instruction: hello doctor I have a few problems with my body since last year I was under work pressure I could see my blood sugar gone up to 289 my do on post prandial up last month and reduced to 175 on up and 109 on fasting last week in the meantime for the past two weeks I suffer from fissure I am a case of vitiligo and epilepsy for 20 years and under medication with valproic acid 500 my reduced to 250 my for the last 10 months and clonazepam 5 my I have been noticing that my penis skin is shrinking for the last eight months and now narrowed down to my opening on the penis forehead skin for the last three months I am suffering from back muscle spasm after consulting my medicine I am taking a sit bath for fissure continuing valproic acid 500 my for epilepsy and back pain following a strict diet for blood sugar and no medication for vitiligo he suggests circumcision as the only option for penis skin problem I request your second opinion
output: hello I understand your concerns I have checked all the attached reports thoroughly attachments removed to protect patient identity and here are my notes repeated high post prandial sugar above 200 means that you are diabetic and need to start therapy do you have polyuria frequent urination do you drink water more than usual repeated cholesterol level above 200 along with fatty liver grade means dyslipidemia that requires management stress egg shows some changes that could mean some cardiac ischemia do you feel any chest pain especially with efforts if yes could you describe it all other investigations are within normal limits advice healthy life style that includes daily 30 minutes walk a healthy diet with low sugar starch and oily foods metformin 500 my after meals plus glimepiride amaryl my before breakfast for diabetes rosuvastatin 10 my once per day for high cholesterol a retinal fundoscopy and urine analysis for microproteinuria are required continue other medications you have follow up after one week regarding the penis problem I agree with circumcision I hope this helps