Not really much of a medical mystery, but many cases of endometriosis that went undiagnosed for years. I also was able to figure out that a patient’s dropping haemoglobin and subcutaneous bleeding was being caused by scurvy, due to his multiple-year long commitment to a strict ketogenic diet.
A cool call I had as a paramedic many years ago immediately annoyed my partner and I. Twenty something year old male, woke up with nausea and vomiting (Sunday morning in a neighborhood that is known for young people partying). The call notes said there was a small amount of blood in the vomit, so it got up-triaged to paramedics responding.
We arrive and are met by the patients girlfriend who is freaked out but guides us to our patient, who is white as a sheet, drenched in sweat, vomiting all but pure blood into a trash can that is already pretty full of blood.
We start our assessment and treatment and he has a vague medical history. He has always had digestive issues, and has to eat a diet with extremely low fat, he has chronic diarrhea, and really bad hemorrhoids. We ask about what he got up to last night, and if he was partying. He says no, he can’t have more than a beer under any circumstances or he’s a mess for days on end, he smoked a little weed, but not more than usual and he’s smoked from the same bag earlier and was fine. He has never thrown up blood before.
He’d never done more than go to an urgent care for his issues before, as he didn’t have insurance.
Obviously he has an upper GI bleed, but something clicked in my cave man brain and realized exactly what was happening. His liver was SCREAMING for help.
Can’t digest fat, can’t process alcohol, and what seemed like an innocuous comment was the key to the whole thing- his hemorrhoids.
If the circulation through your liver gets backed up, it causes pressure in the blood vessels that come in and out to build up. If enough pressure builds up, the veins in your butthole balloon out causing a hemorrhoid.
If that pressure goes north, you can get esophageal varices, which are essentially the same thing as hemorrhoids, but in your throat. They can rupture, and bleed like an absolute son of a bitch.
Despite our efforts, he had lost a ton of blood, and rapidly got worse. Upon arrival into the critical section of the ER, he painted one of their walls, passed out, and needed to be intubated and given many blood transfusions.
The attending (head doc in the ER) had always been an aloof dickhead who didn’t play well with nurses nor EMS, but after the dudes liver labs came back and we were back later in the day with another patient he pulled me aside to be like “what exactly is the scope of your guys training? That was crazy that you caught that”.
I reflected on that moment for the rest of my career, during which I felt like an absolute moron about 90% of the time.
Nothing seemed to help this patient, she really had no significant diagnosis. And she was on over 30 prescriptions. Meds for side effects of her other meds. I’ve eliminated about 12 so far. She’s feeling better but is anxious about reducing further.
Clearly her previous provider was just writing for whatever her complaint of the day was. And never stopped anything.
1.) cardiac amyloidosis from 3 EKGs ~ 9 months apart and an increased frequency of ER presentations for shortness of breath. Echo confirmed speckled myocardium.
2.) scleroderma renal crisis in 84 y/o not previously diagnosed with scleroderma
…transferred to me out of ICU after 5 days with uncontrolled BP and acute kidney failure. 🤦🏻♂️
I realized that the ulcers were from the Levamisole that was used as cutting agent in the cocaine. She quit the cocaine and the ulcers went away. She also gained about a 100 lbs and became diabetic, so…eh?
Munchausen. This lady kept getting septic from weird infections that didn’t “make sense” based on the culture data. Turns out she was quite literally injecting herself with her own poop.
Not my story, but an ER physician (Dr Mark Wahba) in Saskatchewan who recognised that the patient’s headaches were due to carbon monoxide poisoning, and because the patient lived in an apartment complex, he also made some calls and was able to save the entire building from carbon monoxide poisoning!
Not a doctor, but my psychology degrees came in handy when a family member was discussing his brother’s memory issues (featuring confabulation) and I correctly suggested Korsakff’s syndrome (similar symptoms to alzheimers, but most commonly found in alcoholics, which he was)
I also saw various doctors about abdominal issues and got diagnosed (incorrectly) with various digestive disorders and medicated accordingly. I figured out on my own that it was gallstones, got an ultrasound privately, and finally forced my doctor to refer me to a surgeon
I’m a medical
librarian. I had a surgeon call me about a patient she was completely stumped over. He’d had a device installed, but it needed to be replaced. The problem was the location. If she tried to remove it he would have hemorrhaged; if she left it in place he would have died slowly.
