Monthly Report

Top Concerns

• Anxiety episodes (12 occurrences, 3 panic attacks) - primarily triggered by work stress and health worries; peak severity 8/10 on Dec 8 and Dec 15
• Blood pressure variability - one urgent care visit (165/100 on Dec 15); 8 readings above 140/90, correlating with stress, sodium intake, and missed medications
• Persistent fatigue (10 occurrences) - appears connected to poor sleep quality, blood sugar fluctuations, and anxiety; affecting daily activities
• Blood glucose spikes - 5 hyperglycemic events (>180 mg/dL) post-meal, typically after high-carb meals or when medication timing was off
• Kidney function monitoring needed - creatinine increased slightly from 1.8 to 1.9; eGFR stable but at lower end of Stage 3 CKD
• Ankle swelling episodes (5 occurrences) - correlating with high sodium days and missed diuretic doses

Symptom Summary

The patient logged 50 symptom entries across 8 distinct symptom types. Anxiety episodes were most frequent (12 occurrences, avg 6.2/10), with clear triggers including work stress (8x), health worries (4x), poor sleep (3x), and caffeine (2x). Three episodes escalated to panic attacks requiring use of coping strategies. Fatigue was the second most common symptom (10 occurrences, avg 4.5/10), typically lasting all day and correlating with nights of poor sleep or days with blood sugar fluctuations. Headaches occurred 6 times, predominantly at the back of the head (characteristic of hypertensive headaches), with 4 instances correlating directly with elevated blood pressure readings taken the same day. Ankle swelling appeared 5 times, always in the evening or after high-sodium meals, responding well to leg elevation and diuretic timing adjustment. The diabetic neuropathy symptom (numbness/tingling in feet) appeared 3 times, typically after prolonged sitting or on days with higher blood sugar readings. Shortness of breath (3 occurrences) was associated with anxiety episodes (2x) and one instance of physical overexertion while walking uphill.

Vital Sign Trends

Blood Pressure: 52 readings logged. Range: 118/72 to 165/100 mmHg. Average: 138/86 mmHg. Concerning readings (>140/90): 8 instances, typically on high-stress days or after sodium-heavy meals. The Dec 15 spike (165/100) required urgent care. Morning readings averaged 142/88 (higher) vs evening 134/82 (better controlled). Heart Rate: 48 readings. Range: 62-98 bpm. Average: 76 bpm. Elevated readings (>90) correlated with anxiety episodes. Resting heart rate remained stable at 68-72 bpm. Blood Glucose: 58 readings (fasting and post-meal). Fasting average: 128 mg/dL (target <130). Post-meal average: 162 mg/dL. 5 hyperglycemic events (>180): typically post-dinner or after high-carb lunches. 2 hypoglycemic events (<70): both on days with increased physical activity without snack adjustment. Weight: 14 readings. Range: 198.2-203.8 lbs. Average: 200.4 lbs. Weight fluctuations of 2-3 lbs correlated with fluid retention on high-sodium days. Overall stable, no concerning trend. Blood Oxygen: 18 readings. Range: 94-98%. Average: 96%. All readings within acceptable range. Lower readings (94-95%) noted during anxiety episodes. Kidney Markers (logged in custom tracker): eGFR: 47-48 (stable Stage 3). Creatinine: 1.8-1.9 mg/dL (slight increase noted Dec 18). Potassium: 4.2-4.4 mEq/L (normal range, important with ACE inhibitor use).

Medication Summary

The patient is managing 6 prescription medications and 4 supplements. Medication adherence improved to 92% this month (up from 85% in November). Cardiovascular/Kidney: Lisinopril 20mg (ACE inhibitor for BP and kidney protection) - taken consistently; Amlodipine 5mg (calcium channel blocker) - 2 missed doses; Furosemide 20mg (diuretic) - 3 doses taken late, correlating with swelling episodes. Diabetes: Metformin 500mg twice daily - timing adjusted per endocrinologist (Dec 12) to take with meals for better tolerance; 4 instances of missed second dose noted. Mental Health: Sertraline 50mg - taken consistently with no missed doses. Patient reports stable mood overall with breakthrough anxiety during high-stress periods. Cholesterol: Atorvastatin 20mg - taken consistently. Supplements: All taken consistently. Vitamin D3 and Iron are particularly important for CKD management. Magnesium added this month per nephrology recommendation. Side effects noted: Mild GI upset with Metformin (3x), resolved with food. Occasional dry cough possibly related to Lisinopril (monitoring).

