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People Share The Strangest Things They've Ever Seen In A Contract's Terms And Conditions

People Share The Strangest Things They've Ever Seen In A Contract's Terms And Conditions
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When we purchase the latest hi-tech gadgets, we tend to toss aside the accompanying reading materials like the terms and conditions.

Or when it comes to signing a new lease for an apartment, some of us immediately scroll to the dotted line to leave our John Hancock without reading all of the fine print.

Whether they're contracts or literature that come with purchased products, do we ever really bother to read the detailed policies?


In an era of instant gratification, who has the time? But what we really should be asking is, what are we missing out on?

For those who do practice their due diligence, they may find some fascinating information – and in some cases, are rewarded for it.

Curious about what others have found while perusing through the nitty gritty, Redditor Dunnaghlasman asked:

"People who read the Terms and Conditions of things, what weird things did you see?"

Toxic Paint

"PPG (paint company) does not allow their paint to be used on terrorist, biohazard or nuclear facilities."

lsellati

Sign First, Discuss Later

"I was asked to sign a petition for something that I generally was in agreement with, until I read the last part of it, that read something like, 'the chairman of the committee reserves the right to change the wording of this petition.'"

"So it was like, 'sign here, and we'll figure out what you signed later.'"

HarleyWeaver

Java Restriction

"You cannot use the Java programming language to control a nuclear reactor."

grouchy_fox

busch beer no GIF by BuschGiphy

Windows Limitation

"I read the terms and conditions for either Windows 95 or the Windows 98 upgrade. Somewhere buried deep in the middle was a warning that the operating system should not be used to operate a nuclear power plant. I'm assuming it was a joke because it was an individually licensed product rather than a corporate license, and if they were serious about it, I would think that warning would be at the top!"

Victor_HardApple

Beware of Hacks

"For no reason at all I read them for a PlayStation Network update. About the 7th page in, it stated that I would be 'relinquishing my wallet and all funds within.' I didn't update but just assumed it was fancy legal talk(mind you I was in my late teens) so I didn't report it. 3 days later I found out that the update was a hack and thousands had their information stole of their PlayStation accounts."

Smitty_Werbnjagr

Double Whammy

"My daycare's release form had a clause saying that by signing, I was giving them permission to take my kids to Canada. Canada is a day's drive away and there is absolutely no reason they would ever need to take my kids there. I crossed it off before signing."

"My mortgage documents included a clause that says that, if I ever get sued, they have the right to accelerate the loan and demand payment of the entire remaining balance. It doesn't matter if the law suit is meritorious. Just getting sued can lead to acceleration."

Moonlightonthelake80

Property of Elon Musk

"You never own the Tesla you pay for."

bf5005

The Tesla Ownership Explained

"Tesla, (and to various extents, other anti-right-to-repair companies like Mercedes, Apple, John Deere, etc.) hold that their products are intellectual property and cannot be owned by customers, instead claiming that they are effectively leased to buyers."

"Tesla has on on multiple occasions (illegally) disabled features of cars being sold used because of this."

Cessnaporsche01

Posthumous Debts

"On my apartment rent agreement, there was one part that basically said: If you (the renter) dies then your family is responsible for paying the rest of the rent left on your contract."

billyandteddy

Proper Noun

"Accordingly to Photoshop ToS, you can't use Photoshop as a verb and must say 'edited with Photoshop' or similar instead of 'Photoshopped.' In Spanish it's common to use it as a verb, 'photoshoppear.'"

Bitomic

The Canadian Obstacle

"I'm an auto mechanic, I regularly purchase tools from tool trucks. Sometimes there's little giveaways if you spend x amount you get this scratch off ticket that could win you something blah blah."

"One time I was reading the fine print at the bottom, usual legalese stuff then the last line cracked me up - said something like 'residents of Canada will be required to complete a series of mathematical questions in order to claim their prize.'"

"What the hell did Canada do to require being punished to win a prize?"

Brianthelion83

Reading Has Rewards

"The terms and conditions for the rewards card at the grocery store I worked had 'if you've actually taken the time to read this, please email (email) with this code and the pin for your card for $500 in rewards points.'"

"And it actually did, then I started getting a new card every other month or so. Then they changed who the rewards program was with."

whatnameisnttaken098

Dead Serious

"The company I work for has emergency store closure procedures for in case of a zombie outbreak."

"When I discovered it I laughed and asked my boss why they put this joke in with all these serious guidelines. She was dead serious when she explained that this was a real procedure and you honestly never know. I thought she was messing with me. Apparently, I never noticed it printed in out backroom. It's required to be printed and posted in the backroom of all the company's stores."

roomtemppizza

The Gym Contract

"I read the terms and conditions before joining a gym. It said the only reason you could cancel your membership is if you moved out of the area or got injured and had a note from a doctor. Otherwise, you had to give 30 days' notice and pay 3 additional months' worth of fees. I did not join."

sweetlyserious

Canada's Got Talent ... and All Eyes On You

"I considered auditioning for the first season of Canada's Got Talent. I got the contract for auditions and read the fine print."

"'You will pay your own room, board and travel. You agree to being on camera 24/7. We can listen to your private phone calls. We can enter your room at any time to check on you and record it.'"

"I noped out of that audition fast."

jenskal

Reaction GIF by MOODMANGiphy

Bodily Fluids

"I read the warranty for my motherboard once. It said it does not cover damage from bodily fluids including urine and vomit."

fuckgoldsendbitcoin

In Case of an Apocalypse

"One of my old jobs said that if there was ever a contagion that resulted in people losing their minds and acting like violent, mindless, swarming animals (i.e. zombies or infected) then we would be expected to hide in bunkers, rescue our clients and not kill anyone."

theshizirl

S&D Chat

Spybot S&D asks that you send the devs beer money.

pakidara

Is that still around? Haven't used it in forever.

Also, I'm on mobile and too lazy to Google. I got more of this thread to read first and I'll probably forget about this before I'm done.

Fixes_Computers

Apple Law

You also agree that you will not use these products for any purposes prohibited by United States law, including, without limitation, the development, design, manufacture or production of nuclear, missiles, or chemical or biological weapons.

This is from the Terms and Conditions for Apple's iTunes.

cld8

Can confirm.

For references: https://www.apple.com/legal/internet-services/itunes/us/terms.html

Pandafishe

To the Cinema

Ts and Cs for a cinema in the UK. After purchasing a ticket and choosing your seat/seats the cinema doesn't guarantee you the seats you have chosen will be available and you are encouraged to find a different seat if the one on your ticket is taken.

AwSkiba

Alls not Wells 

You can always trust Wells Fargo to serve up some real bull crap. This article shows where they screwed some people in their mortgage terms and conditions, and also briefly mentions their debit card scam.

https://www.nytimes.com/2017/06/14/business/wells-fargo-loan-mortgage.html

Well this is getting some attention so I'll just leave this old gem here as well:

https://m.youtube.com/watch?v=ytX3f6AIcR0

Killashandra19

READ FIRST

paid pay day GIFGiphy

So I know a few years back there was a report of a dude who read through the whole thing and actually earned a cash prize for reading it in the fine print.

I don't know the exact details. not even sure if its true or not but maybe someone has evidence.

