nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Tuesday, December 7, 2010

Disease X, The Unknown.

Two different news articles got me thinking about how often there is no black-and-white answer in medicine.

The first column was from the Washington Post's Medical Mystery series (Dec 6).  This is where they find somebody who can't be diagnosed and, after many erroneous opinions, ends up having some weird manifestation of a condition that occurs so rarely there are only a few hundred cases in human history.  Stupid media stuff, really.  For the Chicken Little crowd.

The other report was about a study (The Lancet, Dec 7) that showed reduced risk of some cancers with taking a baby aspirin every day.  But, we know that there is a risk of GI bleeding from aspirin, so...pick your poison.  What guidance does this provide to the individual?  In a word, none.  That many people in a large population are helped or hurt by something only gives you odds.  You may be in the minority that are contrarily hurt or helped (or unaffected) by the treatment.

I read somewhere that 3% of people with medical issues are undiagnosable.  I don't mean they haven't found the genius doctor yet.  They just don't have anything that fits with a diagnosis that anybody could recognize.  It may be that it's too early in the illness, and the recognizable pattern has not emerged, or it may be that the patient is experiencing symptoms that don't normally fit with the underlying pattern, confusing the issue.  Or it may be that the patient has symptoms for which there's no organic basis--a cognitive mismatch;  i.e., attributing pain to an organ that has no pain sensation, etc.

But, I'm not talking about those situations.  Factor them all out, and there's still a finite percent of patients that have an undiagnosable problem.

This is something that we don't like to acknowledge.

So, what's going on with them?  Is it a unique disorder, one that is particular to that person only and will never be seen again?  Or is it a phantom, something ephemeral, a ghost in the machine?  On those occasions where such a problem resolves spontaneously, do you just shrug and say, "No longer a problem," and press on?

It's rare that a patient will accept this situation.  And they are right.  Something's wrong, but the current state of the art gives us no clue.  Sometimes--very rarely--the Medical Mystery will remain so.

When every possible test has been done, and every specialist seen, and there's no mental disorder gumming up the works, the road ahead is supportive.  "We'll do what we can to limit the effects, and never stop working to figure it out."

You and your patient never have to cross that bridge into hopelessness.

Doc D

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