Most of the results came in over the next few days. It wasn’t Lyme or one of the viruses that attack the brain. It wasn’t myasthenia gravis. But it was weeks before the test for M.F.S. came in. And that test was also negative. That surprised Chen. This was a reliable test. So maybe it wasn’t M.F.S. after all. But what else could it be?
Bariatric surgery often results in nutritional deficiencies. And she’d been vomiting for months; that, too, depletes nutrients. Her presentation, with its strange eye paralysis and loss of strength and reflexes, wasn’t typical of any of the single nutritional deficiencies Chen could think of. But perhaps she had multiple deficiencies and together they caused this unusual constellation of symptoms.
He ordered tests to assess the levels of the vitamins and minerals known to be affected by bariatric surgery that could cause weakness: vitamins B12, B1, C, D and E, zinc, copper. Once the tests were drawn, he started her on replacement levels of these vitamins. Those test results were also unsatisfying. The B12 and thiamine (B1) were normal. So were the zinc and copper levels. Her vitamin C was undetectable, and her vitamin A and D were low; she was already on a high-dose multivitamin, so those were covered. But he wasn’t certain these vitamin deficiencies would have caused her symptoms. And if they had, she should have gotten better once the vitamins were replaced. She didn’t.
And so, Chen found himself back where he started: Could this be M.F.S.? Everything favored that 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. In any case, she had been treated for M.F.S., and over the course of her time in the hospital she started, slowly, to improve. Finally she was discharged to a rehabilitation hospital.
The patient, now home, tells me that her recovery has been maddeningly slow. She had to relearn everything, from eating with a fork and writing with a pen to simply walking. At this point, six months since returning home, her eyes only bother her when she’s tired. She uses a walker less and less. She’ll feel like she’s really recovered, she says, when she can stand and pick up her child. She’s not there yet, but soon, she thinks. Very soon.
Lisa Sanders, M.D., is a contributing writer for the magazine. Her latest book is ‘‘Diagnosis: Solving the Most Baffling Medical Mysteries.’’ If you have a solved case to share with Dr. Sanders, write her at Lisa [email protected]