Chapter 2: Discussion and Summary

[Rebecca]

Chapter 2: The Horowitz Sixteen-Point Differential Diagnostic Map


Chapter 2 Discussion Questions:
1. Did you find any new potential medical conditions linked to your symptoms when looking at the Horowitz Sixteen-Point Differential Map?

2. Dr. Horowitz states that having Lyme by itself is rare. It is more likely for a patient to have overlapping and interconnected conditions responsible for symptoms. Have you found this to be true?

Summary:
• “Most chronic illnesses are the result of complex, multifactorial processes, and therefore require dissecting each illness piece by piece into its component parts.” Dr. Horowitz uses the MSIDS questionnaire, which can be found in chapter 1 to identify a patient’s list of symptoms.

• Instead of seeing chronic disease as a set of symptoms attached to one specific disease, the medical model needs to shift towards the idea that “there may be many interconnected and overlapping illnesses responsible for the chronic symptoms.”

• The CDC, IDSA and ILADS all have their own opinion on the treatment and diagnosis of Lyme disease leading to confusion among medical providers. The IDSA’s narrow guidelines are based on the CDC’s surveillance definition that is primarily used for epidemiological purposes. The CDC’s website states, “This surveillance case definition was developed for national reporting . . . it is not intended to be used in clinical diagnosis.” The CDC even points out there are problems with testing, “and a patient with Lyme disease may not be diagnosed using these criteria.” Taking a much different approach the IDSLA moves away from the laboratory diagnostic model and looks for a clinical diagnosis where lab reports are only there to support the clinical diagnosis.

• The Horowitz Sixteen-Point Differential Diagnostic Map can be found on pages 67-80. The chart looks at symptoms, possible related medical conditions, and laboratory testing to consider. Dr. Horowitz uses the MSIDS questionnaire of patient symptoms’ in conjunction with this diagnostic map to determine possible illnesses.

• We end the chapter returning to Mrs. Q and how Dr. Horowitz decides what tests to order to validate his hypothesis based on the diagnostic map findings

[[deleted user]]

I think that the 16 point differential is genius! If more doctors would take this idea and run with it more people suffering with long debilitating chronic illness could find wellness. Excellent!

[Vicki]

Me too! So helpful! Ugh, I didn't manage to finish Chapters 3 but am getting there. Brain fog.