Summary of "Ep. 78 | The Unbearable Itch" from MrBallen’s Medical Mysteries

Introduction

In Episode 78, titled "The Unbearable Itch," MrBallen delves into the harrowing medical journey of Sandy McKinnon, whose relentless scalp itch spiraled into a life-threatening condition. This episode masterfully intertwines elements of medical mystery, psychological struggle, and the quest for understanding the human body's enigmatic responses.

Sandy McKinnon's Background

Sandy McKinnon, a 38-year-old woman from Boston, Massachusetts, had a tumultuous past that set the stage for her medical ordeal. Five years prior, Sandy was a professional psychologist and a devoted mother of two. However, a painful divorce led her down a path of self-destruction, including alcohol abuse and heroin addiction. This period culminated in Sandy contracting HIV from a contaminated needle, prompting her to overcome her addiction and rebuild her life. Despite being HIV positive with a weakened immune system, Sandy had been sober for two years and was striving to regain stability.

The Onset of the Unbearable Itch

The late 1990s marked the beginning of Sandy's distress. One morning, while preparing for work, she noticed blisters on her scalp, reminiscent of a previous shingles outbreak—a condition she experienced due to her compromised immune system. Dr. John Douglas diagnosed her with shingles again and prescribed antiviral medication, providing initial relief. However, a new, persistent itch emerged, one that felt as though it originated from within her head.

Mr. Ballin [02:58]: "This episode is called the Unbearable Itch."

Sandy's attempts to alleviate the sensation proved futile, leading her to endure sleepless nights and escalating discomfort.

Medical Responses and Escalation

As the itch intensified, Sandy sought further medical advice. Dr. Douglas attributed the itch to various skin conditions but found nothing abnormal on her scalp beyond the fading shingles blisters. He hypothesized a possible psychiatric condition, specifically trichotillomania—an obsessive-compulsive disorder characterized by an irresistible urge to pull out one's hair.

Dr. Douglas [08:30]: "Itching was actually a very common symptom, but beyond the fading shingles blisters, he wasn't seeing anything abnormal on her scalp."

Despite Sandy's skepticism about having an OCD-related condition, Dr. Douglas prescribed antidepressants aimed at managing her compulsive behavior. The situation worsened when Sandy discovered blood and damaged hair on her pillow, revealing that her scratching had led to severe scalp injuries.

Emergency hospitalization became inevitable as her condition-threatening scalp infection threatened to reach her brain.

Hospitalization and Surgical Interventions

In the hospital, Sandy underwent emergency surgery to address the infected scalp wounds. A neurosurgeon revealed the gravity of her condition:

Neurosurgeon [23:15]: "The greenish goo was infected cerebrospinal fluid... we had to get her to the operating room before Sandy suffered extensive and lasting brain damage."

Post-surgery, while under anesthesia, the itch briefly subsided. However, upon waking, the itch returned with renewed intensity, rendering her unable to resist the urge to scratch. Attempts to manage it with medication and restraints only provided temporary relief, leaving Sandy both physically injured and psychologically distressed.

Neurological Insights and a New Perspective

Enter Dr. Mary Evans, a neurologist brought in to reevaluate Sandy's case. Observing that Sandy couldn't feel physical sensations in the itchy area despite the intense itch, Dr. Evans suspected a neurological anomaly rather than a purely psychiatric one.

Dr. Evans [18:45]: "Sandy couldn't feel any physical sensation when someone touched her wound, and yet the wound was itchy to her. That shouldn't be possible."

After administering a local anesthetic that momentarily alleviated the itch, Dr. Evans's suspicions deepened. A biopsy revealed that 96% of the nerve fibers in Sandy's itchy skin patch were destroyed, leading to the conclusion that her brain was erroneously signaling an itch in an area devoid of functional nerve cells.

Proposed Surgical Solution and Its Aftermath

A neurosurgeon proposed severing the main sensory nerve connecting Sandy's scalp to her brain, hypothesizing that this could eliminate the phantom itch. Despite the risks, including potential loss of sensation, Sandy consented, driven by desperation to end her unbearable condition.

Post-surgery, the itch initially vanished for two weeks but soon returned with greater intensity. Traditional treatments failed, and Sandy found herself bedridden, partially paralyzed from repeated self-inflicted injuries, and confined to a wheelchair. Her quality of life deteriorated as the itch overshadowed her daily existence.

A Glimmer of Hope: Dr. Atul Gawande's Intervention

Nine years later, Sandy encountered Dr. Atul Gawande, a renowned medical writer, seeking insight into her condition. He introduced the concept of sensor syndrome, likening it to phantom limb pain—a condition where amputees feel sensations in limbs that no longer exist.

Dr. Gawande proposed a novel mirror therapy, inspired by treatments for phantom limb pain. This therapy involves using mirrors to trick the brain into perceiving sensory input accurately, potentially resetting the brain's faulty itch signals.

Dr. Gawande [30:50]: "The mirrors made their brains see what they needed to see to think that their arms and legs were fine."

Although promising, Sandy's participation in this therapy remains undocumented, leaving her ultimate fate and whether the itch was ever resolved uncertain.

Conclusion

"The Unbearable Itch" encapsulates the intricate dance between neurology and psychiatry, highlighting the challenges in diagnosing and treating conditions that straddle the line between the mind and the body. Sandy McKinnon's story underscores the profound impact chronic, unexplained symptoms can have on an individual's life and the medical community's ongoing quest to unravel such mysteries.

Notable Quotes

• Mr. Ballin [02:58]: "This episode is called the Unbearable Itch."
• Dr. Douglas [08:30]: "Itching was actually a very common symptom, but beyond the fading shingles blisters, he wasn't seeing anything abnormal on her scalp."
• Neurosurgeon [23:15]: "The greenish goo was infected cerebrospinal fluid... we had to get her to the operating room before Sandy suffered extensive and lasting brain damage."
• Dr. Evans [18:45]: "Sandy couldn't feel any physical sensation when someone touched her wound, and yet the wound was itchy to her. That shouldn't be possible."
• Dr. Gawande [30:50]: "The mirrors made their brains see what they needed to see to think that their arms and legs were fine."

This comprehensive summary encapsulates Sandy McKinnon's distressing journey through medical uncertainty, the interplay between different medical specialties, and the elusive search for relief from an inexplicable and debilitating symptom.