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Last updated: 2026-06-06 (RECOVERY CONFIRMED: June 6 comprehensive panel — ANC 1240 [exited severe neutropenia], WBC 2500 [recovering], Hb 12.1 [NORMALIZED], Plt 241K [stable normal], RBC 3.82 [near-normal]; MCV improved to 96.3, RDW improved to 17.2; electrolytes stable normal; Cr 0.6, LFTs all normal; 16 lab marker pages updated; source count 66 → 67; no new pages)

Profile

  • Profile — Ishamma T M (DOB 1944-07-01, Female)

Active Conditions

  • Aml — Acute Myeloid Leukemia with MDS-related gene mutations (adverse-risk, Aza-Ven)
  • Diabetes Mellitus — Type 2, 3 active DM meds (insulin degludec, linagliptin, metformin); insulin glargine NOT being taken (confirmed 2026-05-06); poor control (fructosamine 310)
  • Hypertension — Newly documented 2026-05-04 (PRESUMED based on losartan + nifedipine on Rx; NO BP readings documented)
  • Elevated Esr — Improving with treatment
  • Positive Ana — ANA 2.2, significance uncertain

Resolved Conditions (as of May 2026)

  • Pancytopenia — Resolved May 2026 (WBC, ANC, Plt all normalized; Hb 11.9 approaching normal)
  • Anemia — Resolving May 2026 (Hb 11.9, only 0.1 below normal threshold)
  • Hyponatremia — Resolved May 2026 (Na 142, first normal since Jan 2026)
  • Herpes Zoster — Prior shingles episode (date unknown). Zostavax ~2016. Acyclovir prophylaxis ongoing.

Medications (Active) — 13 TOTAL (2026-05-06)

[!danger] MAJOR MEDICATION RECONCILIATION GAP DISCOVERED 2026-05-04
Handwritten prescription revealed 9 medications NEVER previously documented. Critical safety concerns: posaconazole-atorvastatin interaction (RESOLVED: patient not taking atorvastatin), posaconazole-nifedipine interaction (RESOLVED: patient not taking nifedipine), dual basal insulin (RESOLVED: insulin glargine not being taken — degludec only), prednisolone in diabetes (RESOLVED: patient not taking prednisolone), pregabalin fall risk (age 81 — still active).

  • Active Medications — Updated 2026-05-06: magnesium-oral reinstated active at 400 mg TID (13 active)

AML Treatment + Supportive Care (5)

  • Azacitidine — Hypomethylating agent for AML
  • Venetoclax — BCL-2 inhibitor for AML
  • Acyclovir — Antiviral prophylaxis (HSV/VZV)
  • Posaconazole — Antifungal prophylaxis; CYP3A4 inhibitor (venetoclax boosting strategy; atorvastatin/nifedipine interactions now moot)
  • Renerve — B-vitamin complex (B12, B6, ALA, folate)

Diabetes Medications (3) — Newly Documented 2026-05-04

  • Insulin Degludec — Basal insulin, 10 units daily (only active basal insulin — glargine not being taken)
  • Linagliptin — DPP-4 inhibitor, 5 mg daily
  • Metformin — Biguanide, 500 mg TID (1500 mg/day total)

Cardiovascular Medications (1) — Newly Documented 2026-05-04

  • Losartan — ARB, 50 mg daily (HTN / diabetic nephropathy)

Neuropathic Pain (1) — Newly Documented 2026-05-04

  • Pregabalin — 75 mg daily (presumed diabetic neuropathy, NO symptoms documented; fall risk age 81)

Supplements (3) — Newly Documented 2026-05-04; Mg dose confirmed 2026-05-06

Discontinued

  • Pegfilgrastim — G-CSF, discontinued 2026-03-30 (bone pain)
  • ~~Magnesium Oral~~ — REINSTATED 2026-05-06 — see active Supplements above (400 mg TID)
  • Nifedipine — NOT BEING TAKEN (confirmed 2026-05-06; posaconazole-nifedipine interaction RESOLVED)
  • Atorvastatin — NOT BEING TAKEN (confirmed 2026-05-06; posaconazole-atorvastatin interaction RESOLVED; no statin currently active)
  • Insulin Glargine — NOT BEING TAKEN (confirmed 2026-05-06; degludec is sole basal insulin)
  • Prednisolone — NOT BEING TAKEN (confirmed 2026-05-06; steroid risks resolved)
  • Simvastatin — Low-intensity statin (10 mg bedtime, Nov 2022); replaced by atorvastatin before 2026
  • Menorease — Herbal menopausal supplement (Nov 2022); discontinued before 2026
  • Vitamin E — Evitol 400 mg (Nov 2022); discontinued before 2026; replaced by renerve antioxidant overlap
  • Pregmerve — Multivitamin/folate (Nov 2022); discontinued before 2026; likely replaced by renerve

