Last month, the Diagnosis column of The New York Times Magazine asked Well readers to sift through a difficult case and solve a diagnostic riddle. Hundreds responded, and several of you succeeded in solving the mystery.
If you missed out, here's another chance to play medical detective. Below you'll find a summary of a new case. The first reader to solve it gets a signed copy of my book, "Every Patient Tells a Story," along with the satisfaction of knowing you could outdiagnose Gregory House. Let's get started.
The Presenting Problem:
An otherwise healthy 76-year-old woman with intestinal bleeding and complaints of weakness, fatigue and mood swings.
The Patient's Story:
A fiercely independent and active 76-year-old woman had spent several years caring for her aged mother, who died at 99. Weeks after her mother's death, she collapses at home. She was found to have bleeding from a collection of abnormal blood vessels (known as arteriovenous malformations) in her colon. In the months after treatment, her red blood count returned to normal, but she complained of persistent fatigue and weakness. She told her daughters that she was more tired than she'd ever been in her life, calling it "the big emptiness."
The Doctor's Exam:
Dr. Susan Wiskowski, a family physician in Hartford, had been the woman's doctor for several years and knew her well. Until this year, the patient had been in good health for her age, with only a few medical problems: high blood pressure, which was controlled with just one medication; hypothyroidism, treated with Synthroid; and cataracts, which had been surgically repaired.
Because heart disease can manifest as weakness and fatigue, particularly in the elderly, Dr. Wiskowski referred her patient for a cardiac workup. She also referred the woman to a hematologist, to check on a slightly elevated white blood count detected during the bleeding episode.
More ...
http://well.blogs.nytimes.com/2011/04/20/think-like-a-doctor-a-litany-of-symptoms/?
