Allergies, joint pains, and nerves

If symptoms come in the spring

And don’t have a classical ring

    Allergies?  Please,

    You don’t have to sneeze

To enjoy the Hismanal zing

I won’t say when this happened except it coincided with call.  I got a call from one of the ER docs.  We have a sound working relationship.

A person, not my patient, came to the Emergency Room with some unusual neurologic symptoms, despite previous investigation.  The ER doctor didn’t know how much investigation, but before reinventing the wheel, wanted to know if I could access the medical records.  And strangely, I could, despite the late hour.

With a normal MRI, neurologic consultation failed to reach a diagnosis. 

“Yeah,” I said, “They got all the scans, but it doesn’t look like they did much in the way of chemistries.  Needs a B12 and a folate and a vitamin D, that’s for sure.  Nerve conduction studies are OK.  Spinal tap was normal, ok, yeah, MS is completely ruled out.  Oh, wait a minute, we’ve got a normal homocysteine and methylmalonic acid.  And here’s the B12, it’s 396, kind of borderline, but if the methylmalonic acid level is normal, the B12 is fine.”

(I didn’t mean to show off, my colleague understood me.  Without enough vitamin B12 or folic acid, two toxic products build up in the blood, methymalonic acid and homocysteine; a very savvy neurologist had investigated both chemicals, anticipating that the B12 might come back as marginal.)

“Now, hold on,” I said, coming to another page, “Looks like the symptoms were identical this year, last year, and the year before.  Patient’s been worked up three times already.  Always in the spring.”

We indulged in a thought pause.

“You know,” I said, “A while ago I knew a patient, came in every spring for seven years looking for all the world like rheumatoid arthritis.  All the blood work came out negative.  I tried seven different anti inflammatory drugs that didn’t help, and in the eighth year I gave a prescription for Hismanal [an antihistamine no longer on the market], figuring that if it happened in the spring it was probably allergic.  I got a call back a few hours later saying the pain had completely stopped.”

“Well,” the voice at the other end said, “That’s a thought.”

We agreed that the patient deserved a vitamin D level and a trial of an antihistamine.

If all diseases were textbook, we wouldn’t need doctors so much as textbooks.  In the real world, the five percent of the population who fall outside the normal parameters present eighty percent of the challenges.  Being a doctor requires being able to think outside the box while respecting the contents. 

I talked with that same doctor this evening.  We discussed a patient in the ER.  I broke the news about my coming career move, and my plan eventually to work with the Community Health Center.  When we finished talking I got the impression the other doctor was looking forward to working with me again.

I have 23 days and three call nights left. I talk with recruiters a couple of times a day, resisting taking jobs longer than two months.


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One Response to “Allergies, joint pains, and nerves”

  1. limewire Says:

    dang sweet story dude.

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