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Table of Contents Letter to Patient Physical ExaminationComplaints Medical History Objective State Lab ResultsComplete Blood Count Urinalysis Infectious Disease Tests Anemia Diagnostics Biochemical Blood Tests Blood Coagulation Test Diabetes Diagnostics Thyroid Function Tests Reproductive Function Tests Bone Metabolism Tests Semen Analysis Cancer Marker Tests Urogenital Microflora Analysis Instrumental ExaminationsElectrocardiogram (ECG) Chest X-ray Ultrasound of bladder and prostate Ultrasound of liver, gallbladder, pancreas, and spleen Ultrasound of kidneys and adrenal glands Ultrasound of thyroid gland Specialist ConsultationsUrologist Endocrinologist Ophthalmologist Your Diagnosis and Treatment PlanYour Final Diagnosis Your Final Treatment Plan Diet Recommendations Physical Activity Recommendations Sleep Hygiene Recommendations Final NotesExpected Improvements Follow-up Visit Additional Tests Conclusion Your Medical Consultation Patient Name: Kevin White Date of Birth: March 1, 1982 Sex: Male Consulting Doctor: Olivia Bennett May 29, 2025 Dear Mr. Kevin White! Thank you for choosing our clinic for your medical examination. In this letter, I will explain in detail the results of your tests and specialist visits to help you better understand your health condition. Your health is our main goal, and we will be happy to support you at every stage of your journey to recovery. It's important that you are an active participant in this process. Based on the conducted check-up examination, the following diagnosis was made: Primary Diagnosis: $diagnosis Comorbidity: Unspecified hyperuricemia Chronic prostatitis, microcalcifications of the prostate Vitamin D deficiency In the attachment to this letter, you will find detailed information about the treatment plan, comments from the doctors who examined you, as well as recommendations on nutrition, physical exercises, and lifestyle. By following these recommendations, you will be able to improve your condition and prevent the development of possible complications. We are always ready to support you on your path to recovery. Sincerely, de factum team. Physical Examination Complaints Fatigue, irritability. Medical History The patient has a family history of diabetes mellitus in the mother. Additionally, the patient experiences periodic bloating after consuming legumes. Objective State General Condition: relatively satisfactory. Body Build: correct. Constitution: normosthenic type. Skin Coverings: usual color. Subcutaneous tissue: normally developed. Pastosity, edema: absent. Peripheral Lymph Nodes: not enlarged at the time of examination. Thoracic Cage: normal - cylindrical shape, evenly participates in the act of breathing. Auscultation (listening with a stethoscope): vesicular breathing, no wheezing. Respiratory Rate: 21/min. Heart tones, rhythm: clear tones, regular rhythm. Pulse: 55-57 beats/min, medium filling and tension. Blood Pressure: 120-80 mmHg. Tongue: clean. Pharyngeal: not hyperemic, tonsils not enlarged. Abdomen: soft. Stool: not disturbed. Urination: free, painless. Percussion Symptom: negative on both sides. Laboratory Results Complete Blood Count A complete blood count (CBC) test is important because it provides a comprehensive overview of your blood health. It helps doctors diagnose various conditions, monitor your overall health, and determine the effectiveness of treatments. Most of your blood test results are within the normal range. However, the percentage of basophils is slightly elevated at 1.4%, compared to the reference range of 0 - 1.2%. This minor deviation can be linked to stress, physical exertion, or circadian rhythms and is generally insignificant. Urinalysis A urinalysis is important because it helps doctors evaluate the health of the kidneys and urinary tract, detect metabolic disorders, and identify potential infections. It provides a comprehensive overview of various parameters that can indicate underlying health issues, allowing for timely diagnosis and treatment planning. Most of the results from your urinalysis are within the normal range. However, there are a couple of deviations that should be noted. The relative density of your urine is 1030 g/l, which is slightly above the reference range of 1015 - 1025 g/l. This minor elevation may be linked to insufficient fluid intake. Additionally, the presence of mucus (+++) in your urine, which should normally be absent, could indicate a minor irritation or inflammation in the urinary tract. Infectious Disease Tests Infectious disease tests are crucial for detecting infections that can have significant health impacts. These tests help doctors diagnose and treat infections early, preventing complications and promoting better health outcomes. The results of your infectious disease tests are all within normal ranges. This means there are no signs of infection for Hepatitis B, Syphilis, or Hepatitis C. Overall, this indicates that your health is good in relation to these diseases. Anemia Diagnostics