Am I Dying Read online

  Get to the E.R.

  You have severe eye pain. A whole slew of scary stuff, affecting all the different parts of your eye, can cause sudden eye pain. Your vision may be at risk. See an eye doctor before the end of the day. If you can’t get an appointment anywhere, just go to the E.R.

  You have sudden vision loss or double vision (and didn’t just drink your eighth tequila shot). If you would like to get normal vision back, please rush to the emergency room. Some conditions that cause sudden vision loss, like blockage of the artery supplying the eye with blood, require treatment within ninety minutes. Visual changes can also indicate a life-threatening problem with the brain, like stroke or bleeding.

  You have a red eye associated with pain above the eyebrow, blurred vision, nausea, and halos while looking at lights. You likely have acute glaucoma, which occurs when there is a rapid and sudden increase in the pressure inside your eye. You need urgent treatment to lower the pressure in your eye and prevent permanent vision loss. Get to an eye doctor or E.R. right away.

  One eye is swollen and painful to move, and may have blurred vision. You could have a serious bacterial infection around the eye known as orbital cellulitis. This infection often reaches the eye socket from a nearby sinus infection. You need an urgent evaluation and may require treatment with antibiotics. Some cases even require surgery.

  You have headache, eye pain, and a blistering rash near your eye. You may have a particularly nasty version of shingles. This condition occurs when the chickenpox virus, which has likely been lurking in your body since childhood, reactivates and causes a painful rash. The rash can occur anywhere, but when it involves the area around the eye, your vision can be in trouble. The first symptoms are usually headache and tingling near the eye. The rash then appears, sometimes causing eye redness and a lid droop. You need urgent antiviral medication and possibly steroids to prevent vision loss.

  Hearing Loss and Ear Pain

  EDITED BY JASON A. MOCHE, M.D.

  Like to crank up your favorite jams while you work out or drive? Does the volume on your speakers go up to eleven? Do you also find yourself saying “huh?” and “what?” a lot?

  The ears are complicated, funny-looking, and deeply underappreciated organs. For example, have you ever heard a positive comment about the size or shape of someone’s ears? For all the Dumbos and Spocks out there, we feel your pain.

  The ear is divided into three main sections. The external ear is the part you can—but should not—probe with fingers and Q-tips. Sound waves travel through the external ear until they hit the eardrum and make it vibrate. Just behind the eardrum is the middle ear, which contains small bones that amplify those vibrations. Just behind the middle ear is the inner ear, which converts those vibrations to electrical and chemical signals for your brain.

  In addition to hearing loss, ear problems can cause intense pain, a constant ringing sound (tinnitus), frequent popping, and the sensation that the room is spinning (vertigo).

  So is your ear fullness and hearing loss a sign of too much wax? Do you need to mortgage your home to buy a hearing aid? Are those voices in your head just your conscience—or is it time to get an MRI and make sure you don’t have a brain tumor?

  Take a Chill Pill

  Your ears are frequently popping. The middle ears are closed spaces. If the pressure in the middle ears differs from the air pressure surrounding your head, you’ll experience pressure or even pain. To keep the pressures equal, the middle ears can briefly open to the back of your throat (seriously) and let air in or out. The tubes making that connection are called the Eustachian tubes; yawning, swallowing, or blowing against a pinched nose pops them open. In a fast elevator or descending plane, you’ll feel your ears pop as the air pressure rapidly changes and your ears try to keep up. If you have a cold, you may experience pain and frequent popping because your Eustachian tubes are swollen or plugged with mucus. Decongestants (pseudoephedrine/Sudafed) and anti-inflammatory medications (ibuprofen/Advil/Motrin) can help unblock them. If you’re still struggling, try using a spray like Afrin, but only for a day or two. (More than that and you’ll have a hard time weaning off.)

