Am I Dying Read online

  You have recurrent high fevers and one particularly large lump. You may just have a bad viral infection, like mono, but you could also have a bacterial infection in your throat or neck. Your doctor may first try prescribing antibiotics to see if your symptoms improve. If the lump remains, you’ll need a neck scan to look for persistent infection or alternative explanations, like lymphoma (lymph node cancer, which often causes fever and night sweats).

  Your lump doesn’t sound like any of those already described. Any lump that grows rapidly or sticks around for more than two weeks probably needs further evaluation with a neck scan. There could be an innocent explanation for your lump, but you don’t want to miss the dangerous ones.

  Get to the E.R.

  You have a muffled voice or difficulty swallowing. These symptoms indicate the lump is compressing vital structures in your throat. You need an emergency evaluation to identify the cause and ensure your airway isn’t about to close down.

  Sore Throat

  Surrounded by lozenge wrappers? Can’t even swallow your spit without wincing in pain? Sore throats can be brutally uncomfortable but fortunately are generally not dangerous.

  The medical term for a sore throat is “pharyngitis.” Most cases result from viral infections and get better on their own within a few days. Less common causes of sore throat include bacterial infections, like strep throat, and environmental irritants, like cigarette smoke and dry air.

  Regardless of the cause, you might get some relief from menthol-containing lozenges and, if those don’t work, lozenges or sprays that contain benzocaine. But the best relief will come from addressing the underlying problem—which, of course, you’ll need our book to determine.

  So which is it—a new humidifier or a trip to the doctor for antibiotics?

  Take a Chill Pill

  You also have headache, a cough, and a runny nose. Most sore throats are caused by a viral infection, like the common cold. Other associated symptoms include fever, eye irritation, cough, and hoarse voice. Pain relievers (acetaminophen/Tylenol) and decongestants (pseudoephedrine/Sudafed) can help relieve symptoms, which should clear up in less than a week. If your symptoms persist, or you develop a cough with thick or green phlegm, call your doctor.

  There’s something in the air. Many airborne irritants, like cigarette smoke, pollen, animal dander, and household cleaners, can irritate your throat. If you have other allergic symptoms (itchy eyes, runny nose), you should try taking an over-the-counter antihistamine (loratadine/Claritin, cetirizine/Zyrtec, levocetirizine/Xyzal). You’ll also need to avoid the irritant whenever possible. (If you were looking for an excuse to evict your roommate and her cat . . . )

  Winter is coming. The crisp air of the late fall and winter can dry up and irritate your throat. A common symptom is waking up with a painful, itchy throat (from sucking down dry air all night), which gets better as the day goes on. Get a humidifier for your bedroom and you’ll feel much better.

  You raged at a football game last night. Excessive yelling can strain the muscles of the throat, causing soreness and hoarseness (as well as hearing loss in your family members seated nearby). Try gargling warm water and keeping your voice down. Instead of cheering so aggressively, why not do something more conservative, like painting your body with your team’s colors?

  You have a bitter taste in your throat and/or burning in your chest. You likely have acid reflux disease, which occurs when the acid from your stomach creeps back up toward your mouth and irritates your throat. See here for details and solutions.

  * * *

  Quick Consult

  * * *

  A Flu Good Tips

  The flu vaccine can cause the flu. FALSE

  The flu vaccine contains an inactivated version of the virus, which is not capable of causing the flu. Some people, however, have minor reactions to the injection. For example, you may have a day or two of mild redness and soreness at the site of your shot. A small number of people also experience headache, fever, and body aches for one or two days, which is not the flu but rather your immune system reacting to the vaccine. Everyone older than six months of age should get the flu vaccine to help prevent the flu. (If you are less than six months old and reading this book, please contact us immediately.)

  I got the flu vaccine last year, so I don’t need to get the flu shot this year. FALSE

  As we get older, we change. So too does the flu virus, which mutates and evolves between flu seasons. It’s important to get a new and updated flu shot every year, usually during October or November. The contents of the vaccine change to account for the different flu strains expected to hit the population during flu season, which is between November and April in the United States.

  If you get the flu shot, you can still get the flu. TRUE

  If you do get the flu vaccine, you can still get the flu; however, your chances are much lower, and your symptoms will likely be less severe.

  If you are pregnant you should not get the flu vaccine. FALSE

  The flu can be especially severe in pregnant women, even causing death. Therefore, it’s essential that all pregnant women get vaccinated as soon as the vaccine is available, regardless of trimester. Vaccination actually offers ongoing protection to babies even after birth, helping to bridge the gap until they are old enough to get their own vaccine.

  If you have an egg allergy you should not get the flu vaccine. FALSE

  Although some concoctions of the flu vaccine contain a small amount of egg, this minuscule amount should not cause an allergic reaction. If you have a history of severe, life-threatening reactions to eggs, you can still get the flu vaccine but as an extra precaution should do so in a doctor’s office (rather than a pharmacy). The only reason not to get the flu shot is if you have a history of a severe reaction (anaphylaxis) to the flu shot itself.

