"MY EXPERIENCES WITH GENERAL CELLULAR AND NEURAL CELLULAR PATHOLOGY IN A CASE BASED BLENDED LEARNING ECOSYSTEM'S CBBLE "
Greetings!
This is Mounika ,a medical student from India. As a student in the general medicine department, I embarked on a transformative journey, witnessing challenges and complexities of patient care. In this platform, I will share the glimpse into my journey in the department and recount my experiences and invaluable lessons I gained during my time in the department.
CBBLE PAJR PARTICIPATORY LEARNING ACTION RESEARCH DISCLAIMER
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
In the case - based blended learning ecosystem (CBBLE), I had great experiences studying general cellular and neural cellular pathology. I learned about cellular changes in different diseases and how they affect the body. The case -based approach helped me apply my knowledge to real-life situations, improving my diagnostic skills and critical thinking. Collaborating with classmates and receiving feedback from instructors made the learning process engaging and interactive. The use of technology, like virtual microscopy and online discussions, made learning accessible and flexible. Overall, my time in the CBBLE gave me valuable knowledge and skills that I can use in clinical practice and research.
My Journey in the General Medicine Department: A Student's Perspective (2018-2023)
Introduction:
Embarking on my journey as a medical student in the General Medicine Department in 2018, I was filled with a mix of excitement, curiosity, and a deep sense of purpose. Over the course of five transformative years, I had the privilege of immersing myself in the world of medicine, witnessing the triumphs, challenges, and profound impact of healthcare on patients' lives. In this blog post, I will share a detailed account of my journey in the General Medicine Department from 2018 to 2023, highlighting the milestones, experiences, lessons, and personal growth I experienced along the way.
1. The Early Years: Building the Foundation (2018-2020)
The first years of my medical education were focused on laying a strong foundation of medical knowledge. I attended lectures, participated in practical sessions, and dedicated countless hours to studying anatomy, physiology, pharmacology, and other fundamental subjects. The rigorous curriculum instilled discipline, critical thinking skills, and the ability to assimilate vast amounts of information.
2. Clinical Exposure: Stepping into the Hospital (2021-2022)
In the clinical years, I transitioned from the classroom to the hospital environment. I vividly remember the excitement and nervousness as I donned my white coat and stepped into the wards. Under the guidance of senior physicians and residents, I began interacting with patients, taking medical histories, and performing physical examinations. These hands-on experiences helped me develop vital skills in patient communication, clinical reasoning, and forming differential diagnoses.
3.Rotations in Various Specialties.
During my rotations in the General Medicine Department, I had the opportunity to delve into various subspecialties, including cardiology, pulmonology, gastroenterology, nephrology, and endocrinology, among others. Each rotation exposed me to different patient populations, diagnostic challenges, and treatment modalities. I actively participated in patient care, attended ward rounds, and observed and assisted in various procedures. These rotations broadened my understanding of the diverse spectrum of medical conditions and allowed me to appreciate the complexities of managing complex cases.
4. Interprofessional Collaboration: Learning from Peers
Collaboration with fellow medical students, nurses, pharmacists, and other healthcare professionals was a cornerstone of my journey in the General Medicine Department. Through interdisciplinary discussions and teamwork, I learned the importance of effective communication, mutual respect, and shared decision-making. Working together with professionals from different backgrounds enriched my learning experience, broadened my perspectives, and highlighted the value of a multidisciplinary approach to patient care.
5.Patient Stories: A Lesson in Compassion
Interacting with patients and hearing their stories was a constant reminder of the human side of medicine. I witnessed moments of vulnerability, strength, hope, and resilience in the faces of those fighting illness. Each patient's journey provided me with valuable insights into the profound impact healthcare professionals can have on individuals and their families. These experiences reinforced the importance of empathy, active listening, and treating patients with compassion and dignity.
Experiences :
My first interaction with a patient in the medicine dept was in 2021, I was in the general medicine ward where I saw this young lady facing difficulty trying to reach for her mobile that was placed on the table which was a little farther from the bed she was laying on , I went up to her to help and then I asked her what made her come to the hospital.