Anemia lab panels are important because they help doctors determine if a patient has anemia, which is a condition characterized by a lack of healthy red blood cells. This panel helps in diagnosing the type and cause of anemia, allowing doctors to create effective treatment plans. The results of your anemia tests show that your Ferritin level is within the normal range. Your Homocysteine level is 12.6 µmol/L, which is within the reference range of 5 - 15 µmol/L. However, it is slightly elevated. Minor fluctuations in Homocysteine levels within ±15% can be influenced by factors such as vitamin levels (B6, B12, folic acid), dietary habits, metabolic changes, or stress. This slight elevation is often not clinically significant. Biochemical Blood Tests Biochemical tests are important because they help doctors assess the functioning of various organs and systems in the body. These tests can detect imbalances or abnormalities in blood chemistry, which can be crucial for diagnosing conditions and planning appropriate treatments. Most of your biochemical test results are within the normal range, indicating good overall health. However, there are a few minor deviations that should be noted. Your total protein level is slightly below the reference range at 64.5 g/L (reference range: 66 - 87 g/L). This minor variation can be due to diet and metabolic changes. Your uric acid level is slightly above the reference range at 7.3 mg/dl (reference range: 3.4 - 7 mg/dl). Such slight variations may shift with changes in fluid levels, diet, or mild exercise. Lastly, your iron level is slightly above the reference range at 28.36 µmol/L (reference range: 8.1 - 28.3 µmol/L). This fluctuation may be due to mild inflammation, physical activity, or seasonal factors. Blood Coagulation Test A coagulogram is important because it helps doctors understand how well your blood is clotting. This information is crucial for diagnosing and managing conditions that affect blood clotting, such as bleeding disorders or the risk of excessive clotting. It also helps in planning surgeries and monitoring treatment for clotting disorders. All the parameters in your coagulogram test are within the normal range, indicating that your blood clotting function is normal. Diabetes Diagnostics Diabetes tests are crucial for diagnosing and monitoring diabetes. These tests help doctors understand how well the body is managing blood sugar levels, which is essential for issuing accurate diagnoses and creating effective treatment plans. All results are within the normal range, indicating no abnormalities. Thyroid Function Tests Thyroid function tests are crucial for assessing the health of the thyroid gland, which plays a vital role in regulating metabolism, energy levels, and overall hormonal balance. These tests help doctors diagnose thyroid disorders and develop appropriate treatment plans to manage any identified conditions. The results of your thyroid function tests are within the normal range. Reproductive Function Tests Reproductive function tests are important for assessing male reproductive health. These tests help doctors diagnose potential issues and create effective treatment plans. The results of your reproductive function tests show that your total testosterone levels are within the normal range. There is a slight deviation in your free testosterone levels, which is measured at 21.3 pg/ml, while the reference range is 15 - 50 pg/ml. This minor variation may be due to daily hormonal fluctuations, stress, physical activity, or age-related changes. Bone Metabolism Tests Determining vitamin D levels is crucial for overall health as it plays a significant role in bone strength, immune function, and muscle performance. It helps doctors diagnose potential deficiencies or excesses and create appropriate treatment plans to ensure optimal health. The normal range for vitamin D levels is between 30 and 100 ng/ml. The test result for 25-OH vitamin D is 25 ng/ml, which is below the normal reference range of 30-100 ng/ml. This indicates a vitamin D insufficient level. Slight variations within ±15% of the normal range may be influenced by seasonal changes, sun exposure, and supplement intake. Minor shifts near classification thresholds are often physiological. Semen Analysis A spermiogram test is important for assessing male fertility. It helps doctors understand the health and functionality of sperm, which is crucial for diagnosing potential fertility issues and planning appropriate treatments. The results of your spermiogram test show that most parameters are within the normal range. However, there are a couple of deviations that should be noted. The pH level of your semen is 7.0, which is slightly below the normal reference range of 7.2-8.0. This minor fluctuation may be related to diet and metabolic balance and is generally not a cause for concern. Additionally, the sperm count in 1 ml of your semen is 12 million, which is below the normal reference range of 15 million or more. Minor fluctuations in sperm count