22 11.14.21 Photo illustrations by Ina Jang
Diagnosis By Lisa Sanders, M.D.
It started with the broken rib. Or at
least that’s what made the 36-year-old
physician consider the possibility that
something was really wrong with her,
she explained to Dr. James D. Katz, the
rheumatologist her friends at work rec-
ommended. Right after the birth of her
daughter 18 months earlier, she devel-
oped a cough. At fi rst it was mostly when
she exercised, but she still managed to
complete a half marathon before her
daughter was 6 months old. Her time
wasn’t as good as it was in earlier races,
but she was still pleased. After the race,
though, the cough got worse. She would
get these violent paroxysms so forceful
that her ribs, especially the ones on the
right, started to ache. It hurt to pick up
her baby. It hurt to breathe. And it was
excruciating to cough.
After a few months, when the cough
persisted, she went to her doctor. He
ordered an X-ray, which found what
looked like a pneumonia. Because the
cough had lasted too long to be a pneu-
monia, a CT scan was done the same day.
The scan clearly showed a cracked rib.
She was prescribed prednisone, then
antibiotics. Her lungs fi nally cleared up.
The cough, however, remained. She was
given a diagnosis of asthma and started
on a bunch of inhalers and a high dose of
prednisone. She felt better immediately.
It didn’t take long to fi gure out that the
benefi t wasn’t from the inhalers; the pred-
nisone was miraculous. And she’d been
taking it — a lot of it — ever since. She
knew it was too much, and yet when she
was caring for patients in the intensive-
care unit — something she did four or fi ve
months a year — she needed that high
dose just to keep up with her life.
The medication eliminated the cough,
and that was a blessing. But it did so much
more. She had pain and stiff ness in her
joints that had been there so long she’d
started to consider it normal. She fi gured
this was just how her adult body felt. But
with the prednisone, the pain and terri-
ble stiff ness disappeared. She was a phy-
sician; she knew that taking prednisone
like this would hurt her. It could give her
glaucoma, diabetes, osteoporosis and
high blood pressure. But whenever she
tapered the steroids, the pain, stiff ness —
and cough — all came roaring back. Right
now, she told herself, taking that drug was
the only way she could feel normal. That’s
why she fi nally decided to see Katz.Her persistent cough cracked a rib,
and her body ached all the time.
Then a doctor asked two strange
questions that revealed why.