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"Wastebasket - trashcan diagnosis" terminology and meaning


Barbarannamated
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I've used the term "trashcan diagnosis" and "wastebasket diagnosis" several times on the forum. I realize that my use has been interpreted negatively, as if negating or minimizing distress. That is the polar opposite of my intention. CHRONIC PAIN, regardless of the etiology - known or not - is VERY REAL!! It derails lives and careers, ruins families.

 

I realize that "trashcan" and "wastebasket" are poor terms to convey the concept. It is not that the symptoms should be disregarded or thrown away as insignificant; they should be investigated FURTHER and not thrown into a CATCH-ALL diagnosis when no underlying pathology can be proven through labs, radiology, or electrophysiology testing.

 

Pain - depression - fatigue were always a tangled mess for me, especially after beginning treatment for both pain and depression. The pain was often attributed to depression, even though I had a defined injury. Classic case of blaming the patient. "Depression hurts" - you know the commercial. I will never forget the expression on my treating physician's face when he learned that I had been diagnosed with autoimmune thyroiditis AFTER the pain was attributed to Work Comp injury. He KNEW that the thyroid and autoimmune disease could both account for the pain, at least in part.

 

Fibromyalgia, myofascial pain syndrome, chronic fatigue, irritable bowel, multiple chemical sensitivty are just a few "diagnoses of exclusion" that have no laboratory, radiology, or electrophysiology (EMG, for example) tests to provide a DEFINITIVE DIAGNOSIS.

 

Lymes disease, Epstein Barr, vitamin and mineral deficiencies and endocrine disorders all present with fatigue, low energy, low mood and similar symptoms to FMS, MPS, CFS, depression. The widespread, chronic pain waxes and wanes and is VERY DEBILITATING

.

"Wastebasket/trashcan diagnosis" does not mean that the symptoms and distress are invalid. They are REAL, INTENSE, VALID, REPRODUCIBLE, but have baffled researchers because they cannot find an underlying cause. Various sources say fibromyalgia may be a rheumatologic, musculoskeletal, connective tissue, neuroendocrine, nutritional, genetic, autoimmune, environmental and/or psychological disorder. The symptoms are so confusing and when physicians are unable to pinpoint an underlying cause, the symptoms are thrown into the FMS -MPS - CFS - depression "wastebasket" and a cause is no longer sought.

 

Additionally, once this diagnosis is in place, any of the cluster of symptoms is attributed to the diagnosis (thrown in the wastebasket also). This is extremely dangerous as it allows underlying pathology to progress. It is also very disempowering.

 

Excerpt from

FMS CFS FRIENDS INTERNATIONAL

http://www.fms-cfsfriends.com/info3.html

 

"Fibromyalgia has also been called a 'wastebasket' diagnosis, usually meaning that the doctor doesn't acknowledge real PATHOLOGY or consistent disease. Some doctors and medical researches don't believe that people don't "just have" Fibromyalgia. They suspect that other diseases like for instance Lyme disease or spine problems are undiagnosed and mistaken for Fibromyalgia or other syndromes like Myofascial syndrome. They suspect multiple diseases might be captured with the label Fibromyalgia. Also some believe every case of Fibromyalgia has a cause, like whiplash, Arnold Chiari or cervical stenosis, Lyme disease, Mycoplasma or viral infections, chronic Epstein Barr mono, lupus or rheumatoid arthritis. Join our ongoing discussions in our support group.

 

More dangerous still is that the Fibromyalgia diagnosis gives a label for insurance billing that allows doctors to now explain away huge varieties of symptoms. This has only been lately acknowledged to be very dangerous to the Fibromyalgia patient. According to a report in the British Medical Journal, Feb. 2002, FMS patients die more often from cancer probably because their doctors don't listen to them when they complain of their initial symptoms and the diagnosis is often made too late.

*The FMS DIAGNOSIS CAN BE USED AN EXCUSE FOR DOCTORS NOT TO THINK."

 

The more I research, I realize that MANY diagnoses fit this definition. Very seldom are underlying causes established and treated, the symptoms are treated.

 

Please know that I never dismiss or minimize anyone's distress and pain even though I may disagree with the terminology or semantics.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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I've used the term "trashcan diagnosis" and "wastebasket diagnosis" several times on the forum. I realize that my use has been interpreted negatively, as if negating or minimizing distress. That is the polar opposite of my intention. CHRONIC PAIN, regardless of the etiology - known or not - is VERY REAL!! It derails lives and careers, ruins families.

 

I realize that "trashcan" and "wastebasket" are poor terms to convey the concept. It is not that the symptoms should be disregarded or thrown away as insignificant; they should be investigated FURTHER and not thrown into a CATCH-ALL diagnosis when no underlying pathology can be proven through labs, radiology, or electrophysiology testing.

 

Pain - depression - fatigue were always a tangled mess for me, especially after beginning treatment for both pain and depression. The pain was often attributed to depression, even though I had a defined injury. Classic case of blaming the patient. "Depression hurts" - you know the commercial. I will never forget the expression on my treating physician's face when he learned that I had been diagnosed with autoimmune thyroiditis AFTER the pain was attributed to Work Comp injury. He KNEW that the thyroid and autoimmune disease could both account for the pain, at least in part.

