A bit of a head scratcher

Those of you who have been reading my blog right from the start will be well versed in my journey with attempting to get a diagnosis of Myasthenia Gravis, I was diagnosed with it in 2007, that diagnosis was removed in 2009. Since then on a couple of occasions I have had major issues with Ptosis and generalised muscle weakness and ended up being tested all over again. On every occasion it has  come back negative. So you could have knocked me down with a feather ( twice)  today when Myasthenia Gravis was mentioned.

I gave up long ago trying to find answers for why there are days I can’t take a deep breath . Why I struggle with repetitive movements and then find myself unable to move the affected limb. Why I am always battling this more in the summer than the winter. It seemed every time I mentioned Myasthenia Gravis I was laughed at by the medical profession and given another BS diagnosis. Now it isn’t that I want this condition, I could really do without daily ptosis unilaterally or bilaterally. I could do without the fact that all the time my mind is willing to do stuff but my body frequently lets me down and I am unable to do stuff because my body simply won’t move .

The last time I was investigated for it in either 2017-2018, I was told I had idiopathic hemifacial spasms. Which my then PoTS consultant laughed his head off at as it was very clear that the right side of my face wasn’t in spasm but was paralysed. In fact evry medic who has seen the photo’s has said that isn’t a facial spasm, basically the whole right side of my face droops making me look like i have had a stroke. From then on my PoTS wrote in my medical letters that I had a neurological disorder as yet undiagnosed. No more mention of MG. 

I left the diagnosis alone, there was nothing to be gained by continually going on about a diagnosis that all tests repeatedly kept saying I didn’t have. It made me look like I was only interested in getting that diagnosis and that I was “making” my symptoms up. I didn’t want to be considered a faker / malingerer / sufferer of somatization disorder. So I just shut up about it. Mentioning MG compromised my medical care, so I learned it wasn’t a battle worth fighting anymore. Despite the fact that I was always positive on the icepack test, following a doctors finger with my eyes causing nystagmus and a sustained upwards gaze causing ptosis. Because some doctors believed I was faking all those symptoms. To keep going on about it made me look like I was mentally ill. Sometimes you just have to let shit go and trust at some point no matter how long it takes someone believes you.

This morning I had to attend the major hospital near me, for the ongoing issues with my neck. The doctor was chatting to me and said about my medical history so I took him through EDS and the severe autonomic nervous system dysfunction. He then had a look at his screen and said “well what about your Myasthenia Gravis? That is quite serious”. If I hadn’t been wearing my migralense glasses and a face mask, he might have seen the look of shock on my face. I was for a second temporarily stunned into silence. I said answering honestly and in the least sarcastic way I could, “well the MG thing has been going on for years and the jury is still out on whether or not I have it, I take mestinon to help treat my PoTS and it also takes care of the ptosis and muscle weakness so I just get on with it.”. Nothing more was said.

He then went through my prescription medications and I said to him, “oh I also have home oxygen”. He asked me why I have that, so I replied ” I can desaturate very quickly sometimes or struggle to breathe, now that could be because of the undiagnosed Myasthenia Gravis or it could be the issues with my autonomic nervous system or a combination of both.” Again my reply was noted and nothing more said. I have had my oxygen machine for at least 10 years now. No one has ever attempted to remove it even though I have no one overseeing my care with it. 

As part of my physical exam the doctor did some neurological tests. I had to follow his finger with my eyes. Now not deliberately I promise you ( I woke up with a horrific migraine this morning and almost cancelled the hospital appointment ) I forgot to take my mid morning dose of mestinon, so I was feeling shit because my blood pressure was plummeting and sumatriptan was making me feel fatigued.  He made me follow his finger, well I must have looked bizarre as my eyes just couldn’t keep up. I got nystagmus and my eyes were rolling around in my head. I knew he was surprised as he did the same movement several times, each time it produced the same result. It surprised me if I am honest.

 I know that nystagmus during the neurological exam can be an indicator of MG. Obviously years ago I did lots of research on the subject to educate myself as I had never heard of MG when I was originally diagnosed with it. But I still wasn’t expecting it to happen when I had to follow this doctor’s finger. For so long I have ignored the symptoms I have and blamed them on other things or even accused myself of putting them on that when they happen like that it still has the ability to surprise me.

I never said anything at the hospital. Again I have learned it is better to keep your mouth shut and act like a dumb blonde than to look like you have spent hours on the internet researching stuff. It doesn’t do you any favours and again “appearing to know more than I should” has been held against me previously so I stopped doing it. There was nothing to gain from having the knowledge if the doctors assumed that you were faking your symptoms to get a diagnosis – which I wasn’t let me be clear. If I had any control over my life I would not have been ill health retired in 2008 giving up a career I loved, losing my financial independence, losing my ability to walk on Woodbury common, being socially isolated for long stretches. There was nothing to gain by me becoming sick and just so much to lose.

