*GG*
senior member
- Messages
- 6,389
- Location
- Concord, NH
What Happened To Make Me Sick?
Why? People want to know. Why they have an illness and new, never before experienced symptoms plagues, obsesses and fascinates patients.
The human brain thrives on order, creating it wherever it can. The confusing pixels of a computer monitor processed in the brain come to represent a 1930s film noir or a pile-up on I-75. People want to know why – why do I have hypertension, cancer, osteoarthritis so bad I can’t walk. They want to know how this happens, where it all comes from.
And doctors are supposed to provide answers.
Beyond Handwaving
Many answers doctors provide are in the form of diplomatic statements. Sometimes it’s fine to say “I don’t know”, but many patients and clinicians say that response is inadequate.
So other terms are cooked up with greater or lesser sensitivity. Your narcolepsy is idiopathic – which translates as “nobody knows” but sounds better. The reasons for your osteoarthritis are “genetic”. Yes, your father had osteoarthritis, as did your grandmother, but so eventually does most of the population. A more interesting answer comes when severe osteoarthritis occurs in the 30s or 40s – because then the “genetic” answer argues a different mechanism than what comes to afflict most of us.
But what many people want is some understanding of where all my symptoms came from – in order to figure out where to go. That’s when you start to create usable clinical narrative.
Troubles All Around
Recently a kind woman walked into my office. She looked at me a bit cross eyed. It took me a little while to recognize she was partially blind.
At first she was not at all sure what I might do to help her. She found her list of problems overwhelming. She couldn’t sleep; she had been diabetic for decades; she had gained much weight; she could not think as well as she once had, even when she was not as depressed as now; she had suffered small strokes and heart disease; had thyroiditis; inflammatory bowel disease, which periodically left her unable to control her bowels; felt so generally awful she had returned to smoking; rarely left the house.
That was simply the beginning of the list of what afflicted her. Her life was upended. How had this come to pass?
I tried to explain it to her in terms of two major changes: autoimmune disease – the official medical causes for her type I diabetes, hypothyroidism and Crohns’ disease; and the the follow-up effects of diabetes itself.
Her diabetes had appeared suddenly in her early 20s. She was athletic, well. Suddenly she walks into the ER with sky high glucose levels.
I tried to explain that the immune system is critical to life. It affects virtually every system in the body.
Let’s say you get a cold. The infection puts out new chemicals the body hasn’t seen.
It finds them and often destroys them. Sometimes, like Katharine Harris’ over broad choice of voter “felons’ lists” in the 2000 Florida election, the immune system goes on to target or exclude a whole series of innocent bystanders. They are not foreign, not illegal – and they never did anything wrong.
In this case, the attack included the pancreatic islet cells that produce her insulin. Quickly they were targeted and destroyed. She became diabetic – no insulin production to speak of.
Then her immune problems continued, going on to produce similar effects on her thyroid (thyroiditis) and gut (Crohn’s).
Here was a mistake, an information issue. Her immune system had identified – and continued to identify – friend as foe.
Diabetes then provoked most other of the complications. For glucose is the main fuel of the body. Interfere with it and nothing works quite right.
It’s a bit like looking at the energy flow at a city. Suddenly all the gas station pumps become leaky. Gas lines erratically rupture. Electricity comes and goes – and falling electrical wires electrocute unwary pedestrians.
The small strokes, the partial blindness, the changes in heart and arteries, all had “flowed” from the overflow of glucose – and of medical attempts to control it.
For low sugars are often worse than high ones. Get glucose too low and cells are starved for energy.
cont'd
http://therestdoctor.wordpress.com/...et-sick-creating-a-clinical-narrative-101512/
Why? People want to know. Why they have an illness and new, never before experienced symptoms plagues, obsesses and fascinates patients.
The human brain thrives on order, creating it wherever it can. The confusing pixels of a computer monitor processed in the brain come to represent a 1930s film noir or a pile-up on I-75. People want to know why – why do I have hypertension, cancer, osteoarthritis so bad I can’t walk. They want to know how this happens, where it all comes from.
And doctors are supposed to provide answers.
Beyond Handwaving
Many answers doctors provide are in the form of diplomatic statements. Sometimes it’s fine to say “I don’t know”, but many patients and clinicians say that response is inadequate.
So other terms are cooked up with greater or lesser sensitivity. Your narcolepsy is idiopathic – which translates as “nobody knows” but sounds better. The reasons for your osteoarthritis are “genetic”. Yes, your father had osteoarthritis, as did your grandmother, but so eventually does most of the population. A more interesting answer comes when severe osteoarthritis occurs in the 30s or 40s – because then the “genetic” answer argues a different mechanism than what comes to afflict most of us.
But what many people want is some understanding of where all my symptoms came from – in order to figure out where to go. That’s when you start to create usable clinical narrative.
Troubles All Around
Recently a kind woman walked into my office. She looked at me a bit cross eyed. It took me a little while to recognize she was partially blind.
At first she was not at all sure what I might do to help her. She found her list of problems overwhelming. She couldn’t sleep; she had been diabetic for decades; she had gained much weight; she could not think as well as she once had, even when she was not as depressed as now; she had suffered small strokes and heart disease; had thyroiditis; inflammatory bowel disease, which periodically left her unable to control her bowels; felt so generally awful she had returned to smoking; rarely left the house.
That was simply the beginning of the list of what afflicted her. Her life was upended. How had this come to pass?
I tried to explain it to her in terms of two major changes: autoimmune disease – the official medical causes for her type I diabetes, hypothyroidism and Crohns’ disease; and the the follow-up effects of diabetes itself.
Her diabetes had appeared suddenly in her early 20s. She was athletic, well. Suddenly she walks into the ER with sky high glucose levels.
I tried to explain that the immune system is critical to life. It affects virtually every system in the body.
Let’s say you get a cold. The infection puts out new chemicals the body hasn’t seen.
It finds them and often destroys them. Sometimes, like Katharine Harris’ over broad choice of voter “felons’ lists” in the 2000 Florida election, the immune system goes on to target or exclude a whole series of innocent bystanders. They are not foreign, not illegal – and they never did anything wrong.
In this case, the attack included the pancreatic islet cells that produce her insulin. Quickly they were targeted and destroyed. She became diabetic – no insulin production to speak of.
Then her immune problems continued, going on to produce similar effects on her thyroid (thyroiditis) and gut (Crohn’s).
Here was a mistake, an information issue. Her immune system had identified – and continued to identify – friend as foe.
Diabetes then provoked most other of the complications. For glucose is the main fuel of the body. Interfere with it and nothing works quite right.
It’s a bit like looking at the energy flow at a city. Suddenly all the gas station pumps become leaky. Gas lines erratically rupture. Electricity comes and goes – and falling electrical wires electrocute unwary pedestrians.
The small strokes, the partial blindness, the changes in heart and arteries, all had “flowed” from the overflow of glucose – and of medical attempts to control it.
For low sugars are often worse than high ones. Get glucose too low and cells are starved for energy.
cont'd
http://therestdoctor.wordpress.com/...et-sick-creating-a-clinical-narrative-101512/
