Should you be afraid of vegetative dystonia?

2024 Author: Malcolm Clapton | [email protected]. Last modified: 2023-12-17 03:44

How to live with a diagnosis that does not exist, Lifehacker asked Nikita Zhukov, a neurologist and author of books on evidence-based medicine.

Vegetovascular dystonia, or VSD for short, is a special diagnosis that doctors of the old school love and do not like very much doctors who read modern literature and know what evidence-based medicine is.

And all because there is no such diagnosis: it is absent in the International Classification of Diseases. Meanwhile, he flaunts on the cards constantly, there are whole groups, forums and sites dedicated to the treatment of VSD.

Where does dystonia come from?

The autonomic nervous system is the part of the nerve cells that is responsible for the functioning of the internal organs. Simplifying, we can say that this is the part of the system, the activity of which we do not influence. The autonomic nervous system controls heart rate, digestion, and blood pressure. Dystonia, in theory, means that something went wrong in this system.

Patients experience specific, albeit completely different symptoms. Someone complains of a fast pulse and trembling hands. Someone has dizziness, chest pains. Patients suffer from fatigue or insomnia, and sometimes both. Sometimes stomach pains and much more are added to the bouquet. At the same time, neither cardiologists nor gastroenterologists see any abnormalities, and neurologists also do not see. This is how the VSD appears.

Patients don't pretend, they actually have problems. Only all these symptoms, both together and separately, arise not because of vegetative dystonia, but because of other diseases that remain undiagnosed. Often they need to be treated not by a neurologist, but by a psychotherapist - these are neuroses, panic attacks and anxiety disorders.

What to do when diagnosed with VSD

Writing about vegetative-vascular dystonia with evidence is a thankless task, because, as you might guess, since there is no such diagnosis, there have been no studies on this topic that would meet the requirements of evidence-based medicine.

Now, if some The Lancet published an article on how a nonexistent diagnosis affects the health of the population in Russia! But until this happened, we asked neurologist Nikita Zhukov what to do if your diagnosis is vegetative-vascular dystonia.

Nikita, I am one of those patients who had the inscription VSD on the card. I don't even know what exactly I was diagnosed for. Why is this possible?

- Because it is the main diagnostic garbage dump of all Russian medicine: VSD can be exposed to any patient with almost any complaints. Therefore, it is not surprising that you do not even know why you were given it, this is a common thing. Most likely, the doctor himself does not know either. There is an unspoken rule: if you don’t know what diagnosis to diagnose, expose the VSD.

I come to the doctor with complaints, he says that I have VSD. I know that this cannot be. What should I do? What doctors, besides a neurologist, should you contact?

- Well, there are two options.

1. Aggressive: Try to make the doctor feel like an idiot and learn something. You need a good knowledge of the issue, journalistic impudence and a desire to change the world for the better (as you can see, not a word about healing).
2. To look for a neurologist who does not put the VSD, in 2017 there are already enough of them. We are directly promoting ourselves: "No VSD, homeopathy and physiotherapy!" You can try to go directly to a psychotherapist, but with them everything is even worse than with neurologists.

Is there a movement towards evidence-based medicine? Roughly speaking, if I say: "Doctor, I do not believe in VSD, I can not prescribe nootropics", will the doctor be able to understand this position? What's the chance?

- Of course, not everything is so hopeless! There is OSDM.org, a bunch of popularizers (like me, kek), a Cochrane branch is opening in Kazan, large private clinics began to understand that evidence-based medicine is good, and even the Ministry of Health has made evidence-based guides (there, of course, there is umifenovir, better known as "Arbidol", but there is also a lot of reasonable).

I come to the clinic, leave a lot of money for examinations, waste time, and then the doctor writes that I have VSD. What questions to ask at the beginning of the appointment so that this does not happen?

- The key word here is questions. You must ask questions about all the actions of the doctor, and a competent specialist must clearly answer them. I must! Is the examination exactly necessary? Is it possible to do without it and what will happen then? What does the doctor want to see in him? And if he doesn't see?

What to do right now for those people who have been treating VSD for many years? Could it be that because of this, another disease progresses?

- Theoretically, yes, but I have not come across this and I think that this is unlikely: trainee patients with VSD have all possible examinations several times, which practically excludes the possibility of missing any serious condition.

A person is treated for a long time from VSD, and it helps him. Is it just a placebo effect?

- Yes, if this is a typical "VSD treatment", because it basically implies therapy with fuflomycins, which have one effect - a placebo.

No, if the doctor prescribes some sane drugs (in such cases, these are usually antidepressants), but does not change the diagnosis for any reason, because the patients themselves often adore the VSD, cherish these three letters and will never give them up.

Suppose a neurologist writes SVD (somatoform autonomic dysfunction, F45.3) instead of VSD, but treats it ineffectively. What appointments show that it's time to change your doctor?

- Diagnosis F45.3 is one of the most suitable, modern and correct replacements for the VSD. But here you need to pay attention to the letter F: this is a psychiatric diagnosis. Accordingly, if along with it you are not given antidepressants or anti-anxiety drugs, then either the doctor is a fool, or one of the two.

The only way out is to look for another doctor? Does the patient have no other way to somehow influence the situation?

- You will never prove to a doctor that he is wrong if you are not a doctor, which, however, is typical for any other specialty. I think it is worth going the other way and using the benefits of the information age: collect and leave reviews on doctors, look for word of mouth and some registers "Doctors without VSD". A lot of patients come to me who say so from the doorway: "I came to you, because I have been diagnosed with VSD for ten years, but they say about you that you do not do it."

If you need to learn more about diagnoses that do not exist, and learn how to distinguish proven medicine from shamanism, we recommend Nikita Zhukov's books on the most enduring medical delusions and myths.