Second Opinion Syndrome Clinic
A syndrome is a set of medical signs and symptoms and can be associated with a specific disease. In many syndromes, however, many conditions and diseases may trigger or cause the symptom complex. In other syndromes, the underlying cause is unknown.
We try to make the dots connect and see if treatment can be improved in:
- Chronic fatigue syndrome (systemic exertion intolerance disease)
- Chronic prostatitis (Type III)
- Complex regional pain syndrome
- Cyclic vomiting syndrome
- Ehlers-Danlos syndrome (EDS)
- EDS commonly coexists in postural orthostatic tachycardia and mast cell activation syndromes
- Interstitial cystitis (without Hunner's ulcers)
- Mast cell activation syndrome (MCAS)
- Postural orthostatic tachycardia syndrome (POTS)
- Restless legs syndrome
How can I get help for my syndrome or condition?
- Call 314-997-0554 x102 to get an appointment.
- Leonard Weinstock, MD and Trisha Myers, PA-C will see you for a second opinion.
- Two additional follow up visits will be offered.
- This is meant to give you new ideas but we will not to take over your long-term care.
If you live too far away, please look for a Integrative Medicine Care Provider.
Mast Cell Activation Syndrome
What are the diagnostic criteria, symptoms and the effects of mast cell activation syndrome?
This is a complex disorder that needs to be managed by a team which can include an allergist and gastroenterologist. Please note that Dr. Weinstock has an interest in this syndrome but owing to time schedule and other factors, will only be able to add a new MCAS patients a few at a time and the waiting list for Dr. Weinstock is long.
Major Diagnostic Criteria for MCAS:
- Classic symptoms of mast cell activation in ≥2 organ systems (skin, cardiovascular, nose, respiratory, GI, ocular, and/or history of anaphylaxis)
Minor Diagnostic Criteria for MCAS:
- Response to MC therapy
- Evidence of increased MC mediators
- Focal or disseminated increased MC in BM and/or GI tract (CD117-, tryptase-, and CD25-MC express CD2 and/or CD25)
- Spindle-shaped morphology in >25% of MC
Complex Regional Pain Syndrome
What are the diagnostic criteria, symptoms and the effects of complex regional pain syndrome?
Video of a CRPS patient
- Continuing pain, which is disproportionate to any inciting event
- Must report at least one symptom in three of the four following categories:
- Sensory: hyperalgesia (abnormally increased sensitivity to pain) and/or allodynia (pain caused by something which does not normally provoke pain)
- Vasomotor: temperature asymmetry and/or skin color changes and/or skin color asymmetry
- Sudomotor/Edema: edema and/or sweating changes and/or sweating asymmetry
- Motor/Trophic: decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)
- Must display at least one sign at time of evaluation in two or more of the following categories
- Sensory: Evidence of hyperalgesia (to pinprick) and/or allodynia (to light touch and/or deep somatic pressure and/or joint movement)
- Vasomotor: Evidence of temperature asymmetry and/or skin color changes and/or asymmetry
- Sudomotor/Edema: Evidence of edema and/or sweating changes and/or sweating asymmetry
- Motor/Trophic: Evidence of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)
- There is no other diagnosis that better explains the signs and symptoms
Cyclic Vomiting Syndrome
What are the diagnostic criteria, symptoms and the effects of cyclic vomiting syndrome?
Cyclic vomiting syndrome is characterized by recurrent periods of intense nausea and vomiting lasting hours to days, with symptom-free periods between episodes lasting weeks to months. It is a diagnosis of exclusion and must be supported by negative laboratory, radiographic, and endoscopic testing.
Must include all of the following criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis:
- Stereotypical episodes of vomiting regarding onset (acute) and duration (less than 1 week)
- Three or more discrete episodes in the prior year
- Absence of nausea and vomiting between episodes in the prior year
Supportive criterion: personal history or family history of migraine headaches
Ehlers-Danlos Syndrome (Hypermobility Type)
What are the diagnostic criteria, symptoms and the effects of Ehlers-Danlos syndrome (hypermobility type)?
Major Diagnostic Criteria for the Hypermobility Type of EDS:
- Joint hypermobility, which usually is confirmed by a score of five or more on the nine-point Beighton scale [Beighton et al 1973], including:
- One point for passive dorsiflexion of each fifth finger >90Âº
- One point for passive apposition of each thumb to the flexor surface of the forearm
- One point for hyperextension of each elbow >10Âº
- One point for ability to place the palms on the floor with the knees fully extended
- Soft or velvety skin with normal or slightly increased extensibility
- Skin hyperextensibility is assessed at a site lacking excess or loose skin and without evidence of prior trauma by gently pulling until resistance is met. Extensor surfaces of joints should not be used because of the presence of excess skin. An ideal location is the volar surface of the forearm, where the upper limit of normal is approximately 1-1.5 cm.
- Absence of skin or soft tissue fragility, which is suggestive of other types of EDS. Examples include:
- Spontaneous or easily induced skin cuts or tears
- Spontaneous or easily induced tears or ruptures of tendons, ligaments, vessels, or other internal organs
- Atrophic ("cigarette paper") scars (although mildly atrophic scars are sometimes seen in the hypermobility type, especially in areas subject to physical stress, such as extensor surfaces and the abdominal wall)
- Molluscoid pseudotumors
- Surgical complications, such as incisional hernia, wound dehiscence, or sutures tearing through tissues and failing to hold
Minor Diagnostic Criteria for the Hypermobility Type of EDS
- Family history of similar features without significant skin or soft tissue fragility in a pattern consistent with autosomal dominant inheritance
- Recurrent joint dislocations or subluxations
- Chronic joint or limb pain
- Easy bruising
- Functional bowel disorders (functional gastritis, irritable bowel syndrome)
- Neurally mediated hypotension or postural orthostatic tachycardia
- High, narrow palate
- Dental crowding
Interstitial Cystitis without Hunner's Ulcers
What are the diagnostic criteria, symptoms and the effects of interstitial cystitis without Hunner's ulcers?
