Something about this syndrome reminds me of tinnitus. Tinnitus often occurs due to destruction of the cilia in the ear canal, causing the brain to overcompensate by constantly sensing the frequencies the destroyed cilia would have responded to. (At least, this is one commonly hypothesized theory.) While this may be a bit of reasoning by analogy, I wouldn't be surprised if something similar were at work (particularly to the extent that nerves or other sensitive apparatuses are involved).
I just had this done in February. My turbinates have always prevented me from breathing through my nose. When I was 19 (20+ years ago) I broke my nose. Which is to say that I haven't breathed through it for pretty much my entire life.
A week after the surgery when the splints came out it felt like a draft through the center of my head. Maybe people who have always been able to breathe through their nose are accustomed to this, but for me it was entirely foreign. On top of this, the inside of my head felt cold; headache inducing cold. I can imagine this could get interpreted a variety of ways, especially for people who have never had those senses developed at all.
This sounds like one of those fine lines of medicine between what the patient thinks they have, what the doctors think is wrong, and the quandary of psychology and a disease based model to diagnosing and treating patients.
In fairness: the patient has typical anxiety and depressive symptoms, focused on a prior medical intervention, with fairly typical manifestations. It's the nature of these sorts of conditions that they have enormous and interesting heterogeneity in particular focuses of obsession for the patients.
It doesn't make his suffering, or the suffering of patients with similar ailments, any less real or traumatizing. Its effects aren't any less tragic. However, fundamentally, there isn't really a great model of care for people who won't or can't believe that their ailment is psychological and requires psychological treatment ("But he didn’t stick with them or the psychologist. He felt like no one was listening to him. His head wasn’t the problem — someone needed to fix his nose!")It doesn't help anyone to keep making up new diagnoses for every manifestation of depression and anxiety, just so people can feel "acknowledged" - and validated in not treating the underlying issue. So many of these emerging conditions ultimately show little response to their supposed underlying mechanisms, and normal responses (for depression and anxiety) to anti-depressants and cognitive behavioral therapy. (" He spent most of his time alone in his bedroom with a humidifier. After doctors treated him with cognitive therapy and an antidepressant, many of his symptoms cleared up.")
Of more interest to me, personally, is the frequency of post-surgical anxiety. I've seen it in enough patients to know that it's not restricted to turbinate reductions, it doesn't always correlate to pre-existing mental health problems, and that it can often resolve when the surgery is "fixed" (e.g., removing lap-bands). This is a general phenomenon that receives little attention, causes a lot of suffering, and would help a lot of patients if we understood it better. Chasing down rabit-holes by pretending the anxiety is something /else/ doesn't help anyone.
But how do you know the condition is psychogenic? You seem to have jumped to this conclusion based on your experience with other patients whose symptoms turned out to be psychogenic. Even granting that there's some similarity in the symptoms, I don't see how that provides strong evidence that this condition is also psychogenic.
I'm not saying it's an unreasonable hypothesis, but how can one have enough confidence in it to abandon the search for organic causes? -- Particularly when, if there were an organic cause that therefore got overlooked, the cost to the patient would be very high.
If it really does respond to treatment, then fine.
But though the article doesn't go into this, it's hard to imagine that the doctors who consider ENS to be probably psychogenic haven't attempted to treat it with antidepressants etc. If that had worked in all cases, Dr. Houser wouldn't have had to develop an implant to mimic the lost turbinate, and indeed, this article wouldn't have been written at all.
So we have more than a little reason to think that ENS doesn't always respond to psychiatric treatment -- I'm sure there's more written about this if we cared to dig it up -- and proves resistant often enough to make at least a few doctors think there's something else going on. And then arkades waltzes in here and dismisses all of that.
1) Many people who have post-surgical anxiety do respond to treatment. You'll note that in the article being discussed, one of the other examples given was treated with CBT and anti-depressants and got better. The fact that the article pretty much built itself around the narrative of "people thought he was crazy. Then a doctor somewhere took him seriously, and it was real" does not mean the author of the article in any way did a sweeping education in psych and anxiety.
2) Anxiety is difficult to treat even in people who believe they have it and are committed to treatment; it's not meaningful to say "doctors who consider ENS to be probably psychogenic haven't attempted to treat it with antidepressants." The article itself leads with a number of ENTs saying it's psych and not seeing the patient - because he needed to go to see a psych, not an ENT, and he /refused/ to go. He eventually got brief treatment, and bailed, because he was never actually convinced it was anxiety. There was only one other example of a patient in the article who was treated for psych., and that patient's symptoms resolved.
