Seven Diseases Doctors Miss

[Guest guest]

Seven Diseases Doctors MissBy Alexis Jetter, Preventionhttp://small-url.com/?5jhttp://health./women-overview/seven-diseases-doctors-miss/prevention--22716.htmlIn her early 40s, Pamela Serure was the epitome of health. An energetic New York City marketing executive who'd grown tired of the rat race, she'd moved out to the Hamptons, started a juice business, and written a guide to yoga and fasting that catapulted her onto an international book tour.Celebrities including Alec Baldwin and Barbra Streisand swore by Serure's detox diet. Yet even her own regimen couldn't ease the puzzling symptoms Serure suffered: a burning in her chest, fatigue, neck pain, and a tendency to sweat profusely after just a short workout.Over the previous 10 years, at least a dozen doctors had labeled Serure's chest pain heartburn, her sweating a prelude to menopause, and her exhaustion chronic fatigue. They x-rayed her lungs, looking for pneumonia and bronchitis. "If they couldn't find anything, they would dismiss the whole chest thing," she says.In 1998, the 47-year-old Serure told yet another doctor about her symptoms. "You don't have pneumonia," he said. "You have angina.That's ridiculous," she retorted. The doctor made her promise to take nitroglycerin pills to forestall a possible heart attack. A few days later, she went to see a cardiologist. All the usual tests came back normal, but in the hallway as she was leaving, she felt a burning in her chest and returned to the doctor. In a matter of minutes, heart monitors were hooked up: She was about to have a heart attack. Serure's main artery was 98% blocked; two others were only marginally better. "We don't know how you're walking around," the chief cardiologist told her as she was prepped for bypass surgery. "You must have one hell of a spiritual life."Heart problems aren't the only disease that doctors often overlook in women. Below, you'll read more about this and six others that have subtle or confusing symptoms and are frequently missed by women and their doctors. By learning the risk factors, symptoms, and treatment, you can better protect yourself against some of life's nastier surprises.Heart DiseaseOne in four women has cardiovascular disease; it claims more lives than all forms of cancer combined. More women than men die of heart disease every year, yet they are six times more likely than men to be mistakenly sent home from emergency rooms by unsuspecting doctors.Partly, that's because women often don't have the classic male sign of cardiac failure: severe chest pains. Women tend to experience symptoms such as nausea, shortness of breath, indigestion, and fatigue—and even they don't know that they're experiencing a heart attack.As a result, women often take longer to seek emergency care. And because doctors miss the symptoms, they are slow to take action, delaying emergency surgery to reopen clogged blood vessels and restore blood flow to the heart.A recent University of Michigan study found that women must wait 13 minutes more on average than men for emergency heart surgery. Add to that another 13 minutes they waited before seeking help, and the result is almost a half hour of potentially deadly heart damage. Not surprisingly, female heart attack victims are twice as likely as their male counterparts to die in the hospital.Pamela Serure is now working on a memoir about her long journey to diagnosis. "Finally, someone found why I felt so bad," she says. "Now I feel great. I feel like I'm 20 again."What You Need to KnowGauge risk.Smoking, high cholesterol, inactivity, stress, and obesity can weaken blood vessels. African Americans, diabetics, women with a family history of heart disease, or those who are older than 65 are also at increased risk.Recognize symptoms.If you are experiencing shortness of breath, fatigue, nausea, pressure in your chest, or gastric pain, seek emergency care. Most women have symptoms prior to their heart attack, several times a week, which mimic the sensations of the actual attack 1 week to 6 months later. Pay attention—and make sure your doctor does, too.Get tested.Ask for an exercise echo-cardiogram in addition to standard tests. It's an ultrasound of the heart performed after using a treadmill or stationary bike. If that's inconclusive, and you're still having symptoms, ask for a CT (computed tomography) scan or an MRI. Your doctor may also suggest an angiogram.Find the right treatment.A combination of balloon angioplasty, which widens clogged arteries, and stent placement, which props them open with a wire mesh tube, is more effective than clot busters for treating heart attacks in women. For more information, visit Healthy Women.Ovarian CancerAyala Miron, a civil engineer and mother of four in suburban Philadelphia, has always made sure to inform her physicians of any health problems. Yet Miron, now 49, suffered abdominal cramps, urinary discomfort, longer periods, and abnormal midcycle bleeding for years without getting a diagnosis. She did have an abdominal and