[HN Gopher] Nobody Has My Condition but Me
       ___________________________________________________________________
        
       Nobody Has My Condition but Me
        
       Author : cocacola1
       Score  : 68 points
       Date   : 2023-01-27 17:44 UTC (5 hours ago)
        
 (HTM) web link (www.newyorker.com)
 (TXT) w3m dump (www.newyorker.com)
        
       | SamoyedFurFluff wrote:
       | > Far too often, women who present with hard-to-diagnose
       | illnesses are told that the symptoms are no big deal, that the
       | problem is in their head. They spend years going from doctor to
       | doctor, in a desperate search for someone, anyone, who's willing
       | to help. This has not been my experience. From the first, doctors
       | took my condition seriously, sometimes more seriously than I did.
       | 
       | I would love to know what she did to get doctors to take her
       | symptom profile seriously when she merely presented with the same
       | vague and often dismissed symptoms of women with complex medical
       | conditions. I have multiple friends who get told to just get more
       | fit, despite also having observed cardiac symptoms that worsen to
       | any exercise.
        
         | justusthane wrote:
         | It might have helped that she works at Yale, and that's where
         | she initially went for care:
         | 
         | > "As a professor at Yale, I receive my medical care through
         | the university's health center, a private bastion of socialized
         | medicine [...]"
        
         | InitialLastName wrote:
         | Not even complex medical conditions; a friend with stomach pain
         | issues was being blown off by doctors with "just lose weight"
         | for a year before she collapsed on the sidewalk. In the
         | hospital, they removed a 30-lb cyst from her abdomen, but I'm
         | not sure diet and exercise would have helped with that
         | particular weight loss.
        
           | foobarian wrote:
           | I wish it were easier to self-test with things like CT,
           | ultrasonic or MRI scanners. Until I went to the ER with
           | symptoms that exactly matched a gallbladder condition I was
           | never before let even near one of those machines, but looking
           | at the scans the problem was so obvious. I imagine for this
           | woman the problem would have been obvious too from a simple
           | scan.
        
             | s1artibartfast wrote:
             | Depending on your definition of easy, it is. It just takes
             | money. There are private clinics that will do full body MRI
             | for print event of Medicine and Diagnostics. This level of
             | personal care is just cost prohibitive for most people
        
           | agumonkey wrote:
           | I'd love to contribute to non invasive medical research in
           | any way. The risk/cost of medical procedure makes doctors
           | refuse most of this cases. So you're gatekeeped until it's
           | too late.
        
           | geraldwhen wrote:
           | It would have made it much simpler to identify a huge cyst,
           | and the fat may have exacerbated or caused the cyst.
        
             | rondold wrote:
             | yes lol imagine how incredibly obese you have to be to not
             | know you have a 30lb tumor. its like those women who don't
             | know they're pregnant but actually even fatter
        
         | toolz wrote:
         | > despite also having observed cardiac symptoms that worsen to
         | any exercise.
         | 
         | Isn't this the exact reason they should exercise? I'm sure the
         | symptoms present worse during exercise, but the exercise itself
         | will gradually make your body more resilient or even cure many
         | cardiac issues. I'm unaware of any cardiac disease that gets
         | worse with some form of exercise, granted there are levels of
         | intensity in exercise no one should be attempting without
         | proper conditioning.
        
         | PragmaticPulp wrote:
         | > I have multiple friends who get told to just get more fit,
         | despite also having observed cardiac symptoms that worsen to
         | any exercise.
         | 
         | Clinically, it's rare for people (below retirement age) to have
         | cardiac conditions that exclude _any_ exercise.
         | 
         | I don't know your friends' details, but a common pattern in
         | these situations is for there to be a misunderstanding about
         | what "exercise" means. If someone is having life-threatening
         | cardiac symptoms, no reasonable doctor is going to recommend
         | that they just go to the gym and sweat it out. In the worst
         | cases, what they're trying to avoid is the deconditioning slide
         | that comes with chronic illness. The goal isn't to get fit or
         | go for runs or push to exhaustion. The goal is to slow the
         | physical health decline that comes with being too sedentary.
         | 
         | It can be counterintuitive, but doing extremely light activity
         | (walking 0.1 miles per day, working up to 0.4 miles per day)
         | can be extremely beneficial compared to avoiding activity
         | altogether, even if it's uncomfortable.
         | 
         | Once the fitness is gone, it's hard to get it back. A lot of
         | patients start out with one condition, which then becomes a
         | combination of that condition plus a year of deconditioning.
         | 
         | Physical therapists trained in chronic illness specialize in
         | these treatments and adapting to the bounds of any cardiac
         | limits.
        
