WEBVTT Kind: captions Language: en 00:00:04.633 --> 00:00:08.932 - It's hard to have a condition and then so consistently have normal test results. 00:00:08.933 --> 00:00:12.466 But then, to have the stark pain every day as a reminder, 00:00:12.467 --> 00:00:14.099 no, there's something very wrong here. 00:00:14.100 --> 00:00:16.467 Especially when you don't know what you have, it's a nightmare. 00:00:17.433 --> 00:00:22.766 - It's really frustrating for patients to be treated as a medical mystery. 00:00:22.767 --> 00:00:25.466 While all of this investigation is going on, 00:00:25.467 --> 00:00:29.967 they're disabled and suffering this whole time that they're waiting for a diagnosis. 00:00:31.000 --> 00:00:32.399 - Just being sick is terrible. 00:00:32.400 --> 00:00:38.232 You feel like this body that you have trusted your whole life has betrayed you in this really major way 00:00:38.233 --> 00:00:42.133 and now, nobody can tell you what that major way is. 00:00:49.500 --> 00:00:51.832 - [Courtney] I've seen a lot of different specialists. 00:00:51.833 --> 00:00:55.433 Easily over 50 different physicians in the last 15 years. 00:00:56.467 --> 00:01:02.067 I would wait sometimes months for an appointment and I would be in constant pain. 00:01:02.967 --> 00:01:04.566 - Patients don't want to be sick. 00:01:04.567 --> 00:01:06.532 They don't want to have these symptoms. 00:01:06.533 --> 00:01:08.999 I think it's our obligation to try to figure out, 00:01:09.000 --> 00:01:10.366 to the best of our ability, 00:01:10.367 --> 00:01:16.033 which patients have some underlying condition that needs to be diagnosed and treated. 00:01:17.167 --> 00:01:19.899 - In medicine, we treat patients. 00:01:19.900 --> 00:01:25.999 We do not treat images, radiographic findings or lab tests. 00:01:26.000 --> 00:01:28.399 Patients can have abnormalities 00:01:28.400 --> 00:01:31.632 and not every abnormality needs to be fixed. 00:01:31.633 --> 00:01:33.700 This is the importance of the diagnosis. 00:01:36.100 --> 00:01:38.699 - [Dr. Sanders] Suffering for 15 years is a terrible thing. 00:01:38.700 --> 00:01:42.232 I don't know how common it is, it shouldn't be common at all. 00:01:42.233 --> 00:01:44.066 - Beginning in second year of high school, 00:01:44.067 --> 00:01:48.066 she developed this intense abdominal pain every time she exercised. 00:01:48.067 --> 00:01:50.866 - I would literally feel like something was writhing around inside of me. 00:01:50.867 --> 00:01:52.800 I would feel like there was a snake in my abdomen. 00:01:52.833 --> 00:01:57.300 - [Dr. Inzucchi] So she would run, perhaps 100 yards, and get tremendous abdominal pain. 00:01:57.700 --> 00:01:59.099 - [Courtney] I just sorta got used to it. 00:01:59.100 --> 00:02:03.232 But I would still have the attacks of much more intense pain. 00:02:03.233 --> 00:02:06.266 - Abdominal pain has a lot of different reasons. 00:02:06.267 --> 00:02:08.966 So, it's not uncommon for us to see complicated cases. 00:02:08.967 --> 00:02:12.899 Whenever we see those, there's always communication with different specialists 00:02:12.900 --> 00:02:16.132 to make sure that we're on the right track and we're treating the right condition. 00:02:16.133 --> 00:02:20.799 - The intensity of her pain and the fact that it had always occurred with exercise, 00:02:20.800 --> 00:02:22.299 I mean, that was the clue. 00:02:22.300 --> 00:02:25.567 - I did a lot of research on my own trying to figure out what was wrong with me. 00:02:26.400 --> 00:02:31.433 As a scientist myself, it was really important for me to get something quantifiable to hold onto. 00:02:32.567 --> 00:02:33.899 - Courtney was frustrated. 00:02:33.900 --> 00:02:35.432 She was disabled from the condition 00:02:35.433 --> 00:02:38.733 and she just wanted to get treatment started so she could function in everyday life. 00:02:40.400 --> 00:02:45.499 - Her abdominal pains went back during childhood, she had migraine history. 