  Make an Appointment

  You also have a toothache. Tooth and jaw pain can spread to the entire side of your face, including your ear (even if the ear itself is fine). If you wake up each morning with jaw and ear pain, you may be grinding your teeth at night and should consider sleeping with a mouth guard. Meanwhile, if your jaw frequently pops or cracks, you may have temporomandibular joint disease (basically, a misalignment in the joint connecting your jaw to your skull) and need to see an ear nose and throat (ENT) specialist. If you have constant, steadily worsening pain in your jaw and ear, you may have an infection and should get checked out soon.

  You have some hearing loss and the sensation of ear fullness. Earwax (also known by its fancy name, cerumen) looks gross but protects your ear canal from injury and infection. Your ears should naturally expel extra wax, but sometimes it just accumulates and blocks the canals altogether. Symptoms include ear fullness, hearing loss, itchiness, ringing in your ear, and cough (since stimulation of the ear canal causes cough).

  Cotton swabs are notorious for pushing wax deeper into the ear and packing it into a solid mound. Hearing aids and earbuds can also block wax from exiting the ear. Furthermore, as we age, our ears tend to produce a harder, drier wax that doesn’t easily come out. As a result, up to one-third of older adults need to routinely have their earwax removed by a professional. (Just add it to your usual self-care routine: mani, pedi, earwax removal.)

  If you require frequent visits to have your wax removed, speak to your doctor about whether you should use over-the-counter Debrox ear drops every three to four weeks to prevent significant wax accumulation. Be aware that more frequent use of Debrox drops can irritate the ear canal.

  You have ear itchiness and discharge, and you get ear pain when you pull on your earlobe. You likely have an infection of the outer ear canal known as otitis externa. This condition is particularly common in swimmers, since the constant wetness creates the perfect breeding ground for bad bacteria. External ear infections are also common in people who regularly attempt to dig out their own earwax, since they may cause small skin breaks that allow bacteria to settle. (Also, earwax itself protects against infections because it is slightly acidic, making it harder for bacteria and fungi to grow.)

  If you think you have an external ear infection, see your doctor for antibiotic ear drops (which may also include steroids). If left untreated, a bad infection can spread to the surrounding skin and even bones of your skull. The people at highest risk are older adults with diabetes and people who take medications to suppress their immune system.

  If you have frequent external ear infections, make sure to dry your outer ear with a towel after taking a shower or swimming. If you’re a swimmer, speak to your doctor about using alcohol-based swimmer’s ear drops (available at your drug store), which help dry the ear canals.

  Of note, not all itchy or painful outer ears are infected. People with eczema (see here) or psoriasis (see here) can also develop skin lesions in their ears that cause similar symptoms. Skin cancer can also occur very rarely in the ear canal, causing pain and bloody discharge.

  You have fever and intense ear pain. You may also have hearing loss. You likely have a middle ear infection, also known as otitis media, which can be caused by a virus, bacteria, or fungus. The infection usually starts in the throat or nose/sinuses, then causes fluid to build up in the ear and become infected.

  Middle ear infections are very common in young children because their Eustachian tubes (which connect the middle ear and the throat) are smaller and oriented differently compared to those of adults, and children’s tubes don’t allow for adequate drainage. As a result, bacteria get stuck in the middle ear and easily establish infection. As people get older and their Eustachian tubes mature, infections become less common. When compared to external ear infections, middle ear infections tend
to cause pain deeper in the ear that is worse when lying down. Hearing loss is also more common.

  If you have pain, take nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen/ Advil/Motrin (400 to 600 milligrams every eight hours) or naproxen/Aleve (220 to 500 milligrams twice per day). You’ll probably need antibiotics to avoid serious complications, like mastoiditis (infection spreading to bone just behind the ear), irritation of facial nerves, and hearing loss. See your doctor for a same-day appointment.

