Mysterious fatigue in a pro athlete's fiancee...

[hopeful22213]

For those playing at home, guess the reported diagnosis:

Young woman engaged to a famous pro-athlete feeling increasingly fatigued several months postpartum.

"Usually energetic, [she] felt particularly fatigued and even nauseous after exercises. Something appeared off. That was merely the start of her ordeal. Seven months later, [they' proceed to navigate the daily challenges stemming from ... (MYSTERY DIAGNOSIS)

How Chicago Cubs’ Justin Steele and his fiancee, Libby, are dealing with her debilitating illness during a breakout season

Libby Murphy figured the constant extreme exhaustion she experienced was part of being a new mom. Spring training was underway, about seven months after the birth of her son, Beau, who shares a Jul…

www.chicagotribune.com

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[BoardingDoc]

I understand posting comical nonsense for entertainment, but I don't know why you posted something about chronic Lyme as a "figure out the diagnosis" post.

 

[sylvanthus]

Its always lupus.

 

[AlmostAnMD]

Kinda thought without reading the chronic fatigue would stem from having sex with an athlete in his prime and maximum testosterone 4-5 times a day, every day

 

[JacobMcCandles]

I feel sorry for these people. They likely get some psychological benefit from having a “diagnosis” but they certainly haven’t been done any favors by someone telling them they have chronic Lyme.

 

[DocEspana]

Its the new fibromyalgia. I can literally figure out people's age based on what they have/had in the prime of their life that ruined their entire life - be it chronic pelvic pain/interstitial cystitis/laprascopically negative endometriosis (boomer), fibromyalgia (gen x), chronic lyme/borreliosis (millenial), or... idk.... tide pod chromatosis (gen z)

 

[BoardingDoc]

Its the new fibromyalgia. I can literally figure out people's age based on what they have/had in the prime of their life that ruined their entire life - be it chronic pelvic pain/interstitial cystitis/laprascopically negative endometriosis (boomer), fibromyalgia (gen x), chronic lyme/borreliosis (millenial), or... idk.... tide pod chromatosis (gen z)

My predictions for the new BS disease for gen Z:

PFAS related fatigue syndrome
COVID vaccine induced long COVID
Microaggression related stress disorder

 

[RustedFox]

1. What's PFAS?

2. I will prescribe iron titration for all of these... weight based dose for 3 sets of 12 reps. I mean that seriously.

 

[DocEspana]

1. What's PFAS?

2. I will prescribe iron titration for all of these... weight based dose for 3 sets of 12 reps. I mean that seriously.

"Forever chemicals" in everything you interact with and your water supply.

May or may not be relevant to human health at the amount we retain, and that's not a joke or sarcasm. May or may not be a "thing"

 

[JacobMcCandles]

My predictions for the new BS disease for gen Z:

PFAS related fatigue syndrome
COVID vaccine induced long COVID
Microaggression related stress disorder

Long COVID is a multi-generational illness. It’s perfect, really, and I’m surprised it wasn’t invented before. Literally anything can be a symptom.

 

[Birdstrike]

All fake trend-diagnoses have the same things in common:

-There is no test to rule it in or out.

-There are no pathognomonic historical or exam criteria.

-All the “classic” symptoms are vague, non-specific, could belong to countless other real conditions, or none at all.

Anyone can have it, self diagnose, and there’s no way to prove they’re wrong.

 

[DocEspana]

All fake trend-diagnoses have the same things in common:

-There is no test to rule it in or out.

-There are no pathognomonic historical or exam criteria.

-All the “classic” symptoms are vague, non-specific, could belong to countless other real conditions, or none at all.

Anyone can have it, self diagnose, and there’s no way to prove they’re wrong.

- the entire syndrome could just be depression (I know you already touched on this)

- even if its not "all" depression, depression about having the syndrome is always co-morbid.

bonus:

- 2 weeks of celexa is curative in nearly all cases

- prescribing, suggesting, or even vaguely implying using celexa as treatment leads to negative satisfaction scores in nearly all cases.

 

[Emapp20177]

Long COVID is a multi-generational illness. It’s perfect, really, and I’m surprised it wasn’t invented before. Literally anything can be a symptom.

 

[Apollyon]

Somatic representations of psychological problems. People need the "sick role".

As I would tell the pts, once the damage was done, it was done. If you have a house fire, you might burn down your bathroom. The fire is extinguished, but, what's gone is gone, and you don't keep putting water on fires that aren't burning. Nerve damage from Lyme is that.

 

[RustedFox]

Someone on here called these: "neurasthenia gravis".

I thought that was brilliant.