 

Fibromyalgia, myofascial pain syndrome, chronic fatigue, irritable bowel, multiple chemical sensitivty are just a few "diagnoses of exclusion" that have no laboratory, radiology, or electrophysiology (EMG, for example) tests to provide a DEFINITIVE DIAGNOSIS.

 

Lymes disease, Epstein Barr, vitamin and mineral deficiencies and endocrine disorders all present with fatigue, low energy, low mood and similar symptoms to FMS, MPS, CFS, depression. The widespread, chronic pain waxes and wanes and is VERY DEBILITATING

.

"Wastebasket/trashcan diagnosis" does not mean that the symptoms and distress are invalid. They are REAL, INTENSE, VALID, REPRODUCIBLE, but have baffled researchers because they cannot find an underlying cause. Various sources say fibromyalgia may be a rheumatologic, musculoskeletal, connective tissue, neuroendocrine, nutritional, genetic, autoimmune, environmental and/or psychological disorder. The symptoms are so confusing and when physicians are unable to pinpoint an underlying cause, the symptoms are thrown into the FMS -MPS - CFS - depression "wastebasket" and a cause is no longer sought.

 

Additionally, once this diagnosis is in place, any of the cluster of symptoms is attributed to the diagnosis (thrown in the wastebasket also). This is extremely dangerous as it allows underlying pathology to progress. It is also very disempowering. The exempt expresses my thoughts:

 

FMS CFS FRIENDS INTERNATIONAL

http://www.fms-cfsfriends.com/info3.html

"Fibromyalgia has also been called a 'wastebasket' diagnosis, usually meaning that the doctor doesn't acknowledge real PATHOLOGY or consistent disease. Some doctors and medical researches don't believe that people don't "just have" Fibromyalgia. They suspect that other diseases like for instance Lyme disease or spine problems are undiagnosed and mistaken for Fibromyalgia or other syndromes like Myofascial syndrome. They suspect multiple diseases might be captured with the label Fibromyalgia. Also some believe every case of Fibromyalgia has a cause, like whiplash, Arnold Chiari or cervical stenosis, Lyme disease, Mycoplasma or viral infections, chronic Epstein Barr mono, lupus or rheumatoid arthritis. Join our ongoing discussions in our support group.

 

More dangerous still is that the Fibromyalgia diagnosis gives a label for insurance billing that allows doctors to now explain away huge varieties of symptoms. This has only been lately acknowledged to be very dangerous to the Fibromyalgia patient. According to a report in the British Medical Journal, Feb. 2002, FMS patients die more often from cancer probably because their doctors don't listen to them when they complain of their initial symptoms and the diagnosis is often made too late.

*The FMS DIAGNOSIS CAN BE USED AN EXCUSE FOR DOCTORS NOT TO THINK."

 

The more I research, I realize that MANY diagnoses fit this definition. Very seldom are underlying causes established and treated, the symptoms are treated.

 

Please know that I never dismiss or minimize anyone's distress and pain even though I may disagree with the terminology or semantics.

 

I know of a former professor of low brass and composition who used live here in central pa, where it took the hospital of the university of Pennsylvania 9 YEARS to determine that he and his wife suffer from Lyme disease. They used to hike and camp on the appalachian trail during the summer. This neck of the woods, particularly Adams county (Gettysburg area) is a hotbed for Lyme, which is spread by deer ticks. They now live in Arizona.

History:

1995--Prozac--Quit CT by GP

1995--Effexor--Quit per my GP

1996--Amitriphene--Quit CT when changed GP

2005--Citalopram and BusPar. Prescribed when I decompensated in my GP's office. GP referred me to behavior health. Psychiatrist prescibed these drugs. Taken off citalopram in 2011 due to FDA warning. Quit Buspar during transition to viibryd.

Viibryd--2011 to present. Had a severe reaction in March 2012. Advised both GP and Psychiatrist I was trying to get off these drugs.

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Please know that I never dismiss or minimize anyone's distress and pain even though I may disagree with the terminology or semantics.

 

EEEEkk..Barb I don't!!!!! I sent you a PM. Please not to take what I say to the bank just now.. I'm not as nuanced as usual.. and was in no way thinking you thought that. OUCH! Barb, I sent you a 'PM'.~S

As always, LISTEN TO YOUR BODY! A proud supporter of the 10% (or slower) rule.

 

Requip - 3/16 ZERO  Total time on 25 years.

 

Lyrica: 8/15 ZERO Total time on 7 or 8 yrs.

BENZO FREE 10/13 (started tapering 7/10)  Total time on 25 years.

 

Read my intro thread here, and check the about me section.  "No matter how cynical you get, it's almost impossible to keep up." Lily Tomlin

 

 

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Your post did prompt me to address this, but it seems to be very common topic and misinterpretation among patients who hear they have a "rashcan diagnosis". Wanted to clarify for all.

I don't want MY FRIENDS thrown into trashcan!

 

Hugs!

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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