I recently had a patient encounter that took some interesting twists and turns. He presented with fatigue, joint paint, body aches, ...

fat-bias-nearly-cost-him-his-life

Fat-Bias Nearly Cost Him His Life

a young adult presents to the office with body aches fatigue and joint pain what happened next may surprise you let's get started before i walk in to see the patient i actually do a chart review to see if the patient has been seen before what the vitals are what information has been shared with my medical assistant and i find out that the patient has actually seen several other doctors over the last few weeks for the same issue and hasn't gotten a satisfactory answer meaning a diagnosis or treatment to solve the issue in looking through the notes i saw that the patient was initially diagnosed with arthritis that they attributed to the patient being overweight his bmi i think put him into the category of morbid obesity while that can cause osteoarthritis he seemed to be a little bit too young for that to start happening i walk in to see the patient i introduce myself one of the first questions is what has been the diagnosis thus far what have other doctors told you you went to see a doctor first who diagnosed a patient with arthritis related to his weight the treatment for that was some over-the-counter medications which i thought was a rather incomplete treatment even if that was the correct diagnosis then the patient said when they went home and tried the over-the-counter options the pain did not get better at all in fact it got worse and then a rash appeared so the patient over the weekend went to an urgent care facility where they gave the patient a cream when i investigated what the cream was it happened to be a topical steroid and the rashes did go away with the cream however over the period of about 10 days the pain in the joints in the muscles specifically the knees the elbows started to return for the patient so he came back to that same doctor and said hey why am i not getting better with the treatment what's going on and the doctor made some other evaluations and ended up sending the patient for x-rays to see if there was anything going on uh from the imaging side of things and again reiterated to the patient that the suspicion was all the symptoms were coming from the fact that the patient was overweight clearly that wasn't the issue if you look at the course of illness for this patient the fact that it was getting worse there's not only joint pain but there's also body aches there's also fatigue setting in rash is starting to happen these are multiple systems being involved and that tells me something systemic is going on i decided to ask the patient if he sent a message to any of his friends of the rashes typically we do that right we're like oh my god what is this and we take a picture with our iphones and to my luck he did he took a picture of the rash early on when it started and it looked like an erythematous meaning very red rash of the skin he only had a picture of one of them but he said all of them looked quite similar now this is unique because the fact that it's not happening again in one area tells me that it's not an isolated or localized reaction to something if i have a reaction right where my watch is that tells me something is going on in this area either there's a contact dermatitis where i'm allergic to one of the components of the watch maybe a fungal infection from trapping of the moisture so the the localized nature of the rash would tell me something but when we have a rash that's happening all across the body that means something's happening internally whether it's in the blood in the lymphatic system i need to think further so i started putting pieces together and i said wait you have fatigue joint pain body aches a rash does this patient have lyme disease so i asked the patient uh does he spend a lot of times outdoors hiking gardening and he said no absolutely not i'm kind of a homebody i like to stay home i don't really go outside much and i'm like do you have a dog and he's like yeah i love my dog i sleep with my dog i'm like has your dog ever had a tick i see his eyes open wide and he says yes my dog i actually pulled a tick off of him not that long ago the way that we get exposed to ticks is not only through being outdoors and in tall grass but through carriers or vectors like bear can literally run into a big forested area get a bunch of ticks on his fur and him being brown me not see it climbs into my bed leaves one of the ticks next to me and they could easily start feeding and cause an infection every other provider he's seen this far wrote him off as just an allergy needing some medications it's all due to his weight weight is a problem for a lot of my patients a lot of my patients do suffer with their quality of life because they fall into the category of morbid obesity but it's also not right to blame everything that's going on without doing a proper history and physical like that gets lost right then and there so at this point we make a decision that i think what's going on is that the patient had an erythema migraines rash but what's unique is erythema migraines sometimes appears with multiple lesions throughout the body and sometimes they're all completely red and they don't all look like the prototypical bullseye rash that we study in our textbooks but then i started having to think the patient actually has early disseminated lyme disease why because he's starting to have joint pain migratory arthritis body aches which is myalgia is basically pain in the muscles that means the inflammation is spreading and unless we catch these and act appropriately it could lead to further lyme late lime which is very problematic because then it could spread to your heart causing things like arrhythmias av blocks neurologic complications we had to act quickly we drew blood then and there to do two tests one the elisa test to make the initial diagnosis of lyme disease and then a western blot to do the confirmation test for it and then right away prescribe the course of doxycycline which is an antibiotic that we like to use for the treatment of life patient follows up two weeks later what do we find out a his lyme test both positive b he feels a hundred times better zero fatigue zero joint pain zero muscle aches he's completely cured had he progressed to late-stage lyme disease and had neurologic or cardiac complications he may have needed a hospital stay for iv antibiotics he could have lost his life as a result of a cardiac arrhythmia if you happen to be a patient and you feel your provider is overly focused on your weight and you feel like you're not getting good care because of that you have two options option one be direct point out to your provider that you feel like there's an over emphasis on your weight and while you know it is an important factor in your health it's not the sole determinant of your health and you'd like to have a further discussion on that if they're not receptive move to option two or if you don't even wanna have that conversation that's your choice to move to option two which is seek a second opinion that is your right as a patient and insurance cannot deny you for seeking a second opinion because medicine is as much art as it is a science the relationship between a provider and a patient has to be strong in order for uh proper health outcomes to occur i want to stress this super strongly be careful with certain health providers who make the diagnosis of a condition which is not really a correct condition of chronic lyme disease they say that you need to do all sorts of treatments like chelation therapies extremely long courses of antibiotics that have no real evidence for them and they blame a lot of my patients symptoms on this chronic lyme disease when in reality that's not what's going on if someone's pushing on you expensive lengthy complex treatments seek a second opinion either with another primary care doctor or even an infectious disease specialist because there's a lot a lot of fraud and malpractice that happens in this area and i've seen my patients truly suffer that's just one of my patient stories but click here to check out my bizarre life as an attending doctor as always stay happy and healthy click here to check that out [Music]

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