There’s one question our patients really want answered. The one that gnaws at them at night, that prompts them to make an appointment for the first time in years.
The one that keeps them from ignoring that weird new symptom that’s probably nothing but . . . ‘OMG, what if it isn’t nothing, and what if it’s an early sign of something serious? Am I dying?’
The answer, of course, is , yes. From the moment you were born!
The real question is: will it be sooner than you had expected?
Thankfully, most new symptoms turn out to be no big deal. Sometimes, however, a headache isn’t just a headache, and can actually be the sign of a life-threatening condition. But in the middle of the night, even just a 1 per cent chance of a terrible outcome starts to feel like a 98 per cent chance.
Don’t panic! The good news is that most of the time your symptoms will be benign, and you can go ahead and enjoy that cup of tea
Of course, you could just Google your symptoms. Go ahead. Oh, it says your stuffy nose is a sign of cancer? (By the way, where did Dr Google go to medical school?)
So if you have a new symptom, what should you do?
Here, we go through the most common symptoms and provide guidance on the next steps — whether you can relax and make yourself a cup of tea, or should pick up the phone to make an appointment with your GP, or rush off to A&E.
You’ll get the same advice we offer our family members. (And in case you’re wondering how two cardiologists can know so much about everything, that’s because we enlisted the help of colleagues who specialise in other fields).
The good news is that most of the time your symptoms will be benign, and you can go ahead and enjoy that cup of tea.
Of course, it’s impossible to cover every scenario: when in doubt, ask a doctor.
Also, we assume you’re a generally healthy adult who doesn’t already have a diagnosis directly related to your symptoms. If you have severe chest pain and had heart surgery two weeks ago, please call your doctor!
If you know or suspect that you have a health problem, it is recommended you seek your physician’s advice before embarking on any medical programme or treatment.
Most of us know the familiar pounding sensation that occurs at the end of a long week. But what if this headache is different?
Before you panic, let’s pause to review the facts. Many people have experienced headaches severe enough to warrant a trip to A&E. In fact, one in 50 visits to A&E is about headaches.
Yet most of those people survive, and you probably will, too.
Reality check: Many people have experienced headaches severe enough to warrant a trip to A&E. In fact, one in 50 visits to A&E is about headaches, yet most people survive…
TREAT YOURSELF AT HOME
YOUR headache is mostly in your forehead or face and you’ve recently had symptoms of a cold, such as a fever and runny nose:
One of your sinuses is probably jammed with mucus and is too swollen to drain properly.
You can try to thin out the mucus by inhaling warm vapour. Take ibuprofen along with a decongestant such as pseudoephedrine or phenylephrine (available over the counter from your pharmacist).
If the pain gets steadily worse and lasts for more than a week, you might need antibiotics; make an appointment to see your doctor.
You also have a fever, body aches, pains in your muscles and have a sore throat:
You probably have the flu.
You have recently kicked your coffee habit:
You’re in caffeine withdrawal. You’ll need to ride this out, preferably with the help of a pain reliever, such as ibuprofen.
Your headache feels like a band around your skull, but gets better with rest and medications such as paracetamol:
These symptoms are typical for a tension headache, the most common and least dangerous type of headache. They don’t require medical attention unless they’re happening often enough to interfere with the quality of your life.
The pain is uncomfortable but not intolerable. It came on gradually and isn’t associated with any other symptoms:
Some headaches don’t fit any specific pattern but also don’t have any alarming features.
Take a pain reliever with a tall glass of water and lie down in a quiet room. Give the medicine at least an hour or two to work. You should feel better soon.
Bruising that’s a sign of something serious
Fact: Tiny bruises all over your skin may relate to kidney or auto-immune disease
Your skin, unlike your waistline, reliably gets thinner with age.
The blood vessels become closer to the surface and more susceptible to the slings and arrows of everyday life, with minor injuries more likely to result in bruises.
If you have a long history of sun exposure or steroid cream usage, these changes can occur even earlier.
But tiny bruises all over your skin may be something different: the widespread disruption of small blood vessels can lead to lots of small bruises, about the size of an eraser tip.
