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Symptoms: Disease or Functional?

Posted 03/08/2011

In medical school, you’re taught that patients either have a disease or don’t: That your patient is either genuinely unwell with a name-able condition (and the positive test results affirming this diagnosis) or not.

Consciously or not, surgeons would prefer that you have something so they can fix it and you can be eternally grateful to them. This next statement may sound grim, but most neurosurgeons can barely stifle a yawn if your screaming headache turns out to be from muscle tension instead of a brain tumor. Keep in mind that surgeons live to operate. They didn’t go through all that training to give you advice on stress reduction and how to eat healthfully. As you might guess, this urge to cut can work both for and against you.

Over the years, I’ve repeatedly heard variations on the following sentence from my patients: When my last doctor couldn’t find anything wrong with me, he suddenly lost interest.
I understand this. Unlike our surgical colleagues, we internists rarely fix anything permanently and dramatically. We’re pretty good at the Total Cure for something like strep throat, but don’t press your luck beyond that. Most internists offer advice and “manage” with a plethora of pharmaceuticals health problems like diabetes, high blood pressure, and migraines.

Given that the US healthcare system ranks pretty low compared to the rest of the world, if you manage to make it to a healthy old age, it’s not likely to be due to something we doctors did, but rather a combination of genetics and taking care of yourself.

Functional symptoms vs disease symptoms

The vast majority of physician office visits you’ll make in your life are for symptoms that require neither surgery nor medication. These are called “functional symptoms” and they don’t arise from any illness, but rather come with the territory of being human. Functional symptoms are so-named because they’re actually your body functioning as it’s supposed to given the circumstances you’ve put it in.

Most headaches are caused by poor diet or stress. Your back hurts because your stomach muscles are non-existent. Most digestive symptoms reflect either too much stress or too many rib tips. Most fatigue is functional too, as is the common diagnosis of adrenal fatigue. Nothing’s really wrong with your adrenal glands–they’re just pooped out from the tsunami of stress you bombard them with day after day.

With functional symptoms, your tests come back normal and on your chart your doctor will illegibly scrawl “no disease found.”

It’s helpful to know the difference between symptoms caused by actual disease and symptoms caused by dysfunction. Here’s the general rule:
• Disease symptoms always get worse and usually quite quickly—within days to weeks. Sometimes within a couple of months, but always worse.
• Functional symptoms come and go–often for years. They can be quite uncomfortable and then vanish, only to return months or years later.
When you have symptoms of disease, tests will eventually come back positive (ideally sooner rather than later so you can begin treatment quickly). Tests for functional symptoms are virtually always negative.

The medical profession is not wildly helpful when it comes to functional symptoms
Remember, doctors are trained to diagnose and treat disease and disease symptoms and they all too often make use of the heavy-hitting choices in their armament to treat functional symptoms. You really don’t want to be operated on if you don’t need to be and you also don’t want to be taking unnecessary pharmaceuticals (replete with side effects) when your actual diagnosis is “no disease found.”

Alternative practitioners have conventional doctors beat hands-down when it comes to functional symptoms. Think about it: they have no access to operating rooms or prescription pads, so they can’t lean on these “solutions.” As a result, they spend far more time exploring the source of your dysfunction. Once that’s been identified, most are quite good at coaching you back onto the path of feeling better.

Alternative practitioners–including chiropractors, Chinese medicine practitioners, homeopaths, herbalists, and the array of bodyworkers—also spend far more time on your biography than MDs. They’ll enlist you to play detective and help figure out why things have gone awry for you. They’ll also recommend far more lifestyle changes than you’ll ever hear from a conventional physician. By the time you finish, you’ll have a reasonably good idea of what’s causing your symptoms–often too much stress, not enough good nutrition, or a lack of exercise.

Most alternative practitioners expect you to be a partner who will participate in the process of feeling better. Not surprisingly, follow this path and you likely will feel better.

If you start to pay less attention to what’s important, your symptoms might return, but now you’ll be smarter and know what steps to take. Obviously, it’s good advice to see your primary care doctor if symptoms get worse or change substantively. She’ll run some tests and the results will likely be nice and normal and she’ll tell you not to worry.

Your symptoms are still functional.
Do remember, when it comes to symptoms, the odds they are functional are always in your favor.

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DIAGNOSE-IT-YOURSELF: COVID-19

Far and away, the commonest phone call/e mail I receive asks about COVID-19 diagnosis.
Just print this out, tape it on your refrigerator door, and stay calm.

ALLERGIES

• Runny nose
• Sneezing
• Red, swollen eyes
• Itchy eyes and nose
• Tickly throat
• No fever

COLD
• Runny nose
• Sneezing
• Sore throat
• Mild muscle aches
• Mild dry cough
• Rarely a low fever

STREP THROAT
• Painful sore throat
• Hurts to swallow
• Swollen glands in neck
• Fever

FLU (Standard seasonal flu)
• Fever
• Dry cough (no mucus)
• Sudden onset over few hours
• Headache
• Sore throat
• Fatigue, sometimes quite severe
• Muscle aches, sometimes quite severe
• Rarely, diarrhea

CORONAVIRUS-COVID 19
• Shortness of breath
• Fever (usually above 100 degrees)
• Dry cough (no mucus)
• Slow onset (2-14 days)
• Mild muscle aches
• Mild fatigue
• Mild sneezing

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