Am I Dying Read online

  There’s always a cloud above your head. Depression may present as forgetfulness and impaired concentration. Other symptoms include hopelessness, irritability, loss of interest in activities, fatigue, changes in appetite, loss of sex drive, sleep disturbances, and weight loss or gain. Interestingly, a depressed person usually acknowledges memory problems, whereas someone with Alzheimer’s usually denies or minimizes them. If you think you’re depressed, talk to your doctor about the many treatments that could improve your quality of life.

  Your ticker was recently under the knife. Heart surgery usually requires the use of a bypass machine, which may cause a condition known as bypass brain or pump head. Patients describe a vague mental cloudiness, with loss of memory and acuity. Speak to your doctor if you recently had open-heart surgery and believe your memory issues started soon afterward.

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  Quick Consult

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  Do Crosswords Prevent Dementia?

  You’ve probably seen ads for programs that claim to prevent dementia by exposing your brain to regular exercise—in the form of logic games, crosswords, and arithmetic. Perhaps you’re stocking up on Sudoku books to keep yourself sharp for your golden years.

  Unfortunately, it has been hard to separate hype from hard science. At present, there is no convincing evidence that any specific intervention prevents or delays the onset of dementia. Certainly, there’s no evidence that commercial cognition programs offer more benefits than less organized activities, like reading the newspaper and doing the crossword puzzle. Although some research has shown that the combination of brain exercises, actual physical exercise, and diet can improve brain function, the effect has been pretty small.

  Because there is no quick fix, the best plan is simply to maintain a healthy lifestyle: eat plenty of fruits, vegetables, and whole grains; minimize your consumption of red meat and added sugar; exercise often (at least thirty minutes of jogging, cycling, or aerobics most days per week); and remain socially active and engaged.

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  You were the star high-school quarterback. Chronic traumatic encephalopathy, or CTE, has been in the news lately because of the high frequency of this disease among professional football players. CTE results from repeated blows to the head and causes irreversible dementia along with headache, impulsive behavior, tremor, and depression. A related condition is known as dementia pugilistica, or “boxer’s brain.”

  Your memory has been gradually getting worse over the years, and now it’s interfering with your everyday life. People with dementia suffer progressive memory loss that interferes with everyday functioning and is usually noticed by other people too. Additional issues may include problems with speech, recognizing your location, or routine tasks. You need to undertake a complete dementia workup with your physician, which will consist of a thorough history and memory test, a review of your medications, some blood tests, and possibly a brain scan. The most common type of dementia in people over sixty-five is Alzheimer’s disease, which occurs when protein plaques build up in the brain.

  Get to the E.R.

  You’re not the person you were last week. If you experience the rapid onset (over the course of hours to days) of memory loss along with personality change, headache, and/or fever, you need to get to the E.R. for an urgent assessment, likely including a brain scan and possibly even a spinal tap (removal of fluid from around the spine for testing). You could have a brain infection, stroke, bleeding around the brain, or an imbalance in key chemicals in your blood.

  You caught a baseball with your face. A concussion is a mild brain bruise that results from head trauma. Common symptoms include confusion, dizziness, vomiting, headache, tiredness, and memory loss. See the section on head injuries for more details.

  Head Injury

  After a major head injury occurs, it’s usually clear that someone should call an ambulance. You may not be part of the decision anyway, if you’re unconscious.

  But what if your noggin sustains a lesser injury—one that’s bad enough to knock you over and elicit gasps from onlookers, but not so serious that your life is in obvious danger? This scenario comes up often during sporting events and among older adults who fall.

  The answer, of course, is that even minor head injuries can have devastating consequences, and that it’s always better to be safe than sorry. With that being said, some injuries may not require an immediate trip to the emergency room.

  So what should you do? Ask your friend to watch you sleep? Or ask your friend to call an ambulance? (As an aside, if you’re headed to the emergency room to get a head injury checked out, please do not drive yourself. This seemingly obvious insight is often overlooked. What happens if your brain gets woozy at sixty miles per hour?)

