THE PATIENT DETECTIVE

. Posted in DIAGNOSING YOUR SYMPTOMS

Your role in accurately conveying your symptoms is probably the most important aspect of the diagnosis. I tell my patients all the time that they are the best resource in finding a solution for their problems. I count on my patient’s detective skills: Without them, I could potentially be making a faulty diagnosis.

For instance, the term headache denotes a symptom that is related to many different diagnoses. Headaches can be diagnosed as vascular, migraine, infectious, traumatic, tension, or sinus, among others, depending on their pattern and associated complaints, such as location, duration, and severity. To make things more confusing, each of these types of headaches can sometimes have overlapping patterns. Worse, you may be suffering from more than one type of headache.

For the physician to make the most accurate diagnosis, you must accurately communicate the subtle nuances of exactly what and how you
are feeling. At the same time, your doctor must carefully listen to your description. For example, many people suffer from sinus headaches, yet incorrectly label this symptom as a migraine. They may have learned that a migraine occurs when there is pain located behind the eyes and in the forehead, and this pain causes distorted vision, light sensitivity, and a headache that radiates to one side of the head. Yet these same symptoms can also be attributed to a sinus headache or a sinus headache that precedes a migraine headache. If your physician takes your self-diagnosis of migraine headaches without probing you to describe your symptoms, you may be incorrectly treated for the wrong type of headache for years to follow. When this treatment doesn’t work, you won’t realize that it was your incorrect reporting or your physician’s misdiagnosis that actually caused the misunderstanding.

Unfortunately, people suffering from CAID are routinely misdiagnosed. In fact, CAID is one of the most misdiagnosed medical problems. Often it is overlooked as a cause of chronic fatigue syndrome, headaches, and/or snoring. For instance, my patient Jaclyn is a 28-year-old lawyer who spent an entire year searching for treatment for what she thought was a constant cold. When she finally came into my office, she told me that she suffered from painful headaches that seemed to move around her face: Often they occurred in her forehead, yet at other times she felt the pain in her cheeks and around her eyes. Jaclyn was hoarse and experienced swollen glands, ear congestion, and constant fatigue. She also suffered from intermittent neck stiffness. She regularly missed work owing to her symptoms and never found any relief with over-the-counter medications.

Jaclyn was so uncomfortable that she went to a variety of doctors, including an internist, an allergist, and even an ear, nose, and throat (ENT) specialist; no one was able to help her. Her allergist performed routine testing and told her that she did not have allergies, yet he prescribed antihistamines. When none of the traditional medications worked, Jaclyn began experimenting with alternative medicine. She went to an acupuncturist who treated her with cupping to the point that her back looked as if she had been beaten.

After Jaclyn finished her story, we discussed the details of her symptoms and the treatments she had already received. I followed up our
conversation with a comprehensive workup, including a complete family history and a thorough physical examination. I sent her for a computed tomography (CT) scan and performed an endoscopic examination. The results from my physical examination and from the medical history pointed toward a diagnosis of CAID, manifesting in a problem with her sinuses. My findings were compatible with the initial allergist: The underlying cause was not related to allergies (which was why the prescribed antihistamines never provided her relief). Yet I saw that Jaclyn’s sinus passageways were structurally too narrow, an anatomical condition she had her entire life but that never bothered her until her nasal membranes became inflamed from what I could only guess was a long-term infection. I recommended that, while surgery would be an effective solution, we should first try a new regimen of prescription medications and chiropractic treatment. Luckily for Jaclyn, she was able to find relief by following this protocol.

Today Jaclyn is able to breathe freely and no longer has sinus headaches or neck pain. She subsequently had a baby and told me that she was enjoying motherhood, free of the suffering caused by her sinus problems.

Sinus Tips:
Refrain from drinking or eating for at least Vi hour after the examination because your throat will still be numb. Do not drink or eat any hot foods for approximately 2 hours after
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Your role in accurately conveying your symptoms is probably the most important aspect of the diagnosis. I tell my patients all the time that they are the best resource in finding a
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