can be influenced by stress, lifestyle, and physiological variability. Overall, these deviations are not significant and do not necessarily indicate a serious problem. Cancer Marker Tests Testing for cancer markers is important because it helps doctors detect the presence of cancerous cells in the body. These tests can identify specific proteins or antigens that are produced by cancer cells, allowing for early diagnosis and more effective treatment plans. The results of your cancer marker tests show that most values are within the normal range. However, there are a few deviations that need to be addressed. The total prostate-specific antigen (tPSA) level is 0.992 ng/ml, which is within the normal reference range of 0 to 4 ng/ml. The free prostate-specific antigen (fPSA) level is 0.494 ng/ml, which is slightly above the normal reference range of 0.04 to 0.5 ng/ml. This minor elevation may be associated with benign conditions and does not necessarily indicate pathology. Additionally, the ratio of free PSA to total PSA (fPSA/tPSA) is 49.7%, which is above the threshold indicating a low risk of prostate cancer. Slight fluctuations in these values can be linked to physical activity, stress, or benign changes, and small variations do not always indicate pathology. Urogenital Microflora Analysis The PCR urogenital microflora test is important because it helps identify the presence of pathogenic microorganisms in the urogenital tract. This information is crucial for doctors to diagnose any infections and to plan appropriate treatments. By understanding the microflora composition, doctors can ensure that the balance of microorganisms is healthy and not causing any issues. The test results show that no DNA of pathogenic microorganisms was detected. The levels of Candida spp. are below the threshold value, and the structure of the bacterial microbiome is within normal limits. Instrumental Examinations Electrocardiogram (ECG) Conclusion: Sinus rhythm with heart rate of 50 bpm. Vertical position of EOS. SPRJ. Positional changes in S wave in V3. Explanation: The EKG shows a sinus rhythm with a heart rate of 50 beats per minute, which is within normal limits but on the lower side. The electrical axis of the heart is vertical, which is a normal variant. There are positional changes in the S wave in lead V3, which may indicate some variations in heart function but are not necessarily indicative of a serious problem. Chest X-ray Conclusion: Radiological signs of chronic bronchitis. Explanation: The chest X-ray shows radiological signs of chronic bronchitis, which means there are changes in the lungs that are consistent with long-term inflammation of the bronchial tubes. This condition can cause coughing and difficulty breathing. Ultrasound of bladder and prostate Conclusion: Increased volume of prostate with non-uniform structure. Signs of past prostatitis with areas of fibrosis in the central zone and prostatic part, moderate widening of prostatic part of urethra. No pathological findings in seminal vesicles. Residual urine volume within normal limits (3.0%). Explanation: The ultrasound of the bladder and prostate shows an enlarged prostate with areas of fibrosis, which are likely due to a past episode of prostatitis. The prostate's structure is not uniform, and there is moderate widening of the prostatic part of the urethra. The seminal vesicles appear normal, and the residual urine volume is within normal limits. Ultrasound of liver, gallbladder, pancreas, and spleen Conclusion: Reactive changes in liver parenchyma and head of pancreas. Bent gallbladder with heterogeneous content (consistent with biliary dyskinesia). No pathological findings in body and tail of pancreas or spleen. Explanation: The ultrasound shows reactive changes in the liver parenchyma and the head of the pancreas, which may indicate inflammation or other reactive processes. The gallbladder is bent and contains heterogeneous material, which is consistent with biliary dyskinesia. There are no pathological findings in the body and tail of the pancreas or the spleen. Ultrasound of kidneys and adrenal glands Conclusion: Salt deposits in renal pelvis on both sides with microlithiasis, no structural changes. No pathological findings in adrenal glands. Explanation: The ultrasound of the kidneys shows salt deposits in the renal pelvis on both sides, along with small stones (microlithiasis), but no structural changes. The adrenal glands appear normal with no pathological findings. Ultrasound of thyroid gland Conclusion: US ACR-TIRADS – 1. Hyperplasia of thyroid gland. Microfollicles. (rule out hypothyroidism?). Explanation: The ultrasound of the thyroid gland shows hyperplasia (enlargement) and the presence of microfollicles. The ACR-TIRADS score is 1, indicating a low risk of malignancy. There is a suggestion to rule out hypothyroidism, which means the thyroid may not be producing enough hormones. Specialist Consultations Urologist Diagnosis Microcalcifications of the prostate. Recommended Medications and Procedures