Mental Health Summary

Mental health tracking showed moderate anxiety levels averaging 4.8/10 across 26 daily check-ins, with significant variability (range 2-8/10). Anxiety Patterns: 12 distinct anxiety episodes logged, including 3 panic attacks. Primary triggers identified: work deadlines/stress (8 episodes), health-related worries (4 episodes - specifically concerns about kidney disease progression and diabetes complications), poor sleep nights (3 episodes), and caffeine consumption (2 episodes). Mood Scores: 26 entries averaging 3.4/5. Higher mood days (4-5/5) correlated with: good sleep (7+ hours), completed physical activity, and social connection. Lower mood days (2-3/5) correlated with: anxiety episodes, fatigue, and health concerns. Coping Strategies Used: Deep breathing exercises (18x) - rated most effective, Walking (12x) - helpful for mild anxiety, Meditation app (8x) - used during work breaks, Calling support person (4x) - used during panic attacks, Progressive muscle relaxation (6x). GAD-7 Assessment: Completed twice this month. Scores: Dec 8 = 14 (moderate anxiety), Dec 22 = 11 (mild-moderate). Improvement noted after implementing daily meditation routine. PHQ-9 Assessment: Completed Dec 22. Score: 6 (mild depressive symptoms), primarily related to fatigue and health concerns rather than primary depression. Sleep-Anxiety Connection: Strong correlation observed - nights with <6 hours sleep showed 73% likelihood of elevated anxiety the following day.

Notable Events

• December 2: Nephrology follow-up - eGFR stable at 48, kidney function maintained; continue current medication regimen
• December 5: Lab work showed creatinine 1.8, potassium normal at 4.2 - good news for kidney stability
• December 8: Significant anxiety episode (8/10) triggered by work deadline - lasted 2 hours, used breathing exercises and called support person
• December 12: Endocrinology visit - A1C improved to 7.2% (down from 7.6%), adjusted Metformin timing to reduce GI side effects
• December 15: URGENT - BP spike to 165/100, required urgent care visit; attributed to work stress and high-sodium lunch; resolved with rest and medication
• December 18: Follow-up labs showed slight creatinine increase to 1.9 - nephrology aware, monitoring closely
• December 22: Annual physical - overall stable; discussed stress management strategies; started daily meditation practice
• December 28: Received flu vaccination without adverse reactions - important for immunocompromised status with CKD

Patterns Observed

• Strong anxiety-BP connection: 6 of 8 elevated BP readings occurred within 24 hours of anxiety episodes (correlation noted)
• Sleep-anxiety-glucose cycle: Poor sleep (<6 hrs) → next-day anxiety (73% of cases) → elevated cortisol → blood sugar spike pattern observed on 5 occasions
• Sodium-swelling-BP triangle: High sodium days (>2000mg) consistently followed by ankle swelling AND elevated BP readings within 24-48 hours
• Medication timing critical: Blood sugar spikes more likely when Metformin taken >30 min before meals vs with meals
• Morning BP consistently higher: Average 142/88 AM vs 134/82 PM - may indicate need for medication timing adjustment
• Caffeine as anxiety trigger: All 4 caffeine-related anxiety episodes occurred when consumed after 12pm
• Exercise paradox: Light walking improved anxiety scores, but higher intensity activity triggered shortness of breath and required careful glucose monitoring
• Weekend improvement: Anxiety levels averaged 3.2/10 on weekends vs 5.4/10 on workdays - clear occupational stress component

These patterns are identified from your logged data. Discuss with your healthcare provider to determine clinical significance.