TonerSlinger

WoW

WordWeb dictionary program

WordWeb free version may be used indefinitely only by people who take at most two commercial flights (not more than one return flight) in any 12 month period. People who fly more than this need to purchase the Pro version if they wish to continue to use it after a 30-day trial period. que_pedo_wey

Shady Terms

It's probably best to actually read them, but I really like using this site where they essentially provide you a TL;DR of terms & conditions from popular websites. They also grade sites on how shady their terms may be.

Zee_Ventures

EULA

There was a Windows update about 15-20 years ago that had a clause buried in the EULA that you agree not to release any benchmarking figures. What really sticks in my mind though is that I used to submit a lot of stories to Slashdot at the time, and for some reason they wouldn't report that. Weird.

meejahor

Listen to Aesop

This isn't quite the same, but when I was a kid I had a really cool, creepy picture book that was a satire of Aesop's fables called Squids Will Be Squids, with morals like "if someone calls and asks where your mother is, don't tell them she is out getting her moustache bleached" etc etc. Anyway, one day I was reading the small print publication stuff you get in the front of every book and there's a note from the author's in it about why nobody ever reads that page, with the moral that "you should always read the small print." Which of course I now do (for books at least), although tbf there has yet to be a payoff as good as that one.

tatt3rsall

Steamed....

morning steam GIFGiphy

Technically Steam owns any and all games that you "purchase" from them. What you purchase is basically a copy of one of their games, and they reserve the right to access your library and do whatever.

Disrespectfully-

 because they can

Discord's Terms of Service are worded in such a way that they can literally say whatever they want is a breach of contract on a whim.

Doctor_Myscheerios

Discord can decide you have broken the Term's of Service however they so choose. You can have an entire server dedicated to something harmless, say, puppy photos, and they have the capacity to do whatever it is their punishments and sanctions propose because they can.

DynamiteDogTNT

Save the fur babies....

I have dog shampoo that says "this product not tested on animals." But why not? How do you know it works?? Purposely putting cosmetics in an animal's eyes, or forcing them to ingest it or whatever is cruel and unnecessary. But how are you supposed to know that this dog shampoo is a safe and effective way to clean a dog if you've never tested it by using it to wash a dog??

NC17TurtleCombat

Sinner

Not really a TOS, but the old Doom II for DOS had this screen saying that if you pirated the game, you would go to hell. It would show up after you exit the game. The first Doom also had a similar screen, lol

Brazilian_Soldier

Reasonable?

I think in my country there is a general law that terms and conditions must be "reasonable" so that conditions like "giving away your first born" does not apply anyway.

-piecemaker

Trouble is, reasonable means whatever you can convince a jury and or judge is reasonable. So it comes down to who has better lawyers i.e more money.

SwallowYourGum

Buried Deep

glow treasure chest GIF by gfaughtGiphy

I was searching for a web host for my website and found a discount code buried in the content policy. It was pretty neat, even if they were the kind of place that has at least 3 discounts available at a time.

andrewia

The Rip-off....

Not exactly weird but when I was buying my car insurance they asked if I had been in any previous accidents (I was) and if I was at fault (I was not). Said rates would only go up if the accident was my fault. Okay cool. So at the end when I'm looking everything over, I notice in the fine print that it says any accidents are automatically considered the driver's fault unless proven otherwise... so I send them an email and ask.

Basically they said I'd have to purchase the policy, THEN contact them with the proof that I wasn't at fault for the accident. So I bought the policy, went to my state's DMV website to get the accident report, and email it to the insurance company- one week later I get "refunded" about 1/5 of the policy cost credited to my account. I wonder how many people they've ripped off.

nebraska_jones_

Um No....

Once I installed an App, I think it was a game, asked me to edit, add, delete or format everything from my google drive.

NOPE.

The same app had other horrible terms with other apps, like with Facebook, or Instagram (basically buy your personal info from Mark).

CuboCraft

G-suite and everything. 

It was when I was setting up android work profile (The high school I'm attending rn issued us emails that route the emails through their servers) for online school. G-suite and everything. I couldn't rlly avoid the work profile thing cuz android wanted me to set it up.

Enough with context here.

I downloaded google device policy to set this up and I saw, and I quote.

"Administrators on this domain can have access to any and all data on your phone."

I was like, Hell no! They do random phone searches of the students already why give them full access!?

I then decided to do the online class stuff on my computer and do it web-based instead of giving them full access to my phone.

jimjimmy1243

Lunar Terms

Beopen Aeropex GIF by AfterShokzGiphy

Apple's terms and conditions have plenty of jokes in them. They even made one about faking the moon landing.

ColaNaught

Having a ToS

The school app for a district I worked in had a ToS that essentially said that I agreed to their accessing anything on my phone or deleting what they choose, as well as using anything they find on my phone as evidence against me if they so choose to.access any other apps, documents, downloads, photos, etc... Co-workers said I was being paranoid, but the ToS for the same app in a different district had no such notation, so I don't know.

Reddit

Giving Permission

These are a few paraphrased versions of what I had to sign in order to live on campus at my university:

I give my school permission to charge me legal fees that have nothing to do with me. They also say everyone I know has given up the right to sue the school. They can kick me out at anytime with little warning, and if I do not leave with in a few days I have to pay a +$100 fee. They are not responsible for working amenities such as water. I am aware the school does not own there own dorms, even though the office that handles room and board claims otherwise.

11xomr11

League-of-Legends

Don't remember the exact wording, but some League-of-Legends-type game included this whole paragraph about how, by installing this software, you authorize us to monitor every process on your computer, including but not limited to keystrokes, active programs, some of their memory, browser tabs, open files and potentially their contents, and send that info back, at all times, even if the game wasn't running.

Safe to assume I did not click agree, and managed to live life having never played that game.

kavantoine

Til 2024

I found out our five year contract for argon gas automatically renews if we don't cancel 365 days before the end date. A salesman was fired from the company and told me I should read the very fine print. One year in and we sent our our cancellation form for 2024.

timbenmurr

take the spirit....

wes craven ral GIFGiphy

Gamestation (an old video game store in the UK) had an immortal soul clause. They own thousands of peoples souls!

https://bit-tech.net/news/gaming/pc/gamestation-we-own-your-soul/1/

GhandisMcGonagall

On the Menu

I read ingredients at back of the container (shampoo,creams,food etc) because I don't have anything better to do. But I know how they scam people. Read the ingredients people.

im_phoebe

Sign Off Please

You agree by signing this contract to have your personal information including but not limited to, photographs, public information, address and email to be shared with third parties that may not be disclosed to you.

This was to allow a company I engaged with to send me regular products for testing and giving feedback on prior to going on the open market.

Accomplished_Peach34

The ReadMe File

Not quite Terms & Conditions, but an old-school PC space simulator game from 1995 called Tachyon: The Fringe had a unique ReadMe file. At the bottom of the ReadMe file is a few words of congratulations, and a set of coordinates for a fat stack of space cash for the late game.

Digitalmonster7068

Set in Stone

that's all folks GIFGiphy

That even if you haven't read the terms and conditions you still agree to them. This is pretty common for websites where they are buried in the site, but by going to the homepage you've automatically agreed to them.

smashew

Reddit Says...

Reddit TOS:

WHILE REDDIT ATTEMPTS TO MAKE YOUR ACCESS TO AND USE OF OUR SERVICES SAFE, WE DO NOT REPRESENT OR WARRANT THAT OUR SERVICES OR SERVERS ARE FREE OF VIRUSES OR OTHER HARMFUL COMPONENTS.

