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Screensize: 640 x 480 800 x 600 1024 x 768 1280 x 1024 UserName: Password: Format Mode: Basic  Help  Prompt  Format: Font Andale Mono Arial Arial Black Book Antiqua Century Gothic Comic Sans MS Courier New Georgia Impact Lucida Console Script MT Bold Stencil Tahoma Times New Roman Trebuchet MS Verdana   Size 1 2 3 4 5 6   Color Black Red Yellow Pink Green Orange Purple Blue Beige Brown Teal Navy Maroon LimeGreen Message: * HTML is OFF * Forum Code is ON Smilies [quote][i]Originally posted by shawnsmith[/i] [br]The danger of jumping to conclusions Dr. James Aw Oct 11, 2011 http://life.nationalpost.com/2011/10/11/the-danger-of-jumping-to-conclusions/ “It was a sharp pain where my ribs opened,” said “Allie,” a 25-year-old administrator for a downtown Toronto non-profit. She first noticed the discomfort in March 2007, when she was a 20-year-old university student. At first it happened about 30 minutes after she began eating. As time went on, the duration shrank between pain and the meal’s first bite. By June of that year, she experienced discomfort after just two or three bites. At 5-foot-5, Allie (her real name isn’t being used here to protect privacy) considered her normal body weight to be 125 pounds. Once the pain began to affect her eating, she dropped to 110 pounds, then 100 pounds. It took a summertime visit from her mother for Allie to confront how alarming the weight loss was becoming. Her mother took one look at her and took her to the closest emergency room, where an attending physician asked to speak with Allie alone. “Do you eat?” he asked, and seemed skeptical when she said that she tried, but felt pain soon after she swallowed. “Your daughter’s clearly anorexic,” the doctor told her mother. Given Allie’s background, a diagnosis such as anorexia wouldn’t have seemed out of place. Her family was upper-middle class. Her parents were high-achieving professionals. She had a background in dance. The profile of an eating disorder patient fit her perfectly. But Allie insisted she wasn’t anorexic: “I was trying to eat,” Allie insisted. “It’s just, I couldn’t eat without feeling like I was getting stabbed.” During the summer of 2007, she guesses she saw 10 different doctors — gastro-intestinal specialists, lung specialists, emergency room doctors. Anorexia came up often during these appointments. Half-hearted attempts to discern some other problem came up with nothing. Meanwhile her weight continued to drop, from 100 pounds to 95, then 90. Her parents tried to get her to move home with them. Allie acceded when she hit 85. “Don’t go anywhere, don’t do anything, just sit there and eat,” her parents told her. Allie looked like a skeleton. Friends saw her and gasped. Her relationships with her boyfriend, siblings and parents grew difficult. They felt she wasn’t trying hard enough to eat. She felt everyone else should just leave her alone. With the help of densely caloric foods such as M&Ms and nuts, she was able to stabilize her weight and even managed to get it back up to 90 pounds. Even so, she was slowly dying of malnutrition. Her menstrual cycle stopped. Protein in her urine showed her kidneys were acting up. She was accumulating fluid around her heart. I am a work acquaintance of Allie’s mother, who works as an occupational health nurse for a large company. She came to me, beside herself, about a year after the problem first sent Allie to a physician. I trusted Allie and her mother when they insisted the problem, whatever its nature, was more complex than an eating disorder. So one of the physicians on my team conducted a reboot of the case. He ordered another go-round on every test she’d already been through. We arranged to have her admitted to Mt. Sinai Hospital, where a team of doctors brainstormed over a whiteboard about such possible diagnoses as HIV, heavy metal poisoning or lupus. Allie underwent even more blood tests and scans, including her first computed tomography angiogram, in which dye is injected into the body to allow physicians to better see blood vessels. The turning point came the following afternoon. The astute medical team had wondered about a link to blood circulation in the digestive system. It turned out that the CT-angiogram showed an aneurysm in Allie’s celiac artery, which supplies blood to the stomach, liver and other digestive organs. Few people have ever been so happy to receive a diagnosis that required major surgery. Finally, Allie’s pain had a cause — an extremely rare condition called celiac artery compression syndrome, in which eating causes one of the diaphragm’s ligaments to crimp the celiac artery, sometimes causing severe pain. Toronto vascular surgeon Dr. Daryl Kucey conducted bypass surgery that inserted a plastic sleeve into the celiac artery to straighten out the crimp. After the surgery, Allie put on 20 pounds in six weeks. She married her long-time boyfriend in December 2010. Now she’s expecting her first baby in January 2012. Despite the happy ending, Allie’s case prompts some troubling questions for the medical profession. Celiac artery compression syndrome was first diagnosed in the mid-1960s. It’s rare, but the symptoms of postprandial abdominal pain and severe weight loss perfectly fit Allie’s case. The problem arose because Allie’s symptoms also are typical to anorexics, a vastly more common condition. Allie insisted all along she wasn’t anorexic — that she honestly wanted to gain weight. Why didn’t her doctors believe her? Were the doctors relying on the usual medical testing algorithms when they dismissed this case as an eating disorder? Attentive listening to her specific medical symptoms may have lead to an earlier CT-angiogram, saving Allie from a lot of pain and suffering. That aneurysm could have burst. Allie could have died from malnutrition complications. This is an example of case where we, as a medical profession, could have, and should have, listened better. Despite the advances in science and technology, our profession should never forget the art of listening to our patients. Dr. James Aw is the medical director of the Medcan Clinic, a leading private health clinic in Toronto. For more information, visit medcan.com. [/quote]   Check here to include your profile signature.