Tag Archives: diagnosis

The IPPF conference was the light and guide that walked us through a very dark tunnel. A tunnel we would’ve walked through alone. But everyone involved turned up the light nice and bright, and we found we were two of many. We were not alone and we would never feel alone again!

The IPPF conference was the light and guide that walked us through a very dark tunnel. A tunnel we would’ve walked through alone. But everyone involved turned up the light nice and bright, and we found we were two of many. We were not alone and we would never feel alone again!

Welcome to the Patient Journey Series: Story 1, Halima’s Diagnosis. “My symptoms started at the beginning of April 2018. My mouth was inflamed, and I had painful blisters on both sides that made it very difficult to eat or drink. I had no idea what was causing my symptoms, and I went to four different doctors.”

In January 2013 my husband was diagnosed with prostate cancer. Thankfully, after surgery he was cancer free. But in May 2015 our whole world seemed to turn upside down when he came home with a very unusual sore in his mouth. Fearing the cancer had returned, Tony went to our family doctor and was immediately sent to an oral surgeon for a biopsy. He had the results within days, but the outbreak spread like wildfire.

Photo of Rudy Soto with his family.

My name is Rudy Soto. I am from the great state of Texas and have lived there all of my life. I am married to a wonderful woman, Jennifer, who is my greatest supporter. We have four awesome children—two girls and two boys who range in age from 5 to 23. My motto is Can’t Grind Me Down, which I took on after I achieved remission in November of 2016.

If you suffer oral lesions, how can you partner with your dental health care provider to come up with a definitive diagnosis? A thorough review of your symptoms is critical. Make sure your dentist or dental hygienist listens carefully and asks detailed questions about your concerns, such as . . .

Somewhere along the line, the general public came to believe that doctors are all-knowing they are always right, never wrong. Many of us know doctors who also seem to believe this. Clearly — and thankfully — not all doctors feel this way.
However, we are putting our lives in their hands, and what could be more important than that?  I would venture to say that most people, especially those with rare, chronic illnesses have doctors that they absolutely love and have total confidence in their expertise. Meanwhile, others are not so lucky and believe they have limited physician choices with certain illnesses.

As one of those people whose initial diagnosis took nearly a year to get right, and who got sent to all kinds of “specialists,” I found many of the professionals to be nice people. However, many were clueless even after a biopsy was done (probably because it was sent to a lab for the wrong test). I think some of them felt badly about it. Still, they just kept sending me to other specialists, mostly oral, but no one seemed at all clued in.

As a professional myself, I spent years working with, or parallel to, many other professional doctors who also were stymied. I was never told that my symptoms were psychosomatic or psychological by those who knew me. Because my mouth and throat were practically raw, I could not eat or drink many things. I lost weight (maybe 13 pounds after a year which for me is a lot) and at least two physicians thought I had anorexia – even though it was crystal clear how difficult it was for me to eat and to swallow. I was particularly puzzled by dentists, oral surgeons, endodontists, periodontists and even oral pathologists who could not recognize what was happening in my mouth. Skin and blood were literally falling out and my mouth was horrible to look at — a total disaster!

I was not just discouraged at appointments, but frustrated over the time it had taken me away from my livelihood. These specialists who did not know me seemed to think that I had an eating disorder. I quickly dispelled that notion, told them they would not be paid for wasting my time, and left quickly making sure to call my insurance company to stop any payments for services not provided. It was about the principle for me. I believe that a person cannot know everything — I am the first to admit that.

I am thin by nature – so thin that the first time I was in the “normal” range was when I was giving birth. Still, with all the effort I put into keeping weight on, I kept losing weight. Is there anyone out there with these diseases who hasn’t gone through this? Even for those who are overweight to begin with, the initial weight loss with the oral symptoms has to be traumatic.

My primary care provider (PCP), an Internist, was someone I had known since we had been residents together at the hospital where we worked. We had worked well together and shared a mutual respect with a good relationship prior to all my “new” and “mysterious” symptoms. He had absolutely no idea what was going on, but never seemed to grasp the seriousness of my situation, or that it was a medical condition versus a dental issue.

I remembered writing something in my journal and telling him: “I don’t know what is wrong with me but somehow my immune system has been compromised.” About six months into my symptoms I told him I was going to die if he didn’t figure it out. He was not convinced. He said I was being dramatic which was not like me. I told him I had already written my obituary with only the date and cause of death left blank. I think that threw him over the edge because I was 100% sure of that eventual outcome.

As both a patient AND a provider, I firmly believe that all of us know our own bodies better than anyone else possibly can. I also believe we need to learn to “listen” more carefully to what our bodies may be telling us – regardless if we attended medical school or not.
It took more than nine months for me to get the right diagnosis. It was from a dermatologist – although still completely in my mouth at the time. She laughed at me when I politely said I had come for another reason and that the problem seemed only oral and esophageal. She told me her father was a retired dentist, but that my symptoms were definitely dermatological. She was sure it was one of three specific diagnoses that were not previously on my list. She took yet another biopsy and sent it for the correct lab work. At my urging, the lab also procured my previous biopsy (done six months earlier), which was, as it turned out, a textbook case of pemphigus! IF those other “specialists” had done the proper tests on the original biopsies, my diagnosis would have come much more quickly, and maybe my gums would be more intact and I would not be missing some teeth!

