Mid-40 female presents with acute onset pain in both feet and hands. Questioning reveals that she has experienced episodic numbness in her feet over the past 2 years. Patient suspects gout but blood urate levels are normal and patient’s diet and lifestyle not ‘typical’ of the gout sufferer (high alcohol and meat intake, central adiposity etc.)
A current patient is a 20+ year old male who is trying to recover from a heroin addiction.
Having been on the methadone program for the last 7 months and only having ‘used’ once or twice during this time, he is doing well. He has managed to get down to just 25mg/d of methadone which is typically the final dose before stopping altogether.
Recently I started seeing an 8 year old girl diagnosed with ODD and ADHD as well as impaired IQ at 6yo.
Notable features include:
Parents should be aware persistent snoring is not normal in children and should be investigated. Researchers, whose results appeared in the journal Pediatrics May 2012 found that two- and three-year olds who snored loudly at least a couple of times per week tended to have more behavioural problems, especially hyperactivity, depression and inattention.
The limitations of serum B12 testing have been reported for some time.
When testing for deficiency, Serum B12 does not give an accurate picture unless there is an overt deficiency and even then not consistently. This is because the majority (approx.70%) of B12 in the blood is attached to haptocorrin, which is unable to enter cells, and is termed inactive B12 (Lloyd-Write et al 2003).