From: geb@cs.pitt.edu (Gordon Banks)
Newsgroups: sci.med
Subject: Re: "Problem Patient"
Date: 5 Oct 92 14:26:50 GMT
Reply-To: geb@cs.pitt.edu (Gordon Banks)
Distribution: usa
Organization: Univ. of Pittsburgh Computer Science

In article <6770@blue.cis.pitt.edu.UUCP> doyle+@pitt.edu (Howard R Doyle) writes:

>
>I don't think I have personally come across anyone with Munchausen's,
>although I sometimes wonder if any of the normal appendices I have
>taken out in the past belonged to someone that was just pulling my leg.
>
Multiple surgeries (gall bladder, appendix, hysterectomy) are one of
the hallmarks (but also of the hysteric, which is different).

>arm. Another case involved a young woman who spent a lot of time in the
>hospital being worked up for relapsing fevers and repeated positive blood
>cultures. The bugs isolated from the blood were all typical mouth flora, and
>after about a month at Mass General and having had every test known to man
>they still weren't able to come up with a diagnosis. That is until one 
>morning when an orderly came in very early and whisked her off to have a 
>surprise X-ray of some kind. While she was gone her room was carefully
>searched, and several insulin syringes were found. When confronted with
>this she finally told her physicians she had been injecting saliva into her 
>veins.

I saw a case like this.  A nurse who had real MS was also a Munchausen's.
She had urinary infections chronically and she injected infected urine
intravenously, giving her intermittant fevers and sepsis.  She died of
bacterial endocarditis.

Another famous case was a fellow in Europe who would develop chest
pain at 30,000 feet on airliners, causing diversion to the nearest
airport where he was evacuated by ambulance.  In the CCU he always
ruled out as not having an MI.  Finally the airlines published
his description and he wasn't allowed to fly.

I saw a much more interesting case in Madison Wisconsin.  THis
fellow was not a Munchausen's, but had a compulsion to operate
on himself.  He was a genetics graduate student.  The first
time, he appeared at the ER after having performed an orchiectomy
on himself.  (He said that his sex hormones interfered with his
work and that surgery was "his hobby" (I wonder where he got his
practice)).  He had done a reasonable job, and psychiatry refused
to commit him.  A few months later, he came back in a trench coat.
He said his adrenal hormones were interfering with his work,
and so he had tried to do an adrenalectomy (using an anterior
approach) but was in so much pain when he retracted his vicera,
that he was afraid he would pass out.  He used local anesthesia
and operated standing up in front of a mirror.  His abdomen was
open from pubis to xiphoid and only a taped dressing was holding
his viscera in.  That time, psych took him after the surgeons
sewed him up.  But I think they finally had to release him as
they couldn't do much with him.  I don't know what happened
to him after that.


-- 
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Gordon Banks  N3JXP      | "I have given you an argument; I am not obliged
geb@cadre.dsl.pitt.edu   |  to supply you with an understanding." -S.Johnson
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