Test your Clinical Skills #3

Test your Clinical Skills #3

Test your Clinical Skills #3

Justa, 34 year old female
Case Summary:
Ethnic background: Caucasian/White
Symptoms began: 4 years 7 months ago
Current medications:
Synthroid 1 time daily for Hypothyroid
Constella 1 time daily for Constipation
Trazedone 1 time daily for Sleep (not helpful due to bladder pain)
Advil, Tylenol, naproxen 3 times daily for Pain, but not helpful
Body systems affected:
Genital or urinary (Primary Body Area Affected)
Abdominal or digestion
Symptoms detail:
It started with frequent UTI’s in 2012; I was treated by many many rounds of antibiotics. But after an infection in Feb 201, the frequency, burning and urgency continued non stop even when the infection was gone. 4.5 years later I’m still up almost all night, every night with aching bladder, having to pee every 10-45 mins, sometimes burning after urination. The pain is the biggest problem of all those. I notice that my stomach often feels “stuck” on the left side and I have a lot of gas/constipation that may contribute to bladder symptoms. On the drug constella to make sure I have regular bowel movements but even that makes no difference to bladder symptoms. In fact, sometimes after I’ve had a bowel movement, symptoms get worse.

Since 2013 I’ve been to at least 10 urologists, urogynocologists, gyncologists and have had every type of bladder test. Been told I have a healthy looking bladder. Been put on overactive bladder meds (mybetriq), meds for interstitial cystitis (elmiron), cystitis diets, had an interstim implant in my tailbone – all with zero effect on the symptoms. Tons of ultrasounds, CAT scans, MRIs, neverending emergency hospital visits for the pain. I even had a laparoscopy, which ruled out endometriosis. And 2 colonoscopies, ruling out Crohns colitis and celiac. Still I tried every nutritional modification – cutting out gluten, dairy, nightshade vegetables, grains, corn, FOD map diet, hydrogen breath test. No change. Been seeing a pelvic physiotherapist for a year and zero improvement. One urologist told me I have tiny kidney stones, but there’s nothing he can do and he said they’re not the cause of my pain. My naturopath has tried me on several supplements as well with no change.

I’ve had PCOS since I was 12, and very irregular painful periods. Chronic myeloid leukemia since I was 22. Was put on Gleevec for over ten years. Now off it and monitored closely for past two years. It’s under control. Various muscle/joint pains for 15 years, starting before I started Gleevec. But these are not as intrusive as bladder symptoms.

This bladder issue has been the most debilitating,scary experience of my life. I have my masters of social work and yet haven’t worked because of this for years. Although I’m so motivated to find the problem, it seems I can get nowhere and rarely get even a few mins break from the pain. Very little quality of life like this and would be forever grateful for some help putting the pieces together so I can get my life back.
Current medications:
Synthroid 1 time daily for Hypothyroid
Constella 1 time daily for Constipation
Trazedone 1 time daily for Sleep (not helpful due to bladder pain)
Advil, Tylenol, naproxen 3 times daily for Pain, but not helpful
Problems with specific body parts or systems:
Genital or urinary (Primary Body Area Affected)
Abdominal or digestion
Feels like the stomach pain I have may be connected to this problem. Stomach always feels “stuck” esp on left side with tons of gas I can’t get out. Always constipated so I have to take meds to have bowel movement.
Personal medical history:
Chronic Myeloid Leukemia for 12 years. Was on Gleevec.

Asthma since childhood

PCOS/ hypothyroidism

Cluster headaches

Recent tear duct infection

Some Joint and muscle pain for at least 15 years – not as concerning as bladder problem
Family medical history:
Mother and father are healthy. Dad had colon cancer many years ago but is fine now. Dad has asthma and Back problems related to incident when teen. Two younger brothers are healthy.
Personal lifestyle:
I was finishing my master’s of social work. Was an extra challenge for me bc of joint and muscle pain, but I was functional. Went to gym 5 x a week, enjoyed being social and seeing friends. No huge stressors.
Diagnostic or imaging test abnormalities:
Innumerable tests, but nothing much found. Tiny kidney stones deemed unrelated to my issue.

MRI cat scan ultrasound bladder function tests- show nothing.

Laparoscopy and colonoscopy shows nothing.
Secondary or partial diagnoses:
pelvic floor dysfunction
Possible Ehlers Danlos syndrome, type 3
Mast Cell Activation
Personal struggle:
Exhausting, demoralizing, tormenting.

Affected everything from my self esteem, to competency, to career, to faith in medical community.