You thought four lungs would be better than two. Add shortness of breath to the list of symptoms often endured by pregnant women. Changing hormone levels stimulate the brain’s breathing center, causing the sensation of mild shortness of breath. In addition, the growing uterus can actually block the lungs from fully expanding. As long as your shortness of breath isn’t debilitating and doesn’t suddenly worsen, just mention it at your next obstetrician visit.
You suddenly feel like the world is closing in on you. You may be experiencing panic attacks, which cause abrupt-onset intense fear, shortness of breath, a racing heartbeat, sweating, and a feeling of doom. A combination of therapy and medication can help prevent further attacks.
Get to the E.R.
You’re wheezing nonstop and can’t catch your breath. You could be having an attack of asthma or COPD, even if you aren’t known to have these conditions. In both cases, the airways connecting your mouth to your lungs become dangerously narrow, and air makes a high-pitched noise as it squeaks through. Another possible and equally perilous cause of these symptoms is heart disease, which can flood your lungs with fluid. The airways become swollen and narrowed, producing a wheezing sound. All of these conditions can be fatal if not promptly treated, so call an ambulance (not an Uber).
You also have chest pain and/or a rapid, pounding heartbeat. You could be experiencing a heart attack, which occurs when the heart muscle can’t get enough blood, or an abnormally rapid heart rhythm. As the heart struggles, fluid backs up into your lungs and causes breathing problems. It’s also possible one of your lungs collapsed. Normally, the space around the lungs is a vacuum, making it easy for the lungs to expand. If that vacuum becomes disrupted—for example, because someone stuck your chest with a spear—the lung shrivels into a pathetic little lump. Lung collapse can also occur randomly, for no obvious reason, in tall, thin, young people (thankfully we’re not at risk), smokers, and those with lung disease.
You have a red, splotchy rash all over. What’d you just eat? You may be experiencing a severe allergic reaction known as anaphylaxis. Your airways swell, causing wheezing and shortness of breath. Other symptoms can include nausea and a sense of doom (which is completely justified). Get to the E.R. for an epinephrine injection to open those airways back up, along with other medications to stop the allergic reaction. If you’re feeling really short of breath, and you don’t hear the sirens of an approaching ambulance, you can (as a last resort) ask any bystander with an EpiPen to stick you with it.
You recently took a long trip, or one of your legs is in a cast. You may have a clot in your lungs, blocking the normal flow of blood. This condition, known as a pulmonary embolus, usually occurs when a blood clot forms in a leg vein and then sends a chunk up to your lungs. Leg clots are more common in people who have had their legs immobilized—either by a cast or a long trip in a cramped seat. Smoking, birth control pills, and cancer also increase the risk. The shortness of breath usually develops over the course of hours to days. Some people also experience chest pain. The treatment is an emergency infusion of blood thinners.
You have diabetes and your sugar has been really high. You may have a complication of diabetes known as diabetic ketoacidosis, or DKA, which occurs when insulin levels become really low. Without insulin, your body can’t use any of the sugar in your blood, so it turns to alternative sources of energy. Those sources generate acid that can only be eliminated by breathing faster. Other symptoms include fatigue and abdominal pain. You need intravenous fluids and an emergency insulin infusion under very close monitoring.
You have cancer. There are many reasons for a person with cancer to become short of breath. Unfortunately, most are dangerous emergencies. First, cancer increases the risk of forming clots, which can travel to your lungs and block the normal flow of blood. Second, chemotherapy drugs can interfere with the immune system, making it easier to get a lung infection. Third, cancer can travel to the lungs and either directly block the flow of air (if a tumor is pressing against an airway) or cause fluid to accumulate. Finally, cancer can cause fluid to leak around the heart, making it more difficult to pump blood.
Cough
Are you the one in the movie theater with the horrendous cough? Who sounds like you’re about to eject your left lung into your popcorn bucket? Is everyone around you giving you dirty looks and switching seats?
Coughing is a reflex that keeps our airways and throat clear of dust and other airborne junk. Particles, chemicals, and even strong smells can trigger cough receptors, which initiate the cough reflex. These receptors are not only in your throat and airways, but also in your esophagus (the tube connecting your mouth to your stomach), stomach, diaphragm, and even your ear canals. (Ever start coughing while digging wax out of your ears?)
