Tons of weird symptoms

[thegenius]

You guys seeing any of this?

We are having many fold more young people coming in with just really weird symptoms. It's always

"Chest pain, left toe pain, headache, and arm itchiness"
"nausea, palpitations, left neck pain, and sore throat"
"diarrhea, headache, and transient dizziness"
" head pain, cough-asthma, bilateral knee, foot, arm pain"
"shocks all over the body, left arm swelling"

It's non stop. All in people between 20-40. They all have nothing. Our usual census is 120/day, we are seeing 160/day now, and about 30 of those are these young people with odd symptoms.

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[southerndoc]

Embrace the upcoming fibro pandemic.

 

[RustedFox]

Muggles.

 

[Apollyon]

Somatic representations of psychological problems.

 

[RustedFox]

An adult with nothing wrong with them.
An adult with nothing wrong with them.
An adult with nothing wrong with them.
An adult with nothing wrong with them.

Where's that guy that wanted to do a 2nd residency in EM? Someone get his attention.

 

[BoardingDoc]

Embrace the upcoming fibro pandemic.

My initial reaction to that comment was horror. That said, the recommended first line therapy for fibro patients is exercise. I'm happy to tell these idiots that the only treatment is to get off their ass and go running regularly.

Spoiler alert: they won't.

Double spoiler alert: IDGAF.

 

[GeneralVeers]

The problem is that these patients lack any insight, and often reassurance doesn't help. The young, healthy, 25 yo male with vague tingling thinks he is really dying.

 

[pkwraith]

I think these are called Medicaid patients

 

[Birdstrike]

When fibro's come to see me it's "Savella? Cymbalta? Lyrica? CBT?"

"Tried it. Doesn't work."

Then I give them the most devastating prescription of all:

"Exercise."

 

[Birdstrike]

You guys seeing any of this?

We are having many fold more young people coming in with just really weird symptoms. It's always

"Chest pain, left toe pain, headache, and arm itchiness"
"nausea, palpitations, left neck pain, and sore throat"
"diarrhea, headache, and transient dizziness"
" head pain, cough-asthma, bilateral knee, foot, arm pain"
"shocks all over the body, left arm swelling"

It's non stop. All in people between 20-40. They all have nothing. Our usual census is 120/day, we are seeing 160/day now, and about 30 of those are these young people with odd symptoms.

All long COVID, impending clots

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[RustedFox]

When fibro's come to see me it's "Savella? Cymbalta? Lyrica? CBT?"

"Tried it. Doesn't work."

Then I give them the most devastating prescription of all:

"Exercise."

Amazing!

It doesn't hurt if you're not a p*ssy?

Wow!

 

[RustedFox]

All long COVID, impending clots

This is medicine in America.

 

[Mount Asclepius]

You guys seeing any of this?

We are having many fold more young people coming in with just really weird symptoms. It's always

"Chest pain, left toe pain, headache, and arm itchiness"
"nausea, palpitations, left neck pain, and sore throat"
"diarrhea, headache, and transient dizziness"
" head pain, cough-asthma, bilateral knee, foot, arm pain"
"shocks all over the body, left arm swelling"

It's non stop. All in people between 20-40. They all have nothing. Our usual census is 120/day, we are seeing 160/day now, and about 30 of those are these young people with odd symptoms.

Are you testing any of these with a VRP? I do a decent amount and a surprising few come back positive for COVID-19 without fever, shortness of breath, cough, rhinorrhea or congestion. In my anecdotal experience chest pain, headaches, myalgias and fatigue are common. Diarrhea more common in older adults. They all do fine and are discharged. I find though that a decent number if not tested in the first week have bouncebacks because they can’t adult at home and don’t have an ‘answer’ for their symptoms. They seem to always test negative if over a week of symptoms. I suspect the virus is cleared or in such low numbers by that point it’s not detectable. We aren’t catching the majority of positive cases with mild symptoms in my opinion. COVID-19 is everywhere. I agree though that there is also probably a high number of young adults with somatiziation of mild psychological illness related to the pandemic restrictions or a lack of exercise contributing.

 

[Franzd'Epinay]

I think some people (especially young people without a lot of life experience) expect their body to be in an optimal state with no unexplained phenomena 100% of the time.