She went on explaining that she had been experiencing pain and swelling of left lower limb from a couple of months , fever on and off since 3 weeks
I noticed there was Swelling of her left lower limb ,redness of cheeks with moon face like appearance,fat pad like appearance on the back of the neck which appeared to be Buffalo Hump, white scaly lesions on the skin
It intrigued me and upon asking further history I got to know that she was a known case of Type 2 Diabetes mellitus was diagnosed 3 months ago during a medical camp after experiencing dizziness, calf muscle pain , increased appetite
And 1year ago she developed round skin lesions associated with itching ,went to local RMP doctor and used some topical ointment for period of 3-4 months but patient did not get any relief , then again went to RMP was prescribed with AVIL (anti allergic )and DECADRAN (dexamethasone ) injections and patient used them for a period of 3-4 months even then patient did not get relief from her skin lesions and then she came to our hospital and was given ITRACONAZOLE and her skin lesions were then subsided , and I got to a conclusion that this might be iatrogenic cushing's.
Then I took consent for examination and observed that she had mild Pallor, Normal Blood pressure , thin arms , pendulous abdomen , Swelling of Left lower limb with redness , patient denied history of trauma.
I couldn't help but review her reports and the reports stated that she was indeed anemic, with increased total Leucocyte count of 15000 with 72% Lymphocytes, with Random Blood Sugar of 295 , which indicates that there is infection and the healing that was affected due to Uncontrollable Type 2 DM, iatrogenic Cushing's that caused the swelling and that explains the symptoms
As I concluded my initial assessment, I couldn't help but feel a mix of emotion , compassion for the patient's suffering and a deep sense of responsibility to find a way to alleviate her distress. This encounter marked the beginning of my journey as a medical professional, reminding me of the immense impact our work can have on the lives of those in need. It solidified my commitment to provide the best care possible and find answers for patients like her.
***
I was in my clinical rotations when I saw this patient who appeared visibly unwell, with a noticeable puffiness of face , swollen hands and legs. The puffiness around her eyes and cheeks further emphasized the severity of her condition. It was evident that she was experiencing significant discomfort, as she struggled to catch his breath.
As my conversation with the patient went on I learned that the pedal edema was on and off since 2 months associated decreased urine output , developed generalized edema since 10 days which started from legs and lead to whole body swelling ,Not associated with pain and didn't subside on taking medication.
3 days later she started developing shortness of breath , which was progressive in nature initially she had SOB where she could not do even minimal activity ( Grade 3 NYHA ),There was no diurnal variation and then from past 5 days she is having SOB even while she was lying down(Grade 4NYHA) . These distressing developments prompted her to seek medical attention, and it was this very situation that had led him to our care.
Diving into his medical history, I discovered that she was a known case of diabetes for the past 15 years and is on medication, had been diagnosed with hypertension (HTN) 3months ago and is on medication (Telma).
As I reviewed the patient's medical records and test results, a wave of concern washed over me. The laboratory findings revealed elevated levels of serum creatinine, urea, and alkaline phosphatase . These abnormalities hinted at a severe renal dysfunction.
This Encounter made me realise that not every condition had a one time cure , some needs to go through the hectic process of timely check ups and continuous treatment procedures such as dialysis. This made me remember the phrase "Prevention is better than Cure" Best solution would be early approach and it's us,the doctor's responsibility to create awareness.
