In the first part of our four part Case Files series diving into the upcoming lawsuit against Rady Children’s in San Diego, Andrea and Dr. Bex start with looking into preteen Madison Meyer’s string of diagnoses like Ehlers-Danlos syndrome, POTS, CRPS, and more. They break down what these conditions are and why they - coupled with Madison’s rapid decline - raised red flags. *** Follow Dr. Bex on instagram: @secretdoctorbex Order Andrea's new book The Mother Next Door: Medicine, Deception, and Munchausen by Proxy. Click here to view our sponsors. Remember that using our codes helps advertisers know you’re listening and helps us keep making the show! Subscribe on YouTube where we have full episodes and lots of bonus content. Follow Andrea on Instagram: @andreadunlop Buy Andrea's books here. For more information and resources on Munchausen by Proxy, please visit MunchausenSupport.com The American Professional Society on the Abuse of Children’s MBP Practice Guidelines can be downloaded here. Learn more about your ad choices. Visit podcastchoices.com/adchoices
Chapter 1: What is the focus of the new Case Files series on Rady Children’s?
True Story Media. Hello, it's Andrea. Today, we have the first part in our new series about the lawsuit in San Diego involving Ratty Children's. This is a frequently requested topic for Case Files, and I'm incredibly thankful to Dr. Becks, who is taking on the lion's share of the research and reporting on this one.
Those of you who've been with us for a while may remember that I started off my coverage of a similar lawsuit in Florida, Kowalski v. Johns Hopkins All Children's, intending to make it a four-part miniseries. Dozens of episodes, and I don't even want to know how many hours later, here we are. So, four-part miniseries has really become the three-hour tour of this show.
So I will say that we are starting off with four episodes about this case to get you up to speed on what's going on. But much like Kowalski, this is going to be parts one through four of question mark number of episodes, because we will certainly continue our coverage as we learn more about this case and as it unfolds in real time.
And before we jump in, I really want to thank you because it is truly incredible that this show is able to support as much original reporting as it does. This kind of coverage takes a lot of resources in terms of time, fact checking, interviews, editing and production, legal guidance, etc. And I feel so grateful that we, as an independent show, are able to do it.
It's safe to say that we are the only media outlet covering these cases in depth on an ongoing basis, and while I often feel like I am a combo between a newsroom and a documentary studio, I am very happy that the team and I are able to take this on.
So if you are wondering why I always start these episodes off with a reminder of how to support the show, such as subscribing on Apple Podcasts and Patreon, where you get ad-free listening and two bonus episodes a month,
or rating and reviewing the show, commenting on Spotify, sharing with friends, shopping our sponsors, to give just a few examples, well, it's because we really need that support to do this reporting. And especially given the current economic climate, you better believe that I do not take this for granted a single day in my life. So again, thank you.
And please let us know what you think and let us know which pieces of this case you would like us to explore in our future episodes on it, as well as any other requests you have for Case Files episodes. You can send us an email or voice memo to hello at nobody should believe me dot com or leave a comment on Spotify. And with that, on with the show.
Just a quick reminder that my new book, The Mother Next Door, Medicine, Deception, and Munchausen by Proxy, is on sale right now wherever books are sold. The book was an Amazon editor's pick for nonfiction, and the Seattle Times called it a riveting deep dive into MVP. And if you are an audiobook lover and you like hearing my voice, which I'm assuming you do since you're listening here,
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Chapter 2: What is the background of Madison Meyer’s medical journey?
Note many times that she has multiple dislocations of the same shoulder and that there is significant pain. And I think that is that piece that will feel familiar to people who have followed some of these other stories. But pain to the point she was doing, you know, biofeedback, the TENS, which is kind of those little shock therapy to the area.
She was seeing a pain psychologist, which I think is a wonderful piece, taking medications. And so the injuries were in 2016. And now we're already kind of jumping to 2018, where she has now completed months of like an outpatient pain program, actually at Rady's. Her pain was still severe. At that point, she was on what's called a 504B plan at school.
So she had even more kind of restrictions or special modifications made to her school schedule.
Sorry, was she at Rady's the whole time or did she start her treatment at a different hospital?
The two surgeries were at Rady's with an orthopedist there. Some of the genetic diagnoses, like the diagnosis of Ehlers-Danlos came outside of Rady's, but it was someone they were referred to. And it sounds like actually Kaiser was the hub at first, because when you work for Kaiser, your insurance is Kaiser. And so most of your, like her primary care physician was from Kaiser.
