column CLINICAL CASEBOOK
A symptom jigsaw
Diagnosis is like a jigsaw puzzle, where all the pieces have to fit perfectly to picture the whole. A recent patient reflected this concept: she had a plethora of symptoms and nobody had been able to put a finger on the underlying problem. She had had many medical tests which were essentially normal but she was still feeling unwell.
The pieces
She was in her early 30s with a high-powered job and a social life to match, although she was finding that her tolerance for alcohol was dropping and she was not only feeling increasingly ill when drinking wine but also was suffering severe hangovers the next day, the headaches sometimes lasting all day. For philosophical reasons she had changed to a vegetarian diet over the previous few years. This had initially improved her health, but in the last few months her energy had been decreasing and she was having difficulty managing her job. She felt her memory deteriorating and she was becoming increasingly moody, suffering bouts of anxiety and depression. Espresso coffee had become her go-to just to get her through the day.