The Medical Detectives

Episode: Lori’s Story – Let Her Eat Cake

Date: September 10, 2025
Hosts: Dr. Erin Nance & Anna O’Brien
Guest: Lori

Brief Overview

In this gripping episode of The Medical Detectives, hosts Dr. Erin Nance and Anna O’Brien guide listeners through Lori’s astonishing twelve-year medical odyssey. After the birth of her second child, Lori develops perplexing digestive symptoms that are repeatedly dismissed by healthcare professionals. Her journey is emblematic of the challenges many women face when advocating for their health, especially postpartum. Lori’s perseverance ultimately yields a diagnosis of achalasia, a rare esophageal motility disorder, but not before she endures years of pain, malnutrition, and self-doubt. The episode spotlights medical misdiagnosis, healthcare disparities for women, the power of self-advocacy, and the emotional toll of chronic illness.

Key Discussion Points & Insights

1. Lori’s Background & Onset of Symptoms

Healthy Start: Lori was a lifelong athlete, runner, and successful professional before symptoms began ([02:01]).
Initial Episode: Two weeks after her second child’s birth, Lori is jolted awake by stabbing chest pain. She initially attributes it to postpartum bodily changes ([02:41]).
Intermittent Symptoms: The chest pain recurs sporadically over months, at times relieved by drinking water. The pain is severe, migrates from jaw to chest, and can last hours ([03:31]).
No Other Symptoms: No accompanying nausea, sweating, or shortness of breath—just unpredictable, excruciating pain ([05:14]).

2. Delayed Medical Attention & Dismissal

Caregiver Burdens: Lori delays seeking care due to busy motherhood, husband’s work schedule, and belief doctors won’t catch it due to infrequency ([05:46], [07:43]).
Missed Warning Signs: Dr. Nance highlights the danger of dismissing postpartum chest pain, which can sometimes indicate life-threatening embolisms ([06:12]).

“If something kind of comes and then it goes, you're like, oh, that was nothing... And you're in a bit of the denial phase… you have now adapted to it.”
- Dr. Nance [07:06]
“Every mother I know has this fierce tenacity to be able to just ignore their needs...”
- Anna [07:43]

3. Symptom Evolution & Initial Misdiagnoses

Swallowing Difficulties: Two years in, Lori struggles to swallow certain foods, e.g., dry or dense items ([08:08]).
Medical Consultation: At a checkup, an internist refers her to a GI specialist who rushes her through an endoscopy and diagnoses reflux, prescribing a proton pump inhibitor without thorough investigation ([10:00]).
Dismissal & Gaslighting: The GI’s PA downplays her concerns with statements like “some patients are just sicker than others,” leading Lori to feel unheard and minimized ([11:30]).

“What I heard was, I'm wasting your time… That really stuck with me.”
- Lori [11:46]
Reluctant Perseverance: Lori tries the medication (omeprazole), but it’s ineffective. She stops taking it ([11:46]).

4. Escalating Symptoms & Continued Frustration

Self-Education: Lori learns from online research that she may be having esophageal spasms; finds some relief with peppermint and heat, but pain persists ([13:35], [14:14]).
Normalized Distress: She adjusts her lifestyle around her symptoms, slowly realizing how much she has adapted as the disorder intensifies ([15:04]).

“It wasn't normal, but it was my normal, so I didn't really even notice.”
- Lori [14:36]
First Severe Choking Episode: Twelve years later, Lori can’t swallow food or water, triggering true fear and prompting renewed medical pursuit ([15:56]).

5. Seeking New Care – More Dismissal and Alternative Medicine

Another Endoscopy, Another Dismissal: The new GI doctor finds a minor esophageal stricture, dilates it, and offers little follow-up plan ([17:58]).
Functional Medicine Detour: Frustrated, Lori tries alternative medicine. She’s diagnosed (without evidence) with anxiety linked to menopause and urged toward expensive hormone treatment and a restrictive diet, which doesn’t fit her situation ([19:38]).

“That was completely not helpful.”
- Lori [20:08]
Hosts' Reflection: Dr. Nance and Anna discuss patient tendency to try alternative medicine after repeated failures in the traditional system ([20:10]–[22:15]).

