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Munch

Munch

As the morning greeted me today, I looked outside to see if the sun was shining. It was hiding behind several dark clouds covering the sky. I thought about that past week as I made my coffee. The Labor Day Holiday made it a short week, but we had a busy four days on which to reflect.

A young woman aspiring to be a singer came in for the fourth or fifth time. She has barely reached the age of twenty years old. She is relatively short for the US female population and had a weight problem. Many months ago, she was initially concerned about her weight. She needed to lose a few pounds. She had some minor stomach aches that plagued her off and on. Nothing too serious.

However, over the past year, she has become profoundly ill. She sat waiting for me eating puffed rice cakes. When I walked into the room, I noticed that she had lost a significant amount of weight. She was struggling with energy. She said that rice cakes were the only thing she could eat that did not irritate her stomach. I told her that there was very little nutrition in eating Styrofoam and we laughed together.

A few months earlier, she had shown me a video of her singing in a talent competition. I was flabbergasted. She had an amazing voice and her range was at least three octaves or more. This relatively tiny person had a strong powerful beautiful voice which was as good if not better than any female vocalist I had ever heard. I watched her video a few times in amazement. As she sat in my office eating rice cakes, she stated she did not have the strength to take her voice lessons. That comment made me feel sad. She had not given up on her dream of becoming a successful singer, but the fact that she had to place it on hold was disturbing since we are only given a finite number of years to live out our passions on this planet. Time matters no matter what age we are. Fantasies and dreams matter, they transform our behavior into purposeful living.

She had not given up, but now she was starting to feel desperate. Desperation is a poor place to operate from, it does not allow us to consider the options. Desperation allows ignorance to rule and complications to arise. My grandmother told me that I should never make a life changing decision when I am in a state of desperation. She was right.

Because she was desperate, this amazing vocalist was seeking advice about her health from anyone who would take a few moments of their time to listen to an abbreviated version of her medical history. She told everyone her major symptoms and gave them copies of a few of her blood test results were not in the normal range. The greatest confounding variable was that her gastrointestinal issues seemed to have arisen from some dark unknown place. It made malnourishment a significant factor in contemplating her fatigue and overall health decline.

Testing showed that she had accelerated gastric emptying. Somehow her body has decided to release almost any food stuff in her stomach into her small intestine. She has developed a very rapid gastrointestinal transit time probably a result of an infiltration of eosinophils into the lymph tissues that naturally protects her gut from bacteria, viruses and parasites. Food has become the enemy of her body, not nourishment.

As I carefully dissected her history, there was a point in her life when her gastrointestinal tract absolutely changed from a friendly operating system to one of pain, distention and rapid transit. She was on asthma medications and drugs to treat a presumptive mysterious allergic sensitivity. All of these factors seem unrelated, but in fact they are all related. Mixed therapeutic adventures often lead to the onset of autoimmune diseases and physicians many times dismiss the possibility that two or three drugs administered in synchrony for one specific purpose can often precipitate the development of an autoimmune disturbance of the first order.

My best guess is that a number of well meaning physicians have prescribed therapies that have created an autoimmune disturbance of some kind. The chore at the moment is to unravel the disease and treat her without resorting to desperate measures. Remember there is no time to plant flowers when someone is in a hurricane.

First the storm must subside and the debris removed before anything meaningful can be accomplished. Stop the progression of the illness first, then try to reverse the damage that has been done. In many cases the damage is permanent. I do not believe our future music star has gotten to that point. I have a suspicion that she has developed an autoimmune disease that is quite rare and is a result of taking waxing and waning doses of prednisone while being on a leukotriene receptor antagonist. There are a number of blood tests that might support or refute the diagnosis. The treatment is similar to other autoimmune diseases in the same category.

I have attempted to enlist her every day physician in her diagnostic adventure by writing a personal handwritten note to her because our amazing vocalist's health insurance will only pay for blood tests ordered by her assigned primary care physician. I do not know if her primary care doctor will oblige my requests. In the past, many other physicians have felt threatened by my requests for testing, citing that they did not see the need. I fully recognize that unsolicited advice is many times taken as criticism, however in her case, I had no choice. We will see what unfolds in the next few days. Hopefully we will have some answers that will help her climb out of that deep desperation of wanting to get better as quickly as possible. As I spoke to her at the end of our visit, I told her that there would be no silver bullet to set things right. It would take the all of it. She smiled and said, "Thank you!"

And then she reached in her bag, pulled out another puffed rice cake and began to munch.

Doc
Posted by Amanda Sanders at 8:42 AM
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