Most of the results came over the next few days. It wasn’t Lyme or any of the viruses that attack the brain. It was not myasthenia gravis. But it was weeks before the test for MFS arrived. And this test was also negative. This surprised Chen. It was a reliable test. So maybe it wasn’t MFS after all. But what else could it be?
Weight loss surgery often leads to nutritional deficiencies. And she had been throwing up for months; this too depletes nutrients. His presentation, with his bizarre eye paralysis and loss of strength and reflexes, was not typical of any of the unique nutritional deficiencies Chen could think of. But perhaps she had multiple impairments and together they caused this unusual constellation of symptoms.
He ordered tests to assess the levels of vitamins and minerals known to be affected by weight loss surgery that could cause weakness: vitamins B12, B1, C, D and E, zinc, copper. Once the tests were done, he introduced her to replacement levels of these vitamins. These test results were also unsatisfactory. B12 and thiamine (B1) were normal. The same goes for zinc and copper levels. Her vitamin C was undetectable and her vitamins A and D were weak; she was already taking a high-dose multivitamin, so these were covered. But he was not sure that these vitamin deficiencies would have caused his symptoms. And if they had, she should have been better after the vitamins were replaced. She did not do it.
And so, Chen ended up where he started: could it be MFS? Everything favored this diagnosis, except the test. The test is accurate 85 to 90 percent of the time. He suspected a false negative, but it was impossible to know for sure. Either way, she had been treated for MFS, and during her stay in the hospital she slowly started to improve. Eventually, she was transferred to a rehabilitation hospital.
The patient, now at home, tells me that her recovery has been incredibly slow. She had to relearn everything, from eating with a fork and writing with a pen to just walking. At this point, six months after returning home, her eyes only bother her when she is tired. She uses a walker less and less. She will feel really well, she said, when she can get up and pick up her child. She’s not here yet, but soon, she thinks. Very soon.
Lisa Sanders, MD, is a contributing writer for the magazine. His latest book is “Diagnosis: Solving the Most Baffling Medical Mysteries”. If you have a resolved case to share with Dr. Sanders, write to Lisa .Sandersmd @ gmail.com.