Recalling an episode of the Simpsons, in which Mr. Burns is diagnosed with every illness, I wondered what’s the record for most illnesses diagnosed in one person at a time? And how about the record for most mental illnesses? Or a combination of the two (i’m really beginning to feel sorry for whoever this is).
Interesting question, which I doubt has an answer.
I thought you may find it interesting to hear that the patients I tend to see have, routinely, a dozen, or more, diagnoses (and twenty, or more, prescription medications).
I swear, a list like the following, would not be terribly unusual:
- Chronic Obstructive Pulmonary Disease
- Congestive Heart Failure
- Atrial Fibrillation
- Coronary Artery Disease with h/o NQWMI
- Hypertension
- Diabetes
- TIA’s X 4, Stroke
- Peripheral Vascular Disease with claudication
- vascular dementia
- adenocarcinoma prostate
- depression
- hypothyroidism
- GERD
- Osteoarthritis
- Cataracts
- recurrent basal cell Ca’s
- remote cholecystectomy
Meds:
- Ramipril 10 mg QAM
- Sprinolactone 25 mg QAM
- Metformin 750 mg BID
- Glyburide 5 mg BID
- Warfarin 5 mg alt with 7.5 mg daily
- Salbutamol 2 puffs QID
- Atrovent 2 puffs QID
- ECASA 81 mg QAM
- Metoprolol 50 mg BID
- Donepezil 10 mg QAM
- Venlafaxine 150 mg QAM
- L-thyroxine 88 ug QAM
- Esomeprazole 20 mg QAM
- Bicalutamide 50 mg QAM
- Tamsulosin 0.4 mg QAM
- Nitroglycerin patch 0.4 mg/h 08:00 to 20:00
- Gabapentin 300 mg TID
- Oxycodone 5 - 10 mg Q6H PRN
- Risperidone 0.5 mg BID PRN
:eek:
I had the measles, mumps and chicken pox all at once.
Followed by encephelitus. All this back in the early 60’s.
Fun times.
KarlGauss, all I can say is: wow. That’s a lot of illness. I suppose some things are linked; if you’re overweight, you’re more likely to have heart trouble, diabetes, depression etc.
The amount of pills is what disturbs me most, though…damn, that’d be a big glass of water!
I’ve got nothing factual to add, except the quote from the Simpsons because I think it’s so damn funny:
You’d be surprised.
Patient I saw yesterday:
HIV
TB
Cerebral toxoplasmosis
Hepatitis B
Hepatitis C
Hepatitis E
Longstanding alcoholism
Valium and heroin addiction
Bacterial endocarditis
Septic Arthritis
Peptic ulcer disease
Chronic liver failure
Infected skin ulcers
Pulmonary hypertension
Pulmonary valve incompetence
Tricuspid valve regurgitation
Arterio-venous fistula
Learning disability
Depression
This poor person has been in hospital for ages, so the consultant sends med students to them to see how many of their diagnoses you can get after 30mins history and examination- it’s a sort of test. The diagnoses you don’t get she sends you to go and read up on.
I couldn’t help noticing that both KarlGauss and irishgirl’s lists of diagnoses have one diagnosis in common: depression. Is it possible to have a dozen or more illnesses and *not * be depressed? If not, then any lengthy list of illnesses will inevitably become one item longer…
One fellow in Three Men in a Boat was disappointed, and no doubt would have been depressed if it has been in vogue at the time, that he had every affliction in the book (Gray’s Anatomy or some such) apart from Housemaid’s Knee.
But I still think my mother beats him…
How many are real and how many imagined?
Actual diagnoses and real diseases?
Or are some psychosomatic imitations brought on by a desire to list the latest and greatest medications on their score sheet?
The new drugs being advertised seem to say “You surely must have this disease and you should see your MD to get an Rx for your disease pronto!”
No ringworm or jock itch? I would bet money on Gingivitis too.
If we define “actual/real” as having objective, measurable manifestations (i.e. proof) then:
- Chronic Obstructive Pulmonary Disease - REAL (proof = pulm function tess and presence of low oxygen)
- Congestive Heart Failure - REAL (proof = abnormal findings on echocardiogram, chest x-ray, and symptoms of breathlessness etc.)
