Dear Dr Parikshith
I am a 30 year old married woman,.staying with my husband, we got married 1 year ago and settled in Europe.i am writing this mail to get an idea about what action should i take for my problems.
For the last 3 weeks i am feeling so sad,depressed and really stressed out. I am not getting concentration to do anything, this is affecting my daily life as well, i am doing work which needs lot of focus.Below i am listing some of the problems which are keeping me worried these days
First of all my relationship with my husband is not smooth these days, our sexual life is completely a mess. He is having ED so we never had sexual intercourse, i initiated this issue more than a dozen times, but he is just avoiding it,i think he is having performance anxiety.So i was leading a happy sexless married life till now. i was able to accept it because my belief was marriage is more than sex and above all my husband loves me a lot and he is very caring. Recently i started feeling sexual frustration,i feel rejected, don't know why exactly, may be because people around me started asking me about our plans for a baby. So again i raised the issue with my husband, he started crying .i felt really sad. and stopped the discussion.I never had sex with anyone.
Second : I am not at all happy with my current career.I am not enjoying it. But i don't have much choice here, to change. I always wanted to do something which makes me happy and enjoyable, i was working happily in India before marriage . Currently i feel like what i am doing now is meaningless. and my life itself is meaningless.
Third: I am not ready to discuss these issues with anyone else other than my husband(he is not helpful even if i talk ). i don't want to make my family members sad because they are old and have their own problems. i don't have any friends here. my best friends are busy with their own family and kids.
Fourth: Winter in Europe is making me crazy. i am becoming more and more sad during dull ,cloudy days and in snow.
Fifth: my personality is changing a lot these days. i was a very energetic enthusiastic and cheerful lady. But now i am crying for every single silly things, i am crying almost everyday.i can feel that my confidence and self esteem reducing. i am not having a good communication with my parents and sibling, i am always fighting and arguing with then through phone for all unnecessary things.
Sixth:Health issues:I have a history of migraine, which is more frequent nowadays. i am feeling tired everyday and eating a lot of food than normal and i am gaining weight. rarely i have sleep disturbance also.
i am not so comfortable here to go to a doctor, because of the cultural and language differences.But i go if its really needed.
Please give a good recommendation
Thanks for your time
For Your Husband for ED, etc, begin with the following medicine:
BARYTA CARB. 200C
4 PILLS x 3 Times Daily x 30 Days
For your own self, fill-in & answer the case record below PATIENT’S CASE RECORD (FOR FEMALES)
Patient’s General Information
Patient’s Case Reference No.
Father’s/ Guardian’s Name:
Age/Date of Birth:
Single/Married /Divorced/ Widow
E Mail Address:
Nature of Work:
Blood Group with Rh Factor:
PRESENTING COMPLAINTS (Main Problems)
What Is The Problem?
Mention as per serial order.
Explain - Causation / Onset Or Origin Of Each Complaint. (If Known)
Site of the problem?
When and how it started?
How Has It progressed?
Any extension of pains?
Modalities: (How Your Problem Gets Affected?)
When & How Is It Worse or Aggravated?
(Time - Morn, Noon, Eve, Night. Any Particular Season Etc.)
When and how does it become better or relieved?
In Relation To Circumstances:
(Rest/Motion/Ascending/Descending/Turning in Bed/ Exertion/Motion-Slow, Rapid, First Motion, Continued Motion Etc. Any Other)
Temperature And Weather :
(Heat/Cold/Wet/Weather Changes/Thunder Storms-Before, During, After. Etc.)
(Standing/Sitting/Lying (On Painful Side, On Right Side, On Back Etc.)/Bending Double or Any Unusual Position Etc.)
External Stimuli :
(Touch (Hard/Light) / Pressure/ Rubbing/ Light / Noise/ Music/Odor Or Smell Etc.)
In General (Before/During/After) /Hot Or Cold/Any Particular Food Item Etc.
In General/Before/During/After/In First Sleep Etc.
Discharges Like Sweat Etc
Any other problem related to any other system like :
(Gastric Respiratory/Circulatory/Blood /Nervous/ Urinary, Renal/ Endocrine/Hormonal/Reproductive/ Joints or Muscles etc.)