Surely I can't be the only one in this group who occasionally will go "what's that weird tingling in my finger? Whatever; it'll go away" or "why do I have these random aches in my legs tonight? Meh. I'll just go to sleep." I can imagine an alternate less-medically-educated and more-hypochondriac version of myself seeking care for these things. Hopefully not in the ED, but I can understand some concern.

 

[RustedFox]

I think some people (especially young people without a lot of life experience) expect their body to be in an optimal state with no unexplained phenomena 100% of the time.

Surely I can't be the only one in this group who occasionally will go "what's that weird tingling in my finger? Whatever; it'll go away" or "why do I have these random aches in my legs tonight? Meh. I'll just go to sleep." I can imagine an alternate less-medically-educated and more-hypochondriac version of myself seeking care for these things. Hopefully not in the ED, but I can understand some concern.

Sure. It's just that this has become the norm, and not the exception.

 

[gutonc]

Sure. It's just that this has become the norm, and not the exception.

The issue is that they Google "Symptom X" and Dr. X says Symptom X is a sign of stroke/cancer/CHF/ESRD/schizophrenia, so they freak the F*** out, give no rational thought to any of it (and I know, and am related to many of these people who aren't all Medicaid recipients and are mostly reasonably well educated) and run to the ER "just in case".

 

[Cataclysmic]

You guys seeing any of this?

We are having many fold more young people coming in with just really weird symptoms. It's always

"Chest pain, left toe pain, headache, and arm itchiness"
"nausea, palpitations, left neck pain, and sore throat"
"diarrhea, headache, and transient dizziness"
" head pain, cough-asthma, bilateral knee, foot, arm pain"
"shocks all over the body, left arm swelling"

It's non stop. All in people between 20-40. They all have nothing. Our usual census is 120/day, we are seeing 160/day now, and about 30 of those are these young people with odd symptoms.

Seeing the same in urgent care. After doing all the (limited) work up we can do and reassuring them nothing life threatening is going on they end up mad… I’m sorry you’re not dying???

 

[WilcoWorld]

You guys seeing any of this?

We are having many fold more young people coming in with just really weird symptoms. It's always

"Chest pain, left toe pain, headache, and arm itchiness"
"nausea, palpitations, left neck pain, and sore throat"
"diarrhea, headache, and transient dizziness"
" head pain, cough-asthma, bilateral knee, foot, arm pain"
"shocks all over the body, left arm swelling"

It's non stop. All in people between 20-40. They all have nothing. Our usual census is 120/day, we are seeing 160/day now, and about 30 of those are these young people with odd symptoms.

I'm sure none of them use Social Media.

 

[The Knife & Gun Club]

I'm sure none of them use Social Media.

I had a woman demand testing for “Ureaplasma” because she’d seen it on tiktok and thought that was causing her 2/10 lower pelvic pain. Apparently it’s some kind of urinary colonizing organism?

Did the preg/UA/US/labs/STI/pelvic which were all stone cold normal. Told her we couldn’t test for that here and we’ve ruled out life threats, but could do a course of oral abx if sx were persistent while we wait for cultures. She didn’t want abx, she wanted TESTING FOR UREAPLASMA, DAMNIT.

Recorded a tikTok in her room saying we were the worst most judgmental doctors she’d ever had, and then filed a complaint.

 

[thegenius]

I had a woman demand testing for “Ureaplasma” because she’d seen it on tiktok and thought that was causing her 2/10 lower pelvic pain. Apparently it’s some kind of urinary colonizing organism?

Did the preg/UA/US/labs/STI/pelvic which were all stone cold normal. Told her we couldn’t test for that here and we’ve ruled out life threats, but could do a course of oral abx if sx were persistent while we wait for cultures. She didn’t want abx, she wanted TESTING FOR UREAPLASMA, DAMNIT.

Recorded a tikTok in her room saying we were the worst most judgmental doctors she’d ever had, and then filed a complaint.

Oh dear god! What a nightmare.

 

[thegenius]

I had a woman demand testing for “Ureaplasma” because she’d seen it on tiktok and thought that was causing her 2/10 lower pelvic pain. Apparently it’s some kind of urinary colonizing organism?

