Another mystery solved and another patient’s quality of life has changed for the better after 1.5 years of frustration and confusion. I love my job.

#OralMedicine

The pain and pulling sensation has been resolved but she still has the crackling sensation when she bites. Oddly enough the PT was able to replicate the symptoms when she pressed on the splenius capitus muscle in the back of the neck. After we discussed the case, I advised the PT to focus there

As a chronic procrastinator I even get why, but the entitlement for us to accommodate them… that’s the part that throws me. If you’re going to delay to the last second you have to accept that sometimes you’re not going to beat the buzzer.

Honestly? Same, I am so very curious now!

Nice to know the snake oil industry is still thriving, heck it may end up being the only industry to thrive in the next four years.

No, because then I’d probably be getting a wrongful death suit on behalf of a patient I pumped with enough Lidocaine/Epi to stop the heart of a rhino. 🙄 I wonder what it’s like to be so confident despite being so horribly wrong/incompetent.

She’s currently taking cymbalta per her primary doc to help with the anxiety but stated that it hasn’t really done much either (she’s on week 4 of it)

So what’s going on?

Feel free to chime in with theories and I’ll update you later on how I approach this case!

#OMCase1 #oralmedicine

She also reports pain and tightness along her nose and under her eye and feels like it’s impacting how her face moves. She has developed significant anxiety due to this as it has gone on for over a year and she hasn’t gotten a diagnosis. She tried lyrica with an oral pain doc but noted no change.

She’s had the crowns removed and then replaced but her symptoms haven’t changed. The implants have been checked by OMFS and Perio and CBCT and MRI show no abnormality. She reports a “pulling sensation” when she talks or smiles, and only has pain when she touches the crowns w/ her tongue or lip

Not sure about this specifically but most of the “dropped letters” in US English is due to Webster while he was making his dictionary. He wanted to make words more efficient and also lean more on the Latin roots rather than French.

Or the one who promises “simple” solutions to complex problems with “guaranteed” results!

Nothing raises a red flag faster in my mind.

I mean if we’re going with the practice that “primary burning mouth syndrome” is a neuropathy, then we need a name that accurately describes that like “Neuropathic burning mouth”

In my experience a lot of our failing to get to a diagnosis is due to a lack of a consistent diagnostic process

She’d lost 60 lbs since November. The ED doc did a chest ct and bloodwork, found nothing and told my mom that “actually it’s better that you’ve lost the weight.”

…TBC…

But then she passed out on April 11th. No one had thought to adjust her blood pressure meds and with the loss of weight and limited fluid intake her blood pressure had bottomed out. I came with her to the ER. She wasn’t nauseous but she had extreme fatigue and needed help even lifting her legs.

She finally got in touch with her PCP in January, who referred her to a Gastroenterologist. After about 2 months of waiting and getting worse, she got in and called me to tell me she’d been diagnosed with an H. pylori infection… Finally, I thought, she got an answer and could start feeling better.

This time last year we were having Thanksgiving and she stated that she’d been feeling nauseous and was having foul smelling burps and had lost a few pounds. She had diabetes and was on a few meds that could cause gastroparesis, so I didn’t think much about it other than to tell her to call her PCP.