Wednesday, April 18, 2012

Different symptoms with the same diagnosis. This could happen to you?

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
                                              Cholesterol 116
                                              LDL             57
                                              triglyceride 114
                                              HDL            36

Medications  zocor  ( simvastatin )           20 mg/day for  2 years
                      lisinopril                              20 mg/day  for 3 years
                      metformin                          500 mg twice daily
                      aspirin                                  85mg/day
                      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


Symptoms;


     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



                     
                                           

3 comments:

  1. Hi david..

    Bless you meant for ad this, It's basically exactly what When i was searching for concerning google. I'd loads fairly find out beliefs at a man, just a little as opposed to a business internet page, that's exactly why I really like websites which means noticeably. Cheers!

    Adelina
    Via : Strep Throat Symptoms

    ReplyDelete
  2. This blog is great source of information which is very useful for me. Thank you very much.


    elevated triglycerides

    ReplyDelete
  3. Thank you very much. This really helped me with my work. I appreciate your help. Thanks a lot. good website

    Lingerie

    ReplyDelete

Your comments and questions are appreciated. David Calder,MD