউটারে কাজ করতে যায়। সাড়ে তিনটা নাগাদ ফিরে সামান্য জলখাবার খায়।  আবার ফিরে যায় কম্পিউটারের কাজে। সন্ধ্যা সাড়ে সাতটা নাগাদ বাড়ি ফিরে ফল খেয়ে কিছুক্ষণ টিভি দেখে। 

সাড়ে আটটা নাগাদ পেশেন্ট তার মেয়েকে নিয়ে প্রতিবছরের মত শ্রী শ্রী রামকৃষ্ণ আশ্রমে চলে যায়, সেখানে পেশেন্টের মেয়ের গানের অনুষ্ঠান ছিল তারপর সেখানেই প্রসাদ খেয়ে দশটা নাগাদ বাড়ি ফিরে আসে।

বাড়িতে রাত ১১ টা নাগাদ পূজার সংখ্যার পত্রিকা পড়ার পর ঘুমিয়ে পড়েন।

PaJR daily food plates (energy inputs) 

Thursday 21/12/23

Breakfast : posted at 6:23 AM 




Ĺunch posted at 10:26 AM 





Snack of Grain and pulses posted at 4:06 PM 




Snack of fruits posted at 6:15 PM 




Dinner party posted at 8:35 PM 



Another dinner update on 28/2/24:


[2/29, 6:17 PM]cm: Torkari guno ektu describe Kore dile bhalo hoi

[2/29, 10:46 PM] Patient Advocate 60M DM2: বথুয়া শাক, কাঁচা কলা আলু সেদ্ধ, সবজি দিয়ে অরোহড় ডাল, থোর ঘন্ট, ব্রকলি আলুর তরকারি, ধনে পাতার চাটনি।


Hyperuricemia update in this patient :


[12/29, 6:38 PM] Patient Advocate 60M DM2: 


BP 130/84


[12/29, 6:39 PM] Patient Advocate 60M DM2: ১৫ দিন ইউরিক এসিডের ওষুধ খাওয়ার পর এই রেজাল্ট এসেছে, এখন কি করব, দয়া করে পথ দেখান।


[12/30, 8:33 PM]cm: Tablet Allopurinol 100 mg dine teen bar nicchilen?


[12/30, 8:35 PM] Patient Advocate 60M DM2: দিনে দু-বার ১৫ দিন খেয়েছিলাম।


[12/30, 8:35 PM] Patient Advocate 60M DM2: এখন কিন্তু কোন ব্যথা বেদনা নেই, স্বাভাবিক কাজকর্ম করছি।


[12/30, 8:44 PM]cm: Ota aekhon theke dine teenbar Kore din ebong abar du soptaho baade dekha jaak test Kore


[12/30, 8:45 PM]cm: Apnar patient aer prothom joint a byatha ta kabe hoyechilo ebong tarpor kobar kone kone somoiyer modhye hoyechilo?


[12/30, 9:37 PM] Patient Advocate 60M DM2: একটু পরে জানাচ্ছি


[12/30, 10:13 PM] Patient Advocate 60M DM2: প্রথম ব্যথা হয় ডান হাঁটুতে ২২ সালের জুন মাস নাগাদ।  তারপর পূর্ণিমা অমাবস্যাতে মাঝে মাঝে ব্যথা হতো ৬-৭ দিন ব্যথাটা থাকতো।  হোমিওপ্যথি ওষুধ খেলে কমে যেত।



[12/31, 8:15 AM]cm: Shudhu haanthu te? Buro angul a noi? 

Ekbar shuru hole 6-7 days thakto? 

Majhe majhe mane proti 2 soptaho baade baade?

Some GK (generalized knowledge) on the above PPK (particular patient knowledge) :





Smokes few ciggaretes daily (Not posted) 

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