I did return to one particular oral surgeon to retrieve my records and saw him literally run (yes, run!) into his office and lock his door until I left the office WITH my records. I made sure his office knew I was returning for the sole purpose of procuring those records. I believe in doing my own due diligence and collecting the facts (cognitive model) before considering options.

I often think back to 2002 and my primary care physician who did not believe my problems were too serious or life threatening. I remember going to the medical library at the university medical center and researching everything I could get my hands on. I remember speaking to the dermatologist and when my primary care physician eventually believed the diagnosis. I know my PCP knew how disappointed I was.  Granted, it took another seven years to diagnose my case of Sjögren’s syndrome — which finally explained most of the non-pemphigus symptoms I was experiencing. The Sjögren’s was diagnosed by a rheumatologist who specialized in lupus. I told him I was either totally psychosomatic or that there was definitely something else going on. Fortunately he took appropriate action. That was a true blessing. I believe there are many physicians who really do listen to their patients and see “whole people” and not just symptoms or illnesses. These are the doctors I seek out – and one I try to be in my own psychology practice.
I left my original PCP shortly after the PV diagnosis. After a few other non-successful attempts to find the right care provider, I found one after changing insurance companies. I even found a gynecologist who actually knew the disease in the event it affected me below the belt. I’m happy with my current treatment team because we work well together as patient/physician. Some personalities just don’t seem to work together. I have remained under the care of my rheumatologist for a number of years now and he has no problem making decisions with input from both me and an expert dermatologist.
We as patients are very fortunate that there are experts out there willing to give time and expertise. I never take this for granted, especially since I cannot take prednisone. If not for alternative systemic treatment that only a few people believed in when I was diagnosed, I believe I would not be here today. If not for the generous time of these specialists and experts talking long-distance with my local doctor (at no extra charge to me) and having a local doctor who was willing to ask for help, my life would have ended painfully more than 10 years ago. It has not been an easy road, but I am determined and tenacious – which have served me well over the years. I have been very pleased with my PCP whom I have been seeing for a number of years now. She definitely “listens” and respects her patients.

Amazingly, about a month ago, totally out of the blue, I received a very nice letter from my original PCP whom I had not seen in almost 11 years. I knew he still practiced in the city, but our paths haven’t crossed, except the sharing of a few patients who needed coordination of care. In his letter he made some small talk and also seemed to know how I was doing and about my other diagnosis. Out of sight but not out of mind! He let me know he believed I was a strong person and was sure I had put together a team of competent doctors. Then, surprisingly, he basically let me know he felt he had “failed” me, but that he believed that his failure with me had helped him to improve his care with certain other patients. WOW! I was humbled and felt so empowered.

This letter was very refreshing and very reassuring to me. I have taken several opportunities to present continuing education on pemphigus to the local dental school. This letter has given me HOPE and REASSURANCE that our messages do get across. Yes, we all have the ability to strengthen awareness and to educate: It does not have to a massive audience, but every professional reached makes a difference.

As the Foundation moves forward with our Awareness Campaign, it is my most fervent hope that no matter how frustrated and angry you may get that each if you continue to teach and educate medical professionals about early diagnosis and treatments.

Just don’t give up!
That mindset leads to something called “learned helplessness” – which leads to a core belief system that no matter what you do, nothing will make any difference. This leads to major depression.
Keep going. Move forward. You can all make a difference. All of us can!

How awesome is that?

Erythema multiforme (EM) is an uncommon, immune-mediated disorder that presents with cutaneous or mucosal lesions or both. In herpes simplex virus (HSV)–associated EM, the findings are thought to result from cell-mediated immune reaction against viral antigen-positive cells that contain the HSV DNA polymerase gene (pol ). The target lesion, with concentric zones of color change, represents the characteristic cutaneous finding seen in this disorder. Although EM can be induced by various factors, HSV infection continues to be the most common inciting factor. Histopathologic testing and other laboratory investigations may be used to confirm the diagnosis of EM and to differentiate it from other clinical imitators. Imitators of EM include urticaria, Stevens-Johnson syndrome, fixed drug eruption, bullous pemphigoid, paraneoplastic pemphigus, Sweet’s syndrome, Rowell’s syndrome, polymorphus light eruption, and cutaneous small-vessel vasculitis. Because disease severity and mucosal involvement differ among patients, treatment should be tailored to each patient, with careful consideration of treatment risk vs benefit. Mild cutaneous involvement of EM can be managed primarily with a goal of achieving symptomatic improvement; however, patients with HSV-associated recurrent EM and idiopathic recurrent EM require treatment with antiviral prophylaxis. Inpatient hospitalization may be required for patients with severe mucosal involvement that causes poor oral intake and subsequent fluid and electrolyte imbalance. With this review, we strive to provide guidance to the practicing dermatologist in the evaluation and treatment of a patient with EM.