You're assuming that these patients get regularly treated for psych disorders, and that therefore the persistence of this meme indicates it's not psychogenic. That, despite the fact that many of these patients refuse to believe they have a psychological disorder, and thus refuse to seek or continue treatment for that disorder. You, in fact, make this assumption despite just having read an article that stated repeatedly that he had pre-existing and untreated anxiety; that he went to multiple ENTs and got told "it's psych" but avoided going to a psych for it; and when ultimately he admitted himself for psych care, he bailed after literally a couple of days because he was convinced the problem was his nose, not his mind.
Somehow, despite literally reading an entire biography of "man with anxiety gets surgery, blames anxiety symptoms on surgery, avoids all psych care," you can still make an argument based on the assumption that these patients are getting adequate psych care, and thus we ought to rule it out.
But, hey, no. Let's ignore the disease that has an 18% prevalence among US adults and accounts for all his symptoms, of which he has a history of even pre-dating the surgery, and instead suggest that it's some rare new disease that just happens to overlap completely with anxiety symptoms.
> You're assuming that these patients get regularly treated for psych disorders, and that therefore the persistence of this meme indicates it's not psychogenic.
You're overstating my position. I'm saying the question deserves further investigation. You seem to be claiming that it's settled.
> I'm saying the question deserves further investigation.
My mistake.
> You seem to be claiming that it's settled.
No. There are doubtless many rare variants of human ailment we haven't understood or discovered yet. Literally, you could come up with at least one ailment for every enzyme and cell-surface molecule on the human body, at least.
My issue is that every few years there comes up a new anxiety/depression fad: some subset of folks with anxiety and depression with attribute it to some new undiagnosed condition (almost always musculoskeletal), and whip up a frenzy.
Is it possible that there are these large numbers of usually-musculoskeletal rare disease variants that all happen to look like anxiety and depression?
Well, yes, there could be. But considering how woefully under-diagnosed and under-treated mental health is in this country, and that between anxiety disorder and MDD you have a twelve-month prevalence in the US of >20%, you are far, far, far more likely finding people with anxiety/depression and a dollop of either denial or misunderstanding[1].
All of medicine comes down to the Bayesian discipline of figuring out what the most likely cause of an issue is, and collecting evidence to support/disprove that until it's no longer the most likely cause, or until the ordering stops changing. That's it. Jumping down the list is medically irresponsible. Every treatment, at that point, is unethical: you can't justify cost vs. benefit of treatment benefits and side-effects when there's every likelihood the patient doesn't have that rare thing.
So, before inventing new diseases every handful of years, we need to stop and say "is there any good evidence that this is a 1/1,000,000 new illness, vs. the anxiety/depression for which there's a >20% chance it is?" In this case, the sum total of evidence for novel disease amounts to the possibility of "possible injury to nasal sensory neurons creates a little numbness in the nose; subject of anxious obsession by pts w/ anxiety."
I don't argue this because it amuses me to say "no, silly rabbit, you're not allowed to have your own new disease." It's because these people are suffering terribly, in dire need of help, and when we expend our resources chasing new diagnoses (in the absence of good reason to believe there's a new illness), we're "validating" them at the expense of actually helping them.
[1](Yes, patients with anxiety can just genuinely not understand they have it. Anxiety can come on as strictly somatic symptoms, and the common layperson can rationally say "I don't feel anxious or panicked at all; I'm just having trouble breathing. Non-sense!" It's a poorly named disease.)
I appreciate your reply, and I understand your point. A misdiagnosis in either direction along the organic/psychogenic axis will have unfortunate consequences for the patient. Fair enough.
I don't know if I agree with this, though:
> [T]hese people are suffering terribly, in dire need of help, and when we expend our resources chasing new diagnoses (in the absence of good reason to believe there's a new illness), we're "validating" them at the expense of actually helping them.
Was trying out nasal implants on ENS patients "validating them at the expense of actually helping them"? Because the implants apparently turned out to help in many cases.
And: what constitutes good reason to believe there's a new illness? That's a hard question, which I'm sure can and will be debated forever. But I think that the condition turning out to respond to a novel treatment -- like nasal implants, in this case -- has to be considered some degree of evidence that there's a novel illness.