Coughs can be acute (lasting a few weeks) or chronic (lasting even longer, and driving you and everyone else insane). Coughs can also be dry (nothing comes out) or wet and productive of mucus.
So if you’ve got a bothersome cough, should you just wait it out or head over to the nearest tuberculosis ward?
Take a Chill Pill
You also have a headache, sore throat, and runny nose. It’s amazing that we can transplant a human heart and send people to the moon (and perhaps even send a person with a transplanted heart to the moon), but we still can’t prevent the common cold. Once the cold has taken hold, it generates thick mucus that irritates the airways and causes cough. Pain relievers (like acetaminophen/Tylenol), decongestants (like pseudoephedrine/Sudafed), and cough suppressants can help. Call your doctor if you develop a persistent fever and start coughing up thick or green phlegm, as you could have a lung infection.
You recently had a cold or have terrible allergies. Long after the other symptoms of a cold have improved, a persistent drip, drip, drip of mucus down the back of your throat can keep you coughing. This condition, known as post-nasal drip or upper airway cough syndrome, is very common. It can also result from seasonal allergies. Other symptoms include runny nose and a frequent need to clear your throat. (Does everyone always think you’re trying to get the room’s attention?) Try stopping the drip using over-the-counter nasal steroid sprays, like fluticasone/Flonase or triamcinolone/Nasacort, possibly along with antihistamines like loratadine/Claritin and cetirizine/Zyrtec. If those aren’t cutting it, add over-the-counter decongestants, like phenylephrine or its more powerful cousin pseudoephedrine. (Fun fact: pseudoephedrine is used to cook crystal meth, so you need to show ID to buy it.) If those don’t work and the cough is relentless, speak to your doctor about other options.
Your cough is associated with heartburn or a sour taste in your mouth, or it gets worse when you lie down at night. Another common cause of cough is acid reflux disease, which occurs when stomach acid creeps up toward the mouth. Sometimes acid reflux can even cause cough without heartburn (ordinarily the much more common symptom). Reflux increases when you’re lying down, as acid can travel more easily when your throat is level with your stomach. If you think you have reflux, you should cut out the spicy food, lower your alcohol intake, and definitely kick any smoking habit. Another trick: sleep on a few pillows or use a few books to elevate the head of your bed; gravity will help keep the acid down. If those measures fail, use antacids to dull the acid’s sting. You can also use over-the-counter medications that reduce acid production, like ranitidine/Zantac and omeprazole/Prilosec. If you keep having symptoms or require medications for more than a few weeks, however, you should see your doctor.
You smoke. Don’t act like you’re surprised! Now think how much better you’ll feel, and how much money you’ll save, if you just quit. Your odds of success are much higher if you use a nicotine product, like the patch or gum, along with a prescription medication, like Chantix. If your cough continues after you kick the habit, see your doctor for some additional lung tests. If your cough is new or has suddenly become much worse, it could be a sign of infection or cancer, and you should get checked out.
Make an Appointment
You’re also short of breath and wheezing. Asthma is one of the most common causes for a cough in adults and the most common cause of a cough in children. A similar condition, chronic obstructive pulmonary disease, COPD, also causes cough and wheeze in older adults, especially smokers. Your doctor can arrange testing to confirm the diagnosis. If the shortness of breath is really severe (you can’t move around your house without becoming winded), you need to get to the E.R.
You have had several days of fever. Infections of the airways or lungs often cause cough. Though most infections are from viruses and don’t require antibiotics, you could have a bacterial lung infection (pneumonia) if your fever lasts for more than two or three days and you don’t have typical symptoms of a cold, like sore throat and runny nose. See your doctor, who may order a chest X-ray. Even after the infection has been treated, the cough can linger for several weeks, annoying your coworkers.
You have a fever, night sweats, and some unintended weight loss. It’s possible you have tuberculosis, or TB, especially if you live in a big city or have recently traveled outside of the United States. It’s treatable but also pretty contagious, and you definitely do not want to be the friend who gave everyone TB. See your doctor as soon as possible.
