15 diseases doctors often get wrong
When you experience strange
pains, mysterious digestive issues, or other unexplained symptoms, you'd
hope a trip to the doctor would solve your health woes. But sometimes,
doctors have just as much trouble identifying certain disorders and
conditions as their patients.
"A
lot of symptoms are nonspecific and variable, depending on the person,"
says Dr. David Fleming, president of the American College of Physicians
and a professor of medicine at the University of Missouri. "On top of
that, many diagnostic tests are expensive and aren't done routinely, and
even then they don't always give us a black and white answer."
The following 15 conditions are notoriously difficult to pin down.
Irritable bowel syndrome
Some
conditions are difficult to diagnose because there is no real test to
prove their existence; rather, they require a "diagnosis of
elimination," says Fleming, as doctors rule out all other possibilities.
Irritable bowel syndrome (IBS) -- a chronic condition that affects the
large intestine and causes abdominal pain, cramping, bloating, diarrhea,
and/or constipation -- is one of these cases.
According
to diagnostic criteria, a patient should have symptoms for at least six
months before first being seen for a formal evaluation, and discomfort
should be present at least three days a month in the last three months
before being diagnosed with IBS.
Celiac disease
So
much confusion surrounds celiac disease -- an immune reaction to gluten
that triggers inflammation in the small intestine -- that it takes the
average patient six to 10 years to be properly diagnosed. Celiac
sufferers would, in theory, have digestive problems when eating
gluten-containing foods like wheat, barley, and rye, but in fact, only
about half of people diagnosed with the disease have experienced
diarrhea and weight loss.
Celiac
disease can also cause itchy skin, headaches, joint pain, and acid
reflux or heartburn, and it's all too easy to blame these symptoms on
other things. A blood test can diagnose celiac disease no matter what
symptoms are present, and an endoscopy can determine any damage that's
been done to the small intestine.
Fibromyalgia
Fibromyalgia,
which is characterized by widespread musculoskeletal pain, involves
"medically unexplained symptoms" -- a term doctors use to describe
persistent complaints that don't appear to have an obvious physical
cause. When doctors can't find a root cause for a patient's chronic pain
and fatigue, they often settle on this diagnosis. This may involve
seeing specialists and ruling out other diseases, some of which prove
equally difficult to diagnose, says Dr. Eugene Shapiro, deputy director
of the Investigative Medicine Program at Yale University.
"There
are studies that show that people with certain symptoms who show up at a
rheumatologist will be diagnosed with fibromyalgia, but if the same
patients show up at a gastroenterologist they'll be diagnosed as having
irritable bowel syndrome."
Rheumatoid arthritis
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Unexplained
aches and pains may also be caused by rheumatoid arthritis (RA), an
autoimmune disorder. Unlike osteoarthritis (the "wear and tear" kind
that appears as people get older), RA causes inflammation and painful
swelling of joints and can occur at any age.
"Early
stages of RA can mimic many other conditions -- sometimes it's just a
sense of aches or stiffness in the joints, which could be caused by a
lot of different things," says Fleming. Blood tests can help detect the
presence of inflammation in the body, he says, but an exact diagnosis of
RA also must take into account a patient's medical history and a
doctor's careful physical exam.
Multiple sclerosis
Another
autoimmune disease, multiple sclerosis (MS) occurs when the immune
system attacks the body's own nerve cells and disrupts communication
between the brain and the rest of the body. Some of the first symptoms
of MS are often numbness, weakness, or tingling in one or more limbs,
but that's not always the case.
"Multiple sclerosis can be episodic; the disease waxes and wanes," says Shapiro.
Depending
on the number and location of lesions in the brain, he adds, signs and
symptoms may be more or less severe in different people. Once a doctor
does suspect MS, however, a spinal tap or MRI can help confirm the
diagnosis.
Lyme disease
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You
probably know to look out for tick bites and the telltale bullseye rash
that can form around them if a person is infected with Lyme disease.
But not everyone develops this rash -- and Lyme disease's other symptoms
(like fatigue, headaches, joint pain, and flu-like symptoms) can easily
be confused for other conditions, says Shapiro.
A
blood test can check for Lyme disease antibodies in the blood, but
those usually don't show up until a few weeks after infection and the
test is notoriously unreliable. It's important to remove the tick
immediately and see a doctor right away. Quickly removing a tick can
possibly prevent the transfer of dangerous bacteria, and antibiotics for
Lyme disease are most effective when given immediately.
Lupus
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The
most distinctive sign of lupus -- another chronic inflammatory disease
-- is a butterfly-shaped rash across a patient's cheeks, but that's not
present in all cases. For those who don't develop the rash, diagnosis
can be a long and difficult process, says Shapiro.
"Lupus
can present in different ways; it can affect the joints, kidneys,
brain, skin, and lungs, and can also mimic many different issues."
