A man of forty-nine, told his diagnosis would kill him, arrived looking for a deeper insight than the drugs could offer. The label was real. Behind it lay a range of causes no label could name.
The patient is a forty-nine-year-old man of Indian descent. He was admitted to hospital in 2016 for kidney and bladder stones. During the operation the prostate was traumatised, and afterwards he found it difficult to pass urine. He was prescribed an alpha-1 adrenergic blocking agent. Soon after this he developed weakness of both legs below the knees.
All tests were normal apart from a low serum B12. The weakness persisted. He was hospitalised again in 2017; an MRI of the brain and a CT of the thymus were normal, and again all blood tests showed no evidence of disease apart from the B12 deficiency. Despite this, a diagnosis of myasthenia gravis was made, and he was placed on a sequence of powerful drugs — with lots of side-effects, and rising liver enzymes. When the weakness reached his eye muscles and the neurologist suggested increasing the dose, he read about the drug and decided not to take it.
