# Medical-Minded Dopers: I need a disease :) **URL:** \ **Category:** In My Humble Opinion\ **Created:** [August 7, 2013, 3:51pm UTC](https://boards.straightdope.com/t/medical-minded-dopers-i-need-a-disease/665596 "2013-08-07T15:51:54Z")\ **Posts on this page:** 13\ **Page:** 3
**Author:** ![wonky](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wonky/32/393_2.png) [@wonky](https://boards.straightdope.com/u/wonky)\ **Post date:** [August 8, 2013, 4:52pm UTC](https://boards.straightdope.com/t/medical-minded-dopers-i-need-a-disease/665596/41 "2013-08-08T16:52:27Z")
> [@Infovore](#): > > It’s possible, but he and his mom are pretty close so I think he’d notice if she was sick, and be concerned about it. He’s a pretty sensitive kid–a bit of a geeky mama’s boy since the two of them are all each other’s had for many years (his father died when he was 5 and she never remarried). > > Ideally, whatever’s wrong with her, I’d like it to be something that’s not immediately fatal (so it’s not like “she’s got a terminal disease,” but rather “something bad is wrong with her but we expect her to recover from it” only she doesn’t). Whether that’s an accident or an illness isn’t really relevant. It just has to fit the parameters. Well, one last suggestion that probably would throw too many wrinkles and complications and trauma in but would allow any timing you needed: suicide. ---
**Author:** ![Infovore](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/infovore/32/420_2.png) [@Infovore](https://boards.straightdope.com/u/Infovore)\ **Post date:** [August 8, 2013, 5:00pm UTC](https://boards.straightdope.com/t/medical-minded-dopers-i-need-a-disease/665596/42 "2013-08-08T17:00:27Z")
> [@jsgoddess](#): > > Well, one last suggestion that probably would throw too many wrinkles and complications and trauma in but would allow any timing you needed: suicide. You guys have all given me a lot of great suggestions–thanks! I think there are several different options I can take. Unfortunately due to the circumstances of her death (rather suddenly after taking a fast downturn, in the hospital) and her personality (she wouldn’t do that to her son even if she was physically capable of it at that point), suicide won’t work. ---
**Author:** ![congodwarf](https://avatars.discourse-cdn.com/v4/letter/c/e36b37/32.png) [@congodwarf](https://boards.straightdope.com/u/congodwarf)\ **Post date:** [August 8, 2013, 5:27pm UTC](https://boards.straightdope.com/t/medical-minded-dopers-i-need-a-disease/665596/43 "2013-08-08T17:27:21Z")
This just happened to my coworker. At the beginning of February 2013, she found a lump in her breast which hadn’t been there 3 weeks earlier. A week later she had a biopsy. Less than a week later she had a diagnosis of metastatic melanoma. At this point other than pain in her breast she was still fine. At the end of February she was out of work on medical leave for surgery, chemo, and radiation. At the beginning of June she was feeling great and getting ready to come back to work. About a week into June (and a week before she was due to return to work) she started getting really bad headaches, dizziness, and nausea. She went back to the doctor and found out that the cancer was now in her brain. She was given fewer than 6 months to live. About 3-4 weeks later she went from home to hospice. About 2 weeks after that she was dead. She was under 40 with young kids. When I met her in mid-January she was perfectly healthy and happy. So, fewer than 7 months after she found out she had metastatic melanoma in her breast she died of brain cancer, which she apparently had had for fewer than 2 months. Fuck cancer ☹ ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [August 8, 2013, 7:16pm UTC](https://boards.straightdope.com/t/medical-minded-dopers-i-need-a-disease/665596/44 "2013-08-08T19:16:28Z")
The accident one can be made mto worrk quite well, if it isn’t too much exposition for you. Accidents cause prolonged immobility during recovery. Prolonged immobility can trigger clots, related to a genetic predisposition and other factors like obesity, which break off and go to lung which can be fatal (deep venous thrombosis, DVT, causing a pulmonary embolism, PE). So yeah, bad accident then dying from a PE can easily work. (Of course I still like viral cardiomyopathy, especially for the broken heart metaphor … okay, go with accident!) ---
