Thread by @angryhacademic

"Your test results are normal"

Medical professionals, please ask yourself: at which point would you stop testing?

I have put a ⛔ where I am aware many doctors have stopped with patients.

🧵

#LongCovid #MECFS #vaccineinjuries #chronicillness #TeamClots #MedTwitter

A patient goes to the dr with a range of systemic symptoms that dont neatly fit current diagnostic criteria. Symptoms started rapidly & strongly a few hours after the COVID vaccine; however, the reason for the problem isnt important for this lesson

⛔

The doctor does some tests

Hb, RBC, haematocrit, MCV, MCH, platelet count, WBC, neutrophil, eosinophil, basophil, lymphocyte, & monocyte count. Mean platelet volume is elevated but this isnt reported & is instead hidden in the lab records. “Your test results are normal” the doctor says

⛔

Still, the patient suffers. The doctor does more tests. Na, K, Cl, bicarbonate, urea, osmolality, creatinine, eGFR, alk phos, albumin, total protein, ALT, AST, GGT, bilirubin, lactate dehydrogenase, phosphate, urate, CK. “Your test results are normal” the doctor says

⛔

The patient continues to suffer. Maybe this is immunological. The doctor does more tests. IgG, IgA, IgM, CRP, IL6. “Your test results are normal” the doctor says

⛔

“Are you sure you cant think of anything else?” the patient whimpers. An infection or autoimmune response, the doctor thinks. HIV, borrelia burgdorferi IgG, intrinsic factor, ANA, anti-MPO, anti-PR3, tTG-IgA autoantibodies. “Your test results are normal” the doctor says

⛔

The patient looks confused & is still suffering. The doctor does more tests. Ferritin, folate, PT, INR, aPTT, D-dimer, VEGF. And a head CT scan. “Your D-dimer is elevated, but since all your other test results are normal, this is probably inflammation” the doctor says

⛔

“There has to be something wrong” the patient cries. Maybe hormones/metabolism, the doctor thinks clutching at straws. Cortisol, TSH, free T4, cholesterol, HDL, LDL, TAG, ApoA1/B, glucose, HbA1c, ACE, transferrin, caeruloplasmin. “Your test results are normal” the doctor says

⛔

The patient drags themselves despairingly to their next appointment. “Please help me”. The doctor does more tests, maybe its diet. Vitamins A, B1, B2, B6, D, E, K, Zn, Cu, Se, Mn, Mg, Fe. “Your B12 & D are low, but other than that your test results are normal” the doctor says

The patient feels relief. Maybe vitamins will help.

They do not.

“Your test results are normal” the doctor says, reassuringly. “I’ve checked your blood, kidneys, liver, immune system, inflammation, brain, hormones, metabolism, infection, and nutrition.”

⛔

“I'll have to refer you” the doctor says

This didnt reassure the patient, but the referral brought some hope of answers. Of help. Of treatment

The new doctor looks at the results, does some physical examinations & orders a MRI. “Your test results are normal” the doctor says

⛔

“This must be functional” the doctor says. “I will liaise with psychiatry” the doctor says.

The patient cries. This cannot be functional. Something is wrong. “Your test results are normal” the doctor reiterates.

⛔

Another doctor does not believe this. They dont believe patients suffer for no reason, or the best medicine can do is therapy

They run more tests. Porphyria, ESR, MMA, homocysteine. “Your homocysteine is elevated, but I dont think that explains your symptoms” the doctor says

⛔

"Let’s investigate some more” the doctor says. “We need to understand why your mean platelet volume and D-dimer are elevated” the doctor says.

Another blood test. Venous oxygen saturation. “Your cells are suffocating” the doctor says.

⛔

“We will get a VQ scan”.

“Your test results are *not* normal” the doctor says

“The VQ scan shows multiple pulmonary emboli & areas of no ventilation nor perfusion. This pattern of damage is in line with what we understand about microclots"

"We can treat this” the doctor says

The patient cries with joy

This patient is me.

I am not unique.

“Your test results are normal” is harmful.

Do not confuse normal test results with functional, unexplained, or psychological aetiologies. When a patient presents with an unusual symptomatology, explore don’t ignore.

dontbelievehype.co.uk/covid-%26-vacc…

#MedTwitter

This idea is the brainchild of @DeansKevin

[Timeline and some details of events have been rejigged for the purposes of story-telling]