Did the preg/UA/US/labs/STI/pelvic which were all stone cold normal. Told her we couldn’t test for that here and we’ve ruled out life threats, but could do a course of oral abx if sx were persistent while we wait for cultures. She didn’t want abx, she wanted TESTING FOR UREAPLASMA, DAMNIT.

Recorded a tikTok in her room saying we were the worst most judgmental doctors she’d ever had, and then filed a complaint.

Why not just get a urine culture and discharge her? Would have taken 5 minutes. "Ma'am...the culture results will come back in a few days."

 

[The Knife & Gun Club]

Why not just get a urine culture and discharge her? Would have taken 5 minutes. "Ma'am...the culture results will come back in a few days."

That’s exactly what we did. She didn’t want a culture. She wanted a “Ureaplasma test” and wanted the results now.

 

[Birdstrike]

I had a woman demand testing for “Ureaplasma” because she’d seen it on tiktok and thought that was causing her 2/10 lower pelvic pain. Apparently it’s some kind of urinary colonizing organism?

Did the preg/UA/US/labs/STI/pelvic which were all stone cold normal. Told her we couldn’t test for that here and we’ve ruled out life threats, but could do a course of oral abx if sx were persistent while we wait for cultures. She didn’t want abx, she wanted TESTING FOR UREAPLASMA, DAMNIT.

Recorded a tikTok in her room saying we were the worst most judgmental doctors she’d ever had, and then filed a complaint.

My movie script:

One day all the ER doctors walk out in unison and quit. The world responds in horror and shock. "Why did you do it?"

"It was Ureaplasma girl. She pushed us all over the edge, we got together and just said, eff it. We're done. We're going to sell hotdogs now and lot's off them. We're not sure how much money we'll make, but we know it will be much more rewarding."

 

[WilcoWorld]

That’s exactly what we did. She didn’t want a culture. She wanted a “Ureaplasma test” and wanted the results now.

I asked this doctor to square the circle and he didn't do it. WORST ER EVER

 

[The Knife & Gun Club]

My movie script:

One day all the ER doctors walk out in unison and quit. The world responds in horror and shock. "Why did you do it?"

"It was Ureaplasma girl. She pushed us all over the edge, we got together and just said, eff it. We're done. We're going to sell hotdogs now and lot's off them. We're not sure how much money we'll make, but we know it will be much more rewarding."

Trust me I’ve thought about it 😉

 

[RoyBasch]

You guys seeing any of this?

We are having many fold more young people coming in with just really weird symptoms. It's always

"Chest pain, left toe pain, headache, and arm itchiness"
"nausea, palpitations, left neck pain, and sore throat"
"diarrhea, headache, and transient dizziness"
" head pain, cough-asthma, bilateral knee, foot, arm pain"
"shocks all over the body, left arm swelling"

It's non stop. All in people between 20-40. They all have nothing. Our usual census is 120/day, we are seeing 160/day now, and about 30 of those are these young people with odd symptoms.

Seeing a lot of this to lately.

It's frustrating because the workups are usually laborious and these people put up tons of red flags in their histories (often dutifully copied by the nurses into their triage notes) so they cannot just be dispo'd easily.

Really hurting flow at a time when were already experiencing very high volumes.

Starting to miss the dental pain and isolated sore throats. It's all "chest pain, headache, dizziness, and arm swelling with intermittent numbness/weakness" now.

 

[Apollyon]

(often dutifully copied by the nurses into their triage notes)

Garbage in, garbage out. How many times has nursing documentation stated "abdominal tenderness" when there affirmatively was none when you actually laid hands on the belly? Nursing will write down as objective the subjective that the pt stated (or didn't). And, they don't know the difference, and/or don't care. After all, "the eye does not see what the mind does not know".

 

[Arcan57]

Seeing a lot of this to lately.

It's frustrating because the workups are usually laborious and these people put up tons of red flags in their histories (often dutifully copied by the nurses into their triage notes) so they cannot just be dispo'd easily.

Really hurting flow at a time when were already experiencing very high volumes.

Starting to miss the dental pain and isolated sore throats. It's all "chest pain, headache, dizziness, and arm swelling with intermittent numbness/weakness" now.