It's not weird in a way that it shouldn't be there, just unexpected.

Also not reddit afaik, but a lot of ToS tell they have the right to give certain of your information to companies and Google is ALWAYS there.

Oh and if anyone uses one of those Do Not Track signals, companies don't give a crap about that and say that in other words in their privacy policies.

Ahekahek

Left Without Power

I'm taking a cyberlaw and ethics course and this has been a focal point of the class. Terms and conditions leave you basically Powerless and unable to hold companies liable. There were terms and conditions on a site that literally said by accepting the terms, you would give them your first born child. Granted I believe it was a joke or experiment to see how long they could leave it in there unnoticed.

nlubbers

Amazon still sucks. 

Not me, but when my sister was applying for a warehouse job at Amazon, she spotted a section that stated that Amazon owned all the rights for all intellectual property and products created by the employee for an indefinite amount of time even after leaving the job. In another section, there was something saying that you couldn't say anything bad about the company online or in private, again, for an indefinite amount of time even after leaving the job. Amazon still sucks.

ButterMyFeet

Want my blood too....

We were interested in purchasing a house, and sent the Contract of Sale to our conveyancer as a final 'rubber stamp' before signing.

They quickly got back to us, pointing out a clause buried in the Contract. It said that we agree to forfeiting our cooling off period and all 'subject to building/pest/structural inspection' rights, and that we agreed we must proceed with the purchase no matter what. Even if the house was rotted with termites, or the vendor had blatantly hid some structural fault, they could legally 'force' us to proceed with the purchase.

The conveyancer said that the vendor's legal firm had a reputation of putting these hidden nasties in their Contracts, so she knew to scrutinize every word as soon as she saw their name on it.

Needless to say, we didn't proceed with the purchase.

MisterMarcus

Good Education

A lot of chrome extensions give the developer access to your drive. This is an issue for many education extensions during remote learning. I successfully stopped my school from using one platform over another due to this issue as well.

NYRangers94

You're Still a Feast

fail april fools day GIF by CheezburgerGiphy

I read the waiver at an indoor paintball place one time. It covered everything you'd think it would cover, but that wasn't all. Insect bites and stings. Attacks from wild animals "such as bears, etc" (yes, it specified bears), and dangers such as guides incorrectly navigating rapids.

All of these things were covered.

For paintball.

Indoors.

The experience did not live up to what the waiver implied.

TheNineteenthDoctor

Is Thou Art?

In this app called PopJam in the TOS it says that the developers can freely use any art you post on the app. Kinda screwed me up for a while but I saw some user's art on the appstore banners (with the users in question credited) so it probably just means that they can "show it off" without per but still-

thatsnotajuniceofyou

Always be sure to read the fine print or do a quick Google search to make sure you're not selling away your soul... or your voice.

Do you have anything to add? Let us know in the comments below.

The All-Time Worst Excuses People Have Ever Given For Cheating

Reddit user newlymoneyedrapper asked: 'What is the worst excuse you've heard from someone who cheated?'

When it comes to the dating scene, we all know there are going to be rough moments, from awkward dates to being ghosted to heart-shattering breakups. But the thing everyone hopes will never happen is to be cheated on.

After all, if someone has the intention or inclination to cheat, why would they choose to date at all?

Already cringing at the thought, Redditor newlymoneyedrapper asked:

"What is the worst excuse you've heard from someone who cheated?"

Not 'Meant' for Monogamy

"When they get caught, they try to play the 'humans aren't meant to be monogamous' card."

"I'm like, 'If you don't believe in monogamy, why did you even marry in the first place only to cheat later? You could join a free love hippies commune at any time. But that's not what you did...'"

- fepivo6620

Coming Out as Polyamorous

"I know a girl that cheated, and when she was inevitably caught, said she was 'coming out' as polyamorous."

"She was dead serious and fully expected our support and everything."

- fxckfxckgames

"The difference between polyamory and cheating is informed mutual consent among all parties."

"It's not a sexual orientation, you can't just 'come out' as polyamorous. It's something your partner(s) have to know about and (willingly, not coerced) agree to. Otherwise, you're cheating and making excuses for your s**tty behavior."

- spla_ar42

"Lmao (laughing my a** off), get out of here. Actual poly people would know how important communication is beforehand."

"I would have laughed in her stupid, cheating face."

- kosherkitties

So, Grief Is An Aphrodisiac Now?

"She said, 'It was the anniversary of my cousin's death and I wasn't in my right mind. You know how upset I was. Blaming me is classic victim blaming. You should be COMFORTING me!'"

"This was AFTER I offered to stay with her for the night but she said she wanted to be alone."

"I wish I could say I immediately left her, but it took two months and a second cheating incident. That time she said she was upset over a bad grade (seriously)."

"I walked away. And I blocked her. The bizarre part is how she kept trying to contact me for four years after that. She even confronted me in the parking lot on my first day of work, begging me to take her back. Why f**k around so indiscriminately if you want to be with someone?"

"Anyway, I stopped trying to figure her out long ago."

"It was my first relationship (age 15 to 18), and I was a naive fool."

"I'm not jaded now, but I know a h**l of a lot better."

- midnightsonofab***h

"I am sure her cousin would have been very proud of her using his death as an excuse to cheat and then call herself the victim."

- Acceptable-Stay-3166

Everyone Hates Mercury Retrograde

"My ex was very into astrology. She cheated and later blamed the great American eclipse of August 2017."

- henoney389

"SORRY I KEYED YOUR CAR, LOL (LAUGHING OUT LOUD). I'M SUCH AN ASPARAGUS."

- Skwerilleee

"I think you mean the MOON is in GATORADE."

- Zmb7elwa

So Sweet of them

"'I didn’t even enjoy it, because I was thinking about you the whole time, and I felt terrible.”

- fepivo6620

Those Undeniable Needs

"He said, 'You were at the hospital for two weeks. A man has needs."

- Wichita_Falls_Texas

"My girlfriend had a contagious skin infection for several months, and the post-infection management was even longer. We put off sex for about a whole year, and not once did thoughts of cheating occur to me."

"I’m sorry you had to endure that. Not all men are like him."

- Expensive_Presence_4

Growing the Family, and the Relationship

"They said, 'My wife was pregnant, so I wasn't getting any.'"

- tefama5759

"If I remember correctly, pregnancy is the time or one of the times when women are cheated on the most."

- RBNrando

"This breaks my heart."

- LoreGeek

At Least It Didn't "Matter"

"They said, 'It’s not like it meant anything.' Oh good, glad we cleared that up."

- fepivo6620

"Yet you threw our relationship away over it. So what I'm hearing is I mean less than nothing to you."

- LeRuseRenard

Increased... Appreciation

"He really said, 'I’m just on Tinder to confirm that there’s nothing better out there. It helps me appreciate you more.'"

- tivige8195

Getting a Jump on Things

"My previous partner told me that he cheated because he insisted that he 'thought I was going to break up with him anyways,' so he started seeing other women."

"I believe this was just another one of his manipulation tactics to put the blame on ME for his actions. To this day, I cannot fathom the mental gymnastics he had to do to justify his decisions... Lol (laughing out loud)."

- cuteemogirlfriend

"I wonder if he's familiar with the term 'self-fulfilling prophecy'?"