When I did my training in California, there was a Kaiser down the road. They did kind of the basics of of pediatrics. They had some of the pediatric specialties, but if things kind of became a little bit more complicated or more extensive, then they would refer to us at the local children's hospital, especially if they didn't have a specific kind of surgical option or things like that.
So it does sound like Kaiser initially referred them to Radiesse to go to this orthopedist who specialized in shoulder procedures. We are actually going through her second shoulder surgery. They created a cage around her shoulder joint with ligaments from other people or something and somehow recreated this cage around her shoulder and just to try to keep it in place.
So it sounded like this was a little bit more extensive, but it was still with this surgeon At Rady's during an admission for severe pain after this surgery. So now two surgeries and still with severe pain, unrelenting pain. She is admitted to Rady's and she is diagnosed with complex regional pain syndrome, which
Anyone who went with us in the Kowalski case, that was the diagnosis that really played center stage. I would say in Madison's story, the Ehlers-Danlos becomes more of the story, but this was an interesting little sidebar where she was on the inpatient unit requiring pretty strong pain medications. And then they recommended, actually at Rady's, that she go to an inpatient pain program.
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Chapter 3: What are the key diagnoses involved in Madison’s case?
And it just seems like you can probably speak to this too from your experience, but it's one of those things that once that comes up too, it feels like we're kind of starting down this path. that is similar in a lot of these stories.
Yeah. I mean, POTS is certainly a diagnosis that does come up a lot in Munchausen by proxy cases. And as with many of the things we talk about, most of the things I would say, this is a real condition. So this is not a claim that everyone, that this is just a false diagnosis. And actually, could you explain a couple of things about POTS? Because it's not something I'm super familiar with.
I think that's the hard part with POTS is I think it is there's still a lot that's unknown about it, meaning can it worsen after you get a bad viral illness? And it's one of those things that gets triggered. And then once it's triggered, it kind of never goes away. But the most important thing to know with POTS is it's symptomatic management. So
Things like increasing hydration, increasing the balance of salt intake with fluid intake are things that are recommended early in the course. Then there are the kids who do need medication to basically keep that balance correct. So meaning it's about keeping the blood flow going to your brain and to all of the important organs when you stand up and that you don't get so dizzy that you pass out.
And so some medications will help that balance where it won't let those fluctuations be so great. And it'll keep your heart rate more in a balanced range. That being said, there are these extenuating circumstances with POTS, which I know POTS experts or people that really focus in this field are trying to find solutions.
less invasive ways, you know, rehabilitation and therapy and dietary changes and nutrition changes, because I think there was a push at some point that IV fluids or fluids through an intravenous line is really the way to improve the symptoms quickly. And so this idea of some of these patients needing
G tubes or tubes in their stomach or central lines to be able to give themselves fluids versus like you or I would just attempt to always have a water bottle with us, always be eating crackers, balancing it with a water bottle. It's kind of became more invasive very quickly.
And I think we're now backing off of that a couple years, you know, like years later to realize what other things can we be doing early on. And POTS, from my understanding, is kind of once you are prone to it, It can keep causing issues throughout your life.
But there are times in life where it seems to be more prominent in like the teenage years, probably because your fluid needs and balances and hormonal changes are all playing a role. And it does affect women more than men. So there is that question of kind of.
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Chapter 4: What is Complex Regional Pain Syndrome (CRPS) and how does it relate to Madison?
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This is the downward trajectory that is both rapid and never seems to have that where it starts to climb back up the other way again. And if it does, it's this very little just to have it kind of go down again. So it's the pattern. Yeah. So, okay. So where are we at this point? So we are at Kaiser San Diego. That is where the first NG tube is placed. So nose to stomach to help feed.
And that's because she was showing signs of malnutrition or weight loss. and pain is still the word that pops up time and time again. So she is actually transferred, are you ready, to Kaiser Permanente LA for ketamine treatments. So what do you think?
Well, again, for those of us who did not go on the Kowalski journey, yes, ketamine played a big role in Maya Kowalski's treatment. And so, yes, the combination of CRPS and ketamine treatments is definitely giving me some flashbacks now, I guess, to ground us.
Although I think our relationship with ketamine and our knowledge in general about ketamine has changed quite a lot, even over the last year and a half since the Kowalski case trial took place, because of the death of Matthew Perry, because of a official that is running around being a fan and proponent of it.
