STF

Side Sim: The Confounding Symptoms

Posted Nov. 18, 2022, 6:21 p.m. by Lieutenant Solal Segal (Oncology and Immunology) (Lucas Foxley)

Posted by Lieutenant Commander Alexis Bonner (Assistant Chief Medical Officer) in Side Sim: The Confounding Symptoms

Posted by Lieutenant Solal Segal (Oncology and Immunology) in Side Sim: The Confounding Symptoms

Posted by Lieutenant Commander Alexis Bonner (Assistant Chief Medical Officer) in Side Sim: The Confounding Symptoms
Posted by… suppressed (9) by the Post Ghost! 👻

(snip)
Solal shook his head and gestured at the computer. “Can’t focus. Too tired.” The tone of his voice gave away his frustration which was unusual for him. “I’m cough trying to write a letter cough to V’alura.” He took a sip of the water and then, “She has been unwell lately.”

~ Solal

Alexis sat down on a stool. Normally she wouldn’t offer, but the subject of V’alura was difficult for Solal and he had confided in her before. “Would you like help with it?” Alexis blinked slowly at him once, her brain racing along far too many tangents. Even Alexis couldn’t have said what prompted the unusual interest in a stranger. “I am sorry to hear she was sick. What was wrong?”

Bonner

The tests showed immune response around his lungs, mostly fighting the pneumonia, but there was some damage to the lungs in the process. The more abnormal result was the concentration of immune response around his kidneys, which had absolutely nothing to do with the infection. It had been noted that he had not asked for help reaching the rest room very many times, a symptom that might have gone unnoticed had he not been in sickbay.

Alexis got up and walked over to a quieter area of sickbay. “Devick,” Bonner called out and waited for the nurse to come over. “I want a Serum creatinine, GFR, and BUN blood tests. I want a CT scan of his kidneys. Then a urinalysis, urine protein, Microalbuminuria, and ACR. When I’m done get started on those.” Devick nodded and hurried off to prep for the different tests.

His medical history was extensively detailed with dates of childhood vaccinations and illnesses, as well as how the illnesses were treated and how long they lasted. Childhood injuries serious enough to require a visit to a doctor were also listed along any treatment used. He was overall a rather healthy child, with no hospitalisations or major illnesses. No abnormalities were noted.

To Alexis’ interest would be the results of a 23 year old genetic test - running common debilitating genetic diseases, like Huntington’s, Parkinson’s, Alzheimer’s, Bendii syndrome, among others. All negative. It also listed his exact genetics: he was indeed 50/50 Vulcan/Human, there was a region of Vulcan listed as his likely origin and several earth regions, mostly Scandinavian and western European. Notably, unlike his adoptive parents, the results showed scarcely little French heritage. But that was all the genetic testing that was done. It was general and fairly vague. The Segals had seen little point in doing more than that.

Later in the day Alexis sat down to look over the information. She scanned every single detail included in the genetic study. The test was looking for specific things, and it often happened that the doctors missed other things because they weren’t looking for it. Then she made a subspace connection to the Vulcan Medical Council to see what they knew about the general genetics and health of people from the region it was concluded Solal’s family was from. She then did the same with Earth. Most she knew, but it didn’t hurt to double check.

On the Vulcan side, there were a number of genetic conditions known to affect that region, but Alexis could screen out any of them that required both parents to be a carrier, since Solal’s biologic mother was human, and out of the remaining only one was autoimmune and it was a connective tissues disease, affecting the muscles more than internal organs.

The human side came up with nothing matching the symptoms at all, at least nothing known for being abnormally prevalent in the region he was from.

Solal was complaining of being tired and his mixed genetics could alter how diseases affected him. She ordered a test for the connective tissues disease anyway.

Solal hesitated a long moment and then nodded. The letter was already late and he didn’t want to worry V’alura. If he tried to write it, it might not be sent until he was over this infection. He thought about Alexis’ question for a moment. “She was… tired. And she was getting ill more.” He was trying to remember but his mind did not want to focus. “In her last letter, from what she wrote, I believe she was having shortness of breath. I figured she was coming down with a flu.” The truth was, by now, she was sicker than Solal was. Unfortunately, information could only be conveyed so quickly with letters.

~ Solal

Alexis’ brain kind of exploded at that point and was running too many scenarios to count. She had several things to look into, when she was done speaking with Solal. She turned the computer and began to type for him, when the date of V’alura’s letter caught her attention. “Solal…how long have you been having trouble staying on task?”

Bonner

The letter was dated for a week and a half ago. Solal thought back. Besides his difficulty meditating, which had started in the last four or five days, he hadn’t noticed how bad his focus was. “Four days?” He guessed. “My meditations have been lacking in productivity for that long.” There was, again, frustration in his voice. He was still able to meditate, but it wasn’t as effective, and it was getting worse.

~ Solal

Alexis nodded. She remembered though that the first set of autoimmune tests they ran was very very haphazard, and just little things here and there were suddenly tallying up. “Well you are quite sick. I’m sure you’ll be able to return to more productive meditation once you’re better.” But what when that would be, Alexis had no idea. “What would you like to say to V’alura?”

Bonner

Solal relayed his thoughts to Alexis so she could help him write the letter. It was mostly that he hoped she was getting better, and news about his own condition… News he seemed to be watering down a little so he wouldn’t worry her. He said he’d visited sickbay, but not that he had to stay. His sentences were punctuated with coughs. As he spoke, he ran his hands over Frigga’s fur, the dog still laying over his legs. When he was telling Alexis how to finish the letter, he had another major coughing fit.

Frigga stayed with Solal attempting to give her friend comfort. Alexis dutifully typed up all of his thoughts and then sent off the letter for him. When he had caught his breath as best he could. “Solal, I’ve been monitoring your lymphatic system, as you know, as well as the activity of your white blood cells. Your immune system is attacking your kidneys. And the nurses have noted that your output is not what would be expected. We’re going to run some more tests and see if we can figure out why your kidneys are being targeted.”

Solal nodded. It was comforting for him to fall back on logic, and so he spit out a reply based in logic: “Attacking the kidneys is a signature characteristic of cough systemic lupus. Mixed heritage may affect the way the disease acts.” It was well within his own specialty, and unlike the… eclectic list he had offered a few weeks before, made sense as a suggestion. The meds Alexis had given were clearly helping, the frequency of his coughs and especially his severe coughing fits had gone down.

Alexis’s test for the connective tissue disease was negative, though it was a good move to test it anyway. The nurse came by to do the tests Alexis had ordered: Blood tests, a CT scan of his upper abdomen, and urine samples. Kidney tests. Solal had done them enough on patients.

The kidney test results were made available to Alexis as soon as they came in. The lab report were as follows:
Serum Creatinine: 1.8 and rising.
GFR: 40.
BUN: 30 and rising.
CT: [included are the scans themselves] No blockages, no deformities or abnormalities, no kidney stones. Contrast not used due to unknown extent of kidney damage at time of test.
Urinalysis with Urine Protein dip test: Dip test positive for protein, urinalysis shows no crystallization or other abnormalities.
Microalbuminuria: Positive for albumin.
ACR: 103.
Overall it was concluded on the results that these results were indicative that his kidneys were not functioning as they should, and that they may be declining in function. Vulcan kidneys were highly efficient, retaining more than 50% of water intake, making Vulcan urine pungent and rich with minerals and waste products. When the kidneys were not functioning as they should, it put a Vulcan at high risk for dehydration due to the decrease in efficiency leading to higher water loss through urination. Solal’s recent caffeine habit wouldn’t have helped - while Vulcans did not get the mental effects, it could still work as a diuretic.

~ Solal

“Devick make sure you push more fluids. If we need to set up an infusion unit let’s do it. His body needs to pass more fluid and we have to stop him from becoming dehydrated.” After informing Solal of his results she went back to her office, leaving Frigga to watch over him. She was researching all possible causes for kidneys to malfunction and shut down and what tests needed to be run.