  If you’re coming down with the flu, there’s nothing you can do to stop it. FALSE

  If you think you’re getting sick with the flu, your doctor may prescribe an antiviral medication (oseltamivir/Tamiflu), which is most effective if started during the first forty-eight hours of your illness.

  During flu season, frequent hand-washing with either soap or alcohol-based sanitizers can lower your chance of catching the flu. TRUE

  The flu virus is transmitted in droplets of saliva that get sprayed into the air during speaking, coughing, or sneezing. These droplets can land on surfaces, get onto your fingers, and then cause infection when you touch your eyes or mouth. To keep yourself safe, avoid close contact with people who have flu-like symptoms (fever, headache, body aches, fatigue, sore throat, cough), wash or sanitize your hands a few times per day, and avoid touching your own face while in public places.

  * * *

  Make an Appointment

  You have white patches on your tonsils. Turn on your camera’s flash and snap a picture of the back of your throat. The tonsils are located to the sides of that ball that hangs in the back (which, by the way, is called the uvula—Latin for “the mouth’s disco ball”). If your tonsils are dotted with white spots, you may have strep throat. It can be hard to tell if the sore throat is from a virus, which does not require antibiotics, or strep, which does; however, signs that point to strep include high fever, enlarged lymph nodes in your neck, and the absence of a cough or runny nose. Your doctor can perform a rapid strep test to be certain. If the test is positive, antibiotics can help your symptoms improve faster and prevent rare complications like rheumatic heart disease.

  You have white patches all over your mouth and throat. You may have a fungal infection known as thrush. The usual signs include sore throat and small white patches on the palate (roof of the mouth), tongue, and tonsils. Thrush is generally a sign of immune suppression, either affecting just the mouth (perhaps from a steroid inhaler for asthma or COPD) or the entire body (from steroid pills, infections like HIV/AIDS). See your doctor for a workup.

  You can barely get out of bed. You may have the flu, even if you got your flu shot this season
. The usual symptoms include fever, body aches, fatigue, headache, sore throat, and cough. Most people recover within two weeks by resting, drinking plenty of fluids, and taking pain medications like acetaminophen/Tylenol. If you’ve had symptoms for less than forty-eight hours, your doctor may also prescribe an antiviral medication (oseltamivir/Tamiflu). Be aware that the flu can cause serious, life-threatening complications, such as pneumonia, so if you’re feeling really terrible and can’t get an appointment with your doctor in the next day or two, pop over to an urgent care center.

  You’ve been kissing the wrong people. (Ugh, join the club.) Even though mononucleosis is known as the kissing disease, you don’t actually have to kiss someone to catch it (though it’s more fun that way). Mono results from infection with Epstein-Barr virus, or EBV, which is transmitted in spit. The most common symptoms include fever, fatigue, sore throat, and swollen glands in your neck. You may also have a painful, swollen spleen, located below your rib cage on your left side. Your doctor can perform a simple blood test to check for mono. If it’s positive, you’ll need to take it easy for a few days. If your spleen is enlarged, you’ll need to avoid contact sports for a few weeks. An enlarged spleen is like a water balloon full of your own blood . . . so you don’t exactly want someone charging into it.

  Your symptoms have lasted for more than two weeks. Tumors of the throat or larynx (voice box) can cause persistent sore throat. Other symptoms may include weight loss, ear pain, bloody saliva, and a noticeable neck lump. If you smoke or chew tobacco, you’re at high risk. Your doctor will perform a thorough examination of your neck and likely refer you to a specialist for a camera-based examination of your throat.

  Get to the E.R.

  You have severe throat pain along with fever, difficulty swallowing, and a change in your voice. You could have an abscess (collection of pus) around one of your tonsils. If so, you’ll need urgent antibiotics and may also need to have the collection drained.

  You have a visibly swollen, tender vein on one side of your neck. In rare cases, throat infections can spread to the jugular vein (the major vein in the neck, which drains blood from the brain) and cause a blood clot. You’ll need to get to the E.R. for further testing, intravenous antibiotics, and possibly a blood thinner.

  You have a high fever and a rapid heartbeat, and feel lightheaded. You may have a severe bacterial infection in your throat and/or neck that has spread to your bloodstream. Get to the E.R. right away for intravenous fluids and antibiotics.

  Part 2

  Chest and Back

  Chest Pain

  Chest pain is no joke. Seriously—we tried to think of funny things to say about it and came up blank. Don’t believe us? Try telling a group of doctors that you’re having crushing chest pain, then announce a few minutes later that you were just kidding. They will not be amused.