***
A 40 year old male presented to casualty accompanied by his worried wife, in unconscious state with history of seizures the night before
Diving into the history,I got to know Patient consumes alcohol from age of 20 even before marriage, his wife reports that post marriage he consumed alcohol thrice in a week
Quantity- 90ml ,over the duration of approximately 9years and after that he started drinking daily over a duration of 9 years and she guessed the quantity to be 360ml[12 units] of whiskey and from past 1 month he started drinking alcohol during the day approx 3 times
And that if the patient doesn't drink any day he would experience excessive sweating, tremors, palpitations
She reports patient history of seizures from age of 17 years and had a few episodes (7to8)
Last episode was 15 days back when he didn't consume alcohol but reports he had episodes even when in intoxicated state
Episodes used to be associated with LOC , unrolling of eyes,frothing, tonic clinical movements
Reports No history of blood in stools, vomitus,jaundice, head injury, suspiciousness, self talking,self smiling,Loco mood, over valued ideas ,grandiosity, suicidal thoughts, over ritual,repetitive thoughts, forgetfulness
They visited local RMP in the past and was Given Phenytoin I.p 100mg
Later during examination The patient was conscious ,alert , with signs of meningeal irrigation ,With No neck stiffness, No kerning's Sign. I came to a conclusion that this is a case of a Alcohol withdrawal seizures
Checking on the investigations
All the blood reports were Normal
MRI brain shows No abnormality detected in the brain , Bilateral hippocampi normal
As I concluded my assessment A wave of concern washed over me for him and his family's suffering , it made me look into all the better treatment options and told them about the de-addiction centre and hoped everything gets better
***
I was in my clinical rotations when a saw an old lady with anasarca , I went to her and took a detailed history and got to know that she had fever - intermittent (4 or 5 times since 20 days) and evening rise of temperature was seen for which she took paracetamol and it got subsided . Fever was not associated with chills and rigors.
She also had yellowish discoloration of eyes and urine since 20 days .
She also complained of burning micturition.
2 weeks prior to( on 1/7/22) coming to our hospital and was asked to get admitted but due to financial problems their family denied it.
Treatment advised were- tab Udiliv 300mg BD,
MVT OD, Tab Dolo 650mg sos, continue antihypertensive and anti diabetic medications.
And then she took herbal medicines every monday for 2 weeks and stopped anti diabetic and anti hypertensive medications completely (when she started taking herbal medications){k/c/o DM- II, Hypertension since 2 weeks}.
Two days back (18/7/22 ) she had difficulty passing urine and then she developed generalised weakness, dizziness and sweating ,then she got admitted.
Also had history of frequency used of medications for headache (Advil)
This is a case of a Toxin induced Hepatitis
As I concluded the case I got to realize that something as simple as taking over the counter medications for extended period can cause toxicity and lead to conditions such as hepatitis . It solidified my commitment to provide the best care possible and find answers for patients like her.
***
A 21 year female presented to the casuality with above mentioned complaints. Upon admission initial examination was done, Hess test was negative; No postural drop; Necessary investigations were done. Dengue for NS1 Ag was positive with negative IgM and IgG; TLC 4800 and Platelets 1.3 L. She was started on IVF and advised to drink plenty of oral fluids. On day 2; she c/o body pains, started having menses associated with Dysmenorrhea; abdominal pain was decreased; Oral Mefenamic acid was started and IVF and NEOMOL were continued. USG Abdomen was done, which showed no sonological abnormality. On day 3; she had c/o dry cough, headache, Dysmenorrhea and along with fever spikes. Urine and Blood were sent for Culture and sensitivity. Upon examination postural drop was 18mmHg; PP 34mmHg; on auscultation of lung fields- decreased breath sounds on the Right IAA and ISA when compared to Left lung fields. 1 Unit of SDP transfusion was done on day 4, 1:30 AM i/v/o petechiae and heavy menstrual bleeding. USG Abdomen was done which showed Gall bladder wall edema, Grade I fatty liver, Minimal Ascites at pelvic and perihepatic space. Hess test was negative, No postural drop.
Platelet count
Day 1 -- 1.30 lakh cells/cu .mm
Day 2 -- 80000 cells/cu .mm
Day 3 -- 50000 cells/cu .mm
Day 4 -- 25000 cells/ cu. mm
Day 5 -- 31000 cells/ cu. mm
Day 6 -- 46000 cells/ cu. mm
Diagnosis: DENGUE WITH THROMBOCYTOPENIA AND LEUCOPENIA
She was started on Oral Tranexamic acid + Mefenamic acid.
