Okay, it's time again for you armchair neurologists out there to help me with a challenging case. Here is, verbatim, the first paragraph of my note. See if you can guess the diagnosis:
"When working outside in the Summer, or inside baking, she becomes warm, sweaty, and lightheaded. The symptoms resolve with drinking cold water and cooling down. They don’t occur if she keeps up on her fluid intake."
Seriously? Someone actually went to a doctor for that?
ReplyDeleteEven better. They were referred to me by another doctor for it.
ReplyDeleteLupus! What do I win?
ReplyDelete-Flavius
Menopause or perimenopause.
ReplyDeleteIt's never lupus. Must be sarcoidosis ;)
ReplyDeleteMaybe the other doc thought that her inability to connect the dots was a sign of a deeper problem.
ReplyDeletePlain ole dehydration. Good god! And, I am not even a medical pro. Merely an experienced Grandma.
ReplyDelete"Thank you for this interesting consult."
ReplyDeleteDiabetes insipidus vs. primary adrenal failure.
ReplyDeleteaddison's
ReplyDeleteOverexpression of TRPA channels linked to temporal lobe epilepsy, causing her to experience euphoria and a sense of "rightness" when cooled down.
ReplyDeleteSounds like hypopandiculation to me. :-)
ReplyDeletehttp://well.blogs.nytimes.com/2011/10/03/really-the-claim-yawning-cools-the-brain/?ref=health
I'll take Dehydration for $400 please
ReplyDeleteHypothalamic glioma causing temperature dysregulation.
ReplyDeletePlain ole over-heating and dehydration!
ReplyDeleteKa Ching syndrome.
ReplyDeleteI think it is the lightheaded part that concerned them---just saying.
When I work outside in the summer, not only do I become warm, sweaty but I start to take on an offensive aroma ---please help.
Syphillis!
ReplyDeleteDevelopmentally disabled.
ReplyDeleteHypochondria, complicated by stupidity and generous health insurance.
ReplyDeletemalaria or yellow fever
ReplyDeleteYou'd better run about 100 tests to rule out all of the above. Then run them again, just to make sure. At which point, patient will see another doctor because you can't find anything "wrong", and my insurance rates will go up 10% this year.
ReplyDeleteHmmm, that's a tough one. Better run 100 expensive tests to rule out all of the above. Then repeat, to confirm because patient forgot to mention meds she was taking during tests. Then, after trying about 20 different expensive medications, patient will go to another doctor because you can't find anything "wrong." Shortly after, my insurance rates will jump by 15%.
ReplyDeleteReminds me of the consults for chest pain all the time.
ReplyDelete"How long did the pain last for?"
"About a second."
"And you thought that warranted an 8-hour wait in the ER?"
Either dehydration and/or that syndrome, I can't put my name on it but the one where there's nothing in the space between the two ears??
ReplyDeleteSo what's your treatment plan?
WOW!
Nothing wrong except that you can't fix stupid.
ReplyDeletedon't blame the doctor who referred her to you, that doctor was just doing his/her job, aka CYA :p
ReplyDeleteCould be a precursor to JFA
ReplyDeleteMedical ethics dilemma: what does a doctor do when the interests of the patient are directly opposed to the interests of the human race?
ReplyDeleteMultiple Sclerosis
ReplyDeleteSh** for brains syndrome...
ReplyDeleteTURF to endocrinology.
ReplyDeleteDehydration
ReplyDeleteI battle with it daily. It's the number one trigger for migraines, with overheating as the second.
wv: palifit --> pal i fit
Seasonal Artisanal Hemorrhage
ReplyDeleteMeh. I'm gonna apply for a grant to study it. To validate the Common Sense Hypothesis.
ReplyDeletePssssttt, don't send that doc rural - he's been spoilt by the proximity of Grumpy and his ilk.
Or he / she has no balls.
Or he / she was UBER wise, cut their losses, and pointed her at you with an evil grin.
While America payed.
A serious reaction to pediatric vaccinations
ReplyDeleteDementia. It's time to notify the family.