Interstitial cystitis is a clinical syndrome characterized by daytime and nighttime urinary frequency, urgency, and pelvic pain. It has no clear etiology or pathophysiology, and diagnostic criteria for the syndrome remain undefined.
It is often described as an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms (urinary frequency or urgency) of more than six weeks duration, in the absence of infection or other identifiable causes.
Restless Legs Syndrome
What are the diagnostic criteria, symptoms and the effects of restless legs syndrome?
All of the following diagnostic criteria must be met:
- An urge to move the legs usually but not always accompanied by or felt to be caused by uncomfortable and unpleasant sensations in the legs.
- The urge to move the legs and any accompanying unpleasant sensations begin or worsen during periods of rest of inactivity such as lying down or sitting.
- The urge to move the legs and any accompanying unpleasant sensations are partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues.
- The urge to move the legs and any accompanying unpleasant sensations during rest or inactivity only occur or are worse in the evening or night than during the day.
- The occurrence of the above features are not solely accounted for as symptoms primary to another medical or behavioral condition (e.g. myalgia, venous stasis, leg edema, arthritis, leg cramps, positional discomfort, or habitual foot tapping).
The frequency of symptoms varies considerably, and is defined as chronic-persistent or intermittent, as follows:
- Chronic-persistent RLS: Symptoms, when not treated, occur on average at least twice weekly for the past year.
- Intermittent RLS: Symptoms, when not treated, occur on average less than twice a week for the past year, with at least 5 lifetime events.
The symptoms of RLS cause significant distress or impairment in social, occupational, educational, or other important areas of functioning by the impact on sleep, energy/vitality, daily activities, behavior, cognition, or mood.
What are the diagnostic criteria, symptoms and the effects of rosacea?
The presence of one or more of the following signs with a central face distribution is indicative of rosacea.
- Flushing (transient erythema) – a history of frequent blushing or flushing is common.
- Nontransient erythema – persistent redness of the facial skin is the most common sign of rosacea.
- Papules and pustules – dome-shaped red bumps with or without accompanying pustules, often in crops, are typical.
- Telangiectasia – dilation of capillaries, which causes them to appear as small red or purple clusters, often spidery in appearance, on the skin are common but not necessary for a rosacea diagnosis.
The following signs and symptoms often appear with one or more of the primary features of rosacea, but in some patients can occur independently. The presence of 1 or more secondary features together with primary feature(s) may be indicative of the disorder:
- Burning or stinging – especially on central facial skin.
- Plaque – elevated red plaques.
- Dry appearance – central facial skin may be rough and scaling.
- Edema – may accompany or follow prolonged facial erythema or flushing.
- Ocular manifestations – are common, and include symptoms of burning, itching, and lid inflammation. Styes, chalazia, and corneal damage may occur in many patients with rosacea.
- Peripheral location – rosacea has been reported to occur in peripheral locations, and may or may not be accompanied by facial manifestations.
- Phymatous changes – these can include patulous follicles, skin thickening or fibrosis, and a bulbous appearance. Rhinophyma (phymatous changes of the nose) is the most common form.
Type III Chronic Prostatitis
What are the diagnostic criteria, symptoms and the effects of type III chronic prostatitis?
Prostatitis is a condition that involves inflammation of the prostate and sometimes the area around it. Chronic prostatitis/chronic pelvic pain syndrome, is the most common type of prostatitis. The exact cause of this non-bacterial prostatitis condition is unknown. However, the disease could stem from persistent infection, inflammation and/or pelvic muscle spasms.
Chronic prostatitis/chronic pelvic pain syndrome can be described as persistent relapsing pain or discomfort in any of the following areas:
- Perineum – between the rectum and the testicles
- Tip of the penis
- Below the waist, in the pubic or bladder area
Some of the functional symptoms include:
- Pain or burning during urination
- Pain or discomfort after ejaculation
- A sensation of pain in the lower back and upper legs
- A sensation of pain in the groin and above the bladder
- A sensation of pain or burning high up in the penis
- A sensation of incomplete bladder emptying
- Decreased libido
Other symptoms frequently reported include:
- Fatigue, sometimes to the point of being bedridden
- Discolored semen (yellowish, from dead white blood cells â€“ a sign of inflammation)
- Impaired memory/difficulty concentrating
- Painful lymph nodes
Postural Orthostatic Tachycardia Syndrome
What are the diagnostic criteria, symptoms and the effects of postural orthostatic tachycardia syndrome?
This is a complex disorder that needs to be managed by a team which can include a neurologist, cardiologist and gastroenterologist. Please note that Dr. Weinstock has an interest in this syndrome but owing to time schedule and other factors, will only be able to add a new POTS patients a few at a time and the waiting list for Dr. Weinstock is long.
Diagnostic Criteria for POTS:
- Increase in heart rate (pulse) from the lying down position to standing position by 30 beats per minute in adults and 40 in children
- Increase in norepinephrine levels during the lying down position to standing position
- See educational PowerPoint presentations
- See list of POTS symptoms and severity score form (Excel file download)
- See Dr. Weinstock's approach to treatment of POTS (PDF download)