(The following is #4 in a series of columns entitled Dx IQ from the Society to Improve Diagnosis in Medicine to help you understand how important your role is in getting properly diagnosed.)
Jennifer Mizrahi remembers the first phone call from her daughter telling her, “Chasin is panicking!” He was in a store with his dad and his older brother and sister, and suddenly the 12-year-old felt “strange and nervous.” Jennifer tried to reassure Chasin over the phone, telling him to take a deep breath and to drink some water. The whole episode lasted less than a minute and then he was fine. No one paid much attention to this incident; it was a one-time thing.
Then it happened again a few months later.
This time Jennifer witnessed the whole episode unfold. “He got really nervous, and quickly rattled off, ‘Something’s wrong. I feel really strange, I need to take a walk, I need some water,’” Jennifer says. He looked alert and his eyes were wide open. Fifty seconds later, he felt fine.
The family pediatrician’s reaction was that all kids have a “little angst” and he thought it might be related to stress from Chasin’s parents’ divorce. He examined Chasin but never ran any tests. The pediatrician said he thought Chasin was experiencing panic attacks and supported the techniques Jennifer had already taught Chasin: breathe deeply, drink some water, and maybe go for a walk. The doctor didn’t think it was anything serious or dangerous. In fact, to make light of Chasin’s symptoms, he suggested they give the attacks a nickname, “Fred.”
The Roadblocks and the Signs
Over the next six years “Fred” would return, occasionally at first and then more frequently and in clusters — a few per day and then a few days’ break. But the length of the attacks never varied, 50-60 seconds.
Despite the fact that these episodes interrupted classes, games, and time with friends,
they seemed to have little impact on the rest of Chasin’s day. He did well in class, his teachers were supportive, and his friends stuck by him. While his family was stressed, Chasin took it in stride.
His mother didn’t. “I’m certain I spoke about this to my pediatrician fifty, sixty times,” Jennifer says. “There should have been a time when he thought that this is going on too long,” but he didn’t.
Convinced that Chasin’s symptoms were psychological, the pediatrician refused Jennifer’s repeated requests to bring in other types of medical specialists, including a pediatric neurologist. Why? (Read More)