Whale Shark (2): Finally Figuring Out the Disease
I now knew exactly what was wrong. Urinary stones come from excessive calcium excretion due to parathyroid hormone abnormalities, and gastritis stems from issues with the stomach's endocrine glands.
Alice blinked vacantly. "The nephrology professor just said it was urinary stones and pyelonephritis. No need to consider rare diseases..."
I shook my head. Pyelonephritis is basically a kidney infection. Sure, this patient had it, but it wasn't the main problem. Some doctors just hate complicated explanations. The human body is complex, after all.
"Pyelonephritis is there, yeah. But there's got to be a central cause linking the kidney issues and recurrent gastritis. Probably a genetic disorder."
"A genetic disorder like that?"
"Multiple endocrine neoplasia."
"Huh...?"
"It's called Wermer syndrome. Tumors form in the endocrine glands across multiple organs."
Alice blinked vacantly again. "There's a disease like that? Creepy."
"A gastrin tumor overproduces stomach acid, causing recurrent gastritis. And excess parathyroid hormone leads to—"
"Hold on."
Alice cut me off. She looked like she wasn't following. Well, in the 1970s, there were no genetic tests. It was natural not to know.
"So, an endocrine tumor in the stomach ramps up acid secretion, causing gastritis?"
"Yeah."
"And the parathyroid hormone?"
"It increases calcium excretion in urine, right? Too much calcium in the urine turns into stones."
"Urinary stones... So the stones rolling around in the kidneys caused the pyelonephritis?"
She was finally piecing it together slowly. I nodded. Alice was still scribbling seriously in her notebook.
Non-specific symptoms, right? You wouldn't notice at first glance. Fever, mild headache, back pain, gastritis, abdominal pain. A jumble of symptoms with no clear sequence—it's invisible without sorting it out.
"Exactly."
"No, seriously, how do you even think of this stuff?"
Alice flipped through the internal medicine textbook and finally found the entry on Wermer syndrome. It matched exactly what I'd said. Parathyroid hormone abnormalities and excess stomach acid secretion. Rarely, even pituitary issues could arise.
I stood up. Time to confirm the diagnosis. I'd remembered the next step.
The next diagnostic step was gastroscopy. No reason to delay treatment. There were plenty of piled-up issues. Multiple symptoms too. Better start ASAP.
I was gloving up to prep the endoscope when Dean Rich, whom I'd called, rushed into the endoscopy room. He was the endocrinology professor too. And the root of this patient's problem was an endocrine disorder.
"You came."
"What on earth is going on?"
"Suspected Wermer syndrome patient. Was about to do a gastroscopy, but no gastroenterology prof around, so doing it myself."
Rich nodded. "Wait, what's Wermer syndrome?"
"You know, that weird genetic disease where endocrine tumors pop up all over the body."
"Oh, that."
Rich nodded like he'd remembered. Even in the 1970s, Wermer syndrome was known in academic circles. Diagnosis and treatment were tough without genetic testing, but the disease itself was defined.
"What's the endoscope got to do with it?"
"If gastroscopy shows gastric ulcers or multiple lesions, plus the urinary stones, we can confirm Wermer syndrome."
"Damn ghost would wail... Why do all the weird diseases show up around you?"
I didn't answer that. If I—or someone who digs as deep as me—wasn't there, these odd diseases would probably slip by undiscovered.
We finished prepping the endoscope gear. All set.
"Patient, come on in!"
Our patient entered cautiously and lay on the bed. Still looked okay. Painful expression, though.
I prepped a sedative syringe. "Sedative going in."
The patient nodded, and I injected midazolam into the IV line. Rich fiddled with the screen the scope connected to. The patient's eyes closed.
"Will it hurt?"
"No."
"Last time with gastritis, they didn't do an endoscopy, but this time—"
Mid-sentence, the midazolam hit the bloodstream. Out like a light, no time to get drowsy.
Rich shrugged. "Well... We'll explain to the patient when she wakes up. Let's start the scope."
I nodded.
I slowly inserted the endoscope tip into the patient's mouth. Smooth so far. The esophageal muscles showed on the screen. Black-and-white image. Well, the monitor itself was monochrome—nothing to do about it, I guess.
A small lesion at the esophagus-stomach junction. Some reflux.
"Can we see properly in black and white?"
"Nah. Gotta look directly."
Rich was right. Besides the screen, you could peer through the eyepiece via the fiber optics. Pretty cool... This wasn't black-and-white. Direct view with the naked eye.
I kept lowering the scope while watching the B&W screen, and it reached the stomach. Rich eyed me.
"So, where'd you learn endoscopy?"
"Done a few since med school."
Not a lie. Rich frowned in amazement. Of course, I'd done plenty before reincarnating to America.
"Every time you do something, it's a surprise. You're way too early for proper endoscopy, and barely any practice."
"Thank you."
I pushed the gastroscope further, and gastric ulcers started appearing on the B&W screen. Not just one or two.
"Found them."
"It's real... You were right."
Wermer syndrome confirmed. Mechanism: Endocrine tumor in stomach produces gastrin, gastrin boosts acid secretion, acid causes ulcers.
Rich grabbed the scope himself. "Abdominal pain a symptom?"
"Yes. But it's been so long, patient seems kinda used to it."
Rich nodded gravely, deep in thought.
"If it weren't for you, we'd have missed this too. Wermer syndrome... Who else could've caught it?"
"You're too kind."
More ulcers than expected. Must've been hell. Antacids or acid suppressants might help treat them. Symptoms are key, after all. Daily life must've been tough. At least ulcers are manageable with meds...
Gastroscopy wrapped up fine. I tidied the room and headed back to the patient's bedside. She was lying still, staring into space, mumbling something.
"Feeling okay now?"
"I'll become the Pirate King..."
Sedative not fully worn off? Still recovering. I shook her awake. Hope no issues.
"Huh? Oh. Head hurts a bit..."
I nodded slowly. "Did gastroscopy, found multiple gastric ulcers. Treatable with meds, and that seals the diagnosis."
"Really?"
"Suspected Wermer syndrome. Think of it as a disease causing various hormone imbalances. In your case, urinary stones and gastritis."
The patient frowned this time. "Can it be cured?"
"We can treat it to make symptoms almost disappear. But it's not the kind that fully resolves or vanishes."
Genetic disease—no clean fix. Just management.
"Still, finally something concrete. Lived with those illnesses forever, and now the root cause..."
Common in chronic patients. Even they get worn out eventually. How many doctors had seen her? Probably dismissed it as unknown repeatedly. More than a couple, for sure.
Putting a name to the mystery illness tormenting her for years seemed to bring relief. Good.
Alice stared at the new gastroscopy report added to the patient's chart. Exactly as that guy had said. Amazing. Made sense, even if it seemed off at first. Never wrong.
The nephrologist handling the patient, Dr. O'Bill Parks, scratched his head sheepishly. "That resident was right. Thought it was nonsense, but really Wermer syndrome."
While the professor looked up Wermer syndrome, Alice drifted into thought for a moment.
Gotta go see the whale shark soon.