Five Signs That Something May Be Wrong

Is your body trying to tell you something? There are a variety of medical symptoms that may be manifestations of a more serious, underlying health problem. The following is a description of five common symptoms that may signal that it is time to visit a physician for a more complete evaluation.

1. Blood in the Stool:
Colorectal cancer kills more Americans than breast or prostate cancer combined, more than 50,000 deaths a year, and blood in the stool is one of the signals that should be investigated. If you are older than 50 and have no family history of this cancer, or are experiencing rectal bleeding at any age, it is time to schedule a colonoscopic evaluation, says Mark Gilder, M.D., Section Chief of Colon and Rectal Surgery at Saint Barnabas Medical Center.

“Those with a family history of colorectal cancer should have this test performed before any bleeding occurs, and screening should be earlier and more frequent than those with no family history,” he adds. “This is a true test that can actually prevent cancer, and it is one of the most effective tools for both diagnostic evaluation and treatment.”

Dr. Gilder says a good rule of thumb for those with a family history is to have a colonoscopic evaluation “ten years before the individual’s relative was diagnosed.”

SYMPTOMS: In addition to rectal bleeding, the individual with colorectal cancer might experience changes in the size or caliber of bowel movements, weight loss, abdominal pain or discomfort and fatigue.

PREVENTION: In addition to regular screenings, individuals should consider lifestyle changes such as eating a low fat, high fiber diet, exercising, lowering cholesterol and reducing stress.

TREATMENT: Any polyps that are found through a colonoscopy, Dr. Gilder’s test of choice, are removed during the test. “We consider polyps to be a pre-malignancy that might degenerate into cancer in 5-10 years,” says Dr. Gilder. If polyps or growths are recognized as cancerous, the next step is surgery. After surgical resection, the final pathology of the cancer dictates if adjunct therapy is required. For colon cancer, chemotherapy, administered by a medical oncologist, is the adjunct treatment of choice. The treatment of rectal cancer can involve not only surgery but also a team approach including medical oncology as well as radiation therapy.

For those interested in learning more about colonoscopy, Dr. Gilder recommends viewing celebrity Katie Couric’s website, using herself as a patient, at MSNBC.COM.

For a referral to a Saint Barnabas colorectal surgeon in your area, please call 1-888-SBMC-DOC.

2. Frequently Feeling Run Down:
Thyroid problems, more commonly found in women, can result in a lack of energy and/or a run down feeling. The thyroid, a gland in the neck, produces hormones that regulate metabolism. When someone has an underactive thyroid (hypothyroidism), he or she may gain weight, feel fatigued, constipated and possibly experience hair loss, dry skin, fertility problems, fluid retention or feel cold.

An underactive thyroid affects individuals to varying degrees, from those who experience no symptoms to others with a severe problem who may actually fall into a coma, says George Gewirtz, M.D., endocrinologist and Medical Director of the Endocrine and Diabetes Group, an affiliate of the Joslin Diabetes Center. One in 10 women will have an underactive thyroid.

SYMPTOMS: Those listed above, depending on the severity of the condition, or possibly no symptoms at all.

TREATMENT: A simple blood test of Thyroid Stimulating Hormone is taken and, if the TSH level is high, a measurement of thyroid hormones is performed. For the treatment of an underactive thyroid, an oral medication is taken to replace the hormone the thyroid is not producing, says Dr. Gewirtz. This medication is generally needed for the rest of the individual’s life and is very effective.

For a referral to the Endocrine and Diabetes Group, an affiliate of the Joslin Diabetes Center, please call (973) 322-7200.

3. Numbness/Muscle Weakness:
While many people are familiar with the symptoms of an impending heart attack, the warning signs of an imminent stroke, including numbness and muscle weakness, are frequently not well recognized.

“I had one patient, a 58-year-old, who had muscle weakness along the entire left side of her body,” says Allen Josephs, M.D., Co-Chief of Neurology at Saint Barnabas Medical Center. “Instead of seeking medical care immediately, she waited four hours before contacting a physician. This individual was not paying close enough attention to what her body was telling her.”

A stroke, akin to a brain attack, occurs when blood flow to the brain is either decreased, because of a clot or obstruction, or increased, as in a cerebral hemorrhage. Particular groups, including older adults, diabetics, smokers, individuals with high cholesterol, young women taking female hormones and anyone with a family history of stroke, should seek medical treatment at the first symptom suggestive of an impending stroke.