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Chapter 5: What is Postural Orthostatic Tachycardia Syndrome (POTS) and its significance here?
And they are right now just being villainized in many places in the country, including, you know, Florida, obviously, with the Kowalski case, Lehigh Valley, Pennsylvania, which we're also going to be covering. Here in Washington, I mean, there is a lot of villainization of this subspecialty going on.
It's important to say that there is no legitimate debate in medicine about whether or not this is a real subspecialty.
And if anyone is this specialty, it is Shaylin. She has done her time, she has done her work, she has taken courses and classes and continued her continuing medical education to stay up to date in the field. That's just my sidebar because her name is going to keep coming up.
Well, and I think it's a good sort of preface for us to put on this whole thing, right? Because I think what can be very frustrating about the media coverage of these cases is this sort of like wishy-washiness around some of this. And like, if you consider it a bias that we believe that child abuse is real and believe that Munchausen by proxy is real,
And that child abuse medicine is a real subspecialty of medicine. Like we're not getting anywhere. You know what I mean? So it's like those are things that are science and data based. And so we are going on the assumptions that these are real.
Obviously, I think the other side, you know, and that's the reason if I saw it peaked a little bit at the court filing and you see this like so-called child abuse expert. We've seen that a ton. In all of these court filings, there is this, you know, insinuation that this is not a real subspecialty, that this is not a real job.
So I think like that is a place where, to my mind, when media outlets are covering this, that's something they should debunk for readers. Right. Right. Like that's just like that's a factual piece of information that readers are not going to be able to understand these stories if they are thinking, oh, well, there it sounds like there's some controversy over this subspecialty. Maybe it's not real.
No, the controversy is manufactured. It's not within medical establishment.
Child abuse pediatricians are not the ones going out and hanging a shingle, you know, in the grocery store strip mall and saying, look, I'm a child abuse pediatrician. Come see me. People don't want to see the child abuse pediatrician.
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Chapter 7: What disclaimers and caveats are important to understand about this case?
And the court documents do go into their whole story, but we'll kind of jump ahead to when Madison becomes a preteen And she sounds like an active kid doing well in school. And then she started having issues with her knee and then with her shoulder. And I think the shoulder is the kind of the piece of this, but she dislocated her shoulder while at an intensive surf camp.
And that kind of started her sounds like her medical journey where she really started seeing multiple specialists about her shoulder. First ended up at Rady's Children's in San Diego and kind of that jumpstarted everything. So, I mean, Andrea and I have been through a lot of these cases, but I'm curious, Andrea, what your thoughts are on the pre-Madison story? Yeah.
Yeah. And so obviously, you know, Bex, as you said, these details about her medical journey are coming from the court filings. So I think we can probably safely assume that this is more or less the parents telling of the story, right? Because we do not have at this point, the medical documentation to compare it with. But certainly, you know, the beginning of a story with
some obstetrical complications and a premature birth is just absolutely ubiquitous. We hear about that all the time. And also worth saying that lots of people experience infertility and lots of people have premature babies.
So again, just because something is a red flag does not mean that it is evidence in and of itself, but certainly immediately sticks out to us because we've just heard that beginning to the story so many times.
Right. She is diagnosed with something called hypermobile Ehlers-Danlos syndrome. And within a few months of kind of all these this diagnosis, she is already on like a modified school schedule just because of her pain issues, it seems at that time. And that also always sticks out to me. And then quickly from this diagnosis. diagnosis of the shoulder dislocation.
She has her first surgery, which is a surgery on her shoulder. I just want to kind of give a few more details about how her story with Ehlers-Danlos started and with this shoulder issue. So after the first surgery, you know, she thought everything was fixed. And then very quickly, the pain and all of the symptoms started up again. They
Note many times that she has multiple dislocations of the same shoulder and that there is significant pain. And I think that is that piece that will feel familiar to people who have followed some of these other stories. But pain to the point she was doing, you know, biofeedback, the TENS, which is kind of those little shock therapy to the area.
She was seeing a pain psychologist, which I think is a wonderful piece, taking medications. And so the injuries were in 2016. And now we're already kind of jumping to 2018, where she has now completed months of like an outpatient pain program, actually at Rady's. Her pain was still severe. At that point, she was on what's called a 504B plan at school.
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