Alava Ramya Tulasi Tejasri 11

  Living With Transfusion-Dependent Thalassemia: A Long Medical Journey In the early months of life, a child who appeared healthy began showing signs that something was seriously wrong. At around 3 months of age, during a routine visit for polio drops, severe anemia was detected. Hemoglobin was critically low at nearly 3 g/dL, and the reticulocyte count was elevated at 11%, suggesting ongoing hemolysis and marrow stress. At that stage, the diagnosis was unclear. Possibilities such as dyserythropoietic hemolytic anemia were considered. Initial sickling tests were negative. However, further hematological workup gradually pointed toward a severe hemoglobinopathy. In July 2002, HPLC testing revealed: HbF around 88.7% HbA2 approximately 3.34% Markedly reduced adult hemoglobin fractions This pattern strongly suggested severe beta-thalassemia. Soon afterward, the child required the first blood transfusion of about 150 mL. Unfortunately, this was not a one-time event. Recurrent s...

  Self-Erasure Is a Symptom. We Reward It. Patients Pay My grandmother refuses to go to the hospital even when care is free.She says her pain is “not serious enough.” She worries about wasting doctors’ time. She apologizes for being unwell. Clinically, she looks stable. Medically, she is not. What she has is not stoicism . It is self-erasure. Self-erasure is not a personality trait. It is a learned belief that one’s needs are a burden and must be minimized to deserve care. It develops under scarcity, violence, gendered expectations , and chronic guilt. It is common. It is dangerous. And medicine keeps missing it. Patients with self-erasure do not say “I am suffering.” They say “It’s okay.” They say “Others need it more.” They say “I’ll manage.” Clinicians often hear these as reassurance. They are not. They are warning signs. We call the outcome late presentation . We blame awareness, access, compliance. But the delay is not logistical. It is moral. These patients ra...

  The Cost of Better Choices I didn’t fail to choose because I was careless. I failed to choose because I was trying to choose correctly . An air fryer with ten modes. A CCTV camera that also runs on solar power. Phones with endless configurations. Robot vacuum cleaners that promise intelligence. I didn’t buy most of them. Not because I didn’t need them but because the number of options quietly overloaded me. Repairing my old phone had a lower cognitive cost than choosing a new one. This wasn’t minimalism. It was exhaustion. The same pattern repeated elsewhere. I couldn’t buy a watch for my brother. The options were endless, the standards invisible, and the fear constant: What if there’s a better one I’m missing? When my other brother finally bought it, I felt relief not because the decision was made, but because the responsibility was no longer mine . Buying gifts became another trap. Too many choices meant no single choice felt sufficient. Once, I bought two gifts ins...

 A 68 YEAR OLD FEMALE CAME TO OPD WITH COMPLAINTS OF PAIN ABDOMEN SINCE 4 DAYS  FEVER WITH CHILLS SINCE 4 DAYS VOMITINGS AND ABDOMINAL DISTENSION SINCE 3 DAYS CONSTIPATION SINCE 2 DAYS PATIENT WAS APARANTLY ASYMPTIMATIC 1 WEEK BACK THEN SHE HAD COMPLAINTS OF LOOSE STOOLS 3-4 EPISODES WATERY,NOT ASSOCIATED WITH BLOOD AND MUCOUS, LARGE VOLUME,BLACK COLOURED LASTED FOR 2 DAYS,THEN SHE HAD COMPLAINTS OF PAIN ABDOMEN,DIFFUSE,SQUEEZING TYPE ASSOCIATED WITH  COMPLAINTS OF FEVER  WITH CHILLS,INTERMITTENT,NO EVENING RAISE OF TEMPERATURE ,WITH VOMITINGS,BILIOUS,NONPROJECTILE FOR 4 DAYS AND ALSO COMPLAINTS OF  OBSTIPATION SINCE 2 DAYS CLINICAL CASE OF DIABETES MELLITUS SINCE 10 NYEARS ON MEDICATION. NOT A CLINICAL CASE OF  HYPERTENSION,TB,ASTHMA,CAD,EPILEPSY,CVA   PERSONSAL HISTORY MIXED DIET APPETITE:LOST SINCE 1 WEEK SLEEP: ADEQUATE CONSTIPATION SINCE 2 DAYS BURNING MICTURITION SINCE 10 DAYS ADDICTIONS NONE   GENERAL EXAMINATION PATIENT IS CONSCIOUS...

 COURSE OF LIFE EVENTS:PERSONAL HISTORy 58 male hailing from narayanapuram ,choutuppal, born in 1964 A 6 years got seizures,  from 7th class he got one sided headache associated with bilious vomiting ( stopped at 32 years) studied until 10th class ,kabaddi player long jump(13feet) ,  he started smoking, From 1990 he started consuming alcohol,1994 he got job as a  supervisor in mumbai , got addicted to gambling and alcohol 75ml per day for 15 years , usually smokes 30 cigarrette per day for 15 years , Rich person at those times, usually takes high protein diet.  admitted in hospital for cold with  headache done spinal injection( lumbar puncture ? meningitis?)for 20 days . He quit smoking and alcohol there after .He quit job in mumbai due to some brother disputes and lost his money .He does real estate and also upasarpanch has anger episodes in 2000s ,he got swelling at 1st MTP with severe pain , swelling developed in a day  , joined in a hospital for 10...