  Take a Chill Pill

  You didn’t lose consciousness, remember everything leading up to the injury, are under sixty-five years old, don’t take blood thinners, and feel completely fine. You probably dodged a bullet, but you need someone to watch you for any signs of deterioration. The complications that should prompt an urgent medical evaluation range from the obvious (seizure, confusion, weakness, not waking up) to the subtle (headache, stiff neck, excessive fatigue, vomiting). If you’re an athlete, you should stay on the bench until you’ve felt completely normal for at least twenty-four hours.

  Make an Appointment

  You hit your head a few days ago and now have frequent headaches. You may have post-concussion syndrome, which causes symptoms for days or even weeks after the initial event. Additional signs can include irritability, anxiety, depression, and dizziness (sounds like most medical students, come to think of it). Your doctor may perform a brain scan to ensure there’s no bleeding in or around the brain. If the scan is normal, the treatment is usually just supportive care: pain relievers for headaches and brain rest (avoidance of activities that require sustained attention, like reading and watching television) whenever possible.

  Get to the E.R.

  You’ve had worsening headaches or nausea/vomiting ever since the blow. The skull is a closed space with limited room. If you start bleeding into that space, the brain gets squeezed and loudly registers its displeasure, generating a headache and nausea. As blood continues to accumulate, your brain gets pushed farther down toward the neck and starts to abandon key tasks, like controlling your breathing, before calling it quits altogether.

  You lost consciousness. If your injury was bad enough to knock you out, you need an urgent evaluation. Some fatal brain bleeds cause an initial loss of consciousness followed by a lucid period, during which you wake up and feel perfectly fine. Over the following several hours, however, blood accumulates around the brain and can ultimately cause death.

  You’re over sixty-five years old. As you age your brain shrinks and can move around more easily inside your skull. In addition, the blood vessels surrounding the brain become more fragile. During a traumatic event, the brain can get jostled just enough to tear open those blood vessels. Even if you feel okay, you’ll probably need a brain scan to check for bleeding.

  You take blood thinners. Blood thinners significantly increase the risk of life-threatening bleeding in and around the brain. Although these medications don’t make blood vessels more fragile, they prevent clot formation and therefore make bleeds larger than they otherwise would be. Even if you feel fine, you should always get checked out.

  You can’t remember events from before the injury. Head injuries frequently lead to some degree of memory loss (amnesia). If your blow was bad enough to cause amnesia, you definitely need to see a doctor. If the amnesia is severe—meaning that it extends to events that were more than thirty minutes before your injury—you’ll need a brain scan.

  You have new-onset weakness or numbness. Sometimes a head injury is associated with a severe blow to an arm or leg, which breaks and therefore can’t be moved. If the limb seems physically intact but isn’t properly functioning, however, you may have sustained a serious brain or spinal cord injury. Get an ambulan
ce!

  You fell from a significant height. If your feet were more than three feet above the ground just before you fell, and your head hit the ground on impact, the odds of a serious injury are high enough to warrant a brain scan. And no crowd-surfing at your next concert, please.

  Red or Painful Eyes

  EDITED BY BRYAN J. WINN, M.D.

  The eyes are often described as a window into the soul. So if your eyes are red, swollen, or crusted with an infection, what does that say about your soul? Is it any wonder that people turn and run in the opposite direction?

  Before we solve the riddle of your red or painful eye, take a look in the mirror and get to know this organ a little better. The pupil is the black hole in the middle of your eye. It gets bigger and lets in more light in response to darkness. It also gets bigger in response to fear, which is good to remember at the poker table. Light goes through the pupil and gets focused by the lens.

  The iris is the band of color surrounding the pupil, and the sclera is the white surface surrounding the iris. When people complement your eyes, they’re talking about your irises. (It’s rare to hear: “What deep, penetrating pupils your eyes have!”) The conjunctiva is a thin layer overlying the sclera and the inside lining of the eyelids.