If you had written this comment at the beginning instead of https://news.ycombinator.com/item?id=11651110 , I would have had no reason to take exception. This comment makes perfect sense to me.
The first I would paraphrase as: "The patient refuses to accept that his condition is psychological, and we do him a disservice by validating the idea that it might not be."
The second I would paraphrase as: "While there is always the possibility that this is a new condition we don't yet understand, statistically speaking it is far more likely to be psychological. Given finite resources, diagnosis and treatment for depression/anxiety is by far the best bet for giving the patient real relief."
To me the certainty of exclusion in the first message just immediately sets off alarm bells.
I think part of the miscommunication may lie in professional idiom. In medicine, all diagnosis is provisional and statistical - which both elevates "probably" to "certainly" in casual conversation, and renders most absolute statements hollow. It's just an automatic translation that has to happen: when you tell someone with a three-day sniffle that they have a cold, it's an absolute statement aloud, but in your head you have to honestly say "99.999% cold; 0.0009% HIV; 0.0001% cancer." And you have to treat them accordingly, until proven otherwise, because if you try to rule out cancer on everyone with a sniffle you're going to actually kill more people with complications than you'll ever save.
"This person has X" most of the time means "X has a strong statistical advantage in explaining this patient's symptoms, so we're going to pursue treatment for X until accruing evidence suggests we shouldn't." I guess that's not always true, given a few things that exist by definition, but it's mostly true.
And that's generally good enough, since... well, statistical masses tend to obey statistical properties.
I couldn't possibly prove that ENS will always respond to psychiatric treatment, and it's an absurd thing to even ask for in an argument. There's certainly evidence it sometimes works.
Beyond that, this is an obscure condition; this article may in fact be the most substantive thing ever written on it for a non-medical audience.
It seems wrong to even say the treatment works - of course it appears to when you drug someone's concerns away but it doesn't seem to change the underlying wrongness of the sensations.
If I broke my leg I'm sure I'd appreciate an Ativan but I'd really need a splint.
On what basis do you dismiss the physical sensations felt by these people as nothing but anxiety resulting from surgery?
How do you explain the fact that this only appears to manifest when turbinates are reduced, and not as a result of any other surgical interventions on the nose?
First of all, because anxiety and depression are well known to manifest with physical symptoms. Which is why if you present with physical symptoms, anxiety and depression are diagnoses of exclusion, coming long after everything else has been exhausted. Notably, I didn't say they're /imaginary/ - just psychogenic. Anxiety is well known for significantly reducing the threshold for attention to stimulus: someone having an anxiety attack can feel things without somatic prompt, or they can feel something horrible with an underlying somatic prompt that, if they weren't having an anxiety attack, they'd never have even noticed. Generally people don't get brushed off as having mental disease. Although that's the popular narrative, again, (1) it's usually the last dx, and (2) even in these people's narratives, they go from physician to physician. Doctor after doctor looks at them and detects nothing.
This doesn't mean nothing is there, of course, but mystery illness is rare and anxiety is very common. It would be bad medicine to overlook the prevalent condition that explains your symptoms.
Second, post-surgical anxiety is quite common for a variety of conditions. I actually addressed it at the end of the post I suspect you didn't read. You presume this is somehow unique to turbinate reduction; that is an untrue assumption.
> I actually addressed it at the end of the post I suspect you didn't read.
Are all medical professionals (which I presume you are) this condescending, or just the ones on this thread?
> Anxiety is well known for significantly reducing the threshold for attention to stimulus: someone having an anxiety attack can feel things without somatic prompt, or they can feel something horrible with an underlying somatic prompt that, if they weren't having an anxiety attack, they'd never have even noticed.
Right. So how do you know that this isn't the result of a real physical stimulus that manifests primarily in anxious people because they are more sensitive to that stimulus?
How do you know that anxiety/depression are the "underlying issue", and not merely something that surfaces/amplifies the true underlying issue?
>On what basis do you dismiss the physical sensations felt by these people as nothing but anxiety resulting from surgery?
The parent comment wasn't dismissing it. Quite the contrary. You, however, do seem to be dismissing it, by saying "nothing but anxiety". Anxiety is very real.
>Would you similarly dismiss phantom pain and prescribe anti-depressants and CBT?
Pain can quite often be caused/exacerbated by psychological factors. Perhaps you should google "central sensitization". The parts of the brain that registers pain (the insular cortex and ACC) are also responsible for attaching emotional feelings to pain. In some cases (e.g. fibromyalgia) the pain persists in the absence of any physical pain signal.