ReplyDeleteDehydration, secondary to stupidity.
ReplyDeleteEarly Shy-Drager Syndrome?
ReplyDeleteMEN II
ReplyDeleteone of two things. a tumor on the pituatary gland. or dehydration. My bet is dehydration
ReplyDeletePositive billfold biopsy (or really good insurance) and a patient who demands the doctor "do something".
ReplyDeleteThe md did not want to lose the cash cow so he referred her so that she can be mad at you over her diagnosis (or lack thereof) and not him.
If she is actually experiencing heat and exercise intolerance beyond normal limits (which is possible even with reasonable water intake), she could have a form of orthostatic intolerance.
ReplyDeleteAs a fellow neurologist I have experienced this too. Last month I was called by the ED about a young man who worked at a dry wall production plant where the temperature is hundreds of degrees. He reported he typically had to drink a gallon of fluids a day and sweated profusely at work. He was brought to the hospital after his second episode of passing out. The consult was for a positive Romberg and gait ataxia. I asked them three times to check orthostatic vitals, which they only did after I had seen him. After they were positive they still wanted to admit him to neurology!
ReplyDeleteTime for a Big Work-Up (tm)!!
ReplyDeleteI think you should write this one up and publish it. After all, you have reported to your loyal readers many examples of doctors publishing the f***ing obvious!
ReplyDeleteCheese and Rice! I can't believe someone actually consulted a doctor....a high falootin' doctor too! I hope you charged this person double.
ReplyDeletefibromylasia
ReplyDeleteWell, somebody took MS, so I'm gonna go with Gullian-Barre.
ReplyDeleteI think she should stop working outside in the summer, at least until evening, and should stop baking unless and until her kitchen is air-conditioned. Please provide a billing address for my expert advice!
ReplyDeleteEnergy Field Disturbance...duh. Probably some Risk for Sexual Identity Pattern.
ReplyDeleteGotta love the nursing diagnosis!
GB, RN
I have these symptoms all the time FOU syndrome combined with ncltcg ncltgt= no chilrin left to cut grass
ReplyDeleteFOU=fat old and u
Leprosy.
ReplyDeleteOk, this is a tuff one. Drink more water and set your a** down. that will 19.95 plus tax..
ReplyDeleteThe referring doc knows you have a blog and the patient is his/her cousin?
ReplyDeleteOhhh a tough one eh? Hmmmm OH! I bet it's a glioblastoma...or it could be dehydration...
ReplyDeleteI have a few addition questions prior to making my official diagnosis... Does she get cold when standing infront of an open fridge? Does she get wet when she goes swimming? Does she find these symptoms bothersome or concerning?
ReplyDeleteIf so, I would recommend introducing her to your patient who couldn't see when she closes her eyes, and encourage them to initiate a support group for the terminally stupid. Preferably in a location where Darwin's Theory could get a little help.
Craniorectal impaction.
ReplyDeleteThis is remarkable. If we've ruled in the possibility that fainting may require a valsava maneuver to relieve the excitation and stimulant effect of baking indoors and/or being outdoors--hot and sweatiness, then we'd want more info.
ReplyDeleteI would want more H and P, like what happens when she drinks water at room temperature, or hot water?
Or what happens if instead of drinking water, she drinks lemon squash.
This could very well be the acid-test.
What happens if she drinks water while sitting on a chair, on a couch or here or there? What happens if she drinks it anyhow, or anywhere?
The question for her, then, is not whether she has normal temperature-regulation to respond to ambient temperature, or even there's a snake skeleton in her closet, but how she likes her water.
In a tumbler or a glass, on the porch, or in the grass. And, whether drinking a four pints of Guinness would take care of it.
"Madam, what you describe is normal mammalian physiology. It is only pathological if you are, in fact, a Lizard Person."
ReplyDeleteDr. Dick F---kin' Tracy!
ReplyDeletePOTS.
ReplyDeleteI second POTS. Send her for a tilt table test, and start fludrocortisone if it's positive.
ReplyDelete