         | smeej wrote:
         | It sounds like the obviously swollen hand was a big symptom, at
         | least for the doctor who immediately said, "That's not
         | rheumatoid arthritis."
         | 
         | To use the zebra analogy, it sounded like that was the part
         | where the doctor said, "I don't know wtf this is, but it's not
         | a horse."
        
           | FollowingTheDao wrote:
           | Exactly. Doctors always see horses. Whenever they see a zebra
           | they just tell you that it is a horse that you painted with
           | stripes in your imagination.
        
         | sumtechguy wrote:
         | I have a friend, he gets wild migraines all the time. Dozens
         | and dozens of doctors over 25 years. All he can say at this
         | point is what he thinks doesnt cause them. The issue is
         | diagnosing these sorts of things is tough. You can not exactly
         | crack someone open and poke around and not possibly break
         | things plus the cost of time and money. So you mostly look at
         | the symptoms and hope you can read the tea leaves and get it.
         | For most things that works pretty good. But get a bit out of
         | field of what they do and you will have a bad time with most
         | doctors unless they happen to read the tea leaves correctly. My
         | mother in law went from 'you have the flu' to 'you have stage 4
         | single cell' in under a week and was dead soon after. She went
         | to the doctor dozens of times about it the months before. We
         | get this idea that doctors are miracle worker wizards. But
         | sometimes you feel like they are playing with bear skins and
         | arrow heads.
        
       | FollowingTheDao wrote:
       | It was painfully easy for me to find my PNP deficiency.
       | 
       | - I had my genome run my 23andme (twice). - I plugged the raw
       | data into https://promethease.com/. - I sorted it by frequency. -
       | Then just researched every rare polymorphism.
       | 
       | It would be so simple to write an algorithm that does this.
        
         | cjbgkagh wrote:
         | I found my own genetic condition this way. hEDS/clEDS from a
         | TNXB mutation. I already had a strong indication that I had
         | this by noticing rare behavior about myself was similar to
         | other people with TNXB mutations. DNA sequence confirmed it.
         | The vast majority people with this condition will never get a
         | positive diagnoses from a doctor no matter how many they see,
         | but it's clear as day right there in the DNA.
        
       | atdrummond wrote:
       | If you or someone you love has a disorder you believe is
       | unexplained, reach out to Alabama-Birmingham's Precision Medicine
       | arm. (https://www.uab.edu/medicine/pmi/)
       | 
       | It was founded and is run by Matt Might, a computer scientist and
       | former Obama-admin CTO for the US. He wanted to solve his own
       | son's medical issues and now is helping others. A family member
       | works there as a pathologist and while treatments are expensive,
       | they're also bespoke. And sometimes it's better to have answers,
       | and a sliver of hope, than nothing at all.
        
       | Vapormac wrote:
       | (Non-paywall): https://archive.is/hXnEw
        
       | dangero wrote:
       | I have an unexplained autoimmune disease.
       | 
       | Like others have said, I can't imagine any doctor actually going
       | this deep with me.
       | 
       | I've probably seen 20 doctors, but none of them have taken me
       | very seriously at all. Some prescribe me something and say "see
       | if that helps," others flat out say, "I'm not sure what is going
       | on here and I don't know how to help you," but nobody has said,
       | "We should consider looking at your DNA to see what's up here.
       | I'm really interested and want to figure this out with you."
        
         | AnIdiotOnTheNet wrote:
         | > "I'm not sure what is going on here and I don't know how to
         | help you,"
         | 
         | In my experience even this is significantly better than you'll
         | get out of the average doctor. I'd gladly see a doctor who was
         | willing to say "yeah, something is wrong but I have no idea
         | what" instead of being dismissive.
        
