"Reactivated Epstein-Barr" ?!

[RustedFox]

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Anyone else having 20-30 y/old females complain of this (with absolutely no objective findings of pathology) ? I have not yet run across this in my admittedly limited time in playing this game.

Does this go into the same bucket as people who complain of fibromyalgia/mitral valve prolapse/chronic fatigue syndrome/chakra misalignment/I'm a wilting flower and need love and attention to blossom and grow... syndrome ? I get the feeling that it does.

 

[la gringa]

sounds more like chronic lyme... i guess the good thing is that it's a virus and you won't see people with picc lines put in by charlatans who put those people on rocephin for months. then they get complications...

it was big in NoVA when i practiced up there. biiiiig headache... "oh my special doctor finallllly found what's wrong with me oh he's the best the only one who knows what's really wrong with me and understands me" etc etc.

 

[VA Hopeful Dr]

sounds more like chronic lyme... i guess the good thing is that it's a virus and you won't see people with picc lines put in by charlatans who put those people on rocephin for months. then they get complications...

it was big in NoVA when i practiced up there. biiiiig headache... "oh my special doctor finallllly found what's wrong with me oh he's the best the only one who knows what's really wrong with me and understands me" etc etc.

As a family doctor (and my wife says I'm special), if I hear anything approaching that from a patient, I've found that the chances of them being borderline approaches 100%.

 

[Rendar5]

Well if that's what it is, then I have no tests and no treatments available. I think you should go back to your doctor because he sounds brilliant and surely will be able to help you better than my lowly ER.

 

[Arcan57]

Ma'am, I'm sorry that your untreated psychiatric disorder is causing you problems. Have a blessed day.

 

[RustedFox]

Now, now guys - Sounds like you need to work on your "customer service" skills.


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[Babbitt4MVP]

It's alarming to see practicing physicians on this forum who don't recognize chronic fatigue syndrome and fibromyalgia as legitimate conditions that people suffer from. But it's downright disgusting to see ya'll mock them.

Literally all it takes is a google search of either of these conditions to see there's been extensive research into them that shows (1) these are not purely (or even predominantly) psychiatric phenomenon (2) there are real and measurable physical differences in these patients compared to the general population and (3) these can be very disabling and severely affect patients' quality of life.

And by the way, EBV can reactivate just like any other herpesvirus. All it takes to see is some basic ****ing serology with an elevated IgM to prove. Some people get symptoms from this. Not a huge logical leap to make.

 

[MechEDoc]

It's alarming to see practicing physicians on this forum who don't recognize chronic fatigue syndrome and fibromyalgia as legitimate conditions that people suffer from. But it's downright disgusting to see ya'll mock them.

Literally all it takes is a google search of either of these conditions to see there's been extensive research into them that shows (1) these are not purely (or even predominantly) psychiatric phenomenon (2) there are real and measurable physical differences in these patients compared to the general population and (3) these can be very disabling and severely affect patients' quality of life.

And by the way, EBV can reactivate just like any other herpesvirus. All it takes to see is some basic ****ing serology with an elevated IgM to prove. Some people get symptoms from this. Not a huge logical leap to make.

Sweet. Let me know how I can refer my patients to your practice! Are you in functional medicine by any chance?

 

[Fox800]

It's alarming to see practicing physicians on this forum who don't recognize chronic fatigue syndrome and fibromyalgia as legitimate conditions that people suffer from. But it's downright disgusting to see ya'll mock them.

Literally all it takes is a google search of either of these conditions to see there's been extensive research into them that shows (1) these are not purely (or even predominantly) psychiatric phenomenon (2) there are real and measurable physical differences in these patients compared to the general population and (3) these can be very disabling and severely affect patients' quality of life.

And by the way, EBV can reactivate just like any other herpesvirus. All it takes to see is some basic ****ing serology with an elevated IgM to prove. Some people get symptoms from this. Not a huge logical leap to make.

Neat. None of these things need to be solved in the emergency department.

Are you a physician? Why the incomplete profile? Most of the chronic pain trolls we get are not clinicians.

 

[MechEDoc]

Neat. None of these things need to be solved in the emergency department.

Are you a physician? Why the incomplete profile? Most of the chronic pain trolls we get are not clinicians.

