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How to Tell If a Symptom Is Serious or Not

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Google is not your friend when you’re investigating a mysterious new symptom. Do you rush to the doctor…or try to wait it out?

What doctors know: The vast majority of symptoms that bring people to doctors’ offices turn out to be minor—or at least manageable. But unless you’ve had years of medical training, you won’t know what’s serious and what’s not. Some seemingly “minor” symptoms really do need to be checked out…others can be ignored…and some should send you racing to the ER. Common symptoms—and what to do…

LIGHT-HEADEDNESS

It usually means that your brain isn’t getting enough blood. That sounds scary, and it can be—but not always.

Relax if you sometimes feel light-headed when you get out of bed or stand up from a seated position, particularly when the sensation lasts a few seconds or less and isn’t so severe that you feel like you’re going to pass out. All it means is that your change of position is forcing blood to move against gravity—there’s a slight lag before your blood pressure compensates and the brain gets enough blood and oxygen.

Exception: Light-headedness that occurs every time you stand up…lasts more than a minute…or forces you to sit/lie down could be due to orthostatic hypotension, a large drop in blood pressure that’s often caused by dehydration…side effects from certain medications (such as beta-blockers and diuretics)…or bleeding (from an ulcer, for example) that may or may not have been detected. You’ll want to see a doctor the same or next day. Note: If you’re bleeding and feel light-headed, go to the ER.

Make an appointment if you have worsening light-headedness during exercise. I worry most when a patient is age 50 or older and gets light-headed during mild exertion. This could indicate that the heart isn’t supplying enough blood to the muscles—which can occur because of aortic stenosis, a stiffening of the main valve that separates the heart from the aorta, the large vessel that conveys oxygen-rich blood to your entire body—or weakening of the heart muscle from blockages in the arteries (atherosclerosis). Your doctor will probably recommend an ultrasound and possibly a stress test or other tests to assess the health of your cardiovascular system.

Call an ambulance if you feel light-headed and your heart is racing out of control. You could be experiencing a rapid and irregular heart rhythm, such as atrial fibrillation or ventricular tachycardia, that can be deadly without quick treatment. After you call 911, lie down while you’re waiting for an ambulance and elevate your feet.

HEADACHES

They’re among the most common symptoms that bring people to doctors’ offices and ERs. They’re painful but usually not serious—with some exceptions.

Relax when headaches feel like a band of pain around your skull…improve with rest and medication, such as acetaminophen (Tylenol) or ibuprofen (Advil)…and tend to occur at high-stress moments in your life. They’re probably just tension headaches, thought to be caused in part by muscle spasms in the scalp. They rarely last long and aren’t a problem for most people.

Make an appointment if your scalp hurts when you brush your hair, your jaw tires quickly while chewing and you’re age 50 or older. It could be temporal arteritis, an uncommon autoimmune disease that affects the temporal arteries that carry blood to the head. It can eventually cause severe pain and/or vision loss.

Temporal arteritis can usually be diagnosed with blood/imaging tests, although a biopsy of the affected artery may be needed. Treatment: Oral steroids (such as prednisone) taken for a few months to a year or more. High-dose intravenous steroids may be given at the time of diagnosis. The condition can’t be cured, but drugs will stop the pain and reduce the risk for complications.

Call an ambulance if the headache pain is sudden and among the worst you’ve ever had—like an ice pick stabbing into your head. It could be a subarachnoid hemorrhage, a ruptured blood vessel in the head. It may be accompanied by neck pain, nausea or vomiting. About one in eight people don’t live long enough to get to a hospital. Get help immediately!

FATIGUE

The causes of fatigue run the gamut. But if you feel constantly run-down—even when you get enough sleep (see below)—there’s probably something wrong.

Relax if you’ve started a new medication. Fatigue is a common drug side effect, even among drugs that people don’t associate with sedation. Common offenders: Blood pressure medications—such as atenolol (Tenormin), metoprolol (Lopressor) and other beta-blockers—along with pain relievers, antihistamines and many antidepressants.

My advice: Talk to your doctor if you notice fatigue after starting any new drug. In most cases, all you’ll have to do is switch to a different drug or take a lower dose. Also, remember that there are numerous causes of fatigue, including stress.

Make an appointment if you’re also suffering from constipation…have gained weight…and often feel cold. These are symptoms of hypothyroidism, an underactive thyroid gland. It’s easily diagnosed with simple blood tests. Most people will get back to normal when they start a thyroid-replacement medication, such as levothyroxine (Synthroid).

Other possibilities: Sleep apnea, in which breathing intermittently stops and starts during sleep—and prevents you from getting a good night’s rest. People with sleep apnea usually aren’t aware of it, but their partners often complain about loud snoring and/or gasping. It’s clinically diagnosed with a sleep test.

Progressively worsening fatigue combined with weight loss can be a red flag for cancer. This, too, warrants a visit to your doctor.

Call an ambulance if you suddenly experience bone-deep fatigue that’s accompanied by any degree of mental confusion. There are multiple life-threatening conditions that can cause sudden, severe fatigue/confusion, including a brain infection, stroke or sepsis.

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Source: Christopher Kelly, MD, a physician at Columbia University Medical Center in New York City. His research has been published in The New England Journal of Medicine and other professional journals. He is coauthor, with Marc Eisenberg, MD, of Am I Dying?!: A Complete Guide to Your Symptoms—and What to Do Next. Date: January 1, 2019 Publication: Bottom Line Health
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