- Browncoat85

"Well, he is now."

- cuteemogirlfriend

Cheat or Be Cheated On

"My last boyfriend said he cheated because he thought I had already cheated. But I did not cheat on him."

"He felt like an a**face when he realized I didn't... But he lowkey still thinks I did."

- _mel-issa

For the Sake of the Relationship

"My college roommate would cheat on his girlfriend a few times a semester, and then feel awful about it and realize how much he loved his girlfriend."

"He started to rationalize that 'you need to cheat to stay faithful.'"

- henoney389

​Opportunities to Cheat

"Oh, this thread reminds me of my ex, who was just a complete s**tbag."

"He didn't cheat, but he nearly did, and he told me about it and said 'Hey, I was really drunk and still didn't cheat, everyone around was so so proud of me and said I must really like you. They all thought I did amazing for not cheating on you even though I had a proper chance to do it, so I thought I'd tell you about it.'"

"I just raised my eyebrow at him. I remember that I did hang up on him a few times and told him that it wasn't massively impressive when he was being a d**k. He was very abusive so I couldn't safely leave him, though. If it was safe to do so, I would've dumped his a** right there and then."

"I know he's on Reddit so he'll likely see this, and good riddance because he's a complete t**t. If you see this, you know who you are, and I think you can go to h**l for what you did to me."

- Complete-Mess4054

All About the Rush

"The answer is because cheaters get off on cheating. It gives them a thrill that a 'normal' relationship can't give them."

"This is why I say cheaters will always cheat, because they crave the excitement of it."

"They don't give a s**t about monogamy or non-monogamy; they just find it fun to cheat. They also enjoy chasing after other people who are in relationships because it's more fun for them to chase after someone who's already taken rather than to find someone who's not."

"In other words, they're sociopaths who get off on causing misery to satisfy their own selfish desires."

- MissGrim66

It's clear why these Redditors thought these were the worst explanations for cheating.

Not only do some of them not make sense, but they're a total dismissal of the cheater's accountability in the relationship.

While realizing that a partner you loved was cheating is already bad enough, it seems that receiving a terrible, ingenuine reason for the act would only serve to make it worse.

Think about the last time you were sick; the ritual of checking WebMD, thinking you have a life-threatening illness, then finding out it was a harmless rash that was causing you all that stress. Regardless of the symptoms, we’ve all been there—but what of the unlucky few who actually did have some sort of ill-fated, isolated illness?

A Bad Bridge to Cross

red and white massage chairPhoto by Atikah Akhtar on Unsplash

In dental school, I had an emergency patient come in complaining of sore gums. Upon examination, I found a massive calculus bridge (google it for pictures) behind her lower front teeth. She only had about 3 remaining lower teeth, but they were all connected with a whitish brown mineral deposit that was about the size of a golf ball. She had never had her teeth cleaned and she was probably 55 years old or so.

I basically performed an emergency cleaning. She could speak so much better afterward. Of course, I had to play it off like it was normal, but in my years of practice, I still haven’t seen a case that bad again. Get your teeth cleaned people. Even if you can’t afford every 6 months, once a year, or every other year is a heck of a lot better than never.

SirNobealot

The Neighbors

An elderly lady came into my practice asking if there was anything she could be given to help her sleep, as the Irish terrorists in the flat below were keeping her awake at night. She was reassured that terrorists were not planning to blow her up, or Cannock (a small inconsequential town in the West Midlands) for that matter.

On the second visit, she insisted that they were going to blow something up soon and expressed paranoid thoughts. A full mental health review was conducted by the GP and the community psychiatrist. She came up clean. That's when we contacted the police, a couple of days later the flat below our patient was raided and found to be full of explosive equipment and real IRA members.

"How often have I said to you that when you have eliminated the impossible, whatever remains, however improbable, must be the truth?"

chasealex2

Just a Nibble

When I was on peds ID, we had a young girl come in with a rash on the bottom of her feet. She was also having headaches and joint pains. We spent close to an hour interviewing the girl and her mother. Her history was essentially negative. Finally, as a last-ditch effort, I pulled out the weird questions you ask in med school.

I asked if they had any unusual pets, as we had already ruled out normal pets. They said actually they did just return a pet rat for biting her. They thought that this wasn't really relevant. Bam! Rat bite fever.

psilord34

Pill Problem

I'm not sure if this counts as a rare diagnosis but it was a neat one. This fellow was at dinner with his wife and some friends when "all of a sudden" he slumped forward into his entree and went unconscious. I saw him as a hospitalist in the IMCU. Despite being unconscious, his labs and vitals were all stable and he appears to be adequately protecting his airway.

The wife was initially understandably distraught and not able to offer the best of histories, but as the patient gradually began to wake up, I was able to put together a few facts. The patient had pancreatic insufficiency and thus needed to take six pills with pancreatic enzymes before each meal. He also had a prescription for Ambien. They were both white pills...you can figure out the rest. He recovered fully without any long-term effects.

wastelander

Hoofbeats

I diagnosed a patient with acute intermittent porphyria. He had a history of psychiatric admissions with depressive symptoms associated with nausea (though not much in the way of pain). I saw him as a medicine consult for the psychiatry service and ordered urine porphyrins just for completeness as it apparently had never been tested before. Lo and behold, they come back positive.

There is this old adage in medical school, "When you hear hoofbeats, think horses not zebras." Which while perhaps relevant to a medical student, is actually the opposite for what is needed from a skilled practitioner. The common stuff is easy...practically reflexive. In our case, a better adage would be, "When you hear hoofbeats don't just assume it’s another horse." Too often physicians just hear the hoofbeats and ignore the black stripes.

wastelander

A Staple Food Source

man in blue dress shirt sitting on yellow chairPhoto by Mark Williams on Unsplash

I worked as a mental health tech to get through undergrad. A 15-year-old female in the adolescent ward claims to have swallowed a staple. Eh, but whatever, as I’m taking her down to x-ray, I tell her about the dime I swallowed when I was a kid. It happens. Well, turns out she underestimated the number of staples by around a hundred.

Every printout given by the therapists had been a swallowed staple. She had gotten staples from the other kids. The x-ray of her abdomen looked as if it were a weird staple-y snow globe. And yet, somehow, she was back to trying to take psych ward staples a week later. Never did figure out how they removed them all.

UnfairCanary

No Face

Baby born without a nose and with non-functioning eyes. Diagnosed with Bosma Syndrome. It was kind of crazy, I saw the baby a few months later and it was doing fine. Children with Bosma Syndrome grow up without any cognitive disabilities, it's very interesting.

SamDaManIAm

Spinal Tap

I am an anesthesiologist now, but was a doctor in charge of a small rural hospital in India about 20 years ago. An elderly lady was brought to the hospital by an irate husband who felt she was faking an illness. She would lie in a room all day with doors and windows shut and complained of a headache. She refused to do housework or look after the kids. Other doctors who had seen her before me had treated her for pain with no improvement.

I examined the patient; who complained of severe headaches and just wanted to lie down and refused to open her eyes. I admitted her to the hospital and performed CSF tap (A needle into the lumbar spine to get a sample of fluid surrounding the spinal cord). As expected, it was tinged yellow (Cerebro-spinal fluid should be clear). These days we have CT scans to diagnose sub-arachnoid hemorrhage (bleeding around the brain); but it was a difficult diagnosis once upon a time.

drdeeppakjoseph

One in a Million

The morning report was a good one today. We had a 59-year-old male come in with lower leg swelling. Within 3 days he becomes confused, febrile, and stiff. We put him in the ICU, thinking he had meningitis and got some CSF cultures and started antibiotics. Two days later, the cultures were still negative and he wasn't improving.