Good Lord, the arm numbness.... so much arm numbness. Never a hint of objective findings, and fervent denial of any cause of a compressive neuropathy.

Just had a patient that looked great c/o epigastric pain (10/10) radiating to umbilicus that now was feeling better but the pain moved into a tight band around their chest and was somehow still 10/10. It's like he was CTA seeking... fortunately his COVID came back positive.

 

[calvnandhobbs68]

I just happened upon this thread but I have the feeling this is either a lot of weird mild COVID sx in otherwise healthy younger people (since covid is basically everywhere at this point) or some social media thing…or both.

There was just a psych article about a bunch of these kids “catching” tics from tiktok. Wouldn’t be surprised if it’s a similar thing. People who are constantly watching others post about their fibromyalgia or whatever now being like “oh man I have some muscle aches and weird tingling now too!!!”.

Going Viral: Social Media May Be Increasing Cases of New-Onset Tics

Drs Tamara Milka Pringsheim and Kathrin LaFaver on an emerging theory about why so many young and teenage girls are presenting with so-called 'TikTok tics.'

www.medscape.com

I need to get on TikTok more I guess to scope this crap out cause I bet we’ll be getting the brunt of it 6 months from now when nobody can figure out what’s wrong with them and tries to send them to psych 😭.

 

[NITRAS]

Good Lord, the arm numbness.... so much arm numbness. Never a hint of objective findings, and fervent denial of any cause of a compressive neuropathy.

Just had a patient that looked great c/o epigastric pain (10/10) radiating to umbilicus that now was feeling better but the pain moved into a tight band around their chest and was somehow still 10/10. It's like he was CTA seeking... fortunately his COVID came back positive.

”CTA-seeking”. Almost spit out my drink!

 

[GeneralVeers]

Americans have a bizarre fetish for testing. They think more testing is better, and they get off on it. They also WANT to be sick, mainly so they can get secondary gain from posting hospital adventures on facebook and starting a GoFundMe

 

[calvnandhobbs68]

Americans have a bizarre fetish for testing. They think more testing is better, and they get off on it. They also WANT to be sick, mainly so they can get secondary gain from posting hospital adventures on facebook and starting a GoFundMe

Yeah it used to be harder to figure out why people were “identifying with the sick role”. Now you can basically become a Instagram/TikTok celebrity for having some rare chronic illness….

 

[rokshana]

I had a woman demand testing for “Ureaplasma” because she’d seen it on tiktok and thought that was causing her 2/10 lower pelvic pain. Apparently it’s some kind of urinary colonizing organism?

Did the preg/UA/US/labs/STI/pelvic which were all stone cold normal. Told her we couldn’t test for that here and we’ve ruled out life threats, but could do a course of oral abx if sx were persistent while we wait for cultures. She didn’t want abx, she wanted TESTING FOR UREAPLASMA, DAMNIT.

Recorded a tikTok in her room saying we were the worst most judgmental doctors she’d ever had, and then filed a complaint.

Tell her…oh that test is only available through your pcp…🤦🏽‍♀️

 

[RustedFox]

I had a woman demand testing for “Ureaplasma” because she’d seen it on tiktok and thought that was causing her 2/10 lower pelvic pain. Apparently it’s some kind of urinary colonizing organism?

Did the preg/UA/US/labs/STI/pelvic which were all stone cold normal. Told her we couldn’t test for that here and we’ve ruled out life threats, but could do a course of oral abx if sx were persistent while we wait for cultures. She didn’t want abx, she wanted TESTING FOR UREAPLASMA, DAMNIT.

Recorded a tikTok in her room saying we were the worst most judgmental doctors she’d ever had, and then filed a complaint.

I'll play.

I had a mom refuse to leave until we ultrasounded her teenage daughter's subcutaneous birth control device "to see if it moved", because she had read online somewhere about IUDs migrating. Daughter told mom that "her arm hurt where they put the thingie in" and mom immediately brought daughter to the ER... at 2 am... because.

No amount of rational explanation was going to satisfy this woman. Yep. She complained to my director, who simply threw up his hands and said - "these people... there's no helping them".