**Author:** ![PoorYorick](https://avatars.discourse-cdn.com/v4/letter/p/ecccb3/32.png) [@PoorYorick](https://boards.straightdope.com/u/PoorYorick)\ **Post date:** [August 8, 2013, 7:25pm UTC](https://boards.straightdope.com/t/medical-minded-dopers-i-need-a-disease/665596/45 "2013-08-08T19:25:42Z")
> [@Gestalt](#): > > I think 6 weeks is generally a bit too short even for a virulent cancer. I think something autoimmune or infectious might be your best bet. Not if you’ve been carrying around cancer and not know it. My father went to the doctor with what he thought was pneumonia, and six weeks later he was dead from lung cancer. ---
**Author:** ![Gestalt](https://avatars.discourse-cdn.com/v4/letter/g/90ced4/32.png) [@Gestalt](https://boards.straightdope.com/u/Gestalt)\ **Post date:** [August 9, 2013, 3:17am UTC](https://boards.straightdope.com/t/medical-minded-dopers-i-need-a-disease/665596/46 "2013-08-09T03:17:43Z")
> [@DSeid](#): > > GBS causing death and over that time course would be eyeroll inducing for me anyway. Sorry. It usually gets its worst within two to three weeks not months, and if in a modern hospital rarely kills. In my defense, as I said before the GBS would be for the two week period during which the mother becomes acutely ill, and the month long mildly ill period preceding that would be the viral antecedent. I don’t really think it’s that much more absurd than a viral cardiomyopathy causing a suddenish death. Both are fairly common conditions that are rarely fatal (I could not find good numbers for the absolute mortality rate of viral myocarditis, because it seems that many people who have it are asymptomatic, but I doubt it’s one of the more common causes of cardiac death in the United States) which would, overall, be too distracting to work properly in the story. Also, while death from GBS is rare, I have seen GBS require people to be ventilator-dependent for weeks . . . if someone refused to be mechanically ventilated that long, than they could die from GBS. ---
**Author:** ![Becky2844](https://avatars.discourse-cdn.com/v4/letter/b/91b2a8/32.png) [@Becky2844](https://boards.straightdope.com/u/Becky2844)\ **Post date:** [August 9, 2013, 3:36am UTC](https://boards.straightdope.com/t/medical-minded-dopers-i-need-a-disease/665596/47 "2013-08-09T03:36:38Z")
Just to look at it from another angle, you might want to ask yourself What kinds of care do home health care nurses usually provide? (Since the condition is not supposed to be exotic.) Then the required type of care you choose might dictate the illness/condition and leave room for your needed sudden down-turn. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [August 9, 2013, 5:56am UTC](https://boards.straightdope.com/t/medical-minded-dopers-i-need-a-disease/665596/48 "2013-08-09T05:56:58Z")
> [@Gestalt](#): > > In my defense, as I said before the GBS would be for the two week period during which the mother becomes acutely ill, and the month long mildly ill period preceding that would be the viral antecedent. > > I don’t really think it’s that much more absurd than a viral cardiomyopathy causing a suddenish death. Both are fairly common conditions that are rarely fatal (I could not find good numbers for the absolute mortality rate of viral myocarditis, because it seems that many people who have it are asymptomatic, but I doubt it’s one of the more common causes of cardiac death in the United States) which would, overall, be too distracting to work properly in the story. > > Also, while death from GBS is rare, I have seen GBS require people to be ventilator-dependent for weeks . . . if someone refused to be mechanically ventilated that long, than they could die from GBS. I am sorry to be so critical but a month long viral illness antecedent would be a) very strange and b) not fit the demands of the plot. The viral antecedent is typically a typical viral bug, such as a typical cold, stomach bug, or flu. Such illnesses are more commonly 5 to 7 days, maybe 10, but not for a month, and are not illness enough to warrant a change in the young man’s plans. And put simply you are just plain very wrong about the “absurdity” of viral cardiomyopathy causing sudden death along the course of a worsening debilitating illness. For a concise summary of viral cardiomyopathy see [here](http://health.usnews.com/health-conditions/heart-health/cardiomyopathy). > [@](#): > > Dilated cardiomyopathy, a common form of cardiomyopathy, is characterized by an overall enlargement or stretching of the heart muscle accompanied by a decrease in the heart’s ability to contract. Dilated cardiomyopathy usually begins with stretching of the left ventricle; in some cases, the right ventricle may become affected as well. Dilated cardiomyopathy can lead to heart failure, a decrease in the heart’s ability to contract and pump blood out into the arteries of the body. **Other complications include disturbances in the heart’s electrical system known as arrhythmias, blood clots forming within the heart, and sudden death, any of which can occur at any stage of the disease.