False True-sick

The strength of the doctor-patient relationship

Definition of the False True-sick

At the opposite of the patient who consults for an invisible disease and who is thus considered like a "false" sick person, the checkup will allow, here, to identify the cause of all the symptoms.
The patient is thus claimed to be "truly sick", but is he/she really ?
Here, the diagnosis is the result of a bias introduced during the investigation by the (mutual) wish to give a meaning to these so worrying symptoms which motivate the repeated consultations.

• At that stage, the False True-sick is conditioned enough by his/her environment to join that interpretation and accept its consequences (in the hope of getting better or, at least, to control the evolution). He/she will be a "good" sick person who will totally respect the prescription.
  In the opposite case, he/she will present all the unwanted effects of the treatment and will turn towards another doctor or another medicine.
• There exist several kinds of "False True-illnesses".
  • The one of which the discovery is fortuitous, during a very complete check-up, and to which all not very specific symptoms at the origin of the consultations are linked(problems with bloodpressure, sugar, thyroid gland, various allergies ...).
  • The one for which the person accepts to suffer because it is part of the diseases that have no treatment but are well known and recognized (arthrosis, migraine, circulation, loss of magnesium, age...);
  • The one that gives cause to approximate terms reluctantly shared by the scientific community (tetany, lazy, irritable, fragile bowels, minor vertebral disturbance, low bloodpressure, calcaneal spur, ...) which are sometimes very surprising to the great medicine professors.
  • The one that gives rise to complicated scientific terms or rare syndromes, much to the surprise of the general practitioner in the field (algodystrophy, rhizomelic pseudopolyarthritis, Ehlers Danlos syndrome, Crohn’s disease, Marfan syndrome, Macrophagic myofasciitis and so on ...).
    These diseases, which reality is not questioned with the appearance of - often immunological - objective lesions) are sometimes mentioned untimely in order to give a meaning to unexplained functional disorders.
    Calling the diagnosis into question often comes naturally but the fluctuating character of these (not very well known yet) illnesses, sometimes maintains the misunderstanding over a very long period.

  

  Shadok motto : "If it hurts, that means it is good" - suffer in order to recover...

  
  These difficult diagnoses lead neither to very specific nor efficient treatments but, there again, they offer an alternative to the lack of understanding (not to say "the ignorance") of the previous doctor.

  In all cases, the patient will have to «accept» to suffer... because none of these situations can bring him/her anything else than a bit of recognition.
  Besides, he/she so often changes practicians (when he/she feels that the doctor "no longer listens to him/her") that the term of "roaming" or medical "zapping" has been used.
  The sick person gives the impression of being ready for all sacrifices to get out of trouble and becomes the potential victim of a medical blunder (out of overzealousness) or of a possible new belief (which carries along the risk of a sectarian excess).

  

  The list of the symptoms that lead to misunderstandings is not limited !

  Here, we hold up as examples the most frequent of them, but some have listed up to 100 (regarding fibromyalgia)

  • Arthrosis;
  • Hypertension;
  • Stomach upset and migraine;
  • Bowel disorders;
  • Blood circulation disorders;
  • Problems with magnesium;
  • Stress and masked depression;
  • Thyroiditis and thyroidian hormones.

  
  They end up in often excessive prescriptions favored by a health system that is payed for according to the service provided which leaves no time over for thinking.

Arthrosis


« I have generalized arthrosis, my whole body hurts »

In medicine faculty, arthrosis is a painful movement limitation secondary to a certain level of osteoarticular shape loss linked to age or some kind of mechanical constraints (rugby, strength work). That «fatigue» can be "seen" on the numerous radiographs taken with every painful burst.
But... «there exists no correlation between the radiograph and the clinical» as is taught in 2nd year of medicine.
Clearly, the radiographs do not show the pain but the shadow of the bones’ reliefs and there exist many cases where important shape losses (visible on the print) do not express with pain (but, again, by definition, the sick person does not consult and thus doesn’t know he/she has arthrosis) .
All in all, it is handy to mention arthrosis in front of a rheumatism but there are many cases where tendon or muscle pains only express a lack of sleep efficiency. Fibromyalgia is the caricature of that misunderstanding because even in the absence of medical imaging (in the start of the century) the rheumatologists noticed that some of their chronic algic patients recovered without sequellae and lived longer than their doctor.
Many rachis pains (stiff neck, lumbagos), intercostal pains or tendinitis found there an erroneous explanation with the reading of the radiographs (which are only useful to rule out an organic lesion : infection, tumor, fracture ...)



