Sunday, August 29, 2010

When doctors cannot diagnose disorders

When doctors cannot diagnose disorders**

Nikki Abela Mercieca

Nicola Reiss woke up one Boxing Day feeling extremely unwell. She had pain
all over, her ribs ached and she was running a fever

"It was as though I was involved in a boxing match," she recalled.

The doctors thought the 51-year-old woman had malaria. She was lucky to be a
foreigner in Rwanda as, according to her, foreign patients are treated
seriously there.

However, endless tests would prove that Ms Reiss, who now lives in Malta,
did not have malaria. Two years of fatigue and pain later, one brave Maltese
doctor told Ms Reiss she had Myalgic Encephalomyeltis (ME).

The problem with this condition, also known as chronic fatigue syndrome or
post-viral fatigue syndrome, is the controversy surrounding it. There is no
test to diagnose the syndrome and diagnosis is only made when a certain set
of symptoms are displayed. These can vary in type and severity.

While, on one hand, doctors seem reluctant to diagnose this condition
because the science around it is not as yet concrete, patients feel
misunderstood and unaccepted.

Although local figures on the number of people affected by ME are currently
unavailable, some 250,000 people are said to suffer from the condition in
the UK alone.

Beatrice Gatt, spokesman for the ME support group Malta, said the hospital
should have an inter-disciplinary outpatient clinic and an outreach
programme for better medical understanding. The support group also called
for government recognition for disability benefits.

Patients who spoke to The Sunday Times have voiced frustration that many
doctors do not bridge the condition to the symptoms they complain about.

"Doctors don't make a distinction between ME and people who are tired for
other reasons," Ms Reiss said.

Another patient, who preferred to remain anonymous, said: "When I suggest my
hoarse voice may be caused by ME, they just shrug it off."

This is not the first time the medical world struggled to accept a condition
that science had not yet proven. At the beginning of the 20th century, the
now renowned asthma was seen as a psychosomatic disease – one that is mainly
influenced by the mind.

Treatment involved psychoanalysis as its primary component.
A child's wheeze
was seen as a suppressed cry for his mother.

Psychoanalysts thought that patients with asthma should be treated for
depression. This theory was eventually refuted and asthma became known as
the inflammatory condition it is treated as today.

Although the cause of ME is not yet known, there are various theories – but
none is proved. A popular theory is that a viral infection may trigger the

The latest scientific breakthrough linked a second type of mouse virus to

Although the findings do not prove the virus causes ME, the scientists found
evidence of murine leukemia virus in 86 per cent of ME patients they tested,
but in fewer than seven per cent of healthy blood donors.

This has also raised questions about the safety of blood donations from ME
sufferers, as international talks of banning donations from ME sufferers are
underway as an interim measure.

ME has been classified as a nervous system disorder by WHO, and although the
term "encephalitis" suggests inflammation in the brain or spinal cord, there
is no evidence to support this.

It is characterised by chronic fatigue, associated with other variable
symptoms which include widespread muscle and joint pain, sleeping
difficulties and depression.

The severity ranges from one sufferer to another, and while some people may
live a relatively normal life, others like Ms Reiss are unable to work due
to the severity of their symptoms.

Although the controversy exists, people tend to agree on one thing: patients
are hurting. As one doctor who spoke to The Sunday Times put it, "We cannot
endorse what we cannot see. What we know for sure is that they are

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