A 36 yr old male came with Complaints of upper backache since 9 months.
The patient studied till 9th standard in his village and went to Guwahati, Assam for working as a day labourer in the construction field in 2001/02 at the age of 17. He used to have alcohol from the age of 17 but the quantity consumed was less. He spent 2 to 3 years in guahati and then went to Shillong, Meghalaya to work in the same construction field but he was getting more money compared to Guwahati. In 2003, he was getting work as an independent contractor and was earning around 25,000 rupees of disposable income. During this time, his alcohol intake has increased considerably to around 375 ml per day and he used to smoke a pack of cigarettes a day till the start of covid period during the end of 2019. For Almost 15 years he was drinking alcohol and smoking incessantly.
In 2010, he had septoplasty with Grommet insertion in left ear
By 2012-13, he had savings of around 10-12 lakhs and he wanted to build a house with the money he had but due to his father illness who had issues with his liver, the patient had to spend around 5 lakhs on the treatment of his father. His father had passed away in 2014. Just before his father passing away, on the insistence of his relatives he got married in the end of 2013. He again went back to shillong for the work as usual.
2016, he got the house constructed where his family(himself, wife and two kids aged 7 and 2) has stayed since then. His 2 brothers stay at the house built by the patient’s parents.
During the construction of the house, the patient wanted to build a small temple in the premises of his house but he could not complete it due to lack of money. This is one of the important factor in the history of the patient.
In around 2018 he was having pain in the lower abdominal region which was later detected as hernia after making visits to atleast three hospitals. Ultimately he got operated for hernia. One significant point about the pain in the abdominal region before detecting as hernia was that the patient went to a priest asking for advice for his abdominal pain and the priest directed and highlighted the fact that the INCOMPLETE TEMPLE has to be completed if his problems with health have to be solved. The patient has a strong inclination that the incomplete temple in his house is having some impact on his health and also he fears that this factor might negatively affect his children and his family also.
After the start of Covid from the beginning of the year 2020, he stayed in his village in north Bengal and he could not go to shillong which was his work place since almost 15 years. He was doing heavy physical work in shillong but in his village he started to live a sedentary life. He had started a small grocery store and he says he is earning less than half the amount which he used to earn in shillong.
Since the time of start of covid, his alcohol and smoking habits have also decreased and he now says he drinks alcohol in very meagre amounts that too once in a month or two. He stopped smoking now since almost 2 years.
Since one year he is having issues with pain in upper back, bilateral shoulder pain associated with cramping (on&off) after moving heavy objects. He is having discomfort while swallowing food, formation of gas in stomach. These issues seems to have started after he became sedentary after 20 years of hard physical labour work.
Provisional diagnosis -
Symptoms | 0 = no problem 5 = severe problem | |||||
|---|---|---|---|---|---|---|
| 1. Hoarseness or a problem with your voice | 0 | 1 | 2 | 3 | 4 | 5 |
| 2. Clearing your throat | 0 | 1 | 2 | 3 | 4 | 5 |
| 3. Excess throat mucus or postnasal drip | 0 | 1 | 2 | 3 | 4 | 5 |
| 4. Difficulty swallowing food, liquids, or pills | 0 | 1 | 2 | 3 | 4 | 5 |
| 5. Coughing after you ate or after lying down | 0 | 1 | 2 | 3 | 4 | 5 |
| 6. Breathing difficulties or choking episodes | 0 | 1 | 2 | 3 | 4 | 5 |
| 7. Troublesome or annoying cough | 0 | 1 | 2 | 3 | 4 | 5 |
| 8. Sensation of something sticking in your throat or a lump in your throat | 0 | 1 | 2 | 3 | 4 | 5 |
| 9. Heartburn, chest pain, indigestion, or stomach acid coming up | 0 | 1 | 2 | 3 | 4 | 5 |
| RSI > 13 = Abnormal | Total | |||||
| Subglottic edema | 0 = absent |
| 2 = present | |
| Ventricular | 2 = partial |
| 4 = complete | |
| Erythema/hyperemia | 2 = arytenoids only |
| 4 = diffuse | |
| Vocal fold edema | 1 = mild |
| 2 = moderate | |
| 3 = severe | |
| 4 = polypoid | |
| Diffuse laryngeal edema | 1 = mild |
| 2 = moderate | |
| 3 = severe | |
| 4 = obstructing | |
| Posterior commissure hypertrophy | 1 = mild |
| 2 = moderate | |
| 3 = severe | |
| 4 = obstructing | |
| Granuloma/granulation tissue | 0 = absent |
| 2 = present | |
| Thick endolaryngeal mucus | 0 = absent |
| 2 = present |
