At first I assume this is just a thing, like how your appendages--arms, feet, hands--lose sensation in a variety of situations. But once I've taken my benadryl and am sitting on the side of my bed, I begin rubbing my foot and I still can't feel my middle toe. After about two minutes I begin freaking out, or as much as one can freak out in the middle of the night: rocking back and forth, mumbling prayer-esque incantations, crying.
The symptom, the chief complaint if you will, is Peripheral Neuropathy.
I pull up a differential diagnosis in my mind. Top of the list, do-not-miss: Diabetic Neuropathy. This is terrifying because I am twenty-three years old. Statistically, I have a lot more life to live. I don't want to live it without my legs. But there are more diagnoses--less depressing than diabetic neuropathy, but still depressing.
Chronic Alcohol Abuse. I drink a lot. I assumed I was safely staying within my Federally Mandated limit of two drinks a night. But maybe I was drinking much, much more than that. Although alcohol abuse and pancreatic cancer aren't directly tied to one another, I am still pretty terrified that I will get cancer, and over drinking to the point of developing peripheral neuropathy seems like over drinking enough to give me some type of cancer. Even worse: Alcoholics can develop Korsakoff-Wernicke's syndrome. Now Wernicke's aphasia would be awesome! But the Korsakoff part of Korsakoff-Wernicke's leads to being delusional and "confabulation." I don't need to be any more delusional than I already am.
[Question: Why does chronic alcohol abuse lead to peripheral neuropathy? Answer: A) Alcohol dehydrogenase requires oxidizing agents and can quickly use up important molecules like thiamine (Vitamin B1) or B) Drinking distracts your liver from doing other important things, so that it can't send out as much cycling lipids as it should. Neuron helper cells can't keep producing myelin, and you lose nerve conductance. At least I think this is how it works... If you have a better way of explaining it, please share!]
Malnutrition. I had been on a diet the entire summer. It was great: lost 15 pounds, and now my BMI is 22--super normal. However, there were days when I went "overboard." I tell myself it takes a lot of willpower to only eat 565 calories a day, but it's still probably not a good idea. Being able to lose a pound in a day feels awesome! But really, you should be losing that much in a week, if not even over longer time periods. I tried to eat well, the little I did eat was healthy, but it's possible my body needed more and began shirking its biosynthesis responsibilities, resulting in me losing sensation in one of my feet.
So what do you think I have?
Patient History
Patient is a reliable, 23-year-old diabetic (DM type 1).
CC: Patient's chief complaint is an inability to feel her feet.
Past Medical History
Patient has been diagnosed with:
sickle cell trait (congenital)
exercised-induced asthma (age 8)
seasonal allergies (age 8)
Diabetes Mellitus Type 1 (age 13)
anemia (age 15)
hypertension (age 18)
hyperlipidemia (age 18)
depression (age 19)
Medication
Patient is currently on:
Humalog (short acting insulin)
Lantus (long acting insulin)
Nasonex (seasonal allergies/allergic rhinitis)
Fexofenadine (seasonal allergies)
Atorvastatin (hyperlipidemia)
Vitamin B12 (2000 mcg/day)
Social History
Patient denies recreational drug use. Patient admits to smoking cigarettes, about 8/year and having 1-3 drinks/day, occasionally drinking more (6-8 drinks/night) on weekends.
Patient exercises about 30 minutes everyday.
Family History
Patient's father is alive, has hypertension that has been controlled by diet, and glaucoma.
Patient's mother is alive, has dyslipidemia, and had breast cancer in 2007. Currently in remission.
Both patient's sisters are alive and healthy.
So what do you think I have?
You think I am "healthy."
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