         | minsc_and_boo wrote:
         | I'm in the same boat - unknown autoimmune disease, talked to
         | teams of neurologists in different health networks. All they
         | can do is prescribe treatment for symptoms, not causes, which
         | is frustrating.
         | 
         | How does one even go about sequencing their DNA?
        
           | mrguyorama wrote:
           | Say you get your DNA sequenced, say they even find a segment
           | that seems "off" from other DNA sequences.
           | 
           | What the heck would you do about it? We don't understand DNA
           | and protein folding enough to actually take the output of DNA
           | sequencing and give you something to change that. We don't
           | have a comprehensive view of the human body or biology or DNA
           | to do anything with it. There's not really going to be much
           | in the way of treatment for a single instance of a random
           | negative mutation.
        
             | belval wrote:
             | You can find solace in knowing what's wrong with you and
             | track studies for your particular gene that's off. It's not
             | a given that your autoimmune disease wasn't at least
             | studied at one point, knowing what the markers are and
             | whether you have them could help track down whatever
             | knowledge exists.
        
             | thewebcount wrote:
             | They may be able to tell things like "You are a rapid
             | metabolizer of drug XYZ" or "You are a poor metabolizer of
             | drug ABC". Knowing that they may be able to try more
             | effective therapies for you that they wouldn't normally
             | have thought of.
        
         | PragmaticPulp wrote:
         | > but nobody has said, "We should consider looking at your DNA
         | to see what's up here. I'm really interested and want to figure
         | this out with you."
         | 
         | You could sequence your own genome and use a service to compare
         | it against the ClinVar database that correlates genetic
         | variations with research.
         | 
         | Odds are that you won't find anything useful to your specific
         | condition.
         | 
         | Most autoimmune issues are acquired, not genetic. With few
         | exceptions, the common genetic variations associated with many
         | diseases can't be used in a diagnostic manner. A genetic
         | variant that increases your odds of contracting a rare disease
         | by 10X might sound significant, but if it's truly a rare
         | disease then you could be going from 0.001% to 0.01% odds.
         | 
         | The unfortunate truth is that if your condition doesn't match
         | something that can be diagnosed with the tests available to
         | your doctors, there isn't much they can do to forge ahead with
         | new research on their own. That's the role of researchers, not
         | doctors. And it takes decades to get to the bottom of
         | conditions, if ever.
         | 
         | You might have some luck scouring the internet for similar-
         | sounding conditions and groups who research them. Occasionally
         | you can find your way into clinical trials or registered on
         | waitlists for researchers who might need candidates to test.
        
         | almog wrote:
         | While I (probably) don't have an autoimmune disease, in knowing
         | that I'm not the only person that have experienced that sort of
         | helplessness navigating my way through the medical system,
         | without even finding a defining name for the condition in
         | question. I tried searching online for the symptoms only to
         | find very general cases that do not have some of the main
         | characteristics. Quite the same feeling one gets when they
         | search for an error message only to find the source code that
         | raises that exception. :)
         | 
         | Sometimes I think the medical issue I'm suffering from is
         | annoying enough but not being able to diagnose it just adds an
         | insult to injury. Is it that I cannot express my problem well
         | enough to find similar cases online? Is this such an obscure
         | case or maybe a lot more people are experiencing it but they
         | just handle it so much better that they don't feel the urge to
         | complain about it?
         | 
         | Just to be more specific and less mysterious, I'm suffering
         | from mild chronic joint pains, in pretty much every joint
         | starting from ankle, knee, lower back, neck, elbow and hand.
         | The tricky bit, and the reason I didn't use plural, is that the
         | pains only occur on either left side or right side of my body,
         | but only one side at a time, usually the pains will switch
         | sides (left <=> right) overnight (though not every night). It
         | has low correlation with the intensity and volume of physical
         | activity I'm doing. Blood tests show nothing out of the
         | ordinary, C.T shows that I do have mild case of bulging discs
         | in my back, which would have explained back pains (which I
         | have) but not the issue of feeling them in just one side (along
         | with every other joint in that side). These pains, mild as they
         | are do not respond in any way to NSAIDs. Popping my knuckles
         | (and every other joint you can think of) helps momentarily. If
         | the pain level is above normal, sleeping is affected too (in
         | fact it's almost always affected to some degree), which in turn
         | amplify the pains as poor sleep would do.
         | 
         | Nerve conduction tests also revealed nothing and the doctors
         | I've seen couldn't offer any observation. The fact that I have
         | quite an athletic build doesn't help either since doctors note
         | that and assume that I'm doing just fine. In fact though, these
         | pains, which have started in my teenage years and have become
         | worse in my early twenties (I'm in my late thirties now) take a
         | daily toll on me, in terms of sleep, fatigue and my attention
         | span.
         | 
         | I'm lucky to have been very healthy in my life other than that,
         | but I feel that I could have done so much better if I didn't
         | have that invisible medical issue affecting me every day.
        
