Tumour all in your head

A story about an insidious cause of pain from The Washington Post:

Gajavelli’s doctors — among them an internist, rheumatologist, podiatrist, neurologist and two orthopedists — were puzzled after tests failed to reveal an underlying cause. A physical therapist suggested the problem might be in his head.

Can’t have anyone get through some chronic pain without gaslighting them at least a little bit, amiright?

Mr. Gajavelli’s problems were bizarre and conspicuously pathological, and not just symptoms either: there were clear objective signs that something medically ominous was afoot. He had tumor-induced osteomalacia, “a bone-weakening disease caused by one or more typically benign, slow-growing tumors.” It’s astounding — and yet, sigh, tragically unsurprising — that any healthcare professional would invoke a psychosomatic diagnosis for such a case.

“There was something odd about his presentation early on,” said Mona Al Mukaddam, the University of Pennsylvania endocrinologist who made the diagnosis a few weeks after he returned from India. “If someone had really taken his history and looked at all the factors [in his case], it might not have taken so long.”

No shit.

This is high-grade hypochondriac nightmare fuel, which is always a risky thing to share: stories like this can truly freak patients out, but most of them have pain that is not this ominous and will pass soon enough. But such stories are also useful data points about the extreme diversity of hard-to-diagnose causes of chronic pain — an underestimated diagnostic challenge that needs more light. Both pros and patients need to have greater respect for that challenge because there are so many individually rare possibilities that they are extremely low, but the chances of having some pathological curve ball… not so rare!