I checked in with Sandra to search out out extra about how she writes the column and the teachings we will study from it.
This is our edited dialog.
Q. How do you select your concepts?
A: It must be one thing I have never written about. It must be a solved case. I have to know the final word prognosis. Although it is a solved case, there must be a thriller. And there must be a human story.
Q. When you decide a case, how do you report it?
A: I ask for a chronology of occasions and medical information that affirm the prognosis. The medical information and chronology allow me to see whether or not, certainly, it is a thriller, whether or not it unfolded in an fascinating manner. Will this be an fascinating case?
Then, I interview the affected person, typically the father or mother, typically the partner. The final step is to speak to the physician who made the prognosis or the present treating physicians. Any step alongside the best way, the method can fail.
Q. Do you write about unsolved circumstances?
A. No, it must be a solved case. Lots of people write to me and say, “I’ve this drawback, are you able to assist me?” Sadly, that is not what I do. I did as soon as write a couple of lawyer in Detroit who had gone to the undiagnosed-disease program on the Nationwide Institutes of Well being. He is seen greater than 100 medical doctors and nonetheless does not have a solution. However I assumed his case of him was so uncommon and fascinating, I did make an exception that point.
Q. What are a few of your most memorable medical mysteries?
A: I wrote a couple of household that stored getting recurrent strep throat. They could not determine it out. An enterprising veterinarian obtained concerned. It turned out their cat might have been the vector. After they lastly handled the cat, no person has had a strep.
One of many weirder ones—there was a lady who had critical kidney and coronary heart issues. It turned out she was consuming an excessive amount of licorice. That was actually odd.
And I nonetheless vividly keep in mind a State Division employee who had horrible itching on her head at night time. She had even been labored up for a sort of most cancers. She had seen a number of dermatologists. It turned out she had head lice for a whole 12 months. How did they miss that? That was actually wonderful.
Q. What have you ever realized concerning the medical system from writing about medical mysteries?
A. Medical care has develop into more and more specialised. Medical doctors are accustomed to a small slice of what is going on on, but prognosis is an inherently complicated course of. I additionally suppose time pressures are worsening. It is like: “You’ve got obtained 10 minutes. Go.” That is not going to work with a sophisticated drawback.
I additionally suppose typically sufferers usually are not good at describing the issues. The individuals who are inclined to do higher are organized and may describe their signs in a manner that’s intelligible to a physician.
Q. What’s your greatest recommendation to sufferers for getting higher medical care?
A. Main-care medical doctors can actually assist a affected person. I typically see individuals who go proper to specialists. They might not have a primary-care physician, or they use pressing care after they’re sick. That may be problematic. Individuals actually undervalue the position of primary-care physician.
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Feeling full? Don’t fret. Your abdomen in all probability will not explode.
This week, a reader requested: I all the time really feel like my abdomen goes to blow up after I eat on Thanksgiving. Can that truly occur?
Whereas theoretically potential, this can be very unlikely to your abdomen to blow up from overeating, stated Sophie Balzora, affiliate professor of medication at New York College Grossman Faculty of Drugs and a gastroenterologist at NYU Langone Well being. She writes:
Your abdomen is a tricky organ, with thick muscle partitions and a wealthy blood provide that may simply stand up to even a hearty Thanksgiving meal.
The abdomen additionally has a outstanding capacity to stretch from its resting quantity with out a lot change in stress. Even earlier than that first chew of turkey hits your mouth, the anticipation of it—whether or not via odor or sight—sends a sign to your mind that is delivered to your abdomen, telling it to arrange for meals. As you eat, the abdomen stretches, making increasingly room.
However abdomen rupture has occurred. One case report concerned a 24-year-old feminine affected person who visited an emergency room in Turkey with sudden belly ache, vomiting and nausea after consuming an extreme quantity of fruit. An belly surgical procedure revealed her abdomen from her was perforated and held practically 5 liters of partially digested meals, together with grapes and pomegranate — clearly exceeding a quantity that almost all human stomachs can tolerate.
To study extra, learn the total reply from Balzora in Ask a Physician: If I eat an excessive amount of, will my abdomen explode?
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