“I never fault anyone for trying. And listen, a lot of people... have had lots of success with these alternative medical doctors... But I see it as kind of part of the pathway of misdiagnosis.”
- Dr. Nance [20:10]

6. The Power (and Pitfalls) of Self-Advocacy

Researching Providers: Lori realizes the importance of vetting specialists and checking reviews—which she hadn’t done initially ([22:29]).
Healthcare System Constraints: The hosts discuss challenges of insurance networks and referral pathways, and the necessity—and privilege—of seeking second opinions ([23:18]).

“If you don't think your doctor's listening to you, find a new doctor.”
- Anna [21:46]

7. Finally—A Breakthrough and the Correct Diagnosis

Hope through Media: Lori reads about achalasia and feels, for the first time, “heard” ([26:09]).
Key Encounter: A PA asks her to describe her pain—something no provider had done in 12 years. This leads to a prescription for hyocyamine, which provides relief ([26:09]).
Proper Testing: An esophageal manometry and barium swallow finally reveal classic achalasia and the characteristic “bird’s beak” appearance on imaging ([36:57]).

“As soon as I typed ‘achalasia’ and read the description, it was like—I am not crazy. I was heard.”
- Lori [26:09]
“The PA… said something no one had said to me in 12 years: Can you describe the pain to me?”
- Lori [26:09]
Emotional Validation: For Lori, getting a concrete diagnosis brings relief and validation, despite the daunting implications ([37:57]).

“I knew this was not a fun diagnosis, but I had an answer… I knew I wasn’t crazy.”
- Lori [37:57]

8. Treatment, Recovery, and Reflection

Surgical Decision: Lori chooses a Heller myotomy with fundoplication—an invasive yet long-term surgical solution—over a less invasive “POEM” procedure ([47:42]).
Obstacles to Care: Prolonged delays between diagnosis and surgery, malnutrition, and emotional distress dominate the months preceding her operation. Lori is nearly forced to adopt tube feeding ([42:17]).
Breakthrough Procedure: After advocating for herself (and with the right doctor), Lori receives the surgery, which immediately restores her ability to swallow ([51:10]–[53:34]).

“He was great… He said: I can save your life, I can change your life, I can give you your quality of life back.”
- Lori [43:11]
Symbolic Recovery: Lori’s first real meal is her daughter’s birthday cake, marking a literal and metaphorical return to life ([54:16]).

“It was my daughter’s 14th birthday and it was birthday cake… I took one bite… and it went down and it stayed down and it felt so good.”
- Lori [54:16]

9. Thematic Discussions & Takeaways

Mothers Neglecting Their Health: The episode highlights how mothers often de-prioritize their health needs due to caregiving responsibilities, with Anna and Dr. Nance reflecting on personal and societal tendencies ([66:46]).

“There's value in taking care of yourself so that you can be at your best to help take care of others.”
- Anna [67:34]
Malnutrition & Healthcare Fails: Dr. Nance emphasizes that extended malnutrition is unacceptable in modern healthcare, highlighting available interventions like TPN (total parenteral nutrition) ([55:47]).

“Your description of your malnourished state is unacceptable… There are methods of getting this nutrition.”
- Dr. Nance [55:47]
Difficulty of Diagnosis: The complexity and duration of Lori’s diagnostic process mirrors many women’s experience—particularly in “uncommon” diseases and when symptoms overlap with anxiety or depression ([63:32]).

“The more I do this show, the more I realize… one of our biggest problems with the medical system now is just communication between specialties.”
- Anna [63:32]
Self-Advocacy Lessons: Lori encourages listeners not to give up, to seek second opinions, and to lean on loved ones when advocating for themselves ([65:02]).

“I would hope that even if someone doesn't have this condition, the things I learned… would apply to other things.”
- Lori [65:02]

Notable Quotes & Memorable Moments

[07:43] Anna:
“Every mother I know has this fierce tenacity to just ignore their needs… usually it's the mom's needs to be very real.”
[11:46] Lori:
“What I heard was, I'm wasting your time… That really stuck with me.”
[26:09] Lori:
“The PA… said something no one had said to me in 12 years: Can you describe the pain to me?”
[37:57] Lori:
“I knew I wasn’t crazy. …I had an answer. …This is something that’s treatable.”
[43:11] Lori:
“He was great… He said: I can save your life, I can change your life, I can give you your quality of life back.”
[54:16] Lori:
“It was my daughter’s 14th birthday and it was birthday cake… I took one bite… and it went down and it stayed down and it felt so good.”
[55:47] Dr. Nance:
“Your description of your malnourished state is unacceptable… There are methods of getting this nutrition.”