         | agumonkey wrote:
         | not knowing is one thing, not taking things just a bit
         | seriously is a breach of medical professionalism. it's very
         | common sadly
        
           | thewebcount wrote:
           | Exactly. If your doctor tells you that your symptoms are
           | probably just anxiety, find another doctor. (Yes, anxiety is
           | a real thing, but it's used way too often to dismiss symptoms
           | a doctor doesn't understand.)
        
             | agumonkey wrote:
             | Even if it's anxiety, as a doctor, give something tangible,
             | if you know the inner workings of the body, you can point
             | at improvements. Not just "in your head, bye"
        
         | Calavar wrote:
         | > nobody has said, "We should consider looking at your DNA to
         | see what's up here. I'm really interested and want to figure
         | this out with you."
         | 
         | The vast majority of doctors don't have the expertise or
         | resources needed to do that. A doctor can't write a script for
         | whole genome sequencing just to see what turns up - it will be
         | rejected by insurance 100% of the time because that's going
         | outside the scope of standard practice. And even if they did
         | manage to sequencing done and a novel mutation popped up, there
         | isn't anything to do with that treatment-wise. The next step
         | would be going back to the lab, synthesizing mutant RNA and/or
         | peptide sequences and studying their properties. And it would
         | likely take years for that to translate into knowledge that is
         | clinically useful.
         | 
         | If you want that kind of care, you need a large, academic
         | hospital that has an ultraspecialist with an active and well
         | funded research program in the relevant area. They can cover
         | the costs of nonstandard tests out of their research funds. And
         | if unusual findings pop up, they have the equipment/resources
         | to follow that up with further studies.
        
           | PragmaticPulp wrote:
           | > A doctor can't write a script for whole genome sequencing
           | just to see what turns up - it will be rejected by insurance
           | 100% of the time because that's going outside the scope of
           | standard practice.
           | 
           | To be clear, doctors frequently requisition genetic tests for
           | suspected conditions when the test is justifiable and
           | actionable. If you are demonstrating symptoms of a specific
           | condition and genetic testing can be part of the diagnostic
           | process, you can generally get it covered and performed.
           | 
           | However, getting a whole genome sequence and then scrolling
           | through the results isn't as actionable as it sounds. You can
           | do it yourself for under $500 if you really want. A lot of
           | people have gone down this route and been surprised at how
           | little signal you actually get out of the data, unless you
           | have a rare and significant variation.
        
             | FollowingTheDao wrote:
             | > To be clear, doctors frequently requisition genetic tests
             | for suspected conditions.
             | 
             | No, they do not. I have been fighting for this for 20
             | years. I ended up finding my own genetic issue (23andme)
             | myself and they STILL do not care. They would rather let me
             | rot on disability and homelessness.
        
               | WFHRenaissance wrote:
               | Are you Canadian or something?
        
               | atdrummond wrote:
               | May I ask where you are located, roughly?
               | 
               | YMMV but I was given genetics tests for my leukaemia,
               | polycythemia vera and Crohns. All were routine.
               | 
               | I actually had more issues getting a thiopurine
               | metabolites test ordered than I did with any of my
               | genetic tests.
        
               | astrange wrote:
               | 23andme is not a medical-grade genetics test. Finding a
               | very rare genetic mutation in it isn't convincing unless
               | you get a specific test for it or do 1000x WGS.
        
               | PragmaticPulp wrote:
               | Genetic testing for specific diagnosable and treatable
               | conditions are extremely common in the medical world.
               | 
               | For example, the BRCA gene test is commonly given to
               | people with elevated familial risk of breast cancer.
               | 
               | They do not go searching through entire genomes for any
               | possible variant, though.
               | 
               | > I ended up finding my own genetic issue (23andme)
               | myself and they STILL do not care. They would rather let
               | me rot on disability and homelessness.
               | 
               | Your other comments said you diagnosed yourself with PNP
               | deficiency. This is generally a fatal condition in
               | infants and adolescence unless treated early with
               | hematopoietic stem cell transplantation.
               | 
               | I wouldn't rely on 23andMe's SNP analysis as a genetic
               | diagnosis of anything, especially disorders which are
               | fatal in adolescence. 23andMe has been known to mis-mark
               | certain SNPs at various times in the past, and it's not
               | guaranteed 100% accurate.
               | 
               | Is it possible that you were a carrier, but not
               | homogenous for the variant? The condition is autosomal
               | recessive, meaning you would need to inherit flawed
               | copies from both parents. Having a single bad copy could
               | show up in 23andMe but would not indicate that you have
               | the condition.
               | 
               | To put it in perspective, the number of cases of PNP
               | known to the literature in the entire world is less than
               | 100.
        
               | FollowingTheDao wrote:
               | >Your other comments said you diagnosed yourself with PNP
               | deficiency. This is generally a fatal condition in
               | infants and adolescence unless treated early with
               | hematopoietic stem cell transplantation.
               | 
               | Just stop please. Why do you think I do not know what I
               | am talking about? How long have you researched this gene
               | and have you talked to people who are actively involved
               | in researching this?
               | 
               | Only certain p[polymorphisms are fatal for infants. There
               | are plenty of us living with partial PNP deficiency.
               | 
               | https://pubmed.ncbi.nlm.nih.gov/32695102/
               | 
               | Conclusions: Patients with partial PNP deficiency can
               | present in the third decade of life with mild-moderate
               | immune abnormalities and typical development. Near-normal
               | immunity might be achieved with relatively low PNP
               | activity.
               | 
               | > Is it possible that you were a carrier, but homogenous
               | for the variant? There are many genetic alterations which
               | do not manifest as disease unless you inherit a broken
               | copy from both parents.
               | 
               | I am homozygous for four variants known to effect T
               | Cells. There is not only one polymorphism that can reduce
               | enzyme activity,
               | 
               | rs1049562 rs1049564 -
               | https://www.researchgate.net/figure/Purine-nucleoside-
               | phosph... rs1713421 rs1760931
        
               | PragmaticPulp wrote:
               | If you truly suspect this, it's worth exploring something
               | other than 23andMe.
               | 
               | 23andMe is useful, but not known for accuracy. Even their
               | datasets have known to include mislabeled SNPs in past
               | years.
               | 
               | > Only certain p[polymorphisms are fatal for infants.
               | There are plenty of us living with partial PNP
               | deficiency.
               | 
               | > https://pubmed.ncbi.nlm.nih.gov/32695102/
               | 
               | The finding in this paper is that partial PNP deficiency
               | produced normal development in 2 out of 3 siblings and
               | near-normal immune activity in the 3rd, despite having
               | only 8-11% of the normal PNP activity.
               | 
               | The takeaway is that partial PNP deficiency might, in
               | some cases, present with only mild-moderate immune
               | abnormalities or normal functioning.
        
         | 88913527 wrote:
         | This could be true for many professions. If I need some long-
         | tail obscure help (suppose, for example, my car was acting up
         | in a strange way the mechanic never had seen or heard of
         | before) I'd expect roughly the same set of reactions. Most
         | professionals are state machines that do X Y Z well. You throw
         | A B C at them and few will introspect deeply into it.
        
           | s1artibartfast wrote:
           | Exactly this. You have to run into an individual on the long
           | tail of mechanics that is uniquely curious about finding the
           | root cause, or throw enough money at them that they are
           | incentivized to track down the problem.
           | 
           | Doctors are no different than other humans. Your problem
           | isn't necessarily their problem.
        
             | mindslight wrote:
             | Sure, but coming at it from a programming/engineering
             | background, that is an extremely tough pill to swallow. If
             | I'm going to a "professional" and paying them $1k/hour,
             | _why the fuck aren 't_ they applying their full brain to
             | analyze my problem ? If we just expect front line doctors
             | to be mere rule-applying automatons that just take a few
             | pieces of input and produce outputs like "run standard test
             | A" and "apply standard antibiotic B", that's technician-
             | level work that should cost closer to mechanics' shop rates
             | - where it can't just be entirely replaced by automation
             | and self-service.
        
               | 88913527 wrote:
               | Doctors cost so much because there are artificial caps on
               | supply in the US. So much for the hippocratic oath of "do
               | no harm". Fewer doctors decreases access to the medical
               | system which undoubtedly causes harm.
        
               | nradov wrote:
               | The main cap on the supply of doctors is imposed by
               | limited Medicare funding for residency programs. Members
               | of Congress who control that funding aren't subject to
               | the Hippocratic Oath.
               | 
               | https://savegme.org/
        
         | CogitoCogito wrote:
         | How do you know you have an autoimmune disease? Did those
         | doctors diagnose you with one and then proceed not to take you
         | seriously?
        
           | dangero wrote:
           | My issues respond to immune system suppression drugs that are
           | ill advised for long term use like Prednisone.
        
           | minsc_and_boo wrote:
           | You typically show symptoms of autoimmune attacks, like
           | neuropathies, elevated WBCs in blood/CSF, protein in CSF,
           | inflammation biomarkers, etc. What becomes difficult is
           | determining what triggers the autoimmune attacks, as it could
           | be based on diet, stress, or any range of indeterminable
           | factors.
           | 
           | Providers typically are able to eliminate most of the _known_
           | autoimmune diseases, but for determining a new one, you need
           | a research team and many years.
        
         | janeway wrote:
         | I do clinical genomics. Highly recommend you to find a
         | university hospital that can do genomic analysis for you. The
         | IUIS IEI list has ~500 known genes that could be causal if you
         | have some variant in one of these genes. The key is a good
         | bioinformatic interpretation and clinical follow up.
         | 
         | There are even some good commercial options that might be able
         | to detect a causal variant. These guys can do it after order
         | via healthcare professional
         | https://blueprintgenetics.com/patients/?group=ordering-patie...
         | 
         | or these guys can do it from home; first the genome sequencing
         | and then the immune panel report
         | https://dantelabs.com/products/autoimmunity-panel
         | 
         | Likelihood of finding causal variants has doubled in last 5
         | years.
         | 
         | * IUIS page: https://iuis.org/committees/iei/
         | 
         | * latest version of gene list: https://static-
         | content.springer.com/esm/art%3A10.1007%2Fs108...
         | 
         | * from this paper:
         | https://link.springer.com/article/10.1007/s10875-022-01289-3
         | 
         | Great info also in IPOPI website https://ipopi.org/about-
         | ipopi/mission-and-objectives/
        
           | dangero wrote:
           | Thanks so much for this information I'm definitely going to
           | look into this.
        
             | janeway wrote:
             | Sorry, I added some links in an edit just now - in case you
             | missed them originally.
        
           | thewebcount wrote:
           | FWIW, I can second this. My spouse is currently in the
           | process of getting this done. Know up front that you'll have
           | to fight insurance about it. They won't want to pay for it
           | because they have no existing framework that says doing
           | genomic testing will in any way help whatever you have. (And
           | they're not wrong. It's entirely possible the genome
           | sequencing won't turn up anything useful.) My spouse's doctor
           | works at a university hospital as parent mentions.
           | 
           | The other thing to know is that even once you do get it set
           | up, it generally takes about 6 months before you get the
           | results and the consult with the geneticist. And because
           | there are multiple parties involved, everything moves
           | glacially and nobody knows what anybody else is doing. It's
           | frustrating, but I hope that it helps once it's finally
           | complete.
           | 
           | There are probably multiple companies that do this testing.
           | We ended up going with Variantyx[0] because our doctor works
           | with a geneticist who uses them.
           | 
           | [0] https://www.variantyx.com
        