 

[Tenk]

Its the new fibromyalgia. I can literally figure out people's age based on what they have/had in the prime of their life that ruined their entire life - be it chronic pelvic pain/interstitial cystitis/laprascopically negative endometriosis (boomer), fibromyalgia (gen x), chronic lyme/borreliosis (millenial), or... idk.... tide pod chromatosis (gen z)

Don’t forget POTS!!

 

[Kryptocoin]

It's interesting that most of these psychosomatic conditions are prevalent in the female population. I haven't seen a male fibromyalgia or chronic lyme disease patient before. What gives?

 

[DocEspana]

It's interesting that most of these psychosomatic conditions are prevalent in the female population. I haven't seen a male fibromyalgia or chronic lyme disease patient before. What gives?

Not allowed to say the quiet part out loud

(Though they do exist. It's not how male medical psychosomatic disease generally presents).

 

[skougess]

Not allowed to say the quiet part out loud

(Though they do exist. It's not how male medical psychosomatic disease generally presents).

Males get chest pain, difficulty swallowing, my reproductive organ doesn’t work, etc…

 

[DocEspana]

Males get chest pain, difficulty swallowing, my reproductive organ doesn’t work, etc…

also an unusual amount of delusional parasitosis

 

[Kryptocoin]

also an unusual amount of delusional parasitosis

Yeah, I've seen that in my meth heads..... male and female.

 

[Kryptocoin]

Males get chest pain, difficulty swallowing, my reproductive organ doesn’t work, etc…

ED? Interesting........

 

[DocEspana]

Yeah, I've seen that in my meth heads..... male and female.

bit more of ekboms/morgellons. but also meth.

 

[timpview]

I’m convinced that a good portion had prior sexual abuse…

 

[rokshana]

It's interesting that most of these psychosomatic conditions are prevalent in the female population. I haven't seen a male fibromyalgia or chronic lyme disease patient before. What gives?

The male equivalent is “low T”…🙄

 

[rokshana]

ED? Interesting........

Oh definitely…as well as low libido… must be “low T”… not poor sleep hygiene, OSA, or obesity…

 

[valianteffort]

Had a patient with history of POTS, Fibromyalgia and chronic regional complex pain syndrome last week. Sent the medical student in to see her. The student, god bless her, spent 50 minutes with the patient for her HPI until i called her out of the room for an 'emergency'. Asked the student what this patients emergency was and the student responded 'we haven't gotten to that part yet we were discussing her experience from 2006 when she was first diagnosed with her condition'.

 

[hopeful22213]

I understand posting comical nonsense for entertainment, but I don't know why you posted something about chronic Lyme as a "figure out the diagnosis" post.

The diagnosis was printed under the included link. A multiple choice including interstitial cystitis, fibro, EDS and POTS might have been a better format. Next time I'll ask the news outlet to give relevant history, exam and diagnostic data for you to intellectually challenge yourself.

 

[JacobMcCandles]

Does anyone have just one of these mysterious and untestable diagnoses? I don't think I've ever seen anyone with a diagnosis of chronic Lyme or just POTS and nothing else.

 

[Janders]

I’ve seen multiple cases of chronic Lyme.
They present w/ complete heart block out of the blue and respond to aggressive IV ceftriaxone.

 

[DrDrummer]

My predictions for the new BS disease for gen Z:

PFAS related fatigue syndrome
COVID vaccine induced long COVID
Microaggression related stress disorder

Some other leading contenders: EDS (hypermobile type, obviously, without genetic testing) resulting in chronic pain and recurrent "subluxations", neurodivergent ASD-type self-diagnoses, Tourette's, and recently I've been seeing trending self-diagnosis of hyperacusis (hopefully this one is less likely to result in an ER visit, but may explain why the zoomer in front of you is wearing earplugs).

 

[southerndoc]

View attachment 376813

Don’t forget POTS!!

Ah yes. The cardiac fibromyalgia.

 

[southerndoc]

I’ve seen multiple cases of chronic Lyme.
They present w/ complete heart block out of the blue and respond to aggressive IV ceftriaxone.

That's not chronic Lyme. I had a patient with second-degree AV block 2 weeks ago from Lyme carditis. Used to see it at least once every few months while in Connecticut (along with neurolyme).

Chronic Lyme probably does exist. I think it's more of an autoimmune response. Most people who discovered Lyme do not believe chronic Lyme is responsive to antibiotics and think it is more of an autoimmune response triggered by antibodies generated from acute Lyme.