  Everyone tells you to turn down the television, and you have a hard time following the conversation at restaurants. You likely have hearing loss, which can occur because of age (presbycusis), frequent exposure to loud noises, medications that damage the ears (see here), and other reasons. People with high blood pressure, diabetes, and a history of smoking are at higher risk due to narrowing of the arteries to the ears. For most people, hearing problems get even worse when there’s competing background noise, like clatter at a restaurant. Your doctor should perform a complete ear exam to rule out issues like wax, and you should see an audiologist for a complete hearing test. You should consider hearing aids, even with their shockingly high price tag, since poor hearing can cause social isolation and depression. The new versions are very small and inconspicuous, and they can even connect with your cell phone. If you also have buzzing in your ears, hearing aids may help with that too. If hearing aids fail, you may be a candidate for a cochlear implant, an electrical device implanted deep in your inner ear.

  You hear a constant ringing or buzzing sound. Tinnitus is the perception of buzzing or ringing in one or both ears. It can occur after exposure to loud noises, which damage the inner ear and also cause hearing loss, or for no clear reason at all. High-risk groups include smokers (yet another reason to quit) and older adults. In fact, tinnitus is pretty common in older adults and is associated with age-related hearing loss (presbycusis). In rare cases, tinnitus results from abnormalities in blood vessels (often resulting in pulsatile sounds), an ear tumor, or problems in the neck, jaw, or head. Asymmetric tinnitus (present in one ear but not the other) is even more concerning for a specific, localizable problem and requires an ENT evaluation. Tinnitus that comes on suddenly and is associated with dizziness also needs to be checked out urgently. To prevent this extremely annoying condition, wear earplugs when you expect to encounter loud noises (like at concerts or football games) and keep the volume on your headphones below 80 percent. If you have tinnitus, your doctor will likely order a hearing test and, depending on your symptoms, may order an MRI of your head.

  You experienced hearing loss after taking a new medicine for a few weeks. Several medications can cause hearing loss, tinnitus, and vertigo. These symptoms usually resolve once you stop the medication. However, some medications may cause more permanent damage, particularly the antibiotics called aminoglycosides (gentamicin, tobramycin, and neomycin), used to treat serious infections. When prescribing them, doctors usually closely monitor the drug levels. Several chemotherapies such as cisplatin, fluorouracil, nitrogen mustard, and bleomycin can also cause permanent hearing loss.

  Medications with temporary ear side effects include the antibiotics erythromycin and tetracycline (used to treat pneumonia and acne), water pills like furosemide/Lasix, the malaria medications chloroquine/Aralen and quinine, and aspirin at high doses (taking over sixteen pills a day of the 325-milligram tablets). Taking acetaminophen/Tylenol or ibuprofen/Advil/Motrin more than twice a week for a long time has also been associated with hearing loss and tinnitus. Please speak to your doctor before stopping any medications.

  You have hearing loss, ringing in one ear, and frequent episodes of vertigo. If you have occasional vertigo (lasting twenty minutes to a few hours), hearing loss, and tinnitus (ear ringing), you may have Ménière’s disease. This condition usually affects people between the ages of twenty and forty. It’s thought to result from excess fluid pressure in your inner ear. Salty foods, caffeine, alcohol, MSG (the food additive, not the arena in New York), stress, and smoking can all trigger attacks. Your doctor can prescribe medications to take during an attack. A low-salt diet along with certain medications, known as diuretics, may help lower the pressure in the ear and reduce the likelihood of attacks. Your doctor will also likely order a brain MRI to rule out some other, even scarier causes of these symptoms—like aneurysms (dilated blood vessels), tumors, and multiple sclerosis.

  Get to the E.R.

  You have sudden loss of hearing or severe ear pain. You may have an infection of your inner ear, a blockage in one of the arteries to the ear, or a ruptured eardrum. You need a prompt evaluation to determine the appropriate treatment.

  You have ear pain along with headache, confusion, and a stiff neck. Your ear infection may have spread into the skull, where it can cause meningitis (irritation of the outer lining of your brain), a blood clot (in the veins that drain blood from the brain), and infection of the brain itself.