Timestamps for Important Segments

| Time | Segment/Topic | |-----------|------------------------------------------------------| | 02:01 | Lori’s healthy baseline and early postpartum episode | | 05:46 | Delays in seeking care—parenting & societal factors | | 06:12 | Risks of postpartum chest pain—need for vigilance | | 08:08 | Dysphagia symptoms appear | | 10:00 | First GI consultation and dismissal | | 11:46 | The “some patients are sicker” moment—gaslighting | | 13:35 | Lori self-diagnoses esophageal spasms online | | 15:56 | Severe escalation: food and water stuck | | 17:58 | Second GI, more dismissal, stricture dilation | | 19:38 | Alternative medicine detour, misdiagnosis of anxiety | | 22:29 | Reflection on researching doctors/checking reviews | | 26:09 | Reads about achalasia, finally feels “heard” | | 36:57 | Classic “bird’s beak” on barium swallow confirms Dx | | 42:17 | Chronic malnutrition, emotional breakdown | | 51:10 | Undergoes surgery (Heller myotomy/fundoplication) | | 54:16 | First post-op meal: daughter’s birthday cake | | 63:32 | Hosts reflect on the maze of specialist care | | 65:02 | Lori’s lessons on advocacy transfer beyond illness |

Final Reflections: Themes and Lessons

The Invisibility of Women’s Pain: Lori’s journey is a powerful warning about dismissing women’s symptoms, especially in postpartum, and the implicit expectation that mothers must sideline their health.
Importance of Advocacy and Second Opinions: Persistence is vital. The first answer is not always the right one.
Systemic Healthcare Hurdles: Insurance constraints, poor communication between specialists, and lack of continuity in care delay diagnosis and compound suffering.
Relief in Diagnosis: A correct diagnosis is not just the gateway to treatment—it is a deliverance from self-doubt and gaslighting.
Celebrating Small Victories: Sometimes, eating cake is more than a meal—it’s a reclaiming of life.
Support Systems Matter: Both for practical needs during illness and emotional resilience.

For Listeners Who Haven’t Heard the Episode:

This episode walks the listener through every twist and frustration of Lori’s story—from her athletic healthy life, to her mysterious and life-altering symptoms, the many false leads, the power of finally being heard, and her ultimate return to health with a single piece of birthday cake. If you’ve ever been ignored or dismissed in a medical crisis, or found the system bewildering and lonely, Lori’s hard-won lessons—and the hosts’ compassionate, expert insights—will resonate deeply and equip you with tools for your own journey.

Note: Skipped all advertisements, show credits, and disclaimers as per instructions.

The Medical Detectives

Episode: Lori’s Story – Let Her Eat Cake

Date: September 10, 2025
Hosts: Dr. Erin Nance & Anna O’Brien
Guest: Lori

Brief Overview

Key Discussion Points & Insights

1. Lori’s Background & Onset of Symptoms

Healthy Start: Lori was a lifelong athlete, runner, and successful professional before symptoms began ([02:01]).
Initial Episode: Two weeks after her second child’s birth, Lori is jolted awake by stabbing chest pain. She initially attributes it to postpartum bodily changes ([02:41]).
Intermittent Symptoms: The chest pain recurs sporadically over months, at times relieved by drinking water. The pain is severe, migrates from jaw to chest, and can last hours ([03:31]).
No Other Symptoms: No accompanying nausea, sweating, or shortness of breath—just unpredictable, excruciating pain ([05:14]).

2. Delayed Medical Attention & Dismissal

Caregiver Burdens: Lori delays seeking care due to busy motherhood, husband’s work schedule, and belief doctors won’t catch it due to infrequency ([05:46], [07:43]).
Missed Warning Signs: Dr. Nance highlights the danger of dismissing postpartum chest pain, which can sometimes indicate life-threatening embolisms ([06:12]).

“If something kind of comes and then it goes, you're like, oh, that was nothing... And you're in a bit of the denial phase… you have now adapted to it.”
- Dr. Nance [07:06]
“Every mother I know has this fierce tenacity to be able to just ignore their needs...”
- Anna [07:43]

3. Symptom Evolution & Initial Misdiagnoses

Swallowing Difficulties: Two years in, Lori struggles to swallow certain foods, e.g., dry or dense items ([08:08]).
Medical Consultation: At a checkup, an internist refers her to a GI specialist who rushes her through an endoscopy and diagnoses reflux, prescribing a proton pump inhibitor without thorough investigation ([10:00]).
Dismissal & Gaslighting: The GI’s PA downplays her concerns with statements like “some patients are just sicker than others,” leading Lori to feel unheard and minimized ([11:30]).