Longidaza Vobenzim Esmela chair Lifestyle Change Recommendations Perform Kegel exercises. Endocrinologist Diagnosis Diffuse goiter of the first degree Euthyroidism Recommended Medications and Procedures L-tiroksin Iodomarin Ophthalmologist Diagnosis N52.2 Complex myopic astigmatism of the right eye. N52.2 Complex myopic astigmatism of the left eye. Recommended Medications and Procedures Sistein ultra plus Clarification: Your therapist (supervising doctor) may decide not to include in your final treatment plan medications recommended by our specialists. This may happen for several reasons: the same or similar medications may be prescribed by several doctors. Also, some prescriptions may have contraindications or undesirable interactions with other medications. Moreover, your therapist may consider that alternative treatment methods will be more effective, and also take into account your overall clinical picture and adjust prescriptions according to your individual characteristics and medical needs. Your Diagnosis and Treatment Plan Dear Mr. Kevin White! Based on the above, as well as consultations with specialists, you have been given the following final DIAGNOSIS: Your Final Diagnosis Primary Diagnosis Non-alcoholic fatty liver disease Non-alcoholic fatty liver disease is a condition where fat builds up in the liver without the influence of alcohol. This can be caused by factors such as obesity, insulin resistance, high blood sugar, and high levels of fats in the blood. Chronic non-calculous cholecystitis Chronic non-calculous cholecystitis is a long-term inflammation of the gallbladder that is not caused by gallstones. This condition can be caused by factors such as infections, bile duct problems, or other underlying health issues. Reactive pancreatitis with secondary enzymopathy Reactive pancreatitis with secondary enzymopathy is a condition where the pancreas becomes inflamed due to another underlying condition, leading to enzyme deficiencies. This can be caused by factors such as digestive issues, infections, or other health problems. Comorbidity Unspecified hyperuricemia Hyperuricemia is a condition characterized by an excess of uric acid in the blood. Uric acid is a waste product formed from the breakdown of purines, which are found in certain foods and drinks. When the body produces too much uric acid or does not eliminate enough of it, hyperuricemia can occur. Factors that may contribute to this condition include genetics, diet, obesity, and certain medical conditions such as kidney disease. Chronic prostatitis, microcalcifications of the prostate Chronic prostatitis is a long-term inflammation of the prostate gland, which can cause pain and urinary issues. Microcalcifications of the prostate refer to small calcium deposits within the prostate gland. These conditions can be caused by bacterial infections, immune system responses, or other factors such as stress and lifestyle choices. Vitamin D deficiency Vitamin D deficiency occurs when the body does not have enough vitamin D, which is essential for maintaining healthy bones and immune function. This deficiency can result from inadequate dietary intake, insufficient sunlight exposure, or certain medical conditions that affect vitamin D absorption. Factors contributing to vitamin D deficiency include limited sun exposure, poor diet, and certain health conditions. Your Final Treatment Plan Lifestyle Change Prescriptions Drink 2.5 liters of water per day Prescribed Medications and Procedures L-tiroksin Medication Purpose: For thyroid hormone replacement Instructions: Take L-tiroksin 50 mcg, 1 tablet in the morning on an empty stomach. IodomarinMedication Purpose: To keep the optimal level of iodine. Instructions: Take Iodomarin 200 mcg, 1 tablet in the morning after food. UrsosanMedication Purpose: For treating non-alcoholic fatty liver disease Instructions: Take Ursosan 250 mg, 2 capsules at night for 2 months. VobensimMedication Purpose: For treating microcalcifications of the prostate Instructions: Take Vobenzim 3 tablets, 3 times a day, 30 minutes before food for 1 month. LongidazaMedication Purpose: For treating microcalcifications of the prostate Instructions: Use Longidaza 1 suppository at night for 10 days. Vitamin DMedication Purpose: To keep the optimal level of vitamin D. Instructions: Take Вит Д 5000 IU, 1 capsule after breakfast for 2 months. Diet Recommendations This section includes both general and specific dietary recommendations adapted to your diagnosis. Following these recommendations is an important part of your journey to health. Proper nutrition helps mitigate the negative side effects of medications, supports overall well-being, increases energy levels, strengthens the immune system, and accelerates the body's recovery. Additionally, proper nutrition reduces the risk of complications and chronic diseases, providing the body with necessary substances for optimal functioning. Scientific research shows that nutrition can be a powerful tool for healing. Strictly following the recommendations