Did a bunch of research, even called the device maker and spoke to them; finally found a tiny bit of a thread online which eventually led to a YouTube video of the exact procedure she needed, and she was able to remove the device successfully.
My kid was born with a rare lung disorder called congenital lobar emphysema. At the time, less than 50 cases had been seen in the world. Son shouldn’t have lived past 2 weeks but our pediatrician finally diagnosed it at age 5 months. Son had surgery (left upper lobectomy)
The following year, our pediatrician was at a huge conference with around 700 MDs in attendance and the speaker threw out the symptoms for my kid’s disorder. Only 3 hands in the room raised to acknowledge they knew the diagnosis…and one was our pediatrician!
I don’t think doctors are solving or even helping much of anything these days. I say this after 8 years in our healthcare system. There are a few rare gems who are good and care, the majority are trash doctors and trash humans with big egos and no empathy.
I am not a Dr. but one saved my life by a simple handshake.
I was in hospital with gallstones. I was prepared for surgery. Saw my surgical team etc. All good we are taking you up for surgery. I felt absolutely rubbish but put it down to anxiety and the pain from the gallstones.
The Dr. was in the room to see the woman next to me. He was Irish and I am Irish both outside Ireland so we picked up on the accent and had a little chat (as you do)
As he was leaving he went to shake my hand. He walked away and came back. Questioning me that my hand was extremely sweaty. I explained that I have anxiety and it was going off but he was not convinced.
Thanks to him putting up an argument that my surgery should not go ahead and I need scans. My scan was cancelled 3 times but he kept on pushing it though. I was diagnosed with multiple bilateral PE’s.
Comments
It will never cease to amaze me what humans can fit inside the anus
Not really much of a medical mystery, but many cases of endometriosis that went undiagnosed for years. I also was able to figure out that a patient’s dropping haemoglobin and subcutaneous bleeding was being caused by scurvy, due to his multiple-year long commitment to a strict ketogenic diet.
A cool call I had as a paramedic many years ago immediately annoyed my partner and I. Twenty something year old male, woke up with nausea and vomiting (Sunday morning in a neighborhood that is known for young people partying). The call notes said there was a small amount of blood in the vomit, so it got up-triaged to paramedics responding.
We arrive and are met by the patients girlfriend who is freaked out but guides us to our patient, who is white as a sheet, drenched in sweat, vomiting all but pure blood into a trash can that is already pretty full of blood.
We start our assessment and treatment and he has a vague medical history. He has always had digestive issues, and has to eat a diet with extremely low fat, he has chronic diarrhea, and really bad hemorrhoids. We ask about what he got up to last night, and if he was partying. He says no, he can’t have more than a beer under any circumstances or he’s a mess for days on end, he smoked a little weed, but not more than usual and he’s smoked from the same bag earlier and was fine. He has never thrown up blood before.
He’d never done more than go to an urgent care for his issues before, as he didn’t have insurance.
Obviously he has an upper GI bleed, but something clicked in my cave man brain and realized exactly what was happening. His liver was SCREAMING for help.
Can’t digest fat, can’t process alcohol, and what seemed like an innocuous comment was the key to the whole thing- his hemorrhoids.
If the circulation through your liver gets backed up, it causes pressure in the blood vessels that come in and out to build up. If enough pressure builds up, the veins in your butthole balloon out causing a hemorrhoid.
If that pressure goes north, you can get esophageal varices, which are essentially the same thing as hemorrhoids, but in your throat. They can rupture, and bleed like an absolute son of a bitch.
Despite our efforts, he had lost a ton of blood, and rapidly got worse. Upon arrival into the critical section of the ER, he painted one of their walls, passed out, and needed to be intubated and given many blood transfusions.
The attending (head doc in the ER) had always been an aloof dickhead who didn’t play well with nurses nor EMS, but after the dudes liver labs came back and we were back later in the day with another patient he pulled me aside to be like “what exactly is the scope of your guys training? That was crazy that you caught that”.