“What I heard was, I'm wasting your time… That really stuck with me.”
- Lori [11:46]
Reluctant Perseverance: Lori tries the medication (omeprazole), but it’s ineffective. She stops taking it ([11:46]).

4. Escalating Symptoms & Continued Frustration

Self-Education: Lori learns from online research that she may be having esophageal spasms; finds some relief with peppermint and heat, but pain persists ([13:35], [14:14]).
Normalized Distress: She adjusts her lifestyle around her symptoms, slowly realizing how much she has adapted as the disorder intensifies ([15:04]).

“It wasn't normal, but it was my normal, so I didn't really even notice.”
- Lori [14:36]
First Severe Choking Episode: Twelve years later, Lori can’t swallow food or water, triggering true fear and prompting renewed medical pursuit ([15:56]).

5. Seeking New Care – More Dismissal and Alternative Medicine

Another Endoscopy, Another Dismissal: The new GI doctor finds a minor esophageal stricture, dilates it, and offers little follow-up plan ([17:58]).
Functional Medicine Detour: Frustrated, Lori tries alternative medicine. She’s diagnosed (without evidence) with anxiety linked to menopause and urged toward expensive hormone treatment and a restrictive diet, which doesn’t fit her situation ([19:38]).

“That was completely not helpful.”
- Lori [20:08]
Hosts' Reflection: Dr. Nance and Anna discuss patient tendency to try alternative medicine after repeated failures in the traditional system ([20:10]–[22:15]).

“I never fault anyone for trying. And listen, a lot of people... have had lots of success with these alternative medical doctors... But I see it as kind of part of the pathway of misdiagnosis.”
- Dr. Nance [20:10]

6. The Power (and Pitfalls) of Self-Advocacy

Researching Providers: Lori realizes the importance of vetting specialists and checking reviews—which she hadn’t done initially ([22:29]).
Healthcare System Constraints: The hosts discuss challenges of insurance networks and referral pathways, and the necessity—and privilege—of seeking second opinions ([23:18]).

“If you don't think your doctor's listening to you, find a new doctor.”
- Anna [21:46]

7. Finally—A Breakthrough and the Correct Diagnosis

Hope through Media: Lori reads about achalasia and feels, for the first time, “heard” ([26:09]).
Key Encounter: A PA asks her to describe her pain—something no provider had done in 12 years. This leads to a prescription for hyocyamine, which provides relief ([26:09]).
Proper Testing: An esophageal manometry and barium swallow finally reveal classic achalasia and the characteristic “bird’s beak” appearance on imaging ([36:57]).

“As soon as I typed ‘achalasia’ and read the description, it was like—I am not crazy. I was heard.”
- Lori [26:09]
“The PA… said something no one had said to me in 12 years: Can you describe the pain to me?”
- Lori [26:09]
Emotional Validation: For Lori, getting a concrete diagnosis brings relief and validation, despite the daunting implications ([37:57]).

“I knew this was not a fun diagnosis, but I had an answer… I knew I wasn’t crazy.”
- Lori [37:57]

8. Treatment, Recovery, and Reflection

Surgical Decision: Lori chooses a Heller myotomy with fundoplication—an invasive yet long-term surgical solution—over a less invasive “POEM” procedure ([47:42]).
Obstacles to Care: Prolonged delays between diagnosis and surgery, malnutrition, and emotional distress dominate the months preceding her operation. Lori is nearly forced to adopt tube feeding ([42:17]).
Breakthrough Procedure: After advocating for herself (and with the right doctor), Lori receives the surgery, which immediately restores her ability to swallow ([51:10]–[53:34]).

“He was great… He said: I can save your life, I can change your life, I can give you your quality of life back.”
- Lori [43:11]
Symbolic Recovery: Lori’s first real meal is her daughter’s birthday cake, marking a literal and metaphorical return to life ([54:16]).

“It was my daughter’s 14th birthday and it was birthday cake… I took one bite… and it went down and it stayed down and it felt so good.”
- Lori [54:16]

9. Thematic Discussions & Takeaways

Mothers Neglecting Their Health: The episode highlights how mothers often de-prioritize their health needs due to caregiving responsibilities, with Anna and Dr. Nance reflecting on personal and societal tendencies ([66:46]).