 

[RustedFox]

Some other leading contenders: EDS (hypermobile type, obviously, without genetic testing) resulting in chronic pain and recurrent "subluxations", neurodivergent ASD-type self-diagnoses, Tourette's, and recently I've been seeing trending self-diagnosis of hyperacusis (hopefully this one is less likely to result in an ER visit, but may explain why the zoomer in front of you is wearing earplugs).

Google "misophonia".
This is what the kids are all saying now.
I tell them to stop being such a little b!tch.

 

[Apollyon]

That's not chronic Lyme. I had a patient with second-degree AV block 2 weeks ago from Lyme carditis. Used to see it at least once every few months while in Connecticut (along with neurolyme).

Chronic Lyme probably does exist. I think it's more of an autoimmune response. Most people who discovered Lyme do not believe chronic Lyme is responsive to antibiotics and think it is more of an autoimmune response triggered by antibodies generated from acute Lyme.

If the bacteria are dead, they're dead. Who is believing, who is not a total crockpot, that ceftriaxone is helping "chronic Lyme"? Seriously, name names, because that it pseudoscience.

For a parallel, people that have survived Gram negative sepsis, their fingers and toes and hands and feet weren't taken by active bacteria, but, the remnant of those dead bacteria, namely, the endotoxin.

Otherwise, why don't the crazy people getting chronic ceftriaxone get better?

 

[VA Hopeful Dr]

If the bacteria are dead, they're dead. Who is believing, who is not a total crockpot, that ceftriaxone is helping "chronic Lyme"? Seriously, name names, because that it pseudoscience.

For a parallel, people that have survived Gram negative sepsis, their fingers and toes and hands and feet weren't taken by active bacteria, but, the remnant of those dead bacteria, namely, the endotoxin.

Otherwise, why don't the crazy people getting chronic ceftriaxone get better?

Approximately 30% of them do which is suspiciously about the same percent as benefit from placebos.

 

[TooMuchResearch]

Yeah, I've seen that in my meth heads..... male and female.

It happens in people who don't use meth. I feel particularly bad for those folks. 20 years old, otherwise healthy, now you hallucinate and think you're riddled with infection and no one will treat you. Sometimes they accept my offer of Zyprexa prescription just to prove it won't work. I truly hope it helps.

 

[TooMuchResearch]

Approximately 30% of them do which is suspiciously about the same percent as benefit from placebos.

So you're saying it works? My brother's sister's uncle's nephew's butcher got better with it, according to the Internet.

 

[Apollyon]

So you're saying it works? My brother's sister's uncle's nephew's butcher got better with it, according to the Internet.

And the intertubes NEVAR LYE!! EVARRRRRR!

 

[Zebra Hunter]

Some other leading contenders: EDS (hypermobile type, obviously, without genetic testing) resulting in chronic pain and recurrent "subluxations", neurodivergent ASD-type self-diagnoses, Tourette's, and recently I've been seeing trending self-diagnosis of hyperacusis (hopefully this one is less likely to result in an ER visit, but may explain why the zoomer in front of you is wearing earplugs).

The hypermobile subtype of EDS has never required genetic testing because there is no known gene associated with it. The diagnosis has always been controversial, unfortunately now it is both controversial and trendy due to TikTok.

I had former student I TA’d back in college on Facebook that I used to hate follow due to the crazy stuff she’d post. While I TA’d her in micro lab, we needed to take special precautions for her for her “lupus”. Then one day on Facebook she claimed that she never had lupus, and had finally found a doctor that diagnosed her with hEDS. Then suddenly she’s getting a PEG tube (despite being fat), a PICC line for fluids for her dehydration and POTS, then she gets a PE from her PICC and gets put on anticoagulation, she then gets a port placed which inevitably gets infected and has to be removed. Meanwhile she is posting constantly things like “back in the ER again”, and complaining about how terrible doctors are (despite continuously showing up to hospitals). Then I don’t see any posts from her in a few months and then suddenly she is posting photos of her with a new boyfriend and she has dropped about 50 pounds and looks fit. Haven’t seen another medical post since then.

Amazing what a little exercise and some loving can do for fake conditions.

 

[The Knife & Gun Club]

Its the new fibromyalgia. I can literally figure out people's age based on what they have/had in the prime of their life that ruined their entire life - be it chronic pelvic pain/interstitial cystitis/laprascopically negative endometriosis (boomer), fibromyalgia (gen x), chronic lyme/borreliosis (millenial), or... idk.... tide pod chromatosis (gen z)

Gen Z is tic disorders or autism diagnosed on tiktok 😂

Not sure how common this is in your population but I saw maybe 1-2/month when I was working in the ‘burbs.

22 year old shows up for “autism tic flare” just blurting out random things and rubbing a stuffed animal against their face.

