Vegetovascular dystonia (VSD) is a very common diagnosis.

In Soviet times, it was diagnosed in 70% of patients who sought medical help. And now in the CIS countries every third patient is faced with this diagnosis. But what is surprising is that the term VSD does not appear at all in Western literature and is absent in the international classification of diseases.

What is hidden under this name and what to do if you have been diagnosed with VSD?

Modern view of the disease

The term vegetative-vascular dystonia was proposed by N.N. Savitsky in the late 50s of the twentieth century. In those days, during medical examinations of conscripts, doctors increasingly found people with heart pain and fluctuations in blood pressure.

A new diagnosis was introduced to distinguish these pathologies from coronary heart disease and hypertension.

Although the concept is outdated, it is still widely used by doctors in post-Soviet countries.

In parallel, to reflect the same condition, the diagnoses NCD (neurocirculatory dystonia) and SDS (somatoform autonomic dysfunction) are used.

Considering that none of these diagnoses are in the international classification of diseases, a terrible confusion is created, leading everyone to confusion.

For doctors, such syndromic diagnoses are convenient from the point of view of minimal time spent searching for specific causes. On the other hand, the “vagueness” of the diagnosis and the unclear origin of the disease complicates the choice of treatment.

To understand where VSD comes from, let’s remember the structure of the nervous system. It is divided into two sections:

1. central (brain and spinal cord;
2. peripheral (nerves).

In turn, the peripheral nervous system is divided into somatic and autonomic. The latter innervates internal organs, blood and lymphatic vessels and is responsible for processes uncontrolled by consciousness.

When malfunctions occur in the functioning of the autonomic nervous system, various unpleasant symptoms appear:

• Dizziness;
• difficulty breathing;
• indigestion;
• fluctuations in blood pressure;
• weakness, muscle pain;
• sleep disorders.

The complex of these symptoms is referred to as VSD.

The peculiarity of the disease is that a person complains of pain in a healthy organ due to disruption of the nervous system.

The cause of the disease is neurosis - a psychogenic reversible disorder. Fears and worries are forced out of the mental sphere into the physical, causing the patient not mental, but real pain.

VSD from the point of view of psychiatry

Psychiatrists, as a rule, do not recognize the diagnosis of VSD. They prefer to understand the root cause of the syndrome and usually find the following problems in patients with vegetative-vascular dystonia:

• Reaction to stress. During the period of adaptation to a stress factor, anxiety, helplessness, depression, and depressive mood are observed.
• Phobias. Irrational fears of certain situations or objects.
• Neurasthenia. Manifests itself in increased fatigue, irritability, and inability to concentrate. Occurs, as a rule, with a combination of mental trauma and hard work, physical exhaustion of the body.
• Depression. Characterized by pessimistic thinking, low self-esteem, loss of interest in life, a sense of worthlessness, and loss of strength.
• . It is characterized by a state of persistent anxiety, not related to specific circumstances, often accompanied by muscle tension, trembling, rapid heartbeat, dizziness and sweating. Associated with prolonged exposure to a stressful environment.
• . The symptoms are the same as those of an anxiety disorder, but in the case of panic attacks, the feeling of anxiety is not stable, but manifests itself in the form of repeated attacks lasting 5-20 minutes.
• Anxious and suspicious personality accentuation. People of this type are characterized by indecision, excessive doubts, prolonged worries, and an inability to defend their point of view. This is especially noticeable in childhood. With age, fears hide and appear less outwardly, but do not disappear.

Most often, treatment can be reduced to psychotherapy. This is the most effective method of combating neuroses. In more severe cases, a psychotherapist may prescribe antidepressants or tranquilizers. Medicines here act as catalysts for psychotherapy, but are not the main method of treatment.

Treatment methods

The first step when symptoms characteristic of VSD appear is to undergo diagnostic procedures to rule out more complex pathologies.

There are different approaches to the treatment of VSD.

Drug treatment is usually used, including drugs that affect cardiac activity, drugs that dilate blood vessels in the brain, and vitamin complexes.