***
A 50 year old man who's a resident of nakrekal ,labourer by occupation came to the opd to get admitted under de - addiction and is found to be having high blood sugar levels and was sent to the medicine department
Diving into the history patient was apparently asymptomatic 4 years back ,then he developed
• Burning type of pain in the right and left hypochondrium,3 to 4 episodes for which he went to a local hospital and got medications(He's a chronic alcoholic since 30 years), and the symptoms subsided,his last episode was the day after he got admitted here and was given pantop iv and the symptoms subsided.
• H/o weight loss approximately 20 kgs since 15 months
• 1 year back he was found to have high Sugars at a government camp at his place used OHA's for 4 months
• Then he developed complaints of Generalized weakness, polydypsia, poly urea for which he visited a private hospital at Nakrekal found to high sugars (Uncontrolled DM 2 ) He was on insulin(10 U morning,5U in the night) since then (took Insulin Irregularly) .
• Complaints of Diminution of vision since 8 months and double vision in the mornings since 7 months
• H/o light trauma 3 month back then he developed bubble like lesions along the right 3-4ICS , associated with pain and itching for which he went to a local hospital and got some medications and pain and itching decreased in intensity ,later Complaints of shooting type of pain along the dermatome (on right side of 3-4 ICS,intermittent in nature,occuring one or twice for about 5 to 10 minutes once in 3days since 29/7/22 ,associated with itching and tingling sensation
• H/o Trauma (with mild skin abrations over the ankles and bony prominences ) 15 days back,then he developed itching over the wounds
Came to the opd and got admitted for de-addiction and was sent to GM for uncontrolled DM 2(550mg/dl)
• Complains of body pains since 3 days for which he was given tramadol
• Vomitings on 1/8/22 morning
2 episodes ,projectile type with food particles as content( early in the morning& after consuming milk) for which he's given medication and the symptoms subsided
• Burning type of pain in the right and left hypochondrium and epigastric regions since 2/8/22 on and off for 1to 2 hours in a day
• Fever since 3/8/22 which is low grade, intermittent in nature, not associated with chills and rigor and got relived on medication
Glucose charting
27/7/22
{ 11PM -- 550 mg/dl -- 6 Units HAI given
2 AM -- 247 mg/dl
4 AM -- 47 mg/dl -- 25%D given }
28/7/22
{8am - 100 - TAB.Glimi 2.5 mg ,Metformin 1gm
10am - 85 mg/dl - 2 idly
2pm - Hi - 6U HAI given
4pm - 474
7pm - High - Glimi 2.5 mg,Metformin 2 gm
10pm - 532 mg/dl }
29/7/22
{ 8am - 312 - Glimi 2.5mg ,metformin 1gm
10am - 461
1 pm - 397 - 4U HAI
4pm - 416
7pm - Hi - 4U HAI ,4U NPH
10pm - 404 }
30/07/22
{ 2 am - 355
8 am - 466 - Glimi 2.5 mg,metformin 0.5mg
10pm - Hi - Glimiperide 4 mg,metformin 1gm
12pm - 321 -HAI 4units SC
3pm - 325
7pm - 466 - Tab.Glimi 2.5mg
Tab metformin 1g/dl }
31/07/22
{ 12am- Hi - HAI 4U ,NPH 5U
4am - 177
8am - 239
10pm - 348 Glimiperide 4mg,metformin 1gm
1am - 385
2pm- 324
4pm- 528 Glimi 4mg metformin 1gm
10pm-345 }
01/08/22
{ 2am- Hi Glimi 4mg metformin 1gm
8am-288
10am-352
Ondansetron 4mg given 2episodes of vomitings
1pm-200
4pm-394
8pm-338 - Glimi 4mg metformin 1gm
11pm -333 }
02/8/22
{ 2am - 336
8am-155
Glimiperide 4 mg,metformin 1gm
12 pm -318
2 pm -281
4 pm - 470
8 pm - 391
10 pm 477 Glimi 4mg,metformin1mg }
3/8/22
{ 2am - 362
8 am - 135
Glimiperide 4mg,metformin 1mg
12pm - 300
8pm - 532 - Glimi 4mg ,metformin 1mg
10pm - 411 }
4/8/22
{ 2am - 320
8am - 176
Glimiperide 4mg,metformin 1mg
2 idly
11am 528
1 30 pm - 368
3 pm - 388
4pm - 363
8pm - 515
Glimiperide 4mg,metformin1mg