In some places, the bruises can actually join together. The many different causes include changes in the clotting system, severe infections, calcium being deposited in blood vessel walls (which can occur in advanced kidney disease) and autoimmune diseases.
See your GP — unless the lesions are painful and/or you’re experiencing high fevers, in which case you should go to A&E.
If the pain keeps getting worse or becomes more regular, take a look through the next sections.
SEE YOUR GP
YOU’RE having frequent or intense headaches now, but never used to before:
High levels of stress, poor sleep, or a sudden decrease in caffeine intake can cause new-onset headaches in a person who doesn’t normally have them.
If there’s no obvious explanation, however, you should see your doctor to rule out rare but dangerous causes of headache.
YOU occasionally have gradual-onset throbbing headaches along with nausea and increased sensitivity to light and sound:
This pattern is classic for migraines. If you think you’re having migraines, see a doctor to confirm the diagnosis and get on the right medications.
YOU’RE over 50, your scalp hurts when you brush your hair and your jaw gets tired after chewing for a few minutes:
You may have temporal arteritis, a condition where the arteries on the side of your face become diseased and narrowed. Major symptoms include headache, scalp tenderness, jaw fatigue after chewing and vision changes or loss. If the disease isn’t quickly diagnosed and treated, permanent vision loss can occur. See your doctor ASAP.
GO TO A&E
YOUR speech has also become slurred, or you feel weak or numb in an arm, leg, and/or the side of your face:
You could be having a stroke. (Why are you still reading this article? Go to the hospital!)
YOU’RE feeling groggy and generally not quite right:
A headache associated with confusion, excess sleepiness, or personality changes may indicate high pressure around the brain from infection, tumour or bleeding.
YOU have a fever and your neck also hurts:
An infection around the brain, known as meningitis, causes high fevers, headache, and neck stiffness/pain. Some people also become sensitive to bright lights.
The headache came on fast and furious:
Ones that go from zero to ten within a few minutes are known as thunderclap headaches. They’re often a sign of a serious and rapidly progressing problem, such as bleeding into the brain. You’ll need to get to A&E for an urgent brain scan.
Other people in the house are also having headaches for no apparent reason:
Forgotten to change the batteries on your carbon monoxide detector? Open the windows and get outside quickly.
A LUMP IN YOUR NECK
Because the neck isn’t encased with bones, it’s a common location for noticing lumps and bumps. Some of those growths have been there all along, even if you’re just noticing them. The larynx (voice box), for example, contains rings of cartilage that you can feel in the bottom, V‑shaped part of your neck.
In men, the Adam’s apple is another firm area that moves up and down with swallowing.
Other lumps, however, could be a new sign of a medical condition, ranging from the common cold to cancer.
Don’t worry just yet: Because the neck isn’t encased with bones, it’s a common location for noticing lumps and bumps…
TREAT YOURSELF AT HOME
YOU have, or just had, cold symptoms (fever, cough, sore throat and/or runny nose) and have tender neck lumps:
An upper respiratory tract infection is the most common and least dangerous cause of neck lumps. Infections such as the common cold are the usual culprits — the painful lumps are swollen lymph nodes (clusters of immune cells) reacting to your infection.
The nodes are usually tender, moveable and present on both sides of the neck.
Antibiotics are rarely necessary, and things should go back to normal in a week or two. Large (greater than one centimetre) nodes lasting for more than two weeks will require further evaluation with a scan.
SEE YOUR GP
YOU have a lump near the middle of your neck, feel hot all the time and have had unintended weight loss:
You could have an enlarged thyroid gland, known as a goitre; or a growth arising in the thyroid gland, known as a nodule (the thyroid helps to regulate your metabolism). You’ll need blood tests to check your thyroid function.
YOU have one or more firm, non-tender lumps and recently travelled to Mexico, India, South-East Asia or sub-Saharan Africa:
If you do travel off the beaten path, you may have contracted tuberculosis (TB); this can cause fever, night sweats, weight loss and chronic cough. In some cases, however, TB can primarily infect lymph nodes, usually in the neck.