This method of therapy eliminates the symptoms of the disease, makes organs work properly, but does not fight the causes of the disease. Because of this, the disease soon returns again, you have to fight it for years, and as a result, the patient begins to feel that it is impossible to get rid of the disease.

Also, physiotherapeutic procedures, massage, acupuncture, and swimming are often prescribed. They have a general health benefit and generally have a positive effect on the body. Such procedures do not directly affect the causes of the disease. But by improving the general condition, they contribute.

However, full treatment can only be carried out under the supervision of a psychotherapist, since it is necessary to eliminate the primary cause of the disease - neurosis.

Diet and lifestyle

You can improve your condition by adjusting your lifestyle. A balanced daily routine, proper nutrition and moderate exercise will help you with this.

Yoga, slow running, cycling, and swimming are perfect sports activities.

It is also good to do exercises to music. Physical activity should be varied and involve different parts of the body. Do not overexert yourself, start with small loads, gradually increasing them during subsequent workouts. After classes, you should feel joy and a surge of strength, but not fatigue.

The optimal training duration is from 30 minutes to 1 hour.

Follow these dietary rules:

• Include foods rich in Potassium and C in your diet;
• eat less, but more often;
• do not eat fried, canned and smoked foods, meat and fish broths;
• give up fast food, carbonated drinks, alcohol, and cigarettes;
• drink enough water;
• use less salt;
• add spices to dishes: turmeric, cinnamon, chili pepper, ginger;
• include baked potatoes, apricots, paprika, grapes, tangerines, cottage cheese in the menu;
• add leafy greens, celery, dill to dishes;
• give preference to green tea, kefir, juices and compotes;
• Avoid fasting days.

Conclusions and Cautions

VSD is a symptomatic diagnosis that does not determine the cause of the disease. To understand the causes of the disease and select adequate treatment, you need to contact a psychotherapist.

You should not choose your own medicine. In most cases, vegetative-vascular dystonia does not require drug treatment.

There is no need to adopt treatment methods from other people. Since the diagnosis is general and is based on a number of different mental problems, therapy should be selected strictly individually.

The devil is not as scary as his little one
Folk wisdom

The statistics are disappointing: up to 80% of the world's population suffers from one or another manifestation of VSD, and almost a third of them need qualified medical care. It is noteworthy that women are more susceptible to the disease than men. We can say that VSD is the scourge of modern humanity, the price to pay for the mind, career and material wealth that is so difficult for us to get, doctors say.

There are many myths associated with the diagnosis of vegetative-vascular dystonia. Indeed, if your blood pressure is fluctuating, your stomach hurts, you don’t have enough air and your heart is burning, cutting and jumping out of your chest, where can you suspect psychological problems? Obviously we are talking about diseases of the heart, lungs and stomach. And we begin our long journey to cardiologists, gastroenterologists, and therapists. The medications they prescribe do not bring relief, and often it even gets worse. As a rule, what helps is the favorite since Soviet times, corvaldin and phenazepam, which are not recommended to be used throughout the civilized world, to put it mildly. This is how the journey of every VSD student begins...

- Doctor, what’s wrong with me?
- I don’t know... Let’s write “VSD”.

Let's figure out what vegetative-vascular dystonia is?

Did you know that according to the International Classification of Diseases (ICD-10), there is no such disease as vegetative-vascular dystonia?! In the presence of vegetative-vascular dystonia syndrome, the diagnosis of somatoform autonomic dysfunction of the heart and cardiovascular system is made by excluding diseases such as hypertension, coronary heart disease, etc. That is, when serious organic diseases and pathologies are excluded as a result of the examination, the doctor makes a diagnosis of VSD, which actually says that you are healthy (!!!), you just have impaired autonomic function. It turns out that we become victims of the “vegetative component” of our stress; there is nothing wrong with our organs, their regulation is simply disrupted. And for VSD, it is not the heart, stomach, head and lungs that need to be treated, but the psyche using psychotherapeutic techniques. There is a diagnosis, but there is no disease! With which I congratulate you!