vaginal ultrasound. But both came back clean, and her doctor never suggested a follow-up look. The midcycle bleeding she experienced, he assured her, was normal.But at 40, after the birth of her fourth child, Miron started developing other strange sensations: a sharp pain in her shoulder whenever she drew a deep breath, and a stabbing pain in her abdomen. She called her internist about the pain, and a nurse practitioner told her to take three ibuprofen tablets.Two days later, when the abdominal pain became too much to bear and she couldn't reach her internist, Miron asked her husband to take her to a nearby hospital. "I was literally in my car, sitting in front of the ER, when my internist called me on my cell phone," Miron recalls. "You're probably having a gall bladder attack," he told her. "There's no need to go to the ER." They drove home. Shortly afterward, when the doctor examined her, he found no sign of gall bladder trouble—and took no further action.At age 43, after 3 years of on-again, off-again discomfort, Miron finally landed in the hospital with sharp abdominal pain, a swollen abdomen, and severe fatigue. The emergency room doctor was about to discharge her, saying that she probably had inflammation of the digestive tract. "Shouldn't you check something else?" Miron's husband asked.The doctor relented and ordered a CT scan. It revealed in stark outline what Miron had dully sensed for years: Multiple malignant tumors had invaded her abdomen, pressing on her diaphragm, bladder, and nerves. She had ovarian cancer and it had reached stage 3, treatable with a hysterectomy and chemotherapy but with no guarantees against a recurrence.This aggressive cancer strikes one out of 57 women, and though it can be effectively treated in its early stages, it's usually caught too late—when tumors have spread throughout the abdomen and to other parts of the body. Ovarian cancer is tricky to catch because most women have few distinctive symptoms during its initial stages, or doctors attribute the symptoms to irritable bowel syndrome, menopause, or aging.Five years later, Miron has beaten the odds—for now. She spends her spare time educating women and medical students about the early signs of the disease. "Women need to trust their own bodies," she says. "If you're feeling that something is wrong, don't assume anything. Be persistent. And don't wait."What You Need to KnowGauge risk.Incidence rises sharply after age 50. Women with a family history of ovarian, breast, or colon cancer are more likely to get ovarian cancer—and at an earlier age. Those who have never had children are also at increased risk.Recognize symptoms.Recent studies have reached a startling conclusion: This so-called silent killer isn't quiet after all. Nearly 90% of women with early-stage ovarian cancer have a cluster of identifiable symptoms several months before their diagnosis: most commonly, abdominal and pelvic pain, urinary urgency, and a bloated sensation. Other signs are abnormal vaginal bleeding, constipation, and fatigue. If women alert doctors to a sudden onset of these ailments, they may catch the disease early, when it's 90% curable.Get tested.Women should get a pelvic/rectal exam from their gynecologist every year. It's not comfortable, but it does a far better job than a simple vaginal exam at assessing the health of your ovaries—which in some women are tucked behind the uterus.If the exam raises any questions, your doctor should follow up with a transvaginal ultrasound. And if any abnormal masses are found, a CA-125 blood test may be used to determine if they are malignant.Find the right treatment.It can range from removing the ovaries and uterus to taking out the omentum (thin tissue covering the stomach and large intestine) and lymph nodes in the abdomen. Chemotherapy may be given to destroy any cancer cells remaining after surgery.Celiac DiseaseMeredith Conen knew something was wrong with her stomach, but the answers from her doctors just didn't add up. "It's in your head," one told her. When she insisted it wasn't, he amended the diagnosis: "You eat too much candy. And you probably shouldn't have so much caffeine."Conen, then a student at the University of Maryland, was young, trim, and otherwise healthy. So why was her stomach hurting all the time—sometimes causing her to bend over in pain? The discomfort would start the minute she ate. "It felt like gas, but higher up," says Conen, now 28.She moved to New York City, got a high-pressure job, and started hunting down answers to her malady. On a hunch, Conen cut out dairy, but that didn't help. She had a colonoscopy to rule out colon cancer, which runs in her family. Switching to a less-stressful job eased her symptoms—for a while. But soon she was running to the bathroom again, just as bloated and achy as before.Conen consulted three or four gastroenterologists until one sat her down, asked about her history, and requested she keep a food diary. The doctor's hunch was irritable bowel syndrome. But when he looked at her food diary 2 weeks