10:30pm - 563 }
5/8/22
{ 2am - 374
8am - 194
Glimiperide 4mg,metformin 1mg
10am - 328
1pm - 181
2pm - 363
8pm - 384
Glimiperide 4mg,metformin 1mg
10:30pm - 560 }
6/8/22
{ 2pm - 370
8am - 342
10am - 247
Glimiperide 4mg ,metformin 1
1pm- 334
10pm - 526
Glimi 4mg,metformin 1mg }
7/8/22
{ 2am - 357
8am - 249
Glimi 4mg , metformin 1mg
1pm - 200
10pm - 360
Glimi 4mg , metformin 1mg }
8/8/22
{ 2am - 325
8am - 139 }
Diagnosis: Chronic Alcoholism with Uncontrolled Diabetes Mellitus 2 with Post Herpetic Neuralgia
***
This is a case of a 17 year old ,who looked like she was around 11 years , pale , so her chief complaints are loose stools for 3 days after outside food consumption with her friends, (but apparently they are perfectly fine, with no complaints)
Coming into her previous history
She is a known case of
Autoimmune hemolytic anemia
Common variable immunodeficiency syndrome
Recurrent RTIs
Recurrent Indirect hyperbilirubinemia
Failure to thrive
Delayed hemolytic transfusion reaction
With a total of 5 blood transfusions done till date
Now she developed Acute Gastroenteritis
This encounter made me feel a mix of emotion , compassion for the patient's suffering and a deep sense of responsibility to find a way to alleviate her distress.It solidified my commitment to provide the best care possible and find answers for patients like her.
***
A 38 year old male , civil engineer by occupation ,who was a chronic alcoholic ,came with chief complaints of abdomen pain on and off for the past 5 years , associated with vomitings 5-6 episodes in the past 1 year previously it was 1 episode in every 4 to 6 months , associated with weakness and Giddiness
Last episode was 25 days ago , where he had multiple episodes of vomiting after consuming fish and rice , not associated with pain. Vomitings did not stop after taking oral medication
Abdominal pain in umbilical, left hypochondriac, left lumbar and hypogastric regions,gets increased after food intake , Very severe type of pain interfering with daily activities , Pain is throbbing type and radiating to the back and is associated with nausea and vomiting , which is non bilious, non projectile and has food and water as contents
This is a classic case of a acute on chronic pancreatitis due to alcohol abuse,stress
***
A 37 year old male with chief complaints of Itchy skin lesions all over the body since 8 months
8 months back he developed small papules over the cheek ,transformed into erythematous scaly plaques first on the nose and cheek then over the entire face,neck,back,hands and legs.
Associated with itching over the plaques ,photosensitivity
C/o Tenderness in wrist joint, metacarpophalangeal joint,interphalangeal joint
H/o fever 4 episodes in last 8 months,last episode 20 days back.fever lasted for one day relived after taking medication.
H/o oral ulcers on hard palate since 10days
This is a case of an auto immune condition called SLE , with viral pyrexia
***
A 35 year old female with SOB since 3months , fever and generalized weakness since 1 month
Complaints of heavy bleeding last month lasted for 11 days( heavy bleeding for first 6 days , no bleeding for 2daysand then bleeding continued for 5days , anaemia secondary to mennorhagia
Anemia is a commonly seen condition in women after 20's , and should be treated promptly
***
A 14 year old female known case of type 2 diabetes mellitus came to OPD with complaints of shortness of breath and vomitings. On taking further history I got to know that she missed 2 Insulin shots after which she developed Shortness of breath along with vomitings. This was a typical diabetic ketoacidosis case and patient's condition improved after providing appropriate treatment by giving electrolytes and insulin.
