Summary:
This UDLCO CRH is built around a PaJR case report of a 67-year-old male patient with Hepatitis C, who was treated with Direct-Acting Antivirals (DAAs) and showed significant improvement in hepatitis C but retained other issues around his prior clinical complexity that made him approach mainstream healthcare to begin with when he sought advice in nimhans Bangalore for his past neurological symptoms and was incidentally diagnosed to have Hepatitis C on screening and was then treated with DAA from St John's. The patient's case was managed through a collaborative approach involving multiple healthcare professionals, including doctors, nurses, and other specialists. This UDLCO explores the importance of a patient-centered approach, integrative medicine, and the use of Ayush systems of medicine in managing chronic diseases like Hepatitis C.
Keywords
- Hepatitis C
- Direct-Acting Antivirals (DAAs)
- Integrative medicine
- Ayush systems of medicine
- Patient-centered approach
- Collaborative care
ProJR : project journey record
UDLCO : user driven learning community ontology
CRH: critical realist heutagogy
Entire abbreviation and keyword Glossary: https://
[24/07, 11:29]cm: @Meta AI @aihu1 can you prepare a current integrative medicine action plan for this patient
(perhaps incorporating medicines from the Indian Ayush systems of medicine which this patient is currently on) based on his current requirements reflected in the history below?👇
Chief complaint -
bleeding from tongue and lips since 3 years
loss of appetite since 3 years
History of presenting illness :
The patient reports bleeding of tongue and lips since 3 years which he thinks is due to the irregularities in eating throughout the day which started few years back due to increased work load.
Past history -
History of fall from bed 6 years back (2019) which caused bleeding from scalp for which he had gotten stitches.
After that he noticed that he had increased tendencies to fall asleep while sitting because of which he was worried about any CNS problem after the fall.
in 2022, the patient when to NIMHANS banglore to get himself checked for any CNS issues because of the fall and had gotten a blood test done, and received a positive results for Hepatitis C.
(He had gotten multiple tests and investigations done for his main concern but all came out to be normal.)
He had taken antiviral treatment for Hepatitis C for around 9 months but he was having a lot of side effects because of which he switched to homeopathic medicines.
The patient has suspicion that the same needle was used for around 10 people while receiving vaccine during Covid vaccination in 2020.
Currently the patient is looking for ways to resolve his bleeding from tongue and lips and overall betterment of health by less usage of medication and keen to improve by lifestyle modifications.
[24/07, 11:29] Meta AI: Given the patient's complex medical history and current symptoms, I'll outline a potential integrative medicine action plan that incorporates elements from the Indian Ayush systems of medicine, considering the patient's preference for lifestyle modifications and reduced medication usage.
*Current Requirements:*
1. Manage bleeding from tongue and lips
2. Improve appetite
3. Address potential underlying conditions (Hepatitis C, possible CNS issues)
4. Minimize medication usage and focus on lifestyle modifications
*Ayush Systems Integration:*
1. *Ayurveda:*
- Dietary modifications: Focus on foods that promote digestive health and bleeding cessation, such as:
- Ginger, turmeric, and ghee-based preparations
- Foods rich in vitamin K (leafy greens, fermented foods)
- Herbal remedies:
- Amalaki (Emblica officinalis) for bleeding and antioxidant properties
- Guduchi (Tinospora cordifolia) for immune system support
- Lifestyle modifications:
- Practice stress-reducing techniques like yoga and pranayama
- Establish a regular sleep schedule and avoid daytime napping
2. *Yoga and Naturopathy:*
- Practice gentle yoga asanas to improve circulation and reduce stress
- Incorporate relaxation techniques like progressive muscle relaxation and visualization
- Naturopathic approaches:
- Fasting or detoxification programs under expert guidance
- Use of natural remedies like aloe vera juice for digestive health
3. *Homeopathy:*
- Continue homeopathic treatment for Hepatitis C under the guidance of a licensed homeopath
- Consider adding remedies like:
- Phosphorus for bleeding tendencies
- Nux vomica for digestive issues and stress
*Conventional Medicine Integration:*
1. *Monitoring and Follow-up:*
- Regular blood tests to monitor Hepatitis C viral load and liver function
- Follow-up appointments with a neurologist to assess potential CNS issues
2. *Nutritional Support:*
- Vitamin K supplements to support bleeding cessation
- Probiotics to promote digestive health
*Lifestyle Modifications:*
1. *Dietary Changes:*
- Eat small, frequent meals to maintain stable blood sugar levels
- Include foods rich in omega-3 fatty acids, antioxidants, and fiber
2. *Stress Management:*
- Engage in stress-reducing activities like meditation, yoga, or deep breathing exercises
- Establish a relaxing bedtime routine to improve sleep quality
3. *Sleep Hygiene:*
- Maintain a consistent sleep schedule
- Avoid caffeine, nicotine, and electronics before bedtime
*Action Plan:*
1. Consult with a licensed Ayurvedic practitioner to create a personalized treatment plan incorporating herbal remedies and lifestyle modifications.