The main thing that a person with VSD needs to understand is:

1. No one has ever died from VSD (the attacks are unpleasant, but that’s all).
2. When diagnosed with VSD, there are no serious physical diseases of any organ that affects the VSD.
3. With VSD, we become hostage to our anxieties and habits. Let's learn to react to them correctly - let's forget about VSD.

A case from one's life:

One day before the New Year, I was getting ready to decorate the Christmas tree after work. But since the work day turned out to be busy, and I was very tired, I didn’t want to decorate the Christmas tree. But, being an obligatory person, I still forced myself to go decorate the forest beauty. And what came of it? Exactly 5 minutes later, I began to have a severe stomach cramp. The pain was so strong that there was no talk of any Christmas tree anymore. I had to lie down. And who defeated whom? Thus, over time, I realized THAT YOU NEED TO BE FRIENDS WITH YOUR BODY. The body is cunning. If you force him, he will still get out of it and put you to bed, but he will do it through illness.

As the wonderful Australian psychologist Andrew Matthews writes in his book “Live Easy!”:

This is how life works. First, they throw small stones at us to give something like a first warning. When we ignore these pebbles, bricks fly at us. Ignore the brick and you'll be crushed into dust by a huge boulder.
If we are able to be honest with ourselves, we can always tell when we did not pay attention to these warnings. But sometimes we have the audacity to ask: “Why did all this fall on me?”

In fact, with vegetative-vascular dystonia we pay for our inattention to our own mental health. Therefore, it is very important to learn the right attitude towards life, develop positive thinking and improve the quality of your life!

Patients with vegetative-vascular dystonia live poorly, but for a long time - there is a lot of truth in this medical joke. This strange attack can greatly complicate life, sometimes turning it into hell, and at the same time pose no threat to life. Even with completely healthy internal organs, people suffering from VSD can feel so bad that they feel like real disabled people. The most offensive thing is that those around them begin to consider them malingerers - in fact, how can you trust a person who claims that his heart hurts despite an excellent cardiogram? Even some doctors believe that VSD does not exist. Who should you trust and why then does a person feel so bad?

What is VSD

VSD is one of the most mysterious diseases. It seems to be there, and it seems to be not. Some doctors believe that such a disease does not exist and that completely different diseases are hidden under the mask of VSD, which simply have not been identified and are not treated. Other doctors, on the contrary, believe that this disease exists, and it is associated with a violation of the regulatory function of the autonomic nervous system. But this failure can be caused by a variety of reasons, ranging from infectious diseases to hereditary predisposition, neurasthenia and liver diseases.

VSD has many names, as well as many faces. It is also hidden under the names of neurocirculatory dystonia, or dysfunction, vegetative dystonia, it can be called cardioneurosis, vegetative neurosis. Because the disease has many names, symptoms and manifestations, it is treated by a number of specialists: cardiologist, neurologist, endocrinologist, psychotherapist and psychiatrist. Seven nannies have a child without an eye - VSD continues to be the most mysterious disease. And what helps some sufferers has no effect on others.

So, it is completely unclear whether this is a separate disease or a set of symptoms (syndrome), but many suffer from this scourge, and women are 2 times more likely to suffer from this scourge. And almost 25% of patients who consult a cardiologist about heart pain have a completely healthy heart - obvious VSD.

VSD is actually an imbalance between the sympathetic and parasympathetic systems of the autonomic nervous system, which regulates the activity of internal organs. Unconscious and automatic activities - blood pressure, heartbeat, hormone release, and so on. As a result, at the slightest critical situation, the body begins to react inadequately to stimuli. And a vegetative crisis or attack occurs, so well known to all vegotonics - sharp fluctuations in pressure, dizziness, heartbeat, excitement. The autonomic system gives conflicting orders, the glands secrete hormones that are not currently required, the organs begin to prepare for stress in the complete absence of it. And everything leads to poor health in complete health.