His wife then says this whole event seems similar to her husband’s (the patient’s) mom. She had Creutzfeldt-Jacob disease and passed from it. It's a 1 in a million (literally) diagnosis and our tests are still coming back for it. Really rare case most doctors will never see.

corf1

The Living Dead

I had a lady come into the ER listed as “Multiple Medical Problems”. This usually means diabetes and the issues stemming from it, or maybe bleeding issues from another disease or maybe odd blood tests results at a clinic. I hadn’t seen the patient yet, but the doctor came to the nurse’s station asking who had room 15. I jumped up and followed him into the room.

I walked in and saw what I thought was a corpse. Then the patient’s eye swiveled over to look at me. She truly looked like one of the people they found in a concentration camp. I could see every bone, and her body was twisted in a decorticate position with her jaw locked open. Then the smell hit me: rotting flesh and body fluids. I struggled to keep a neutral face and not gag.

I tried to place a blood pressure cuff on her arm and her skin just started flaking off in my hands. I gagged. The doctor started removing her clothes to examine her. Her feet were black to the ankles. Her hip bones were poking through her skin and were black. The skin around her ribs was worn away to oozing muscle fibers.

Her calves were incredibly swollen and the skin was splitting like ripped pants. I removed her Depends, and there was excrement coating her entire genital area. Then the doctor went to remove a large bandage on her lower back. Her entire sacrum was exposed and the bones were BLACK! The skin around it was a black liquified mass.

It smelled like nothing I’ve ever smelled. I can’t even describe it. The doctor told her family I would clean up her ulcers and wounds in preparation for surgery (liar, no surgeon would operate on her). I had no idea how to clean dead bone tissue and liquified skin (they don’t cover that in nursing school). When I went to clean her sacral area, all the liquified skin separated and oozed all over the bed. I really struggled to keep myself together.

Afterward, I needed a moment in the supply closet to cry it out for a second. I had no idea the human body could break down so much without dying. I still think about that woman sometimes, and what led to her living like that. It still breaks my heart. My guess is that she had some sort of traumatic brain issue or a stroke.

Family members were taking care of her, and I think they were treating her absolutely horribly. I think as her skin deteriorated, she developed terrible pressure ulcers that never healed. The swelling was probably due to starvation and a lack of protein in her diet. I’ve had nightmares about her face since then. Once, I dreamed she crawled into bed with me.

I freaked the heck out and ran into the hallway. My toddler walked out after me, rubbing his eyes, asking why I ran away.

cohen14722

Catching Zebras

zebra standing on wheat fieldPhoto by Jeff Griffith on Unsplash

My first rotation as a medical student was psychiatry. I was really nervous, and made a flashcard for each psych condition and a list of diagnoses to consider. One of the patients being discussed on rounds was psychotic (think: KGB is after me!) but was otherwise put together. He was really into doing art and was very, very religious.

I looked at my flashcard for psychosis and casually mentioned that we should consider temporal lobe epilepsy, which presents with religiosity and exaggerated artistic ability. An EEG showed that he had it. I've caught a few zebras since, but that was my favorite.

implante

Cat Calling

A six-month-old baby was not getting bigger and dropping off the growth charts. The baby wouldn’t move and cried all day long. I couldn’t figure it out. I was making preparations to transfer the baby to the university hospital for admission. One of the clinic nurses commented that the baby's cry sounded like a cat. Ding, a bell went off in my head.

Cri du chat syndrome or cats cry syndrome. Very rare. I looked it up on UpToDate and the baby had a high probability of having it. I referred her to genetics and they confirmed it. The attending called me and marveled at my clinical skills. I chuckled and told him the nurse diagnosed it. Good news, the baby had a small deletion of the 5p chromosome and managed to stay somewhat healthy and functional.

stheonlyone

Socrates’ Demise

We had a young fellow come in who worked as a landscaper. He showed up in the ER with severe GI distress. The diagnosis was almost entirely from history. Apparently, he forgot to bring lunch so decided to munch on some "wild carrots" he found while he was out working. I Google "wild carrot dosing" and quickly figured out the diagnosis (this was in the this was Northeast USA by the way). I will give you a hint...a certain Greek philosopher also had an affinity for the substance...it was hemlock. AKA: Not good for you.

He recovered fine, though he did get a night in the ICU for observation.

wastelander

The Worse of Two Evils

We had a good case a few years ago. An otherwise healthy, 40-year-old migrant worker from Central America started coughing up blood intermittently. Everything suggested tuberculosis: History (they were from an area with lots of TB), chest x-ray looked like tuberculosis, illness script looked like tuberculosis...but his tests for it (sputum/quant gold) were all negative.

I decided to test his urine on a whim to rule out pulmonary-renal pathologies. Ding, ding, ding! Blood. Lots of blood. The patient never noticed it, and his kidney function was superb, so this was a tricky diagnosis. Turns out he had granulomatosis with polyangiitis (Wegner's). Kind of a sad story, because TB is largely curable, but with Wegner's he'll be on chemo for a very long time with this disease. I'm glad we caught it before irrevocable damage to his organs, though.

gettheread

A Bad Prognosis

As a third-year medical student, I had a patient come in with four years of worsening balance issues and garbled speech. She had gotten a crazy work up at an outside hospital system with every sort of imaging possible, biopsies of random sites, and a number of very expensive tests. She was at our university hospital for the first time.

When I first entered the room, I reached out to shake her hand, and from her wheelchair she had to raise her head at me because she couldn't look up with her eyes. This was the first red flag. I also asked her if she had the sensation where one of her limbs would move without her controlling it, and she said yes, suggesting something called Alien Limb Phenomenon.

I diagnosed her with Progressive Supranuclear Palsy with features of Corticobasal Degeneration, a very rare disease on the spectrum of Parkinson's plus syndromes, and my supervisors agreed. Unfortunately, it was a bad prognosis, but the family was consoled by the fact that at least they had a name for what was happening.

yourredditMD

Hard to Miss

person in blue denim jeans lying on bedPhoto by National Cancer Institute on Unsplash

A woman came in with severe opiate withdrawal and some shortness of breath. Because she was so insistent about how miserable she was, everyone sort of wrote her off as drug-seeking. The morning I rounded on her, I decided to do a thorough physical exam. Lo and behold, she has a hard non-mobile clavicular lymph node...it was so big that it was impossible to miss if you just did the exam.

Immediately we got a chest x-ray and then a CT scan. There was a perihilar mass. After a biopsy, we learned it was small cell carcinoma (lung cancer).

eatonsht

A Hard Revelation

I was visiting a friend’s house when I was introduced to his dad who had no medical issues. He was a hard-working farmer, but looked a bit too thin. Something told me there was something not quite right, and so I asked him if I could examine him. I promptly discovered hard lymph nodes in several areas. Further investigations revealed he had disseminated cancer. He kicked the bucket less than a year later.

drdeepakjoseph

The Meat of the Issue

A patient came in with an itchy rash that would not go away for weeks, and a new swelling of the mouth and tongue. She had "hives" all over her body and the only thing that had helped was repeated steroids. She was a mid 40s female who worked with dogs, so we assumed that she had a new allergy to pet dandruff, fragrance in a shampoo, flea medicine, or something along those lines. We discharged her home with an appointment for the dermatologist to do a biopsy of the lesions. But that wasn't the last we'd see of her.