High blood pressure


«I have high blood pressure and I feel it rise from time to time»

In medical faculty, hypertension is an illness described as “asymptomatic” (without symptoms) - as it may not be unnecessary to remind everybody, doctors and patients..

The epidemiologic studies of the last 50 years all agree to consider it as a risk factor for heart-vessel diseases that shortens life. But hypertension presents the disadvantage of being a silent illness until the the signs of visceral decompensation (renal, cardiac, ophthalmic and cerebral) appear. Before that stage, it is the «Silent Killer» and the purpose of the treatment is to obtain a lowering of the blood pressure, which is rather badly endured in the start.

Clearly, when a patient claims to «feel his/her blood pressure rise», what he/she feels is not linked to what he/she believes; the rising of the measures that can be measured at that occasion is the consequence, not the cause, of his/her unrest.

100% of the «bloodpressure symptoms» (palpitations, dizzy spells, ear buzzings and headaches (+++) are of (probably somnosomatic) neurodystonia kind. On that basis, they are especially worrying and and justify a very scrupulous observance of the treatment and the multiplication of the medical consultations (and that, even more since the treatment is poorly endured).

In practice, the true hypertensed sick people are screened at the occasion of a systematic investigation. They often feel little concern for their treatment because they felt better before taking it. The doctor must be persuasive to make sure the concept of long term risk factor is understood.

Finally, according to some cardiologists, in France, 50% of "False True-hypertensed" are treated for high blood pressure (with numerous medication induced complications) whereas 50% of the truly hypertensed sick people, who do not feel in danger, escape a treatment that would lengthen their lives !



"Liver attack" (Stomach upset in French) and migraine

"They must be told ! ... THE LIVER ATTACK DOES NOT EXIST"
Very beautiful quote of our colleague on esculape.fr (French website) that summarizes quite well the misunderstood that is often observed in subjects who suffer, without knowing it, of migraine with a strong digestive component.

The False True-colopathy-sufferer or the person who has a "liver fragility", consults gastroenterologists excessively.

• Here, the surgical risk is, in the end, very important if, by any chance, the "gall bladder", a "hiatal hernia" or "polyps" are suspected erroneously.
• If the checkups are normal, the risk to go over to a psychiatric medication (sedative or antidepressant) is frequent, too.
• Sooner or later, the patient will try "alternative medicines" out of pique and enter an irrational approach of his/her disease with the aim of inventing "his/her own answer" (which can, from a certain point of view, reveal less prejudicial than the risks carried by allopathy, in that case).

By the light of sleep medicine, migraine is indeed an emergency stop signal (cf.). The digestive outward signs are very frequent there and are so unpleasant that they sometimes come to the foreground.

It is not rare that the subjects with migraine are in a situation of hypersomnia during the days that precede the migraine burst. It comes indeed as a repercussion of a sleep rebound in the morning or in the course of a too long nap which destabilizes the balance of sleep. When hyposleep decompensates, the subject lies down, sleeps (sooner or later, unfortunately for him/her) and generally gets up as soon as possible to resume his/her obligations.

There exist many medications for migraine; but very few subjects with migraine receive good medical advice as far as sleep is concerned.
Yet, many sick people or former sick people are ready to witness about the relations they end up drawing empirically between sleep and their attacks. But it is difficult to sort right from wrong amidst the opinions that are provided by the majority of the medical and paramedical professions.

Besides, university teaching on that subject is still strictly unexistant. It is not surprising, then, that many subjects with migraine are doomed to remain so until a very advanced age without having ever been guided towards sleep.

