I want to give an update on a patient I described several months back. This was a patient that came to me who had a history of having bacterial pneumonia requiring hospitalizations almost once a year for the past ten years. In addition, the patient had a long history of recurrent sinusitis and mastoiditis. When the patient asked her primary care provider why she was getting sick so often, she was told it was most likely due to anxiety and depression.
In a previous update I mentioned that there was a strong suspicion that the patient may have had an underlying immunoglobulin deficiency. The diagnosis has been confirmed and the patient has what is known as Antibody Specific Immunoglobulin Deficiency. She has received two doses of IVIg in the past month and a half and is feeling much better.
She has also been diagnosed with severe obstructive sleep apnea and is enjoying more restful sleep using her CPAP. The CPAP has also helped in managing her GERD better, both of which are contributing factors to her chronic sinusitis and chronic mastoiditis.
Her ENT is very pleased with the outcome of her last surgery believing that aggressive medical management helped considerably. The patient has also been diagnosed with Allergic Fungal Sinusitis and continues on a medicated sinus rinse containing an antibiotic, an antifungal and a steroid.
So, in a few months this patient went from being told that her complaints were due to anxiety and depression to having multiple diagnoses that are now being treated aggressively and appropriately. Sadly, she’s not alone. Recently I saw a young woman who has been diagnosed with Mast Cell Activating Syndrome, Ehlers-Danlos Syndrome, and POTS with some components of diabetes insipidus thrown in there for good measure. For ten years, until she was seen by clinicians who understand multiple chronic conditions, she was also told that she was suffering from anxiety and depression.
This new patient is seeing me because she most likely has an underlying immunological deficiency identical to the above patient. Confirmation testing is pending. She may also have underlying obstructive sleep apnea. Again, testing is pending. I will keep you posted.
In the meantime, between gross mismanagement of the Covid-19 pandemic and gaslighting, medicine has two black eyes. Confidence in medicine is eroding. If the profession is to be salvaged, we need to get back to basics. We need to have a better understanding of basic system-based pathophysiology and learn how to take an extensive history and physical, before dismissing patients. Medicine needs to use a holistic approach. Holistic medicine does not mean handing out nuts and berries, it means looking at the body as a whole. With eight billion people on the planet and life expectancy moving into the 80’s there are a lot of people with multiple chronic conditions which may impact each other. If things don’t change within the medical community, then you can add a fat lip and a bloody nose to the black eyes.
