1. Signs are what a doctor sees, symptoms are what a patient experiences.
2. While signs are the physical manifestation of injury, illness or disease, symptoms can be described as what a patient experience about the injury, illness or disease.
3. Signs are objective. Symptoms on the other hand are subjective
Lester S. King, author of Medical Thinking, argues that an "essential feature" of a sign is that there is both a sign [or "signifier"] and a "thing signified". And, because "the essence of a sign is to convey information", it can only be a sign, properly speaking, if it has meaning. Therefore, "a sign ceases to be a sign when you cannot read it".
So the patient says "I have a tremor." or "My hands shake." It is a symptom. The doctor has the patient touch their nose and their hand shakes, and the doctor says "You have a cerebellar tremor." That is a medical sign.
The sad thing is, as you have said before..; Some docs. need a slap upside the head by Captain Obvious.!!! LOL
I have had clinical signs showing, hyperreflexia, tremor and optic nerve paleness during the eye part of the exam.
my symptoms I have complained about are slurred speech, buzzing, nystagmus,spasticity dizziness for 8 months and forgetfulness.
I never know what to think as far as how to present my "issues" to the doc. but I know I have made some sort of a light bulb go off with a few of my docs. maybe when I see my regular neuro in a couple of weeks, his light bulb will go off too and have an answer.
Its too bad all of my doctors aren't seeing me at the same time... because i have had my eye muscle doc. notice the nystagmus, my family doc. and endo. hear my slurring and all of them have stood back when testing the reflexes!!
My tremor is definately not little hand shakes, My thyroid disease causes that,, this tremor is only on the left side and of course I am left handed but it is crazy to watch; I talk with my hands alot, and the look on my friends and family's faces are like wow, have you had that checked out by the doc. I say yep,, no answers..
I know that this is something my doc. has to dx. but its so nice to hear from other people their experience or input on this matter
A patient explains their sx, doc tests and reproduces sx so therefore sx no long subjective but objective clinical signs. Makes perfect sense until you see the doc that doesn't belive the clinical signs they themselves have produced, not because they dont exist but because of their inept medical knowledge, therefore they can't read the clinical signs so therefore they dont exist. Am I in a fishbowl?
Therefore, "a sign ceases to be a sign when you cannot read it".
Isn't that justifying medical incompetance?
hmmm forgive my ignorance but my brain is working very slow today!
It's not hard for me to understand what Bob is saying. My chief complaint was lower back pain. For nine years I ran from doctor to doctor trying to find an answer. There were no "signs" that a doctor could see. There was no arthritis. There was no damage to my disks. There was no damage to muscles. So it is easy to see why a doctor could find no reason for my pain. They ran tests available to them. The last thing on their mind would be MS. Lower back pain just is not a " sign" of MS.
I don't think Bob is saying that the doctor should not treat the symptoms. He is just stating that there would be no sign for a dx. Even my first neuro treated my symptoms without a clinical sign. I won't go into how he should have gone further as the strength in my body declined. He never gave me a real neurological exam. Therefore he missed the signs.
It would be nice if we could sue these neurologist for malpractice. However, they are so protected with the excuse that MS is hard to diagnose. It just wouldn't be worth the time or effort.
I think this all depends on the situation. In Sumanadevii's case I can understand that the dr couldn't see it as a sign of ms, this happened to me as well with my back pain. But as supermum_ms said, sometimes they are too incompetent to see the sx as a sign of anything, or in my view, some are just happy to have you come back over and over to collect the pay for each visit. If everyone were healthy, they'd be out of a job!
What bothers me is the fact that you give a list of sx, but the dr doesn't see them as anything. Lets put it this way, in 4 yrs with almost every ms sx in the book, I had to ask my dr to be referred to an arthritis specialist, and yell at him to be referred to a neurologist. And that's all that was done, no offer of anything to treat my sx, with no suggestions from him in any way other than restless leg syndrome and meds for that. And why then a dx of RLS? I had no "signs" of that! The arthritis specialist I saw dx fibromialga without out any tests or signs.
My new dr, without any file to look at and no physical examination, figured things out in a 30 min conversation, either ms or brain tumor! He said that the minute I told my ex-dr about my arm being numb, he should have known there was something wrong in my brain and sent me for an mri. He sent me for the mri which confirmed what he thought. In this case there were no signs for him to observe, just a list of sx, which led to an mri showing lesions. It's still not a dx but on the way to one at least and I got some relief from the meds he put me on. So is he a genius? Or did he just pay attention and believe me?