** > > Although it can occur in infants and the elderly, dilated cardiomyopathy occurs most frequently between the ages of 20 and 60. It is three times more common in men than women and more common in African-Americans than Caucasians. > > The progression of dilated cardiomyopathy can be rapid; some studies have found that 50 percent of deaths due to dilated cardiomyopathy occur within two years of diagnosis, although the risk of dying within one year for all patients with heart failure symptoms is about 12 percent. In general, the worse the symptoms, the worse the outlook. For example, a patient with mild breathlessness during significant exertion may have a 5 percent chance of dying within a year, while a person who has these symptoms while sitting in a chair may have a 30-50 percent risk of dying within a year. (Bolding mine.) A bit more detail [here](http://pmj.bmj.com/content/77/903/4.full). > [@](#): > > Myocarditis is a common cause of dilated cardiomyopathy, which in the western world is the underlying aetiology in about 45% of patients undergoing heart transplantation.3 … Viral infection is thought to be the most common cause of myocarditis … myocarditis can occasionally be a devastating illness that evolves into a chronic progressive disease. Its clinical manifestations are variable and reflect abnormalities in left ventricular systolic and diastolic function and electrical activation, leading to arrhythmias or conduction defects. Masonet al carried out the largest prospective study of patients with myocarditis,18 evaluating a series of 111 patients with dilated hearts, histological evidence of myocarditis, and a left ventricular ejection fraction of less than 45%. They produced some important clinical data about the natural history of myocarditis and showed that mortality (taken as death or the need for a heart transplant) was 20% at one year … Mean age of onset is 42. Rapid onset of progressive CHF symptoms requiring home health care for daily functioning for a couple of months, then killed by a fatal arrhythmia or clot would be a very realistic course. ---
**Author:** ![Gestalt](https://avatars.discourse-cdn.com/v4/letter/g/90ced4/32.png) [@Gestalt](https://boards.straightdope.com/u/Gestalt)\ **Post date:** [August 9, 2013, 11:24am UTC](https://boards.straightdope.com/t/medical-minded-dopers-i-need-a-disease/665596/49 "2013-08-09T11:24:25Z")
Okay fair enough that most viral illnesses are days, not weeks long; however, with viral cardiomyopathy, my point was not that death from dilated viral cardiomyopathy is absurd, but rather death from viral cardiomyopathy is not common. Like I said, I could not find any cites for the mortality rate from viral cardiomyopathy. The BMJ article you cited said that death was 20% for patients who had _already_ progressed to dilated cardiomyopathy. Whereas the death rate for GBS is [2-3%](http://en.wikipedia.org/wiki/Guillain%E2%80%93Barr%C3%A9_syndrome) even in the best ICUs. That is not an insignificant rate of death, and frankly I would be surprised if the rate of death for all cases of viral myocarditis is that high (although I freely admit I could be wrong on that point). ---
**Author:** ![Gestalt](https://avatars.discourse-cdn.com/v4/letter/g/90ced4/32.png) [@Gestalt](https://boards.straightdope.com/u/Gestalt)\ **Post date:** [August 9, 2013, 11:29am UTC](https://boards.straightdope.com/t/medical-minded-dopers-i-need-a-disease/665596/50 "2013-08-09T11:29:49Z")
Also, re GBS antecedent infections, c.jejuni is the most common one (which does have a short course), but [in this study](http://www.ncbi.nlm.nih.gov/pubmed/9781538) 13% had CMV, 10% EBV, both of which have more protracted courses. > **[Cytomegalovirus (CMV) infection: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000568.htm)** > > Cytomegalovirus (CMV) infection is a disease caused by a type of herpes virus. > **[Epstein-Barr Virus: Symptoms, Causes, Treatment & Prognosis](https://www.emedicinehealth.com/epstein-barr_virus_infection/article_em.htm)** > > Epstein-Barr virus (EBV) causes mono and plays a role in nasopharyngeal cancer. Learn about diagnosis, symptoms, treatment, prognosis, and prevention. I concede that the viral illness would probably not be enough to cause a young man to change his travel plans ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [August 9, 2013, 12:08pm UTC](https://boards.straightdope.com/t/medical-minded-dopers-i-need-a-disease/665596/51 "2013-08-09T12:08:14Z")