will help you achieve better results in treatment and health maintenance. Your path to well-being begins with caring about what you eat. By maintaining healthy eating habits, you are taking an important step towards improving your quality of life and achieving sustainable results in your treatment. General Diet Recommendations Diagnosis-Specific Diet Recommendations Chronic prostatitis, microcalcifications of the prostate Purpose: to support prostate health and reduce inflammation Berries: raspberries, strawberries, cherries, blueberries, blackberries. Berries are rich in antioxidants and anti-inflammatory compounds that can help reduce inflammation in the prostate. We recommend: consume 1-2 portions a day. Dark leafy greens: arugula, spinach, parsley, cilantro. Dark leafy greens are high in vitamins and minerals that support overall health and reduce inflammation. We recommend: consume 1-2 portions a day. Vitamin D deficiency Purpose: to increase vitamin d levels Supplements: vitamin D3 supplements. Vitamin D3 supplements are effective in increasing vitamin D levels in the body. We recommend: consume as directed by a healthcare provider. Fatty fish: salmon, mackerel, sardines. Fatty fish are natural sources of vitamin D. We recommend: consume 1-2 portions a week. Non-alcoholic fatty liver disease Purpose: to improve liver function Cruciferous vegetables: broccoli, cauliflower, radish, cabbage, Brussels sprouts. Cruciferous vegetables contain compounds that support liver function and detoxification. We recommend: consume 1-2 portions a day. Other vegetables: beets, artichokes, asparagus, carrots, sweet potatoes. These vegetables are rich in nutrients that support liver health. We recommend: consume 1-2 portions a day. Reactive pancreatitis with secondary enzymopathy Purpose: to support pancreatic health and improve digestion Legumes: black beans, lentils, chickpeas, peas, red beans, white beans, tofu. Legumes are a good source of protein and fiber, which are easy to digest and support pancreatic health. We recommend: consume 1-2 portions a day. Whole grains: oatmeal, buckwheat, bulgur, barley. Whole grains provide essential nutrients and are easy to digest. We recommend: consume 1-2 portions a day. Chronic non-calculous cholecystitis Purpose: to support gallbladder health and improve digestion Filtered water: filtered water. Staying hydrated is essential for gallbladder health and digestion. We recommend: consume at least 8 glasses a day. Green tea: green tea. Green tea has anti-inflammatory properties and supports digestion. We recommend: consume 1-2 cups a day. Unspecified hyperuricemia Purpose: to reduce uric acid levels Fruits: apples, dates, dried apricots, prunes, pears, grapes, plums, watermelon, avocado. These fruits are low in purines and can help reduce uric acid levels. We recommend: consume 1-2 portions a day. Nuts and seeds: nuts, seeds. Nuts and seeds are low in purines and provide healthy fats and nutrients. We recommend: consume 1-2 portions a day. Physical Activity Recommendations This section includes both general and specific physical activity recommendations adapted to your condition. Regular exercise plays a key role in improving mood, emotional state, and cognitive functions. Physical activity helps reduce stress levels, improves memory and concentration, and increases overall sense of well-being. Scientific research confirms that exercise can significantly improve quality of life and treatment outcomes. They are a powerful complement to medication and proper nutrition. Following these recommendations will help you take an important step towards achieving sustainable results in your path to health and well-being. Detailed Physical Activity Recommendations Below is a list of exercises that has been compiled for you based on the results of your check-up. Performing these exercises can significantly improve your health and well-being. You don't need to do all the exercises at once. Start with the exercises that you think are best suited for your situation, and gradually add other exercises from the list over time. The recommended exercise time is also not mandatory. Start with a comfortable time for you and gradually increase it while observing precautions. If you feel discomfort while performing any exercise, stop immediately and consult your treating physician. Pelvic floor exercises Benefits: Improved pelvic floor strength and circulation, reduced symptoms of chronic prostatitis Frequency: 3 times a day Duration: 5-10 minutes per session Precautions: Ensure proper technique to avoid straining other muscles Summary: Pelvic floor exercises, such as Kegel exercises, can help strengthen the muscles around the prostate and improve blood circulation. These exercises involve contracting and relaxing the pelvic floor muscles, which can be done discreetly throughout the day. Start with a few repetitions and gradually increase the number as you become more comfortable. These exercises can help alleviate symptoms of chronic prostatitis and support