Primary Care Physician
Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…
10 Symptoms you can't ignore
Posted in Acne by Dr. Sharon Orrange on Dec 27, 2008

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.

  "Our bodies are our gardens to which our wills are gardeners."

William Shakespeare (1564 - 1616)

Happy New Year!

Dr O.  



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TOTAL COMMENTS: 32 - View All Comments »

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Displaying comments 32-13 of 32
When you feel something unusual you shouldn’t ignore it, chances are it may lead to a chronic disease. It cost you a lot to get sick remember. Sometimes our health solely depends upon us, to our lifestyle if we took good care of our health more probably we seldom got or acquire disease. More importantly bear in mind that sanitation is a must. Make sure that the food and water you intake are safe and water must be potable. Anyway there is a campaign spearheaded by dome school known as H20 for Life. H20 for Life has now over 100 participating schools, sending clean water for drinking and sanitation as short term loans for health to Africa as well as South and Central America. It's a wonderful thing that they are doing, as thousands die from unsanitary water conditions annually. It's like debt relief for the human race by donating to">H20 for Life.
By BrendanP  May 19, 2009
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By lara123  Jan 31, 2009
Useful information..thanks.

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By lara123  Jan 31, 2009
I have Hep C and thyroid disorder, so I get these sweats sometimes. I'm on meds for the thyroid, but waiting for a better tx for the Hep C as I failed it the first time around, and it (or the meds for tx) is why my thyroid stopped funtioning. I have noticed how I would describe aas n electrical pulse in my head that comes and goes, it's like being shocked lightly, and runs a thump, thump, thump sometimes twice sometimes three times. This is almost continual, and is annoying but not painful. I have so much stuff going on, I am reluctant to speak with my PCP about it, he's like "oh this broad is a nut", which true, I take neurontin among other meds, nonetheless, I'll report this to my psych rather than my MD. Sad, nonetheless, true.
By Amaterasu  Jan 28, 2009
god is there one doc.out there that would tell me what the hell it going on with the midle of my feel like some thing has hit me right across the mild of my back.i am in so much2:00am in the moring. they sayed i had a cyst.the next gone.!!they say i have f.m.a.just becouse i dont hahe ins. the a clinck want write out pain med.but some that has ins.can have pain meds.called in . the doc. are full of it.if i had ins.i could get it.s.c.columbiait all about ins!!right??
By seagull  Jan 14, 2009
I felt like a selfish idiot when I asked my neighbour to drive me the 250kms into Canberra to have an doppler ultrasound done. I was fearful that I had developed a second DVT, but I'm the sort of person who won't want to put someone out of their way to help me until my leg is falling off. But some inner voice told me to get it checked, and thank god I did because it was indeed another clot, much bigger than the first one, and much higher in my body. Listen to your body people, if it doesn't feel right then it's probably not. I'd rather be wrong and embarrassed than dead
By JennyMay  Jan 14, 2009
Last week I experienced severe sudden lower back pain to the point I was in severe pain. It had come on rather quickly. I could not sit or lay down. I told my ex-husband that he needed to take me to the emergancy room because I could not take the pain anymore. I said I would rather go through child birth because that was so much less painful then what I was going through. I agree with you on that!!! I was given 20 mg of morphine through a shot and an antibiotic. The morphine did not take the pain away. It made it tolerable. But when I got tipsy from the morphine and needed to lay down so I would not fall down I laid on my right side (good side) and instantly was back in massive pain. I could not help but to cry out loud and it was not a muffled cry. Everyone knew I was in pain. My nurse ended up bringing me in 2 Percocets to help relief some of the pain. My doctor came in and told me that he can not take all the pain away. That I needed to see a back specialist ASAP and that my lower discs are deteriating and have pinched the nerves in my lower back. I am not to bend at the waist or get something down from above my head. I can not vacuum without being in pain. The worst part is...that my insurance is being transferred from my moving and I have to wait to see a specialist. But I do agree with you on the fact that do NOT ignore this type of pain.
By birdlady  Jan 13, 2009
Gret article Dr. O. I always hate to go to the ER. I do not want to bother those poor people in the emergency room, unless I am definietly in an emergency situation. As a result, sometimes when I am in an emergency type situation, I still do not go in. Then I get scolded because I waited to long to have myself checked. Its nice to have a sort of guide line from a medical doc. Hugs! JoAnn
By BreatheEasy  Jan 12, 2009
Thanks, excellent info!!! You answered questions to several problems i've had and had nothing done about. I did get night sweats bad and i got graves and hashimoto's disease, so you were definitely right about that. Also, I get short of breath when exerting myself, my doc was interested in putting a Halter Monitor on me for a day, but i am only 37 so i wondered if it was stupid. Thanks for the info.
By Funkyhashi  Jan 10, 2009
Loss of appetite is also known as anorexia. Cancer-associated anorexia is probably due to a combination of physiological changes as well as the psychological impact of the disease. In certain types of cancer, there is an increased basal metabolic rate and increased total energy expenditure. This means that more energy (calories/kilojoules) are required to maintain current weight and lean body mass. This is compounded by a loss of appetite; hence it is easy to see that people with cancer are at risk of developing malnutrition, either as the result of the cancer itself, or the side effects of common cancer treatments such as surgery, chemotherapy, and radiotherapy.
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By manoj87  Jan 06, 2009
I really appreciate this. Strokes have happened in my family, and I am dealing with water retention so I've wondered if the tightness I feel is something else, or water. I keep in contact with my doctor's nurse about it often.
I've read lists like this before that explain when to go to ER and for what, but I liked yours because you explain exactly why those things worry you!! Thank you!
By stuffanie  Jan 03, 2009
Thanks for your input on your concerns on the symptoms above. Finally someone who takes notice....
My family physician sent me to a Neurologist Dec. 12 and he immediately took me off of five medications cold turkey! He replaced them with one. He has me in a state of withdrawal that is not any fun. I can't sleep, I am having hot flashes day and night. I have sweat pouring off of me when this happens.