If someone is experiencing a physical symptom and you tell them it's not actually physical, that is dismissing it. If someone has whiplash from a car crash and you tell them the pain is just a result of their anxiety about the crash, that is dismissing their physical pain. Because the pain actually has a cause independent of their psychological state that you are declining to acknowledge or treat directly.
More specifically, if the physical sensation is caused by something physical, then this is really quite dismissive (from grandparent):
> there isn't really a great model of care for people who won't or can't believe that their ailment is psychological and requires psychological treatment
Maybe it's your problem that you won't or can't believe that the ailment might not be psychological.
> You, however, do seem to be dismissing it, by saying "nothing but anxiety". Anxiety is very real.
I am not dismissing anxiety in the least. I know more about it than I would like to, and yes it is very real.
>If someone is experiencing a physical symptom and you tell them it's not actually physical, that is dismissing it.
If you think diagnosing something as anxiety is the same as dismissing that person's experience and suffering and need for help, you're part of the problem.
It's dismissive if the cause is not actually anxiety.
Your entire argument only works if you accept the premise that this condition stems from anxiety alone. Since you have accepted this with what appears to be near certainty, then of course the rest of your argument makes sense to you, and your diagnosis of anxiety probably feels compassionate and sensitive.
To a person who does not share your confidence that anxiety is the only factor in play here, your dismissal of other possible factors is crazy-making.
Just acknowledging that there might be a factor here we don't fully understand would be enough. It's fine if anxiety is the best diagnosis and treatment plan given what we know right now. But the certainty that it's the entire story is off-putting.
You said yourself that depression/anxiety for physical symptoms are "diagnoses of exclusion, coming long after everything else has been exhausted." They are a fallback when you don't have another explanation. So why do you present a fallback diagnosis with certainty?
>If someone is experiencing a physical symptom and you tell them it's not actually physical, that is dismissing it
Nobody is saying that at all. The physical causes should be investigated, obviously. Suggesting to the patient that it might be psychological is not "dismissing" anything. Of course, it is true that most patients are vehemently opposed to the idea of psychosomatic pain, as well as many/most doctors. John Sarno's books are a fascinating read.
In this case there doesn't appear to be any pain, or physical sensation at all. You can't sense a "hole", any more than you can sense inflammation or the like.
I'm not familiar with Dr. Sarno personally, but I am familiar with New York's PM&R scene. I'd be mildly skeptical about things coming out of there. Not very skeptical, they're excellent doctors, but there's a strong strain of very-alternative medicine running in that particular sub-culture.
On the other hand, if you want a really mind-expanding read about the fuzzier edges of medicine, you might want to read Daniel Moerman's "Meaning, Medicine, and the 'Placebo Effect'." Don't let down your skeptical guard, but it's worth a read.
"dismiss"..."nothing but anxiety": Your question seems to imply that a psychological etiology is somehow less important than a physical etiology. Wouldn't the most important thing be developing a standard reproducible diagnostic criteria, then working on preventing or curing the problem? The parent comment seems to me to be a well-reasoned, nuanced description of the difficulties of dealing with this clinical scenario, and doesn't impose any value judgements regarding the 'intrinsic worth' of a medical symptom or etiology.
The whole "lived experience" folks are often overly self-important when they suggest that no-one can ever understand another person unless they literally are that other person because lived experience is the only thing that counts.
But there's some truth to that idea, just because you think you know what's happening to another person doesn't mean you actually do.
>> How do you explain the fact that this only appears to manifest when turbinates are reduced, and not as a result of any other surgical interventions on the nose?
By all fairness if you haven't had turbinate reduction it's going to be very hard to think you're suffering from a condition that is said to be caused by turbinate reduction.
> By all fairness if you haven't had turbinate reduction it's going to be very hard to think you're suffering from a condition that is said to be caused by turbinate reduction.
In all fairness, did you read the article? The patient suffered the symptoms first (before ever hearing of the syndrome), then went looking for an explanation, then found a syndrome exactly matching his symptoms linked to turbinate reduction, thought that was weird because he didn't think he'd had that, and only then saw "turbinate reduction" in the records from his surgery.
On the other hand its a standard procedure performed on many people. And if anxiety after surgery is common, then there is a good chance he will find enough people on the internet that they will already have formed a theory about this.
