A man, Mr S. age 37 came with his wife for the treatment of his obsessive compulsive disorder. He has hypertension from last 7 yrs. and taking Lisinopril 10 mg daily once. He has been diagnosed as a pre-diabetic too recently. Works in IT industry.
Big tummy, but looks lean thin, height 5’.6’’ weight 160lbs. fair, thin hair.
Mr. S started telling, “Couple of months back in Nov 2013, I had a feeling as if I am having heart attack. I called my wife from office and said get ready and I will be there soon; we are going to the urgent care.”
I was telling my wife, “look my palms are sweating and my pulse is beating faster. I have pain in chest.” The physician took his ECG and all was normal.
Then we visited our physician the next afternoon and he said it’s a panic attack. And if you want I can prescribe you some medicine that will help you reduce these symptoms.
He prescribed alprazolam which is a sedative, sleep medicine.
Wife said: We went there and it was obvious that he has nothing wrong with his heart. He was fine but inside he had that feeling as if he has heart attack.
Wife: I insisted him to take only when he really needed. And there should be some really holistic medicine which will act on him completely giving relief and not just removing the symptoms for time being. So I brought him to you.
I know he will not talk much so I will tell you all the details. He does not listen to me; he feels very irritable in small small things; he gets angry easily. He does not want to exercise. He has increased weight, his tummy is so big and he has been diagnosed as pre-diabetic. Already has high pressure; he will not sleep well too.
He has some habits like he will wash his hands very commonly.
He will drink water for 5 times means he will take exact 5 sips and after every sip he will do namasakar (Namaste with hands) to the God. He will never leave the kitchen then if there are odd numbers; the odd minutes in the oven clock. He will never face south and do any important work.
He will do all these rituals each and every day. He calls them all his processes; but then also he will forget his phone at office or at home. He will forget his glasses too at home or restaurants.
I once told him that you have OCD and he laughed but when he googled then he realized and accepted.
Mr. S, “Oh yeah I will add one more thing that I listen to one particular singer’s songs on particular timing. Means 10 to 11 am only specific singer's songs.”
Wife: He many times speaks too in poems which he himself makes or are very famous poems or songs.
He has anxiety especially for future life. He many a times worry about retirement. What will happen financially after his retirement. We should have sufficient finances to sustain in the world. He does not worry that much about our daughter’s future or college fees though.
Frankly speaking after having SEX he says he will feel better or relaxed; but I don’t feel to have it so frequently. He says many times in joke that I did not get good sex partner, I got a good wife but … a woman should be like who gives that satisfaction to the husband. That does not mean he is not happy with me but he has many ideas/ ideal concepts related to sex. One should have so many times in a week, before 40 one should enjoy it, once you cross 40 there is no charm.
He has many concepts in the manner of ideal situations in general. My world should be like this. I should have a cool and cozy house; enough money for retirement. In young age a good sex life. As once we grow older what else we have to think about then.
Parents: Both Hypertension, Diabetes
Grandparents: Paternal: both died of old age; no history of any major illness
Maternal: Grandmother died of chronic kidney disease had diabetes,
Grandfather had hypertension.
Review of Systems:
Circulatory: Hypertension and on daily medication from last 7 yrs. BP: 124/94mm of Hg, pulse: 80/min
Nervous: sleep disturbed sometimes, forgetfulness, headache: dull kind of pain in temples, during day time. It will be there many times.
Skin: few warts on neck; mother and aunt has many warts on face, and neck.
Respiratory: had bronchitis in childhood and treated with penicillin
GI: HAS MANY TEETH DECAYED, CARIES, ROOTCANAL DONE TO MANY MOLARS. Appetite good, thirst increased and drinks water in sips as a part of his rituals. He says, “Your urine should be clear like water.”
Reproductive: has many concepts/ ideas for sex (according to wife)