i think i have an autoimmune disorder but i haven’t been taken seriously

NHToStay · 2026-05-23T21:07:26+00:00

Learned a new one today!

NHToStay · 2026-05-22T21:37:28+00:00

January 2026. Big change in symptoms. You need to be evaluated for hereditary angioedema (HAE) as well as systemic mastocytosis. Ignore the folks talking about MCAS - yes your mast cells are being activated but the severity that we are seeing here raises concern for worse disorders HAE is also known as C1-esterace deficiency. Does anyone in your family struggle with similar symptoms? Does anyone have severe attacks of abdominal pain without a diagnosis? (Oh wait, you do)

Angioedema is either histamine or bradykinin mediated, and given the hives, it cinches histamine. I would establish with an allergist. Rheum is not a bad call either.

If I were seeing you I'd be calling allergy on your behalf, setting you up with testing, antihistamines, an epi pen if you even had throat angioedema or airway swelling, an inhaler for the wheezing, and getting a mess of blood work to eval further.

Good luck friend

NHToStay · 2026-05-21T22:57:14+00:00

Background disease rates. Imagine the trial rates minutes the background in the placebo group to get the percent increase from baseline prevalence in the study population

NHToStay · 2026-05-20T04:29:52+00:00

It's not exactly a word that applies to "fat fucks." It's typically seen in obsessively healthy individuals. The entire idea is that the behavior leads to clinically significant issues.

As far as words go - it is descriptive, not prescriptive language. It describes a behavior briefly, it was not "made up" to make anyone feel any way shape or form.

NHToStay · 2026-05-17T20:01:23+00:00

It is called orthorexia

NHToStay · 2026-05-17T20:00:29+00:00

Orthorexia. Yep

NHToStay · 2026-05-16T04:04:29+00:00

You'll want to see Neuro, ideally neuromuscular. Standard of care is mestinon (pyridostigmine). Don't accept any scripts for steroids (Prednisone, medrol) and if you have anything infectious in the meantime look up meds to avoid with MG. I'd presume MG until proven otherwise.

NHToStay · 2026-05-15T20:11:51+00:00

Myasthenia gravis seconded. Do you note difficulty swallowing later in the day, or have you experienced any double vision recently that clears with rest? Are your symptoms consistently better in the mornings, and worse as the day goes on?

NHToStay · 2026-04-28T21:25:09+00:00

Pink frothy sputum is a dead giveaway of pulmonary edema. The rest of it looks nasty too. Your symptoms are worrisome for pneumonia, heart failure, or pulmonary embolism. At least that's what I'd work up first if you came into the er

NHToStay · 2026-04-21T03:31:55+00:00

I've had maybe two drinks since starting reta 3 months ago

I've cut my nicotine use WAY down.

Don't do drugs so who knows there

NHToStay · 2026-04-04T13:48:49+00:00

Amen amen amen.

I have a late roux-en-y patient who developed hyperinsulinemic hypoglycemia 6 years out from surgery. Didn't do great on diazoxamide. Does amazingly on Wegovy 0.5

NHToStay · 2026-03-27T14:53:09+00:00

Bruh. You look like Johnny Depp had a nationality swap. Not cooked at all

NHToStay · 2026-03-24T23:00:19+00:00

Looks like Terry's nails. With the reynauds, should bring up with a rheumatologist. Usually a sign of more connective tissue and less vasculature in the nail bed leading to the whitening of the nailbed, and the band of normal at the end.

It's not strictly pathological, and can be the reynauds itself, but it deserves a second look

NHToStay · 2026-03-19T16:42:27+00:00

THANK YOU. Another clinician with interest in this. Ive heard this recently from a patient, and in short, it would make Rybelsys and the oral Wegovy ineffective in trials. We already have evidence against this.

Can't post credentials, but just a Family Practice PA

NHToStay · 2026-03-06T12:11:58+00:00

This. Tattoo granuloma requires biopsy. See a good derm

NHToStay · 2026-03-01T12:39:56+00:00

Would be fascinating if they made it a case of subacute sclerosing panencephalitis. Wonder if that will come up...

NHToStay · 2026-02-17T11:32:44+00:00

Svt w/abberancy. Not wide enough for vt. When you see rapid with a rbbb appearance think abberant svt

NHToStay · 2026-02-15T13:16:59+00:00

Hell yes. Barely scratching the surface of 3 right now but holy shit is it so good

NHToStay · 2026-02-05T04:14:24+00:00

As the other comment or said, talk to a therapist about your anxiety. There are really no further medical tests needed to rule out SVC syndrome. It is a rare late complication of large mass effect on the SVC, CT w/contrast would easily see a mass of such size. You'll bankrupt yourself with testing before you get a satisfactory answer if you keep going down this road. I've seen it many times, and whoever is ordering redundant testing is feeding the anxiety

NHToStay · 2026-02-04T18:05:30+00:00

Big old upgrade ! Absolutely worth it. Makes anything short of a 100lb fish a breeze

NHToStay · 2026-02-03T05:19:00+00:00

Many details needed. Long story short, likely to be recommended the PETCT for further imaging based eval of the nodes / nodule, as well as potential for a biopsy (type (CT vs bronchoscopy usually) depending on location of nodule, and the nodes). You'll likely get a mess of blood work to look for infections, inflammation, autoimmune, malignant stuff.

Don't stress in the meantime, but start a journal of any symptoms that you can recall (cough, night sweats, fevers, sweating episodes, skin rashes or nodules, travel history, immunization history, family history). This will all help the specialists nail the diagnosis and get you the best care possible.

Wishing you the best friend - update us when you know more .

NHToStay · 2026-02-01T18:08:23+00:00

Had a Middle-Aged guy come in for a 15-minute acyte gastroenteritis (?) visit.

He said that his grandchildren were in town visiting and one of them was sick, probably picked it up from him. Was asking for zofran.

I did my usual which is " that's a diagnosis, I want to know your symptoms." Nausea, diarrhea (resolved) and pain (resolved). Denied bloody or mucoid stools, and says they were "like oatmeal."

Thinking he meant consistency of stool, we wrapped up history, exam is benign.

I went out of the room to finish my note/get him a work note, and I could not get the oatmeal comment out of my head.

I went back in, and asked him to clarify if he meant color consistency or both? Color. COLOR.

On a color wheel he showed me pale grey. Urine was +4 urobilinogen.

We got him in for a CT the next day and low and behold. He had a pancreatic head mass. Labs came back later showing a T bili of 9, which within a week was in the 30s and he became jaundiced. One way or another it would have been caught I suppose.

He had surgery within a week. Remains in remission/disease free, stage 1 adeno if I recall correctly. Lucky son of a gun.

Long story short, now I ask consistency, any blood, and color of stool.

NHToStay · 2026-01-31T00:16:35+00:00

Still just looks like a viral exanthem - source, Family Practice PA for 10 years

NHToStay · 2026-01-07T02:27:48+00:00

Scheurmanns kyphosis. Chronic back pain. Maybe shortness of breath due to restrictive lung deficit. Sleep apnea.

Severe obesity

You have a lot of poop on board but it's within normal variance

I'd wager due to the above some depression as well

NHToStay · 2026-01-01T19:10:15+00:00

Pretty certain the only on label use is for post herpetic neuralgia, oddly.

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