My bed is soaked every night. I have had to get rid of so many pillows and 2 pair of jams....I called my regular Dr. this morning and he just said to give it a chance to work. This new Dr. has my Fibro so messed up I feel like I am at square one again and haven't found out what it is that I have yet. This has set me back 6 years in treatment!
What should I do? Sueba
By sueba  Jan 02, 2009
Thanks for giving us these guidelines. It's always good to know what we really ought to check out. On occasions I wonder if my symptoms are bad enough to see a Doctor, so these are a great help to remove the negative thoughts.
Very much appreciated.
By MaRhianna  Jan 01, 2009
By the way I am printing this off and keeping it handy for several reasons. Both my hubby and I have several of these symptoms that should be attended to. You just helped us to speed up the tests to get or not.
Thanks again.
By tiredtiredtired  Dec 31, 2008
Dr. Orrange...Thank you for such a good cklist and also your reasoning why these signs worry you. Much appreciated.
Lifeline screenings is coming to our town next week. Both me and hubby are going to be cked.We have no real insurance but this is one way we can do some basic but very important test to maybe save our life. All for under 130 dollars.
I get the impression you are a doctor that goes the extra mile.Thank God for ones like you that haven chosen to dedicate much of their lives to help others.
May this next yr be very good to you.
Love Rhea
By tiredtiredtired  Dec 31, 2008
professional I meant can't see that well this norning lack of sleep.

how about some sort of a response or referral for angelde8 is there not someone on DS that could communicate with her about options that she may have??

You guys need Doctors in residence so to speak for this site. That and spellchecker...
By BillyJackTurtle  Dec 31, 2008
Happy New Year Dr.O

I like the way the above information was presented,

very easy to follow along and very proffesional.
By BillyJackTurtle  Dec 31, 2008
Easy to say 'Go to your doctor when this happens' but if you have no insurance and no money, that isn't an option. Also, when most GPs have a 3 week waiting list to be seen it's not going to help. So where do you go, the ER? That's $800.00 the moment you walk in the door, and at least a 6 hour wait to be seen (if you're lucky). Again, for most people it's not a viable option.
I also get concerned when I see statistics like '20% of people with this...' that means that a whopping 80% have NO problems at all. I'm cautious about spreading more panic on top of whatever is already out there. If you run to the doctor with every twinge you get you'll be branded a hypochondirac and they won't pay any attention to you at all, even if you DO turn out to have something serious. I've seen it happen.
By ALC67  Dec 29, 2008
thank you
By windigo  Dec 29, 2008
very helpful.
By MaryBobbe  Dec 29, 2008

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