Later that day, she turns back up in the Emergency Department with swollen lips, increased rash, and trouble breathing. She started having these problems 15 minutes after eating a roast beef sandwich. Someone on the team remembered that she works with dogs and asked if she'd had any recent tick bites. Sure enough, she had been bitten by a tick a few weeks ago and identified a picture of a Lone Star Tick.

Turns out she had developed an allergy to red meat after a bite from that tick. This allergy is called an alpha-galactosidase allergy, and is a reaction to a carbohydrate carried on the outside of cells (think like the carbohydrates on red blood cells for ABO blood type) by all other mammals except humans and monkeys.

The tick had bitten one of these and kept some of the protein in its digestive system, and then after biting her, her body developed antibodies to the carbohydrate, causing her to have a new allergy to meat.

thepunctuator

Unexpected Guests

Ordered an abdominal ultrasound on a refugee from Iraq via Syria, expecting to find gallstones because she felt full easily after eating and was having pain in her right upper quadrant. Instead of gallstones, there were two, 7 cm cysts in her liver. Hydatid cysts from a tapeworm.

kgjohnson2

More Than Meets the Eye

As a fourth year during my rotations, I noticed my patient had a vertical subluxation of her crystalline lens during a dilated eye examination. The part of the eye that develops a cataract later on in life was shifted significantly up. She had severe myopia and astigmatism (-14.00 - 5.00 x 180 OU), and her 6'1" tall body along with disfigured teeth led me to believe she had Marfan's Syndrome.

She had never heard of it, never seen a cardiologist, etc. A few lab tests confirmed. She can live a normal life; she just needs some meds and education. She had very long fingers that jumped out at me and braces on her teeth. As an optometrist, I focus on glasses and contacts, but I see (no pun intended) and treat an unbelievable number of systemic diseases that manifest in the eye or retina.

Permalink

My Old Mother

woman wearing eyeglassesPhoto by Todd Cravens on Unsplash

One of my favorites is when we had an 85-year-old man in for cellulitis or something, and everyone was documenting he was confused—in part because he kept talking about his mother; his mother was going to be so worried, he had to be discharged to take care of his mother etc. He became agitated and was actually getting ready to be dosed with Haldol because he was insistent he was going to leave to take care of his mother.

Note, the standard is to play along, tell the patient something like "Oh, we already called your mom, she knows you're here" that sort of thing, but he wasn't buying it. Finally, the nurse asks him if we can call his son to make sure the patient's mother is being taken care of (really, just to placate the patient), and the patient agrees. We call the son, the nurse explains the situation, and the son informs us that the patient's mother is indeed alive at the age of 101, but that he is staying in his father's house assisting in her care.

Poor patient was legitimately worried about his mom, and we all thought his infection (or just old age) was causing him to be confused!

Permalink

On a Hunch

ED referred a guy to me who had a platelet count of 2. The guy looked bloody sick with abdominal pain, petechial rash, feverish, diaphoretic, and he was a bit confused and drowsy too. I talked to my boss who said to give him prednisolone and he'd see him tomorrow, but I was convinced this guy had a really rare condition called TTP (Thrombotic Thrombocytopenic Purpura) and so I called the major hospital in my area and sent him to their ICU for a procedure called plasma exchange.

I ordered a test called ADAMTS13 to prove the condition, and still have a paper copy of the result (he had none of this chemical) because it's the best diagnosis I've ever made, it helped save his life!

sam_galactic

Growing White

Menkes kinky hair syndrome. I was called to see a 3-month-old boy with hard-to-control seizures. His most remarkable exam finding was his hair: he had been born with a full head of black hair (he was Hispanic), but at the time I saw him, the first 3-5 mm of each hair shaft was nearly white, with an abrupt color change, still black on the tips. The hair was a giveaway for this disorder, almost no need for confirmatory testing, but the admitting team had already ordered whole exome sequencing.

This was not a fun and exciting diagnosis to make, more a sinking feeling upon discovery of the hair (neurodegenerative disorder due to a defect in copper metabolism that is irreversible once symptoms appear), but it was interesting to see at that transitional stage. I had only seen older boys with Menkes before, once the hair was already pale and brittle all over. Usually the hair has changed long before the diagnosis is made.

Allyeknowonearth

Ignoring the Issue

I'm an anesthesiologist. This happened when I was a resident. It changed me for life. We had a 29-year-old male in for finger surgery. We had an uneventful induction maintained on Sevoflurane. Within 20 minutes we started to have rising ETco2. I called my attending after trying to hyperventilate the patient (She was a young Harvard trained peds anesthesiologist).

She comes in and asks me what I think is going on. I tell her things seem strange. She tells me to chill. Five minutes later, the ETco2 is over 100 and I'm freaking out! I call her and tell her this is MALIGNANT HYPERTHERMIA (easily fatal reaction to certain anesthetics caused by congenital aberrant sarcoplasmic reticulum receptors).

She says that I'm being ridiculous when I tell her I'm afraid this is the real deal. My pages get ignored by her. The patient’s temperature starts to rise. I'm bugging out and call the board runner (supervising Anesthesiologist for all the operating rooms). He's old. He knows me well and trusts me. Comes in, looks at the monitor—and his face went white.

Needless to say, we save the patient after many dozens of vials of Dantrolene. Six months later I'm made to do an M&M and the young Harvard attending insinuates I did something wrong in front of the department. Most of the rest of them come to my aide. She leaves the job shortly thereafter. I will soon be at her fellowship.

Weird.

Awesam

Flippant Flipping

I didn't diagnose it, but I have a patient with primary Ciliary Dyskinesia with Situs Inversus, aka Kartagener syndrome. The cilia in the body don't move well, and this mainly affects the respiratory cilia/lungs, although it also causes infertility, related to the cilia inside the fallopian tubes and the sperm tails not working well.

Situs Inversus is when the organs inside the thorax are mirror images of normal, the heart is on the right side instead of the left, etc. I was looking over this patient's old medical records and one of the radiology reads of a chest x-ray said, "There has been interval development of dextrocardia. Since this is physiologically impossible, the film has been flipped."

Probably the original film the radiologist had been comparing to had been incorrectly flipped to look "normal," maybe by someone who assumed there had been an error. Another chest x-ray report just read: "The film has been flipped" and then went onto the rest of the interpretation.

Kirsten

A Quick Diagnosis

person holding baby feetPhoto by Omar Lopez on Unsplash

I once saw a child with mosaic trisomy 8. It was a complete mystery why he had speech apraxia, and the geneticist I was working with took one look at his feet, saw that they had super deep creases lengthwise, and ordered a karyotype with mosaic trisomy 8 in mind. Sure enough, he was right. I was amazed how spot-on he was predicting that.

blizpix

Caught in Her Throat

Primary doctor here. Had a two-year-old refugee child (whose parents couldn't communicate well) who swallowed a button battery and it was stuck in her throat. For clarity, I didn't know it was a button battery, but something just didn't feel right, so I sent her to the ED. If she had gone perhaps one more day, she might not have made it—it had already destroyed a good amount of tissue in her esophagus and was apparently somewhat close to perforating.