People can go to doctors in circles for years, researching the causes of illnesses and becoming disillusioned with medicine. A cardiologist, endocrinologist, neurologist will not find any abnormalities in health, all tests will show that there are no organic lesions of the heart and brain. But there are symptoms, and we will talk about them on our website.

Who suffers from VSD

As a rule, VSD mainly affects emotional people, with a very, as doctors say, labile, that is, unstable, nervous system. This type very easily displays inadequate vascular reactions to everything - from physical activity to stress and weather.

It can appear at any age. But almost always those who suffer from it in adulthood discovered the first symptoms in childhood or early adolescence. And most often, the first symptoms appear during the period of hormonal changes in adolescence. In women, VSD can appear and worsen during any period of hormonal upheavals - during pregnancy and after it, during the restructuring of the body during menopause.

It can also be a consequence of illness and disruption of the endocrine glands. Although here everything remains unclear - whether the disorder causes VSD or the failure of the regulatory function of the autonomic system causes disruption of the endocrine glands.

It is assumed that heredity also plays a role. Parents with VSD have a high risk of having a child who will also subsequently suffer from the same disease. Flowers delivered in Moscow. Flor-boutique - flower delivery in Moscow. . Excellent flowers at reasonable prices. Delivery within the Moscow Ring Road is free!

What causes VSD

In addition to hereditary or non-hereditary weakness of the autonomic nervous system, other factors can cause VSD. Infectious diseases, including influenza and tonsillitis, can cause a failure of the regulatory ability of the autonomic system. Injuries, especially concussions, can also lead to this. A sedentary lifestyle leads to the fact that the blood vessels, due to lack of load, begin to work poorly and symptoms of dystonia appear.

There is a theory that states that symptoms of VSD are caused by improper functioning of the digestive system, especially chronic gastroduodenitis. After a course of treatment for gastroduodenitis, the symptoms of dystonia disappear. This theory was put forward back in the 50s of the last century, and there is information about successful cases of healing of VSD after treatment by a gastroenterologist.

A psychologist can help here too. In a number of people, VSD is caused by mental causes. Neurosis-like conditions lead to dystonia. Psychotherapists suggest the existence of a deep connection between secret fears and the appearance of VSD. A number of experts claim that a strong fear of death, expelled into the subconscious, can lead to the development of vegetative-vascular dystonia. In the same way, fear of life can give its symptoms.

Symptoms of VSD

She has many symptoms. But according to groups of symptoms, different types of VSD are distinguished.

If problems mainly arise with the heart, then VSD follows the cardiological type; If you have breathing problems, use respiratory. The cerebral type gives headaches; digestive disorders are a gastroenterological type; visceral leads to disruption of thermoregulation.

Often, the same person experiences several different types of VSD.

For cardiac type, arrhythmia, palpitations, dizziness, fainting, pressure surges. Based on how the pressure changes, VSD is classified into hypotonic, hypertonic or mixed type.

With VSD of the hypertensive type, sharp causeless increases in blood pressure, anxiety, palpitations, chills with cold extremities, and panic attacks are observed. With VSD of the hypotonic type, weakness, dizziness, fainting, drop in pressure, sweating, and lightheadedness appear. With a mixed type, these symptoms can change each other, exhausting a person and leading to loss of performance.

A panic attack is especially frightening for many, when suddenly, without any reason, an attack begins - pressure surges, increased heart rate, lightheadedness, dizziness, an uncontrollable attack of fear of death. A panic attack can last for several minutes or hours. In severe cases, the help of a doctor is required.

When cardiac symptoms predominate, VSD is often called neurocirculatory dystonia (dysfunction). An attack of VSD of the cardiological type is terribly frightening because it can resemble a heart attack. A person feels pain in the heart, he develops a feeling of fear, blood pressure can rise to high numbers and drop to low ones. Almost 30% of emergency calls for a possible heart attack occur precisely because of an attack of vegetative-vascular dystonia.

Many accuse the unfortunate person of malingering and suspiciousness and even stop paying attention to his complaints, considering him a manipulator. Meanwhile, he really feels very bad. Moreover, such people are actually in great danger. They themselves get used to the fact that all these sensations are associated with VSD and a panic attack. And if they actually have a heart attack, they may not see a doctor in time, considering the symptoms to be a normal attack of VSD.

