Key Takeaways
- Mr. X faces multiple health challenges, including diabetes, hypertension, thalassemia trait, and post-viral arthralgia.
- He initially adopts lifestyle changes to manage diabetes but later experiences severe joint pain after a mild fever.
- Despite being treated at Ghaggar River clinic, Mr. X shows reluctance toward long-term medication for diabetes and hypertension.
- His health conditions present a conundrum for doctors who struggle with patient compliance and the importance of preventive care.
- Modern medicine must address chronic conditions, yet many patients prefer quick fixes, hindered by costs and perceived inconvenience.
Patients decision, What would have been Yours.
—
by
in Health and Clinical Medicine
Mr X
“When trouble knocks, it rarely comes alone. Meet Mr. X — carrying the weight of diabetes, hypertension, thalassemia trait, and post-viral arthralgia.
His journey is not only a medical puzzle, but also a reminder of the doctor’s challenge: ensuring compliance, fostering prevention, and caring for the whole person.
Post viral Joint pains, Thallassemia trait, Hypertension, Diabetes
A 50-year-old man was diagnosed with diabetes four months ago, a clear case of common lifestyle disease. He decided to take control of his health without medication by walks over 10 km daily. He also exercises and makes dietary changes. His starting weight was 92 kg, and his HbA1c level was 9.95%. In just one month, he lost 10 kilograms, showing his determination and ability to focus on his goals. Lymphocyte predominance if suggestive of certain infections, Viral, TB, or some marrow problem, even leukaemia .
At this time, he came down with a mild fever and was treated for it symptomatically. The fever went off but then he started experiencing intense joint pain. His doctor prescribed a course of painkillers and anti-inflammatory medicines for post viral arthralgia, but they didn’t help.
This is when he came to us at the Ghaggar River clinic.
He looked tired and discouraged, as people with long-standing pain do. His heart was racing at 106 per minute, with his BP riding high at 160/110; however, his ECG was unremarkable. Other investigations revealed haemoglobin at 14, with a low MCV of 65. HbA1c at 8.45, and inflammatory markers like ESR and CRP were still high. Curiously, his lymphocytes were twice the number of neutrophils, while the total white blood count was normal. Small RBC on CBC with normal haemoglobin suggested some disorder like the thalassemia trait or spherocytosis. The former is more likely as his 2-year-old grandchild was diagnosed with Thal Major recently.
He was treated with a diagnosis of post-viral arthralgia with diabetes and hypertension. However, with limited investigations available at this time, his blood abnormalities have defied or precluded precise diagnosis,
He was put on a short course of oral steroids and SOS-acetaminophen. His pain improved dramatically, and he became cheerful.
He joined his office and worked with double the energy. He had to be called for further consultation, he said he is feeling good and walking 10 K again, so where is the problem? At the same time, he resented being put on anti-hypertensive and anti-diabetic medication and the need to go for further investigations. What to say for this happy-go-lucky attitude, let him go, and wait for him to come back with a heart attack, to educate him, or to force him is a conundrum faced by every doctor in general practice.
At the time of writing, he has diabetes, and hypertension and we suspect him of having the thalassemia trait and a possibility of GI malignancy, given his low MCV ( Low mean corpuscular volume of RBC). However, the inversion of his lymphocyte-to-neutrophil ratio seems suggestive of bone marrow abnormality rather than a machine error. One can see there are at least two errors in his marrow and Bone marrow studies are warranted.
He has been advised accordingly, but ever since the disappearance of pain, he seems reluctant to receive more bad news. He is Happy with his 10 K walk, endorphins taking care of anxiety. Wants to treat it with will, I say let him do . till he wants.
Modern medicine is not just about treating loss of function or some inflammation or fever, but also certain invisible things like hypertension, diabetes, and the prevention of heart and kidney disease, all needing long-term medication and a lifestyle change.
However, the motivation for long-term treatment is very low in the general population due to inconvenience and continued seemingly unnecessary expenditure. Poor people are less likely to comply with medical advice. Panacea is what they are looking for with a one-shot diagnosis and one-shot treatment!