00:02:45.500 --> 00:02:50.299 People who have had migraines have that symptom elsewhere. 00:02:50.300 --> 00:02:54.900 - And abdominal pain is something that we`common see in the headache world. 00:02:57.600 --> 00:03:02.699 A bell definitely went off when I saw that there may be a family history of migraine 00:03:02.700 --> 00:03:06.932 because there's certainly a connection between the gut and the brain. 00:03:06.933 --> 00:03:12.132 - Your brain and your stomach have a lot of the same neurotransmitters, 00:03:12.133 --> 00:03:16.332 so a lot of the things that effect your mind can also effect your stomach. 00:03:16.333 --> 00:03:20.966 - I diagnosed Courtney with chronic migraine and abdominal migraine. 00:03:20.967 --> 00:03:23.966 Abdominal migraine is a type of migraine disorder 00:03:23.967 --> 00:03:27.999 that, most commonly, effects children and adolescents. 00:03:28.000 --> 00:03:33.566 We often see classic migraine or chronic migraine with abdominal migraine 00:03:33.567 --> 00:03:36.099 and so, when we think of treatment options, 00:03:36.100 --> 00:03:38.767 we try to think of treatment options that target both. 00:03:42.600 --> 00:03:47.966 - [Courtney] After about eight weeks, I just woke up one morning and my pain just wasn't there. 00:03:47.967 --> 00:03:49.799 That was something that I had dreamt about 00:03:49.800 --> 00:03:52.767 but it was something that I didn't ever actually know was going to happen. 00:03:53.567 --> 00:03:57.366 - [Dr. Inzucchi] Courtney's case is a great example of multidisciplinary medicine. 00:03:57.367 --> 00:04:00.966 Starting with the primary care doctor, seeing an endocrinologist 00:04:00.967 --> 00:04:02.699 and also a vascular surgeon 00:04:02.700 --> 00:04:07.433 and ultimately gastroenterologist and neurologist coming up with her diagnosis. 00:04:08.400 --> 00:04:10.866 - They took the condition seriously 00:04:10.867 --> 00:04:13.666 and so, regardless of what they personally thought 00:04:13.667 --> 00:04:15.666 about my symptoms or about me, 00:04:15.667 --> 00:04:19.499 they took their responsibility to figure out what was going on very seriously. 00:04:19.500 --> 00:04:21.999 - When a patient comes to see a doctor, 00:04:22.000 --> 00:04:25.466 it's really the meeting of two experts. 00:04:25.467 --> 00:04:27.599 There's no way for the patient to know what I know, 00:04:27.600 --> 00:04:31.266 but there's also no way for me to know what the patient knows 00:04:31.267 --> 00:04:34.999 except to ask them and to listen to them and to believe them. 00:04:35.000 --> 00:04:38.899 - Not being believed by doctors is perhaps one of the worst feelings I've ever had, 00:04:38.900 --> 00:04:40.499 besides the actual phyical pain. 00:04:40.500 --> 00:04:43.299 It's a terrible thing to have someone say, 00:04:43.300 --> 00:04:46.899 'you know, you say that narcotics only work so you're probably just looking for drugs.' 00:04:46.900 --> 00:04:49.266 - No one else can tell you, 00:04:49.267 --> 00:04:53.432 no test can tell you how this patient feels. 00:04:53.433 --> 00:04:55.632 - Getting to know the patients on a person level, 00:04:55.633 --> 00:04:59.099 what they cherish, what they enjoy doing in the life on a daily basis, 00:04:59.100 --> 00:05:02.032 is very important because by knowing the patients, 00:05:02.033 --> 00:05:05.799 you will be able to achieve your goals of treatment. 00:05:05.800 --> 00:05:07.732 - This is why we do medicine. 00:05:07.733 --> 00:05:11.366 When somebody comes in with a symptom for 15 years and 00:05:11.367 --> 00:05:14.299 you help them and they're pain free, 00:05:14.300 --> 00:05:15.932 it feels fabulous. 00:05:15.933 --> 00:05:19.199 - Her life has been completely changed since receiving the diagnosis. 00:05:19.200 --> 00:05:21.267 She's had a happy ending.