Looking at this person's other posts, it looks like they are currently trying to get into medical school.

 

[thegenius]

It's alarming to see practicing physicians on this forum who don't recognize chronic fatigue syndrome and fibromyalgia as legitimate conditions that people suffer from. But it's downright disgusting to see ya'll mock them.

Literally all it takes is a google search of either of these conditions to see there's been extensive research into them that shows (1) these are not purely (or even predominantly) psychiatric phenomenon (2) there are real and measurable physical differences in these patients compared to the general population and (3) these can be very disabling and severely affect patients' quality of life.

And by the way, EBV can reactivate just like any other herpesvirus. All it takes to see is some basic ****ing serology with an elevated IgM to prove. Some people get symptoms from this. Not a huge logical leap to make.

Honestly....this is akin to going to an allergist with a neurological complaint. We are the wrong docs.

We spend z.e.r.o. time learning about CFS and “Fibro” (as a patient once called it because she was on a first name basis with it) because they ain’t acutely sick. Plus the ones we see are all f’ing mental, but maybe that’s because the real people with chronic fatigue and fibro don’t come to the ER and we have a biased cohort

 

[deleted859535]

It's alarming to see practicing physicians on this forum who don't recognize chronic fatigue syndrome and fibromyalgia as legitimate conditions that people suffer from. But it's downright disgusting to see ya'll mock them.

Literally all it takes is a google search of either of these conditions to see there's been extensive research into them that shows (1) these are not purely (or even predominantly) psychiatric phenomenon (2) there are real and measurable physical differences in these patients compared to the general population and (3) these can be very disabling and severely affect patients' quality of life.

And by the way, EBV can reactivate just like any other herpesvirus. All it takes to see is some basic ****ing serology with an elevated IgM to prove. Some people get symptoms from this. Not a huge logical leap to make.

Thank you, professor. Just remember: we know more about this than you, we're actual physicians with many years of experience beyond you and for which there is no substitute, we know when to suspect underlying psychiatric disease as a contributor to a physical complaint in the emergency department, and we know when the amount and caliber of evidence for some conditions is different than others -- and when some people exploit and abuse conditions.

Bumping five and a half year old threads for this? Christ.

 

[BoardingDoc]

Thank you, professor. Just remember: we know more about this than you, we're actual physicians with many years of experience beyond you and for which there is no substitute, we know when to suspect underlying psychiatric disease as a contributor to a physical complaint in the emergency department, and we know when the amount and caliber of evidence for some conditions is different than others -- and when some people exploit and abuse conditions.

Bumping five and a half year old threads for this? Christ.

I feel like someone who doesn't have the wherewithal to realize they're bumping a 5 year old thread is the same sort of person who might carry around a "reactivated EBV" diagnosis.

 

[d2305]

I actually thought I might die when I was infected. I didn't feel normal for years. It did wax and wane.

 

[GonnaBeADoc2222]

My fav thing is when the pre-med comes in here to tell the attendings what's what.

 

[d2305]

I was working in the EM before there was EM.

 

[Mad Jack]

As a family doctor (and my wife says I'm special), if I hear anything approaching that from a patient, I've found that the chances of them being borderline approaches 100%.

Hey now, they could also be histrionic or have OCPD

 

[VA Hopeful Dr]

Hey now, they could also be histrionic or have OCPD

5 years ago VA Hopeful was still in residency so he can't be expected to know everything

 

[Mad Jack]

5 years ago VA Hopeful was still in residency so he can't be expected to know everything

Oh god, I didn't realize this was necro'd

 

[GeneralVeers]

Legit illness or not, the reason we hate these patients is that they show up and interrupt our busy ED lives. We can't help or fix them in any way, yet they keep coming back. If I showed up at a business and requested a service for which they don't provide, why on earth would I stick around and argue with them and cause the employees grief?

1. They have an unprovable illness for which there is no ED testing available
2. They usually have some major co-existing psychiatric diagnosis like bipolar, borderline, or sociopathic behavior
3. They make demands for which we can't possibly accommodate: testing, pain meds, mri, admission, etc.
4. They are addicted and/or narcotic dependent
5. They have an enabling spouse/friend with them ALWAYS who doubles our annoyance and makes it near impossible to discharge these people
6. They (or their enabler) will always write a complaint letter detailing how rude/inappropriate we were the next day, which will mean I have to waste my valuable time responding to nonsense.