I had anxiety with panic attacks that had came with (for me) real physical (pain) experience for a few years. so I think that those people really need help, but not in the form of creating new disease-names for them. They need psychological treatment and maybe some physical 'placebo' treatment/surgery to cure them.
I got cured by telling myself over and over everything is okay, which felt like lying to myself.
Then why aren't we seeing a similar set of cases for other frequent surgeries that result in such debilitating pain as to drive people to suicide? I'm guessing we could look at appendectomies, gallbladder removals, wisdom tooth extractions, c-sections, etc - where are the similarly acute cases if it's purely anxiety unrelated to the specifics of the surgical procedure?
There are many. This is why many elective procedures associated with anxiety and depression now require psych evals before a surgeon will consent to do them, at least at more prestigious medical centers. You'll note if you go in for cosmetic surgery, lap band, gastric bypass, etc. many of these centers will ask for you to see a psych before proceeding.
Additionally, more anecdotally, have you ever visited the "alt med" internet? It's literally swarms of people with anxiety and depression obsessing over how random medical minutiae (related to their dental work, their lap-choli, etc.) explain their set-of-symptoms-that-are-typical-anxiety.
These "similar sets of cases" aren't hidden. They're ubiquitous. They just set themselves as opposed to (1) the idea that they might have a psychological illness, and (2) anything that smacks of "establishment" medical care (which they both view with anxiety and with disdain and hurt, because it was that establishment that does not take their complaints at face value.)
>> he didn't think he'd had that, and only then saw "turbinate reduction" in the records
So what? That's just something that was in the article. Who knows what really happened. Maybe the guy knew and he forgot about it (it's called cryptomnesia). Maybe the article misreports it. Maybe, who knows what. You can't draw firm conclusions by something someone said once.
Now can I check with you whether you read what you wrote? Because it didn't make any sense at all. How can anyone who hasn't had turbinate reduction think they have a condition that is caused by turbinate reduction? That does not compute.
> You can't draw firm conclusions by something someone said once.
The only people in this thread who are drawing firm conclusions are the ones expressing the firm conclusion that Empty Nose Syndrome is 100% attributable to anxiety.
I certainly don't claim to know what is going on. But I am not at all convinced by the people who are confidently dismissing the possibility of any other causes.
> So what? That's just something that was in the article. Who knows what really happened.
Even if I grant you that he might have unknowingly remembered that his surgery included turbinate reduction, that doesn't matter unless he knew about Empty Nose Syndrome before he experienced the symptoms.
> Now can I check with you whether you read what you wrote? Because it didn't make any sense at all. How can anyone who hasn't had turbinate reduction think they have a condition that is caused by turbinate reduction? That does not compute.
Here is why it computes. Empty Nose Syndrome, as described from various sources, has a common set of symptoms and is linked to one specific surgical procedure. Now let us suppose your theory is correct and it is caused solely by anxiety focused on the surgical intervention. If that were the case, you would expect many people to express this same set of symptoms from other nose-related surgeries. You would expect that the description of Empty Nose Syndrome would then expand to be linked to a number of different nasal surgeries. After all, if these patients are hypochondriacs whose anxiety causes physical discomfort, why would this anxiety be limited to only turbinate reduction?
Now maybe your theory is that awareness of the syndrome itself creates the power of suggestion that causes the patient to feel these symptoms. And without that and the intellectual link to turbinate reduction, they will not experience the symptoms. Now that theory is completely contrary to the story given in the article. But besides that, how under your theory did the syndrome begin? If it takes the power of suggestion to create the sensation, how did the first people experience it?
Anything that created this syndrome out of thin air for turbinate reduction should be able to create it out of thin air for other nose surgeries. And yet for 15 years it has continued to be linked specifically to turbinate reduction. Why?
First, please don't use "hypochondriac" - it's a horribly outdated term and no-one here is trying to diminish the suffering that people feel from this condition, even if they think it's somataform.
> Here is why it computes. Empty Nose Syndrome, as described from various sources, has a common set of symptoms and is linked to one specific surgical procedure. Now let us suppose your theory is correct and it is caused solely by anxiety focused on the surgical intervention. If that were the case, you would expect many people to express this same set of symptoms from other nose-related surgeries. You would expect that the description of Empty Nose Syndrome would then expand to be linked to a number of different nasal surgeries. After all, if these patients are hypochondriacs whose anxiety causes physical discomfort, why would this anxiety be limited to only turbinate reduction?