  Lump in Your Neck

  The neck provides a nice, squishy break from the hard bones of the skull and rib cage. It contains the spinal cord, major blood vessels to and from the head, esophagus (connects mouth to stomach), trachea (connects mouth to lungs), thyroid gland (regulates metabolism), parathyroid glands (regulate calcium levels), and multiple chains of lymph nodes (packed with immune cells). All of which have, over the years, made the neck the perfect target for a hungry predator seeking to quickly turn off your lights. Wearing the label JUICY has not always been a good thing.

  Because the neck isn’t encased with bones, it’s also 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, 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 in the center of the neck that moves up and down with swallowing.

  Other lumps, however, could be a new sign of a medical condition—ranging all the way from the common cold to full-blown cancer. So should you wait it out and see if it goes away? Or rush over to your doctor’s office for a biopsy?

  Take a Chill Pill

  You have, or recently 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 like the common cold or infectious mononucleosis (a.k.a. mono) are the usual culprits. The painful lumps are actually swollen lymph nodes (clusters of immune cells) reacting to your infection. The nodes are usually tender, movable, and present on both sides of the neck. Antibiotics are rarely necessary, and things should go back to normal within a week or two. Large (greater than one centimeter) nodes lasting for more than two weeks require further evaluation with a neck scan. Of note, if you have risk factors for HIV, like unprotected sex or intravenous drug use, the combination of fever, headache, sore throat, and tender neck lumps could indicate recent HIV infection. (See the next section for details.)

  Make an Appointment

  You’ve had a small lump in the center of your neck since childhood, which moves up when you stick out your tongue. Sometimes the building doesn’t exactly match the blueprint. In the case of your neck, a slight error in development can produce a round structure known as a thyroglossal duct cyst. This type of cyst is located near the center of the neck, about an inch or two below the jaw. It’s attached to and moves with the tongue. The diagnosis can be confirmed with a neck scan. Because the cyst can get infected, it’s usually removed.

  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, known as a goiter, or a growth arising in the thyroid, known as a nodule. The thyroid gland helps regulate your body’s metabolism. Abnormal growths can lead to unregulated production of thyroid hormone, sending your metabolism into overdrive. (In some cases, an enlarged thyroid actually works less than normal, leading to a slow metabolism, weight gain, and fatigue.
) You’ll need blood tests and a neck ultrasound. If the growth is larger than one centimeter, it may need to be biopsied.

  You have one or more firm, nontender lumps and recently traveled to Mexico, India, Southeast Asia, or sub-Saharan Africa. Did you visit a luxury spa or the local men’s shelter? If your travel habits skew off the beaten path, you may have contracted tuberculosis, or TB. TB is best known for causing fever, night sweats, weight loss, and chronic cough. (If you have those symptoms, please step out of our subway car and see a doctor right away.) In some cases, however, TB can primarily infect lymph nodes, usually in the neck. There’s no way to confirm the diagnosis without removing and testing the swollen nodes.

  You have multiple tender lumps, and you’ve had unprotected sex or used intravenous drugs in the past few weeks. You need to consider the possibility you’ve contracted HIV. In its early stages, the virus causes a flu-like syndrome consisting of fever, headache, sore throat, and tender, enlarged lymph nodes. Of course, there are plenty of other viral infections that can cause these symptoms—one major example is mono—but if you’ve had a possible HIV exposure, you need to get tested. Trying to ignore the problem won’t make it go away and may lead to preventable complications.

  You have a rock-hard lump that doesn’t move. Hard nodes that are firmly attached to one spot are likely to be cancer. Your risk of head and neck cancer is particularly high if you’re a longtime smoker or heavy drinker. You should see your doctor for a physical examination and, in most cases, a neck scan.

  You already have a known cancer. Cancer frequently spreads to lymph nodes, like those in the neck, and can then invade other organs. Notify your oncologist right away, as you may need urgent testing to determine if your cancer is progressing (like a PET scan, which looks at how active the cells in your lymph nodes are).