Many people suffering from VSD report difficulty breathing, a lump in the throat, sore throat, and shortness of breath. In fact, this is not shortness of breath in its classic form.

With the gastroenterological type, the stomach often hurts for no apparent reason. In this case, a person can go to doctors and undergo detailed examinations. As a result, nothing will be revealed. In this case, many are given a vague diagnosis of “irritable bowel syndrome”, and that’s where it ends. In this case, VSD is characterized by unstable stools, digestive disorders, poor appetite, even its complete absence.

The cerebral type can cause numbness in the limbs, goosebumps, pain in different parts of the body for any reason. This is very frightening for many, because the person begins to suspect that he is having a stroke.

In women, VSD can cause disruptions in the menstrual cycle, and in men - erectile dysfunction.

Emotionally and psychologically, patients with VSD suffer from frequent mood swings, suspiciousness, increased anxiety, fatigue, drowsiness or overexcitation, problems with memory and concentration, and insomnia. In this case, the help of a psychologist or psychotherapist is necessary. Unfortunately, people with VSD turn to a psychologist last.

How to cope with a panic attack and VSD

At the onset of an attack with surges in blood pressure and palpitations, you can drink a glass of water, to which you add 50 drops of tincture of valerian/motherwort and eleutherococcus. Taking no-shpa and glycine tablets will help.

To get rid of a strong heartbeat, you need to close your eyes and press your fingers on your eyeballs for a minute. Massaging your fingers and neck will help normalize blood pressure.

In fact, simple methods are effective. A daily routine, proper nutrition and an active lifestyle will help reduce the number of attacks and make them less severe. Daily walks of at least half an hour help keep VSD within limits.

VSD is a disease so many-sided that it is simply impossible to describe all its symptoms. And despite the fact that it does not threaten life, it makes it much more difficult, since the person is afraid of attacks and does not know at what point he will feel bad again. Therefore, it is best not to delay your visit to the doctor and start treating the disease in a comprehensive manner.

You can say that this is all frivolous and close this page. But don't rush. Vegetative-vascular dystonia or cardiopsychoneurosis, which means the same state of the body, are able to feel and suffer, according to various researchers, from 25% to 75% of residents of developed countries. About 40% of the population of planet Earth constantly take tranquilizers and antidepressants. So how? Impressive? Let's talk a little about why and how VSD syndrome develops. If you understand this message, then you can consider that success in treating this and many other diseases is already in your pocket.

Statistics say that one in four Americans suffers from some kind of mental illness. Think about your three best friends. If they're okay, then it's you. This saying comes from Rita M. Brown.

The nervous system plays the main role in life support and regulation of internal order (homeostasis) in the body of any living creature. It’s not for nothing that they say that all diseases are caused by nerves, nerve cells are not restored, and the fish rots from the head.

Now some general brief information about the structure of the human nervous system. It consists of two functional departments:

Central nervous system;

Autonomic nervous system.

The central department is responsible for consciousness and thinking, as well as for the conscious general reaction of the whole organism to environmental irritations. In simple words, if you were called bad words, then the central department evaluates what these words mean and what to do next - run away or attack the offender. The higher the development of the central nervous system the animal is, the more complex the response reaction. For example, in fish this section is very poorly developed. Maybe this is why they are practically impossible to train and, what is very important, they do not know what vegetative-vascular dystonia is.

The autonomic nervous system controls the work of all internal organs. These are the heart, lungs, stomach, intestines, blood and lymphatic vessels, genitourinary organs, skin, eyes, etc. She does this work on a kind of autopilot. Independently preserves and maintains normal various indicators of the internal environment of the body: body temperature, blood pressure, heart rate, production of gastric intestinal juices, bile production, sweating. It also carries out functional adaptation (adaptation) of the body to changing environmental factors: stress, physical or mental work, climate and weather changes. But if the central department decides that it is necessary to run away from the offender, then the autonomic system will immediately begin to mobilize the entire organism to complete the task received. Stress hormones will be released, blood pressure and pulse will rise to provide oxygen to the muscles. This excited state will continue for some time, after the situation normalizes (the offender apologized and calmly left). After all, organs need some time to normalize their work, destroy and remove stress hormones.