Procedures

Lab Markers Tracked

  • Lab Trends — Master longitudinal tracker
  • Hemoglobin — 32 data points (Nov 2025 – June 2026), 12.1 g/dL (June 6) — RECOVERED TO NORMAL from 11.3 (June 1); second sustained normal since diagnosis
  • Wbc — 33 data points (Sep 2022 – June 2026), 2500 cells/cumm (June 6) — RECOVERY +300 from June 1 nadir (2200); leukopenia improving
  • Anc — 31 data points (Nov 2025 – June 2026), 1240 cells/cumm (June 6) — EXITED SEVERE NEUTROPENIA (was 990 June 1); moderate neutropenia, infection risk downgraded
  • Platelet Count — 32 data points (Sep 2022 – June 2026), 241 K (June 6) — stable normal; bleeding risk resolved
  • Rbc Count — 31 data points (Sep 2022 – June 2026), 3.82 million/cumm (June 6) — near-normal recovery +0.29 from June 1; only 0.02 below normal threshold
  • Mcv — 32 data points (Sep 2022 – June 2026), 96.3 fL (June 6) — improved −3.7 from June 1 peak (100 fL); macrocytosis decreased
  • Rdw — 32 data points (Sep 2022 – June 2026), 17.2% (June 6) — improved −1.1 from June 1; anisocytosis decreased
  • Sodium — 25 data points, 139 mmol/L (June 6) — stable normal
  • Esr — 5 data points (Sep 2022 – Feb 2026)
  • Crp — 3 data points
  • Hba1C — 3 data points (Jul 2025 – Mar 2026), unreliable in AML
  • Fructosamine — 1 data point (Apr 2026), HIGH — preferred glycemic marker
  • Mcv — 30 data points (Sep 2022 – May 2026), persistent macrocytosis (95.0 fL May 27, stable)
  • Rdw — 30 data points, persistent anisocytosis (17.8% May 27, stable)
  • Chloride — 24 data points, 99 mmol/L (June 6) — stable normal
  • Potassium — 23 data points, 4.8 mmol/L (June 6) — stable normal
  • Bicarbonate — 22 data points, 28.2 mmol/L (June 6) — stable normal
  • Ana — 1 data point (positive)
  • Anti Dsdna — 1 data point (negative)
  • Reticulocyte Count — 1 data point (normal)
  • Anti Ccp — 1 data point (negative, ruled out RA)
  • Complement C3 — 1 data point (normal)
  • Complement C4 — 1 data point (normal, upper end)
  • Ceruloplasmin — 1 data point (normal)
  • Copper Serum — 1 data point (normal, Wilson's ruled out)
  • Spep — 1 data point (inflammatory pattern, no M-spike)
  • Free Light Chains — 1 data point (polyclonal elevation, normal ratio)
  • D Dimer — 1 data point (normal, 2022)
  • Total Ige — 2 data points (elevated, 2022)
  • Peripheral Smear 2025 11 19 — Pre-AML pancytopenia with eosinophil predominance (DDRC)
  • Peripheral Smear 2025 11 17 — KIMS PBF: pancytopenia, eosinophils 18%, macrocytes
  • Folic Acid — 1 data point (>20, normal, folate deficiency ruled out)
  • Iron Profile — 1 data point (transferrin low, TSAT normal — anemia of chronic disease)
  • Lft — 4 data points (Jan, Mar, Apr & June 2026), all normal — no hepatotoxicity confirmed
  • Creatinine — 7 data points (Nov 2022 – June 2026), 0.6 mg/dL (June 6) — stable normal renal function
  • Magnesium — 5 data points (Mar & May 2026), 1.5 mg/dL (May 11) — below normal
  • Lipid Panel — 2 data points (Jul 2025 & Mar 2026, optimal)
  • Calcium — 4 data points (transient hypercalcemia Jan 19, resolved by Jan 22)
  • Creatinine — 5 data points (stable normal renal function through treatment)
  • Urea — 2 data points (normal, Jul 2025 & Apr 2026)
  • Lab Timeline — Chronological lab result log (all dates)

