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TwitThisNo Obvious Warning Signals
Sharron Marionneaux loved her job. The 60-year-old had worked for 28 years in a busy ophthalmologist's office in Baton Rouge, La., fitting patients for contact lenses. Three years ago she was overcome by persistent exhaustion. Regular checkups indicated Marionneaux was in good health. "Nothing was wrong with me, so I thought, Well, I'm old -- that's why I'm tired."She cut her workweek from five days to three, but it didn't help. "At the end of the day, I was literally climbing up the stairs on hands and knees to get to my bedroom." Then she became impatient and forgetful. She called her internist; she knew something was terribly wrong. He ordered a battery of tests, but after three months, Marionneaux still had no diagnosis. Then her doctor recalled that Marionneaux had had emergency heart surgery in 1983 and had needed blood transfusions. Could she have hepatitis C? "He said, 'I know you don't have this, Sharron, but let's test you anyway.' " But she did, and her liver had extensive scarring.
For 19 years, Marionneaux had suffered from a potentially fatal disease, and no doctor had noticed it. Unfortunately, stories like this are far more common than they should be. Diseases and disorders sometimes develop stealthily, presenting no obvious warning signals. Or they may exhibit symptoms so vague that doctors are left scratching their heads as test after test fails to detect anything amiss.
Hepatitis C
This disease is caused by the hepatitis C virus, which is spread by contact with infected blood, leading to inflammation and scarring of the liver.
Who's at risk. Anyone who had blood transfusions or organ transplants before July 1992, when better testing of donors was implemented. Also at risk: health care workers who may have been jabbed with a needle or splashed with blood. At highest risk are users of illegal drugs, people with tattoos and long-term hemodialysis patients.
Symptoms. In its early stages, the only symptom is fatigue. "Hepatitis C is a silent killer," says Carroll B. Leevy, associate professor of medicine at the Liver Center at the University of Medicine and Dentistry of New Jersey. "Probably almost half who are infected with hepatitis C in this country do not know they have it." Late-stage symptoms include digestive upsets, muscle and joint pain, kidney disease, autoimmune problems and cirrhosis.
Diagnosis. A simple blood test can detect the virus.
Treatment. A combination of anti-viral drugs can slow or stop the disease, but the course can last up to 48 weeks. Marionneaux took pills and got injections for nearly a year, and it was worth it: "I feel terrific," she says.
Lupus
Relief. That's what Kevin C. Crews felt when he was diagnosed with lupus. Since childhood, Crews had been plagued by health problems -- fatigue, fever and trouble breathing. As an adult, joint pain and rashes added to his woes. Yet no doctor could ever tell him why. Finally, after a bout of severe chest pains and visits to four different specialists, a rheumatologist figured out Crews's problem. "Actually coming up with the diagnosis was kind of a relief. Now I have a name to put with it," says the 43-year-old, who does special effects for theatrical productions in California. He also discovered that the autoimmune disease had provoked his body's defenses to attack his own tissue and organs.
Who's at risk. Lupus has a genetic basis and most commonly strikes young women, which is one reason doctors failed to pinpoint Crews's problem.
Symptoms. They're maddeningly tough to predict, according to Joan T. Merrill, co-chair of the Medical and Scientific Advisory Board of the Lupus Foundation of America. "Lupus can affect almost any organ in the body," Merrill says. One person may have swelling in the feet and pain while breathing. The next patient may have sores in the mouth and nose or rashes.
Diagnosis. Doctors consider a patient's medical history and immune function. One survey suggests more than half of all patients suffer for four or more years and visit three or more doctors before being diagnosed.
Treatment. A variety of drugs are used, depending on how lupus manifests itself. Crews still struggles with his symptoms, but he has been well enough to work and lead a full life.
Celiac Disease
While pregnant with her second child, Jackie Rosenblum of Los Angeles, now 37, developed a burning, itchy, blistery rash on her face and upper body. "I was told I was allergic to being pregnant," says Rosenblum. Six miserable months later, a doctor diagnosed celiac disease.
Imagine being sensitive to most grains -- wheat, barley, rye. They all contain the protein gluten. And when Rosenblum eats grains, the hairlike projections in her small intestine called villi -- they absorb nutrients from food -- shrink or disappear, leaving her unable to digest properly. Celiac disease can lead to osteoporosis, iron-deficiency anemia and serious vitamin deficiencies.
Who's at risk. About 20,000 Americans have been diagnosed, but experts estimate that more than a million Americans are sufferers. In genetically susceptible people, the disease can be triggered by pregnancy, severe stress, surgery or viral infection.
Symptoms. Typically, they include abdominal cramping and bloating, gas, diarrhea or constipation, unexplained anemia and mysterious weight loss or gain. Sufferers may also feel joint pain, fatigue or depression, and some develop a substantial rash.
Diagnosis. Doctors look at the symptoms and rely on blood tests to detect the sensitivity, followed by a small-bowel biopsy.
Treatment. Avoidance. At first Rosenblum cut out bread and pasta, but not the gluten that is hidden in so many products under names such as "modified food starch" and "texturized vegetable protein." After two more years of troubles and a doctor's reprimand, Rosenblum finally began eating a 100% gluten-free diet. Now, she says, "I feel really, really good."
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