Postural orthostatic tachycardia syndrome (POTS) occurring during treatment for breast cancer.

Postural orthostatic tachycardia syndrome (POTS) is a common condition of orthostatic intolerance in response to changes in position. We report a case of a middle-aged woman presenting with a new onset of POTS likely due to chemotherapy for treatment of breast cancer. She was started on a trial of a beta blocker, which was effective in controlling her symptoms and heart rate. The objective of this report was to encourage clinicians to consider POTS as a differential diagnosis, while managing patients with symptoms of orthostatic intolerance.

Absent monofilament sensation in a type 2 diabetic feet.

Neuropathy is a common complication which can affect up to 90% of patients with diabetes mellitus. Asymptomatic neuropathy is a common presentation. We present a case that emphasises the importance of foot screening in people with diabetes. It also highlights that patient education is key to prevent development of foot ulceration which can lead to amputations. In addition, pharmacological therapy (as per NICE guidance) can be offered for pain relief. Patients with diabetic neuropathy are at high risk of falling and sustaining fractures.

Infertility in a young woman with Type 2 diabetes.

KEY MESSAGES: Ovulatory dysfunction is the most common female cause of infertility in the UK.Polycystic ovarian syndrome is associated with oligo-ovulation and Type 2 diabetes.Good glycaemic control is essential before getting pregnant to prevent congenital malformations and miscarriages in young women with Type 2 diabetes.Metformin is safe in the first trimester and reduces the rate of miscarriages and gestational diabetes.Labetalol, methyldopa and hydralazine are deemed safer in pregnancy.Women should not conceive on statins due their potential teratogenic effects. WHY THIS MATTERS TO ME: Polycystic ovarian syndrome (PCOS) is a frequently encountered condition in general practice and can have a significant impact on the quality of life of young women. Apart from addressing ovulatory problems in these women, it is important to remember to screen for other associated conditions such as Type 2 diabetes, hypertension or hypercholesterolaemia. This article outlines the pathophysiology of PCOS and its diagnostic pathways and also summarises the safety of medical management for the metabolic complications in pregnant women. It is important for healthcare professionals to be aware of the latest guidance for treatment of PCOS in order to provide high-standard evidencebased care.

Three care plans from one West London multidisciplinary group workshop.

This section of LJPC provides multidisciplinary insights into ways in which to explore the problems of patients, particularly those with long-term conditions. Each case presented must have had multidisciplinary discussions to arrive at a management plan. To retain patient anonymity the specific location of the case study must not be mentioned and details that might identify specific individuals should be altered. When submitting papers to this section your covering letter should explain which bits have been altered. Each case should be structured as follows: The Problem(s) as perceived by the clinician presenting the case;The Story-a brief summary of the history and context;Suggestions made by team members about ways to think about the problem(s);Action Points, including data to be gathered by the clinician to explore the approach to the problem; andA Review (where done)-of what happened. Authors are encouraged to complete this section at a later date including what they learned. The Editor for this section of LJPC is Dr Senan Devendra, Consultant Physician in Acute Medicine & Endocrinology, West Hertfordshire Hospitals NHS Trust. Email: ddevendra@nhs.net.