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Case Study 2

    • Patient Name
      Mehta Rasikbhai
    • Age
      68 years
    • Residence
      Amreli, Gujarat
    • Presenting complains
      Inability to control urine, passing urine in clothes since 3 months. Frequency of day as well as night times. Hesitancy, cannot travel or attend social occasions.
    • Past history
      No history diabetes or other medical disease.
    • Drug history
      On urinary antibiotic (Saltum 375 mg) and prostate medicine (Tamsulosine 4 mg) since 20 days, with no symptomatic improvement at all.
    • Reports done (6/11/17)
      Hb – 15.4 gm % Total WBC – 5410 / cmm ESR – 26 mm at one hour RBS – 263 mg / dl S. Creatinine – 1.0 mg / dl S. Urea – 23 mg / dl HIV , HBSAG – negative PSA – 0.92 ng / ml Uroflowmetry – Voided volume ( 77 ml ) – Max Flow Rate ( 10 ml / sec ) – Average Flow Rate ( 8 ml / sec ) – Voiding time ( 9 sec ) – Time to Max Flow ( 2 sec ) Ultrasound of abdomen & pelvis – Rt. Kidney 104x60 mm , PT 14 mm normal Lt. Kidney 110x60 mm , PT 14 mm normal Urinary bladder – normal Prostate - 25 cc
    • Purpose of online consultation(23/11/17 )
      Second opinion regarding the surgery of prostate ( as advised by expert urosurgeon after 20 days treatment )
    • Clinical suspicious from symptoms, evaluation of reports
      Diabetic neuropathy affecting bladder
    • Advised for
      HB1Ac , Fasting Blood Glucose , Post Prandial Blood Glucose
    • Reports ( 26/11/17 )
      HB1Ac - 8.96 % Mean Blood Glucose – 217.93 mg / dl Fasting Blood Glucose – 228.0 mg / dl Fasting Urine Glucose - +++ Post Prandial Blood Glucose – 391.0 mg / dl Post Prandial Urine Glucose - ++++
    • Treatment recommended
      Strict anti diabetic diet Anti diabetic medicines Muscarinic receptor antagonist Methylcobalamine and vitamin B12 Prostate medicines and antibiotics stopped Life style modifications with regular walking , exercises , YOGA
    • Follow up progress of the patient
      Almost 50% symptomatic improvement within 10 days. Patient is symptoms free at 21 days from the starting of treatment. Patient has no clothes wetting, he can travel even 100 kms and attend all social occasions without surgery of prostate. Patient is on only anti diabetic medicines, rest all medicines are stopped since one month. Diabetes is strictly under control as Fasting Blood sugar ( 120 mg / dl ) , absent urine sugar & Post Prandial Blood Sugar ( 150 mg / dl ) on 18/1/18

Why case study

    • Patient was not ready to undergo lab tests further after frustration from 20 days fruitless treatment.
    • Anxiety and panic was at tip when first consulted.
    • Ultimately patient was saved from unnecessary surgery, which was going to put him in more trouble than curing (because urinary control after prostate surgery of this patient was not going to recover for rest of his life).
    • Patient is fit, fine, happy , appreciating care of the experts .

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