- Atrial Fibrillation - REAL (proof = diagnostic ECG)
- Coronary Artery Disease with h/o NQWMI - REAL (proof = angiogram and abnormal blood tests)
- Hypertension - REAL (proof = simple BP reading)
- Diabetes - REAL (proof = simple blood test)
- TIA’s X 4, Stroke - REAL (proof = objective motor weakness [for example] and abnormal brain CT scan)
- Peripheral Vascular Disease with claudication - REAL (proof = objective evidence of impaired blood flow to legs and abnormal blood pressure readings there)
- vascular dementia - REAL (proof = validated indices for dementia and SPECT scan of brain [specific etiology of dementia is, admittedly, impossible to improve])
- adenocarcinoma prostate - REAL (proof = biopsy positive for cancer)
- depression - Ah hah! I don’t know.
- hypothyroidism - REAL (proof = simple blood test)
- GERD - MAYBE (I admit that symptoms are nonspecific. If direct inspection (i.e. endoscopy) done, that CAN be diagnostic)
- Osteoarthritis - REAL (proof = x-rays, physical exam)
- Cataracts - REAL (proof = simple eye exam)
- recurrent basal cell Ca’s REAL (proof = biopsy)
- remote cholecystectomy - REAL (proof = surgeon’s word for it
)
So, 15/17 are objectively ‘real’, one ‘maybe’, one ‘don’t know’
Maybe I’m not understanding your point? Are you saying that the presence of abnormal symptoms and signs and test findings doesn’t necessarily imply the presence of a (specific) disease to explain them? I agree. And, just because something is outside of the usual range of “normal” doesn’t mean there’s pathology going on. But, if a particular set of symptoms, signs, and test results is associated with, or leads to, disability (e.g. shortness of breath which corresponds to low oxygen level) or death, then I think it’s fair to say that the set represents a real disease process.
Did I understand your point? (We’re you joking?)
After reading this thread, I am reminded of the situation at my school…
Our school has an on campus infirmary for when you are sick, which is nice, we think.
Everyone who we know that has gone there, gets at least three “standard issue” medicines. It always seems right away, no matter what you are there for, you get a medicine for pain called motrin 800. After that, you usually get two decongestants, deconamine and entex. Apparently one of them is for morning, and one for night. And if they think you are really sick, they give you ceflex. of course, I am not a doctor of any sort, but the thought always makes me smile when I go there…
I would like to propose the “most prescriptions for one illness.” A few weeks ago, I went there, turns out I had tonsilitus (spelling?). For this I received 6 medicines:
Motrin 800
Entex
Deconamine
Ceflex
Some sort of cough syrup, I don’t have the bottle anymore.
and some type of steroids I had to take (6 pills a day to start, one less every day after)
I got better about a week later. Does anyone know if all these medicines were really necessary?
(emphais mine) Well, if I were in that condition, I might be driven to drink too.
spingears-I think the point is better made that some diseases occur together in groups, either because of the aetiology or because treatment has side effects.
e.g.
High cholesterol, Ischaemic Heart Disease, diabetes, strokes, foot ulcers, blindness, kidney failure, angina.
Or
Severe Arthritis, diabetes (from the steroids), osteoporosis (from the steroids), Addison’s disease (from steroids), depression (from the pain), peptic ulcer disease (worsened by NSAID medications for pain).
Nobody actually tries to diagnose stuff that isn’t there for fun.
ImaginalDisc-the alcoholism and drug addiction happened first, almost everything else is a consequence of that.
Jeez, I didn’t even know there WAS a Hepatitis E! :eek:
About half and half.
Your patient roster must be geriatrics, alcoholics, drug addicts, and others who have neglected their health for their lifetime.
I have had two cataract implants, two “TUR’s,” two tonsilectomies, removal of left middle sinus turbinate, apendectomy, thoracotomy w/negative pathology, pinned ankle from torn achilles tendon, total hip replacement, and total knee replacement.
I consider these as existing conditions not diseases. The pinned ankle allows walking on a level or inclined surface but grows increasingly uncomfortable as the side slope increases!
I’m sure you are well aware of individuals that revel in being able to list their ailments and medication for the ‘benefit’ of their friends.
Now sinusitis is a grey horse of another color.