I feel like it would have been very easy to just say she had a sore throat from an illness, particularly with the language barrier. I'm glad that something felt weird to me—she didn't look that bad, but was just holding herself and breathing weirdly.

En_lighten

Rare and Terrible

Wolman Disease. A genetic disease that affects about 1/200,000 kids, terrible outcome. It leads to calcification of the adrenal glands, which is how I picked it up on a chest x-ray on-call (I'm a radiologist). The kid had failure to thrive and a big spleen so I brought it up. He got further testing which confirmed the diagnosis.

Bottom line, don't forget to look at the adrenals or ribs on peds x-rays!

Proxyfloxacin

Dr. Google

Probably Stiff Person Syndrome. Technically it was paraneoplastic antibodies causing a case of mild stiff person-like syndrome, but it was basically a lady who had glutamic acid decarboxylase antibodies which caused her to be really stiff. How'd I figure it out? Well, she was really stiff and it was very odd. I was out of ideas and literally googled "stiff person" and got the result of a disease I'd probably heard mentioned in passing in med school but is so rare you forget about it: Stiff Person Syndrome.

Yes, it's real. I thought it was a joke at first—but it's all too real. Ordered the test, it was positive. Later, after more research, I learned that you can have similar antibodies and symptoms with paraneoplastic syndromes, so I did a scan, and found a lung tumor. Boom. SPS is really rare. Paraneoplastic syndromes are less rare. She was somewhere in the middle.

Digitlnoize

Miracle Porridge

I made a clinical diagnosis of fairly early-stage necrotizing fasciitis (the infamous flesh-eating bacteria) in West Africa which was pretty cool... The patient was a young adult male who was writhing and screaming in agony as he was carried in. He spoke a tribal dialect and I spoke ugly French, so it was basically impossible to get any information out of him or the friends who brought him in.

I laid him on the table and did a rapid trauma assessment. When I stripped off his shirt, I saw a small patch (maybe 4" x 6") of blackened tissue below his left nipple along the side of his ribs. It looked like a chemical burn to me at first glance. I realized that some of the skin had torn off the area when I removed his shirt, and when I touched the lesion to examine it, I could feel the skin separating from the tissue below it.

The technical term is "desquamating." It had a horrible odor like spoiled meat/rotting garbage mixed with 100 degree west African heat and 100% humidity. Putrid. His temperature was over 40C (104+ F) and his O2 saturation was terrible. The rotting garbage smell indicated anaerobic bacteria, the skin peeling off indicated connective/soft tissue involvement, and the disproportionate pain (relative to the size of the lesion) is a hallmark of necrotizing fasciitis.

I ran back to my room and grabbed the Oxford Handbook of Tropical Medicine (highly recommend if you work over there in medicine) to double-check because I had never seen a case of flesh-eating bacteria in person before and didn't want to screw up the diagnosis and move things in a different direction if I was wrong. Sure enough, everything matched up and the chief of medicine stopped by to confirm the diagnosis. He basically said, "Oh yeah we see these fairly frequently, people get a cut or a bug bite and then rub dung or dirt into it and the infection takes hold."

The craziest part was the outcome. In the United States, patients with necrotizing fasciitis in one limb frequently die or suffer amputations of both arms and both legs—even in the best ICUs. Here we were in the middle of West Africa at a remote bush hospital and this guy has it on his chest, which pretty much wrecks the standard aggressive surgical approach since you can't exactly amputate the chest.

We loaded him up with high dose IV ampicillin a few times a day and his wife forced him to eat multiple bowls of porridge...miraculously he made a full recovery and left smiling 10 days later. I'm convinced it was the porridge.

greedo4president2016

Wearing Your Heart on Your Sleeve

pruning topless babyPhoto by Jakob Owens on Unsplash

I diagnosed a little girl at birth who had Ectopia Cordis. It's a birth defect where the heart is located outside of the chest or thorax (yet it's still underneath the skin). It only happens to about 5-7 per one million live births. Warning, if you plan to search up "Ectopia Cordis," the images available may not be for the faint of heart.

Say No to Drugs

Today I took care of a man who believed he had been bitten on the abdomen by a baby rattlesnake that had fallen out of his ceiling vent, crawled up his abdomen under his skin, up his throat, and was currently coiled and rattling in his brain. Diagnosis: methamphetamines. Just say no.

2ThineOwnZelphBeTrue

Against All Odds

Five years ago, I spent six months working in a small rural Zambian hospital in the medical ward as part of a volunteer/outreach program. I have done mostly family medicine, and some surgery in my early days, but decided to mix life up a bit. The hospital was typical third world—a few basic medications, rudimentary clinical tools, a small lab on site which was usually broken.

No resuscitation tools whatsoever. HIV, TB and malaria were rife—it would not be uncommon to encounter a loss per day despite our best efforts. On one of my first days there an unconscious person was carried in by a mob of locals. I could smell him before I saw him. He had been in a house fire and his skin was cooked—completely black around his chest, face, and over his legs.

He was still breathing on his own and maintaining his airway but we had no doubt he had inhaled a lot of smoke. With no way to intubate or provide oxygen we merely had to hope that he didn’t swell up and close off and deal with the rest of the burns while he was unconscious. Two colleagues who worked in the hospital came over urgently.

We all kept our cool externally and got the nurses to translate to the man’s family that we were going to do everything we could to get him better. In reality, all three of us knew his chances at survival were in the single-digit percentages. We decided that due to the extent of his burns we were going to have to do an escharotomy (cutting the burned skin to prevent it contracting and stopping him from breathing).

Turns out I had the most surgical experience so despite having never done one before I gave it a go, hoping for the best. We got an IV into a neck vein and got fluids going. The local nurses dressed his burns. We gave him whatever pain relief we had. He was unconscious for a couple of days but eventually came to.

Each day we were expecting his kidneys to pack up but to our surprise, gradually he got better. He was with us for just over four months recovering. He came out severely scarred but he had beaten the odds and survived.

drcopperfield

A Rare Talent

I've diagnosed anti-NMDA receptor encephalitis in a patient that was thought to be withdrawing from an unknown illicit substance. Then, not two months later I had another patient with the same disease. I was talking to a neurologist recently and he thought it was a condition that is far more common than we thought it was, but still a pretty good catch for an internist.

I've caught a few conditions that were rarer, but it's nice to talk about one that's treatable.

throckmortonsign

Improvise. Adapt. Overcome.

I'm PhD, not MD. The weirdest to me was a bloodstream bacterial infection that looked sensitive to antibiotics in the clinical lab, but the patient could not be cured. We got samples of the bacteria and turns out it was "tolerant" to antibiotics in a biofilm (heart valves) but not sensitive in the clinical sense. Opened my mind as a microbiologist to how insanely adaptive bacteria can be, and how they're more a population than individual cells. The most interesting paper I ever published, and unexpected.

aussie-vault-girl

Subtle Symptoms

man reading papers in front of computerPhoto by National Cancer Institute on Unsplash

Not super rare but sort of diagnosed/missed Myasthenia gravis. I was an intern in the emergency department. A woman presents with the classic vague symptoms of fatigue and weakness. Notably, her father had very recently passed. Full blood panel was normal, her examination was almost completely normal but I did find she had proximal weakness (her upper arm strength and thigh strength were poor but her hand and feet and shins etc. were normal).

