May 26, 2011
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My First Diagnosis
On yet another day of continuity clinic, I was expecting more mundane blood pressure and diabetes follow ups, another visit from my fibromyalgia patient, and possibly some genital related question. All in all, pretty standard fare.
Hmmm…25 year old here for yearly physical, no past medical history. Oh good, I figured, this wouldnt take long…go in, listen to heart lungs poke around stomach and reflexes, send him on his way with a clean bill of health.
Pt: Oh doc, I had a couple questions while I am here, the last doctor wasnt really able to answer them to my satisfaction and just sort of brushed me off.
Dr J: alrighty, fire away…
Turns out that the patient had had a 15-20 pound weight loss in the last two years, most likely because everytime he ate anything, he would throw up about 20 minutes later. He said his previous physician 2 years earlier told him he was a healthy weight and not to worry about it. Now, he was still a healthy weight, but I asked him, if he threw everything up, was there any pain or difficulty with swallowing, and he denied any. Then I asked him what foods if any he was able to keep down…and he mentioned his diet consisted entirely of fruits and vegetables
At this point, the hamster wheel in my head began to spin…
Upon further review I learned that the foods which tended to make him sick following their consumption included spaghetti, rice, milk and cereal, and occasionally alcohol, specifically beer
Noticing a pattern? all grains. all gluten containing foods.
So I sent him off to GI after ordering a comprehensive celiac disease workup including an iron panel and IgA antiendomysiall antibody and Iga antitissue transglutaminae. In earlier times, an antigliadin antibody would have been ordered as well, however that has been found to have a lower sensitivity. It came back positive.
What makes this patients case so exciting (at least to me) is that he had no family history of any digestive diseases, and was from an ethnicity in which this particular disease is fairly rare and unlike the majority of my celiac patients who show up with the diagnosis already made, this was somebody who had absolutely no clue what was going on with him.
Sure it was a fairly textbook presentation in terms of symptoms, but had he not seen me, he could have gone on for who knows how many years with the same problem, just being brushed off until some other doctor picked it up on a whim.
My patient
My knowledge
My Diagnosis
It was one of those moments that helps to remind me why I went into the field.
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Why Not Zoidberg
Comments (6)
We need more doctors like you, Seriously. Some doctors just do their “job” and there are a few that really does care about their patients. I have health issues too and my family doctor just brushes everything off and tells me, “you’re perfectly fine!” yes…I’m always “fine” until I’m in the ER screaming bloody hell! Frustrating.
whooooot! Awesome. Great job.
Keep up the good work, that is exciting
*high five*
@nerdyveggiegirl - i actually thought of you when i was writing this post. But yeah, my patient is another one of those races who doesnt get it, but the first thing they teach you in med school is that diseases dont read textbooks. Also, I want to specialize in GI, so i tend to pay more attention to gastro things
I have celiac disease. I wish I were your patient! It’s so frustrating, my doc diagnosed me w/ IBS for 6-7 years, lactose intolerance, and then the ubiquitous “it’s stress” diagnosis. It took 2 fainting spells & visits to urgent care when my bp dropped to 70/52 for someone to order the antibody blood test. 7 months later, I’ve gained 10lbs & feel healthier than ever. I asked my md why she never checked for this before. she said asian people didn’t get it =[
Way to go! That’s really fantastic.