 

[RustedFox]

Gen Z is tic disorders or autism diagnosed on tiktok 😂

Not sure how common this is in your population but I saw maybe 1-2/month when I was working in the ‘burbs.

22 year old shows up for “autism tic flare” just blurting out random things and rubbing a stuffed animal against their face.

You know what would fix that?
Parents hitting the kid when it misbehaves.

 

[DocEspana]

That's not chronic Lyme. I had a patient with second-degree AV block 2 weeks ago from Lyme carditis. Used to see it at least once every few months while in Connecticut (along with neurolyme).

Chronic Lyme probably does exist. I think it's more of an autoimmune response. Most people who discovered Lyme do not believe chronic Lyme is responsive to antibiotics and think it is more of an autoimmune response triggered by antibodies generated from acute Lyme.

They (primarily Dr Wormser, who is the amazingly named ID doctor behind most legit Lyme research) prefer the term post Lyme syndrome. They specifically hate the term chronic Lyme because the spirochetes are objectively not present and this is just sequelae of having it at all the first time (usually sequelae of letting it go untreated for a few months before finally shotgunning some doxycycline).

But yeah. The presumption is autoimmune mediated months or years after an acute episode

 

[DOswag]

I have to come visit the ER forum every once in a while for a little comic relief and common sense from seeing outpatient psych patients all day. I've been flooded with ADHD evals and had an alarming number of patients tell me they think they're autistic after watching tik tok videos.

 

[DocEspana]

Gen Z is tic disorders or autism diagnosed on tiktok 😂

Not sure how common this is in your population but I saw maybe 1-2/month when I was working in the ‘burbs.

22 year old shows up for “autism tic flare” just blurting out random things and rubbing a stuffed animal against their face.

I would love that population just to get a change of pace. I'm deep within the 30 year olds with legit STEMIs and diverticulitis community. The genetics are competing to kill them faster than the diet.

Over here (which I believe you know exactly where I mean) the amusing patient is the sickle trait (or, to be fair, SA with beta thalassemia) patient swearing they need their twice weekly Dilaudid infusion and I should ignore the Hg of 9. Also every patient with lupus has allergies to all anti-inflammatories.

 

[DOswag]

My predictions for the new BS disease for gen Z:

PFAS related fatigue syndrome
COVID vaccine induced long COVID
Microaggression related stress disorder

Definitely will be in the next iteration of the DSM...

 

[CoolDoc1729]

One of my shifts this weekend I had 4 people tell me they have chronic Lyme and 2 ask to be tested. I was starting to think I was being pranked.

 

[DoctwoB]

Not allowed to say the quiet part out loud

(Though they do exist. It's not how male medical psychosomatic disease generally presents).

Oh dudes definitely psychosomaticize (word? If not it should be)

Urologist here. Chronic orchalgia. Post Vasectomy pain syndrome. Culture negative chronic prostatis. And that's just Urology, I'm sure every specialty has their folks.

Not saying all of these are BS, they're not and the pain is real. But like most pain syndromes it's a mix of real pathology (like pelvic floor muscle spasticity) strongly associated with stress/anxiety and whatever Fed up stuff our body does that makes pain chronic.

It's nice that no one recognizes amitryptiline as an antidepressant anymore. It's a pain medicine to treat their symptoms.

 

[GassYous]

Oh dudes definitely psychosomaticize (word? If not it should be)

Urologist here. Chronic orchalgia. Post Vasectomy pain syndrome. Culture negative chronic prostatis. And that's just Urology, I'm sure every specialty has their folks.

Not saying all of these are BS, they're not and the pain is real. But like most pain syndromes it's a mix of real pathology (like pelvic floor muscle spasticity) strongly associated with stress/anxiety and whatever Fed up stuff our body does that makes pain chronic.

It's nice that no one recognizes amitryptiline as an antidepressant anymore. It's a pain medicine to treat their symptoms.

Pain is psychological
It may or may not have an organic cause

 

[EM Junkie]

-There is no test to rule it in or out.

-There are no pathognomonic historical or exam criteria.

-All the “classic” symptoms are vague, non-specific, could belong to countless other real conditions, or none at all.

Anyone can have it, self diagnose, and there’s no way to prove they’re wrong.

You forgot that they all are somehow all on high dose narcotics at home and/or seem to require IV narcotics to treat their “disease” in the ED.

It's interesting that most of these psychosomatic conditions are prevalent in the female population. I haven't seen a male fibromyalgia or chronic lyme disease patient before. What gives?

I’ve always said that “Cyclic Vomiting Syndrome” is the male equivalent of fibromyalgia.