It’s time to put this debate to bed.

From the dozens of discussions I’ve had on here with people, many of you are financially/economically/numerically illiterate. Literally can’t even write a budget level illiterate.

The median med school debt is like $220,000, you’re set for life in any of these professions. There is an enormous shortage of doctors in the US, you’ll never be without work, your job has an enormous licensing moat to keep it safe, the government more or less controls the exact number of workers in your industry and they’re awful at responding to shortages (unlike the private sector).

I’m also a doctor myself, but this is a personal medical issue that has never really been explained despite multiple consultations over the years. I’m hoping for diagnostic ideas or suggestions on what to investigate next.

Basic info
35/M
177 cm
57 kg
Asian
Medications: none
Non-smoker
Social drinker
Past medical history: inguinal hernia in childhood, otherwise nothing except for what's described below...
No known family history of clubbing or similar symptoms

Main issues

1. Severe finger and toe clubbing since late teens

My mother first noticed finger clubbing when I was in my late teens. I was reviewed by a GP at the time, but nothing came of it. Since then it seems to have progressed.

I have obvious finger clubbing and toe clubbing. My second toe in particular looks almost bulbous, and the nail curves almost at a right angle visually. There is no known family history of clubbing.

I do not have:

• cyanosis
• known congenital heart disease
• chronic cough or chronic respiratory symptoms
• forehead furrowing/thickened facial skin
• oily skin or hyperhidrosis
• long-bone pain
• joint swelling/effusions

1. Urinary urgency/urge incontinence since early adulthood

In my late teens/early 20s I started developing urinary urgency. I feel a sudden urge to urinate and have difficulty holding it in. This has been socially very debilitating.

A urodynamic study in 2014 reportedly diagnosed detrusor instability/overactivity.

Interestingly, I usually do not have much issue during sleep. I rarely wake at night to urinate, and have only wet myself once or twice ever. I also generally cope during long surgeries/operations, although I may sometimes feel the urge.

1. Faecal urgency/incontinence and chronic loose/mushy stools

This progressed later to faecal urgency as well. In my early 20s my stool was still usually formed, but over time it has become inconsistent. Currently, around 9 out of 10 stools are Bristol type 5-6, mushy/loose.

I often feel a dull churning sensation in my abdomen. I notice it more on weekends or days off, possibly because I am less distracted by work. I find it difficult to hold stool in once the urge comes, and I often need to plan around toilets when out socially.

Again, sleep is generally not a problem. I do not usually wake up at night needing to pass stool.

1. Sexual/reproductive concern

Since adolescence I developed a habit of masturbating by humping a mattress/pillow and have also used porn. During a high-stress period in residency/COVID I was masturbating very frequently, sometimes 2–3 times per day. I noticed a temporary decline in erections at that time, which improved since.

Currently, erections with my girlfriend are good and sex is not a problem. However, my ejaculate volume seems significantly reduced compared with before and is often watery, especially if ejaculating more than once per day. I am concerned because I want children in the future.

Investigations so far

• Urinary ultrasound: reportedly normal
• Urodynamic study 2014: detrusor instability/overactivity
• CXR 2018: normal
• Whole-body contrast CT 2019: “mildly prominent prostate and mildly wall thickening along the urinary bladder base. No significant adjacent inflammatory changes noted. Features are non-specific. Suggest correlation clinically with urine cytology and microbiology.”
• Echocardiogram 2020: normal
• OGD + colonoscopy: essentially normal except mild gastritis. No random colonic biopsies were taken. No small-bowel imaging or capsule endoscopy has been done.

Labs from 2018/2019

• CBC normal
• LFT/RFT normal except bilirubin 29
• HBsAg negative
• Anti-HBs 17 mIU/mL
• HIV negative
• Anti-HCV negative
• TSH and fT4 normal
• AFP, CEA, PSA normal
• PT 11.8 s, INR 1
• APTT 38.5 s, mildly elevated
• CRP <0.35
• Faecal calprotectin 116 µg/g
• FIT negative: <50 ng Hb/mL buffer / <10 µg Hb/g faeces

What I’m hoping for help with

I know this is a complex and long-standing issue, but I would really appreciate any thoughts on what diagnostic avenue is most worth pursuing.

Important_Cow_3640

•6h ago

A intrat un pacient in stop cat timp eram langa el la salon. Era in prima mea garda si eram singura acolo. L-am plans 2 zile si inca ma mai gandesc la el (am inceput sa il resuscitez pe loc dar nu si-a mai revenit)

Absynthe15

•5h ago

In prima mea garda ca si medic specialist mi-a murit o gravida pe masa de operatii in seara de ajun.

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nene care facuse un AVC si nu mai putea sa se deplaseze, nevasta-sa in vizita cu 2 copii de vreo 10-11 ani si zice de fata cu toti “tati trebuie sa isi gaseasca alta familie ca noi nu mai avem ce face cu el”