Bonner

Along with the concern of dehydration, his kidneys weren’t filtering his blood as well as they were supposed to, and if they began to function much worse, his body would need help filtering the blood, or waste would begin to build up in the bloodstream and cause toxicity. Solal shook his head. “I’ll try to drink the water before we do an infusion unit.” And then Alexis left, leaving Frigga behind on his lap. Secretly, he was glad she let the dog stay. Frigga was a small comfort in a lonely sickbay at a scary time. He was lucky he could still tune out the usual commotions of sickbay.

~ Solal

Alexis poured through the database and the collection of medical texts in her office. With her memory she knew all of this, but she never left things to chance incase she happened to not know some small detail. Solal was not diabetic nor did he suffer from high blood pressure. He did not smoke or drink alcohol and the CT scan ruled out kidney stones and polycystic kidney disease. She didn’t think it was nephrotic syndrome but she ordered the urine and blood tests for those as well. She included tests for IgA nephropathy and Lupis (it was never Lupis, until it was).

Bonner

The tests for nephrotic syndrome was negative. IgA nephropathy was also negative. The ANA test for lupus was negative.

The next day it seemed Solal’s pneumonia hadn’t gotten worse, which meant he might be starting to get better, the infection shortened by the early catch and antibiotic treatment.

~ Solal

Alexis sat down on the stool next to his biobed. Frigga was with her again and hoped up on the bed without an invitation. “Solal, all your tests came back negative, but your kidneys are continuing to fail. When you are over the pneumonia I want to do a biopsy. Normally I wouldn’t wait, but I don’t want to put more strain on your body.”

Solal took a breath as long as he could manage without coughing and opened his eyes to look up at her when he heard the stool. He had clearly been asleep. He patted Frigga gently when she hopped up. “Getting over the cough pneumonia could take cough a week.” He sat up a little and took a sip of water. “What if my kidneys don’t have a week?” His voice was soft, groggy, and hoarse from coughing.

Alexis nodded, “That is a major concern. Any procedure carries risk, but given how ill you are, we must take that into account. The decision, of course, is yours to make.”

Solal nodded. “We can wait.” He paused to have a small coughing fit, then, “I trust your judgement.”

Alexis looked quite serious. She knew Solal was having trouble staying awake, talking, and concentrating and she had the patience to wait. “You said you were having trouble concentrating and meditating. I looked back over your workload for the last few months, your reports and such. Solal, I need you to think back. Really think and be honest. How long have you been having trouble concentrating? It could be lack of focus, or intense mental focus making you tired or a lack of desire to do the work.”

Bonner

Solal took a long moment to think. His first thought was he loved his work, he always wanted to do it, but he realized that wasn’t exactly what she meant. She might’ve thought he fell back to sleep before he finally answered, “Two months… A little longer, possibly.” He patted the dog again, “Remember when I asked you about the benefits of keeping pets?”

~ Solal

“I do remember.” She tapped a stylus against her leg, a clear sign she was deep in thought. “Two months, the time other symptoms were beginning to show…” Meningitis, encephalitis and brain abscesses all affected energy and cognitive ability. Solal didn’t have all the symptoms but he was half Vulcan, and they reacted differently to the diseases. Only one was autoimmune though - Autoimmune Encephalitis. “Solal we’re going to run a neurological panel and an EEG. Then we’re going to test you for Autoimmune Encephalitis. We’ll let you get some sleep and eat between though.”

Bonner

Solal nodded again. “I’m still having the trouble sleeping.” It was odd to say, considering how much sleeping he was doing, but it was because he was sick. The trouble sleeping was still there, keeping his sleep light and making it take longer to get to sleep.

The EEG was normal, which meant there was no brain damage, brain tumors, or seizures happening, but the neurological panel showed decreased function in parts of the brain that would make sense for his symptoms, in the areas responsible for focus and cognition, as well as the brain’s sleep regulation center.

~ Solal


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