  The eyes turn red when blood vessels swell or burst. The most common causes are dry eyes, allergies, eye strain (definitely not from reading this book), and wearing contact lenses for too long. Unfortunately, red or painful eyes can sometimes signal a serious, sight-threatening condition. For example, acute glaucoma (elevated pressure in the eye) can cause a red, painful eye and rapid, permanent loss of vision.

  So if you have a red or painful eye, should you just quarantine yourself and regularly wash your hands? Should you get eye drops—and if so, which kind? Should you put on a pair of sunglasses and go to work anyway? Or should you freak out, see an ophthalmologist, and start searching Amazon for an affordable glass eye?

  Take a Chill Pill

  After staring at a computer, reading, or driving for a few hours, you get pain around your eyes, headache, and difficulty focusing. Eye fatigue, or strain, occurs when you focus for a long time and the muscles around your lenses get tired or spasm. Your eyes are not indentured servants and deserve routine vacations! If you’re working in a dimly lit room or just feel tired in general, you’ll experience strain even faster. Many people also don’t blink enough while working or reading, causing dryness (okay . . . blink!).

  Give your eyes a break at least once every thirty minutes by walking around and looking at faraway objects. In addition, ensure your workspace is brightly lit with minimal glare. If your eyes feel dry, use over-the-counter artificial tears two or three times per day. (If you use artificial tears more than that, stick with the preservative-free variety to avoid further irritation.) Avoid eye drops that claim to reduce redness, as they can actually irritate your eyes further. If you keep having this problem, see an eye doctor for a complete examination. In some cases, the only effective solution is prescription glasses.

  You have red, puffy eyes along with a fever, sore throat, and/or runny nose. The common cold is never a good look. Your sinuses become plugged up with thick mucus, pressing against and engorging the blood vessels around your eyes. You can reduce the swelling with anti-inflammatory medications (ibuprofen/Advil/Motrin), decongestants (pseudoephedrine/Sudafed), and saline nasal sprays. See your doctor if your symptoms continue for more than a week.

  You have red, itchy, watery eyes with dark circles and a runny nose. You likely have allergic conjunctivitis (allergies irritating your conjunctiva). The most common triggers are pollen, dust, pet dander, chlorine (if you’re a swimmer), and cigarette smoke. If you wear contact lenses, you may be allergic to the solution. Avoid potential irritants whenever possible, and try an over-the-counter antihistamine (loratadine/Claritin, cetirizine/Zyrtec, levocetirizine/Xyzal) or nasal spray (fluticasone/Flonase). If your symptoms continue, you can try over-the-counter allergy drops (such as ketotifen/Zatidor). Your eye doctor can also prescribe stronger antiallergy drops or even steroid drops.

  You have a pimple on your eyelid. You could have a blocked oil gland on your eyelid, also known as a stye. Do not—we repeat, do not—give in to the strong temptation to pop that sucker. (You may damage your eye and will also increase the odds of infection.) To reduce the swelling, make a warm compress by soaking a small hand towel with warm water, wringing it out, and then applying it to your closed eye for ten minutes. (Imagine you’re at the spa.) Repeat this routine every few hours for a few days. If you’re concerned about smearing your eye makeup, toss a couple fists full of dry, uncooked rice into a cotton sock (preferably a clean one!), tie a knot in the sock, and then microwave the sock for ten to twenty seconds until the rice is warm (not scorching hot). Place the sock over your eye. The rice will retain its heat for about five minutes.

  You have blood in the whites of your eye. You likely burst a small vessel on your eyeball, creating a subconjunctival hemorrhage (blood under the conjunctiva). Your friends may think you’ve been to hell and back, but the condition is not actually dangerous. It can result from high pressure in the veins around the eye, which occurs during coughing fits, multiple bouts of vomiting, or lots of eye rubbing. In some cases, blood shows up for no reason at all. The blood usually looks worse after the first two days as it redistributes, but it should disappear within two weeks. See your doctor if the bleeding keeps happening, or if it occurred after head injury and is associated with a headache.