YOU have recurrent high fevers and one particularly large lump:
You may just have a bad viral infection, but you could also have a bacterial infection in your throat or nearby lymph node. Your doctor may try prescribing antibiotics. If the lump remains, you’ll need tests to look for persistent infection or alternative explanations.
YOU have a rock-hard lump that does not move:
Hard nodes that are firmly attached to one spot are more likely to be cancer.
GO TO A&E
YOU have a muffled voice or experience difficulty swallowing:
These symptoms indicate the lump is compressing vital structures in your throat. You need an emergency evaluation to ensure your airway isn’t about to close down.
BLOOD IN URINE
Most discoloured urine doesn’t contain actual blood, but some by-product of your food or medicine that looks like blood.
So, do you keep swigging water and pray your urine clears up . . . or visit A&E?
Did you know? Most discoloured urine doesn’t contain actual blood, but some by-product of your food or medicine that looks like blood…
TREAT YOURSELF AT HOME
YOU just had a beetroot salad or soup:
After eating beetroot, some pigment may get absorbed into your blood and colour your urine. Interestingly, people with anaemia are more likely to absorb beetroot pigment into their blood, so if you’re feeling short of breath and find that the veg is turning your urine redder than usual, get tested for anaemia.
IT’S that time of the month:
In almost all cases, your urine is just being contaminated with menstrual blood.
YOU just ran a marathon:
Nearly one in four people experiences bloody urine after intense aerobic exercise, such as long-distance running or swimming. Doctors don’t know why it occurs, but it hasn’t been linked to long-term kidney problems.
If your muscles are really hurting after an intense workout, you could have a different condition called rhabdomyolysis (muscle breakdown). The damaged muscle fibres release chemicals that colour the urine brown and can cause kidney failure. The condition is serious and warrants a trip to A&E.
SEE YOUR GP
YOU look like the Michelin man:
The combination of red urine and body swelling, particularly in the face and legs, strongly suggests kidney damage.
The struggling kidneys can’t get rid of fluid fast enough, so it instead ends up under your skin. The kidneys also fail to keep blood out of your urine. You need an urgent evaluation to identify the cause and begin treatment.
YOU take lots of pain medicine:
If you take pain medications known as non-steroidal anti-inflammatory drugs (such as ibuprofen, naproxen or aspirin) for a long time in high doses, you could experience kidney damage. In some cases, the first symptom is bloody urine.
If you suffer from chronic pain, consult your doctor to find a long-term treatment plan that’s both safe and effective.
YOU take a blood thinner:
If you have heart disease or a history of blood clots, you might be on a blood thinner such as warfarin, apixaban (brand name Eliquis), rivaroxaban (Xarelto), or dabigatran (Pradaxa).
One inevitable consequence of these drugs is the increased risk of bleeding. Sometimes the bleeding is from something minor, such as a tiny burst vessel in your bladder. Sometimes, however, the bleeding is from a problem that requires immediate attention, such as a tumour. In this case, the blood thinner may have saved your life by revealing the problem early.
YOU’RE a man, and your urine dribbles out:
You’re likely to have an enlarged prostate. With age, the prostate gland wraps around the urethra (the tube that drains urine from the bladder). As the prostate gets bigger, the urethra gets squeezed, and you have to generate more effort to force urine through.
The enlarged prostate can bleed into the urethra, turning urine red. You’ll probably need tests to rule out less likely but more serious conditions such as prostate cancer.
GO TO A&E
YOU have spasms of severe pain in your lower pelvis and/or back:
You’re probably passing a kidney stone — these can get stuck in the tube that drains to the bladder. As that tube tries to squeeze the stone through, you experience spasms of intense pain.
As the stone inches its way down, it often shears a few blood vessels. Once the stone finally reaches the bladder, the pain and bleeding should slow down. You should get to A&E for an urgent assessment.
YOU have fever, chills and feel lightheaded:
You probably have a severe infection in your kidneys or bladder requiring intravenous fluids and antibiotics.
Dr Christopher Kelly, a senior clinical fellow, and Dr Marc Eisenberg, an associate professor of medicine, work at the New York-Presbyterian Hospital/Columbia University Medical Center in the U.S.
