Symptoms you should not ignore

Winter 2009 CSANews Issue 73  |  Posted date : Dec 12, 2009.Back to list

It is always a sad event when someone develops certain ominous signs or symptoms and does not seek professional assessment in a timely period, consequently suffering irreparable damage or succumbing to the illness.

Travellers in particular must not postpone the early assessment of certain new symptoms that could lead to early diagnosis and treatment, just because they are away from home. Snowbirds, who are often away from their home for many months, should especially be reminded of the fact that early detection and treatment of many conditions, including cancer, can have a very positive outcome. For many reasons, people postpone seeing a doctor while away. Sometimes it's because they worry about cost or whether their insurance will come through. It may be a high deductible on their policy or, in some cases, they would just prefer to see their own doctor. For some people, it's just denial that the symptoms might not be serious.

My personal experience was with my sister, who had been travelling in Europe for several months and did not seek attention for her changing bowel habits. Upon return to Canada, the diagnosis of colon cancer was established but, unfortunately, it had already spread to her liver. She died 18 months later at the age of 53. A close friend of mine was on his winter holiday in Florida and developed stomach pains, getting initial relief with antacids. When his Florida physician recommended a gastroscopic examination because of his persistent symptoms, his insurer would not "authorize" it. Not wanting to go home, he put up with the discomfort until his own doctor in Ontario diagnosed inoperable stomach cancer upon his return several months after the onset of his symptoms. Another friend, a 70-year-old man who still smoked, developed chest pain one evening, thought it was indigestion and took some antacid without relief. He did not seek medical attention until the following morning, when he walked into the emergency department. He died an hour later from his major heart attack.

We know that prompt treatment of many conditionscan have a profound effect on the outcome. These are just three examples in which earlier intervention may have made a big difference. Pay attention to new and persistent symptoms. The following are my 10 symptom groups which you should not ignore.

Neurological Symptoms
Remember the most common signs and symptoms of a TIA (transient ischemic attack, "little stroke") or stroke. Signs are what you or someone else notice and symptoms are what you experience. The Heart and Stroke Foundation lists the five warning signs of stroke as:

Weakness – Sudden loss of strength or sudden numbness in the face, arm or leg, even if temporary.

Trouble speaking – Sudden difficulty in speaking or understanding, or sudden confusion, even if temporary.

Vision problems – Sudden trouble with vision, even if temporary.

Headache – Sudden severe and unusual headache.

Dizziness – Sudden loss of balance, especially with any of the above signs.

Even if these occur for only minutes before resolving, you need to call 911 or the local emergency number immediately. In the case of a blood clot causing these symptoms, the emergency use of the clot-busting drug called tPA can often prevent a permanent disabling stroke. Furthermore, certain investigations will be done to detect and treat any underlying condition which may have caused the symptoms, in order to prevent a recurrence or major stroke.

Visual Changes:
There are two other conditions associated with sudden visual disturbances which merit immediate attention.

Retinal detachment is the most common sudden disorder. It may present as an onset of increased "floaters" or specs that float about in one's field of vision, light flashes in the affected eye, or a curtain-like effect over the field of vision. It more commonly occurs in a person who has had a previous detachment, has a family history, is extremely nearsighted, or has had cataract surgery. Immediate examination by an optometrist or ophthalmologist is essential to diagnose and treat this condition. Laser treatment or surgery can prevent permanent damage or blindness in more than 90% of cases.

Acute glaucoma is another eye condition requiring immediate assessment. Although not as common as chronic glaucoma, this type of increased pressure in the eye occurs in a matter of hours, is associated with severe pain in the eye and sometimes nausea and vomiting. The eye can look red and blurring of vision can occur. The condition can be successfully treated if urgently managed by an ophthalmologist. The consequences of procrastinating can be cataracts, chronic glaucoma or even permanent loss of vision in the affected eye.

Respiratory Symptoms:
There are common conditions affecting our breathing such as colds, influenza, asthma and emphysema, but the onset of respiratory symptoms not associated with these conditions or different from the usual symptoms can indicate a new and sometimes serious condition. New and persistent cough in the absence of other "cold" symptoms, chest pain, coughing up dark phlegm or blood-tinged sputum are symptoms requiring urgent medical assessment. Although not necessitating an emergency room visit, an appointment in a doctor's office should be arranged within a few days. Lung cancer is the most worrisome possibility, especially for smokers or former smokers and, as with other types of cancer, early treatment can often result in a cure.

Sudden, severe chest pain associated with shortness of breath can be caused by a pulmonary embolism (blood clot in the lung) and requires an immediate 911 call.

