Cars move, I move. Cars have gas, I have gas. Therefor I am a car

So you’re really tired all the time? Yes and the sky is blue. You got a flat tire? Yes and I got a cold last week. Your hair is falling out? Yes and my thumb started to peel a few weeks ago. Are these connected or non-sequiturs? A more common example of a non-sequitur would be tress are tall, giraffes are tall, so all giraffes are purple with beige dots. The hairloss and the peeling thumb are what inspired this post today. Taking a break from antibiotics for today. 

The patient is a 64 year old female with diffuse hairloss over the last 6 months. New medications? No. Family history? Only her dad at age 85. New stress? Nope. New shampoo? Negative ghost rider. Any bad bouts of illness in the last year? Oh hell nah bro. Hmmm ok what could it be then. She did start to notice her thumb started to peel and the tip developed paresthesia. No burning, ulcerations, redness, not tender, grossly normal appearance. Hmmm times 2. 

Is this related to her hairloss? Hell if I know. Neither does the provider I work with. Long story short and not the point of this blog. There is a history of benign thyroid nodules and multiple surgeries to remove them. Did the thyroid get damaged enough to make her hair fall out but not enough to produce other symptoms? That’s my thought. In the same way thyroidectomies can nic the parathyroid and cause hypocalcemia. For my own benefit, the parathyroid stimulates osteoclasts to break down calcium in the bones in relation to hypocalcemia. Like a regulator. Take that away and there is no intrinsic method to prevent hypocalcemia. 

I digress. What was I on about? Yes. It doesn’t logically follow. Are there other common non-sequiturs we normally see? And how do we know? Do you trust that it really isn’t related? Another patient came in for a firm, mobile nodule on her chin. It had lived there for years and she was a healthy 60 something, no chronic health conditions. It’s a cyst right? Gotta be. Nope lymphoma. Damn, got that wrong. So did the thumb cause the hair to fall out? I doubt I’ll ever find out. But once the patient is in again I hope to be able to follow the case through. 

The moral of the story? Just because the complaint doesn’t follow the history or vise versa, doesn’t mean it ain’t the truth. I like this from the beginning of a 1969 paper in JAMA:

  

“A non sequitur is not always apparent. Although obvious in the syllogism, "birds sing, Smith sings, ergo Smith is a bird," it may escape notice in the plausible, "men sing, Smith sings, therefore Smith is a man." In similar fashion, plausibility often disguises a non sequitur in the interpretation of laboratory data. The conclusion that Smith is thyrotoxic may be correct, but if based solely on the finding of a high protein bound iodine value, it is a fallacy; nonthyrotoxic subjects who have ingested iodine or have received radiopaque iodinated dyes also manifest this characteristic. In fact, every false-negative or false-positive test is a non sequitur.”

Pancakes burn, a sunburn is a burn, I sunburn, I burn, therefore I am a pancake. Flawless. My dream comes true. 

References 

A medical non sequitur from JAMA Network March 24, 1969.

Anatomy Head and Neck, Parathyroid from the NIH National Library of Medicine by Ilahi et al. 2022. 

Non-sequitur by Wiley Miller.