I will add "re-actived epstein barr" to my list of dreaded unprovable (but narcotic-dependent) illnesses: sphincter of odi spasm, chronic pancreatitis, cyclic vomiting syndrome, gastroparesis, fibromyalgia, polymyalgia rheumatica, restless leg syndrome, IBS, and the rare "abdominal angioedema".

 

[Apollyon]

Somatic representations of psychological problems.

I mean, you can see something in the cystoscope in interstitial cystitis, and the IBD people are, literally, full of ****, or crapping their brains out. However, the basis is in the mind.

 

[thegenius]

Legit illness or not, the reason we hate these patients is that they show up and interrupt our busy ED lives. We can't help or fix them in any way, yet they keep coming back. If I showed up at a business and requested a service for which they don't provide, why on earth would I stick around and argue with them and cause the employees grief?

1. They have an unprovable illness for which there is no ED testing available
2. They usually have some major co-existing psychiatric diagnosis like bipolar, borderline, or sociopathic behavior
3. They make demands for which we can't possibly accommodate: testing, pain meds, mri, admission, etc.
4. They are addicted and/or narcotic dependent
5. They have an enabling spouse/friend with them ALWAYS who doubles our annoyance and makes it near impossible to discharge these people
6. They (or their enabler) will always write a complaint letter detailing how rude/inappropriate we were the next day, which will mean I have to waste my valuable time responding to nonsense.

I will add "re-actived epstein barr" to my list of dreaded unprovable (but narcotic-dependent) illnesses: sphincter of odi spasm, chronic pancreatitis, cyclic vomiting syndrome, gastroparesis, fibromyalgia, polymyalgia rheumatica, restless leg syndrome, IBS, and the rare "abdominal angioedema".

Also add low back pain. I hate treating that because you can't make people better. And most testing, which is almost never indicated, shows no pathology.

 

[BoardingDoc]

and the rare "abdominal angioedema".

Is this code for fat people?

 

[GeneralVeers]

Is this code for fat people?

Nope. When I worked in South Dakota there was a patient who presented weekly with chronic abdominal pain that was only responsive to dilaudid. His GI specialist had diagnosed him with angioedema of the abdomen, even though there were no objective physical or radiology findings. Of course he always got admitted at the recommendation of the quack specialist and pumped full of IV narcs only to repeat the following week.

 

[thegenius]

Nope. When I worked in South Dakota there was a patient who presented weekly with chronic abdominal pain that was only responsive to dilaudid. His GI specialist had diagnosed him with angioedema of the abdomen, even though there were no objective physical or radiology findings. Of course he always got admitted at the recommendation of the quack specialist and pumped full of IV narcs only to repeat the following week.

Interesting how angioedema of the lips and tongue, which is real angioedema, almost never have pain as the first, second, or third symptom or complaint. But abdominal angioedema....LOL treating with dilaudid!

I just looked up a paper on this

World J Gastroenterol. 2010 Oct 21; 16(39): 4913–4921.
Published online 2010 Oct 21. doi: [10.3748/wjg.v16.i39.4913]
PMCID: PMC2957599
PMID: 20954277
Diagnosis and management of angioedema with abdominal involvement: A gastroenterology perspective
Ugochukwu C Nzeako

The abstract reads (and underlining is my emphasis):

Abdominal involvement in angioedema is often a challenge to diagnose. Acute onset abdominal pain is its most common presenting symptom, and misdiagnosis may lead to unnecessary surgical intervention. Familiarity with the types and presentations of angioedema can be invaluable to clinicians as they consider the differential diagnoses of a patient presenting with abdominal pain. Detailed personal and family histories, careful physical examination of the patient, combined with knowledge of angioedema types, can help clinicians perform their diagnostic evaluation. An accurate diagnosis is essential in order to provide appropriate treatment to patients with angioedema. Depending upon the diagnosis, treatment may be the avoidance of provoking factors (such as allergens or medications), inhibiting histamine-provoked reactions, or treating C1 esterase inhibitor deficiency.




what a mess

 

[deleted547339]

Nope. When I worked in South Dakota there was a patient who presented weekly with chronic abdominal pain that was only responsive to dilaudid. His GI specialist had diagnosed him with angioedema of the abdomen, even though there were no objective physical or radiology findings. Of course he always got admitted at the recommendation of the quack specialist and pumped full of IV narcs only to repeat the following week.

