Hi, everyone, my wife is having tremendous pain behind her right knee which travels both up and down. though she manages to do all the house chores but is complaining about the continuous pain

MEDICAL HISTORY


Patient Name:          Tahmeena Islam
Sex:                     Female
Age:                    51 Years

History     
1.     Eldest child of the family, with 2 younger brothers and father working as flying instructor in Civil Aviation. Her mother was an adhoc teacher. Parents had a love marriage father being Pathan and mother being Kashmiri. Initially there were some problems in her mother adjusting in the family and had rough time in the family. Once Tahmeena was born her mother put her in a box trying to dump her, which the patient quiet often talks about. The patient got married in 1985 and also had her first born a baby girl. She remained quiet perturbed and observed that her in laws and her husband did not approve of a baby girl. Being in the Army she was devoid of living together with her husband for a long time which also added to her false beliefs and anxiety of being discarded & thrown out of her husbands life through visible conspiracies (according to her own opinion) of her late mother-in-law and sister-in-laws and her father as well.
2.     Her mother meanwhile left her father & went to live with her own mother being a British Citizen and being a patient of maniac depression and went through ECT treatment both in Pakistan and abroad. Her mother tried committing suicide twice.
3.     The patient lost her second daughter in an unfortunate accident in 1996 which aggravated her depression.
4.     Then her father expired in 2003.
Medical History:-
5.     After nervous breakdown of her mother she had episodes of elations and depression. She remained depressed, gloomy & sometimes very talkative. Dod Zikr is very religious with disturbed sleep. She was initially diagnosed as bipolar effective disorder & was put on tablets Tegrol 200 mg 1+1 & Ativan 1 mg for two weeks in December 2004. She was also put on medication for blood pressure Cardiace. We also consulted Prof Dr Malik Hussain Mubasher. He advised tablets Talopran 200 mg and tablets Tofranil 25 mg. In May 2005 Dr Khalid Saeed advised her Triptinol 25 mg twice daily. Meanwhile in November 2005 she had an A.P repair for second UV prolapse. Dr Ambreen Haq did the procedure. During the procedure


and tests she was diagnosed for fatty liver and severe osteoporosis. She also has a Subcutaneous Lipoma in left upper abdominal wall.
6.     In May 2005 she developed Thyroid and is on thyroxin 50 mg since then she also showed symptoms of being diabetic.
7.     In year 2007, she was put on following medical by Dr Nauman Nayaz.
     Tab Eziday 50 mg 1+1
     Tab thyroxin 50 mg 1
     Tab zolid 30 mg
     Tab cipralex 10 mg 1+1
     Tab risek 20 mg 1+1
8.     The medication proved very beneficial & she remained quiet peaceful till date. She remained under treatment in PNS Hafeez till surgical Capt Tahir Mukhtar reviewed her case and suggested tab seroxat 125 mg instead of cipralex which had adverse affects on her and developed symptoms of early 2004 with violent mood disorders, On complaint the Dr reverted the medication to cipralex including tab risp 1 mg 1+1 and also told the patient to resort to ECT if she doesn’t improve. Simultaneously, he advised the patient to take second review of a psychiatrist. The patient went to her Principal Physician Dr Nauman Nayaz who advised her to consult Brig Moudad Rana only.
Observations By Dr Brig Muwadid Hussain Rana
(Dated 22 June 09)
9.     51 years old lady-wife of a senior Army officer with a strong family history of bipolar affective disorders coupled with almost a decade’s history of valid fluctuation of mood. Has had prolonged periods of uncalled for elations of moods at least twice a year during changing seasons.
10.     These periods are interspersed with periods of low mood, profound irritability, weeping spells and a state of anhedaria and lack of energy, will and enthusiasm.
Attempts of shifting her from Escitalopram (Cipralex) to Prosectum (Seroxat), have led to worsening of her state. Extensive use of Benzodrazepina or es(alprazolam-Alp) have not helped her.
11.     In the light of above she is diagnosed to be suffering from Bipolar Affective Disorder. Currently in a MIXED AFFECTIVE STATE, she needs to go on to a prolonged use of Valporic Acid as a mood stabilizing drug, alongside management of her mood-states and physical disordersof Hypertensionand Diabetic meltitia.
12.     Advice
Tab Epival 250 mg half daily at bed time X 5 days
Then I daily 5 days
Then 2 daily 5 days
Simultaneously taper of ALP 0.5 mg ½ + ½ X 5 days
Then ¼ +¼ X 5 days
Then stop
Cipralex 10 mg daily
See after 2 weeks
13.     2nd Visit (Dated 06 July 09)
Coping well Mood has stabilized
14.     Advice
Tab Epival 500 mg, one at night
Tab Cipralex 10 mg one daily
Regards
Tariq Butt