Thread by @Dr_M_Guthridge

thread

Remarkable @bmj_latest @BMJCaseReports report documenting the extreme lengths a bedbound patient went through to get a diagnosis of #POTS, #MCAS, #SIBO and #tachycardia

read her story here

#MedEd #MedTwitter @MayoClinic
casereports.bmj.com/content/2018/b…

2. After suffering for 16 years, seeing 19 docs with repeated misdiagnosis:

Her cardiologist couldnt diagnose #POTS

Her gastroenterologist couldnt diagnose #SIBO

Her immunologist couldnt diagnose #MCAS

Her neurologist referred her to a #psychiatrist!

casereports.bmj.com/content/2018/b…

3. Patient: the "neurologist was out of ideas and suggested I get a psych evaluation, which I declined"

the patient <referred herself> to @MayoClinic

#SickNotWeak #chronicillness #chronicpain #MedEd #medtwitter

casereports.bmj.com/content/2018/b…

4. in the diagnosis of #POTS, the @MayoClinic excluded the possibility of #MECFS, cardiac arrhythmia, venous insufficiency, #anxiety disorder, #IBS, #IBD, #colitis, pelvic floor dysfunction, carcinoid syndrome and #pheochromocytoma

#MedEd #medtwitter

casereports.bmj.com/content/2018/b…

5. in the diagnosis of #MCAS, the @MayoClinic excluded the possibility of #MECFS, #fibromyalgia, generalised #allergy, #asthma, #sinusitis, #rosacea, #anxiety, #IBS, #colitis, #IBD, interstitial #cystitis,
carcinoid syndrome and #pheochromocytoma

#MedEd
casereports.bmj.com/content/2018/b…

6. She was treated with low-dose #naltrexone #LDN, which improved #pain, #memory, #sleep, flushing, food and odour sensitivities: 7% decrease in #POTS and 17% decrease in #MCAS

See treatment below

#SickNotWeak #chronicpain #MedEd #medtwitter @MayoClinic
casereports.bmj.com/content/2018/b…

7. after 10 intravenous immunoglobulin #IVIG treatments, the patient no longer experienced #tachycardia and #POTS

See treatment below

#SickNotWeak #chronicillness #chronicpain #MedEd #medtwitter @MayoClinic @bmj_latest @BMJCaseReports casereports.bmj.com/content/2018/b…

8. Rifaximin #antibiotic eliminated 20 years (!) of #SIBO including severe gastrointestinal symptoms including #bloating, abdominal #pain, #constipation and foul gas

See treatment below

#SickNotWeak #chronicillness #chronicpain #MedEd #medtwitter
casereports.bmj.com/content/2018/b…

9. "IVIg.. [was] effective for.. #POTS but this treatment is expensive and has.. side effects... #LDN is inexpensive, safe and appeared to [be] effective.. in both #MCAS and #POTS.. #antibiotic treatment can lead to significant gastrointestinal relief"

casereports.bmj.com/content/2018/b…

10. Conclusion:

-19 docs failed to perform the correct investigations for this severely ill bedbound patient

-Once correctly diagnosed, the patient was able to receive appropriate treatment and showed remarkable improvement

-her illness was not psychiatric or psychological