Imaging Studies

Providers

Insurance

Syntheses

  • Qol Bang For Buck — Highest-impact quality of life interventions, ranked by effort vs. return
  • Mrd Targets Explained — MRD targets: what they are, why they matter, and Ishamma's MRD landscape
  • Ngs And Mrd Importance — NGS and MRD: clinical importance, NGS→MRD pipeline, Ishamma's status, why monitoring matters without transplant eligibility
  • Counter Intuitive Insights — 8 counter-intuitive patterns in Ishamma's medical data (HbA1c illusion, liver resilience, fall risk > cancer risk, 2022 mystery, etc.)
  • 2022 Inflammatory Episode Clonal Evolution — Hypothesis: 2022 inflammatory storm (CRP 128, WBC 14.7K, Plt 501K) as early signal of dysplastic clone, with phenotype shift to AML bone marrow failure by 2025
  • Cyp3A4 Metabolizer Venetoclax Implications — CYP3A4 metabolizer status implications: hepatic resilience raises question of rapid metabolism, which could undermine the posaconazole-venetoclax dose-reduction strategy
  • Treatment Regimen Assessment — Overall treatment regimen assessment: Aza-Ven appropriate and responding, but significant monitoring/documentation gaps (no drug levels, no MRD, doses unknown)
  • Vaptan Assessment — Vasopressin receptor antagonist assessment: both vaptans contraindicated due to posaconazole CYP3A4 interaction; fluid restriction + salt + Mg correction preferred
  • Medication Cessation Risk Assessment — What would happen if all medications stopped: interlocking system analysis, timeline of deterioration, compounding risk factors
  • Siadh Diet Indian Context — Dietary strategies for SIADH management in Indian/Kerala context: fluid restriction, salt loading, protein, magnesium-rich foods, sample meal plan
  • Magnesium Diet Kerala Context — Kerala-specific dietary magnesium augmentation: tiered food table (ellu, kadala, ragi, muringa ila, cashews), sample day plan, neutropenia safety rules, caveats for DM/SIADH/renal function
  • Non Hematology Labs Insights Apr2026 — Integrated non-hematology lab analysis, Apr 20 2026: electrolyte disturbance (Na 128 nadir, Mg 1.2 worsening, Cl 93, HCO3 22.8), stable renal/hepatic function, HbA1c interpretive caution; euvolemic/SIADH pattern confirmed; 6 monitoring gaps identified
  • Magnesium Glycinate Oral Dosing — Oral Mg glycinate prescribing reference: start 200 mg elemental Mg b.i.d., escalate to 800 mg/day, maximum 1200 mg/day (400 mg t.i.d.); IV MgSO₄ threshold and formulation rationale for Ishamma
  • Duloxetine Vs Mirtazapine Diabetic Neuropathy — Duloxetine vs. mirtazapine for DPN: duloxetine preferred (FDA-approved first-line, no posaconazole CYP3A4 interaction); mirtazapine relatively contraindicated by CYP3A4 interaction with posaconazole, glycemic worsening, and additive fall risk with pregabalin
  • Grapefruit Fruit Juice Restrictions — Grapefruit/Seville orange/pomelo strictly contraindicated: CYP3A4 interactions with venetoclax, atorvastatin, and nifedipine, compounded by posaconazole; regular grape juice is safe
  • Travel Clearance 2026 05 27 — Travel clearance assessment (2026-05-27): NOT travel-suitable — active myelosuppressive nadir (Hb 9.9, Plt 103K, ANC nadir imminent), no G-CSF backup, symptomatic anemia risk, thrombocytopenia, poor DM control. Requirements for clearance documented.
  • Lint Report 2026 05 06 — Full wiki lint report: ~127 pages audited, 3 auto-fixes applied, 15 flags (5 clinical, 6 documentation, 4 structural); clean: 0 broken links, 0 orphan pages, 0 frontmatter violations

Queries

  • Lint Report 2026 05 06 — Full wiki lint report: ~127 pages audited, 3 auto-fixes (pancytopenia resolved, hyponatremia resolved, imaging timeline populated), 15 flags (BP undocumented, falls risk absent, fructosamine due ~May 20, Cr due, prednisolone indication unknown, oncology doses unknown)
  • Lint Report 2026 05 03 — Full wiki lint report: 103 pages audited, 3 auto-fixes, 11 flags (ECG, fructosamine due, DM meds gap, imaging empty, SIADH workup missing)

Raw Sources Ingested: 67

Pages: 99 (no new pages)

Last ingest: 2026-06-06 (RECOVERY CONFIRMED: June 6 comprehensive panel — ANC 1240 [exited severe neutropenia], WBC 2500, Hb 12.1 [normalized], Plt 241K, RBC 3.82 [near-normal]; MCV/RDW improved; electrolytes/Cr/LFTs all normal; 16 lab marker pages updated)

Last refine: 2026-04-17

Last lint: 2026-05-06

Last query writeback: 2026-05-06 (/lint synthesis filed)

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