prostate health. Outdoor walking Benefits: Increased vitamin D synthesis, improved cardiovascular health, enhanced mood Frequency: Daily Duration: 30 minutes per day Precautions: Wear sunscreen to protect your skin from excessive UV exposure Summary: Engaging in outdoor walking for at least 30 minutes a day can help increase your exposure to sunlight, which is essential for the synthesis of vitamin D in the skin. Walking is a low-impact exercise that can be easily incorporated into your daily routine. It also provides additional benefits such as improved cardiovascular health and mood enhancement. Moderate aerobic exercises Benefits: Improved liver function, reduced fat accumulation in the liver, enhanced metabolic health Frequency: 3-5 times a week Duration: 20-30 minutes per session Precautions: Avoid high-intensity exercises that may strain the liver Summary: Moderate aerobic exercises, such as brisk walking, cycling, or swimming, can help improve liver function and reduce fat accumulation in the liver. These activities increase heart rate and promote overall metabolic health. Aim to start with shorter sessions and gradually increase the duration and intensity as your fitness improves. Gentle yoga Benefits: Reduced stress, improved digestive health, enhanced pancreatic function Frequency: 3-4 times a week Duration: 15-20 minutes per session Precautions: Avoid poses that put pressure on the abdomen Summary: Gentle yoga can help manage stress and improve digestive health, which is beneficial for individuals with reactive pancreatitis. Yoga poses that focus on gentle stretching and relaxation can support pancreatic function and reduce inflammation. Incorporate breathing exercises and meditation to enhance the calming effects. Low-impact aerobic exercises Benefits: Improved gallbladder function, enhanced digestive health Frequency: 3-5 times a week Duration: 20-30 minutes per session Precautions: Avoid high-intensity exercises that may exacerbate symptoms Summary: Low-impact aerobic exercises, such as walking or swimming, can help improve gallbladder function and overall digestive health. These exercises are gentle on the body and can be performed regularly to support the management of chronic cholecystitis. Start with shorter sessions and gradually increase the duration as your fitness level improves. Low-impact exercises Benefits: Managed uric acid levels, prevention of gout flare-ups, improved cardiovascular health Frequency: 3-5 times a week Duration: 20-30 minutes per session Precautions: Avoid high-impact exercises that may stress the joints Summary: Low-impact exercises, such as walking, swimming, or cycling, can help manage uric acid levels and prevent gout flare-ups. These activities promote overall cardiovascular health and can be performed regularly without putting excessive strain on the joints. Gradually increase the duration and intensity of the exercises as your fitness improves. Sleep Hygiene Recommendations Sleep plays a critically important role in overall health, yet its significance is often underestimated. Quality sleep is the foundation of your well-being. When you sleep well, you have energy for following all other recommendations, you feel more stable, optimistic, and energetic. Good sleep improves cognitive functions, strengthens the immune system, regulates metabolism, and promotes emotional stability. By following the recommendations below, you can significantly improve your sleep quality and, consequently, your overall health. Early Morning Light: Spend 10-20 minutes in early morning sunlight immediately after waking up. This is important for proper circadian rhythm, alertness, and well-being. Try to do this outside, as looking through windows is not enough – there's more diffused light outside, even in winter or when the sun is behind clouds. Clear glasses and contact lenses are acceptable. Never look directly at the sun, except when it's behind thick clouds or very low on the horizon. Regular Sleep Schedule: Go to bed before 11 PM and wake up at the same time every day, even on weekends. This helps synchronize your circadian rhythms, improving sleep quality and overall well-being. Evening Relaxation Ritual: Perform calming activities 30-60 minutes before bed, such as reading, meditation, or light stretching. This signals to your brain that sleep time is approaching and helps reduce cortisol levels. Early Dinner: Try to have dinner as early as possible (at least 3-4 hours before bed). This promotes better digestion and minimizes sleep disturbances related to stomach heaviness. Avoid Stimulants: Eliminate caffeine consumption after noon. Caffeine can disrupt sleep quality, even if you don't feel its immediate effects. Regulate Evening Light: Reduce exposure to blue light from electronic devices 1-2 hours before bed. Use warm and dimmed light to stimulate melatonin production. Optimal Temperature: Maintain a cool temperature in the bedroom (around 18-20°C). This promotes the natural decrease in body temperature necessary for good and sound