Topic: Illness

Illnesses can be tricky things. I have to deal with that fact daily in my job. It’s always important to consider multiple possible explanations for the condition a patient presents with. And once I experienced a sort of misdiagnosis personally.

I had just moved to Albuquerque in October of 2008. I was settling in to my new job as an Urgent Care doc reasonably well. But then I started to experience nausea on a daily basis. Sometimes it was mild, sometimes it was severe. I never had to vomit but I sure felt like it. I had no fever, no change in stool, no change in appetite, no other symptoms at all. Sometimes I even had to miss work because of it.

One morning it was particularly bad but I simply couldn’t miss work. After I got there one of my partners began to quiz me. I revealed that almost a year before coming to Albuquerque I had to get a stent in one of my coronary arteries. “Holy Shit!”, she said. “Your stent may be blocked!” To be honest, I hadn’t considered the possibility of my coronary artery disease causing the nausea, though nausea can be a sign of a heart attack. She made me get an EKG which showed some modest changes, though nothing consistent with an acute blockage. But she called the ambulance anyhow and soon I was on my way to a downtown hospital.

In the ambulance I reflected on the fact that I been a really lousy, non-compliant patient. I had been diagnosed with diabetes 5 years earlier and never really took the medicines I was prescribed. And I was prescribed several other medicines after the stent, which I also didn’t take. In the ER the doc asked why. I told him I was very depressed and unhappy and I supposed that was my passive way of committing suicide. “GODDAMN IT WHY DID YOU TELL ME THAT?!!”, he erupted. “Now I have to call a Psychiatry consult! You knew that!” Actually that hadn’t crossed my mind but before Psych arrived the Cardiologist showed up.

The Cardiologist took a history, looked at my EKG and offered me the choice of a stress test or a repeat cardiac catheterization. I chose the cath, since I knew that cardiothoracic surgeons frequently operated on people who had had a normal stress test the week before - in other words, the stress test could miss a blockage whereas a catheterization would let the Cardiologist see my coronary arteries directly.

So I underwent the cardiac cath. And to my surprise, my stent had gotten blocked - it was 99% occluded and I could have had a heart attack at any minute. Actually I guess I shouldn’t have been surprised, given the fact that I hadn’t been taking the medicines I was supposed to. The Cardiologist speculated that the blocked artery, passing close to my diaphragm, may have been provoking the nausea. 

I had to spend that night in the hospital. I was on a morphine pump for pain control, which usually is unnecessary but in my case I woke up while they were clamping my femoral artery, which caused the worst, most visceral pain I had ever felt. The Cardiologist promised me if I let them finish clamping the artery he would give me whatever I wanted for pain so I went for the gold standard. I don’t know if you’ve ever had to have a narcotic pain medication but the way they work is such that you still know you have pain but you don’t care.

Anyhow after a day or two, I was back at work. They wanted me to take a week off but I didn’t want to just sit around my condo. And - the nausea came right back when I returned to work. I was really frustrated.

Finally it dawned on me that I hadn’t had my vision checked for years. It turned out that my glasses prescription had changed drastically due to my untreated diabetes, and after I got new glasses the nausea resolved. So in my case a misdiagnosis may have saved my life!

EPILOGUE: Psych visited me after the cath. I assured them that I didn't actually want to hurt myself. She said she would visit me again before I left the hospital, but she never came back. So either I reassured her sufficiently, or she gave up on me, not sure which. At any rate, my mood is now great!

I have subsequently had 2 more cardiac caths, with stent placement, despite complying with my meds. So I think I just tend to block off arteries easily. 

My diabetes is under excellent control now. Glycohemoglobin is a lab test that shows how one's blood sugar has been running over the last 3 months. Normal is between 4.0 and 5.6. My glycohemoglobin is now 6.2; for well-controlled diabetes it should be less than 6.5. Mine had been as high as 13! My excellent endocrinologist figured out that I actually have something called Cushing's Disease, in which one's adrenal glands are too active. This causes excess cortisol production, which leads to high blood sugars. She gave me a medicine to suppress the excess cortisol & my sugars are great now.