The vegetative system, in turn, consists of two sections:

Sympathetic /responsible for strengthening the functions of internal organs/;

Parasympathetic / responsible for weakening the functions of internal organs/.

Each internal organ receives nerve impulses simultaneously from the fibers of both the sympathetic and parasympathetic divisions of the autonomic nervous system.

If both sections of the autonomic system work correctly, and the central section of the nervous system does not interfere with this work, but respectfully and carefully provides general guidance to the individual, then the human body feels normal and is in a state of health. Each department of the nervous system is responsible for its own area of ​​work. You can tell your body to increase saliva production for a long time. There will be no reaction. But as soon as you imagine a bright yellow and very sour lemon, feel and remember its taste and smell, your mouth will immediately fill with a lot of saliva. There is no lemon and there never was, but there is saliva!!! This is how the central nervous system shamelessly interferes with the work of the autonomic nervous system to show who is in charge. This is the most important phrase in this article. If balance is restored, then the disease will recede and be defeated.

Any disruption in this balance affects the state of the entire organism.
Attack of VSD can begin at any moment when the central nervous system begins to dictate its terms to the autonomic one.

This is precisely why vegetative-vascular dystonia begins to develop. And everything else, including the unstable functioning of blood vessels, which manifests itself in constantly freezing palms of the hands, is not a cause, but a consequence.

VSD reasons:

Signs of VSD develop as a result of several triggering reasons:

Hereditary predisposition, congenital instability of the nervous system;

Hormonal changes in the body (pregnancy, childbirth, breastfeeding,);

Constant chronic stress in the family or at work;

Mental, physical and emotional fatigue;

Violations of the work and rest regime;

Exacerbation of concomitant endocrine, neurological and somatic diseases;

Consequences of injuries, infections, intoxication;

The reason can be very simple and banal. For example, dissatisfaction with life or the inability to do what you love. This condition provokes negative thoughts and contributes to the emergence and development of VSD.

Vegetative-vascular dystonia in children may appear as early as early adolescence. Women suffer from VSD three times more often than men. Autonomic dystonia syndrome develops at the prime age, from 16-20 to 45 years. Some researchers say that the roots of VSD lie in the earliest childhood of every person.

Once, a guy at the age of 20, for the first time, while visiting a steam room in a bathhouse, when he drank a little alcohol, had his first panic attack. After which, attacks haunted him constantly in hot rooms, including in the shower. He had to wash himself with water at room temperature.

As it turned out later, he was an unwanted child in his family. His mother, being pregnant, decided to get rid of the fetus and decided to do it using the traditional method. After drinking a decent amount of vodka, she climbed into the hot bath. One can only imagine how frightened the unborn child was by this action of the mother. The woman’s plan did not work out. The abortion did not occur, the pregnancy continued without problems. Then the expectant mother reconciled with her husband and gave birth to a healthy child. And 20 years later, this child again found himself in the very conditions that his own mother had created for him in her womb before birth. All this time, the child’s brain stored information about that dangerous situation and responded to it with a panic attack.
Therefore, the relationship between parents and children, as well as genetic inheritance, play a large role in the onset and development of the disease. Recognizing it in time and knowing how to defeat it is already more than half of the victory over this evil disease. You can figure this out yourself with great success. This article and book will help you to independently determine the causes of your illness, namely vegetative-vascular dystonia.

Vegetovascular dystonia, or VSD for short, is a special diagnosis that old-school doctors love and are very disliked by doctors who read modern literature and know what evidence-based medicine is.

And all because there is no such diagnosis: it is not in the International Classification of Diseases International Classification of Diseases, 10th Revision (ICD-10). Meanwhile, it constantly appears on cards; there are entire groups, forums and websites dedicated to the treatment of VSD.