But these things tend to self limit. Ann says she has chronic fatigue. She undergoes some psychological therapy. She gets some relief from her symptoms. A bunch of people in the CFS organisation now shun Ann, and tell her that she didn't have real CFS.
I believe and trust that no one is trying to diminish the suffering. But within that I still feel there is condescension when someone describes the idea of investigating a person's symptoms as directly reported "Chasing down rabit-holes by pretending the anxiety is something /else/". There is way more certainty and dismissal in that attitude than anybody has justified in my opinion.
Don't get me wrong, I understand if investigating the direct symptoms might not be practical under some circumstances. But saying it's useless and "pretending" goes too far IMO.
> But these things tend to self limit. Ann says she has chronic fatigue. She undergoes some psychological therapy. She gets some relief from her symptoms. A bunch of people in the CFS organisation now shun Ann, and tell her that she didn't have real CFS.
I don't see how this scenario answers my question. Your story suggests that their is social pressure to resist the idea that the condition is treatable. It doesn't explain what would prevent an expanding scope for where the condition is identified.
Sorry but I can't keep up with you. You're trying to reason about things you
don't even know happened, based on an account in an article you read on the
internet, and on things that people report. That's no way to make sense of
anything.
I'll give you an example. Where I come from, people believe in the Evil Eye:
that if you stare at someone or something with a bad intention, if you're
jealous etc, you can cause real, physical harm to that person, thing etc.
I've been accused of it a couple of times (I got scary eyes). Once a friend got
a headache and then called her mom and asked her to say a special prayer people
say that supposedly banishes the Evil Eye, then made a big todo about how a
certain person always gave her the Evil Eye (it didn't take rocket science to
figure out she was talking about me).
So, my friend obviously had an ailment, if you like: her head hurt. She felt
bad, she blamed it on me. It helps that we were having an argument at the time
it happened. We often had arguments. She often had headaches. She believed I was
giving her the Evil Eye.
You can take the events themselves and try to reason about them. Did I give my
friend the Evil Eye? Was the headache unrelated? Which happened first? What
tells us they were cause-and-effect? What tells us they weren't?
Except, there is no such thing as the Evil Eye and you're basing your whole
reasoning process on empty air- and convincing yourself that you're on firm
ground.
The thing to ask is not "did I give my friend the Evil Eye?". The thing to ask is
"is there such a thing as the Evil Eye?". Equally, you should be asking whether
ENS is real in the first place. But you jump immediately in discussions of
cause-and-effect, symptoms and accounts. If you're already convinced that ENS is
real, those are not that important. But you have to ask yourself: why do you
think it's real? Just because people say they have it? There doesn't seem to be
anything else at the moment.
Like others say, I don't doubt for a moment that people suffer from - something.
But I'm not convinced that it's what they say it is. I don't blame people for
going mad about it, I do blame their doctors for not listening to them, but I
don't blame ENS, because it sounds like the Evil Eye, or Morgellon's or whatever
similar crazy thing people latch on to in their desperation.
And of course the worse thing is: by latching onto ENS (or whatever), people
deprive themselves of the chance to have what ails them treated.
> If you're already convinced that ENS is real, those are not that important. But you have to ask yourself: why do you think it's real?
I don't know how many times I have to say it. I don't claim positively to know it is real.
I'm going to write it just once more so that hopefully you don't miss it this time: I don't claim to positively know that ENS is real.
Here is what I do know. Nobody on this thread has presented enough information to categorically deny that it exists. So if I see people who appear to be doing that, I'm going to call them on it.
>> Here is what I do know. Nobody on this thread has presented enough information to categorically deny that it exists. So if I see people who appear to be doing that, I'm going to call them on it.
That's not how it works. The side that makes a claim has to show that it's real. Everyone else has every right to doubt the veracity of the claim until that time. Otherwise we'd all be endlessly bogged down in pointless conversations.
Anyone can come up with a wild, fantastical idea. That doesn't mean everyone else has to waste their time trying to disprove it.
Btw, if you've made such a big todo just because you don't get that, I'll be a bit upset 'cause I've been wasting my time here.
> Anyone can come up with a wild, fantastical idea
The idea that a person's physical symptoms might have a physical cause is not wild or fantastical. By Occam's Razor it is (absent other information) the most likely explanation.
