Clinic Visit Note — Jothydev's Diabetes Centre, 25 Nov 2022
Clinic Visit Note — Jothydev's Diabetes & Research Centre (2022-11-25)
Facility: Jothydev's Diabetes & Research Centre, Mudavanmugal, Thiruvananthapuram
Physician: Dr. Jothydev Kesavadev MD (Ref); Dr. Arun Shankar (Attending)
OP No: 4096 | UHID: 4096/EC Economy Category | Lab No: 22-33976
Visit date: 2022-11-25
Patient age: 74 years
Visit Summary
Annual/routine diabetic follow-up with comprehensive foot screening at Jothydev's Diabetes & Research Centre. This was a dedicated diabetic care visit covering:
1. Complete blood count (CBC)
2. Renal function tests (RFT)
3. Fasting blood sugar (FBS)
4. HbA1c
5. CRP
6. ABI Doppler vascular study
7. Biothesiometry (vibration perception threshold)
8. 10g Monofilament test
9. Medication review and prescription
Labs from Handwritten Note (IMG_9748)
The handwritten clinic note (left side) recorded the following values — some overlap/confirm the JDC Lab reports:
| Test | Value | Note |
|---|---|---|
| Hb | 12.1 | g/dL — slightly different from JDC lab CBC (12.4); same-day measurement variability |
| Plt | 68 | K? (unclear units — if K/µL, this is thrombocytopenic; see note below) |
| CRP | 1.5 | mg/L (confirmed JDC lab: 1.5 mg/L, normal) |
| BTC | 5.8 | (likely BTC = Blood Triglycerides, or possibly HbA1c — HbA1c was 5.8% per JDC lab) |
| Creat | 0.7 | mg/dL (confirmed JDC lab: 0.7 mg/dL) |
| Uric Acid | 2.0 | mg/dL (confirmed JDC lab: 2.0 mg/dL, LOW) |
| OTLPT | 28/16 | (possibly OT/LPT = AST/ALT?) |
| TC | 140 | mg/dL (Total Cholesterol) |
| TG/H | 50 | (Triglycerides?) |
| LDL | 53 | mg/dL |
| FBH | 1.72 | (possibly FBS? or another marker) |
| Vit D | 74.18 | (likely 74.18 nmol/L or IU/mL — see note) |
| SPGL | 29 | (unclear) |
| Leucocytin +25 N/B/c/Lc | Differential note |
[!note] Platelet 68 discrepancy
The handwritten note records "Plt-68" while the JDC CBC lab report shows Platelet Count = 2.3 lakhs/cumm (230,000). This discrepancy is large. Possible explanations:
- The handwritten "68" may refer to a different unit or parameter
- The handwritten note may have been from a different day or lab
- A transcription error in the handwritten note
The formal JDC lab report (platelet count 2.3 lakhs = 230K) is considered more reliable.
The Sep 2022 DDRC labs showed Plt 501K (reactive thrombocytosis). By Nov 2022, even 230K would represent normalization — not thrombocytopenia.[!note] Vitamin D 74.18
Vitamin D value of 74.18 — if ng/mL (nmol/L), this is in the normal-sufficient range (>30 ng/mL). This would be an important baseline. However, units not confirmed on the handwritten note. A dedicated Vitamin D lab report would be needed to verify. Flagged as unconfirmed — cannot create a Vitamin D page without verifying units.
Blood Pressure (Right side of handwritten note)
BP readings noted as part of the visit:
- BP: 152/93 mmHg (first reading — elevated, Stage 2 hypertension range)
- PR: 82/min (pulse rate)
- KX (second measurement): BP 145/69 mmHg, PR: 81/min
- NI: 51.4 (unclear — possibly a reading or index)
BP was elevated at this visit (152/93 and 145/69). This is consistent with the Nifedipine 30 mg prescription below.
