[Congressional Record Volume 140, Number 32 (Monday, March 21, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]
[Congressional Record: March 21, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]
WOMEN OFTEN MISDIAGNOSED
(Mrs. SCHROEDER asked and was given permission to address the House
for 1 minute and to revise and extend her remarks.)
Mrs. SCHROEDER. Mr. Speaker, I want to bring to my colleagues'
attention an article in the March 1994 edition of Lear's magazine
entitled ``The Most Common Misdiagnoses.''
As the article points out, doctors too often misdiagnose female
patients because they do not take their complaints seriously or because
they don't think a disease affects women.
As the magazine points out, some of the ailments most commonly
misdiagnosed in women are endometriosis, cardiovascular
disease, thyroid dysfunction, interstitial cystitis, ovarian cancer,
clinical depression, and lupus.
All this is no surprise to women, who historically have been slighted
when it comes to health care research and treatment. Recently, we
learned that the National Surgical Adjuvant Breast and Bowel Project
used falsified data in critical breast cancer studies. What is worse, 3
years have passed without a published reevaluation of these findings.
Recently, women's confidence in the science behind their doctors'
recommendations was shaken again when the National Cancer Institute
retreated from its national mammography screening guidelines for women
in their forties.
And we know in the past women were not included in Government-
sponsored clinical trials or drug studies, which prompted the
Congressional Caucus for Women's Issues to introduce the Women's Health
Equity Act.
This blase attitude toward women's lives must change. I would like to
take this opportunity to insert the Lear's article in the Congressional
Record as a reminder to my colleagues that when the health care reform
train leaves the station, women expect to be on it in numbers equal to
men.
[From Lear's, March 1994]
The Most Common Misdiagnosis
(By Peg Byron)
All too often, doctors make the wrong call on female
patients. Early signs of a heart attack are written off as
stress; lupus is mistaken for Lyme disease. Women need to be
vigilant about these and other overlooked ailments.
Women's health is attracting some overdue attention these
days, resulting in welcome policy changes. The Food and Drug
Administration, as of this October, will require all
mammogram providers to be certified. Last year the Centers
for Disease Control expanded the definition of AIDS to
include symptoms that occur only in women; this may free up
public funds to help HIV-positive women. And the National
Institutes of Health, after acknowledging that virtually all
information about major diseases derives from studies of men,
has taken steps to ensure gender equity in future research.
Nonetheless, problems persist between women and their
doctors. Some physicians are still too quick to attribute
women's complaints to stress or emotional disorders.
``Doctors are much more willing to write off real symptoms in
women as hysteria,'' says Marianne J. Legato, a New York
internist. And certain diseases are erroneously perceived--by
doctors and patients alike--as primarily affecting men, which
means that women may not be tested for some obvious culprits.
Below are some commonly missed ailments, most of which affect
women disproportionately.
endometriosis
Endometriosis, which affects more than 5 million women, is
a painful, chronic disease that occurs when tissue similar to
the lining in the uterus (endometrium) grows where it
shouldn't--usually in the pelvic area, sometimes in the
abdomen or on old surgery scars. It is now known why this
happens. Until recently, the discomfort caused by
endometriosis was usually attributed, incorrectly, to
menstrual distress. Mary Lou Ballweg of Milwaukee founded the
Endometriosis Association in 1980 after doctors could not
identify the source of her pelvic-area pain. ``They put me on
birth control pills,'' she says. ``Then they told me I needed
a vacation.'' It wasn't until she did her own research that
she discovered what was wrong. Endometriosis can cause
infertility, ectopic pregnancy, ruptured ovarian cysts,
adhesions, and general debilitation.
Symptoms: painful and heavy periods; discomfort with
intercourse; fatigue; painful bowel movements. Diagnosis:
Laparoscopy is needed to confirm diagnosis, though some
endometrial growth can be felt with a pelvic exam. Treatment:
Endometriosis is often not curable, but painful symptoms can
be lessened by drug therapy or surgery. Mild cases may simply
be monitored, and pregnancy may bring temporary relief of
symptoms. Endometriosis usually goes away after menopause.