That's not Occam's Razor. That's an egregious misunderstanding of Occam's Razor. The simplest explanation is indeed that those people suffer from anxiety, which is a very common condition that covers all their symptoms, as others have said. You need to make too many assumptions to be convinced of the contrary.
> However, fundamentally, there isn't really a great model of care for people who won't or can't believe that their ailment is psychological and requires psychological treatment
To quote from the article:
> “We detected a statistically significant central location in the nasal airway that swells in the CT scans of ENS patients, but not in any control patients,” Nayak says of the soon-to-be-published study.
> it can often resolve when the surgery is "fixed" (e.g., removing lap-bands)
If the ailment is exclusively psychological, then presumably you believe this would hold even for a sham surgical intervention. E.g. you tell/convince the patient it's been removed but it's still there, and they get better. Is that the case? Otherwise it sounds like a mixture of physical and psychological, and you are being overly reductive.
Let's just hope not to be in this situation too often ourselves. Being such a small statistical minority it's hard to believe they will ever receive any serious scientific backup.
Yes, it can teach us the most, but you can't get funding for studies that globally only impact 12 people. So no scientist who needs to put food on the table at the end of the month can focus on these cases.
Unrelated but I also gave up on fixing my problem: For the past ~8 years I have a constant feeling that one of my nostrils is almost closed and hard to breath. I went to several doctors, did all kinds of exams and they found nothing.
I feel like I need to blow my nose all the time and it drives me crazy sometimes. It gets worse when I have a flu. Sometimes it even bleeds a little, like it's irritated.
My family thinks I'm crazy so I stopped mentioning a long time ago, and one of the doctors even laughed at me.
An ear nose and throat doctor (otolaryngologist) should be able to inspect the opening quite well by sticking a scope in your nose (I recently had this done). One of the reasons I visited the doctor was a persistent feeling of fullness in one of my nostrils.
With a Face and Jaw CT they would be able to walk you through it all visually (ask how much it will cost up front though, it varies a lot).
I did, they said I have a slightly deviated septum, but that's common for most people and there's no need for surgery. And that I shouldn't even feel anything.
I also checked my lungs and everything was fine.
It might be related to a mental disorder or something. I have anxiety and maybe other stuff that I never bothered to fix.
> No one knows for sure why some turbinate reductions result in ENS and others don’t, but there are currently two prevailing theories. Houser’s theory argues that for ENS to occur, turbinate tissue must be removed or damaged, and then the sensory nerves in that area must regenerate poorly. Some methods of turbinate surgery can damage the nerve-rich mucosal layer more than others.
This sounds like the sensation people with acute bronchial spasms have. Maybe his issue was further down than his nose, so the sinus surgery gave him a more open feeling, but he still wasn't getting enough air. :-(
I feel like we have an article where a person is convinced they have a medical condition and no doctor will agree with them literally every week here. I'm not sure why it's interesting at this point.
And regardless of the physical situation, this guy most definitely had serious psychological problems.
because the medical system is poor, and many relate to it. In fact, I am personally going throug this right now. No doctor "agreed" with me, and I am currently programatically trying to aggregate my test data because it is frustrating. I, and many people, can relate to being dismissed by doctors or having the medical system fail them.
To be clear, for > 6 months and 4 appointments I was told I was fine. I finally think what I have was an auto-immune disease which was what the 2nd ER doctor I saw thought my symptoms were, and her tentative diagnosis. Obviously, she could only run preliinary tests because if she ran the confirmation panels...well...she would have to follow up with me and that isn't her job.
If a preliminary test shows something they're happy to run more tests. It's how they make money. ER is triage. If it's not something they can fix with a needle and a bag (or a needle and thread) rolling you in for expensive tests and specialist consultations is their entire business model. Your commentary doesn't make sense.
It seems partly related to a wider, ongoing wrestling match between those who want\need to approach things with an "and not or" view point versus those who arrogantly and/or ignorantly insist "something must be one thing and not another".
It's not hard to identify the paragraphs in this piece that an experienced, real news organization wouldn't publish. From the headline to the structure, I'm very uncomfortable with this type of material. When the comments to an article are filled with obvious attention-seeking nutjobs maybe that's a warning sign that you're not doing appropriate journalism, BuzzFeed. This isn't the type of "engagement" that Pulitzer rewards.
Do you have any pre-existing mental health conditions? The article makes it sound like there is a strong correlation between mental health issues and this syndrome.