This gave me a valuable insight of importance on treatment of such acute conditions in simple ways and about the threatening complications that follows if immediate care is not provided. It also made me understand that it's the my responsibility to create awareness of danger signs of such morbid conditions.
***
A 48 year old male came with chief complaints of abdominal distension from past 20days,was insidious in onset and gradually progressed to present size and not associated with abdominal pain.
10 days back , he went to a local hospital where was given medication, but didn’t give him relief.
H/o SOB (progress Ed from grade 1 to 2 ) It increased on exertion and relieved on taking rest.
H/o increased frequency of stools on 15th and 16th April, hard in consistency, green in colour, 5 episodes per day, blood stained and had 5 to 6 drops of blood at the end of defecation. It is not associated with pain and relieved on medication.
H/o bilateral pedal edema since 15 days which is pitting type and extending till the knee joint.
He has decreased urine output since 10 days.
Not associated with burning micturition,orthopnea , PND,fever, nausea, vomitings,chest pain, giddiness, cough
History of jaundice in the past- 2 years back and 6 months back and was managed conservatively with medication.
K/c/o Hypertension since 10 years, initially was on T.TELMA 80 mg which was later reduced to T.TELMA 40 mg and now the patient is on T.amlong 5mg and atenolol 50mg.
Diagnosis: De- Compensated Chronic liver disease , k/c/o hypertension
This encounter made me feel compassion for the patient's suffering and a deep sense of responsibility, reminding me of the immense impact our work can have on the lives of those in need. It solidified my commitment to provide the best care possible and find answers for patients like him
PJAR Discussion :
Project : Clinical complexity in patients with low backache
Learning points :
✓✓✓ JOA scoring https://www.researchgate.net/figure/The-Japanese-Orthopaedic-Associations-scoring-system-JOA-Score_tbl1_268790894
✓ ✓✓what would the successful treatment for back ache? , Is the success duration dependent
We analysed 3859 patients with Lumbar Spinal Stenosis [(LSS); mean age 66; female gender 50%] and 617 patients with Lumbar Degenerative Spondylolisthesis [(LDS); mean age 67; 72% female gender]. The accuracy of identifying 'completely recovered' and 'much better' patients was generally high, but lower for EQ-5D than for the other PROMs. For all PROMs the accuracy was lower for the change score than for the follow-up score and the percentage change score, especially among patients with low and high PROM scores at baseline. The optimal threshold for a clinically important outcome was ≤24 for ODI, ≥0.69 for EQ-5D, ≤3 for NRS leg pain, and ≤ 4 for NRS back pain, and, for the percentage change score, ≥30% for ODI, ≥40% for NRS leg pain, and ≥ 33% for NRS back pain. The estimated cut-offs were similar for LSS and for LDS.
Conclusion: For estimating a 'success' rate assessed by a PROM, we recommend using the follow-up score or the percentage change score. These scores reflected a clinically important outcome better than the change score.
Sixty-four patients aged 25-60 years with low back pain lasting longer than 1 year and evidence of disc degeneration at L4-L5 and/or L5-S1 at radiographic examination were randomized to either lumbar fusion with posterior transpedicular screws and postoperative physiotherapy, or cognitive intervention and exercises. The cognitive intervention consisted of a lecture to give the patient an understanding that ordinary physical activity would not harm the disc and a recommendation to use the back and bend it. This was reinforced by three daily physical exercise sessions for 3 weeks. The main outcome measure was the Oswestry Disability Index.
Results: At the 1-year follow-up visit, 97% of the patients, including 6 patients who had either not attended treatment or changed groups, were examined. The Oswestry Disability Index was significantly reduced from 41 to 26 after surgery, compared with 42 to 30 after cognitive intervention and exercises. The mean difference between groups was 2.3 (-6.7 to 11.4) (P = 0.33). Improvements inback pain, use of analgesics, emotional distress, life satisfaction, and return to work were not different. Fear-avoidance beliefs and fingertip-floor distance were reduced more after nonoperative treatment, and lower limb pain was reduced more after surgery. The success rate according to an independent observer was 70% after surgery and 76% after cognitive intervention and exercises. The early complication rate in the surgical group was 18%.
