Solve the Medical Riddle: She Itches All Over Even Though She has No Rash or Hives, Third Week
Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.
The first week of this riddle, the patient reported her symptoms to her PCP. The doctor proceeded with the examination using the classic S-O-A-P notes as follows:
S=Symptoms or Chief Complaint
A=Assessment or Analysis
P=Treatment Plan or Recommendations
This second week, the doctor reviewed the results of Nancy’s tests and did a complete physical examination. This week, we’ll let you know what some people have suggested as possible diagnoses. Next week, the doctor will reveal the actual diagnosis. Then we’ll begin a new riddle for the following month!
Some Guesses as to What the Diagnosis Will Be
“I read a while ago about folk singer Joni Mitchell saying she has Morgellons disease, which some experts believe could be psychosomatic or a mental disorder. I’m no expert so I’m not passing judgment, but Nancy did say she wondered is she was ‘going crazy’. The symptoms of Morgellons include what has been described as ‘crawling sensations’ on and under the skin. Some people also have fibers or threads coming out of the skin. Ew! On another note entirely, it turns out that Joni Mitchell recently had a brain aneurysm but survived. Whew! I wish her well!”
— Lucy K.
“Could Nancy have come into contact with something that’s making her itch? Contact dermatitis is pretty common. I used to get it from fragrance in beauty products so now I always look for fragrance-free products. Usually I did see a rash, though, and Nancy doesn’t have a rash. I wonder if the Claritin or Allegra will help her. I took Claritin and it definitely worked!”
— Marianne S.
“I really hope I’m wrong, but that word ‘lymphadenopathy’ was a giveaway for me. I learned that term when my sister had Hodgkin’s lymphoma. It’s a cancer of the lymphatic system. Scary! Her doctor said the minute he felt an enlarged lymph node in her neck, he was pretty sure of his diagnosis – and he was correct. The good news is that my sister had radiation and no chemotherapy because the disease was caught early. She’s fine and still with us, hale and hearty five year later. We just celebrated her 60th birthday!”
— Kathy G.
“Well, Nancy has been scratching to the point that the doctor could see what I suppose were marks or lesions on her skin. He used the term “excoriation”. My mother always used to tell me that scratching makes you itch more. I thought that was an old wives’ tale but I read a report right here on ThirdAge.com in October of 2014 that said researchers at the Washington University School of Medicine in St. Louis published a report in the journal Neuron saying they found that scratching causes the brain to release the neurotransmitter serotonin, which intensifies the itch sensation. So maybe Nancy just created a vicious cycle!”
— Debbie P.
To be continued . . .
Come back to ThirdAge.com next Thursday when the doctor will reveal the actual diagnosis and treatment plan.
Marie Savard, M.D., a former Medical Contributor for ABC News and a frequent keynote speaker around the world, is one of the most trusted voices on women’s health, wellness, and patient empowerment. She is the author of four books, including one that made the Wall Street Journal list of the best health books of 2009: “Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About.” Dr. Marie earned a B.S. in Nursing and an M.D. degree at the University of Pennsylvania. She has served as Director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations’ Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women’s Health, health columnist for Woman’s Day magazine, and senior medical consultant to Lifetime Television’s Strong Medicine. Please visit DrSavard.com.