Posted by Lieutenant John McCandless (Head Nurse) in Primary Sickbay- Private Consultations

Posted by Lieutenant John McCandless (Head Nurse) in Primary Sickbay- Private Consultations

Posted by Lieutenant Solal Segal (Oncology and Immunology) in Primary Sickbay- Private Consultations
Posted by… suppressed (26) by the Post Ghost! 👻
<snip>

At first Dira said nothing, but then she nodded. “Let’s keep going then,” she said softly. Myqian had a medical degree, but she residency had been in psychiatry. Still, she knew physiology enough to parse the potential problems they were facing.

Captain Myqian, CO

John raised an eyebrow. Hashimotos. Intriguing he thought as he listened to the next lot of required tests. John grabbed a second hypospray and walked over to Dira, ready to take more blood samples for the antibody tests.
“May I Captain?” He asked waited for permission to proceed.

Lt John McCandless, Head Nurse

Dira gestured with a flourish towards her arm. “By all means,” she said. At least she could sound neutral about the whole situation, even if inside, she was stressed. But answers were the goal, so she had to be open to the process.

Captain Myqian, CO

John placed the hypospray on Dira’s arm and drew the required blood again and walked over to the testing station. He ran the scan of the blood sample and waited patiently for the results. He was surprised that she was seemed so outwardly in control of her reaction to the news that she might have an autoimmune disease. He made a note to talk it about later when it would be more appropriate..
Lt John McCandless, Head Nurse

His surprise floated over her sense and Dira just watched as he took the sample. She wasn’t sure if she should say something, and as she had more or less reminded herself lately, just because she sense something or picked up on someone’s thoughts to easily, didn’t mean it was okay to let them know that. She chided herself for not wearing the headband Solomon made for her.

As the computer analyzed her blood, the antibody test results were very curious: there were negative for all the conditions they were testing for. Whatever it was, it wasn’t a specific autoimmune disease, even though it was making her body react as if it was.

Captain Myqian, CO

John looked at the results, if he was surprised before he was certainly was now. Dira would be able to feel it. He turned to Solal.
“Doctor, come and take a look these results.” He said thoughtfully wandering what the Doctor would think when he saw the negative results.

Lt. John McCandless, Head Nurse

Solal checked the results. “Well, Captain, you do not have hypothyroidism. I still find myself certain we’re looking at an autoimmune condition, but finding which one can be tricky. Unfortunately, which one plays a major role in treatment.” He thought a moment, “Are there any other symptoms you might have forgotten earlier? Perhaps even something minor you didn’t think worth mentioning?”

~ Solal

Dira steadied herself by taking a slow inhale. “I told you about the sleep issues, so um… ” She frowned, racking her brain for anything that she should mention. She went to say something and then stopped herself, frowning more deeply. “Well, I feel warm after a workout. But not the usual sort of heat that comes with exertion. Like really warm? But it goes away when I have a sonic or water shower and I just assumed it was the rest. But I also feel rather tired after those workouts too. Even doing the simple rehab exercises for my dislocated wrist and shoulder. The wrist required further surgery so I’ve been extra careful with it and doing the physical rehab I was prescribed.”

“And I know after the whole thing with Franks”-she waved her hand dismissively-“I was having some… issues, afterwards, but the anxiety and panic attacks have been… easily explained.

Captain Myqian, CO

John listened as Dira spoke, she hadn’t mentioned the sleep issues to him. He wrote it off as something her and Solal discussed before brining him in. He notice that she went to say something but didn’t. He made a note to ask her about that later. He listened to the rest of the symptoms. Could it be diabetes? He thought to himself. The symptoms sort of fit, but he wasn’t a Doctor so didn’t suggest it outright.
“Do you have any pins and needles or numbness in your feet or hands?” He asked.

Lt. John McCandless, Head Nurse

Dira shook her head. “No, nothing like that. Just the aches around my body, especially areas I’ve recently injured.”

Captain Myqian, CO

No nerve disorders, then. Connective tissue perhaps? But which one? “Feeling tired with exercise can be the fatigue. The warmth could be an autonomic nervous system problem, but it’s a reach…” Solal frowned. “How are your reflexes?”

