Anatomy Physiology Video Project
02
December

By Adem Lewis / in , , /


I’ve received all your records from your
primary care physician. Have your symptoms changed at all since you saw him? Not really… He told me I should go get some physical therapy just in case that
helps but it didn’t really seem to me at all. Also I haven’t been to the restroom in 10 days. Okay. So your tailbone still hurts really bad? Have you had any major changes and
your sleeping or eating habits? Are you getting enough exercise? Um… yeah the tailbone still hurts pretty bad… I have been peeing a lot too. Like a lot. Also, I have this crazy appetite so I’m eating a lot but I don’t seem to be gaining any weight Okay. Hm.. That is interesting. Yeah what I have here says all of your X-rays and MRI reports and all of your blood work that you did last time are completely normal. so from my perspective, there doesn’t seem like anything gastrointestinally is wrong, so I’m going to have to refer you out to a neurologist to see if they can find out what’s really going on. Thanks doc. Your muscle strength seems pretty good So, what do you think is causing all this? I think there could be a neurological basis because if you know you have a
lesion on one side of your brain it could cause pain just on the other side
or on you can have overactive muscle contractions which would cause your spasms. Um, I’ll take a look at your scans again but I really do think you should go see an
endocrinologist because there could be a hormonal issue at play. Okay, thank you. Yeah, it was good to see you. Looking over the symptoms you gave Dr. Roof, I believe there’s evidence you
might have a hormonal imbalance. Um, bodily functions such as urination, digestion, immune response, and hunger are all regulated by hormones. Uh, specifically
the hormone cortisol is released when you experience stress, so this can be responsible for causing some of your symptoms such as excessive urination,
constipation, and alterations in appetite. Um, also it can suppress the immune system
which could explain why you’ve been having chronic sinus infections. Also, in some cases, cortisol has been shown to exacerbate pain, so this may be a contributing
factor to the pain you are experiencing in your tail bone region. Um, if the cortisol is what has been exacerbating your pain, it makes sense that your physical therapy has not been helping. So what exactly is causing this increase in cortisol? Um, so the release of cortisol is regulated by a system in the brain called the HPA axis and this is usually
triggered when the body perceives a situation as stressful so it turns on
and cortisol is produced. Now normally, this spike in cortisol turns off as soon as the stressful situation is over. However, if you’re constantly being stressed, the system doesn’t have a chance to turn off so cortisol is constantly released. This can have really detrimental effects your body. And I know this may be a sensitive area, but I understand you were sexually
assaulted as a child? That’s correct. Um, okay so research has shown that trauma from sexual assault can lead to an altered HPA axis yeah I also don’t as you remember much details either oh so this could explain that a short burst of cortisol usually boosts brain function but chronically elevated cortisol can actually damage hippocampus so
this have caused the lapses you have in memory. So I’m going to convene with the other doctors to see if we can come up with a course of treatments. Thank you. None of the symptoms seem to be consistent with GI disorders The brain scans also came back normal with no lesions. The neuro work up came back normal. There are no signs of any degenerative (neurological) disease. (Psych specialist): It seems that the childhood sexual abuse seems to be the cause of constant pain. We should take efforts to manage his mental health, and take care of his daily stressors like pain and trauma. Practicing meditation and low intensity cardio (exercises) should help lower his daily cortisol levels, as well as improve his mental state. His leaky potassium channels have a role in his pain regulation and sleeping patterns. If the current steps are still not working, we can schedule weekly therapy sessions, and/or switch to pregabalin, which is more readily absorbed into the body. It may be more effective for neuropathic pain than gabapentin (which is he is currently taking). Also, phosphatidylserine has been shown to reduce free cortisol levels, probably by blunting the cortisol response to stressors. We could try prescribing these pills in addition to his current antidepressant. And if this treatment works, this (decrease in cortisol) should reduce his pain, so his current pain medication, gabapentin, will be unnecessary.


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