Medical Mystery (or Not) Student Stops Needing Sleep

News-sites love to lead with the headline "Scientists Baffled", or "Medical Mystery". Mostly a complete fabrication and/or distorted truth. Not all medical professionals are created equal and everyone is capable of mistakes. That does not mean that all of the medical world is mystified. The story "Medical Mystery, Student Stops Needing Sleep" published by ABC news December 3rd, was a leading viewed story on Yahoo and Google. This news story is a confirmation of my poor opinion about headline writers. After reviewing the story it is not a "Medical Mystery" and probably never was. It is instead another example of a total disregard for minimal research and fact checking. A common theme in reporting. What they care about is eyeballs on the website. Using questionable methods by attracting attention with exaggeration, about a story with a marginal association. These methods only worsen the declining public knowledge about science based medicine. The lay public has a distorted enough opinion about medicine and medical science without this common "mystified doctors" reporting phenomenon.

People outside of the medical field have a distorted view of medical science, diagnosis, and treatment. What I would call Dr. House syndrome. The overemphasis on a brilliant specialist being able to see a complicated problem and properly figuring out what is wrong. He/She, with exceptional intelligence (usually poor bedside manners), is able to find the only proper treatment.

Medicine in real life does not work that way. Short story is.. it's complicated. You don't need an obnoxious super genius to diagnose you. Physicians are trained to look at all the angles, expect the unexpected, and are imparted with a broad spectrum of knowledge to help make those decisions. Physicians are trained to systematically evaluate an unknown to come to the best treatment outcome. Commonly doctors utilized a differential diagnosis list, mentally prioritized by probability. You don't start a medical mystery without tools to figure it out. Physical exam, anatomy and physiology knowledge, as well as diagnostic studies are just some of the tools. Additionally if answers are not readily apparent you don't throw your arms up and claim"Its a medical mystery". You continue to move on with the investigation.

I am not a physician, and for the last 8 years I have worked as an orthopedic specialist. I have extensive experience in emergency medicine, inpatient acute care, and surgical intensive care. Truthfully I have not done anything other than spine and sports medicine over the last 8 years. Despite those facts I had a preliminary diagnosis based on her symptoms not too far off the mark.

The Facts as Reported:

"Cristina Speirs, 22, was a self-proclaimed "health freak" during her senior year of college, which is all the more reason she would have never guessed that her body wouldbetrayher the way it did.

She exercised six times a week, taught hot yoga classes and drank a lot of water throughout the day to stay hydrated. So, when she stopped feeling tired and started getting up more frequently in the middle of the night to go to the bathroom, she didn't think anything of it."

"I had a lot of energy," Speirs said. "I wasn't sleeping. ... I was always on the go. I was never tired."

I have never met this girl, haven't examined her, don't know her, yet I already had a sneaking suspicion what was wrong with her. Preliminary differential list: Illicit Methampetamine use, or Pheocromocytoma. High blood pressure in a young fit healthy female with insomnia. Either drugs or a renal issue. Again I am not a "Dr. House", yet I had a pretty close to target Diagnosis in about 5 seconds.

Here is what the story tells us:

"Doctors first noticed a problem at Speirs' annual checkup in the fall of 2012 when they found that her potassium levels were low, but her blood pressure was "through the roof."

But they had no idea what was causing the strange symptoms.

"That really freaked me out because them not knowing what's wrong with me -- they're doctors, you know?" Speirs said.

A cardiologist quickly determined there was nothing wrong with her heart, but Speirs' mother suggested a renal sonogram to check her kidneys."

Really? Mom diagnosed it? I find it hard to believe that multiple physicians neglected to consider a well known source of hypertension and hypokalemia in a young fit healthy patient.

Here is the answer as reported:

Speirs noticed that the sonogram technician spent a long time lingering over her kidneys and looked confused. Alarmed, Speirs asked what was wrong. The technician told Speirs she needed an MRI right away because she suspected Speirs had one large combined kidney instead of two normal-sized kidneys.

"She said, 'You don't feel anything?'" Speirs said. "I was like, 'No. I feel fine.'"

The MRI would reveal that Speirs had normal kidneys. It was a 10-centimeter tumor that the technician was seeing.

"I was in complete shock," she said, explaining that she phoned her parents immediately to tell them that she'd need surgery. "Then, I got so upset honestly. I had no idea where this came from."

Then she met Dr. William Inabnet, co-director of the Adrenal Center at Mount Sinai Hospital in New York City. Upon learning that Speirs' tumor was producing two hormones -- cortisol and aldosterone -- he feared that the tumor was cancerous.

Nothing about the patient's story rings true to patterns in most medical situations. Even if it is true, this is not a medical mystery. Her symptoms are what happens when your body is constantly revved by sustained adrenalin.

The lead headline makes you think that some form of super girl has been found. A girl who has no need of sleep. Like she is one of the X-men (AKA:Caffeine Storm, or Finals Girl). Plus those pesky "doctors" just can't explain the mystery. The story give the impression that until mom demanded the right test, the doctors just couldn't understand why she never needs sleep. Just not true.

Although a patient may often misinterpret hesitancy to offer speculation as a a sign of being mystified, it is often just to reduce unwanted anxiety until you have firm diagnosis. You would not say off the cuff to some young healthy girl "well I think you probably have a renal tumor." without some data to back that up. Cruel and possibly wrong. My attending physician in the ICU always had a good saying. "You never talk about cancer until you have a tissue diagnosis and a treatment plan." Good advice. It is much easier to deliver the bad news when you follow it up with "and this is the plan."

I am betting that if you interviewed the Doctor that ordered the renal ultrasound you would find that.

• A. he/she was not mystified just concerned,

• B. It was not Mom's idea to order the ultrasound.

I suspect the medical record would support my suppostition. I could be wrong or mom could be a MD. I'm just saying this article has an improbable title with an improbable story to grab your attention. All to publicly elevate the process of figuring out a relatively apparent diagnosis. With the express purpose of getting my eyeballs to stop on their site. Yes I am completely aware that it worked.

Amazing and complete legitimate news media science failure. Yet it works, that's why they do it. The moral of the story is.... whenever you see the headline "Scientists baffled" or "Medical Mystery."

You have good reason to be skeptical.

Ref:

1. http://abcnews.go.com/Health/medical-mystery-student-stops-needing-sleep/story?id=21073404

2. http://www.mayoclinic.org/medicalprofs/pheochromocytoma.html

3. http://www.cancer.net/cancer-types/adrenal-gland-tumor/symptoms-and-signs