It can be real. I had a lady come in with abdominal pain and hx of abdominal angioedema. She got intubate twice in the next two weeks for airway angioedema. Good times.

 

[deleted859535]

I've seen actual abdominal angioedema one time as well. C1 esterase inhibitors, abnormal CTs consistent with what you'd expect, etc.

Oddly, haven't had anyone try to bull**** me about it yet.

 

[RustedFox]

I've seen actual abdominal angioedema one time as well. C1 esterase inhibitors, abnormal CTs consistent with what you'd expect, etc.

Oddly, haven't had anyone try to bull**** me about it yet.

We had one honest-to-God abdominal angioedema patient who came in 2-3 times a year at my one shop. We knew him as a polite guy who would direct you to mix and administer his Kalbitor drip, which would provide him relief in an hour or two. Its a real disease with a real fix.

But yeah; Veers is generally right. Fakers prefer narcotics, and they quickly learn the "right" things to say.

 

[GeneralVeers]

We had one honest-to-God abdominal angioedema patient who came in 2-3 times a year at my one shop. We knew him as a polite guy who would direct you to mix and administer his Kalbitor drip, which would provide him relief in an hour or two. Its a real disease with a real fix.

But yeah; Veers is generally right. Fakers prefer narcotics, and they quickly learn the "right" things to say.

I'm always suspicious of any condition (even if real) that ONLY responds to Dilaudid. Sickle Cell Crisis I'm looking at you........

 

[RustedFox]

I'm always suspicious of any condition (even if real) that ONLY responds to Dilaudid. Sickle Cell Crisis I'm looking at you........

Oh, you're not wrong.
You should be suspicious of such.
Abdominal angioedema is a truly rare bird, and (fortunately) one that the fakers haven't caught onto yet.
I've had 1 or 2 of these fakers claim to be an abdominal angioedema patient, and one who even "stuck out his abdomen" so I could feel how "tense" it is.
He got nothing.
Sadly, I've noticed a lot of these fakers are ex-military, or at least claim to be ex-military.
Now, I'm suspicious of anyone who is ostensibly displaying clothing with an abundance of military paraphernalia and reporting a generally unverifiable condition.

 

[Zebra Hunter]

I'm always suspicious of any condition (even if real) that ONLY responds to Dilaudid. Sickle Cell Crisis I'm looking at you........

I’m honestly confused on why it has become standard of care in the US to treat pain crisis with IV opiates when most other countries, there first line therapies are meds like toradol and Tylenol. Or even why they are being rx’d chronic opiates? There was a relatively recent EM:RAP segment on sickle cell pain crisis that made me want to scream at the absurdity they were perpetuating. They were talking about sickle cell disease as a “terminal” disease that needed to be treated much like an end stage cancer patient should be treated, by loading them up on IV Dilaudid (this is ignoring the fact that the life expectancy of someone with sickle cell is 45 years). One guy even recommended stacking doses of opiates every 15 minutes until pain relief set in. I have to imagine that none of these guys making these recommendations have actually seen more than 1 or 2 sicklers per year.

 

[EM Junkie]

Now, I'm suspicious of anyone who is ostensibly displaying clothing with an abundance of military paraphernalia and reporting a generally unverifiable condition.

Along those lines, I love how so many of these folks roll in with their obviously old T-shirts/hats/jackets from some random fire department, hospital, etc thinking that they’re going to get some sort of special treatment. I want to tell them, “Hey jackwad, we know all the local EMS/fire folks around here - and you’re not one of them. Also, that agency hasn’t existed in 20 years, but nice try.”



Sent from my iPhone using SDN mobile

 

[Matthew9Thirtyfive]

Sadly, I've noticed a lot of these fakers are ex-military, or at least claim to be ex-military.

Not saying none of them are vets, but a lot of the folks running around in military paraphernalia got it at a thrift shop or Goodwill. I’ve seen folks cruising on bikes with their blueberry tops flapping in breeze, surfer hair cut and huge beard and all. And they got the top at Goodwill lol.

 

[deleted109597]

Locking this as no good can come of it.