A study compared lumbar fusion surgery with cognitive intervention and exercises in 64 patients with low back pain and evidence of disc degeneration. The main outcome measure was the Oswestry Disability Index. Results showed that the Oswestry Disability Index was significantly reduced from 41 to 26 after surgery, compared with 42 to 30 after cognitive intervention and exercises. The success rate according to an independent observer was 70% after surgery and 76% after cognitive intervention and exercises. The early complication rate in the surgical group was 18%.
Surgery is not always the best option: Clinical trials have shown that low back pain surgery may not always be the best treatment option for patients with chronic low back pain. In some cases, non-operative treatments such as cognitive intervention and exercises may provide similar outcomes to surgery.
The JOA score can be used to assess the need for surgery in our patients with low back pain. A score of more than 7 can be conservatively treated, while a lower score may indicate the need for surgery.
✓✓✓ Failed back surgery syndrome
Failed back surgery syndrome (FBSS) is a term used to describe persistent or recurrent low back pain following spinal surgery. It is a complex condition that can have a significant impact on the quality of life of patients. The reasons why surgery may fail are multifactorial and can include incorrect diagnosis, inadequate surgical technique, complications during surgery, and underlying medical conditions.
Some common symptoms of FBSS include chronic pain, numbness, tingling, and weakness in the back and legs. Treatment options for FBSS may include physical therapy, medications, nerve blocks, spinal cord stimulation, or revision surgery. It is important to consult with a healthcare provider to determine the best treatment plan for individual cases of FBSS.
✓✓✓Discectomy vs Sham surgery
This study compared two treatments for long-term low back pain. One group received surgery, and the other group received exercises and education. After one year, both groups had improved, but the surgery group improved slightly more. However, the differences were not significant, meaning they could have happened by chance. The surgery group had more complications than the exercise group. Overall, both treatments were helpful for most patients, but surgery had more risks.
✓✓✓Why was our patient on sulfasalazine
In the case of lower back ache, Sulfasalazine may have been prescribed if the patient is suspected to have an inflammatory condition, such as ankylosing spondylitis or psoriatic arthritis
Based on antero - posterior diameter of spinal canal or on the cross sectional area of the dural sac, lumbar canal stenosis can be diagnosed. Cross sectional area of dural sac >100 mm² at the narrowest point is normal and 76–100 mm² is moderately stenotic and <76 mm² are severely stenotic
This study compared two treatments for long-term low back pain. One group received surgery, and the other group received exercises and education. After one year, both groups had improved, but the surgery group improved slightly more. However, the differences were not significant, meaning they could have happened by chance. The surgery group had more complications than the exercise group. Overall, both treatments were helpful for most patients, but surgery had more risks.
Hence we went forth with cognitive interventions consisting lumbar back support painkillers (pregabalin ,duloxetin ),pyscho education as our patient score was 9
7. Research and Scholarly Activities
Engaging in research and scholarly activities played a significant role in my journey. I had the opportunity to participate in research projects, present posters at conferences, and contribute to scientific publications. These experiences fostered critical thinking, enhanced my understanding of evidence-based medicine, and cultivated a lifelong appreciation for the importance of research in advancing medical knowledge and patient care.
8. Personal Growth and Resilience: Overcoming Challenges
The general medicine department ignited my passion for lifelong learning and research. I immersed myself in exploring the latest medical advancements, reading research papers, and engaging in scholarly discussions. Participating in research projects allowed me to contribute to the expanding body of medical knowledge and fostered critical thinking skills that I can apply to future patient care.
Conclusion:
My journey as a medical student in the general medicine department has been a transformative, challenging, and immensely rewarding experience.
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