[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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