A neurologist in the Lyme light
In the doorway of the neurology clinic, Dr. Colin Quinn can look at you and tell whether you have ALS. And it’s true of a number of neurologists when dealing with patients within their specialty. There’s a gestalt, a gut feeling, doctors have when they meet a patient for the first time. It’s a skill you can’t teach, but it’s one you can learn.
Unfortunately, this skill is unidirectional. From that same doorway, Colin can’t look into himself and say with any degree of certainty, something’s wrong with me. But something was. About a decade ago, while a neurology resident in Philadelphia—at the same place where I just completed my own training—Colin got sick. He should have known it—maybe he did know it—but he denied it. Had he been a patient and not a physician, he probably would have figured it out sooner. But doctors, we’re a little different. We make the worst patients. And men are worse than women according to some data, but overall doctors are worse than non-doctors about this. It has to do with the way we think of ourselves, the way we underplay our own symptoms, and how after years of seeing the worst in physical health, we could never imagine that one day we’d be needing a doctor ourselves.
The first symptom Colin noted was a fever. He felt hot, and in hindsight he realized it was a fever. His wife, Pallavi Kumar–also a physician–knew it was a fever. But denial is a force to be reckoned with, whether or not
you’re a doctor and whether or not you’re diagnosing yourself with a symptom. Colin simply could not come to terms with it. But later, there was a rash–his second symptom. A lot like this one on the right, but on his belly button. It kind of looks like an advertisement for Target. And this is a pretty specific sign for a very particular disease, more than 80% specific for it actually. But even with this rash, Colin was not convinced.
Then came the nuchal rigidity (symptom no. 3). Pain, with passive neck flexion. This began a few days into feeling hot and right about the time that he was starting to feel really crummy. But did he take time off of work? No. He went into his second overnight call shift, but at least acknowledged he should be testing himself for Lyme Disease at this point. So he sent off the blood test, and the result: NEGATIVE.
I could not believe it when I heard this story. But that’s what Colin saw, and he was immediately relieved to learn that he had not contracted this tick-borne meningitic illness, that he was overplaying his symptoms (when in reality, he was underplaying them), and you know what? This self-assurance…it actually made him feel better. Another few days pass, still on service at the hospital as a resident, and he gets to his third night of call. Overnight, he loses the ability to close his left eye. And that side of his face won’t move. Symptom no. 4: Facial palsy.
The next morning, a diagnostic test is performed. Colin admitted himself to his own service actually, the service that he was just admitting patients to overnight. He gets a lumbar puncture from his own attending, a painless experience, and the CSF profile is mildly inflammatory but non-specific. Then the result returns: Positive for Borrelia burgdorferi. It turns out, Colin had actually misinterpreted his own blood test for Lyme disease.
It’s a pretty crazy story right? And one thing I’ve learned from it is that you shouldn’t ignore your symptoms—don’t elaborate them, but definitely don’t ignore them. Especially as doctors. Because we are awful at it. It does not pay to be a tough guy. For more on how Colin deals with his condition, you should take a listen to the show and the commentary. It’s a truly compelling story, and huge thanks to Dr. Colin Quinn for sharing it to our audience, and to his incredibly patient wife, Dr. Pallavi Kumar, for allowing him to.
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