Recent Investigations & Reports if any (Blood, X-Rays, Ultrasound, E.C.G., CT Scan, MRI, etc.):
Can be sent as Attachments also.
Details of Treatment taken till now
PAST HISTORY (Previous Diseases & their Treatment)
Any significant disease like :
(Typhoid/Malaria/Jaundice/Measles/Tuberculosis / Allergies/ Chicken pox etc.)
Any problem of Diabetes/ Hypertension/ Arthritis/ Asthma etc.
Hospitalisation if any e.g. Accident/Disease/Any Surgical operation?
Any treatment taken earlier, its duration and its outcome.
Previous Investigations & Reports if any (Blood, X-Rays, Ultrasound, E.C.G., CT Scan, MRI, etc.)
Any history of same suffering among Blood-related family members i.e. Parents Grandparents, Siblings, Aunts, Uncles and Cousins etc. from maternal or paternal side. Specify your relation with the person.
Any Family History of Diseases like :
(Diabetes Mellitus, Kidney Failure, Stones)
Arthritis like: (Gout/ Osteo Aarthritis/Rheumatoid Arthritis)
Tuberculosis, Cancer /Malignancy, Thyroid / Obesity
Hypertension, Heart Problem / Angina / Coronary Artery Disease
Asthma/ Allergic Bronchitis / Sinusitis / Hay Fever
Skin Disease i.e Psoriasis / Vitiligo / Eczema / Urticaria
Anxiety Neurosis/ Depression/ Psychiatric & Mental Disorders / Schizophrenia, Epilepsy / Paralysis / Stroke
Gonorrhoea /Syphilis or STD/ AIDS
Any Genetic problem, or any other Sickness not mentioned
(Kindly elaborate and mention habits, addictions like Alcohol, Smoking, Tobacco etc.)
Allergies : If any (Known or Unknown Allergens specially Any Drug / Food Allergy )
Tendencies like: (Cold, Viral, Infections, and Boils etc.) or any other.)
Are you Vegetarian or Non Vegetarian? (Diet - Veg / Non Veg)
Do you take Eggs? (Yes / No)
Smoking? (If Yes - How many and since when)
Drinking Alcohol? (If Yes - quantity, duration and frequency)
Any Other Addictions?
Tobacco/ Pan Masala/ Drugs etc?
Temperature? (Normal/Subnormal/ Raised)
Physical Activities? (Walking/Jogging/Swimming/Sports/Playing/ Horse Riding/Wok Outs)
Dancing/Aerobics/Cycling etc. or others? Regular/often /Occasional/ Seldom/Not At All.
SLEEP: (Whether restless/ disturbed/ sound/ position during sleep)?
DREAMS: (Whether regular / occasional. Type of Dreams – Pleasent/ Unpleasent/ Frightful/ Day to day affairs/ Animals/ Snakes/ Water / Journey/ Accidents / Death / Dead people/ Sexual – Wet dreams/ Past Events / Loss or missing something Heights/ Failure / Night Mares etc
Any Other, Explain.
Do you see same dream repeatedly again?
Do you wake up because of dream / Are you able to sleep again easily afterwards / Do you have to make efforts to go to sleep again / Does the same dream continues again?
Do you normally remember / forget the dream?
What is the effect of Dreams on you the following day?
APPETITE: (Whether hunger is proper or not, any food substance allergic to or it suits or does not suit)?
THIRST - How is your Thirst? Please mention the grade of thirst? If you are very thirsty, you may mention grades +, ++ or +++ (Quantity, frequency, liking for cold or normal, or thirstlessness)?
TONGUE: (Whether clean /coated /White /Thick/ ulcerated/ mapped. Any Spots - / Bluish/Blackish. Taste in the mouth – Bitter / Bland/ Rancid/ Metallic / Tastelessness/ Sweetish etc. Any Smell)?
DESIRE or CRAVINGS - (Mention grades of preference +, ++ or +++ For example if you like sweets, mention + or ++ or +++) Sweets, Salty, Sour, Fried, Spicy, Cold or Hot /, Tea, Coffee, Milk, Fruits, Eggs, Meat, Fish, Alcohol etc.)
Anything else Unusual like Mud, Chalk, Pencils etc, Does it cause any problem?
