Atypical presentations of diseases can be misleading and hide a killer disease behind innocent symptoms
A lady suddenly developed a severe headache. The family wasn’t aware of her ever having suffered from headaches in the past and so her agony seemed natural. They gave her medications, applied topical balms and offered beverages and brews to give her relief.
But not only did none of them give any relief, she started becoming drowsy and less responsive. A good 24 hours after her symptoms started presenting, they decided that she need to be treated by a professional and brought her to the hospital.
On hearing the case history, the doctors decided to conduct a scan as they identified significant symptoms of an intracranial event. The scan revealed a massive bleed. But it was too late for the doctors to save her and she succumbed in the hospital.
In another case, a gentleman was suffering from a severe back and arm pain. Assuming it to be a muscular cramp, he applied relaxants. But his condition worsened and he was in a state of collapse when he was taken to the hospital. The doctors managed to resuscitate him and perform surgery on him. He was lucky to survive.
The patient was suffering from aortic dissection - revealed in imaging – a condition where the wall of the aorta dissects and there is seepage of blood in between the layers. Aortic dissection can present itself in many ways, and back and arm pain is one of them.
In yet another instance, there was another presentation of backache where the patient – a manual labourer - even consulted a GP, but refused to do the prescribed blood test, assuming his pain to be a result of a muscular cramp. But the condition worsened to such an extent that he lost the power in both the legs and had to wear diapers as he was unable to control his bladder.
He was suffering from a type of blood cancer called Myeloma. This condition has a specific treatment and there could have been a significant difference had he come earlier.
People often ignore or put up with sinister symptoms like headaches, chest discomforts, limb weaknesses, altered sensations, numbness – all those could mean something more serious. In emergency medicine, a significant number of mishaps or bad outcomes are seen because presentations could be a bit atypical and the patients delay consulting a doctor, points out Dr Dhavapalani Alagappan, Emergency Medicine, Apollo Hospitals, Chennai.
“Heart attacks are mistaken for heart burns or gastritis, reflux and other similar conditions. Similarly, there are many such conditions where the symptoms are misread and the real problem left unaddressed,” he explains. That is because people do not understand the significance of the presentation.
“In emergency medicine, the first thing they teach us is to exclude all the life-threatening causes. Because there are many atypical presentations, what’s the most likely cause is not important, what’s the most dangerous thing it could be – that gets excluded. And then we work down the list,” he reiterates.
As in the instance of the lady with the headache, people may mistake it for migraine and treat headache. But it takes a certain amount of a clinician’s time to get a proper history and examination and have a higher level of suspicion to think that this is not the typical migraine they are suffering from, but intracranial bleed. That needs to be dealt with.
An experienced clinician will have his index of suspicion very high. For instance, migraine is unilateral, accompanied by watering eyes and provoked by certain triggers. Instead, if the headache seems to come out of the blue, something unbearable, then that’s suggestive of a bleed. Careful history taking and examining usually gives pointers to serious problems that an experienced clinician can usually pick up. The aid of investigative tools also helps doctors diagnose more accurately, which is denied to a layman.
To a large extent, such surprises don’t happen among the western population, he adds. “Maybe because they have better access to healthcare, or maybe, they take their health more seriously,” he suggests. But in the Indian subcontinent, it’s quite unfortunate that doctors often see people presenting quite late, when they can’t bear the pain any more or when they start to suffer the real consequences of the problem.
Apart from pain, people generally seek help only when there is bleeding or when they suffer a condition like heart attack that could potentially kill them. “Lots of other conditions such as cancer, stroke, chronic infections like TB seem to be delayed in their presentation. By the time they reach, it may be too late and we tend to think – had I seen these patients earlier I could have offered better care,” the doctor says.
Symptoms of cancer are often mistaken for other problems. Bowel cancer, for instance, can present itself as loose stools. Altered bowel habits without any reason and which goes on for a few days is a cause for concern. “Be mindful of your body and symptoms. Ignoring them or self-medicating is going to be disastrous. Weight loss, loss of appetite could mean something more sinister growing underneath. So these need to be checked up,” he stresses.
Stroke is another condition that is often ignored because there is no discomfort, only some weakness and inability of one part of the body to function properly – like limb weakness, facial drift, speech difficulty, etc. Since it is not painful, people tend to wait and hope for things to improve. “Stroke has a narrow time window to be treated – just a few hours to open up the block,” Dr Dhavapalani points out. Stroke treatment has changed in a big way, and the time window keeps extending, so getting to the hospital quickly can be crucial. While there may be no significant symptom prior to a stroke, the quality of life suffers after. So prevention is better than cure.
Seeking timely help is important as it can keep one alive, and lead a good lifestyle.