She went undiagnosed until almost too late | Medical Mystery

For weeks, Ann Malik hadn’t felt like herself but couldn’t pinpoint what was wrong. Other than a history of mild asthma that didn’t require medication, the 39-year-old had been healthy. So when her family physician attributed her malaise and fatigue to mild anemia, Malik felt relieved by the explanation and expected to feel better.“I felt anxious and overwhelmed,” recalled Malik, who lives in Barrington, R.I.

A major reason: Malik is in the vanguard of a group of patients who didn’t fit the profile for their disease. Her symptoms and, she later learned, the interpretation of her imaging tests had been attributed to illnesses that are more common. Her primary care doctor administered a depression screen — a list of questions designed to unearth the problem. Malik said she “flunked.”all in my head,'" she recalled. Around March, at her doctor's suggestion, she began taking an antidepressant. She also started walking for exercise and practicing yoga, hoping the combination of medication and physical activity would boost her mood.

Hoping for more actionable advice, Malik turned to an alternative medicine practitioner. She diagnosed “adrenal fatigue,” which is not an accepted medical diagnosis but rather a collection of symptoms including fatigue, anxiety, and insomnia. “My husband said, ‘This is not normal,’” Malik recalled. The couple pushed for additional testing. The ER doctor told them that if they were concerned, Malik could consult a lung specialist.

She remembers that the pulmonologist, who called her with the news in early September, tried to be reassuring. “I remember him saying, ‘Hopefully, we caught it early.’ And I remember thinking, ‘Nope.’ I’d been sick for a long time.” She flashed back to the unexplained fullness in her abdomen. Now she knew what it was.

At the hospital, doctors determined that Malik had suffered a stroke. The Stage 4 lung cancer had spread to her left lung, liver, spine, and hip bones and had invaded her brain, causing the stroke. “It was everywhere,” Malik said.Doctors decided Malik needed to begin chemotherapy right away.

“Ann is not so uncommon,” said Piotrowska, now an assistant professor at Harvard Medical School. Despite increasing awareness of lung cancer among nonsmokers, “unfortunately it’s common to see at Stage 4,” she noted. Lung cancer in its early stages causes few symptoms. And in female nonsmokers, particularly young women, symptoms tend to be attributed to other ailments.

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