Adapted from Am I Dying?!, by Christopher Kelly and Marc Eisenberg (William Morrow, £20). To order a copy for £16 (offer valid to March 19; p&p free), visit mailshop.co.uk/books or call 0844 571 0640.
To share your stories with the authors, go to amidying.com
WILL INDIGESTION PILLS DO – OR SHOULD I CALL AN AMBULANCE?
Phew! If you’re having chest pain and haven’t already called an ambulance, you’ll be relieved to learn that most of the time it turns out to be wind or a pulled muscle
With chest pain, the main worry is that it could indicate a heart attack, which means part of the heart muscle is no longer receiving adequate blood flow.
If you’re having chest pain and haven’t already called an ambulance, you’ll be relieved to learn that most of the time it turns out to be wind or a pulled muscle.
But how do you know which way it’ll turn out? Do you need emergency heart surgery? Or just an antacid?
TREAT YOURSELF AT HOME
You strained your chest, and now have sharp chest pain when you twist your body or raise your arms:
Perhaps yesterday you decided to go all out at the gym or took a tennis ball in the ribs. Either way, if your pain is worse when you contort your chest, it’s likely to be from a sore muscle or even a rib fracture.
As long as the pain isn’t disabling, soldier on with an ice pack and ibuprofen. See your doctor if you took a major blow to the chest and now have shortness of breath or tenderness over multiple ribs.
You have sharp pain in one spot when you take a deep breath:
The most likely explanation is that you pulled one of the muscles between your ribs, which produces sharp pain when you take a deep breath and stretch it out. The pain usually improves with ibuprofen or paracetamol.
If you also have a fever, chills and a cough, you could have pneumonia, an infection in the lungs. The infected area inflames the adjacent part of the chest, causing pain with deep breathing.
If you do think you have pneumonia, see your doctor ASAP.
You had chest pain for a few seconds, but then it went away and hasn’t come back:
The truly fearsome causes of chest pain usually aren’t shy or short-lived. If you felt uncomfortable for a single, short episode (lasting less than a minute), you may have just had wind or a brief muscle spasm. You can safely wait to see if it happens again.
You’ve been coughing a lot and now have sharp chest pain when you cough:
Repeated coughing bouts can pull chest muscles. They also irritate the airway. Both situations can result in sharp chest pain with coughing. Thankfully, neither is a big deal. The cough, on the other hand, may be a reason to see your doctor.
SEE YOUR GP
You get chest pain when you really exert yourself, and you feel better with rest:
The arteries supplying your heart muscle with blood may have severe blockages (also known as plaques). As a result, the heart isn’t getting enough flow when it’s working hard and needs extra blood. You may need an exercise stress test.
You have sharp chest pain that improves when you lean forward, but you otherwise feel fine:
You may have an irritation of the lining around the heart, a condition known as pericarditis.
This can be an isolated problem, can occur alongside or shortly after a bad cold, or can be a sign of a serious disease, such as the autoimmune condition lupus.
See your doctor as soon as possible. If you also feel lightheaded or very short of breath, just head to A&E.
You get burning chest pain after eating or when you’re lying down:
You may also have a sour taste in your mouth: You could have acid reflux, where digestive juices from the stomach bubble back towards the mouth.
If a glass of water improves the pain, consider the diagnosis confirmed (since water washes acid back down into the stomach).
Try taking antacids to neutralise your stomach acid. If those fail, try taking ranitidine (brand name Zantac) or omeprazole, which you can get over-the-counter from your pharmacist; these stop the stomach from generating acid in the first place.
If the problem (or need for medications) lasts for more than two weeks, see your doctor.
GO TO A&E
You’ve had severe, constant, pressure-like chest pain for several minutes, and it’s not getting better:
You may be having a heart attack; call an ambulance.
YOU’RE also short of breath:
The combination of chest pain and shortness of breath can indicate a heart attack, fluid around the heart, a blood clot in the lungs, a bad asthma attack or pneumonia — all require prompt attention in A&E.
You have sharp chest pain along with a fever and cough:
You could have pneumonia. See your GP today. However, if you’re feeling lightheaded or really short of breath, go to A&E.