Basically what I'm saying is that if he had gone by "signs" I still may not know about my lesions. I believe that signs are not what dx should be based on either, since dr's don't always see things the same way. And if you don't see your neuro for 5 months, do you think he's going to remember how strong you were the last time? No, that's the problem.
Some things are dx just by symptoms and without any "signs", like angina. A heart can beat normally, and show no signs of abnormality, but based on the pain, chest tightness etc. described, a dx is made finding no other reason for it. So why is it so hard for a neuro to dx ms after everything els is ruled out?
You make some good points actually, and you've made me wonder about early MS because arn't the sx usually more often sensory (invisible) before a person gets to the stage of having objective (visible) clinical signs? Isn't the theories on sx going to make it almost impossible for MSers to get dx early in the disease process, waiting until sx are clinical means from my perspective that you now have to live with disability.
btw my brother in law had heart attack sx, all tests came out normal, the day after his specialist cleared him he had a major heart attack. Cardiologists here now use his experience as an example of when test results lie but the sx dont.
My examples of related subjective vs objective clinical signs, btw i'm an athlete maybe now in mind only though i'm still trying lol:
sx 1 falling over and off balance: neuro tests & reproduces sx => clinical objective sign.
sx 2 left leg repeditive bouncing when foot arched in walking: neuro tests & reproduces ankle clonus on left side only => clinical objective sign
sx 3 muscle spasms: neuro tests & reproduces rippling reactive spasms on left side only => clinical objective sign
sx 4 Identified highly gifted with notable cognitve changes (ie lost nouns, memory): neuro psych eval identifies 30-45 loss of IQ, 2 areas notibly below average (information, recall) => clinical objective sign
sx 5 talk-a-holic with verbal communication problems: testing reproduces word recall issues & the slowing down of verbal communication, slurring and occasional stutter => clinical objective sign
sx 6 left side rib spasms with pain: dx intercostal muscle spasm of no known origin => clincal objective sign of MS Hug imho
I have 'subjective' sx too, weakness, though tested 8 hours after admittance and although observable no objective clinical sign evident => no clinical sign. Tremor sx isn't subjective anymore, but when I first brought it up it wasn't even observable, when i started stabbing my self in the face with my fork and throwing knives across the room, it was lol not reproduced on the one and only nose to finger test => no clinical sign.
There are signs and there are SIGNS still doesn't guarantee a dx though!
I was only having sensory symptoms when I was diagnosed. There were signs from the VEP and MRI. I had a negative LP. Buzzing feet and burning pain down the left arm with a normal EMG/NCS. No weakness, no hyperrefexia, no bladder issues, no hug, no tremors.
Even with one lesion, the neuro-ophthalmologist said we had to keep track of this and rule out MS. It was the only diagnosis that they really had in mind. Watch and wait for six monthsThen the TN and more lesions on the second MRI. Still had pretty normal neuro exam. That was enough for an MS center to say RRMS and start me on Copaxone.
With the last relapse, the neuro started to find weakness on my right side and spasticity in my legs and feet. Good for the doctors, but I'd be quite happy if it went back to being a "sensory" (and subjective) problem.
LOL,I hope you didn't hurt yourself when you were stabbing your face with your fork!! I am sorry I was lauughing, but I was imagining it, and the throwing the knives across the room, lol, hopefully no one was around.. lmao
Anyway, its amazing this whole process on what the doc.s say as far as what they do see. Honestly, any doc. that I have seen and my reflexes are soooo crazy high with the other leg flying up after the knee reflex test is done, they do not say anything. Why is that?
Not one of my neuros have ever said to me, hey thats a sign of ms. Nope nothing.
As far as my finger to nose test, my family doc, feels I am progressing ( she didn't say from what) but the new neuro I saw said something about central sensitazion sp.??
These doc.s definately are scared to say anything to me because my MRI's are not showing anything but I am showing all of these "Clinical" signs. I don't get it.
Maybe I should travel to see your doc. LOL He seems to see it alot quicker than these NY docs.
Its so so easy to laugh at my self, hmmm maybe too easy lol i look like a 'drunk' string puppet when I walk (not all the time now fewww). I was giggling like a nut on spped hmmm apparently thats another clinical sign lol I was laughing at anything, with so many bizar things going on, I just couldn't stop.
LOL I think falling off my chair during dinner was even funnier, i lifted my fork, my arm did the jerk and I just kept on going. Everyone, including me froze for a minute in shock, well everyone except our youngest who had spontaneously burst out laughing, which then set me off, great dinner party after that, an ice breaker ROFL!
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