The challenges of medical diagnosis

Medical diagnosis is known as both an art and a science. Now, with access to medical information on the internet, patients have joined in the investigative process. But that can be a problem, especially if a medical study or report is misunderstood.

For instance, the anti-parasitic drug ivermectin has been approved by the U.S. Food and Drug Administration for use in animals and people.

An article published in late 2020, which was picked up by the media, indicated the broad-spectrum antiparasitic had demonstrated success in a trial with antiviral activity against a number of DNA and RNA viruses, including the coronavirus. The article went on to explain that despite this promise, the drug has not yet been proven effective in fighting a virus on a living organism.

Calls to poison control centers about ivermectin exposures have risen dramatically in recent months, jumping fivefold since in July, as people have used it to fight COVID-19, according to researchers with the Centers for Disease Control and Prevention.

The FDA posted warnings on its website alerting the public not to take the drug to prevent or cure COVID-19.

News coverage of public health issues is important, especially during a crisis like the coronavirus pandemic.

But news reports are brief and cannot provide all research details.

Johns Hopkins Medicine, like many hospitals, has online information on health conditions and treatment with the warning, “Do not self-diagnose.”

My family doctor has listened patiently to me these last few months as I have discussed diseases I have read about that include symptoms similar to my nightly itching issues.

The other day I asked my doctor, “What about lupus?”

“No,” he said with a laugh. “It is never lupus.”

He was referring to House MD, a TV show I hadn’t seen.

Later I found the YouTube video, Every Time It’s Not Lupus! — youtube.com/watch?v=QmP4DJO6IzE — with clips from the TV show on the many wrong lupus diagnoses.

In 2017, a study showed 21 percent of patients who sought a second opinion at the Mayo Clinic left with a completely new diagnosis.

A doctor in a specific area of medicine may also “pull” a diagnosis toward their own specialty or refuse to diagnose a condition outside of their specialty, according to a 2003 study published in the Journal of Biomedical Informatics.

To determine a diagnosis and treatment of a disease, a medical professional will order laboratory tests and analyze results, review a patient’s family history and perform a physical examination of the patient.

Early diagnosis and treatment of disease can be lifesaving and reduce treatment costs.

But many diseases have similar symptoms, and as more information is learned about a condition, a diagnosis may change.

A friend who was diagnosed as having lupus a few years later learned, after a new doctor ordered additional testing, that she actually had Lyme disease.

And sometimes the disease is detected incidentally.

My nephew David, a neurologist, recommended I have more testing after my doctors agreed my diagnosis of shingles earlier this summer may have been wrong.

After an MRI on the brain, a radiologist suggested further evaluation with whole-body bone scanning.

After that, a seasoned medical oncologist ordered a CT scan and additional bloodwork. He diagnosed chronic lymphocytic leukemia. The process of diagnosing CLL usually begins with a routine blood test called a complete blood count.

The average age of someone diagnosed with CLL is 71.5, my age.

Although my father, 96, has not had the diagnosis, he has had severe anemia, shortness of breath and fatigue for over five years, which are all symptoms of CLL.

Approximately 10 percent of individuals with CLL have a family history with the disease or a related lymphoproliferative disorder.

There are two different kinds of CLL; one grows very slowly and the other grows faster and is a more serious disease. Between these two types of CLL, there are several subtypes that differ at the genetic level.

Testing and time will tell what type is mine.