Saturday, January 22, 2005

A patient responds to "Worried Sick"

"I cannot really blame the doctors for not figuring it out sooner, since it was rare presentations of two disorders," he writes. (He is amazingly magnanimous, after his ordeal.) This patient reminds us of Dr. Robert Centor's advice: "We must keep an open mind," when making diagnoses. Plus, this patient has excellent advice of his own:

Several years ago I developed alarming symptoms that fluctuated over time: extreme indigestion, general feeling of sickness, lightheadedness, ringing in the ears, scratchy dry-feeling eyes, inability to think clearly, stopped-up nose, pounding heartbeat, always feeling like the air was too cold, and these weird attacks where I would feel like something was terribly wrong with my body for a few minutes. After months of investigation, the doctors could find nothing wrong. All the tests and exams had textbook ideal results. "You're the healthiest patient I have," which is dismaying to someone who barely slept in the past two days and feels like death warmed over. The diagnosis was "somatization", a gentle way to say "you're a daft hypochondriac".

Rationally, I had to accept that it was a bizarre set of symptoms, and that I didn't exactly seem to be dying. So I accepted the diagnosis, began bringing my engineering career to a close, pretty much gave up hope, and told an ENT doctor to do whatever it took to fix my poor stopped-up nose. (Telling that to a surgeon is like giving car keys to a teenage boy. He did make my nose work better, but it's still true.) It's hard to accept that you've lost your mind, but what else can you do when real disease has been objectively ruled out by scientific means?

After more months of suffering, the truth finally worked its way out, by sheer blind luck. The attacks of "wrongness" were intermittent atrial fibrillation. (Diagnosed when decongestant from the ENT brought it on long enough to catch on an ECG.) The other stuff was due to migraine with minimal pain and major autonomic effects. (Diagnosed by an ophthalmologist when visual aura appeared.) So I had to unlearn that I had lost my mind and/or developed an untreatable disorder, yet accept that various neurons and heart cells had joined a commune and started dropping acid. It was very confusing.

My family doctor tried to help with Zoloft. It made me so happy it was funny, but also made the migraine problem far worse. I took it for a whole month because I couldn't decide whether things were better or worse. Afterwards it was obvious that the migraine aspect had been grinding me down in a major way. I really empathize with psych patients stuck between drug side effects and their disorders.

I cannot really blame the doctors for not figuring it out sooner, since it was rare presentations of two disorders. I'm not sure what the lesson is. Maybe "When you hear hoofbeats, it can be a pair of zebras." Or how about "Migraine is not a type of headache. It is a major neurological disorder." Or "Sinus headache is diagnosable ONLY by CT scan." Or "The patient is telling you what is wrong with them, even if they sound like a Martian who just stepped off the mothership." Or "Only a fool tries to solve all problems in 15 minute chunks."
(emphasis added)

The Internet is certainly a mixed blessing. The literature is vast, confusing, and contradictory. The syndrome descriptions list unremarkable symptoms that everybody has along with terrifying ones. Go looking for information about mild diabetes and you get a gallery of horrors--blindness, nerve damage, gangrene, the whole nine yards--complete with gruesome color photos. It's like a '50s school safety movie: "Don't let this happen to you!" Most of the web is not designed for the layman hypochondriac. Me? I found the web frustrating and useless. There are so many possibilities, and no obvious match to my weird symptoms. I did develop a lasting interest in medicine and biology, so I guess it wasn't a total loss.

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