Medications Prescribed (as of 2022-11-25)
11 medications documented on the prescription:
| # | Medication | Dose/Frequency | Class | Notes |
|---|---|---|---|---|
| 1 | Inj. Tresiba 10 | Daily (insulin pen) | Insulin (degludec) | Long-acting basal insulin for T2DM |
| 2 | Tab Trajenta 5 | 1-0-0 | DPP-4 inhibitor (linagliptin) | Oral antidiabetic |
| 3 | Tab Glucoformin XL 500 | 1-1-1 | Biguanide (metformin XR) | Oral antidiabetic |
| 4 | Tab Sin 10 | 0-0-T (night) | Statin (rosuvastatin? pravastatin?) | Lipid-lowering |
| 5 | Tab Lo 50 | 0-1-0 | Likely beta-blocker or ARB (atenolol 50 or losartan 50?) | Cardiovascular |
| 6 | Tab Nifedipine 30 | 1-0-T (or 1-0-1) | Calcium channel blocker | Antihypertensive |
| 7 | Tab Menoease | 1-0-0 | Menoease = typically a herbal/nutraceutical formulation | Supplement |
| 8 | Tab Vit D 2000 | 1-0-0 | Vitamin D3 supplementation | Supplement (2000 IU) |
| 9 | Tab Pregmerve 1b | 1-0-0 | Pregabalin 75mg? or Pregmerve B — likely pregabalin/methylcobalamin combo | Neuropathic pain |
| 10 | Tab Evitof | 0-0-T (old) | Possibly alpha-lipoic acid or similar | Neuropathic supplement |
| 11 | Tab Macnomed | 1-0-P × 15 days | Possibly macrolide antibiotic × 15 days, or a nutraceutical | Short course |
Follow-up: 2 days, then 3 months
[!info] Clinical Picture from Prescription
The medication list reveals the patient's active comorbidities as of Nov 2022:
- Diabetes mellitus (on insulin + 2 oral agents: metformin + linagliptin)
- Hypertension (on Nifedipine 30 mg + likely another antihypertensive [Lo 50])
- Dyslipidemia (on statin [Sin 10])
- Diabetic peripheral neuropathy (on pregabalin/Pregmerve + Evitof)
- Vitamin D insufficiency (on Vit D 2000 IU)This fills a major gap in the medical history — the patient had type 2 diabetes being managed with insulin by Nov 2022, which had not previously been documented in the wiki. The current wiki lists no diabetes-specific medications — this confirms those medications were active in 2022 but are not documented during the AML treatment period (2025–2026).
Foot Screening Summary (Nov 2022)
| Test | Result | Interpretation |
|---|---|---|
| ABI (bilateral) | 0.92 / 0.92 | Normal |
| TBI (bilateral) | 0.69 / 0.69 | Borderline abnormal |
| Biothesiometry avg | R: 33V / L: 29V | Moderate neuropathy risk |
| 10g Monofilament | All sites intact | Protective sensation present |
| Overall foot risk | Low-to-moderate | Normal macrovascular, borderline microvascular, subclinical neuropathy |
Chronological Context
This visit is from 3 years before AML diagnosis (Nov 2022 → Nov 2025). The 3-year gap (Sep 2022 – Jul 2025) identified in the vault as a data gap is partially filled by this visit. Key contextual data:
- HbA1c 5.8% in Nov 2022 (on full diabetic meds) vs 6.7% in Jul 2025 (off meds?) — suggests glycemic control worsened between 2022 and 2025
- Sodium 132 in Nov 2022 — mild hyponatremia already present 3 years before AML diagnosis (previously thought to have started with AML treatment)
- WBC 10,500 in Nov 2022 — in normal range, between the Sep 2022 inflammatory peak (14,770) and the Nov 2025 AML presentation (2,320)
Related Pages
- Diabetes Mellitus — Primary diagnosis managed
- Hba1C — HbA1c 5.8% this visit
- Fasting Blood Sugar — FBS 68 this visit
- Sodium — Na 132 this visit (pre-AML hyponatremia)
- Creatinine — Cr 0.7 this visit
- Jothydev Kesavadev — Managing physician
- Abi Doppler 2022 11 25
- Biothesiometry 2022 11 25
- Monofilament 2022 11 25
Sources: raw/assets/20260429_IMG_9748.jpeg through raw/assets/20260429_IMG_9754.jpeg (all 7 images from this ingest)