Friday, February 10, 2006

The young woman who had to wee 6 times a night

You know, I think I may have diagnosed something rare, and potentially quite harmful (if left untreated), in one of my lady patients. I arrived at the diagnosis through a brilliant and little-known process called 'scratching my head and feeling baffled', followed by the also particularly clever method I like to refer to as 'phoning the pathology lab for help'. You're really impressed, now, aren't you?

Names and other details are changed here, but the medical facts are correct.

Amy, a 25-year-old child care worker, has seen me on 3 or 4 occasions now. She seems a bit quiet, and a bit anxious about her health. Each time she has complained of a few unrelated ailments. She is a thin young woman, who has lost more weight over the couple of months since she first came for a consultation. I know this because I weighed her at the first consultation - I originally suspected she may have an eating disorder, and wanted to keep a check on her weight.

On her last visit, she was complaining of an episode of backache. To rule out a kidney infection, I asked her to provide a sample, and I enquired about any symptoms. Amy denied having any pain but admitted she was troubled by frequent urination. The urine test was normal.

After further questioning, I calculated that Amy was drinking over 3.5 litres of fluid a day, and discovered she was waking multiple times through the night to pass urine (well no wonder, with all that drinking). Hmmm...perhaps she has diabetes, I hear you thinking? That's what I wondered, but the fingerprick test showed a normal blood sugar. Hmmm again.

Blood tests showed nothing out of the ordinary except a high blood protein level ... something that is often found when people are a bit dehydrated. Dehydrated? On almost 4 litres of a fluid a day? I knew something was not right here. I knew it could be something endocrine (hormone-related).... all those weird endocrine disease names began to romp around in my head... medical school was so long ago... it's all so hazy...... I rang the local pathologist. He was very charming.
'I agree with you,' he said, 'that this most likely is a case of diabetes insipidus.'

AH-HA! That's what it's called. I mean, 'Yes, that's exactly what I was thinking.'

Amy is having further tests, but the endocrinologist I spoke to is confident that Amy does have diabetes insipidus. Most cases can be managed or cured. So, hopefully, Amy will soon be drinking less and sleeping a whole lot more at night.

You know, I complain about my job but I also really love it. Sometimes I think I really do make a difference - not by knowing a lot or having any great powers of deduction - just by being diligent and following through. It's good to feel useful.

PS if you want any information on diabetes insipidus, you can go here


Motherkitty said...

Wonderful! I'm sure that your patient Amy will thank you forever, Dr. Sherlock, for your perserverence and the fact that you care. Another physician might have pooh-poohed her symptoms and complaints, and tossed it off to "it's all in your head" female stuff. Not you, and isn't the patient glad.

I'm happy you just didn't say, "Elementary, my dear reader" or "I was just doing my job." I'm happy that you cared enough about your patient to follow through until you got an answer. You were brilliant enough to consult with others who might provide you with the answer.

We all thank you for your kindness and sensitivity.

Abandoned in Pasadena said...

As I have said are a wonderful and caring person/doctor and that is why your patient's love you.

My husband has chosen a GP, much like yourself...who is a caring individual who follows up and gets to the bottom of things. He, as yourself does not hesitate to consult others as far as finding the cause of a problem or the right diagnosis.

I would love to be able to use my husbands GP, but I know him personally and it's a little embarrassing (to me) to have to lay with legs up in stir-ups.

I enjoy reading your posts and thank you for leaving such nice comments on mine.

Heather said...

Of course you make a difference. Probably far more often than you realize.

I've had one patient with Di whose sodium got so low that he had seizures. I am glad you helped this young lady before that happened.

Anonymous said...

I love the fact that you didn't give up on helping her even though there were no sure signs that anything was wrong.

Alipurr said...

Thanks for the link, You just saved me some Googling time. :) I think Motherkitty's kitty has this....

Good job on good diagnosis