There is no uncertainty when it comes to crushing substernal chest pain, severe abdominal pain or a fainting episode, get yourself to the ER or call 911. There are symptoms, however, that fall into a middle ground and you wonder: should I bother the doctor on call? As an Internal Medicine Doctor I am often surprised when patients tell me weeks later they suffered one of the following complaints and didn't seek help. New Year's Day or not, contact the on-call doctor or get an appointment soon if one of these symptoms pops up.
1) Numbness or weakness of one side of your body, especially when it involves the face. Make a distinction from the above symptoms occurring out of nowhere to your arm being asleep when you wake up, that is harmless. Even if the above symptoms are present for 5 minutes or less do not ignore this as it may be what we call a TIA or Transient Ischemic Attack. Think of this as a mini-stroke and many people ignore this because the symptoms resolve quickly. If you report these symptoms to your doctor he/she will likely order a carotid ultrasound, have you start an aspirin a day and may check a CT scan or MRI of your brain as well.
Why this worries me: Twenty percent of people who have a TIA will have a stroke within 90 days, and that's why we care.
2) Shortness of breath when you exert yourself. We call this "dyspnea on exertion" and this doesn't mean you get short of breath when you are running, but rather you would notice when you walk up the hill to your office or walk around the mall like you always have, you get more short of breath than usual. It's true that deconditioning and extra weight can also do this but dyspnea on exertion is often a sign of coronary artery disease.
Why this worries me: In women more than men this is often the presenting complaint of coronary ischemia, as opposed to the chest pain radiating down one arm you all hear about. I have sent patients to cardiac stress tests after the above complaints and often a significant coronary blockage is found.
3) Dark black stools (also known as tarry stools or melena). This is never normal unless you are taking iron or Pepto-Bismol. Dark black stools are a strong clue that there is blood in your stool likely coming from higher up in the gastrointestinal (GI) tract.
Why this worries me: Peptic ulcer disease, esophagitis, stomach cancer and even colon cancer can do this. See your doctor who can easily check in the office with a simple rectal exam and a hemoccult card whether there is microscopic blood in your stool.
4) Burning with urination. Men and women this is never normal. Women can try drinking plenty of water and cranberry juice in hopes of overcoming a urinary tract infection on their own but often that is not going to work.
Why this worries me: Here is my warning to patients and I see this all the time. Waiting even 45 minutes may take a urinary tract infection from mild pain to severe discomfort, peeing blood, fevers, nausea and vomiting. Come see us with this complaint we can help you out very quickly.
5) Blood in your urine with or without pain. Bladder and prostate Infections will do this and that will be obvious to you because you will have symptoms mentioned in #5 and while blood in your urine may have a benign cause it should ALWAYS be evaluated while it is present.
Why this worries me: Kidney cancers, kidney stones, bladder cancers and kidney failure can also be the cause of blood in your urine.
6) Blood tinged sputum when you cough. A simple bronchitis is the most common cause of this but you need to be evaluated as soon as you see blood in your sputum to make sure it isnt something more ominous.
Why this worries me: Lung cancer, pulmonary emboli, tuberculosis among other serious lung problems can present this way.
7) Low back pain with numbness or tingling down one leg to the foot. This is not scary in the sense that if you ignore this you will be paralyzed, because you won't. Radicular back pain, described above, is a warning sign that there may be a disc compressing the nerve root exiting the lumbar spine. This can be treated with anti-inflammatories and may even require a course of steroids in the short term but please come see us.
Why this worries me: The reason I don't want you to ignore this is that ALL THAT DISC NEEDS TO DO is move 1 or 2 millimeters more the WRONG way and you will be stuck in excruciating pain, unable to move on your back in your living room. I mean it, I get this call often from someone afraid to move because of the knife stabbing pain In their back, and there were usually a couple days of warning before it got to that point.
8) Vaginal bleeding after menopause. If you are on cyclical hormone replacement therapy this is more ambiguous but if you are not this IS ALWAYS CAUSE FOR IMMEDIATE EVALUATION. If you have NOT had vaginal bleeding in 6-12 months (menopause is official) and you have even the smallest amount of vaginal spotting you must be evaluated. The standard of care is well established here and a transvaginal ultrasound AND likely an endometrial biopsy which can be done in your Gynecologist's office.
Why this worries me: There are benign causes of postmenopausal bleeding but it is also the initial presentation of endometrial cancer and as your age increases it is more likely that cancer of the uterus is the cause of the bleeding.
9) Weight loss and loss of appetite. Unless intentional, weight loss is always concerning. While it may be thyroid disease, a medication side effect, or anxiety it cannot be ignored.
Why this worries me: This symptom worries primary care doctors because many malignancies declare themselves with weight loss (colon, stomach, lung, lymphomas, multiple myeloma) as the initial signal.
10) Night sweats. Unless you are going through menopause or live in a hot muggy climate this needs to be sorted out. Drenching night sweats where you get up in the middle of the night and have to change your shirt need to be investigated. Again, this can be something benign like thyroid disease or a side effect from a medication and Effexor is notorious for this.
Why this worries me: Chronic illnesses like HIV, Tuberculosis, fungal diseases and malignancies (especially lymphomas) present with night sweats.
William Shakespeare (1564 - 1616)
Happy New Year!