 

[thegenius]

Americans have a bizarre fetish for testing. They think more testing is better, and they get off on it. They also WANT to be sick, mainly so they can get secondary gain from posting hospital adventures on facebook and starting a GoFundMe

It's one free thing in society for these 50M or so people. Imagine living suboptimally, eating Popeyes every day, constantly arguing with your boyfriend or girlfriend, living paycheck to paycheck. If you go down the street, you get free access to this extremely large building with fancy equipment that costs 100's millions of dollars every year to operate. Everything in that large building you get for free. No questions asked. You can go in anytime you want. Day and night.

Of course it's going to be abused beyond all hope.

 

[alpinism]

Emergency Medicine is basically the Spirit Airlines of medicine.

 

[GeneralVeers]

It's one free thing in society for these 50M or so people. Imagine living suboptimally, eating Popeyes every day, constantly arguing with your boyfriend or girlfriend, living paycheck to paycheck. If you go down the street, you get free access to this extremely large building with fancy equipment that costs 100's millions of dollars every year to operate. Everything in that large building you get for free. No questions asked. You can go in anytime you want. Day and night.

Of course it's going to be abused beyond all hope.

The Medicaid people are the worst. In Nevada we have the subset of "Medi-Cal" people who are super-abusers of the system. None of them have PCPs, because they still have Medi-Cal. When asked why the left CA, they shrug their shoulder and give a blank look. When asked what their plan was for getting local Medicaid or a PCP I get the same blank stare. These are people who are literally unable to adult in any part of their lives......yet we have given them free, unlimited access to hugely expensive services. I'm all for mandatory MSEs for these people and turning them away if they don't have one.

 

[thegenius]

The Medicaid people are the worst. In Nevada we have the subset of "Medi-Cal" people who are super-abusers of the system. None of them have PCPs, because they still have Medi-Cal. When asked why the left CA, they shrug their shoulder and give a blank look. When asked what their plan was for getting local Medicaid or a PCP I get the same blank stare. These are people who are literally unable to adult in any part of their lives......yet we have given them free, unlimited access to hugely expensive services. I'm all for mandatory MSEs for these people and turning them away if they don't have one.

Most shouldn't even get an MSE. They should just be turned away.

It would be cheaper for the state and federal government to build a building adjacent to every hospital and ER and call it "Urgent Care for the Hapless". It would be a free clinic 24/7 for the denizens of forlorned adults in the US.

This is one thing I agree with you on

 

[GeneralVeers]

Most shouldn't even get an MSE. They should just be turned away.

It would be cheaper for the state and federal government to build a building adjacent to every hospital and ER and call it "Urgent Care for the Hapless". It would be a free clinic 24/7 for the denizens of forlorned adults in the US.

This is one thing I agree with you on

Unfortunately we need to meet EMTALA obligation otherwise I'd tell people to GTFO. The problem is that the hospitals, in their greed refuse to let us turn people away because they want everyone to be seen in order to bill the facility charge. The only way to change this is for Medicaid, and insurers to refuse payment to hospitals for BS nonsense.

 

[nikolaite]

Unfortunately we need to meet EMTALA obligation otherwise I'd tell people to GTFO. The problem is that the hospitals, in their greed refuse to let us turn people away because they want everyone to be seen in order to bill the facility charge. The only way to change this is for Medicaid, and insurers to refuse payment to hospitals for BS nonsense.

From what I’ve heard (and read in the local paper), our ED is becoming notorious for kicking out altered LOC patients with EMCs, especially if they’re male. I guess recently one such pt either came back or threatened to come back with a gun...which got some due attention by the local police...hence the newspaper article. It’s like they’re begging CMS to investigate them from what one of my colleagues tell me.

 

[nikolaite]

You guys seeing any of this?

We are having many fold more young people coming in with just really weird symptoms. It's always

"Chest pain, left toe pain, headache, and arm itchiness"
"nausea, palpitations, left neck pain, and sore throat"
"diarrhea, headache, and transient dizziness"
" head pain, cough-asthma, bilateral knee, foot, arm pain"
"shocks all over the body, left arm swelling"

It's non stop. All in people between 20-40. They all have nothing. Our usual census is 120/day, we are seeing 160/day now, and about 30 of those are these young people with odd symptoms.