  You have dark, puffy circles under your eyes. The dark circles under your eyes are actually enlarged veins near the skin surface. Fatigue, allergies, and frequent eye rubbing can cause that dreaded raccoon look. Some people also just inherit baggy-looking eyes, so perhaps you should pull out the photo album and figure out who passed along this gift. To reduce the swelling and discoloration, apply a cold compress by rinsing a washcloth under cold water, wringing it out, and laying it over your eyes for about ten minutes. If that doesn’t help, a dermatologist may suggest procedures to shrink the veins (for example, laser therapy).

  You wear contact lenses and have dry and/or red eyes at the end of most days. If you’re a bad match with either your solution or your lenses, you may experience itchiness and/or contact lens–induced dry eye (also known in cool medical circles as CLIDE). First, check your solution. If you are using a multipurpose solution to clean and store your lenses, switching to a peroxide-based solution may reduce irritation. Second, try applying lubricant eye drops before inserting your lenses. Third, if you use weekly or biweekly lenses, ask your doctor about switching to daily disposables. Fourth, never ever sleep in your contact lenses, no matter how lazy you’re feeling, because you’ll dry them out and significantly increase the risk of infection. Finally, if your eyes become irritated while you’re wearing contacts, take the lenses out and give your eyes a break!

  Your eyes get red, itchy, and/or painful when you light up. It shouldn’t be a surprise that the toxic fumes from cigarettes and other recreational substances can irritate your eyes. (When people pour out of a Phish concert with red eyes, it’s not because they’ve been reading so hard.) Smoking also increases your risk of developing cataracts (clouded lenses that are difficult to see through).

  Make an Appointment

  Your eyes are dry, like your humor. You may be one of the millions of Americans with dry eye syndrome, which primarily affects women, older adults, and contact lens wearers. Many medications can further worsen the dryness, including antihistamines, estrogens, some antidepressants, nicotinic acid, and amiodarone. Besides dryness, other common symptoms include redness, itchiness, increased light sensitivity, and the feeling that there’s a hair or other small object in your eye (even though there isn’t). A few simple solutions may help. First, use preservative-free artificial tears a few times per day. Second, avoid eye drops containing decongestants, since your symptoms can worsen when you try to stop using them. Third, wear glasses to protect your eyes from dr
y air. Finally, get a humidifier for your bedroom or workspace. If your symptoms continue, your doctor may recommend prescription drops.

  You have little eyes in your pelvis. Pregnancy causes hormonal changes that can leave your eyes looking bloodshot, itchy (especially with contact lenses), and sensitive to light. Just let your obstetrician know about your symptoms, which should improve after your baby is born—until, of course, the all-night feeding sessions begin.

  One or both eyes is red and slightly painful, with some discharge but no change in vision. You likely have conjunctivitis, or pink eye. This common, often highly contagious condition results from a bacterial infection, viral infection, or allergic irritation of the eyes. (In fact, it’s so contagious that if you’ve recently been to an eye doctor, you likely caught it there.) Discharge often accumulates overnight and sticks the lids together in the morning. In bacterial conjunctivitis (the most serious kind), a thick, pus-like oozing continues through the day. If your eyes look like they’re constantly weeping yellow goop, see an eye doctor for antibiotic drops. If instead you have clear discharge and minimal pain, you can probably get by with antihistamine drops (naphazoline-pheniramine/Naphcon, available at the drugstore) and a cold washcloth. Wash your hands often so you don’t infect others.

  You feel like someone is periodically hammering a nail into one of your eye sockets. Between these episodes, you feel fine. You may be experiencing cluster headaches. See the section on headaches for more details.