First information Case report by medical intern: http://
PaJR UDLCO conversational learning transcripts :
[8/20, 8:40 PM] Rakesh Biswas: To quote from your case report 👇
"He used to go to his work daily since he meet with this accident he is going once in 2-3 days"
Please share how his hourly routine that you described has been hourly disrupted after his injury. When he goes once in 3 days to his office, what is that day like in comparison to how it was before the accident?
[8/20, 8:43 PM] Rakesh Biswas: @~Hitesh Can you add the patient advocate to the group and ask him to not reveal the patient's identity to preserve his confidentiality and ask him to keep logging the patient's daily hourly activities (energy expenditure) along with sharing his food plate images (energy inputs)?
[8/20, 8:48 PM] +intern : Ok sir
[8/20, 9:42 PM] +intern : Sir patient said specifically he has no pain in the knee joint he just mentioned difficulty in walking
[8/20, 9:43 PM] +intern : Changes in daily routine
He wakes at same time 6:30
He has difficulty in going to washroom (western toilet)
He will walk downstairs or to market near his home at very slow pace and if it's at more distance he will go by bike (self driving)
He will walk slightly after lunch and dinner and there are no changes in lunch ,dinner and sleeping pattern
Previously he used to walk to railway station to go to his work now he is using bike(self drive)
[8/21, 6:45 AM] Rakesh Biswas: So please tell us specifically what makes it difficult for him to walk if not pain!
And if it's pain then where exactly is the pain anatomically located?
[8/21, 9:37 AM] intern : Usually he doesn't have any pain but on walking for 5-10 min or standing he developes mild pain in knee, burning type,gradually progressive, radiating to ankle which is relieved on rest
[8/21, 9:40 AM] Rakesh Biswas: How long after rest is this mild pain relieved?
Was the pain as mild as now when he got his MRI done that revealed a cruciate ligament tear?
[8/21, 9:42 AM] Rakesh Biswas: How does he reach his office if he's unable to walk for more than 5 minutes due to the pain? Does he drive his own car to office?
What kind of work does he do in his office?
[8/21, 9:45 AM] intern : It releives on 5 min of rest
MRI report :partial Tear in the anterior cruciate ligament associated near tibial attachment involving posterior lateral fibers
[8/21, 9:52 AM] Rakesh Biswas: The mri report wasn't my question
The question was :
Was the pain similar then as now? Has it reduced or increased?
Added question :
When was the mri done?
[8/21, 9:55 AM] +intern : He walks to bustop which is 3 min away and goes by bus
Before the incident he used to walk to railway station then go by train to his working place
[8/21, 9:57 AM] +intern : Yes sir MRI is done
Pain relieved gradually after MRI
[8/21, 9:58 AM] Rakesh Biswas: How far is the Railway station?
[8/21, 9:58 AM] Rakesh Biswas: Therapeutic mri?
[8/21, 9:59 AM] Rakesh Biswas: How many days since mri now
If pain was 10 during mri how much is it now?
[8/21, 11:31 AM] +intern : 1 min away from his home but he has to stand while travelling so he prefers bus as he can travel by sitting which is 3 min away from his place
[8/25, 10:48 PM] Patient Advocate 48M Knee Ligament Tear WB: I am not getting any update in the case of ligament tear.what's the imigiate steps to be taken for that's purpose? I have wants to be a doctor's prescribed format,which shows in my work place for taking maximum rest of my left leg
[8/25, 10:57 PM] Patient Advocate 48M Knee Ligament Tear WB: Not me it's patient working place..
[8/26, 6:21 AM] Rakesh Biswas: We need to know exactly how much is his current knee pain and how much disability is it causing.
From the discussion above with the other patient advocate @~Hitesh we realize that the patient has mild pain but he's still able to manage his walk to the bus stand and then for the entire day he has to sit in his workplace which would automatically put the knee at rest?
@~Hitesh We will need both the knee images taken together for comparison
[8/26, 7:35 AM] intern : Ok sir
[8/28, 10:17 AM] Rakesh Biswas: The left knee does appear more swollen than the right. Well taken image
[8/30, 10:03 PM] Patient Advocate 48M Knee Ligament Tear WB: Patient wants to know the precaution measure in daily Life,& any remedies in prescribed format ..
[8/30, 10:04 PM] Rakesh Biswas: Avoid riding the bike as that was the cause of this injury
[8/30, 10:21 PM] Patient Advocate 48M Knee Ligament Tear WB: Okay ok...but how to walk when attend office? Bcos don't know the precaution of this injury in walking concern
[8/30, 10:23 PM] Rakesh Biswas: Walking won't cause injury
[8/30, 10:24 PM] Patient Advocate 48M Knee Ligament Tear WB: Okay ok..I can walk as like as before
[9/24, 12:40 PM] Rakesh Biswas: How is your patient now? Hope he's walking well and didn't need surgery?
[9/24, 12:56 PM] Patient Advocate 48M Knee Ligament Tear WB: Patient Walking well but after walking about 15 minutes..then feel some mild pen...one thing is that cramps happened in midnight or in morning on left leg..it's for walking more?or some other problems?
[9/24, 12:57 PM] Rakesh Biswas: How many times has the patient experienced cramps? How many days previously since the injury?
[9/24, 1:02 PM] Patient Advocate 48M Knee Ligament Tear WB: Patient very much experience this cramps in two legs also since 8to 10 year's when walking more & more than normaly daily walking
[9/24, 1:04 PM] Patient Advocate 48M Knee Ligament Tear WB: Now in left leg cramp more in this period
[9/24, 1:09 PM] Rakesh Biswas: Okay so this is a separate problem of muscle cramps and unrelated to his knee pains 👍
It's thought to be because of a malfunctioning molecular pump that makes the calcium accumulate in the muscles. One can take Paracetamol 650 mg or any other NSAID to relieve this problem but as it's thought to be a faulty pump due to a genetic coding error there's no current permanent solution to this problem as you may have learned over last 8-10.years
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