  The main concern, of course, is that chest pain could indicate a heart attack, which means that part of the heart muscle is no longer receiving adequate blood flow. Since a heart attack can rapidly produce catastrophic complications, including death, doctors tend to freak out whenever this diagnosis is on the table. In most emergency rooms, patients with chest pain have to be seen within ten minutes of arrival. (A stern warning: no one will be laughing if you cry “chest pain” to jump to the front of the line with your infected toenail.)

  If you’re having chest pain and haven’t already flagged down an ambulance, you’ll be relieved to learn that most of the time it turns out to be gas or a pulled muscle. But how do you know which way it’ll turn out? Do you need emergency heart surgery? Or just some Tums?

  Take a Chill Pill

  You strained your chest, and now have sharp chest pain when you twist your body or raise your arms. Perhaps yesterday you decided to ditch your office job and become a professional body builder. Or perhaps you were watching a baseball game and caught a foul ball with your ribs. Either way, if your pain is worse when you contort your chest, it’s likely 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/Advil/Motrin. 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/Advil/Motrin or acetaminophen/Tylenol. Of note, if you also have a fever, chills, and a cough, you could have a lung infection known as pneumonia. The infected area inflames the adjacent part of the chest, causing pain with deep breathing. If you think you have pneumonia, call your doctor for a same-day appointment.

  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 under a minute), you may have just had gas 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 bouts of coughing can pull muscles in your chest. They also irritate the airways leading from your mouth down to your lungs. 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 here).

  Make an Appointment

  You get chest pain when you really exert yourself, and you feel better with rest. The arteries supplying your heart muscle with blood likely 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. When the heart slows down and relaxes, however, the flow becomes adequate again and the pain improves. See your doctor as soon as possible. You’ll probably need a stress test, in which your heart is monitored while you run on a treadmill. If the pain becomes more frequent, or starts to occur at rest or with minimal exertion, go to the E.R.

  You have sharp chest pain that improves when you lean forward, but you otherwise feel completely fine. You may have an irritation of the lining around the heart, a condition known as pericarditis. The complications can include fluid or scarring around the heart, which interfere with the normal filling and pumping cycle. Pericarditis can be an isolated problem, can occur alongside or shortly after a bad cold, or can be a sign of a serious disease, like lupus. See your doctor as soon as possible. If you also feel lightheaded or very short of breath, just head to the E.R.

  You get burning chest pain after eating or when lying down. You may also have a sour taste in your mouth. You could have acid reflux, which occurs when digestive juices from the stomach bubble back toward the mouth. The esophagus, the tube that connects the mouth to the stomach, does not like being doused with stomach acid and screams in pain to signal its displeasure. If a glass of water improves the pain, consider the diagnosis confirmed (since water washes acid back down into the stomach). Try taking antacids, like Tums or Rolaids, to neutralize your stomach acid. If those fail, try taking ranitidine/Zantac or omeprazole/Prilosec, which 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.

  Get to the E.R.

  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, which occurs when one of the arteries supplying the heart muscle with blood becomes blocked. The affected part of the heart generates intense pain as a distress call. In many people, the pain tracks down one or both arms and is associated with shortness of breath. If you don’t get emergency treatment the affected portion of the heart may die, and during its last gasps, it may generate a dangerous arrhythmia (abnormal heart rhythm) that brings you down too. Call an ambulance.

  You have sudden-onset, severe, constant, sharp chest pain. You are also very tall or have a history of high blood press
ure. You may have a tear (also known as a dissection) in the wall of the aorta, the large blood vessel that receives blood from the heart. The pain is often described as searing, knifelike, and unbelievably intense. (A common saying is that people with heart attacks are afraid they’re going to die, whereas people with aortic dissections are afraid they won’t.) An aortic dissection is diagnosed with a CT scan or ultrasound. Risk factors for aortic dissection include genetic conditions that weaken the walls of your arteries (like Marfan syndrome, which also causes tall stature and long fingers) as well as a long history of poorly controlled high blood pressure. The longer a dissection goes without treatment, the higher the risk of death. Call an ambulance right away!

  You’re also short of breath. The unsightly duo 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 of which require prompt attention in the E.R.

  You have sharp chest pain along with a fever and cough. You could have pneumonia, an infection in the lungs. Get a same-day appointment with your doctor. If you can’t make it on the schedule, or you’re feeling lightheaded or really short of breath, just go straight to the E.R.

  Fast or Irregular Heartbeat

  Under normal circumstances, you should only feel your heartbeat when you’re hustling at the gym, creeping through a haunted house, or locking eyes with your dream crush. If you’re just sitting around and doing nothing, then suddenly feel your heart racing, skipping beats, or knocking against your chest, you may have a problem. If you also feel lightheaded or have chest pain, you really have a problem, since your heart is going too fast to effectively pump blood. (Please lie down and call for help.)