Recently I had a patient come to me with a very complex chronic sinusitis (CRS) history. To make matters worse, the last two visits to her ENT and PCP these complaints were dismissed. Their response is something heard way too often, “Maybe it’s anxiety?” Most likely the clinicians diagnosed her as a “Whiny Woman” often coded in medical shorthand as WW.
In short WW is a derogatory term given to middle-aged women who present with multiple medical complaints, such as fatigue, brain fog and decreased exercise tolerance. The presentation may be vague and complex at the same time. Unfortunately, WW is a form of medical gaslighting where symptoms are dismissed as being based on emotions and exaggerations.
I’ve talked about medical gaslighting in the past and it is real, but moving on with this particular patient, there were more than just her symptoms that supported her claim to being chronically ill.
Besides her sinus congestion, she was complaining of constant thirst and from a laboratory point of view she always appeared dehydrated, despite adequate hydration. Her CT scan of the sinuses showed inflammation in multiple sinus cavities, and she had a calcified amygdala on the MRI of the brain. She is now having dental problems with cavities as an adult but never had cavities as a child. She’s been hospitalized on multiple occasions with pneumonia. Lastly, she has had documented exposure to Histoplasmosis, a type of fungus, as a young woman.
Currently she is undergoing an extensive workup to address all her complaints. First, there was DNA sequencing of her sinus secretions to determine the microbial makeup of her sinus disease. Second the patient has GERD, and we’re starting with lifestyle changes to see if we can bring it under control while doing a home sleep study. The patient definitely has physical risk factors for obstructive sleep apnea which can worsen GERD. Third, with a history of recurrent pneumonias, there is concern that the patient needs a workup for an IgG deficiency. Lastly this patient has had mold exposure and possibly Allergic Fungal Sinusitis that may be confirmed from the DNA sequencing. She also may have Central Diabetes Insipidus which can occur with brain lesions. Remember the calcified amygdala?
So, this patient now goes from being suggested to being treated for anxiety or depression to having multiple workups for the underlying risk factors for associated with CRS. Patients should not be dismissed; they need to be listened to. So often medical clinicians are forced to make a diagnosis in a matter of minutes because of time constraints. The art of taking a medical history is being lost because of these constraints and patients are suffering. It’s time to take back our art.