Some of them, False True-sick, have taken a lot of medications for the liver and the bowels and have sometimes tragically been multi-operated of the abdomen. The illness is often punctuated by antidepresant or sedative treatments because the exhaustion often takes pseudo-depressive aspects but suicidal attempts are in fact exceptional, on the other hand.
The others, True False-sick are terribly angry against the medical profession and are ready to suffer in silence with an extremely strict diet (circle quadrature...) until they retire (and when everything gets back into order like it did for Pépé, my Grandfather - sorry for that personal allusion).
Others than Pépé would have turned towards a complicated "organic" diet or would have consumed many "alternative" medications for "the liver and the bowels".
NB. The "glutenfree diet" is an example of the excesses that can be caused by that illusory approach of migraine.



Bowel disorders

Aerophagia, colitis, constipation, hemorrhoids, hiatal hernias, heartburn and surge :
« my bowels are fragile, I can’t stand anything »
« I swell like a pregnant woman»
« I have emeralds (sic) and I have been constipated for 8 days »


The functional disorders of the bowels are amongst the first symptoms of hyposleep. (One night of sleep deprivation is enough to notice the transit disorders that it induces to be convinced of it). The "stress" situations when sleep is made more fragile (without the person being aware of it) are well known for their impact on digestion.

In practice, the root of many «turistas» (the travellers’ diarrhea - because it is not always infectious); of many hemorrhoid bursts (said to be related to «stress»); the origin of many stomach upsets and "liver attacks" can be found there.
All those disorders that generally express tiredness are, from our point of view, derived forms of migraine. (See above)

Just like all the other functional disorders, these symptoms can become very disabling and their care is difficult. That failure of the conventional treatments expresses itself in the presence, on the market, of a multitude of medications «used ... in the absence of proven activity».
NB. The "gluten free diet" is the sad caricature (for the epicureans) of the excesses that colopathy can lead to.



Blood circulation Troubles

« I have a bad circulation »
« My legs are heavy »
« I have cold extremities »
« I have low blood pressure »

The sensation that "blood circulates badly" is very frequent in situations of neurodystonia. Feelings of swelling, stinges, electricity, paralysis ...
are often not really correlated with the anatomic lesions that can be observed (varicose veins, œdema).
As in the disturbances mentioned before, the circulatory disorders are difficult to relieve, and justify a multitude of treatments «used... in the absence of proven activity».
They are, besides, a part of the list of the numerous medications that are no longer repaid because of «unsufficient medical service provided».



Lack of magnesium

« my doctor says that I loose my magnesium »
« I take magnesium cures when I’m tired »
« when somebody feels eyelid spasm, that means he/she lacks magnesium »
« I have palpitations when I "lose" my magnesium »

The «supposed» lack of magnesium has par excellence been the «wrong culprit» during the 80’s and 90’s. Under the pressure of the pharmaceutical companies who had understood, so it seems, the importance of the functional disorders, the practicians of all specialties had got into the habit of avoiding the question in front of a "nervous" symptom and, with the aim of comforting their patient and in order to avoid prescribing "tranquillizers", mentioned that diagnosis.
In front of palpitations, palpebral spasms, cramps and even nervousness or insomnia, patients have been told that should look towards a lack of magnesium and that it would be enough to have a "cure" of it to solve the problem.

Spasmophilia (or tetany) holds, in that matter, the record of dishonesty because millions of sick people have been conditioned to believe that they lost their magnesium in a mysterious way.

At the same time, in hospitals, with the truly ill people, (seric or intraglomerular) magnesium is never measured out except for burns or recovery units...
Finally, it is the Public Welfare System that thought, in 1989, that it should better put a stop to it (for the matter of health expenses cuttings) by stopping the repayments of magnesium measurement and sales. The prescription habits have changed but the "conditioning" remains effective in sick people who take cures of it in a self-medication logic.
It is relevant to remind, here, that magnesium can induce diarrhea or colics ! (Which is not recommended to a subject who might suffer from colopathy, with "fragile bowels". These are the ingredients of a vicious circle.).



A fantasist causality relationship

"Lacking magnesium induces irritability, stress, ants sensation, eyelid spasms, nervousness"



Masked depression or "False True depression"?

In front of the repeated failure of conventional "symptomatic" therapies, and in order to medically respond to the health demands of the patient who "always hurts somewhere", the diagnosis of masked depression will be carried out, sooner or later.
The phamaceutical companies publish a lot on that subject. The tremendous effect of the launching campaign of the famous "pills of happiness" which have been introduced like a kind of "all purpose medication" (even for losing weight) can be estimated.