later, he said he'd erred.Eight years after she'd first experienced symptoms, Conen was diagnosed with celiac disease, a genetic inability to digest gluten, a protein found in wheat, rye, and barley. Gluten damages the lining of the small intestine, making it difficult to absorb nutrients such as calcium, vitamin D, folic acid, and iron. Left untreated, the disease can cause osteoporosis, anemia, infertility, miscarriages, and lymphoma.Mostly, celiac disease is left untreated. It takes, on average, 11 years to diagnose. In many cases, a person is symptom-free even while the illness destroys the intestinal lining.Until recently, the disease—which strikes women three times more often than men—was thought to be rare. But recent research reveals that it affects 3 million Americans, 10 times more than previously estimated. A new study of women with osteoporosis found that celiac disease was 17 times more prevalent among this group than in women with healthy bones. And the more severe the disease, the worse the bone loss was.Celiac disease may be causing other health problems as well, says Peter Green, MD, a professor of clinical medicine at Columbia University Medical Center and director of the university's Celiac Disease Center. "The question is: Where are all these people with celiac disease? They're not getting diagnosed. It may be hiding behind other diseases—irritable bowel syndrome, infertility, and anemia."There's no magic pill to cure the problem—just permanent elimination of gluten sources from the diet, including cereals, pasta, flour products, bread, cold cuts, prepared foods, and soy sauce.For now, Conen is willing to make that sacrifice. She even had a small, just-for-her, gluten-free cake made for her wedding reception in 2004—alongside a traditional one for her husband and guests. "Why should everybody else have to eat a gluten-free cake?" she reasoned. Staying away from the protein has restored Conen's small intestine to health—but she's suffered bone loss. She's taking calcium supplements, doing weight-bearing exercises at the gym, and toting around her own gluten-free bottle of soy sauce when she dines out. "It's for life," she says, matter-of-factly. "Your symptoms can go away, but it doesn't."What You Need to KnowGauge risk.Only 1% of Americans are estimated to have celiac disease, but if one family member has it, the immediate family is 10% more likely to have it also, even if they show no signs of it. Relatives who already have an autoimmune disease are 25% more likely to get celiac disease.Recognize symptoms.They can include chronic diarrhea, abdominal bloating and pain, weight loss, foul-smelling stool, seizures, edema, and a painful skin rash.Get tested.Your doctor can give you a panel of blood tests to assess the levels of certain antibodies that are typically high in people with celiac disease. If the tests are positive, he may perform a biopsy to sample tissue in your small intestine—the only sure way to diagnose the problem. This biopsy is done with an endoscope, a long thin tube that's eased through the mouth and stomach into the small intestine. Hospitalization is not usually required.Find the right treatment.Only one approach works: Eliminate gluten.LupusElizabeth Oen, 42, has learned to take bewildering maladies in stride. Like the time, as a child, that her feet swelled up like balloons from walking barefoot on freshly mown grass. Or when, at 24, she discovered in a preoperation exam that her blood platelet count was only 7,000 parts per cubic millimeter. (Platelet counts in healthy people are 150,000 to 400,000 parts per cubic millimeter.)Oen was diagnosed with an autoimmune disorder that destroys platelets, which aid clotting. Without platelets, the blood leaks into the skin and tissues. "The doctors said they couldn't figure out why the blood wasn't just dripping through my skin because the count was so low," she says.Her doctor put her on massive doses of prednisone, a potent steroid, and ordered her not to move—no exercising, no jogging, no working out, nothing. A normal steroid dose is between 5 and 200 mg a day. Oen's prescription was 350 mg a day. "I was locked in my house for 6 months," she says. "My weight went from 160 pounds, all muscle, to 200 pounds, with no muscle. When I finally got off the prednisone, I couldn't move. All my joints hurt."She sought help from a rheumatologist, who took some x-rays and tested her for Lyme disease. When nothing turned up, he diagnosed Oen with laziness. "He decided I was just a fat woman and was looking for a magic pill to take it all away."Oen, a tall, determined person with a soul-saving sense of humor, plowed on. At 24, a single mother with a daughter to support, she went to graduate school, seeking a combined medical degree and PhD. But weird, painful conditions kept plaguing her. Bruises appeared without her ever bumping into anything. A long ropy scar crawled around her wrist after she scratched herself slightly on a car door. A flu bug caused her neck to swell to twice its size. Doctors told her