SYMPTOMS: The five most commonly experienced precursors to a stroke that require immediate medical attention are the following:

• Sudden loss of vision in one eye: If you have a loss of vision that is akin to a curtain shade being drawn over one eye for a few minutes, the next episode could be “a full blown stroke,” relates Dr. Josephs. Many people are lulled into a false sense of calm by this condition, known as amaurosis fugax, because it lasts only a few minutes, then disappears. It occurs because blood is not getting to a main artery, and vision is restored as soon as the blood flow resumes. However, another clot could occur at any time and a stroke could quickly follow.
• Sudden double vision: This condition can occur because of loss of blood flow to the brain stem that controls eye
  movement. Images can either appear one on top of the other or side by side. When the individual closes one eye, the double vision will appear to be gone. The double vision may be transient, and many people erroneously think the event is the result of fatigue or eye strain.
• Sudden difficulty expressing yourself: A brain attack can leave the victim with an inability to speak in a comprehensible way, actually having difficulty “getting the words out,” says Dr. Josephs.
• Numbness of the extremities: Unlike the foot that has gradually fallen asleep, this numbness might leave the individual with no control over his or her hand or foot. Loss of balance may occur. When blood is not reaching a portion of the brain, speech and movement are often the first to be affected, says Dr. Josephs. As blood flow returns to the area of brain involved, speech and movement improve, however, the next episode could be a major stroke.
• Sudden, massive headache: If you feel like “someone suddenly hit you with a 2 by 4,” and you have the worst headache of your life, you may be experiencing an aneurysm. This is not a headache that builds gradually and can be helped with over-the-counter medication. About 30,000 people in the United States each year suffer from a ruptured aneurysm.

PREVENTION: When arteries to the brain are completely blocked during a stroke, a section of the brain tissue dies. Because of the damage a stroke can do, Dr. Josephs says the best way to treat a stroke is to prevent it. Through the use of CAT scan, MRI, blood tests and vascular studies, physicians in an Emergency Department can determine if a stroke is imminent.

TREATMENT: If the potential stroke victim can recognize the early warning signs, he or she can receive either anticoagulant medication or surgery to remove a blockage of an artery in the neck or brain. For those in the throws of a stroke, the use of Tissue Plasminogen Activator (TPA) is sometimes given in the three hours since the first symptoms occurred; however, its use is controversial because of the risk of bleeding into the brain.

For a referral to a Saint Barnabas Medical Center neurologist, please call 1-888-SBMC-DOC.

4. Sudden, Extreme Fatigue:
Prior to a cardiac event, the heart is generally not functioning as effectively as it should. As the heart loses its efficiency as a pump, an individual may begin to feel extreme exhaustion and experience shortness of breath or a feeling of heaviness in the chest. “Most physicians recognize that people report changes in their capacity to do work, which may be subtle, before a heart attack,” says Gary J. Rogal, M.D., Chief of Cardiology Services for Saint Barnabas Health Care System. “The feeling of fatigue may precede the cardiac event by several weeks.”

Dr. Rogal relates that it is generally found that men experience more “typical or textbook symptoms” prior to a heart attack, while women’s symptoms may be more atypical such as indigestion, abdominal or midback pain, nausea and vomiting, in the absence of classical chest pain.

SYMPTOMS: For some, a heart attack may not be preceded by any symptoms. On the other hand, many people experience extreme fatigue, shortness of breath, chest heaviness and chest pain, with radiation to the arm, neck or jaw, before a cardiac event.

PREVENTION: Risk factor modification includes controlling weight through diet, eliminating overconsumption of excessive cholesterol and saturated fats, exercising to reduce high blood pressure, eliminating cigarette smoking and working to control stress. In diabetics, tight control of blood sugar may help reduce risk as well.

TREATMENT: A medical examination might include a blood test for lipids, blood pressure check, full physical examination, a stress test or possibly an echocardiogram. If the workup does not indicate a current heart problem, the patient would be assessed on his or her risk for a future coronary event. If the patient has a heart in distress, treatment ranges from the use of medications to invasive techniques such as angioplasty or cardiothoracic surgery.

To reach The HEART HOSPITAL of New Jersey, please call 1 (888) 8-HEART-1.

5. Excessive Thirst and Frequent Urination:
One sign of diabetes is both excessive thirst and increased urination. The hormone insulin allows the transfer of sugar from the blood to the muscle and tissue. In Type 1 diabetes, the body produces antibodies that destroy the cells that produce insulin. In Type 2 diabetes, insulin is produced, but at a deficient level. Without the regulation provided by insulin, blood sugar rises to dangerous levels that can damage tissue, lead to stroke, heart disease and other complications.

“When the amount of sugar in the blood is very high it spills over into the urine, much like a dam that is overflowing,” says Dr. Gewirtz. “This extra sugar absorbs fluids from the body, resulting in both dehydration and excessive urination. Individuals may notice that they are getting up three and four times a night to urinate.”

In addition to those experiencing these symptoms, individuals should be given an annual blood test for diabetes if they are older than 45, overweight, sedentary, have a parent, brother or sister with diabetes, are African - American, Hispanic, Native American, Asian or are a Pacific Islander.

SYMPTOMS: Extreme thirst, excessive urination, extreme hunger, weight loss, fatigue and irritability are all symptoms of diabetes.

PREVENTION: For Type 2 diabetes, exercise and maintaining a healthy weight can lower your risk of developing the condition. “The number of people diagnosed with diabetes is exploding because of the increase in obesity,” says Dr. Gewirtz.

TREATMENT: Some diabetics can control their condition with diet, exercise and medications, while others require insulin injections.

For more information, please call The Endocrine and Diabetes Group, an affiliate of the Joslin Diabetes Center, at (973) 322-7200.