2020年11月5日星期四

hemorrhoids and ibs,PMP-T506 friends training learning plan

    PMP-T506 female, 29 years old. Yichang training number: PX0658 First consultation time: December 16, 2018 Time to obtain training number: December 28, 2018 Time to obtain PMP number: March 17, 2019

    [Consultation link] https://fangqing123.haodf.com/doctorteam/flow_team_6465193677.htm

    (1) Personal general information report: (1) Gender: female, date of birth: 1989, native place: Hubei

    Marital status: unmarried, ready to get married

    Educational background: undergraduate

    Occupation: company salesman

    Economy: Average

    Personality: strong personality, easy to be irritable, depressed

    Hobbies: I like to watch mobile news and occasionally watch movies

    (2) Height: 156cm

    Weight: 46kg

    blood pressure:/

    Background information on other diseases of past non-liver disease: hemorrhoids

    (3) Living and working conditions:

    Including diet: normal diet, usually more vegetarian, see nausea

    Drinking water: less, one cup a day

    Work and rest patterns: work reasons, sleep late, fall asleep 11:30-12:30

    Bad habits: no smoking, no drinking,

    Exercise: Do not exercise much morning and evening, but there will be a certain amount of exercise at work

    Life pursuit: filial piety to mother, husband and wife, have a healthy baby, work smoothly, stable and happy.

    (2) General information about hepatitis B

    (1) Hepatitis B discovery experience and treatment process:

    The physical examination of the college entrance examination found that there was no concept at the time. It was different from the classmates’ yin and yang. The mother was very nervous and took to the doctor. The third people’s hospital hepatologist, the doctor replied that there was no need to take medicine. The mother said that he still had to take one. Chinese medicine for the month, and later went to university, but I didn’t review it! Later, the intern doctor prescribed hepatoprotective drugs for a few months, and then returned to Yichang for a review. The transaminase was elevated. The doctor suggested to use interferon. After 3 months of interferon, all indicators should go to work! During the Chinese New Year review in 2015, the liver function was abnormal. The doctor recommended taking Entecavir for 3 years, and the anti-viral phase started. During the three years, three reviews were very effective! For the last time in early 2017, the big three yang became the small two yang! After the doctor retired, I couldn't contact! But keep in mind that the doctor asked to stop the medication after 3 full years of consumption in March 2018! During this period, I have never changed doctors and have been taking medicine under the guidance of this doctor. Later in 2018, he had liver discomfort and nausea, but at that time, the family was busy and he was afraid that he could not face the liver problem after the examination. So he did not dare to go for the examination. At the end of November, the liver discomfort was severe and he asked for leave for examination. After taking the medicine and taking it for half a month, the side effects are strong, such as nausea, severe bloating, and vomiting. After talking to my girlfriend, my girlfriend recommended Dr. Fang Qing. The results of the examination on November 28 are as follows:

    Gu Bing 295 and Gu Cao 179 exceeded the normal value by 7 times, and the total protein was TP64.11. Total bile acid TBA 10.9. Pre-albumin Pre-ALB101.0 is reduced by one time.

    HBV-DNA 1.22*10 to the seventh power. Alpha-fetoprotein AFP 3.6

    Liver hardness test 6.8

    The results of the inspection on January 20 are as follows:

    Binggu 199, Bingcao 138, prealbumin 124.3

    HBV-DNA 1.19*10 cubic

    The results of the inspection on February 13 are as follows:

    Cinggu 53, Cingcao 49. Prealbumin 79.7

    (2) The influence of hepatitis B on oneself:

    Recently, I have been very worried and uneasy. I cannot concentrate on my work, which has led to a decline in performance. The leaders have complained!

    Secondly, I have reached the stage of discussing marriage with my boyfriend. I am not sure whether it has been infected with him. I am very scared and guilty. Especially now that hepatitis is active, I don't want to face him, which leads to small relationship problems. But I don’t know how to say it. I’m afraid he won’t be able to accept it. I’m afraid he will accept me with a sympathetic attitude. I don’t want to be different from others, and I don’t want to be sympathized! Now taking medicine secretly and paying attention to the condition! Every time I go for an inspection, I find various excuses.