There
is no one way to diagnose lupus, but blood and urine tests, along with a
complete physical exam, are usually involved. Treatment also depends on
a patient's individual signs and symptoms, and medications and dosages
may need to be adjusted as the disease flares and subsides.
Polycystic ovary syndrome
Irregular
periods, unexplained weight gain, and difficulty getting pregnant can
all be symptoms of polycystic ovary syndrome (PCOS), a hormonal disorder
affecting women of reproductive age. Many women with this condition
also have enlarged ovaries with numerous small cysts, but not everyone
with PCOS has these enlarged ovaries, and not everyone with enlarged
ovaries has PCOS.
To be diagnosed
with PCOS, a woman must also be experiencing infrequent or prolonged
periods or have elevated levels of male hormones, called androgens, in
her blood. Androgen excess may cause abnormal hair growth on the face
and body, but women of certain ethnic backgrounds (like Northern
European and Asian) may not show physical signs.
Appendicitis
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You
might think that an inflamed or burst appendix should be easy to
identify, and often, it is: typical appendicitis symptoms include
nausea, pain and tenderness around the belly button, and possibly a
low-grade fever. But not always.
"Some
people have an appendix that points backward instead of forward in the
body, so the symptoms present in a different location," says Shapiro.
"And sometimes people do have pain, but then the appendix ruptures and
the pain is relieved so they think they're fine."
In
this case, he says, intestinal fluids can seep into the abdominal
cavity and cause a potentially life-threatening infection -- but it can
take days or even weeks before these symptoms appear.
Endometriosis
Many
perfectly healthy women deal with menstrual pain and discomfort, so
it's not surprising that endometriosis is often misdiagnosed. However,
women with endometriosis (in which uterine tissue grows outside the
uterus) often report pelvic pain, cramping, and heavy bleeding that's
far worse than usual, and that gets worse over time. A pelvic exam can
sometimes detect endometrial tissue or cysts that have been caused by
it. In other cases, an ultrasound or laparoscopy is required for a
definite diagnosis.
Migraines
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For
many migraine sufferers, nothing could be more obvious than the severe
headaches, which are usually characterized by intense throbbing or
pulsing and can be accompanied by nausea, vomiting, or sensitivity to
light and sound. But some people may get migraines without even knowing
it, says Fleming.
"Sometimes
migraine symptoms can be very severe, where the patient can even develop
paralysis, and other times they can be very subtle," he says. "Patients
might feel dizzy or lightheaded or feel a vague discomfort in their
heads, and oftentimes they'll get treated with medication that might not
be appropriate for a true migraine."
A neurologist should be able to rule out other possibilities, and make the proper diagnosis.
Cluster headaches
Another
headache disorder that's often misunderstood, cluster headaches are
extremely painful but also very rare -- affecting less than 1 million
Americans. Cluster headaches tend to occur close together, often on the
same day, and last 30 minutes to three hours, on average. Scientists
aren't sure why, but cluster headaches tend to occur when seasons
change. Because of this, they can sometimes be misdiagnosed as
allergy-related sinus headaches.
Hypothyroidism
Hypothyroidism
(also known as underactive thyroid) is a condition in which the thyroid
gland produces an insufficient amount of the hormones that help
regulate weight, energy, and mood. In the early stages, thyroid problem
symptoms are subtle and can include fatigue, weight gain, dry skin,
muscle aches, and impaired memory.
"It can mimic depression, fibromyalgia, and many other conditions," says Shapiro.
And
because hypothyroidism is most common in people (especially women) over
60, it's easy to attribute its symptoms to simply getting older and
more out of shape.
Diabetes
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Type
2 diabetes can't stay hidden forever; if left untreated, it can cause
life-threatening damage to the body's major organs. Before signs of
diabetes develop, says Fleming, adults can have diabetes for years
without knowing it.
"There are a
lot of people out there with elevated blood sugar levels who aren't
getting to the doctor regularly, so they aren't getting checked for it,"
he says. "They won't realize it until it gets severe enough that they
start developing side effects, like problems with their vision or
numbness in their feet or hands."
To
avoid these problems, watch for earlier symptoms like increased thirst
or hunger, frequent urination, sudden weight loss, and fatigue.
Inflammatory bowel disease
There
are primarily two types of inflammatory bowel disease (IBD): Crohn's
disease and ulcerative colitis. Both cause inflammation of the digestive
tract, as well as pain, diarrhea, and possibly even malnutrition.
Because there's no one test for IBD, however, it is diagnosed primarily
by excluding everything else.
"If a
patient comes in with severe abdominal pain, we might first think it's
their gallbladder," says Shapiro. "If he comes in with loose stools, we
might think it's an infection. So we go through a litany of tests --
imaging, blood tests, assessments -- and sometimes we finally come down
to the fact that we've ruled out every other possibility, so this is
what we're going to treat you for and we'll see if it works."
15 diseases doctors often get wrong originally appeared on Health.co
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