I will present 2 cases of patients with pre-diabetes , mild hypertension , dyslipidemia who have very different symptoms of the same medical problem.
Case #1 72 y/o male with a Fasting blood glucose of 116 mg/dl, A1c of 6.1,
Blood Pressure 126/78
Medications zocor ( simvastatin ) 20 mg/day for 2 years
lisinopril 20 mg/day for 3 years
metformin 500 mg twice daily
omega -3 FA 960 mg twice daily
Symptoms . recurrent episodes , separated by weeks or months , of a stinging sensation followed by itching and swelling of the top of his right or left foot . The swelling and itching would subside over the next 4 to 5 days and he would be asymptomatic until the next episode. He attributed the symptoms to insect bites.
One afternoon while watching TV he developed a numb tingling swelling sensation in the left half of his tongue that lasted about 1 hour. The tongue symptoms prompted a doctor visit .
A diagnosis was made , treatment was started with complete resolution of all symptoms.
What is your diagnosis ?
Case #2 71 y/o female with a : Fasting glucose of 112
Blood Pressure 132/86
Cholesterol 168 mg/dl
LDL 66 mg/dl
HDL 52 mg/dl
Triglycerides 249 mg/dl
Medications Zocor (simvastatin ) 40 mg/day for years
Omega -3 -Fatty Acid 4000 mg/day for years
Lisinopril 40 mg/day for years
coumadin 5 mg/day for 3 years
The sudden onset of severe chest pain , nausea , sweating and difficulty breathing. The symptoms subsided in the emergency room. Her physical exam , EKG, chest x ray and test for heart damage was normal. They did find 3 abnormal liver test. She had similar symptoms about 15 years ago which resulted in a diagnosis of gall bladder disease and surgery.She had repeat liver test the next week that were normal.She saw a cardiologist who could not find any evidence of heart disease. She continued to have the same recurrent symptoms , multiple Emergency room visits. Abnormal liver test that quickly returned to normal were present with each episode of pain . She was referred to a gastroenterologist to for further evaluation and to rule out a retained gall stone. After the visit and plans for further invasive studies were discussed . A doctor friend suggested a unusual possible diagnosis. Treatment was initiated with complete resolution of her symptoms.
What is your diagnosis ?
Are these 2 cases the result of the same problem?
The clue to the diagnosis of both cases is discussed above.
Have Fun Be Smart and make a diagnosis and don't overlook these symptoms.
This could happen to you
The answer and discussion tomorrow.
David Calder, MD