By Gary Pransky, M.D.
Family Medicine & Geriatrics in Winthrop, MA
Dr. Pransky sees patients for a variety of internal medicine conditions in his Winthrop clinic.
Years ago, I saw a cartoon in the newspaper. A woman is on the phone with a doctor, saying, “My husband’s having chest pains. What do I do?” In the next frame, the doctor says, “He only thinks he’s having chest pains.” In the final frame, the woman is back on the phone with the doctor, saying, “My husband thinks he’s dead!”
Sometimes patients are plagued with symptoms, and we simply can’t pinpoint the cause. That doesn’t mean the cause isn’t there or isn’t real. It just means we can’t find it. These patients sometimes are labeled by family and friends as hypochondriacs – people who constantly think they’re sick or have something wrong with them when they actually don’t. They feel isolated, or may ask themselves, “Is something really wrong with me, or am I losing my mind?”
Hypochondria is an old diagnosis that is no longer recognized. The new term is somatization, which is characterized by physical symptoms which may not be able to be explained by a known medical condition. However, sometimes it turns out that we’re simply unable to pinpoint what’s causing the symptoms. When I started practicing medicine, ulcerative colitis, menopause, and even asthma were considered psychosomatic diseases – conditions that were caused by stress. Of course we know now that these things are real and can seriously disrupt your life if left untreated.
Two other conditions come to mind in which patients are labeled as hypochondriacs when there is actually something serious going on: fibromyalgia and Lyme disease.
Fibromyalgia is a medical diagnosis that isn’t easily diagnosed during an office exam. An estimated 5 million American adults have fibromyalgia, and up to 90 percent of them are women.
The condition involves a variety of symptoms, including:
- Radiating pain
- Neuropathy (numbness) throughout the body
- Trouble sleeping
- Cognitive disturbances, difficulty focusing or remembering
- Related problems, including anxiety, depression, and headaches
- Widespread musculoskeletal pain and fatigue
- Poorly understood pain symptoms, including abdominal and chest wall pain
Patients’ pain ranges from mild to debilitating. Often they have trigger points – areas of the body which, when touched even lightly, can trigger pain to shoot through the limbs or the entire body. We work with fibromyalgia patients to find non-medicinal ways to manage pain, as well as to find the right combination of medications that give them the most relief.
Doctors aren’t entirely sure what causes fibromyalgia, but its onset has been linked to traumatic accidents (like car crashes), emotional trauma, infections, or genetics. In some patients, it appears to develop without any of these potential causes. Research continues to figure out how it develops and what we can do to help these patients feel better and get the support they need.
Lyme disease symptoms
I know a woman from New York who suffered debilitating knee pain several years ago. She saw many doctors and eventually was diagnosed with rheumatoid arthritis by one of the top rheumatologists in the state. She started treatment but didn’t see much improvement.
One day, her father came to visit and was reading the newspaper at her kitchen table. Suddenly he dropped the paper and exclaimed, “You have Lyme disease!” There was a big story in the paper about Lyme disease in Long Island, and her symptoms aligned perfectly with what was reported in the article.
Lyme disease is contracted by tick bites. After you’re bitten, a red bump will rise up and go away after a few days, which is completely normal.
However, if you’re infected with Lyme disease, other symptoms may arise within a month after the bite:
- Rash that looks like a target, with red around the ring and white in the middle
- Flu-like symptoms, including chills, fatigue, body aches, headache, or fever
If left untreated, Lyme disease can cause a host of serious problems, including:
- Severe joint pain and swelling
- Mental/cognitive symptoms
- Weakness and numbness of the limbs
- Rash in other areas of the body
Antibiotics are the main treatment for Lyme disease, especially when it’s caught early. For later stage Lyme disease, we can help you find the right balance of medications and therapies to alleviate your symptoms and try to keep them from getting worse.
What to do if you know you’re sick
I tell patients to always ask questions and look for answers. You have nothing to lose by checking into every possibility. Sometimes your doctor may not be able to find an answer, but our goal is to help you live a high quality of life.
Here’s what I recommend for patients who are seeking answers:
- Try a new doctor if yours dismisses your complaints.
- See a specialist for your condition.
- Do your homework. Keep a log of your symptoms and when they appear. Do a little research on the web, but make sure to use reputable health websites.
It may take time to rule out conditions or make a diagnosis. When patients come to me to help determine the cause of their symptoms, we always investigate each complaint. Sometimes there is one overarching pain or issue, and sometimes there are many. For these patients, we schedule weekly or monthly visits to try to pinpoint what is going on and alleviate symptoms that may change from week to week. We can help by treating your symptoms until a firm answer is found.
Think about how many people were written off as “nuts” who actually had a serious disease. Just because we don’t know the answer yet doesn’t mean nothing is wrong. It just means we have to work a little harder, together, to figure out what’s causing your symptoms.
Tags: internal medicine; geriatrics; fibromyalgia; Lyme disease