~ Solal

Myqian blew out a breath. “I mean, fine? I guess. When I’m tired, obviously things are more difficult, but I don’t feel like things are impacting me in that way. Then again I haven’t exactly been doing range practice lately.”

Captain Myqian, CO

John listened intently to Dira, his thoughts racing trying to think what it could be. So far the only tests they’d done had been blood work, maybe a scan might show something? he thought. It was definitely a puzzle, they just had to fit all the pieces together. John turned to Solal.
“Is it worth doing a scan and or testing her reflexes Doctor?” John asked.

Lt. John McCandless, Head Nurse

“Do both,” Solal said to McCandless. “What we need is more information, and while testing randomly would be illogical, a scan and a quick reflex test do not take long and may give us relevant information - even if that information is we’re not on the right path.”

~ Solal

John nodded those were his thoughts exactly. More information was required.
“Aye Doctor.” He replied picking up a medical tricorder from the table and walked over to Dira.
“Captain, I’ll do the scan first. Then we’ll test your reflexes. Let’s see what’s going on.” He stated with a smile and began to scan Dira.

Lt. John McCandless, Head Nurse

She gave a small nod, and though she managed to smile back, it didn’t quite reach her dark eyes.

As the tricorder displayed her results, a few things would be of note when compared to her baseline:

-her cortisol levels were 30% higher than normal, not only indicating that she was stressed, but that her body itself was stressed. This could indicate an issue with her adrenal glands.
-her weight had dropped 6%, which might not be too much considering her previous good health, but was currently unexplained given her fatigue made exercising harder for her recently.
-it was brief, but it seemed that her heart beat was irregular beyond a single skipped beat, but then it went away.

As he did the scan, Dira braced her hand on the bed as if to hold herself up and closed her eyes. “There’s that dizziness again. It was only slight though.”

Captain Myqian, CO

John tapped the desk thoughtfully as the the scan results came in. The issue with her cortisol definitely could indicate adrenal issues. He immediately though cancer, but he had thought that had been ruled out. He could be wrong though. He turned to Solal.
“Doctor, the results of the scan are in.” He said handing Solal the medical tricorder.

He then noticed Dira and made to support her. Feeling concerned.
“Are you alright Captain? Please lie down.” He said.

Lt. John McCandless, Head Nurse

“I’m fine,” Dira said as she laid back down on the bed. “It passes relatively quickly.” And it did, though it was hard to say if it was because she was lying down or if the episode had passed.

Captain Myqian, CO

John nodded with relief, he didn’t want anything to happen to the Captain not on his watch. He turned to Doctor Solal.
“I wander what could be causing the the dizziness? An irregular heart rate combined increased cortisol levels. An adrenal gland issue perhaps?” He asked out loud hoping Doctor Solal would have some ideas.

Lt John McCandless, Head Nurse

“Dizziness can be caused by a myriad of things.” Solal told John, shaking his head. “It’s possible, but without other adrenal symptoms, I’m hesitant to consider it. Did her blood pressure drop when she became dizzy?”

~ Solal

The readings showed her blood pressure was stable. The arrhythmia seemed to be its own thing apparently causing the dizziness.

John turned to Solal.
“Her blood pressure was stable. It would seem most likely that the arrythmia is isolated to everything else. Maybe we should rule out the dizziness as a symptom?” He asked lost in thought.

“No. Throw out a symptom, throw out a piece of the puzzle. It’s related,” Solal replied firmly.

John nodded and looked away briefly raising an eyebrow at Solal’s tone.
“Aye Doctor.” He replied flatly.

“Sometimes I get sweaty with the dizziness, but that’s been hard to isolate because of work outs. But like I said, I’ve bene doing less of those lately,” Dira said in a rather stoic manner. Not everyone knew her super well, but the general impression most of the crew had of their captain was that she was warm and approachable. If anything, the woman lying on the biobed seemed more timid.

Captain Myqian, CO

John pondered for a while trying to think. Then he remembered something.

“Captain, you’re Halian and Betazoid. Perhaps whatever it is, is related to that?” He suggested more bluntly than he would like but he didn’t really have any other ideas.

“I don’t know. The only complication I’ve ever had from my mixed heritage is that my telepathy has been harder to filter than either species typically experience. I have a way to handle that externally now, but as far as I know I haven’t had any other issues. Though my immune system can be a bit funny. I get really sick with some things and not at all with others, but I’m generally ill so rarely,” Myqian said.

