I recently had the pleasure of reading a new book written by a friend of mine, Tracy Krulik — “I Have Cancer. And I’ve Never Felt Better: How I Took the Power Back from Cancer.” The book details Tracy’s nine-year battle with pain and debilitating gastrointestinal symptoms, her often-frustrating journey through the medical system and her eventual diagnosis with a rare form of pancreatic cancer.
More importantly, the book is the story of a woman who learned to become her own health-care advocate, has taken control of her disease and the management plan, and is living a very healthy life today, despite having an incurable cancer.
Over the years, Tracy was diagnosed with and treated for numerous diseases, including irritable bowel syndrome, cholelithiasis and eventually gastroparesis, when more serious etiologies for her symptoms were seemingly ruled out.
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If the cancer on her pancreas had been diagnosed and removed earlier in the course of her illness, Tracy could have been cured completely. But by the time she was diagnosed, the tumor had metastasized to her liver and chest.
As a healthcare provider, Tracy’s story scared me. As I read her book, it struck me just how many different physicians had told Tracy she should just decrease her stress levels. I started wondering if this was because she was a woman. Would a man complaining of similar symptoms have been given the same advice ? Or would he have been told he was working too hard?
More importantly, I asked myself, “Do clinicians blame so much on stress and lifestyle that we miss the big picture?”
While reading the book, I also thought of my father. A man who rarely complained about anything, he had developed gradual onset of debilitating rib and back pain and was sent from specialist to specialist. During a six-month period, numerous doctors told him that he had pulled a muscle or had “slipped a disc,” or offered some other generalized diagnosis.
A busy attorney, my father was advised to rest more, was sent to physical therapy and was referred to a chiropractor. But nothing helped him. It was not until he lost 10 lbs., that my mother insisted his primary-care physician do extensive blood work, which lead to a diagnosis of advanced stage multiple myeloma.
During our education and training as health-care providers we are told to look for horses, not zebras, when we hear hoof-beats. But the problem is that once we notice the stripes, the disease is often deadly.
I have heard too many stories from patients and friends to believe that my father’s and Tracy’s misdiagnoses were isolated cases. As health-care providers, how can we best avoid these scenarios?
It’s too easy for clinicians to write a prescription and advise lifestyle changes for every problem that they do not immediately understand. I’m not advocating that we consider cancer in the differential diagnosis of every patient presenting with dyspepsia or back pain. However, if a patient’s symptoms develop a pattern, or if he or she experiences years of recurrent problems, or a pain that won’t go away despite conventional treatments, it is a clinician’s job to become a medical detective. At some point, we must consider the zebra.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.