This is spot on to the COVID pattern we’re seeing right now. Just curious: Are you testing these pts for sars-cov-2 or antibodies?

 

[thegenius]

This is spot on to the COVID pattern we’re seeing right now. Just curious: Are you testing these pts for sars-cov-2 or antibodies?

I rarely test for SARS-COV-2 in these patients with weird symptoms. If they have infectious symptoms then I will.

I don't think we have the ability to test for antibodies at this time. And even if we did, I doubt I would do that because determining existence of antibodies is not a medical emergency.

 

[FrustratedFamDoc]

I'm primary care and have seen the same thing. I believe there are several factors at play.

Pandemic + Fear + social media + google = complete freak out.

In general, everyone is freaked out. For over a year people have had wall to wall coverage of this new virus that can present as *ANYTHING and *WILL kill you. Everyone. People then google their vague symptoms, receive validation of their worst inner fears, and to the doc they go. I've had far more new starts for mood meds this past year than at any other time, even in my most solid and grounded patients. My already anxious patients are even more so. My typical easy visits now include several somatic symptoms to sort through. As painful as it can be, at least make an attempt at validating their symptoms, or be prepared to lock horns on every single one and have the encounter take 3x longer than it needs to. I know my preference, but my patient encounter setting is vastly different that y'alls.

Yes, we have become a society of testing needlessly, but there is no going back to the old ways so either adapt, or stay salty all the time. I certainly don't mean to pan scan everyone, but good luck showing someone otherwise who has already diagnosed themself. Only after their google train has gone completely off the side of the mountain are they open to other, more realistic alternatives.

 

[gutonc]

I'm primary care and have seen the same thing. I believe there are several factors at play.

Pandemic + Fear + social media + google = complete freak out.

Twice in the last 2 weeks I have gotten called by a local ED because a patient of our oncology practice got an abnormal lab resulted in the patient portal (which now happens automatically...thanks 21st Century Cares Act), Googled it and ran to the ER without so much as calling our RN triage line or sending a portal message to their doc.

So...I apologized to the EPs that called me and I apologize to all of you in the pits in advance.

 

[dadaddadaBATMAN]

Twice in the last 2 weeks I have gotten called by a local ED because a patient of our oncology practice got an abnormal lab resulted in the patient portal (which now happens automatically...thanks 21st Century Cares Act), Googled it and ran to the ER without so much as calling our RN triage line or sending a portal message to their doc.

So...I apologized to the EPs that called me and I apologize to all of you in the pits in advance.

i get why they pushed for it (though I think it’s bull$hit that they Christmas treed this in). But if I have to explain one more damn red cell distribution abnormality then I am going to combust.

 

[southerndoc]

I'm seeing an uptick in young people presenting with conversion disorder.

 

[nikolaite]

I rarely test for SARS-COV-2 in these patients with weird symptoms. If they have infectious symptoms then I will.

I don't think we have the ability to test for antibodies at this time. And even if we did, I doubt I would do that because determining existence of antibodies is not a medical emergency.

It’s undoubted that determining antibodies is not a med emergency. However, if you’re taking potential urgent care, etc. pts in the ED like you described, you may find former or active SARS-CoV-2 as the underlying explanation of their weird cluster of symptoms. Hence virus and/or antibody testing. All the best!

 

[pkwraith]

It’s undoubted that determining antibodies is not a med emergency. However, if you’re taking potential urgent care, etc. pts in the ED like you described, you may find former or active SARS-CoV-2 as the underlying explanation of their weird cluster of symptoms. Hence virus and/or antibody testing. All the best!

Then at this point we might as well start checking people for Lyme and EBV antibodies and blame all their problems on chronic EBV and chronic lyme

 

[turkeyjerky]

Then at this point we might as well start checking people for Lyme and EBV antibodies and blame all their problems on chronic EBV and chronic lyme

I'll be first in line for a PICC for long-term remdesivir and dexamethasone infusions.

 

[southerndoc]

I'll be first in line for a PICC for long-term remdesivir and dexamethasone infusions.

It's only 3 days worth of infusions that take 30 minutes each. Why do you need a PICC?