AVERSION or DISLIKE to any like Sweets, Salty,
Sour, Fried, Cold or Hot, Bread, etc. or any thing in particular like Meat/ fish/ egg/ milk/ vegetables/ chocolates etc. Or anything else
URINE : (frequency, character, color , pain /burning, involuntary urination, stress incontinence, any complaints before/during or after urination - Any Blood, Sediments etc ?
STOOL: (Frequency, Bowel movements, constipation, loose/hard, any complaints before/during or after stools. Any Mucus or Blood in stool. Any pain /burning while passing stool)?
Do you have Piles: (Bleeding/ Non Bleeding/ Painful/Painless/ Single/Bunch Degree)?
Any Gas formation: (Belching like small burps or loud Eructations and how you feel after / whether it comes empty stomach or eating after?
SWEATING: (More /Less / Normal Summers/winters .Any particular part where you sweat more, Odour or Smell of sweat does it stain the clothes)
State how you are affected by or how you react to the following :
Cold in general, old Air, Drafts, Cold Winds?
Do you like to cover your head (or wear a cap) when you go out in the cold or when exposed to the draft of cold air?
Warmth in general, warmth of bed or room, External warmth like Hot Fomentation etc?
Weather: Dry, Cold wet, Rains, Cloudy etc?
Thunderstorms / Open Fresh Air
Near the Sea / Mountains
Eating and Drinking (Before, During and After
Any particular item of Food / drinks which adversely affect you or make you sick?
Closed, Crowded places, Elevators / Lifts etc.
Exertion or Physical Strain, Mental Strain?
Lack of sleep?
In what part of the day i.e. 24 hours do you feel the Best or Worst?
Does your trouble tend to occur or become worse, periodically (e.g. Daily, or Alternate days, Weekly, Monthly, Yearly, during New or Full Moon etc?)
THERMAL REACTION Feel Heat / Cold more, Senstivity/tolerance, any coldness of the Hands/Feet.
Mention about sexual difficulties
Menarche: (At what Age did the Ist Menses started)?
Menopause: Age when menses stopped. Any complaints/symptoms associated with it.
Date of Last Menstrual Period?
Menses : (Regular / Irregular /Early /Late /Painful Non
Duration of cycle: (After how many days you get your periods.)
Duration of flow: (For how many days the Bleeding remains).
Character of flow :
(Thin/Fresh/Clotted/ Intermittent/ Dark/ Bright Red/ Black/ Stringy / Irritating )
Amount of flow : Scanty/Less / More /Profuse
Odour : Offensive/ Strong Smelly/ Normal
If Painful Menses: (location and character, Is it Continuous or Spasmodic?) Breast pain or hardness of the breast.
When does it start, any relation of pain with flow of blood. How does the pain Increases or Decreases?
Any other symptom associated (e.g. Headache, Backache, Vomittings, Vertigo, and Faintness etc.
Leucorrhoea / Watery Discharge: (Thin / Thick/ Stringy; Scanty / Moderate / Profuse; Irritating / Burning /Bland; Color – White/ Transparent / Milky/ Yellow/ Bloody etc. Smell – Offensive / Non Offensive; Staining / None Staining.
Intermenstrual Bleeding : (Yes / No)
Any PMT: (Pre-Menstrual tension)? Do you have any complaints associated with, before, or after menses? e.g. Moods Swing , Headache, irritability Anger Weeping Depression Diarrhoea or Constipation
Any change in your skin around menses?
Contraceptive History: - Oral Pills/ IUCDs/ Tubectomy & the effects thereafter
Any history of Venereal Disease? (E.g Gonorrhoea, Syphilis, Herpes, AIDS.)
Sexual Behaviour? (Single / Multiple Partners; Bi-Sexual ; Homosexual ; Lesbianism; Indulgence ; frequency ; Masturbation etc.)
Any Problem like? (Orgasms, Painful intercourse; Vaginal dryness, breast sagging, Partial or Complete loss of interest in sexual activities Specify if any other problem?)
Desire / Dislike/ Hate to Inter Course / How does Sexual activities affect you?
Any persistent sexual thoughts / dreams / fantasizes.
OBSTETRICAL HISTORY: (For Mothers Only - Pregnancy, Deliveries & Child-bearing)
How many times have you been pregnant?
How many children do you have and their age?
Year of 1st and Last Delivery & state whether Normal, Forceps or Caesarian?