she had an underactive thyroid and a lousy attitude. One insisted on putting her on antidepressants. No one connected the autoimmune blood disorder, the strange scarring, the joint pain, and the bruises that appeared out of nowhere.Soon, painful sores appeared in her mouth, and her knees felt like they would buckle under her when she walked. She was forced to leave school. A doctor examined her and said she had the worst case of flu he'd ever seen.Finally, at age 33, she was referred to a rheumatologist who'd done his homework. He looked at her medical chart, gave her a thorough physical exam, and listened to her history. "This is lupus," he said. It was bad news, because lupus—a degenerative autoimmune disorder where the body attacks the brain and organs as "other"—is incurable and only minimally treatable. Lupus can strike the joints, kidneys, heart, lungs, and brain.But Oen was relieved to finally have a name for her disorder—and to be assured that it was not all in her head. It took 10 years for her to get diagnosed. Today, she's working out, bicycling, and working at—of all things—a blood bank. She still has bad days, and she knows more are on the way. "It almost feels like something is chewing on my bones," she says. But she keeps up with the research and is an advocate for other lupus sufferers across the country. "Don't go to these appointments alone," she tells them. "You feel like such a lunatic. And most doctors are so overworked that they'll just take you in and ship you out. They're happy to give you prescriptions. But I needed answers."What You Need to KnowGauge risk.This disease strikes women 10 to 15 times more often than men. It tends to emerge in people between the ages of 15 and 44, and is two to three times more common among African Americans, Hispanics, Asians, and Native Americans.Recognize symptoms.Lupus develops slowly, with symptoms—called flares—that come and go. They can include a "butterfly" rash across the nose and cheeks, skin rashes on parts of the body exposed to sun, sores in the mouth or nose, painful or swollen joints, hair loss, fatigue, painful breathing, purple or pale fingers or toes, abdominal pain, and headaches.Get tested.If you have four (or more) lupus symptoms and your doctor can rule out other causes, you should ask for an anti-nuclear antibody test (ANA), which can identify lupus. Consult a rheumatologist.Find the right treatment.There's no cure, so the focus is on reducing swelling, using nonsteroidal anti-inflammatory drugs, antimalarial drugs (which relieve joint pain and rashes), corticosteroid hormones, and in extreme cases, chemotherapy.Hepatitis CHepatitis C is the most common chronic bloodborne virus in the United States. It grabbed headlines in 1991 when Naomi Judd, the country-western singer, announced that the disease had forced her retirement. As a young woman, Judd had worked as an intensive care nurse—and accidentally nicked her finger with an infected needle. Yet 14 years later, sufferers are still going undiagnosed.What You Need to KnowGauge risk.Hepatitis C lives in blood. Shared intravenous drug needles, unprotected sex with infected partners, tainted blood transfusions or organ transplants (before 1992), health care work, and—potentially—tattoos and body piercing can put you at risk.The Centers for Disease Control and Prevention (CDC) estimates that 4 million Americans carry the virus. And every year, 25,000 more join their ranks. Hepatitis C is a leading cause of liver disease and the major reason for liver transplants. About 5% of infected mothers transmit the virus to their babies in the womb. Hepatitis C is also present in breast milk, and though doctors say it's too small a dose to worry about, an infected mother with cracked nipples should express her milk rather than breastfeed.Recognize symptoms.The disease can remain hidden for decades. As many as 70% of those infected are unaware that they carry the virus. Early onset is often asymptomatic, but the few signs that emerge look like the flu—fatigue, sore muscles, headache, nausea, and loss of appetite. Occasionally, the virus yellows a person's eyes, skin, and mucous membranes. But those symptoms quickly disappear, lulling up to 85% of hepatitis C sufferers into inaction—and chronic disease. If left unchecked for more than 6 months, hepatitis C can chronically inflame the liver. Left untreated for many years, the virus can cause cirrhosis (scarring that leads to liver failure), edema, muscle wasting, and death.Get tested.Within 50 days of exposure to the virus, most people infected with hepatitis C will exhibit elevated levels of liver enzymes on a routine blood test. That test should be followed up with a specific hepatitis C antibody test, which is highly accurate. A liver biopsy can assess the severity of disease and need for treatment.Find the right treatment.Drug treatments are often successful in clearing the virus from the body; Judd, for example, says she is fully recovered.But a word of caution: Ribavirin, a drug commonly used to treat hepatitis