For more information: the Endometriosis Association, 800-992-
3636.
Cardiovascular Disease
The number one killer of women is coronary artery disease--
in which plaque deposits build up on the walls of major
arteries and disrupt blood flow to the heart. Stroke--in
which blood flow to the brain is impaired--is number two.
Together they kill nearly 350,000 women per year. But studies
have shown that men are more likely than women to get proper
attention in the emergency room at the first sign of trouble.
Symptoms: for heart attacks: pain for more than a couple of
minutes and a tightening in the chest; shortness of breath;
nausea; sweating; lightheadedness or faintness; severe pain
in the jaw, neck, shoulder, or arm; severe indigestion not
alleviated with an antacid. For strokes: sudden numbness;
sudden dimness or loss of vision; loss of speech or trouble
understanding speech; sudden severe headaches; dizziness.
Diagnosis: exercise stress tests and thallium stress tests,
though they are less reliable in women than in men;
echocardiograms; angiograms; various imaging techniques, such
as CT scans or MRIs. Treatment: coronary artery bypass
surgery; angloplasty (whereby a tiny balloon is threaded
through the artery and expanded to compress plaque against
artery walls); drug therapy; diet changes; exercise. There
are some indications that estrogen-replacement therapy
reduces heart attack risk in women, but researchers have yet
to prove this conclusively. For more information: local
chapters of the American Heart Association; the Women's
Health Information Service at the National Women's Health
Network, 202-347-1140. Women with heart disease may want to
enroll in the NIH's first major clinical trial to determine
the effectiveness of estrogen supplements in preventing heart
disease: 800-54-WOMEN.
thyroid dysfunction
The thyroid gland, located just below the larynx, regulates
hormones that control digestion, heart rate, body
temperature, sweat gland sends out the wrong amount of
hormones, resulting in any number of different symptoms. Many
of these are often blamed on stress, menopause, or even the
aging process. But thyroid disease, which affects up to 11
million people, can wreak havoc on the body, eventually
leading to serious or even fatal outcomes.
Symptoms: Hypothyroidism (an underactive thyroid) is
characterized by chronic fatigue, muscle aches, cold
intolerance, constipation, heavy periods, brittle nails,
thinning hair, and elevated cholesterol. Hyperthyroidism (an
overactive thyroid)can cause insomnia, lighter periods, hand
tremors, rapid pulse, heat intolerance, and protruding eyes.
Diagnosis: a simple blood test. Treatment: Drugs (such as
radioactive iodine) and careful monitoring can, in many
cases, cure all symptoms. Surgery is an option for people
with enlarged thyroids. For more information: the Thyroid
Foundation of America Inc., 800-832-8321; the American
Thyroid Association, 800-542-6687.
interstitial cystitis
A poorly understood bladder disease that affects some
450,000 women, interstitial cystitis is an inflammation of
the bladder wall. It may be caused by infection, a defect in
the bladder's lining, or an autoimmune reaction. Until 1986,
however, Campbell's Urology, the standard urology textbook,
referred to this painful disorder as ``a pathway for the
discharge of unconscious hatreds.'' When orthopedist Vicki
Ratner, in her third year of medical school, encountered the
textbook description for the first time, she knew it was
bunk. Suffering from what felt like a nonstop urinary tract
infection, she consulted 14 doctors, who tested her for
everything they could think of; some then suggested that she
quit medical school and get married. After doing her own
research, she diagnosed the condition. She then went on to
found the Interstitial Cystitis Association.
Symptoms: pain in bladder and urethra; lower-abdominal and
often vaginal pain; pain during intercourse; urgent need to
urinate many times a day. Diagnosis: After ruling out
infections, cancer, and other problems, the physician will
perform a cystoscopy, in which a tiny scope is threaded into
the bladder to view hemorrhages on the bladder wall.
