THEMATIC ANALYSIS OF A 35/F PRESENTED WITH PAINFUL SKIN LESIONS

THEMATIC ANALYSIS OF 35/F PRESENTED WITH PAINFUL SKIN LESIONS OVER BOTH HANDS AND LEGS WITH HISTORY OF RHEUMATOID ARTHRITIS LATER DIAGNOSED AS PYODERMA GANGRENOSUM . 

Case blog link:https://asjad24.blogspot.com/2023/09/note-following-e-log-aims-at-discussing.html

INTRODUCTION :This thematic analysis provides insight into the multifaceted experiences of my patient living with Pyoderma Gangrenosum, highlighting the physical, emotional, and social challenges she faces as well as the coping strategies she employs.

AIM : This analysis aims at figuring out different aspects of impairment including physical, mental and social agonies faced by patients living with Pyoderma Gangrenosum. This will help in all round targeted interventions and support for patients suffering from this painful disease .

METHODOLOGY : The following data has been captured by bedside history taking followed by telephonic semi structured interview.

THEMES

Theme 1: Physical Agony

     Subtheme 1.1: Pain

     Subtheme 1.2: Unpredictable Flare-Ups

     Subtheme 1.3 Impact on daily routine 

Theme 2: Psychological Agony

     Subtheme 2.1: Emotional impact 

     Subtheme 2.2: Depression and anxiety 

     Subtheme 2.3:  Seclusion

Theme 3 : Financial constraints 

     Subtheme 3.1 : Unemployment 

     Subtheme 3.2 : Medical Expenses 

     Subtheme 3.3 : Limited healthcare access

Theme 4: Health care Challenges

     Subtheme 4.1: Lack of Awareness

    Subtheme 4.2:Complex treatment Regimen

    Subtheme 4.3: Prognostic Uncertainty 

THEME 5 : Coping strategies 

     Subtheme 5.1 : Family Support 

     Subtheme 5.2: Seeking professionals

     Subtheme 5.3: Resilience 

ANALYSIS /RESULT 

➤PHYSICAL AGONY 

  PAIN: Patient consistently reported burning pain at site of ulceration. As she described in telugu, “Noppi chala undi jaraga nivvatledu". Means pain is too much to let her move. 

 UNPREDICTABLE FLARE UPS : Pain is marked with frequent flare ups. 

 IMPACT ON DAILY ROUTINE :Pain often gets exaggerated on physical activities thus it always limits her movements as well as her daily routine. It interferes with her sleep thus prevents restorative rest. 

➤PSYCHOLOGICAL AGONY 

  EMOTIONAL IMPACT :The visible nature of the skin lesions led to development of self-esteem issues and gradual withdrawal from peers . 

  DEPRESSION :Patient describes feelings of depression and anxiety due to the chronic nature of the condition. She said'“Chala sarlu Em matladakunda kurchunta". Means most of the time she remains quiet. The patient feels helpless as she is unable to find a permanent cure for her endless pain and suffering. 

  SECLUSION : The chronic nature of pain and her ulceration deprived her of social interaction and she mostly stays with her family. She said, “Na bharta inka pillalatho undalani pistundi". Means she prefers company of husband and children. 

➤FINANCIAL CONSTRAINTS 

  UNEMPLOYMENT :The  nature of the disease has deprived my patient from earning her livelihood as her pain restricted her movements. Along with patient even her husband is deprived from going to work as he opted to stay at home supporting his wife both physically and mentally, who are the breadwinners of a family with 3 young children. She said "Memu ippudu sampadiyatledu dabbula ibbandi vundi". Means they both are not earning and facing financial crisis. 

  MEDICAL EXPENSES AND LIMITED       HEALTHCARE FACILITIES :Their meagre savings is not meeting her medical expenses and often restricts access to better health care facilities. 

➤HEALTH CARE CHALLENGES 

  LACK OF AWARENESS :Patients and healthcare providers often struggle with the limited awareness of Pyoderma Gangrenosum and misdiagnosis is common issues. Even my patient is not fulfilling the major criteria that is histopathological confirmation of neutrophilic infiltration but still we can't turn our heads from this disease. 

  COMPLEX TREATMENT REGIMEN:Patient mentioned unawareness regarding the complexity of Pyoderma Gangrenosum and it's management , including the need for multiple medications, dressings and wound care routines .Compliance with treatment plan is also challenging as she has not been  compliant to Rheumatoid Arthritis medication previously. 

  PROGNOSTIC UNCERTAINTY :Even though with the complex treatment regime the patient is still not seeing the light at other side of the tunnel as according to literature this disease can't be cured.   

➤COPING STRATEGIES 

  SUPPORT SYSTEM :Patient has a strong support system, including her caring husband and loving children. Their company helps her to cope with the condition.

  SEEKING PROFESSIONALS :Patient is seeking proper medical treatment and sterile dressing along with regular telephonic follow-up. 

  RESILIENCE :My patient has a history of Rheumatoid Arthritis with deformities but still she adapted to those conditions and has been doing well but pyoderma gangrenosum is testing her patience at every level . She always has had a positive mindset but now it seems blotted. 

CONCLUSION : The detailed interview along with biopsychosocial history of the patient well illustrates the fact that Pyoderma Gangrenosum is not only affecting patients physically but also hampering their emotional and financial well being. So this disease with definite PNI component seeks all round management including medical and psychological support along with emotional support from family and society for improving their quality of life. 

Biopsychosocial history :https://asjad24.blogspot.com/2023/09/biopsychosocial-history-of-35f.html