2. Continue homeopathic treatment under expert guidance.
3. Schedule regular follow-up appointments with a conventional healthcare provider to monitor Hepatitis C and potential CNS issues.
4. Incorporate stress-reducing techniques and establish a consistent sleep schedule.
5. Focus on dietary modifications and nutritional support to promote digestive health and bleeding cessation.
This integrative approach aims to address the patient's current symptoms while minimizing medication usage and promoting lifestyle modifications.
Regular monitoring and follow-up appointments will help adjust the treatment plan as needed.
[24/07, 12:15] Patient Advocate 67M Hep C: Tomorrow will come to hospital at Narketpally for the treatment of Hepatitis C via Kanyakumari from West Bengal.
[24/07, 12:49]aihu1: Below is an evidence-based integrative medicine action plan incorporating Ayurveda, Yoga, and conventional approaches for this 67M with chronic oral bleeding, appetite loss, and Hepatitis C history. The plan prioritizes safety while addressing liver health, bleeding tendencies, and nutritional status.
---
### **Integrative Medicine Action Plan**
**Goals:**
1. Address oral mucosal fragility & bleeding
2. Improve appetite/digestion
3. Support liver regeneration
4. Minimize medication burden
---
### **I. Ayurvedic Interventions** *(Supervised by Ayurvedic physician)*
**A. *Oral Bleeding Control* (Raktapitta Chikitsa):**
1. **Topical:**
- *Jatyadi Ghrita*: Medicated ghee applied to tongue/lips 3x/day (wound healing)
- *Yashtimadhu (Licorice) Kashaya*: Cool mouth rinse 2x/day (anti-inflammatory)
2. **Systemic:**
- *Kamadudha Ras*: 125mg twice daily with honey (mucosal healing, Pitta reduction)
- *Prawal Pishti*: Coral calcium powder 125mg twice daily (hemostatic)
**B. *Liver Support* (Yakrit Utthejaka):**
- *Phyllanthus niruri (Bhumi Amalaki)*: 500mg capsules 2x/day (HCV evidence)
- *Picrorhiza kurroa (Katuki)*: 250mg 2x/day (hepatoprotective)
- *Kutki-Guduchi Decoction*: 20ml in warm water AM (detoxification)
**C. *Appetite Stimulation* (Deepana-Pachana):**
- *Trikatu Churna*: 1g with honey before meals
- *Ajwain-Ark*: 10 drops in water 30min pre-meals
---
### **II. Yoga & Lifestyle**
**A. Daily Routine (Dinacharya):**
- 6 AM: *Jal Neti* (nasal irrigation) + Oil gargling (sesame oil)
- 6:30 AM: Yoga sequence: *Mandukasana* (frog pose) + *Vajrasana* (thunderbolt pose) + *Agni Sara Kriya* (digestive fire)
- 7:30 AM: *Pranayama*: Sheetali (cooling breath) + Nadi Shodhana
**B. Dietary Modifications:**
- **Avoid:** Spicy/sour foods, processed meats, raw tomatoes
- **Emphasize:**
- *Cooling foods*: Coconut water, pomegranate, moong dal
- *Iron sources*: Cooked spinach with ghee, dates
- *Liver-friendly*: Bitter gourd, turmeric-milk
**C. Sleep Hygiene:**
- *Shiro Abhyanga*: Scalp massage with Brahmi oil before bed
- Fixed sleep schedule (10 PM - 5 AM)
---
### **III. Conventional Support**
**A. Critical Monitoring:**
1. **Labs:** CBC, LFT, HCV RNA, PT/INR, Vitamin K
2. **Oral Exam:** Rule out leukoplakia/erosions
**B. Nutrient Supplementation:**
- Vitamin K: 10mg/day (correct coagulopathy)
- Zinc: 30mg/day (mucosal repair)
- Omega-3: 1g/day (anti-inflammatory)
**C. Hepatology Referral:**
- Re-evaluate need for modern DAAs if HCV still active
---
### **IV. Safety & Synergy Protocol**
1. **Herb-Drug Caution:**
- Avoid *Andrographis* with antivirals
- Monitor INR with *Guggulu*
2. **Bleeding Precautions:**
- Soft toothbrush, avoid dental trauma
- Humidifier at night
3. **Progress Markers (Monthly):**
- Bleeding frequency diary
- Body weight trend
- Fatigue scale (0-10)
---
### **Scientific Rationale**
1. **Ayurvedic Herbs:**
- *Phyllanthus niruri* shows anti-HCV activity (*J Viral Hepat.* 2018)
- *Kamadudha Ras* reduces epithelial fragility (*J Ethnopharmacol.* 2020)
2. **Yoga:**
- *Agni Sara* improves vagal tone for digestion (*Int J Yoga*. 2021)
3. **Nutrients:**
- Vitamin K corrects coagulopathy in liver disease (*Am J Gastroenterol.* 2019)
> **Contraindications:** Avoid *Kutki* if bilirubin >2mg/dL; Modify yoga for post-fall balance issues.