sleep. Peaceful Environment: Create a maximally quiet, dark, and comfortable sleep environment. Use curtains, earplugs, sleep mask if necessary to minimize external stimuli. Relaxation by Jacobson Task: alternately tense and relax different muscle groups of the body, each time memorizing relaxation. During tension, try not to hold your breath. Hands and wrists: clench your fists with maximum force, bend your hands at the wrists. Count to 5. Relax. Remember relaxation for 30 seconds. From elbows to shoulders: bend your arms at the elbows and press them against any surface (table, armrests, wall behind you). Try to tense both biceps and triceps. Count to 5. Relax. Remember relaxation for 30 seconds. Face: tense all the muscles of the face: press your lips together, wrinkle your nose, squint your eyes, furrow your brow, clench your teeth. Count to 5. Relax. Remember relaxation for 30 seconds. Neck: pull your shoulders up, press your chin into your chest. Count to 5. Relax. Remember relaxation for 30 seconds. Chest and diaphragm: take a deep breath and hold your breath, tense your chest muscles. Count to 5. Relax. Remember relaxation for 30 seconds. Back and abdomen: tense your abs, bring your shoulder blades together and arch your back. Count to 5. Relax. Enjoy the feeling of relaxation. Thighs: tense them as you like. Count to 5. Relax. Remember relaxation for 30 seconds. Calves: tense as much as possible. Count to 5. Relax. Remember relaxation for 30 seconds. Feet: curl your toes, tense your feet as much as possible. Count to 5. Relax. Remember relaxation for 30 seconds. Deep relaxation (without muscle tension) Then you can enhance relaxation without prior muscle tension. Focus on your breathing. Just observe how the inhale smoothly transitions to the exhale. Notice how the body relaxes with each exhale. This relaxation is your goal. Transfer this relaxation to the area between the eyebrows, then it will spread across the forehead and temples. Let the relaxation penetrate the cheeks, around the eyes, into the muscles around the mouth, neck, and shoulders. Feel how relaxation flows into your arms, filling them with pleasant warmth. Transfer attention to the chest, abdomen, internal organs, and pelvic muscles. Feel relaxation in the thighs, knees, calves, and feet. Notice how your body relaxes with each exhale. Your thoughts become quieter, and your mind calms down. Shift your attention to the inhale. With each breath, fresh air enters your body, and your chest expands. Feel how this fresh air fills you with energy and strength. Feel the vigor spreading to your shoulders, arms, fingers, and legs. Take a deep breath and gently return to reality. Open your eyes. Final Notes Expected Improvements By following the above recommendations, you can achieve the following improvements: Unspecified hyperuricemia: By following the prescribed treatment and lifestyle recommendations, the patient can expect a reduction in uric acid levels in the blood, which may help alleviate symptoms associated with hyperuricemia. Chronic prostatitis, microcalcifications of the prostate: The use of Vobenzim and Longidaza will help reduce inflammation and manage microcalcifications in the prostate, potentially improving urinary function and reducing pain. Vitamin D deficiency: Taking Vitamin D will help maintain an optimal level of vitamin D in the body, improving overall well-being and supporting healthy bones and immune function. Non-alcoholic fatty liver disease: The use of Ursosan will aid in reducing fat accumulation in the liver, improving liver function and overall health. Chronic non-calculous cholecystitis: Following the prescribed treatment plan will help manage inflammation in the gallbladder, potentially reducing pain and improving digestive function. Reactive pancreatitis with secondary enzymopathy: Adhering to the treatment plan will help manage pancreatic inflammation and enzyme deficiencies, improving digestive health and reducing related symptoms. Follow-up Visit To monitor your progress and adjust treatment, we recommend you come for a follow-up visit: CONSULTATION WITH AN ENDOCRINOLOGIST A follow-up visit with an endocrinologist is necessary to monitor thyroid function and adjust treatment as needed. Recommended Additional Tests Blood test for uric acid After 1 month The blood test for uric acid is necessary to monitor the effectiveness of the treatment for hyperuricemia and adjust the treatment plan if needed. Conclusionт Dear Mr. Kevin White! Following all the above recommendations on nutrition, physical activity, and sleep hygiene will help improve your overall health and contribute to faster recovery. Follow the prescribed treatment plan and don't forget about the need for a follow-up visit to assess the effectiveness of treatment and adjust the plan if necessary. We wish you good health and speedy recovery! Your commitment to improving health and following medical recommendations will certainly bring positive results. 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