Friday, February 27, 2009

Diagnosis: Not Murder, Just Feels Like It

I'm feeling particularly proud of myself today, in a professional kind of way.

I have a patient* who was referred by a health professional a few months ago for frequent intense nausea and occasional vomiting.  They couldn't figure out any treatment other than pretty heavy sedatives (in my opinion), and thought psychological factors could be an issue.

I discovered in my interviews that she had a family history of migraine, so I wondered if this might be some kind of atypical migraine.  Upon discussion with the physician, we couldn't find anything that exactly matched the patient's symptom profile.  However, the physician did take my recommendation and he began prescribing migraine meds for the patient.  They work pretty well when she takes them, so that part is good.  

And then just yesterday, when I was researching some narcolepsy issues for another patient, somehow I came across this syndrome.  That's totally it!  I'll tell you what, you are glad you don't have this.  The interesting thing is, the syndrome profile is just as I "conceptualized" it (improper English, but proper jargon).  Also, even some weird little aspects that the patient said that seemed like they wouldn't really be related, are discussed, such as weather.

So basically, it validates both my conceptualization and treatment and the patient's experience.  It doesn't change the treatment,  but it may make it easier for her to accept it, now that there's a name for it (including treatment focusing on managing anxiety, which no one likes to hear when they have physical symptoms).  Oh, and it also  means that I figured out the diagnosis of something that baffled the physicians.

It even comes with support groups and a website that shows medical trials going on all over the world that is searchable by disorder and by location (the maps tab is pretty darn cool).  I don't think they're doing any near her for this patient, but still, it's pretty cool.  Even though it is mostly corporate and probably eevyil, as far as I can tell.

*Important aspects of this case are made vague and changed to protect confidentiality.  However, the diagnosis is real.

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