    I don’t know what to do at this stage. I am taking anti-viral and liver-protecting drugs, and I am afraid that taking the drugs will affect my pregnancy next year (I have planned to get married next year). Therefore, I am very worried about whether it will affect my future. life! Really hesitated.

    (3) Family background information of hepatitis B infection:

    My mother had acute hepatitis and was cured. There is no obvious abnormality so far. My father died in an accident last year. My younger sister had been infected during physical examination but healed on her own and she has antibodies in her body. My sister and child are 3 years old this year, very healthy, and have been nursed 24 hours after birth.

    (4) Cognitive level of hepatitis B infection: Patients with three positives who know that liver function is normal are regarded as virus carriers and do not affect work and life, but abnormal liver function is a symptom of hepatitis. And I have repeated drug interventions several times!

    Personal mentality: flustered, but feel young, and found out early, everything is still too late

    Family and family mentality: Family members accept the reality and express the need for active treatment. The fiance doesn’t know yet! Very worried!

    (4) Self-assessment of the risk of hepatitis B disease:

    (1) Discrimination risk: There is no discrimination in the family, and my colleagues don’t know that I have this problem. They haven’t informed them, and try to avoid talking about them.

    (2) Disease risk: The doctor judged that it is chronic hepatitis B, but I know that if you receive the correct treatment and follow up regularly, the disease is not terrible.

    (3) Economic risk: One antiviral drug per day has been greatly reduced in price, and the price can be eaten at the current price reduction. I don't know how far it will develop in the future.

    (4) Occupational exposure risk: Not temporarily, but the expenses cannot be reimbursed by the company, and the reimbursement will be exposed.

    (4) Risks related to poor lifestyle: often stay up late, and these need to be corrected slowly in the future, because in rural areas, often eating bacon, sausages, peppers, etc. will have an impact.

    (5) Self-evaluation of medical seeking ability:

    Through learning, I know that it is very important to establish a stable doctor-patient relationship during running-in. I never changed doctors before seeing a doctor. I used to have a good relationship with doctors and often talked with each other. After the doctors walked around our house. Although I will also look at the knowledge of hepatitis B related science, I will look at some of the usual dietary concerns. Dr. Fang Qing himself was introduced by a girlfriend, who said that Dr. Fang Qing is also well-known in the country for hepatitis B, so there is no question of questioning doctors, and the traditional doctor-patient distrust relationship should not exist. In the days to come, I just need to be patient and follow the doctor's advice. If I don't watch marriage, I will scare myself. In many cases, I will scare myself to death!

    (1) Summary of past experience and lessons of individual seeking medical advice:

    The expected purpose of hepatitis B treatment: liver function returns to normal, viral load is reduced, marriage and childbirth can be normal, and antiviral drugs are best not to affect the next generation. It lasts until the medicine that cures completely comes out and is affordable.

    Execution of doctor's orders: able to perform regular review and follow-up visits, follow the doctor's orders, cognitive intervention is already in progress, lifestyle intervention is slowly changing, and drug intervention is in progress!

    Relevant factors affecting the execution of medical orders: At present, there may be more overtime at work, and the problem of sleeping late may be the biggest problem; secondly, at the age of wanting a child, do not want to take too much medicine to cause unknown effects.

    (6) Personal consultation purpose and improvement plan:

    1. The short-term goal is to reduce transaminase as soon as possible, restore abnormal liver function, and take a normal antiviral drug per day with peace of mind (I think one drug per day does not affect work and life). In view of the above situation, I want to What is the best treatment for my child now with abnormal liver function? This is very important and very urgent and I want to know now.

    2. I have already had my second antiviral treatment at the age of 29. Will it be more serious when I am 40 years old, and even develop into a trilogy of liver cirrhosis and liver cancer? How long will this cycle be?

    3. The long-term goal is to join Dr. Fang’s pmp group, join Dr. Fang’s group, and work with the majority of patients to control hepatitis B, treat hepatitis B with the correct attitude and method, and achieve clinical cure. They also help each other, remind themselves and everyone of regular physical examinations and supervise each other. Strive to live longer!

    Health assistant!

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