> [@Gestalt](#): > > Okay fair enough that most viral illnesses are days, not weeks long; however, with viral cardiomyopathy, my point was not that death from dilated viral cardiomyopathy is absurd, but rather death from viral cardiomyopathy is not common. Like I said, I could not find any cites for the mortality rate from viral cardiomyopathy. The BMJ article you cited said that death was 20% for patients who had _already_ progressed to dilated cardiomyopathy. > > Whereas the death rate for GBS is [2-3%](http://en.wikipedia.org/wiki/Guillain%E2%80%93Barr%C3%A9_syndrome) even in the best ICUs. That is not an insignificant rate of death, and frankly I would be surprised if the rate of death for all cases of viral myocarditis is that high (although I freely admit I could be wrong on that point). Yes, asymptomatic cardiomyopathy is pretty common. Clearly the character in question does not have an asymptomatic or extremely mild condition; she has something that has made her ill enough that she has become significantly impaired fairly quickly, needing home helath care and disconcerting enough that her son changed his plans to be around to help out, emotionally if not physically. That puts her in the group that has dilated cardiomyopathy and some significant, perhaps severe degree, of heart failure. (Those are generally the cases that we know about, who get labelled, as the asymptomatic and mild cases are often never diagnosed.) That group is not so tiny as to be exotic and the time course is consistent. Remember also that the predictor of that uncommon mortality with GBS is older age and pre-existing comorbidities, which do not apply to the character in question. And again the tempo of the illness is off: it gets as bad as it is going to get fairly quickly and then not much worse even if recovery is prolonged. Did not know that association of EBV and CMV with GBS though. Thanks for the link. ---
**Author:** ![Gestalt](https://avatars.discourse-cdn.com/v4/letter/g/90ced4/32.png) [@Gestalt](https://boards.straightdope.com/u/Gestalt)\ **Post date:** [August 9, 2013, 12:15pm UTC](https://boards.straightdope.com/t/medical-minded-dopers-i-need-a-disease/665596/52 "2013-08-09T12:15:12Z")
You know what, upon further research I will concede your point. There is no way to determine what percentage of people with viral myocarditis develop dilated cardiomyopathy, simply because viral myocarditis is usually asymptomatic. However, [http://www.sciencedirect.com/science/article/pii/0735109794907404](http://www.sciencedirect.com/science/article/pii/0735109794907404) this article says that there is an idiopathic etiology for 59% of dilated cardiomyopathy, [this website](https://www.clinicalkey.com/topics/cardiology/cardiomyopathy.html#sectionEpidemiology) states that the incidence of dilated cardiomyopathy of all causes is 148/100,000. The incidence of GBS from all studies I could find, including this one [including this one](http://www.karger.com/Article/Pdf/324710) demonstrate an incidence not greater than 2/100,000. The fatality rate for dilated cardiomyopathy is also much higher than for GBS, as mentioned in **DSeid’s** post. So the incidence of death from viral cardiomyopathy could be as high as 18/100,000 (assuming all cases of idiopathic dilated cardiomyopathy are viral in origin) The incidence of death from GBS is .08/100,000 So I will agree that an average person, not taking into account gender or age, is much more likely to die of virally-induced cardiomyopathy than GBS. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [August 9, 2013, 3:18pm UTC](https://boards.straightdope.com/t/medical-minded-dopers-i-need-a-disease/665596/53 "2013-08-09T15:18:07Z")
You, Sir or Madam, are a gentleman or lady and a scholar. 🙂 [Previous page](https://boards.straightdope.com/t/medical-minded-dopers-i-need-a-disease/665596.md?page=2)