Unit 4 Peer Response

Samantha Dieken

· Mid-point in the course, is your differential diagnosis more closely centered upon a specialty? Are you focused upon metabolic, autoimmune, infectious, psychological, or neurological? Reconfirm or reestablish your top two diagnoses and rationalize your answers.

I am more focused on a metabolic disorder because I still believe it is type 2 diabetes. Cushing’s syndrome could still be a possibility, but my best bet is type 2 diabetes so far, which is a metabolic disorder. Type 2 diabetes affects ones metabolism/how our body digests food. Cushing’s Syndrome is caused by increased cortisol, so this has to do with glands and hormones, it is hormonal disorder.

This weeks symptoms stood out to me because fibromyalgia is commonly found in patients with type 1&2 diabetes. The other symptom for this week also stood out because diabetes can cause muscle pain, wasting and twitching which is also known as diabetic amyotrophy, a nerve disorder that causes pain and muscle wasting. These two symptoms are commonly found in patients with type 2 diabetes.Focusing on a metabolic disorder narrows it down more, but there could be more symptoms not shown yet that could point me in a different direction/specialty. For the previous weeks/symptoms, I will keep type 2 diabetes as my diagnosis.

· Is this a systemic disease affecting multiple organ systems or do you believe this is an isolated condition with random symptom presentation? Rationalize your answer.

This systemic disease is affecting multiple major organs such as your heart, blood vessels, nerves, eyes, and kidneys. Type 2 diabetes can put you more at risk for other health issues such as heart and blood vessel disease, nerve damage, and kidney damage, controlling your blood sugar when having type 2 diabetes can help prevent permanent damage to organs. Although more symptoms are to come, I do think this is a systemic disease affecting multiple organs and body systems/functions.

· Based upon what you currently know through symptom presentation and the process of differential diagnosis, what further tests would you order to help confirm your current diagnoses? Rationalize your answer.

In order to help confirm my current diagnosis, I would run the following tests:

Blood test: To test if blood sugar is too high.

Oral glucose-tolerance test: This is another type of blood sugar test done to see how ones body handles sugar. Initial blood draw, then drink a glucose drink, then get your blood drawn in intervals of 30 to 60 minutes for up to three hours. This test will show exactly how well your body can handle glucose.

Fasting blood sugar test: This is an easy and common blood test ordered for a variety of reasons, but is used for diagnosing diabetes by testing to see if your in normal range for your blood sugar. The test should be done after fasting overnight, meaning you haven’t eaten or drunken anything (besides water) for at least 8-12 hours before the test.

Two-hour postprandial test: A blood test done two hours after a mean to test your blood sugar range.

And the last test I would test would be the hemoglobin A1C test: This blood test tests to see how high your blood sugar HAS been in the recent months.

All of these tests would help rule out any sickness and/or other conditions that can be detected by these tests. Blood tests are highly effective in diagnosing diabetes because the tests look for elevated blood sugar levels (hyperglycemia), which is one of the main symptoms of type 2 diabetes. If the blood sugar levels are too high, this tells the doctor that the hormone insulin is not being produced or used properly in the body. Insulin is used to help keep your blood sugar levels from getting too high, when your body doesn’t produce enough insulin, your blood sugar levels will elevate, which can help confirm the diagnosis, which I still think is type 2 diabetes.

Jennifer Parker 

RE: Unit 4 Unidentified Condition: Fibromyalgia, Muscle Atrophy - Click her to respond

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I did research on fibromyalgia and my findings are that it is chronic pain that last three months or longer. If you have an autoimmune disease like rheumatoid arthritis you are more likely to develop fibromyalgia. Certain infections can also trigger fibromyalgia. 

Muscle atrophy is defined as a decrease in the mass of the muscle; it can be a partial or complete wasting away of muscle, and is most commonly experienced when persons suffer temporary disabling circumstances such as being restricted in movement and/or confined to bed as when hospitalized. Autoimmune Diseases can cause muscles to waste away or can make movement difficult, leading to muscle atrophy. 

I feel that each symptom can affect different systems of the body. They could start out as affecting one system at a time but the worse they get or the longer before treatment they can spread and affect multiple other body systems. While there is no lab test to confirm a diagnosis of fibromyalgia, your doctor may want to rule out other conditions that may have similar symptoms. Blood tests may include: Complete blood count Erythrocyte sedimentation rate Cyclic citrullinated peptide test Rheumatoid factor Thyroid function tests. Diagnostic tests for muscle atrophy are physical examination, blood tests, urine tests and muscle biopsy. 

Savanah Ducharme

RE: Unit 4 Unidentified Condition

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I wasn’t focused on just a specialty and narrowed to top 2 diseases to either Crushings Disease or Type 2 diabetes. I made this based on the fact that both fibromyalgia and muscle atrophy both appear in these medical diseases. Fibromyalgia is very much associated with diabetes. The higher a person’s A1C levels are the higher their likelihood is to suffer from fibromyalgia as well. Muscle weakness, fatigue, and mental changes are all also common symptoms with Crushings disease.

                I don’t believe these symptoms to be random, they all affect the whole body in one way or another which leads to an indefinite diagnosis. All the presented symptoms are all indication of something that your body is trying to fight off. By them all presenting themselves it allows medical professionals to pin point the problem based off of what it is that your body is doing in reaction to the disease.

                For crushing’s disease I would have urine, blood, saliva, or imaging tests done. These will all help to rule out other conditions that have similar signs and symptoms. For diabetes I would have blood sugar level test at random done. If the reading is over 200mg/dL or higher it is suggested that its diabetes.

Vera Waters

The first condition fibromyalgia is a condition that doesn’t seem to be related to past symptoms. From the research I conducted about the condition it is noted that this is not a clinical disease but a syndrome. The difficulty of understanding this syndrome is the symptoms consist of a set of symptoms but doesn’t have a specific cause. For these reasons, this is a condition that cannot be categorized in any group because it not known where this condition comes from.

The second condition: muscle atrophy. Researching this condition, I was intrigued by the information about the particular symptom. This condition comes in two forms disuse and neurogenic atrophy. Disuse a form that is caused by lack of exercise and not using the muscles enough. This condition causes wasting of the muscle and tissue. This form can be reversed with exercise and better nutriments. Neurogenic is the second form, and it’s more severe than the first. This is caused when there is an injury to the body, or there is a disease of the nerve like MS,diabetes, certain cancers, AIDS, congestive heart failure, chronic obstructive pulmonary disease. This form is non-reversible due to the nature of it causing physical nerve damage. Due to this information this condition is highly linked to past symptoms

With the questions of if my differential diagnosis is listed in the specific categories of, autoimmune, physiology, infectious or neurological. With the past symptoms and the present, my diagnosis has not changed, I’m very much still convinced that type 1 and type 2 diabetes is the primary diagnosis, considering the new symptoms this week of a muscle of atrophy of disuse or neurogenic both of these conditions can cause nerve damage and tissue damage. Nerve damage is a critical symptom in patients with uncontrolled diabetes. For that my diagnosis has not changed, and this would be a metabolic issue.

Is this disease affecting multiple organs? Yes, diabetes is a disease that causes damage to other organs. If diabetes is poorly controlled, it can start the development of heart disease, kidney disease, neuropathy and other developments. With these symptoms, I’m not sure if there would be any other further test needed. The reason being is that fibromyalgia is a condition that is unknown. And muscle atrophy is a condition that developed through preexisting conditions or diseases.

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