The diagnosis of depression is difficult and must not become a very handy ragbag in front of unexplained functional disorders.
That "ad hoc" diagnosis approach can be found again in the problematic of the True False-sick.



Thyroidian failure, Hashimoto’s auto-immune thyroiditis

.
All the patients who consult for tiredness are subject to multiple thyroidian checkups.
More than 50% of the patients diagnosed with fibromyalgia are, or have been, treated with thyroidian hormones.
The diagnosis of "rough" thyroidian failure is sometimes mentioned in front of "borderline" biological results.
The cause of these disturbances seems to be of an auto-immune kind and carries Dr Hashimoto’s name, who was the first to describe that still mysterious illness.
Here, we raise the hypothesis of that immune disturbance being a matter of sleep disorders ... like the existence of common neuromediators (as it can be seen in the endocannabinoid system or for substance "P" (Cf.).
The frequence of familial cases and of the combination with other auto-immune diseases suggests the existence of a genetic ground that might concern the genes close to those who code for other sleep disturbances.
However, it seems probable to us that, in in some cases, the implication of thyroiditis in tiredness pertains to an "ad hoc" explanation because the symptoms of the hormonal failure show a lot of differences compared to those of an unefficient sleep and
On the other hand, it is known that the hormone replacement therapy with thyroidian extracts (as well as the beta blockers that are sometimes combined with it) can be harmful to sleep.
That vicious circle situation is often encountered in consultation for tiredness.
It is sometimes difficult to obtain the cooperation of the sick person and of his/her doctor when one dares to express doubts on the relation of causality put forward by the "precious" diagnosis.

(The fact that these hormones have the (doubtful) reputation of making a person lose weight and give more tonus must not be obliterated. Why should people want to do without them ?).
The story of the "homeless of medicine" is, thus, punctuated by sometimes untimely treatments which, all in all, satisfy the sick person and his/her doctor:

• - until another decompensation of the "somnobar" occurs, and the new specialist calls it all into question.
• - elsewhere, but for surgical operation or medical complication, everything gets back into shape spontaneously .
  It also happens that a Hashimoto’s thyroiditis (with the biological confirmation of the presence of antibodies) is spontaneously reversible while other untreated forms sometimes evolve towards a true thyroidian failure.
  The therapeutic choice of the endocrinologist (abstention or not) should not be based on tiredness without trying to unveil the possibilty of a "hidden" sleep pathology.



"Do you sleep well ?" ...

Despite all these checkups, the sick person never hears about sleep during his/her medical journey in a different manner than through the question which has a strong "psychological" connotation : "how do you sleep ?"
In his/her answer, the subject will do anything to reassure his/her doctor because he/she is afraid to have to take a sleeping pill or to have to enter a psychological therapy for his/her personal problems.
Moreover, when tiredness begins, sleep is still present and even appears to be an aid for the sick person who hopes to retrieve his/her tonus from it. The answer is sincerely positive : "Oh yes, I do sleep well, I even sleep a lot!".
We think that asking a sick person about his/her sleep that way sounds like asking a starving and malnourished subject about his/her appetite.
One must be able to interview him/her about sleep by observing how the person wakes up. Then, it is often surprising to note that that "good sleep" often leaves the patient more tired when he/she wakes up than he/she was the evening before.
The psychological signs of tiredness and the row of embarrassments labelled as "anxiety" or "depression", which lead the diagnosis towards the "psycho-somatic" ground will show up later.



Deafs dialogue, jargon?

"The healing faith"

Charcot and Freud did not acknowledge the role of sleep.
For Jean Martin Charcot (who was Freud’s master), the miraculous healings (in Lourdes, for example) "had no other meaning than that of a healing operated outside the field of the means which medicine usually seems to have at its disposal" .
He thinks that : "those healings that are commonly called miracles, have a double character :
- a special disposition of the sick person (trust, credibility, suggestibility) of which the starting varies,
- and illnesses which healing does not require any other intervention than that of the power that the mind possesses over the body".
He adds :"I also believe that the lesions of that group (ulcers, tumors) are, despite their looking the opposite, of the same kind as paralysis and convulsions" (which means of "psychogenic" origin).
("Faith healing" 1897, La Revue hebdomadaire)