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)