The author, herself a physician, presents cases with unusually diagnoses, in language lay person like myself can understand. She discusses the patients' symptoms and the effects they have, detrimentally, on the patients. The reader of her book is absorbed with the patients as people and and with their medical and lifestyle problems.
There is the story of a patient with symptoms doctors can't explain. Many diseases are ruled out, even Lyme's disease. But it turns out patient does indeed have a tick-borne disease, one that is not susceptible to the medication that treats Lyme's disease, which medication she had been put on. In fact, the patient had Rocky Mountain Spotted Fever, from a different species of tick.
Another patient with a myriad of symptoms that baffled doctors for a while turned out to have Schnitzler syndrome, wherein macrophages go wild and tell the body to act like it's infected. An expensive drug was available to treat it, but the patient's insurance company wouldn't pay for it. The doctor appealed to the drug manufacturer, which thereupon provided the drug to the patient for free. The patient then became symptom free.
Another patient wound up having Lemierre's syndrome. It's a rare infection that was very fatal before antibiotics. Even now, with antibiotics, it's 18 percent fatal. It's caused by a strep throat going awry. It took month, but this patient recovered completely. There's a message from this case : take strep throat seriously.
There can be serious side effects from prescribed medications. One patient was on allopurinol for gout. She developed an allergic reaction that affected the kidneys. She was on dialysis for weeks. The gout medication was stopped. The patient then rapidly improved.
Another patient turned out to have a disease from flying squirrels. It was endemic typhus, a rare bacterial disease. Once diagnosed and treated, the patient recovered.
A patient with mystifying symptoms was determined to have hereditary angioedema, a genetic anomaly . She was treated with steroids to prevent the swelling caused by the disease.
Another patient developed symptoms that included tingling, numbness and an irregular heart beat. Turns out the patient had cinguatera poisoning from a barracuda fish he ate. The toxin therefrom came from organisms that grow on reef algae in some tropical waters. Cooking doesn't destroy the toxin. The symptoms can persist for months, even years. I only eat fish from cold water, fish such as cod,haddock, flounder, sole.
In another case, s young woman with a medical problem that defied diagnosis, died. Her organs were donated. The recipient of her liver died within days of receiving the liver transplant. Turns out the dead donor had a rare genetic defect and was missing an enzyme that breaks down proteins and thereby allows ammonia to build up with fatal conclusions.
A patient presented with pain,fever, and inflammation. She had familial Mediterranean fever, which caused malformed proteins. White blood cells overreacted. The patient was put on the medication colchicine,which prevents most attacks. The patient takes this medication regularly. I assume for life.
Another baffling set of symptoms in another patient turned out to be Whipple's disease, caused by a bacterium. The patient was on antibiotics for more than a year. The patient was able to stop using a wheelchair, then able to put aside a walker, and even be able to walk without a cane -- but not far.
And so it goes, one medical mystery after another in this compendium of interesting and challenging medical cases. I was enthrall despite my lack of a medical background. I love good detective stories, including medical ones. I recommend this book.
Pockets
Allyson M. W. Dyar