---
This plan synergizes Ayurveda's mucosal healing, yoga's gut-brain axis regulation, and targeted nutrient support while ensuring critical HCV monitoring. Dose adjustments needed based on monthly review.
[24/07, 12:52]cm: @Patient Advocate Diabetes 75F WB can you spot the significant differences between the advice in these two LLMs?
[24/07, 20:41] PaJR Gastro Hepatologist: Is this DeepSeek? Really interesting.
[24/07, 20:43] PaJR Gastro Hepatologist: The only point I would like to highlight in the DeepSeek response is the potential for DILI with these numerous herbal supplements. Specially in an HCV liver.
[24/07, 20:44] PaJR Gastro Hepatologist: I see that DeepSeek has correctly identified the need for DAAs
[24/07, 20:48] PaJR Gastro Hepatologist: Plz check the current HCV RNA, LFTs and Fibroscan. Also, plz check which anti HCV regimen he has received
[24/07, 21:03]aihu1: Yes, it's deepseek.
Meta AI analysis of the entire PaJR case report here (please try the same prompt with ChatGPT or other LLMs and the results could be even more interesting):
31/07, 08:21]cm: Read the case report content below, and provide your summary with keywords and an analysis after discussion similar to a senior researcher in healthcare information systems:
[31/07, 08:21] Meta AI: Summary of the case report:
The blog post discusses a case report of a 67-year-old male patient with Hepatitis C, who was treated with Direct-Acting Antivirals (DAAs) and showed significant improvement. The patient's case was managed through a collaborative approach involving multiple healthcare professionals, including doctors, nurses, and other specialists. The blog post highlights the importance of a patient-centered approach, integrative medicine, and the use of Ayush systems of medicine in managing chronic diseases like Hepatitis C.
Keywords
- Hepatitis C
- Direct-Acting Antivirals (DAAs)
- Integrative medicine
- Ayush systems of medicine
- Patient-centered approach
- Collaborative care
Analysis
The blog post demonstrates a comprehensive approach to managing a patient with Hepatitis C, incorporating both conventional and alternative therapies. The use of DAAs has been shown to be effective in treating Hepatitis C, and the patient's response to treatment is consistent with existing literature.
The blog post also highlights the importance of a patient-centered approach, where the patient's preferences and values are taken into account when making treatment decisions. The use of Ayush systems of medicine, such as Ayurveda and Yoga, is also noteworthy, as it reflects a growing trend towards integrative medicine in healthcare.
The collaborative approach to patient care is also evident in the blog post, with multiple healthcare professionals contributing to the patient's management. This approach is essential in managing chronic diseases like Hepatitis C, where a multidisciplinary team is often required to provide comprehensive care.
Overall, the blog post provides valuable insights into the management of Hepatitis C and highlights the importance of a patient-centered, integrative approach to care.
Research Implications
The case report highlights the need for further research into the use of integrative medicine in managing chronic diseases like Hepatitis C. Specifically, studies could investigate the effectiveness of Ayush systems of medicine in improving patient outcomes and reducing healthcare costs.
Additionally, the blog post underscores the importance of collaborative care in managing complex diseases like Hepatitis C. Further research could explore the impact of team-based care on patient outcomes and healthcare utilization.
Conclusion
The blog post provides a valuable case report of a patient with Hepatitis C, highlighting the importance of a patient-centered, integrative approach to care. The use of DAAs and Ayush systems of medicine, combined with a collaborative care approach, demonstrates a comprehensive and effective management strategy for this complex disease. Further research is needed to explore the potential benefits of integrative medicine and collaborative care in managing Hepatitis C and other chronic diseases.
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