A doctor fights for his diagnosis
“Swimming Upstream: My Struggle and Triumph Over Cancer and Medical Establishment” is a story of a physician who struggled against the medical profession to reach a correct diagnosis and treatment. The struggle is not only against the mysterious disease but also against the patronizing and resistant physicians he encountered at every step in his uphill journey.
It is well known that the medical profession jealously guards its turf. It feels it alone has the right and privileges to make a diagnosis and prescribe treatment. Those doctors are right most of the time, butoccasionally they falter.
Sajjad Iqbal is a pediatrician from New Jersey who in 2000 noted a sudden pain in his left face accompanied by drooping of that side. There started a twoyear battle to make the correct diagnosis.
Most physicians told him he had Bell’s palsy or paralysis of the facial nerve. It is generally a selflimiting disease where the nerve completely recovers within a few months with no residual effects. Most specialists when making the diagnosis of Dr. Iqbal’s disease did not pay attention to what the patient had to say. And in this case thepatient had a lot to say.
Dr. Iqbal knew that the diagnosis of Bell’s palsy did not explain the pattern of facial paralysis but to no avail. It seems the patient knew more about the facial nerve and its branches than some of the experts. His hypothesis was that because only part of the facial nerve was paralyzed
and that the facial nerve after branching out passes through the parotid gland, there must be something in that gland that was causing the problem.
The parotid gland is a small plum-size collection of glandular tissue that secretes saliva and is located between the ear and the angle of the jaw. The facial nerve, after exiting from the skull, breaks into branches, and the branches traverse the gland and innervate muscles of the face. Dr. Iqbal correctly surmised that a small malignant growth in the gland had destroyed a branch of the facial nerve. The pattern of paralysis of his face fitted neatly withhis hypothesis.
However, the specialists were not convinced, and they pointed out that the CT scans of the gland were normal. But those scans were not ultra fine, and they had missed the pea-sized tumor in the gland. Finally, it was seen on special scans, and a biopsy was carried out. It turned out to be a very rare but highly virulent cancer of the parotid gland. By the time it was diagnosed, itwas beyond cure.
From his own account, Dr. Iqbal was not an easy patient to deal with. But he fought his way against the specialists and later against cancer specialists who were content to tell him that there were no effective drugs against his cancer, and they gave him two years to live.
But the man did not give up.He searched the literature, learned the behavior of cancers and found that even though the cancer that he had wasrather rare, he was able to find cross references and comparisons with other cancers, and he brought that information to the oncologists. When some would not accept his research, he switched doctors. There were oncologists who listened to him and bought into the idea of using drugs for his recurrent cancer even though they had no experience using them in this kind ofcancer. And they worked.
He has had some recurrences but is still coping and living with the cancer after 17 years. In itself it is a record survival.
Barry Schaitkin, a UPMC physician, was one of the few doctors who paid attention to Dr. Iqbal’s story and the details of his painstaking research. He also made the final diagnosis. In his foreword to the book Dr. Schaitkin, a professor of otolaryngology at the University of Pittsburgh School of Medicine, writes that Dr. Iqbal presented with an uncommon problem and was repeatedly given a common diagnosis. He believes Dr. Iqbal is clearly alive today because he took on the challengeof his disease.
“Swimming Upstream” is an easy read. Despite a few redundancies it is a fastpaced story interspersed with parts of the author’s early upbringing in rural Pakistan that made him a methodical and resolute physician. Those traits and a unique tenacity of purpose helped saved his life.
S. Amjad Hussain is an emeritus professor of surgery and humanities at the University of Toledo. He is an op-ed columnist for the Toledo Blade.