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The Question:
D.M. is a 25-year-old healthy man who, one day for no apparent reason, began
to notice tingling on the right side of his face. Then, the tingling
stopped but he began to notice that the right side of his face was drooping
-- his eyelid sagged on that side, and he was unable to close it. The
corner of his mouth drooped, and he had a hard time keeping food or saliva
from coming out the corner of his mouth. The skin of his face felt normal
to touch. He had no headache, no change in his vision, no confusion or
disorientation, and except for the facial weakness felt well.
His doctor asked him about any recent unusual health problems. There were none that he could remember, except that he had noticed that after his summer vacation on the island of Nantucket he had returned home with a funny rash and some aches and pains that went away within a few weeks, without any treatment. Until his facial weakness started, he had felt fine.
Questions:
Last Week's Answer:
The answer is Lyme disease.
Named for Lyme, Connecticut where the disease was first described in the late 1970s, Lyme disease is due to an infection by an organism that is transmitted by ticks. These "deer ticks," so named because they are often (but not exclusively) found on deer, are tiny -- about the size of the head of a pin. Therefore, it can be very easy to not notice when they have latched on to the skin. As it turns out, Nantucket Island has the highest incidence of Lyme disease of any place in the world.
The earliest symptoms are a red rash, usually surrounding the site where the tick is (or was). Then there are flu-like symptoms of fevers, fatigue, and aches and pains. This is the first stage of illness, and goes away whether you are treated or not.
If not recognized and treated in the first stage, there are a number of symptoms that can occur weeks to months later as part of the second stage. It was at this point that our puzzler-patient developed what many of you recognized as "Bells' palsy". This is a condition where the seventh cranial nerve, the nerve that controls all muscle movement on one side or the other of your face, becomes injured (usually temporarily). This caused all the muscles of the right side of his face to become weak and to droop. Lyme disease is one of the most important causes of Bell's palsy in otherwise healthy people.
Plus, the answer to the bonus question: "How did the Greeks diagnose diabetes?"
It is said that the ancient Greeks were able to diagnose diabetes by tasting the urine for sweetness (when the blood sugar gets very high, it spills into the urine.)
One of our answerers suggested testing to see if ants were atttracted to the urine. It's a great answer, although I don't know if it's true.
Unfortunately, there was nothing the Greeks, or anyone else for that matter, could do about the disease. It wasn't until the middle of this century that insulin was discovered, and diabetics could actually be treated.
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