Where does dystonia come from?

The autonomic nervous system is that part of the nerve cells that is responsible for the functioning of internal organs. To simplify, we can say that this is that part of the system whose activities we do not influence. The autonomic nervous system controls heart rate, digestion, and blood pressure. Dystonia, in theory, means that something has gone wrong in this system.

Patients are bothered by specific, although completely different, symptoms. Someone complains of a rapid pulse and trembling hands. Some people experience dizziness and chest pain. Patients suffer from fatigue or insomnia, and sometimes both. Sometimes abdominal pain and much more are added to the bouquet. At the same time, neither cardiologists nor gastroenterologists see any deviations, and neurologists don’t see them either. This is how VSD appears.

Patients are not pretending, they actually have problems. Only all these symptoms, both together and separately, arise not because of vegetative-vascular dystonia, but because of other diseases that remain undiagnosed. Often they need to be treated not by a neurologist, but by a neurologist - 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, then no studies have been conducted on this topic that would meet the requirements of evidence-based medicine.

If only some The Lancet would publish an article about how a non-existent diagnosis affects the health of the population in Russia! But until this happens, we asked neurologist Nikita Zhukov what to do if your diagnosis is vegetative-vascular dystonia.

Nikita Zhukov

Nikita, I am one of those patients whose card had the inscription VSD on it. I don’t even know why exactly I was diagnosed with this. Why is this possible?

Because this is the main diagnostic cesspool of all Russian medicine: VSD can be diagnosed to any patient for almost any complaint. 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 doesn’t know either. There is an unspoken rule: if you don’t know what diagnosis to make, make a VSD.

I come to the doctor with complaints, he says that I have VSD. I know that this can't happen. What should I do? What doctors, besides a neurologist, should I contact?

Well, there are two options.

1. Aggressive: Try to make the doctor feel like an idiot and learn something. You need good knowledge of the issue, journalistic arrogance and a desire to change the world for the better (as you can see, not a word about healing).
2. Look for a neurologist who does not diagnose VSD; in 2017 there are already enough of them. That’s exactly how we advertise: “No VSD, homeopathy or physiotherapy!” You can try going straight to a psychotherapist, but with them it’s still worse than with neurologists.

Is there a movement towards evidence-based medicine? Roughly speaking, if I say: “Doctor, I don’t believe in VSD, I don’t have to be prescribed,” will the doctor be able to understand such a position? What's the chance of that?

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 have begun to understand that evidence-based medicine is good, and even the Ministry of Health has made scientifically based guides (there, of course, there is umifenovir, the better known like Arbidol, but there is also a lot of reasonable stuff).

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 should you ask at the beginning of your appointment to prevent this from happening?

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

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

Theoretically, yes, but I have not encountered this and I think it is unlikely: experienced patients with VSD have all possible examinations several times, which practically eliminates the possibility of missing some serious condition.

- A person is treated for a long time for VSD, but it helps him. Is this just a placebo effect?

Yes, if this is a typical “treatment of VSD”, because it, in principle, involves therapy with fuflomycins, which have only 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 VSD, cherish these three letters and will never give them up.

Let’s say a neurologist writes SVD (somatoform autonomic dysfunction, F45.3) instead of VSD, but the treatment is ineffective. What prescriptions indicate that it is time to change doctors?

The diagnosis F45.3 is one of the 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 medications, then either the doctor is a fool or one of two things.

- The only way out is to look for another doctor? Does the patient have any other ways 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’s worth taking a different route and taking advantage of the benefits of the information age: collecting and leaving reviews of doctors, looking for word of mouth and some “Doctors without VSD” registries. Quite a few patients come to me who say right out of the gate: “I came to you because I’ve been diagnosed with VSD for ten years, but they say about you that you don’t do it.”

If you need to learn more about diagnoses that do not exist and learn to distinguish proven medicine from shamanism, we recommend Nikita Zhukov’s books about the most persistent medical misconceptions and myths.