Upper Gastrointestinal Symptoms:
The most common symptom is "heartburn." For many, this is a chronic symptom for which they take an occasional antacid or are on an acid-reducing medication from their doctor. More common in persons who are overweight or who ingest spicy foods and excess alcohol, the condition has been diagnosed and treated by their home physician. New-onset heartburn characterized by pain in the upper abdomen or behind the breastbone, though often relieved by antacids or milk, can be the sign of more serious problems. As in the case of my friend, postponing evaluation of these symptoms by a physician may have disastrous results. Again, this requires much more immediate attention. Esophagitis, esophageal or gastric tumour, hiatus hernia or ulcer are possible causes, all of which should be treated without delay.

Bowel Symptoms:
Colon cancer, if detected in its earliest stage, can be associated with total cure and yet this is one of the most common causes of cancer death in the senior age group. In addition to regular screening by your home physician through fecal occult blood tests or colonoscopy, early notification of new bowel symptoms, even if away from home, can make a huge difference to the outcome. A change in bowel habits such as constipation, episodes of diarrhea or blood in the stool could indicate early colon cancer. Early diagnosis and removal by colonoscopy or surgery can result in a cure, in many cases.

Heart Symptoms:
No other set of serious new symptoms is ignored with such frequency as those experienced with a heart attack (myocardial infarction). Many lives could be saved if persons familiarized themselves with the symptoms of lack of oxygen to the heart muscle, and if they sought immediate medical care. This is especially the case with women. For many who have suffered from angina or have been treated for known heart disease, the onset of cardiac symptoms may be familiar and immediate calls are made. In the absence of previously known heart disease and heart symptoms, particular attention should be paid to these listed symptoms. This is particularly important to those more likely to have undiagnosed coronary artery narrowing, such as diabetics, those who have a history of tobacco use, high cholesterol, high blood pressure, obesity or a family history of heart disease. Symptoms include the onset of tightness in the chest, crushing chest pain, or discomfort into the jaw or down the left arm. Pain may come on with exertion or even at rest. There may be perspiration with or without some shortness of breath. Women can experience these symptoms as well, but often experience symptoms other than pain, thereby reducing the suspicion that they may be suffering a heart attack. Women may have shortness of breath, weakness and unusual fatigue, may perspire and/or suffer dizziness. They often have a history of fatigue, insomnia, shortness of breath and anxiety. Both men and women suffering from suspicious new symptoms such as these should call 911. Often, the spouse will have to "take control" when there is procrastination on the part of the patient! Early intervention with clot-busters, angioplasty or bypass surgery may make a huge difference to the outcome.

Skin Changes:
A commonly delayed treatment is the development of worrisome skin changes. Most skin cancers develop on exposed surfaces which are readily noticeable. Most skin cancers are slow-growing and are characterized by a small ulcerating or growing "mole" which is changing or not healing. Malignant melanoma often presents as an irregular-bordered mole with multiple colours, often growing larger than 6 mm. Because it may occur anywhere on one's body, monthly skin checks by your spouse is good advice for picking up suspicious spots that you cannot see. This highly malignant tumour requires very early attention in order to achieve the best outcome. Have a physician assess the suspicious spot before you return, and determine whether immediate removal is recommended.

Acute Abdominal Pain:
Fortunately, this symptom usually results in one seeking medical attention early and is the least likely to be ignored. For acute pain in a senior, a 911 call is indicated because there are several conditions which demand immediate surgery, the most notable being a leaking abdominal aortic aneurysm. A bowel obstruction or twist, acute gallstone and acute appendicitis are some of the other conditions requiring immediate treatment.

Acute Back Pain:
Back pains are common to us all but, when they are muscular or skeletal in origin, we usually know. Unexplained back pain must always be urgently assessed and in the case of the sudden onset of severe pain, immediate assessment is necessary because of the possibility of kidney stone, ruptured aortic aneurysm and acute disc problems, among others.

General Symptoms:
The gradual onset of new symptoms of a general nature should also not be ignored, however, there is often a period of time before individuals seek medical attention. Such symptoms include increasing fatigue, unexplained weight loss, palpitations, insomnia, joint pains, muscle aching, etc. If such symptoms persist, make an appointment to see a physician sooner rather than later. There may be a diagnosis and effective treatment for your symptoms.

Snowbirds in particular should be aware of the importance of early diagnosis and treatment of many conditions. While away from home, most winter travellers are able to locate excellent local medical services when unexpected symptoms of a worrisome nature arise.

If there's an emergency, seek help immediately. In other cases, your health insurer is there to offer help and guidance in seeking out the most appropriate medical care. And a few companies have trained medical staff available 24/7 who are there to assist when you need us.