C, is known to cause birth defects—so pregnant women should not take it. Interferon alpha, another common treatment, is not recommended for pregnant women either, because its effects on the fetus are not well-known.ChlamydiaChlamydia is the most commonly reported infectious disease in the United States—and one of the most dangerous sexually transmitted diseases among women. But 75% of infected women have no symptoms at all—and only one in four young women at risk for the disease is getting tested for it, according to the CDC.Those are scary statistics, doctors say, because an estimated 3 million Americans unknowingly contract—and spread—the disease each year. When detected early, chlamydia is easily treated and causes no long-term problems. Ignored, it can cause pelvic inflammatory disease (PID), infertility, ectopic pregnancies, and miscarriage. (Of the estimated 1 million cases annually of PID, half may be caused by chlamydia.)Babies who are exposed to chlamydia in the birth canal are at risk for pneumonia; conjunctivitis (leading to blindness); and ear, nose, and throat infections.What You Need to KnowGauge risk.Three of every four reported cases occur in people younger than 25. By age 30, one in two sexually active women probably has had chlamydia.Recognize symptoms.Contact a health professional immediately if you experience painful urination, cloudy urine, abnormal vaginal discharge or bleeding, lower abdominal pain, genital itching, or swollen glands around the vaginal opening. Symptoms, if they emerge at all, usually surface 1 to 3 weeks after exposure to an infected person.Get tested.A urine test provides quick results without swabbing genital secretions. Annual screening is recommended for all sexually active women younger than 25, as well as women who engage in high-risk sexual behavior. The government, for some reason, has not issued recommendations urging routine screening for men.Find the right treatment.The cure can be as simple as a single-dose antibiotic. But be warned: Treatment doesn't protect you against future infections. Having chlamydia may make women more vulnerable to HIV.Multiple SclerosisMultiple sclerosis, a degenerative nerve disease, is more than twice as common among women as men. One reason: Women are more likely to have a gene variant that promotes inflammation and tissue damage. But MS is elusive to diagnose because it appears, disappears, and imitates several other conditions before ultimately dropping its veil.Much remains unknown about MS, except its often relentless course. In healthy people, nerve fibers are coated in a protective sheath, called myelin. Multiple sclerosis attacks the myelin, destroying nerves and building up scar tissue (or sclerosis) in the brain and spinal cord. Without myelin, the brain's electrical signals are scrambled: It can neither send nor receive messages, and the patient gradually loses muscle control throughout the body. Speech, motion, vision, memory, concentration—even swallowing—are affected.No two cases are the same, which makes diagnosis particularly tricky. Some experience a gradual decline; others won't notice any symptoms until late-stage disease. In the United States, about 400,000 people are known to have the disease; an unknown number may have it and not know it.What You Need to KnowGauge risk.People whose parents have MS are 20 to 50 times more likely to develop it themselves. Having a mother with MS may be one of the strongest risk factors of all—although whether the link is genetic, viral, or environmental remains a mystery. Strangely enough, a new study suggests that early childhood exposure to infant siblings—the great inoculators—may significantly reduce one's risk of contracting the disease. MS is most pronounced in colder climates, especially in northern Europe.Recognize symptoms.Most people get their first signs of the disease between the ages of 20 and 40: blurred or double vision, fatigue, tingling, dizziness, lack of coordination, tremors, and diminished concentration.Get tested.No single test is yet available to accurately diagnose MS, although MRI scans are 90% effective at spotting lesions in the brain or spinal cord. Spinal taps can reveal other abnormalities that are associated with the disease, such as high levels of white blood cells or proteins. Doctors will also test nerve responses to visual, auditory, and electrical stimuli, looking for MS damage. Researchers are working on blood tests to diagnose the disease much earlier in its onset because studies suggest that early intervention can dramatically slow MS.Find the right treatment.There are five federally approved medications to delay the progress of MS. A new drug, Tysabri, which received fast-track approval from the FDA, was pulled off the market in February of this year following a fatal reaction.Last Updated: 12/04/2006 16:04:192007 Rodale Inc. All rights reserved. Prevention ® is a Registered Trademark of Rodale Inc. No reproduction, transmission or display is permitted without the written permissions of Rodale Inc.