Blog: The Sherlock Holmes of Medicine

I want to tell you about a doctor in Vienna who helped my friend, Emily. Emily suffered her whole life from stomach problems. She thought it was a natural part of digestion to feel cramping and experience diarrhea after every meal. She was told more than once when she was a teenager it was all in her head. Doctors and family figured she had outgrown whatever the problem was when she left home for college and her symptoms somewhat improved. 

Still, Emily experienced bouts of stomach upset. Tests for various ailments had always been inconclusive or negative. During her three pregnancies she felt great, though, and she noticed she felt better when she stayed away from processed foods. But she never felt resolutely normal.

During her 40th year, Emily realized something was truly wrong when she missed her flight home from a trip to the Midwest because she could not leave the stall of a Detroit airport bathroom. All she had eaten that afternoon and evening was a scone.

She got herself home the next day, went to see her general practitioner at a family medical practice in Vienna and felt like she was again getting nowhere. Emily says they were not compassionate. When she voiced her fears, becoming upset as she talked about missing a lot of work and not to mention missing out on her life, the nurse practitioner who examined her did not say anything, just handed her a referral for a gastroenterologist.

She didn’t go straight to the gastroenterologist. She spent the next 10 days in bed. Her husband and kids helped out where they could, trying to keep things running as normally as possible. To Emily it felt like she was in self-imposed solitary confinement. Her diet had become toast and chicken broth.

A friend told Emily about a doctor who made house calls. Though she was hesitant, Emily reached out to the medical practice, DocTalker Medicine. And that's when she met Dr. Dappen.

Dr. Alan Dappen worked in family medicine for 25 years and decided he wanted to provide better access and higher quality of care than what insurance-driven health care offered. Dappen created a model which included offering patients 24/7 access to the medical team. Also, patients could be treated anywhere they wanted, by phone or email consultations, same-day office visits or house calls.

Granted, this is not the cookie-cutter approach to medicine. Your insurance provider will call this an out-of-network doctor's visit. But it is reminiscent of the kind of care many of us remember receiving a generation ago. Dr. Dappen says the average patient pays around $250/year for his services out of pocket. It's certainly a lot for some folks, but when I think about my own family's health history, we've easily spent more than that in a year. My daughters have each received care from various specialists over time who were the best in the area and also happened to be outside of my insurance network.

Emily says Dr. Dappen is the first doctor to really listen to her when she shared the chronology of her sickness. At his first visit, Dappen gave Emily some medicine so she could get out of bed and go to the specialist without living in fear of having to stay within 10 feet of the nearest bathroom. She could even get a little bit of work done.

Dappen checked in on Emily before her scheduled colonoscopy and endoscopy, for which she had to fast for 48 hours. Emily told him it was very odd. She felt better than she had in months. Why was she stronger now even though she hadn’t eaten in two days?

Dappen said he had been thinking about all she had told him. Dappen felt she might have Celiac Disease (CD). He said this could be true even if the tests for CD came back negative. When her illness was diagnosed, it was 2007 and CD wasn’t on everyone’s radar as it is today. Five years ago it was virtually unknown.

Celiac Disease is a digestive condition caused by the consumption of the protein gluten, which is primarily found in foods containing wheat, barley or rye. People with celiac disease who eat foods containing gluten experience an immune reaction in their small intestines, causing damage to the inner surface of the small intestine and an inability to absorb certain nutrients. To top it all off, CD causes abdominal pain and diarrhea. Testing is determined by scraping the internal wall of the small intestine and examining the samples for disease. Emily’s tests were false negatives probably because the samples examined did not contain enough of the damaged cells to detect the disease.

While waiting for the test results to return, Emily tried removing all wheat from her diet. Emily almost immediately felt vastly improved and returned to work.  She overhauled her food choices completely and hasn’t spent a day in bed since. Even though her test results came back negative.

This all clicked for Emily, though. Looking back at her health history she could see how her disease hid behind the standard American diet. She had grown up with processed food — notorious for its high gluten levels — and when she went to college she felt better because she ate more whole foods. Likewise, during pregnancy she chose the best things to eat and so, too, the symptoms for CD abated. For a while. Who would have ever guessed toast and a simple scone could lay her so low?

Emily suggests to women who have long-term mysterious health problems to find a doctor who will really listen.  It’s the difference between a doctor who diagnoses a health problem based on tests and one who heals based on spending the right amount of time and energy to understand the whole of the patient.

This blog is an excerpt from another article: http://www.empowher.com/community/share/living-mystery-elusive-diagnosis-stomach-illness

Sources:http://www.bing.com/health/article/mayo-MADS00319/Celiac-disease?q=celiac+disease&qpvt=celiac+disease

http://www.doctalker.com