The second mention of Myasthenia Gravis came this afternoon. I got a summons for Jury service this week, which is a physical impossibility for me. I contacted my doctors surgery expecting them to do me a fit note / medical certificate. Instead they have printed off my Patient Summary Hospital Print out, which lists all my current prescription medications and my medical conditions. On the top line of the section marked Active Major Problems is Myasthenia  Gravis. It has the word probable alongside it but it hasn’t been updated since 2011 but that is at least a year after the diagnosis was removed. I also changed gp surgeries in 2011 so I am confused that if it is a clerical error why it has simply been repeated when they would have had that information in front of them saying that diagnosis had been removed in either 2010 or 2009. The diagnosis was poo pooed again in either 2017 or 2018. So why is it on this patient summary and being used by the gp practice and the hospital?

But it would also explain why the doctor at the hospital was talking about this as I am guessing this information would have been attached to my referral. It has me scratching my head. Does it mean they think I have a probable diagnosis of MG? Is it a clerical error? Because if it is there have been multiple opportunities to correct this. So many hospital letters etc all saying it isn’t MG. I am sat here just thinking WTF?

I don’t want to open up a can of worms by asking what that diagnosis is doing there as I have previously suffered serious breathing problems and was blue lighted to hospital where it was suspected that I was on the verge of or maybe having a myasthenic crisis. To have that removed and then suffer from major breathing difficulties again would be just my luck and the hospital writing it off as a panic attack or anxiety could be dangerous.

It is a bizarre place to be when someone brings up a diagnosis that you long ago thought was off your records. It is strange what is on these records as on the Majory Inactive side are a Diagnostic endoscopic examination of Right Knee joint surgery form 1988 – a life time ago!  Acute Pyelonephritis ( kidney infection) in 1999 ( I actually think that date is wrong as it was 2009 I was in hospital with that).  Laparotomy and division of band adhesion 8th July 1998. Again that one feels like a life time ago and it was an utterly hideous experience and very, very painful.

So I am sat here scratching my head again, do I say something and get a couple of errors corrected when I haven’t had access to all my notes and have no idea what information those entries have been based on or do I just leave it ? I just am clueless as to what to do.

4 thoughts on “A bit of a head scratcher

  1. I think you’re not understanding fundamentals of medicine.

    A major principle of medical diagnostics and treatment (or lack thereof) in everything non-cancer- related is to keep the patient on unsure footing and also teach him that he or she is constitutionally stupid even if only particularly in medicine.

    So if you’re in front of any given doctor, he will deny what the last doctor said and say that since you repeated it, “you” believe and accepted what he said and in fact maybe you even “diagnosed yourself” with it. He will sometimes deny that the condition written in your medical file even exists.

    When a few doctors don’t understand that they have to call you an idiot, they will sometimes say the right thing. Was the doctor who said you “have” “myasthenia gravis” today young?

    I’ve been in similar situations and of course, it always involves at least the fact that I can’t breathe without Mestinon. But today I never hold back on the sarcasm.

    Liked by 1 person

    • Hi,
      Thanks for reading my blog post and taking the time to write a comment.

      The doctor I saw yesterday was indeed young probably mid thirties at the oldest. He didn’t say the words that I “have MG” it was basically “what about your MG?” . I was thrown because I had no clue what was written on the screen in front of him. Did it say “patient is utterly convinced she has MG despite tests saying otherwise?” Did it say ” Probable MG? ” Who knows it is a topic I have avoided as much as possible since around 2010. I have had many interactions with doctors during that time and none of them have brought it up until yesterday, other than the neurologist I saw in either 2017 or 2018 specifically for more diagnostic tests. So it threw me for a loop.

      If indeed I do have MG my symptoms are very mild, although if I push myself beyond my normal levels of physical activity they come very quickly visible, like when I was assisting my husband laying a floor which meant I continually had to move over his bed ( no way to take it out of his room) after the second time of doing this my legs stopped working. I had to pick them up to get them to move. It shocked me as it came on so quickly and it had been such a very long time since the symptoms other than ptosis had been that obvious.

      I have learned the hard way not to be sarcastic when dealing with doctors. In the NHS you are very limited with who you can see. Funding is hard to come by to see people outside of your area so all the doctors you see in a speciality tend to know each other. Being rude or even sarcastic quickly compromises your care. It isn’t worth it, as everything gets written off as anxiety or some other mental health issue and you are left having to struggle alone.

      I am lucky my symptoms are mainly quite mild, I know when a dose of mestinon has worn off. Breathing issues are few and far between but can and do crop up hence why I have home oxygen. I would hate to be in the position where I had no treatment at all and having to continually pushing to be heard.

      I have seen so many doctors over the last 13 years that I have run through every possible kind, from the arrogant arsehole to the pleasing bedside manner but as effective as a chocolate teapot. I have no expectations when I have to meet a new doctor other than the fact it maybe yet another bruising encounter where I don’t get any further. I am sure you have had your own experiences of all of these.

      As stated in my post I am left scratching my head as to what the note on my care summary means, a clerical error or doctors hedging their bets or an actual diagnosis.

      R

      Like

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