As mentioned in the video, if one of the manifestations of a "failure to thrive presentation" is unusually prominent relative to the others, I would frame the illness around that manifestation - particularly if weight loss or cognitive decline. Likewise, if the history, exam, or key labs identifies something abnormal, that should be explored. For example, abdominal imaging and LP are not indicated for the vast majority of patients with FTT...however, if a patient presented with FTT + severe N/V, or presented with FTT + prominent confusion + fever, those studies would be likely indicated in those individuals. And although SPEP and UPEP are not indicated for most patients, if the key labs identified anemia, elevated creatinine, and hypercalcemia, SPEP and UPEP would almost certainly be indicated at that point. In summary, identifying a patient is presenting with the failure to thrive syndrome is the beginning of the diagnostic evaluation, not the end!
Great video! I'm a Psychiatrist and have been consulted on several patients with this diagnosis that turned out to be catatonia! It most often co-occurs with another mental health diagnosis (doesn't have to be schizophrenia as previously thought), and is diagnosed via the Bush Francis Catatonia rating scale and positive Ativan challenge (resolution of symptoms 10-30min after 2mg IV or IM Ativan administration).
On unnecessary labs, that seems to generally be a very popular alt med approach, including to its patients, I think mainly because the odds of finding "something" to point to is strictly equal or greater than with fewer labs. And FtT sounds like the kind of condition someone would be more likely to see an alt practitioner for. Placebo effect isn't "fake," and so some lab finding's putative basis as a "target" for treatment is apparently worth spending lots of money without any evidentiary basis. Mistrust of institutions is probably part of it ("doctors won't tell you this"), but in fair charity I think it's more that people just want something, anything, to explain symptoms and provide hope. An interesting contrast because physicians' ordering of many marginally useful labs, as you tell it (I'm not one), sounds more like it's for the physicians' peace of mind.
As mentioned in the video, if one of the manifestations of a "failure to thrive presentation" is unusually prominent relative to the others, I would frame the illness around that manifestation - particularly if weight loss or cognitive decline. Likewise, if the history, exam, or key labs identifies something abnormal, that should be explored. For example, abdominal imaging and LP are not indicated for the vast majority of patients with FTT...however, if a patient presented with FTT + severe N/V, or presented with FTT + prominent confusion + fever, those studies would be likely indicated in those individuals. And although SPEP and UPEP are not indicated for most patients, if the key labs identified anemia, elevated creatinine, and hypercalcemia, SPEP and UPEP would almost certainly be indicated at that point.
In summary, identifying a patient is presenting with the failure to thrive syndrome is the beginning of the diagnostic evaluation, not the end!
Great video! I'm a Psychiatrist and have been consulted on several patients with this diagnosis that turned out to be catatonia! It most often co-occurs with another mental health diagnosis (doesn't have to be schizophrenia as previously thought), and is diagnosed via the Bush Francis Catatonia rating scale and positive Ativan challenge (resolution of symptoms 10-30min after 2mg IV or IM Ativan administration).
Thanks for the comment - catatonia is a good addition to the list of etiologies to consider!
On unnecessary labs, that seems to generally be a very popular alt med approach, including to its patients, I think mainly because the odds of finding "something" to point to is strictly equal or greater than with fewer labs. And FtT sounds like the kind of condition someone would be more likely to see an alt practitioner for. Placebo effect isn't "fake," and so some lab finding's putative basis as a "target" for treatment is apparently worth spending lots of money without any evidentiary basis. Mistrust of institutions is probably part of it ("doctors won't tell you this"), but in fair charity I think it's more that people just want something, anything, to explain symptoms and provide hope.
An interesting contrast because physicians' ordering of many marginally useful labs, as you tell it (I'm not one), sounds more like it's for the physicians' peace of mind.
This covers the majority of Reddit.
GOD BLESS YOU (i'm an atheist but still)