Labour Pains : Normal/ Induced/ Short/ Prolonged
Any ailment during pregnancy: (e.g. Blood Pressure, Vomitings, Fever, Diabetes etc. & Treatment taken during Pregnancy).
Any Complaint After Delivery: - Fever, Thyroidism, Convulsions etc. Lactation ( Milk Feeding)
Abortion if any (specify the cause) - MTP/ Threatened/ Miscarriage. In which month of pregnancy?
Effects after abortion: Irregular Periods/excessive Bleeding/Menses Stopped/Pains etc.
MENTAL STATE (Mental Nature)
(It’s very important to give as much details as possible in this section especially in chronic diseases).
Do you like to be alone or in company?
Any Fears or Phobias (of being alone /darkness/ heights/death/ water/ falling/ghosts/ thunderstorms/ animals /thieves / robbers / sudden noises or any other things) Specify.
How is your temperament? (Irritable/ Weep easily/ Sensitive/ get Angry soon / Depressed/Moderate/ Accommodating / Cool).
If angry: (What brings the anger, and what do you do – Shout / Abuse / Violent / don’t show and suppress or something else, Specify)
Do you weep easily? Yes /No
(Do you weep when alone or in front of others?
How do you feel after weeping? What is the effect of consolation on you?)
Do you share your feelings with others or keep inside you?
How about taking Decisions: Indecisive / Take quick decisions and stick on them or Wavering?
Jealous/ Suspicious/ Religious/ Superstitious, if yes, then of what and to what extent?
How about keeping things Neat and Tidy /clean? Any Fault finding in others?
Anxiety if any about (What / when/ what happens when you have anxiety/ does it associate with any physical problems. (Sweating/Trembling/Palpitation/ Breathlessness, Sinking etc. Pls. specify)
Do you get startled easily by sudden noises, telephone bells, banging of doors etc?
Are you very caring by nature or indifferent? (Towards family members, friends, close ones etc.?)
How do you feel when contradicted?
Any Guilt or Regrets in life?
Do you Apologies or Not?
Any Negative or Suicidal thoughts? Explain and if yes, any such Attempt made.
How ambitious you are?
Any non-fulfillment of ambition in your life?
How do you like your work? Like it/ don’t want to do.
What do you think about your disease?
Do you forgive easily? Keep the bad things done to you in mind and plan to give it back when time comes Revengeful/ Coward/ Brood.
Any feeling of complex about yourself?
Do you hurry for everything and become Impatient?
Do you postpone the things or become worried with Anticipation?
How do you rate yourself? (Self Esteem, Haughty, Shy, Rational, Egoistic, Sympathetic, Conscientious, Emotional, Strong Headed, Calculative, Impulsive etc.)
What according to you others think of you?
What makes you feel happy?
What makes you feel sad?
Please mention any Incidence: (Mishap, Loss, Betrayal, Death, Disappointment, Love, Insult, Failure, Depression etc. which has any impact or relation to your present problem either has affected you deeply or otherwise also.)
GENERAL PHYSICAL APPEARANCE
Built (Strong, Thin, Stout, Obese, Average)-
Colour Complexion: (Fair/Wheatish/Dark/Pale)-
Nutrition: (Well nourished, Undernourished or over nourished):
Swelling or Growth/ Tumour – If any?
Part of the Body: (Hard/Soft /Cystic, Firm or Mobile. Whether Pitts on pressing/Non pitting, Size/Shape/ Inflammation /Painful/ Painless/ Itching/Burning. Any Discharge - Pus/Blood etc.)
Skin – Dry/Rough/Smooth/Oily/Greasy etc.
Hair- Texture etc.
Fever: (If have fever, when, any periodicity, particular time, duration of fever, if feel chilly/ hot/ sweat/ duration of each phase; any time modality, thirst, tongue, headaches, nausea, vomiting, thirst, appetite, body aches, restlessness if any.)
If feel like covering or just want to lie down quietly. Any other complaint with it like burning, Skin feels hot/cold/clammy. Any Ghabraahat?
Please mention any thing else pertaining to you and your problem which you feel has not been asked in the Questionnaire and is persistent and unusual, Do mention strange feeling if any. (All histories, Case reports are kept Confidential)
Photos can be attached if required.
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