Treatment: There is no cure, though symptoms may be reduced
with diet therapy, painkillers, anti-inflammatory drugs, and
such drugs as DMSO and Elmiron. Cystoscopy, which stretches
the bladder, may also being relief. Surgical removal of the
bladder is only for the worst cases. For more information:
the Interstitial Cystitis Association, P.O. Box 1553, Madison
Square Station, New York, NY 10159.
clinical depression
Even though the crushing symptoms of clinical depression
can be treated, doctors often assume ``the blues'' are simply
part of every woman's life. ``They may just write if off, and
that's a tragedy,'' says Leah Dickstein, a professor of
psychiatry at the University of Louisville in Kentucky and a
past president of the American Medical Women's Association.
In fact, researchers are finding that the disease is due to
abnormal brain function rather than psychosocial issues.
Depression affects about 11.5 million people and occurs about
twice as often among women as men. Despite this, says Susan
Blumenthal, an NIH psychiatrist and cofounder of the Society
for the Advancement of Women's Health Research, most
antidepressant drugs have been tested on men.
Symptoms: According to the National Institute of Mental
Health, at least five of the following symptoms must be
apparent nearly every day for at least two weeks: a depressed
mood; suicidal thoughts; changes in sleep, appetite, or
energy; decreased interest in sex; slowed speech; feelings of
worthlessness; diminished ability to concentrate. Diagnosis:
evaluation by a psychiatrist. Treatment: Most clinical
depression can be effectively treated with therapy and drugs.
For more information: the National Institute of Mental
Health, 800-421-4211; the National Foundation for Depressive
Illness, 800-248-4344.
ovarian cancer
While cancer of the ovaries is relatively rare, it is often
deadly, simply because early detection is so difficult.
Nearly 22,000 women get the disease each year; more than
13,300 die of it annually. And like comic Gilda Radner, many
women waste precious time before a doctor thinks to look for
ovarian cancer. Often the disease is mistaken for an ulcer or
a gallbladder problem. The earlier treatment begins, the
better the chance for survival.
Symptoms: prolonged abdominal pain or bloating; the
sensation that clothes are too tight. Diagnosis: Three
tests--a pelvic exam, a sonogram, and the CA-125 blood test--
have yet to prove effective at identifying ovarian cancer.
Surgical biopsy (laparoscopic) is the only way to confirm
diagnosis. Treatment: surgery to remove ovaries and any
tumors; chemotherapy (including, sometimes, taxol);
radiation. For more information: the Society of Gynecologic
Oncologists, 401 North Michigan Avenue, Chicago, IL 60611,
provides referrals to doctors and clinical trials. Women with
a family history of this disease should see a genetic
counselor and may want to enroll in clinical trials conducted
at major medical centers to gauge the effectiveness of the
above-mentioned tests.
lupus
Systemic lupus erythematosus, commonly known as lupus, is
an autoimmune disorder of unknown origin that afflicts nearly
half a million women. Characterized by flare-ups and
remissions, it mimics other ailments. Patients occasionally
suffer extreme mood swings, and are inappropriately referred
to a psychiatrist. An unusual facial rash might be
misdiagnosed as rosacea. Joint pain can be mistaken for signs
of Lyme disease. And persistent fatigue could erroneously
suggest chronic-fatigue syndrome. If left untreated, lupus
can attack major organs, especially the kidneys. It tends to
appear before age 45 and is more common in African American
and Hispanic women than in other groups.
Symptoms: low-grade fever, swelling and aching joints and
muscles; digestive problems; easy bruising; extreme reaction
to cold; pain with deep breaths; anemia; chronic fatigue;
mood swings; butterfly-shaped facial rash; mouth ulcers; hair
loss; occasionally, even seizures. Diagnosis: an array of
blood and urine tests. Treatment: There is no cure. Drugs,
regular rest, and sunscreens to prevent rashes can keep the
disease in check indefinitely. Early diagnosis can improve
response to treatment. For more information: the Lupus
Foundation, 800-558-0121.
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