I reflected on that moment for the rest of my career, during which I felt like an absolute moron about 90% of the time.
Sleeping beauty syndrome
Mediterranean macrothrombocytopenia.
Nurse here. I learned a really terrible way that Herpes can potentially be cured
Nothing seemed to help this patient, she really had no significant diagnosis. And she was on over 30 prescriptions. Meds for side effects of her other meds. I’ve eliminated about 12 so far. She’s feeling better but is anxious about reducing further.
Clearly her previous provider was just writing for whatever her complaint of the day was. And never stopped anything.
1.) cardiac amyloidosis from 3 EKGs ~ 9 months apart and an increased frequency of ER presentations for shortness of breath. Echo confirmed speckled myocardium.
2.) scleroderma renal crisis in 84 y/o not previously diagnosed with scleroderma
…transferred to me out of ICU after 5 days with uncontrolled BP and acute kidney failure. 🤦🏻♂️
Had a patient that was getting weird ulcers and was diagnosed with “Atypical Behcet Syndrome” ( https://en.wikipedia.org/wiki/Behçet%27s_disease ).
I realized that the ulcers were from the Levamisole that was used as cutting agent in the cocaine. She quit the cocaine and the ulcers went away. She also gained about a 100 lbs and became diabetic, so…eh?
Munchausen. This lady kept getting septic from weird infections that didn’t “make sense” based on the culture data. Turns out she was quite literally injecting herself with her own poop.
Not my story, but an ER physician (Dr Mark Wahba) in Saskatchewan who recognised that the patient’s headaches were due to carbon monoxide poisoning, and because the patient lived in an apartment complex, he also made some calls and was able to save the entire building from carbon monoxide poisoning!
Not a doctor, but my psychology degrees came in handy when a family member was discussing his brother’s memory issues (featuring confabulation) and I correctly suggested Korsakff’s syndrome (similar symptoms to alzheimers, but most commonly found in alcoholics, which he was)
I also saw various doctors about abdominal issues and got diagnosed (incorrectly) with various digestive disorders and medicated accordingly. I figured out on my own that it was gallstones, got an ultrasound privately, and finally forced my doctor to refer me to a surgeon
I’m a medical
librarian. I had a surgeon call me about a patient she was completely stumped over. He’d had a device installed, but it needed to be replaced. The problem was the location. If she tried to remove it he would have hemorrhaged; if she left it in place he would have died slowly.
Did a bunch of research, even called the device maker and spoke to them; finally found a tiny bit of a thread online which eventually led to a YouTube video of the exact procedure she needed, and she was able to remove the device successfully.
My kid was born with a rare lung disorder called congenital lobar emphysema. At the time, less than 50 cases had been seen in the world. Son shouldn’t have lived past 2 weeks but our pediatrician finally diagnosed it at age 5 months. Son had surgery (left upper lobectomy)
The following year, our pediatrician was at a huge conference with around 700 MDs in attendance and the speaker threw out the symptoms for my kid’s disorder. Only 3 hands in the room raised to acknowledge they knew the diagnosis…and one was our pediatrician!
I don’t think doctors are solving or even helping much of anything these days. I say this after 8 years in our healthcare system. There are a few rare gems who are good and care, the majority are trash doctors and trash humans with big egos and no empathy.
Dr House here…where shall I start?!
I am not a Dr. but one saved my life by a simple handshake.
I was in hospital with gallstones. I was prepared for surgery. Saw my surgical team etc. All good we are taking you up for surgery. I felt absolutely rubbish but put it down to anxiety and the pain from the gallstones.
The Dr. was in the room to see the woman next to me. He was Irish and I am Irish both outside Ireland so we picked up on the accent and had a little chat (as you do)
As he was leaving he went to shake my hand. He walked away and came back. Questioning me that my hand was extremely sweaty. I explained that I have anxiety and it was going off but he was not convinced.
Thanks to him putting up an argument that my surgery should not go ahead and I need scans. My scan was cancelled 3 times but he kept on pushing it though. I was diagnosed with multiple bilateral PE’s.