It Had to Be More Than Just Stress

Why Else Was Her Tongue Burning?

Deborah Turner was afraid she had an illness that might kill her. (By John Russell -- Associated Press)

In the months before she wound up in the emergency room, Deborah Turner was so exhausted she sometimes had to drag herself up the office stairs clinging to the railing. How, she wondered, had things gotten so bad? Four years earlier she had walked a 26.2-mile marathon. Now she was so short of breath she sometimes had to lie down after brushing her teeth.

The clue to the cause of Turner's baffling symptoms lay in one of medicine's simplest tests, and the solution prescribed by the ER doctor who solved the mystery was straightforward: a $3 bottle of pills. Before that, though, Turner had endured months of misery and a growing sense of dread -- and she had received a potentially dangerous misdiagnosis from another doctor.

Then 48, Turner suspected that the episodic heavy feeling in her chest and her swollen ankles were the result of less than stellar health habits. A substantially overweight self-described workaholic, she spent long hours at two relatively low-paying jobs -- as a newspaper reporter in rural McKenzie, Tenn., and as a Web designer.

But she didn't think her lifestyle explained the other strange symptoms that had surfaced in the previous year: a burning sensation in her tongue, rapidly thinning hair and incessant feelings of restlessness in her legs when she tried to sleep.

Turner was certain she was suffering from congestive heart failure, a life-threatening condition of which swollen ankles and breathlessness are common symptoms. She kept her worries to herself. She didn't have health insurance or a regular doctor. Because she was rarely sick, she tended to wait until things got bad to seek treatment.

As a small-town reporter, she added, she felt compelled to project an upbeat persona so people would talk to her. But she was also terrified that one night she would go to sleep and never wake up -- and that her 4-year-old granddaughter, whom she saw frequently, would never remember her.

"Every time I saw her I told her I loved her and that she should never forget that," Turner recalled.

On June 14, 2005, Turner consulted a family practitioner. Turner said he ordered some blood tests, but not a complete blood count (CBC), once a staple of annual physicals that can detect a broad range of disorders.

"He told me it was possible my iron was low," Turner recalled. But what the doctor focused on was her emotional state.

The doctor told her the symptoms were probably stress-related, and he handed her a prescription for a popular drug to treat what he thought was the underlying cause of her symptoms: anxiety.

Turner didn't bother to fill the prescription. "I was anxious because I thought I was going to die," she recalled. "I felt that anxiety was warranted."

Seven weeks later, back at her desk after a late lunch, Turner said her chest felt so heavy she worried she was having a heart attack. She slipped out of the office and drove herself to the emergency room of McKenzie Regional Hospital.

Records show she was admitted at 3:30 p.m. and promptly seen by the doctor on duty, Will D. Foston, a former surgeon.

Foston said his first thought was that the ankle swelling, chest pressure and Turner's weight pointed to a cardiac cause. She seemed depressed, he recalled, but that wouldn't have caused her symptoms. Foston ordered a battery of tests including a CBC, a chest X-ray to detect pneumonia or an enlarged heart, and an electrocardiogram, which can chart disturbances in heart rhythm.

The EKG and chest X-ray were normal. The CBC definitely was not. It showed that Turner's hemoglobin, the oxygen-carrying protein in red blood cells; her hematocrit, the concentration of red blood cells; and several measurements involving iron were much too low.

All pointed to one diagnosis: anemia.

Turner's baffling symptoms -- including the burning tongue, restless legs, exhaustion, thinning hair and intermittent heaviness in the chest -- are seen in people with long-term anemia. If the disorder is severe, protracted and untreated, it can cause life-threatening problems such as heart failure or organ damage, according to the National Heart, Lung, and Blood Institute.

Anemia made sense to Turner. Low iron levels had prevented her from donating blood in the past, she said. She avoided taking vitamins or pills containing iron because she had read the mineral was bad for adults' hearts.

His next task, Foston said, was to figure out why Turner was anemic. Was she bleeding internally from an ulcer? Did she have colon cancer? Was her diet badly deficient in iron? Had she taken too much aspirin or another medication that can cause internal bleeding?

After a quick test found no blood in her stool, Foston asked Turner about her periods. Turner told him they were extremely heavy. Heavy menstrual bleeding is a cause of iron deficiency anemia.

Foston said he discharged Turner with a prescription for iron pills; Turner said the bottle she bought cost $3. Subsequent tests showed definitively that she had iron deficiency anemia.

"It's not something you see every week," said Foston, adding that he has diagnosed several cases.

Less than two hours after she arrived in the ER, Turner was on her way home, hospital records show.

Turner said she immediately began taking the iron supplements. Within a month she was walking easily up the office stairs. The burning tongue and restless legs vanished. Her hair grew back.

"I can't help but think that had I bought the [first doctor's] diagnosis, I might have taken that prescription and felt no anxiety as I waited for my demise," she said. ·

If you have a medical mystery that's been solved, e-mail us atmedicalmysteries@washpost.com.