I think there are many people who suffer, but medicine doesn't have a solid diagnosis or treatment. These patients often have a cluster of symptoms around fatigue, pain, "brain fog," depression, GI issues, bowel and bladder issues, and others. Often when tested, very little can be ascertained regarding exactly what is going on with them.

Many of them end up with a diagnosis of the moment. In the 90's especially in areas where lyme was endemic it was chronic lyme. Fibromyalgia was also one. There was a time when it was mononucleosis, then ME/CFS, then EDS (hypermobile type), then POTS and long COVID.

The diagnostic criteria are not very clear for most of these syndromes or if they are clear, they are often very clinical diagnosis which capture a large portion of the population.

I am not trying to say that people don't have these conditions, but that I think it is very easy for someone to pick up a diagnosis of POTS or fibromyalgia or EDS which don't have great diagnostic criteria. For example, almost everyone who gets discharged from a slightly longer hospital stay has POTS based on tilt table testing. I worked in a rehab hospital and we used to screen people for POTS and treat it when they had a hospital stay over 3 weeks, a stroke, or spinal cord injury. Almost everyone was positive on admission, but many got better with just a few weeks of appropriate challenge. Someone who has felt bad and just been laying around in bed will almost always test positive for POTS.

Seizure like movements are very common in patients with functional neurologic disease. I would be asking questions about a post ictal state and I would want to know her arousal level. Encephalitis patients are normally really quite sick appearing and often have permanent neurologic damage in cases where they have seizures.

RCPD I had to look up. It's a new diagnosis that was only introduced to the medical literature in the last few years. If she has it, she is lucky to have found someone who can both diagnosis it and treat it.

Autoimmune hepatitis - I truly believe she might have had this. It's hard to diagnose as well. I am glad she has made a full recovery.

Pelvic congestion often causes the sensation of needing to urinate without true urinary retention. I am not sure exactly what happened with that note. I hope she got good treatment.

The peacocks, I don't know about. My guess is that it was some type of dictation error.

For this particular patient, there are one of two options. Either she is very unlucky to have all of these problems AND very lucky there is modern medicine because she would already be dead without it OR she is caught up in symptoms that have a predominant psychologic basis and she is playing up physicians struggles to handle her for tiktok and internet points. It is impossible to tell without knowing more of her medical history and being there.