“There's value in taking care of yourself so that you can be at your best to help take care of others.”
- Anna [67:34]
Malnutrition & Healthcare Fails: Dr. Nance emphasizes that extended malnutrition is unacceptable in modern healthcare, highlighting available interventions like TPN (total parenteral nutrition) ([55:47]).

“Your description of your malnourished state is unacceptable… There are methods of getting this nutrition.”
- Dr. Nance [55:47]
Difficulty of Diagnosis: The complexity and duration of Lori’s diagnostic process mirrors many women’s experience—particularly in “uncommon” diseases and when symptoms overlap with anxiety or depression ([63:32]).

“The more I do this show, the more I realize… one of our biggest problems with the medical system now is just communication between specialties.”
- Anna [63:32]
Self-Advocacy Lessons: Lori encourages listeners not to give up, to seek second opinions, and to lean on loved ones when advocating for themselves ([65:02]).

“I would hope that even if someone doesn't have this condition, the things I learned… would apply to other things.”
- Lori [65:02]

Notable Quotes & Memorable Moments

[07:43] Anna:
“Every mother I know has this fierce tenacity to just ignore their needs… usually it's the mom's needs to be very real.”
[11:46] Lori:
“What I heard was, I'm wasting your time… That really stuck with me.”
[26:09] Lori:
“The PA… said something no one had said to me in 12 years: Can you describe the pain to me?”
[37:57] Lori:
“I knew I wasn’t crazy. …I had an answer. …This is something that’s treatable.”
[43:11] Lori:
“He was great… He said: I can save your life, I can change your life, I can give you your quality of life back.”
[54:16] Lori:
“It was my daughter’s 14th birthday and it was birthday cake… I took one bite… and it went down and it stayed down and it felt so good.”
[55:47] Dr. Nance:
“Your description of your malnourished state is unacceptable… There are methods of getting this nutrition.”

Timestamps for Important Segments

Final Reflections: Themes and Lessons

The Invisibility of Women’s Pain: Lori’s journey is a powerful warning about dismissing women’s symptoms, especially in postpartum, and the implicit expectation that mothers must sideline their health.
Importance of Advocacy and Second Opinions: Persistence is vital. The first answer is not always the right one.
Systemic Healthcare Hurdles: Insurance constraints, poor communication between specialists, and lack of continuity in care delay diagnosis and compound suffering.
Relief in Diagnosis: A correct diagnosis is not just the gateway to treatment—it is a deliverance from self-doubt and gaslighting.
Celebrating Small Victories: Sometimes, eating cake is more than a meal—it’s a reclaiming of life.
Support Systems Matter: Both for practical needs during illness and emotional resilience.

For Listeners Who Haven’t Heard the Episode:

Note: Skipped all advertisements, show credits, and disclaimers as per instructions.

wavePod

Lori's Story: Let Her Eat Cake

Powered by Wave AI

Summary

The Medical Detectives

Episode: Lori’s Story – Let Her Eat Cake

Brief Overview

Key Discussion Points & Insights

1. Lori’s Background & Onset of Symptoms

2. Delayed Medical Attention & Dismissal

3. Symptom Evolution & Initial Misdiagnoses

4. Escalating Symptoms & Continued Frustration

5. Seeking New Care – More Dismissal and Alternative Medicine

6. The Power (and Pitfalls) of Self-Advocacy

7. Finally—A Breakthrough and the Correct Diagnosis

8. Treatment, Recovery, and Reflection

9. Thematic Discussions & Takeaways

Notable Quotes & Memorable Moments

Timestamps for Important Segments

Final Reflections: Themes and Lessons

For Listeners Who Haven’t Heard the Episode:

Summary

The Medical Detectives

Episode: Lori’s Story – Let Her Eat Cake

Brief Overview

Key Discussion Points & Insights

1. Lori’s Background & Onset of Symptoms

2. Delayed Medical Attention & Dismissal

3. Symptom Evolution & Initial Misdiagnoses

4. Escalating Symptoms & Continued Frustration

5. Seeking New Care – More Dismissal and Alternative Medicine

6. The Power (and Pitfalls) of Self-Advocacy

7. Finally—A Breakthrough and the Correct Diagnosis

8. Treatment, Recovery, and Reflection

9. Thematic Discussions & Takeaways

Notable Quotes & Memorable Moments

Timestamps for Important Segments

Final Reflections: Themes and Lessons

For Listeners Who Haven’t Heard the Episode: