Putting My Diagnosis Where My Mouth Is

That isn’t me treating the patient, but in a few years? Photo: “House, M.D.” / Fox.

Okay, so the title doesn’t make much sense.

I wanted to say something like “putting my money where my mouth is,” but that doesn’t connect with the topic of this post. Anyway, money is crawling with microbes and all kinds of awful stuff. You don’t want it anywhere near your mouth.

The Well blog on The New York Times today had a diagnosis contest under the title “Think Like a Doctor.” Since I’m going to be a doctor in a few years, I gave it a try.

The blog article was written by Lisa Sanders, M.D., who is a clinical professor of medicine at Yale University. She’s also technical advisor to the TV series “House, M.D.” and author of the book Every Patient Tells a Story.

Dr. Sanders described a patient’s history and symptoms, then challenged her readers to make the correct diagnosis. Hundreds of readers replied, including practicing physicians, nurses, and medical students. And me.

Since I’m not even in medical school yet, I don’t expect my diagnosis to be right. But it makes sense to me, and a lot of the other diagnoses that people wrote about don’t make sense to me.

The Patient’s History and Symptoms

Here’s the short version of the patient’s situation, obviously focusing on what I think is important. I encourage you to read the whole article on The New York Times site.

The patient was a 76-year-old woman previously in good health except for a few minor complaints (high blood pressure and low thyroid) that were well controlled with medication. Her mother, 99, had died a few weeks earlier.

The patient initially had intestinal bleeding for which she was hospitalized. A colonoscopy found that she had blood vessel abnormalities. She was treated without surgery and recovered, but she still complained about feeling very tired.

More tests revealed a heart valve abnormality that the patient had probably had for a long time. She had an elevated white blood cell count. Although white blood cells are involved in fighting infections, an elevated white blood cell count shows only that the patient’s immune system is “on red alert,” possibly due to an infection. There can be other causes.

The patient started having mood swings and behaving bizarrely. She was alternately manic and depressed. She still complained of extreme fatigue. An MRI of the patient’s central nervous system (including the brain) was normal. She developed dark spots and infected-looking lesions on the skin of her hands and arms. She gained weight.

That’s the essence of it. And people came up with a lot of diagnoses.

Proposed Diagnoses

Many of the people who replied came up with diagnoses that I considered and then rejected.

Lyme disease was one: it’s a bacterial infection spread mostly by tick bites. It causes seemingly unrelated symptoms like the woman had. The microbe is similar to that for syphillis, a sexually-transmitted disease that several people also suggested as the cause. People who have had those infections for years can develop dementia. However, there was no indication that the woman was at risk for Lyme disease or had syphillis, so I rejected those possibilities.

Other suggestions were Cushing’s disease (caused by too much stress hormone) and Lupus Erythematosus, an “autoimmune” disease in which the patient’s immune system attacks the patient’s own body. But neither of those would have developed over a period of a few weeks. The patient had a family doctor who had treated her for years, and who would have known if she had either of those conditions. I rejected those possibilities.

Some people suggested Creutzfeldt–Jakob disease, better known as “mad cow disease” that people can contract by eating infected beef. It’s a horrible disease, but it wouldn’t have developed over a period of a few weeks. Rejected.

Some people suggested that her medications had made her sick. That’s certainly possible, since “iatrogenic illness” (illness caused by medical treatment) is the third leading cause of death in the United States, right after heart disease and cancer. But I think that her first symptom was intestinal bleeding, and that occurred before she started treatment with all the new drugs. So although iatrogenic illness is a good guess, I rejected it.

A lot of people suggested vasculitis, which is kind of a non-specific disease of blood vessel inflammation. However, from the doctors in my family, I know that vasculitis is a “diagnosis of exclusion.” That means you diagnose someone with vasculitis when there’s obviously something wrong with them, but you’ve eliminated all the other possibilities and you can’t figure out what the problem actually is. Dr. Sanders wouldn’t have used that as a diagnostic challenge. Rejected.

My Diagnosis

I won’t find out if my diagnosis is correct until The Well blog is updated on Thursday, when Dr. Sanders has promised to reveal the answer. As I said, I don’t expect to get it right but will be thrilled if I do.

Here’s what I think. You can throw out most of the patient’s previous medical history because the onset was relatively sudden. Also, the intestinal bleeding strikes me as a symptom rather than a cause. The patient probably had the blood vessel malformations in her intestines for years. Something caused them to start bleeding.

Two facts are key:

  • The symptoms appeared within a few weeks after she had been caring for her mother, who died. We can assume that she cleaned out her mother’s house, and that the house contained items that had been there for many years undisturbed.
  • We want a diagnosis that explains fatigue, intestinal bleeding, dementia, elevated white count, and skin lesions.

My diagnosis: While cleaning out her mother’s house, the patient was exposed to black mold (Stachybotrys chartarum) and infected. Most of her symptoms resulted from the infection and from attendant mycotoxicosis from Tricothecene.

We’ll see on Thursday, April 21 if I was right.

And the Results Are In

Looks like I still have to go to medical school! 🙂

The correct diagnosis was Cushing’s syndrome, which I rejected because I thought that the patient’s symptoms developed too quickly and it wouldn’t explain the intestinal bleeding.

Apparently, however, the bleeding was unconnected. The Cushing’s syndrome was confirmed by a test that in a normal person should suppress blood levels of cortisol, a stress hormone. However, the test did not suppress the patient’s cortisol levels, which remained very high.

But the really exciting thing is …

Even though my diagnosis was wrong, Dr. Sanders commented on it in her blog. She said that my diagnosis was “very House-ian.” To me, that seems like a huge compliment, since she’s the medical advisor for “House, M.D.” and House is supposed to be a genius. I was excited about it, anyway. 🙂

Copyright 2011 by Rinth de Shadley.


Praying to be Straight? Why?

Dr. Drew discusses a religious program to "cure" gays with the program director and a gay couple.

I was walking past a TV this afternoon when a talk show topic caught my attention: “Gay to Straight with Prayer?”

The show was “Dr. Drew” on the HLN news channel. I’ve never watched the show beyond the few seconds I saw today, but I know who Dr. Drew is. He’s a psychiatrist who graduated from medical school at the University of Southern California. Before that, he graduated from Amherst College, so he’s local to Shadley and he’s smart enough to get into Amherst. In other words, he’s no random homophobic nut.

From what I could tell, his guests included a fundamentalist Christian minister who wants to “cure” gays, a gay man who he supposedly cured, and a gay minister. I didn’t watch long enough to follow the discussion, but the viewpoints are easy to predict.

The fundamentalist minister probably cited the Bible’s Book of Leviticus to say that gays will burn in Hell. The ex-gay(?) man probably told about how he’s now married to a wonderful woman. And the gay minister pointed out that Leviticus prohibited many other things besides homosexuality, such as shaving and wearing clothes made from two kinds of cloth.

I Wasn’t Quite Right

I just watched some of the show on the Web so that I could grab the picture for this blog. My earlier guess about the fundamentalist minister wasn’t quite fair. He seemed much nicer than I expected, though he’s obviously still wrong about gays needing to be “cured.” The two men on the right side of the picture are a gay couple who met at the minister’s cure-the-gays program. They’re both still gay and are very happy.

People Should Be Happy

Now, I’m probably going to get in trouble with friends for saying this, but I think people can sometimes change their sexual orientation. Not always, but sometimes. Gays can become straight. Straights can also become gay, though I’ve never heard anyone bring up that option.

What makes it so radioactive to discuss changing sexual orientation is that it gets mixed up with a lot of other issues that really have nothing to do with it. It amounts to guilt by association.

Most people who talk about gays changing their sexual orientation are either nutty homophobes or self-hating gays. They believe that gay relationships are wrong, disgusting, an abomination, and all that hateful bigotry. So people think that it’s the only context in which gays might ever want to be straight or vice-versa.

As a future physician, I have what I consider a common-sense attitude: People should be happy. Helping them be happy and healthy will be my goal.

Two Options

If a patient of mine was gay and unhappy about it, we would have two options.

The first option is better. We would try to correct any mistaken beliefs or emotional biases that cause the unhappiness. Since being gay is a perfectly healthy form of human sexual expression, it’s better not to try to change that unless absolutely necessary. I would very strongly advocate the first option.

The second option is more difficult and risks reinforcing negative beliefs. If we’ve tried the first option but the patient just can’t be happy and gay, we could try to change that. Sexual orientation (gay or straight) has multiple causes, both biological and psychological. Some people’s sexual orientation is pretty much set in stone, and the second option won’t work for them. Other people’s orientation is more flexible. If they really want to change, and are absolutely determined to do it, then they can. I’m not saying it’s right or that I’d recommend it, but it’s an option. It shouldn’t be dismissed just because some of the people who push it are hateful homophobes.

Happiness is More Important Than Stereotypes

I reiterate: People should be happy — preferably by accepting and loving themselves as they are.

But if for some reason they can’t do it, we shouldn’t let ideology or stereotypes stand in the way of helping them be the people they want to be and having the lives they want to have.

Copyright 2011 by Rinth de Shadley.

Sneaky Scientists Undermine Patriotic Ignorance

According to the Boston Herald, a majority of Massachusetts residents think that global warming is real:

More than half of Massachusetts residents believe global warming is real and at least partially caused by human activity …

Now that might be only because Massachusetts is dominated by them godless libruls, Democrats, and Kenyans who want to take away everyone’s guns and require gay marriage for first-graders. As Stephen Colbert said, reality has a well-known liberal bias.

But global warming isn’t the only subject on which progressives, scientists, and other subversives have worked their insidious deceptions. Other polls reveal that:

  • Only 40 percent of Americans deny the theory of evolution.
  • Only 44 percent of Americans still believe that God created the world in six days.
  • Only 43 percent of Americans believe that gay relationships are wrong.
  • A full 59 percent of Americans believe it’s okay for unmarried people to have sex. That’s fornication! OMG, we are all doomed.

There’s only one reassuring statistic:

  • About 60 percent of Americans are unsure why Justin Bieber exists. The other 40 percent have never heard of him. 🙂

Copyright 2011 by Rinth de Shadley.

Political Realism Bites

I’ve been a progressive Democrat since before I could vote. And I voted for President Obama in 2008 because I thought he would change things. Or at least that he would fight to change things.

Now, I don’t know what I am. Disappointed, I guess.

We wanted change. Almost all of us wanted it, not just Democrats or Obama supporters. Even McCain and Palin supporters wanted change. As misguided as they were, even they knew that America couldn’t go on the way it had under Bush and Cheney.

We wanted an end to costly and unjustifiable wars, to torture, to Guantanamo, to wiretapping, to excessive secrecy. We wanted an end to the incestuous relationship between government and big business. We wanted regulation of Wall Street to prevent another economic catastrophe. We wanted greater equality. We wanted government to listen to ordinary people, not just to lobbyists with paper bags full of cash that they delivered to politicians and regulators.

Surprise. We didn’t get any of that. Instead, we got a few token victories. Very few.

Elena Kagan and Sonia Sotomayor are on the Supreme Court. “Don’t ask don’t tell” is on its way to the dumpster.

Elizabeth Warren is temporarily running the Consumer Financial Protection Bureau, but the Obama administration won’t support her publicly because it might annoy Republicans and Wall Street.

We got a kinda sorta health care reform that moves an inch in the right direction but sells out to insurance companies, drug companies, and the medical industry. It has no public option or Medicare for all, which are ways to provide quality care and control costs. (As a future doctor, I feel no shame or hesitation in criticizing the medical industry. I’ll be working to improve it.)

On the other side, we got airport strip-searches that don’t catch terrorists but do humiliate passengers. We got more money shoveled into Wall Street with almost no strings attached. We got another war, this time in Libya, and no end in sight to the two big wars in Iraq and Afghanistan. Guantanamo is still open for business. The U.S. government still tortures prisoners, including U.S. soldiers like Bradley Manning who have no link to terrorism. We got one Obama surrender after another to the craziest elements of the Republican Party — on taxes, on regulation, on policy.

In the middle of an economic crisis with real unemployment over 10 percent, Obama knows better than to think that it’s a good time to cut government spending or jobs programs. With inequality in America higher than in Egypt, where they just had a revolution over it, Obama knows better than to cut taxes on the super-rich and cut assistance to poor people. But the nutty Tea Party people and the Wall Streeters want it, so he agrees with them that it’s a wonderful idea. He just wants to do it a little smaller.

Where is the leadership? Where is the standing up for what’s right? Where is the change?

I’d hate to think that 2008 could be the first and last time I bother to vote in a presidential election.

If the only choice is between a “know nothing” party dominated by big business, and a “smart enough to know better” party dominated by big business, then why should I waste my time? I don’t want them to shut down the federal government or ravage the neediest to enrich the richest, but it’s not like I have any control or even influence over any of it.

The Obama administration has to give me a reason to support it other than “we’re not quite as bad as the Republicans.” Otherwise, I’ve got studying to do.

Copyright 2011 by Rinth de Shadley.

Whither Weather?

Ugh. Rain. And snow coming. One to three inches.

May, and graduation, loom ever closer. I’m excited. And happy. And I want to cry.

Does that make any sense? Of course not. I know it’s silly. I’m studying and working like crazy to finish everything for graduation, and at the same time, I don’t want it to be finished. I can’t believe that my life will ever be like this again. But I guess you never know, it might be even better in ways that I haven’t imagined.

I know that there’s a world going on outside of Shadley, but lately I’ve barely had time to notice it. President Pasquerella sent a stern letter to the Governor of Maine, who had ordered a mural about labor history removed from the Maine Department of Labor. Our connection was that the mural included a picture of Francis Perkins, an MHC alumna who fought for workers’ rights. Of course, the Governor of Maine went right ahead and had the mural removed because the Department of Labor should be on the side of … who? That’s right, big business.

Anyway, back to Shadley at least until May. Someone said that life is what happens while you’re busy doing something else. So I guess this is life. It’s good. But sometimes you have to let go of things that you don’t want to let go. That’s the only way you can move on to other things when it’s time for you to do that.

Sorry, I know that probably sounds really morose. I’m about halfway through a homework assignment, and I’m enjoying it but I’m procrastinating a little about finishing it. Shouldn’t do that.

Have a great rest of the week! See you at the Dirty. 🙂

Copyright 2011 by Rinth de Shadley.

Stupid Pickup Lines

We went clubbing tonight but have an early-morning start so I’m in early.

No time to write much but I heard two amazingly stupid pickup lines tonight.

Hey, I’m not criticizing. Sometimes stupid works. If a guy is willing to make a fool of himself and risk almost certain rejection, it shows that he’s motivated.

Pickup line #1 was addressed to my friend Kris, not to me. If I posted a pic of us from tonight you would understand. When we’re out, she gets most of the attention. I’m okay with that. We aren’t usually interested in the same kinds of guys, so there’s no conflict.

Anyway, here’s the line: “You are two babes’ worth of sexy.”

Yeah, I told you it was stupid. The guy was okay though. And obviously motivated.

Pickup line #2 was a guy making a joke about how good he was in bed. At least, I think he was making a joke.

He said, “I know that I’m good in bed.” When I asked him how he knew, he said, “Because I’m always satisfied.” And then he grinned. And I laughed, it was kind of funny.

That guy wasn’t awful, either, but not worth canceling tomorrow morning’s plans.

How to Help Japanese Disaster Victims

After the earthquake, a devastating tsunami. Thousands are dead and many more are in danger.

We interrupt Spring Break for something much more important:

How can we help the victims of the earthquake, tsunami, and nuclear meltdowns in Japan?

That horrible wave that engulfed mile after mile of Japan’s inland was one of the saddest and most terrifying things I’ve ever seen. It destroyed and submerged everything in its path, including human lives. People just like you and me. Adults and children. Good people and bad people. People at work, people on vacation, people who thought they were just driving to the store. Gone. Lives, hopes, futures snuffed out in an instant. Senseless and tragic.

Then, as if the earthquake and the wave weren’t enough, several of Japan’s nuclear power plants started to melt down, releasing deadly radioactive material into the atmosphere. That was even worse. Instead of a quick death from drowning or trauma, thousands of people will now suffer illness, debilitation, and cancer that develop over years and decades. They did not escape just by surviving the initial disaster. Now they have to watch themselves, and their children, always alert for long-term effects of the radiation from the nuclear power plants.

We should do three things.

First, we should pray for those who are still alive. Pray for their rescue and deliverance from danger.

Second, we should learn from what happened to them. None of us know if we will be alive tomorrow, or even five minutes from now. We should seize every moment of our lives, enjoy it, and use it the best way we can.

Third, we should (if we can) donate to help the victims of the disaster in Japan. The New York Times listed some legitimate charities that are providing disaster relief. I made my donation to Doctors Without Borders, but all the charities are trying to help.