Thursday, February 2, 2023

What medical mysteries can teach us about getting better health care


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Who doesn’t love a good mystery?

For 15 years, medical reporter Sandra G. Boodman has been tracking down the weirdest, weirdest, and weirdest medical cases for her monthly Medical Mysteries series. Recent stories have focused on one teenager who couldn’t wake upa woman misdiagnosed with ALS, and an entire family and guest were knocked down by one a strange flu-like illness.

I caught up with Sandra to learn more about how she writes the column and the lessons we can learn from it.

Here is our edited conversation.

Q. How do you choose your ideas?

A: It must be something I haven’t written about. It should be a solved case. I need to know the final diagnosis. Although it is a solved case, there must be a mystery. And there must be a human story.

Q. Once you choose a case, how do you report it?

A: I require a chronology of events and medical records that confirm the diagnosis. The medical records and the chronology allow me to see if, indeed, this is a mystery, if it has unfolded in an interesting way. Will this be an interesting case?

Then, I interview the patient, sometimes the parent, sometimes the spouse. The last step is to talk to the doctor who made the diagnosis or the current treating doctors. Every step along the way, the process can fail.

Q. Do you write about unsolved cases?

A. No, it should be a solved case. A lot of people write to me and say, “I have this problem, can you help me?” Unfortunately, that’s not what I do. I once wrote about a lawyer in Detroit who had gone to the undiagnosed disease program at the National Institutes of Health. He has visited more than 100 doctors and still does not have an answer. But I thought his case was so unusual and interesting that I made an exception that time.

Q. What are some of your most memorable medical mysteries?

A: I wrote about a family that was still being made recurrent strep throat. They couldn’t understand it. An enterprising vet got involved. It turned out that their cat may have been the vector. When the cat was finally treated, no one got strep.

One of the strangest ones was a woman who had serious kidney and heart problems. Turns out she was eating a lot of licorice. It was really strange.

And I still vividly remember a State Department employee who had terrible itching on her head at night. She was even treated for a type of cancer. She had seen several dermatologists. Turns out she had head lice for a whole year. How did they miss it? It was really amazing.

Q. What have you learned about the medical system from writing about medical mysteries?

A. Medical care has become increasingly specialized. Doctors are familiar with a small part of what is going on, yet diagnosis is an inherently complex process. I also think the time pressures are getting worse. It’s like, “You have 10 minutes. Go.” This will not work with a complex problem.

I also think that sometimes patients are not good at describing problems. People who tend to do better are organized and can describe their symptoms in a way that a doctor can understand.

Q. What is your best advice for patients to get better medical care?

A. Primary care physicians can really help a patient. I often see people going straight to specialists. They may not have a primary care physician, or use urgent care when they are sick. This can be problematic. People really underestimate the role of a good primary care physician.

2022 Wellness Gift Guide

Need a gift idea? of The Well+Being team shared our favorite finds for cooking, exercise, spending time at home, improving our mental health, gifts for your pets and more.

Some gifts are practical and affordable; others are definite defamations. I just bought the air fryer for my family members because our Eating Lab columnist, Anahad O’Connor, recommended it. Runners will appreciate the perfect running shorts recommended by fitness writer Kelyn Soong. Amanda Morris, who writes about disability, suggested hearing aid jewelry. Journalist Teddy Amenabar has found the perfect travel cup of coffee.

There are many to choose from and each item brought us closer to living a healthy and fulfilling life. We hope they do the same for you and your loved ones this year.

Feeling full? Do not worry. Your stomach probably won’t explode.

This week, a reader asked: I always feel like my stomach is going to explode after eating at Thanksgiving. Could it actually happen?

While theoretically possible, it’s highly unlikely that your stomach will explode from overeating, said Sophie Balzora, associate professor of medicine at New York University Grossman School of Medicine and a gastroenterologist at NYU Langone Health. She writes:

Your stomach is a strong organ, with thick muscle walls and a rich blood supply that can easily handle even a hearty Thanksgiving meal.

The stomach also has a remarkable ability to expand from its resting volume without much change in pressure. Even before the first bite of turkey hits your mouth, the anticipation of it—whether through smell or sight—sends a signal to your brain that is sent to your stomach, telling it to prepare for food. As you eat, the stomach stretches, making more and more room.

But stomach rupture happened. A case report involved a 24-year-old female patient who visited an emergency room in Turkey with sudden abdominal pain, vomiting, and nausea after eating an excessive amount of fruit. An abdominal operation revealed that her stomach was perforated and contained almost five liters of partially digested food, including grapes and pomegranates – clearly exceeding a volume that most people’s stomachs can tolerate.

To learn more, read the full response from Balzora at Ask a Doctor: If I Eat Too Much, Will My Stomach Explode?

It was another busy week! Check out these stories from the team.

How exercise affects your Thanksgiving appetite: High-intensity exercise can suppress your appetite for several hours. But regular moderate exercise can make you hungrier.

Invite pets to the party? Know the foods you can and cannot share: Vets offer guidelines for a fun and safe holiday dinner with your furry family members.

9 tips for dealing with grief with children during the holiday season: Check in with yourself and your kids, show yourself some care and create new traditions.

My mother’s diet affected me too: My mother’s obsession with weight is not unique. Researchers have studied how a mother’s restricted eating habits can affect her children, especially girls.

What is the difference between RSV, influenza and Covid-19? Three respiratory viruses are straining families and hospital systems. Here are the tips of infectious disease experts.

The ‘most common hand mutilation condition’ you’ve never heard of: Often, people with Dupuytren’s contracture mistakenly assume they have arthritis or tendonitis, or don’t notice a problem until their fingers start to bend.

Why it seems like your doctor doesn’t care about you: Many patients define care as listening, investigating, following up and advocating for results. This type of care requires time and resources that many doctors don’t have, says Dr. Shirlene Obuobi.

Please let us know how we are doing. Email me at wellbeing@washpost.com.



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