             | PragmaticPulp wrote:
             | > My spouse is currently in the process of getting this
             | done. Know up front that you'll have to fight insurance
             | about it. They won't want to pay for it because they have
             | no existing framework that says doing genomic testing will
             | in any way help whatever you have. (And they're not wrong.
             | It's entirely possible the genome sequencing won't turn up
             | anything useful.)
             | 
             | The whole genome sequencing linked above is $200, plus more
             | if you want specific reports run against it (rather than
             | doing it with 3rd party tools).
             | 
             | $200 can still be a lot of money depending on the
             | circumstances, but for most of us with tech jobs I'd gladly
             | pay the $200 out of pocket and get it going right away
             | while waiting for the glacial process of getting insurance
             | and appointments coordinated.
        
           | FollowingTheDao wrote:
           | I wish it was this easy. I am on permanent disability. I have
           | PNP Deficiency which I discovered on my own through two
           | genetic tests.
           | 
           | https://rarediseases.info.nih.gov/diseases/4606/purine-
           | nucle...
           | 
           | https://mayoclinic.pure.elsevier.com/en/publications/lupus-a.
           | .. https://www.researchgate.net/figure/Purine-nucleoside-
           | phosph...
           | 
           | I suffered for years with a mood disorder which made them
           | think every thingw as all in my head. I have consistently low
           | WBC counts and not one doctor care sto look into it. I have
           | an immune deficiency but all they see is the mood disorder
           | brought on my the same gene polymorphism.
           | 
           | https://link.springer.com/article/10.1007/s40263-022-00934-0
           | https://link.springer.com/article/10.1007/s10875-011-9593-8
           | 
           | Thanks for that link to Dante, I might do it since it has PNP
           | on their list.
           | 
           | But I have found that very high dose zinc increases my WBC
           | and I think it is because it helps stimulate PNP
           | 
           | https://pubmed.ncbi.nlm.nih.gov/1906845/
           | https://academic.oup.com/nutritionreviews/article-
           | abstract/4...
           | 
           | But no one gives a sht about freaks like us. If they invested
           | $100k when I was first sick they would have saved the 20
           | years of money they gave me for diability. It is so idiotic I
           | hate it.
        
       | flobosg wrote:
       | Related: The journey of Bertrand, Matt Might's son, who became
       | the first patient ever diagnosed with NGLY1 deficiency -
       | https://bertrand.might.net/
        
       | orzig wrote:
       | I've been blessedly free of chronic illness myself, and found The
       | Deep Places to be a good window into the shortfalls of the
       | medical response (including being written off as nuts), even by
       | someone who should have a tremendous amount of privilege (White
       | male New York Times columnist)
       | 
       | https://www.goodreads.com/book/show/57341765-the-deep-places...
        
       | [deleted]
        
       | AnIdiotOnTheNet wrote:
       | Echoing others who are saying they can't imagine a doctor ever
       | going to these lengths, I might never have been diagnosed with
       | hypothyroidism if it hadn't been for an airport toll booth
       | attendant. I've told the story in full elsewhere, but the short
       | version is I saw doctors for two years who told my mother I was
       | just fat and lazy and needed to get outside more. I have since
       | encountered plenty of arrogant and dismissive doctors.
        
       | viksit wrote:
       | * in the US.
       | 
       | I find it a bit concerning when articles like this assume that
       | all 7 billion people have had the resources to get the kind of
       | check ups that would have their samples in a global database of
       | genetic mutations.
        
         | jaggederest wrote:
         | Well, at least for the kind of de novo mutation that the
         | article is talking about, it's vanishingly unlikely that anyone
         | has the same exact mutation. It looks at a cursory glance like
         | the gene in question is ~180k base pairs long, so the idea that
         | someone else also has this (potentially fatal) truncation in
         | the same spot is really unlikely. Especially if the mutation
         | would be fatal if it were misplaced a bit.
         | 
         | It's also a bit of misdirection, since the net effect is "half
         | of your PLCG2 expression is turned off", which is probably also
         | represented in that 60 similar patients the article talks
         | about. So it's technically true but almost certainly something
         | that other people have as far as a "half knockout of gene XYZ".
        
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