Diagnosis, the Beginning

Diagnosis

What does this word mean anyway? It is very important to know this for many reasons. It is particularly relevant to me for two major reasons: autism and Lyme disease.

Diagnosis is the identification of the nature and cause of anything.[1] If someone knows the nature of something, then one knows how to respond to it. For example, a while ago, I found a lump inside the palm of my hand. I was freaked out until the doctor told me it was something common that he’d seen before. The name he gave it was “Dupuytren’s contracture”, a thickening of tendons. He said there was nothing to worry about. If he called it “cancer”, he would have responded in a much different way, and I would still be freaked out.

Even if something has a name…

What if I had a fever? That’s easy to determine: just take my temperature. But a doctor needs more information in order to ‘identify it’s nature and cause’. If I was out in the rain all night, that would provide a clue; if I spent all night in the rain in a swamp in a foreign country, that would be a different clue. Did I catch malaria? Typhoid? They are caused by different organisms even though symptoms are very similar.[2] Public health depends on the immediate and appropriate treatment of malaria, according to the Center for Disease Control (CDC).[3]

Diagnosing autism

Autism presents itself in widely different ways and severities. the American Psychiatric Association (APA) established criteria for it in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). Since it can’t be defined simply, the DSM described a spectrum of criteria, from low functioning, like my brother, to very high functioning; Asperger’s Syndrome was described separately. This month (May 2013), DSM V was released after many years of work. This is a controversial document that I will discuss in other posts. Among other things, Asperger’s Syndrome was folded into Autism Spectrum Disorder (ASD). Establishing criteria is an intricate process and depends upon methodologies used. I plan to discuss methodology in a separate post.

Diagnosing Lyme disease

This month (May) is Lyme Disease Awareness Month.[4],[5] There is great controversy about Lyme disease: too much to delve into in this space. Many diseases present the same symptoms. In fact, a cursory search of the internet reveals that several diseases have been termed “great pretenders”; for example Lupus[6], Panic disorder[7] Celiac disease[8] and syphilis[9] have been so termed. How does one establish criteria to distinguish one disease from another? Very difficult. Doctors, who have gone through years of academic training as well as practical clinical training must be able to rely upon their experience rather than looking up symptoms on a table of criteria.

My point, with regard to Lyme disease is that CDC established criteria for the monitoring of Lyme disease on a national level, and thus define symptoms narrowly. Later stages of Lyme disease are not accounted for in CDC criteria[10].

One must rely upon Lyme Literate Doctors (LLDs) to go beyond surveillance criteria and account for clinical symptoms.

(Note: Full disclosure – a loved one of mine was diagnosed with Lyme disease)

4 thoughts on “Diagnosis, the Beginning

  1. Although I don’t know yet what you are going to say about this, i would say that in relation to bacterial/viral infection and mind matters there is a good point to be made in terms of the interpretation of the medical practitioner. for example, if the MD doesn’t recognise the mental health manifestation of a disease that is of bacterial/viral/ pathogenic origin and will need the appropriate medication to counteract the problem. Where DSM (which ever version) may not cover this ( I haven’t got a copy myself so i can’t check for pathogenic infection). Medicine and the resulting treatment is very much dependent on the Health Care Practitioner, their knowledge of all factors of medicine (not just DSM, but a ‘whole’ picture). So if you get a person who doesn’t look at the body in 3d they may put a mind condition into 2d and miss the 3d Lymes Disease. Any how I’ll let you get on and as I said this looks interesting..
    (plus the insurance problems this really makes it 4d)

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    • There are a couple of problems with practitioners as regards diagnosing mental conditions: 1) detecting mental problems is not cut and dry – even today, with brain imaging techniques, mental health practitioners generally cannot point to one test or two and say that a person has X mental condition; 2) doctors are skeptical, and don’t always believe patients. This is true particularly when a doctor cannot help a person. A code word used among doctors to discuss patients they don’t believe is “supra tentorial”. The tentorum is a membrane that supports part of the brain. “Supra” means “above”. Therefore supra tentorial means, “all in his/her head”.

      One faction of the public doesn’t even believe that mental illness exists.

      Lyme disease is another issue. A substantial number of docs think it is an epidemic. Controversy surrounds Lyme disease. Check out my posting of Dr. Ken Liegner’s speech at NYC’s Union Square, for a thorough explanation of some of the issues.

      Thank you for your comment, Ruth.

      Like

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