I presented to my superior and we decided to send her home because we couldn't diagnose her with anything and we can't admit someone to hospital for fatigue. She was upset that we couldn't help her. After she left, I couldn't shake this terrible feeling. I asked my superior, what about Myasthenia Gravis? Well, too late now, besides the testing takes weeks.

She represented a week later (I didn’t see her). She was admitted this time and seen by a physician. More tests were ordered and eventually she was diagnosed and treated for Myasthenia Gravis. I saw her 6 months later and she remembered me, she was doing much better and wasn't upset that we missed the diagnosis.

It can be very hard to diagnose some things because of how non-specific the symptoms are. In this case I had a feeling she had a real disease especially with her proximal weakness but there wasn't much we could do about it.

DudeWhoSaysWhaaaat

Jaw-Dropping News

I'm not sure if I count because I'm a veterinarian, but I saw trigeminal neuritis in a dog. Basically, the dog can't move his lower jaw, but it's not stiff or painful or anything, it just hangs slightly open. It looks like the dog has just received some unbelievable news, basically. It goes away on its own in 2-4 weeks, but the dog can't eat or drink very well, so you have to syringe feed them, do elevated food bowls, etc.

cloud_watcher

Benadryl to the Rescue

I had a patient transferred to our hospital for a STEMI (major heart attack). When they arrived, I noticed they looked a bit red and asked them, other than the chest pain, what symptoms they were having. The person said that they had been having a rash for a few days as well as nausea, vomiting, and diarrhea. Those symptoms go along with a condition called scombroid poisoning which you get from eating old, dark meat fish (tuna, mackerel, etc.).

I asked the person if they had recently been eating fish and sure enough, they had been eating salmon for the past few days. Assuming they had it, I treated them with Benadryl which fixed the rash, nausea, vomiting, and diarrhea. They were taken by the cardiology service to get a cardiac catheterization (how you find clogged blood vessels in the heart) for the heart attack and the results came back normal (no vessel occlusion).

Best I could tell, the condition stressed their body and made them tachycardic/hypotensive which made their heart work harder. The increased demand on the heart + an already weak heart led to the heart attack. Also, was pretty awesome to see the EKG go from showing a clear heart attack to normal after being treated with Benadryl!

1llumina

Face-palm Parenting

I'm a nurse and I work in a pediatric ER. A young woman brought her baby in to be seen for vomiting. I ask her to put the baby on the scale. While on the scale I notice a strong odor of bug spray so I asked about it. Her response made my blood run cold. Mom: "A roach crawled into her mouth so I sprayed a little Raid in there." She said it in a matter of fact tone, like it was no big deal.

Queue up calls to the police, CPS and a 1:1 sitter for the child and the mom. When all was said and done the baby was fine and turned over to her grandmother so no worries there. I have no idea what happened to the mother. I don't believe she was intending to hurt the child. I think she was just completely ignorant.

TomTheNurse

Non-FDA Methods

We had a case a couple of years ago that still gives me chills whenever I think about it. A younger girl goes to her family doctor in a small town outside of the bigger city where I live. She had persistent headaches, which just started a few days prior. No past medical history of anything similar or really at all about her that stood out as relevant.

Unable to diagnose or treat her headaches (which were rapidly growing more severe), she was sent to our hospital (X state's Childrens' Hospital) for evaluation. We ran her through the typical gauntlet of testing for common causes, CBC/CMB/CT/MRI etc. still with no clue. Nothing came up on blood cultures either. At this point she was in the PICU rapidly deteriorating, with high fevers and periodic losses of consciousness.

After eliminating all the horses, we had to start looking for zebras...and quick. We collected a CSF sample for culture thinking it might be one of the rarer forms of bacterial meningitis. While this was cooking (cultures usually take at least a few days) we tried again to get any other possible info from her parents...that's when we learned the whole story.

For the first time, they mentioned that they had visited a local waterpark a week or two before the girl’s symptoms started...and this was in the middle of summer. For any Peds doctor, or especially ID doctors in the room, those words made their hearts sink. Sure enough, the cultures came back, positive for Naegleria Fowleri, the pathogen responsible for Primary Amoebic Meningoencephalitis (PAM). Which up until that point, I don't think there was a documented case of a patient being diagnosed with PAM who survived.

It’s the incurable brain-eating amoeba that lives in warm stagnant water and can enter through the cribriform plate at the top of the nose if the patient gets water up there...which happens all the time at waterparks. Anyway, long story short, we basically cook up a (very non-FDA-approved) drug cocktail as a sort of Hail-Mary attempt at fighting this infection, as nothing else in any other case had ever worked.

In addition to this, we basically stick her in a Mr. Freeze chamber, lowering her body temp to below what N. Fowleri can usually survive. Unfortunately, most people can't survive it either. But for some reason, (though in an induced coma the whole time) she steadily improved. When we took her out of the deep freeze and allowed her to wake up, it was incredible...

She was alive with no apparent neuro/cognitive deficits, and the new cultures showed no growth of N. Fowleri. It's not too hard to figure out where this occurred, as it may still be the only successfully treated case in the US.

duck_doctor

Like Flipping a Switch

man in white dress shirt wearing black framed eyeglassesPhoto by Usman Yousaf on Unsplash

I can't remember all the details though so bare with me. I'm at a big tertiary hospital, and had an elderly veteran brought to us one day after being found unconscious in a park. He had alcohol in his system and a quick look at his records showed that this was an ongoing problem with him. He was a sweet old man who was very grateful for our help, up until day 3 of his hospitalization. That's when things took a dark turn.

He developed pneumonia-like symptoms and became somnolent for a few days. Then, out of nowhere, he became very inappropriate—he begins grabbing the nurses and repositioning them, touching himself, and constantly licking his lips in a disgusting manner when anyone even looked at him. He went from a sweet old man to a deviant almost overnight. We even had to wrap his hands up in bandages to stop him from touching himself and others. Oddly though, he hit on anyone and everyone (women and men) except for me. I guess I wasn't his type.

We ended up diagnosing him with Kluver-Bucy syndrome, caused by HSV encephalitis (herpes). Symptoms include hypersexuality and hyperorality. It's pretty rare and I haven't seen it since, but as you might imagine, it left a lasting impression on me. He improved with treatment though, and was incredibly embarrassed after finding out what he had done.

DrTapioca

Factitious Disorder

When I was an intern, we had a 22-year-old man with persistent abdominal pain, all studies negative. His symptoms were unexplained. His mother was constantly at his bedside, and his medical history, which was extensive according to his mom, included multiple hospital stays with no definitive diagnosis. I noticed that he would frequently take ill after meals, which his mother brought from outside the hospital.

It eventually became clear that he was a victim of Munchausen by proxy. His mother was making him ill. I'd had a patient with Munchausen's when I was in medical school (she was injecting her own waste into her IV), so I was particularly tuned in. Both cases were very sad.

Milesman1971

child being fed
Tanaphong Toochinda on Unsplash

We may have many fond memories of childhood that center around food.

A favorite meal, a special celebration dinner, simple comfort foods, baked goods enjoyed with grandparents or holiday feasts.

But not everyone is blessed with culinary talents. And some cooking impaired are responsible for feeding children.

For those kids, memories of meals might be more trauma than beloved tradition.

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