Illustration by Monsieur Cabinet
"Please — if you have to — just cut me open and take it all out," the young woman pleaded. Tears welled and threatened to spill down her cheeks. Her voice cracked as she continued, "Anything is better than this."
The 15-year-old girl had been a nationally ranked gymnast. Then a year ago, her body suddenly changed. Her belly bulged as if she were six months pregnant. After a year of inconclusive examinations, she and her parents had traveled from their home in Southern California to the Mayo Clinic in Rochester, Minn., desperate for an answer. This strange transformation of the girl's body had brought her athletic career and her life to a standstill.
STOMACH REBELLION
Dr. Rayna Grothe, a pediatric gastroenterologist, shook her head at the girl's request. I won't let that happen, she told her and her parents. She wasn't sure what was going on, but she was certain surgery wasn't the answer.
When Grothe initially reviewed the girl's extensive medical records, she felt that familiar tug of worry — many tests had already been done. What could she add? In tough cases like this, she knew, it was the patient's story and exam that often provided the needed clue.
The day all this started, the young woman told the doctor, she woke up at around 4:30 a.m., as she always did, and got in a quick run. She didn't feel great — she was a little feverish, a little congested, but she didn't let that slow her down. After breakfast, she did some schoolwork. (Her training and frequent competitions made school difficult, so she was taught at home.) Then she headed to the gym to work with her coach.
She'd only been there for an hour when she felt a sudden need to go to the bathroom. She had terrible cramps and diarrhea more than a dozen times before lunchtime. When she looked at herself in the mirror, her belly, normally flat and ridged with muscles, looked big and round. By evening, the young woman felt completely worn out — feverish and dehydrated. She drank as much as she could and went to bed early.
The next morning, her stomach was still huge. Her parents were immediately concerned and took her to a local hospital. Blood tests and X-rays were normal. The doctors weren't sure why her belly was distended, but there was no obstruction. She would probably get better on her own, the doctors told them.
The diarrhea stopped after a couple of days, replaced by terrible constipation. And the girl's stomach remained painfully distended. Shortly after, she had an extensive work-up at another hospital. She was discharged after several weeks without a diagnosis.
EVERY TEST IN THE BOOK
The patient told Grothe that she felt as if she'd swallowed some wild animal, and it was trying to scratch its way out. In the year since that initial hospitalization, she'd been to a half-dozen hospitals and had X-rays, CT scans, M.R.I.'s and ultrasounds. She saw gastroenterologists, neurologists, urologists, psychiatrists, surgeons, physical therapists, an endocrinologist and a cardiologist. She'd taken weeks of antibiotics and spent months on a gluten-free, lactose-free, sugar-free diet.
Still, no one seemed to understand why the girl looked pregnant. Or why she couldn't go to the bathroom without large doses of laxatives.
When neither tests nor treatments were revealing, some of the doctors began to suspect that there was nothing really wrong. It was all in her head, she was told. She knew it wasn't, she told Grothe, but she took the antidepressants, antispasmotics and antianxiety pills they prescribed. But she didn't get better.
Her parents also turned to alternatives. She saw a hypnotist, an acupuncturist and a Chinese-medicine doctor — all to no effect.
And she missed the gym. Since age 6, she lived and breathed gymnastics. It was the center of her day and of her life. Now it was gone. She watched her friends compete on television until she had to turn it off.
A CLUE IS REVEALED
If you have a solved case to share, you can send an e-mail to lisa.sandersmd@gmail.com.
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