“I also wondered if we should do a more in depth scan. So far the scans and tests have been superficial.” He suggested.

Lt. John McCandless, Head Nurse

“It is possible your ethnicity has something to do with it,” Solal agreed. “But that doesn’t change that nothing useable has shown up in tests.” He turned to John, “If nothing shows up in superficial tests, it is exceedingly unlikely a more in depth - and likely more invasive - test, would show anything more useful.”

~ Solal

Dira sighed in frustration and pushed herself slowly upwards. “Then if there is nothing else to be gained right now, I should get back to work.”

Captain Myqian, CO

John nodded in agreement with the Captain.
“It seems like we’ve covered everything we need to Captain. Although I’m sure Doctor Solal and I will have much to deliberate on.” He stated looking over to Solal.

Lt. John McCandless, Head Nurse

Solal nodded. “I apologize we have been unable to find concrete answers, Captain. I assure you, research and deliberation of this case with Nurse McCandless will be my top priority.”

~ Solal

Slipping off the biobed, Myqian noded. “I know. And I didn’t expect answers immediately.” Though a small part of her had hoped for answers, or at least something that was obvious enough. “The symptoms have been all so random, so I get it. I appreciate both your efforts. If you need me to return, just call.”

She gave both a nod and then slipped out of the exam room, her posture and demeanour that of a captain utterly in control.

Captain Myqian, CO

John gave a small smile and a slight nod back as the Captain left the room. He paced around thinking, trying to put the puzzle together. He turned to Solal.
“Well, I’m stumped.” He said. “Any suggestions?”

Lt. John McCandless, Head Nurse

Solal led McCandles into his office. “Alright so far we have nothing conclusive, but your scans show something is going on. The change in her cortisol levels could be caused by Adrenal or pituitary gland tumors, steroid medications or Familial cushing syndrome.”

John followed Solal into his office listening intently as he walked next to him.

“Her drop in weight could be several things: cancer, diabetes, overactive thyroid, infections, inflammatory conditions, Addison’s disease, amyloidosis, copd, chron’s disease, HIV, ulcer, TB, blood imblances, parasitic infections, pancreatitis, parkinson’s disease.”

“Her heart rate could be a sign of a problem with her sinoatrial node. Autoimmune myocarditis and Lupus can cause these problems as well. There is a portion of Lupus patients who test negative on the ANA, so we need to run more specific tests for that, just to rule it out.”

“I’ve heard it’s never Lupus though.” He stated with a smirk but nodded just the same.

“Let us not take medical advice from old-Earth fiction, shall we?” Solal replied with all the no-nonsenseness expected of a Vulcan.

“Let’s give the captain a small break. Then get her back in here and we’ll test for all those things. I’m interested in knowing your thoughts though. You’ve been a nurse for some time and I’m sure you have some observations of your own.”

~ Solal

John sighed as he paced around the office thinking. All of those conditions were a lot to test for.
“You think each symptom is unrelated? I do wander if its something related to her being Haliian and Betazoid? It might be worth checking the database to see if anyone else of those species has displayed similar symptoms. It might throw up suggestions or narrow down our search. There are a lot of things to test for.”
“My initial thoughts went to Cushing’s but not all the symptoms really fit to that.” John sighed as he thought away. “The Captain did say her immune system can be funny.” John continued to think while he waited for Solal to respond.

Lt John McCandless, Head Nurse

“Occam’s Razor suggests they are related,” Solal replied. “Having unrelated conditions would be quite a coincidence.” He nodded, “Please, do, search for anything similar or related in both species. Also search for any other known Haliian/Betazoid crosses. “The symptoms don’t align with Cushing’s. I will allow a Cushing’s test if you can find any way to logically explain it.”

~ Solal

John nodded he had clearly misunderstood Solal. He took some notes on a padd just to make sure he had everything that he needed.
“Is there anything else you’d like me to look into while I’m doing the search? Might as well do everything we can.” John replied.

Lt Joh McCandless, Head Nurse

<Bump>

Solal considered it, “Search the symptoms outside the scope as well, anything that matches this presentation. As a measure of caution in case we are on the wrong track.”

~ Solal