You have heart, liver, or kidney disease. In these conditions your body may retain too much fluid, which can end up in your lungs and cause a nagging cough. Other telltale symptoms include leg swelling and the inability to breathe comfortably in bed without elevating your upper body with multiple pillows. (Like stomach acid, fluid often stays out of your chest if you stay upright and use gravity to your advantage.) Your doctor can prescribe a diuretic to help you pee out the excess fluid. If you’re really short of breath, get to the E.R. for more urgent treatment.
You snore like a bear. Sleep apnea is a common condition in which your throat periodically closes down at night, causing loud snoring and interfering with normal breathing. Sleep apnea can cause many health problems, including chronic cough from airway irritation. If you snore loudly at night and wake up feeling tired, talk to your doctor about having a sleep study. If you’re diagnosed with apnea, you may need to wear a mask at night that helps blow air into your lungs. In many people, weight loss also reduces apnea symptoms.
You’ve had a worsening cough for more than four weeks. You need to get checked out, probably with an X-ray, to make sure you don’t have a simmering infection or something even worse, like cancer.
Get to the E.R.
You’re coughing up blood or phlegm streaked with blood. Obviously, this is not a good sign. The best-case scenario is that you’ve been coughing so much that you tore a small blood vessel in your airways—which is not necessarily a big deal, as long as the amount of blood coming up is small. More frightening possibilities, however, include infections, lung clots, and lung cancer.
You have chest pain and/or severe shortness of breath. Heart attacks and acute heart failure can suddenly flood the lungs with fluid, causing shortness of breath and cough. You could also have a bad lung infection. Get to the E.R. as soon as possible.
Back Pain
EDITED BY ALLEN CHEN, M.D., M.P.H.
If you’re a human not currently serving in Congress, you have a spine. And if you have a spine, you are almost certainly familiar with back pain.
The spine is a stack of bones called vertebrae, held together by ligaments and muscles. Between vertebrae are squishy discs that serve as spacers. The spine is divided into sections known as the cervical spine (in the neck), thoracic spine (chest), lumbar spine (abdomen), and sacrum (pelvis). The spinal cord, a thick bundle of nerves originating from the brain, travels down the middle of the vertebrae, sending off nerves to the arms, legs, and internal organs.
In humans, the spine is arranged to let us stand upright and get into all sorts of complex contortions. Have you ever seen a dog perform compelling gymnastics? Or seen a cat do the whip and nae nae? (If so, please contact us immediately.)
The major downside of upright life is that the bottom of your spine has to carry most of your weight. If you’re frequently carrying around extra pounds (either because of your job or your waistline), your back will feel the crush. Sometimes, the discs between the vertebrae get squeezed out (herniate) and press on the nerves, causing pain. Other times, degeneration of the vertebral joints or changes in how the vertebrae stack up compresses nerves as they exit the spine (called spinal stenosis), also causing pain. And at some point, everyone gets degeneration of the intervertebral discs, which sometimes (not always) leads to pain.
Even if you’re thin, young, and in fine shape, you can pull a muscle in your back and become incapacitated for a few days. It’s also possible to feel back pain that’s actually arising from one of your organs, like your kidneys. So if your back starts to ache, should you break open the piggy bank and book a deep tissue massage? Get a piece of plywood from your garage and sleep on it? Call up your doctor for a muscle relaxant? An MRI? Back surgery?
Take a Chill Pill
Your back has been aching on and off for less than a month, but it isn’t significantly interfering with your life. You may simply have a muscle spasm, which usually gets better within a few days and disappears within a month. Avoid heavy lifting and other sources of strain, but don’t just stay in bed (and don’t sleep on a board). In fact, bed rest usually prolongs the suffering. If you can afford it, spring for a massage, which can help stretch out your muscles. Take long, hot showers or use a heating pad to relax your muscles. If you’re still feeling terrible, try over-the-counter pain medications (see the Quick Consult). If you’re still not feeling better, see your doctor.
Make an Appointment
You have long-standing (months to years) lower back pain that gets better with rest. Your pain likely reflects breakdown of your lumbar spine. Most older adults, especially those who are overweight, experience wear and tear on the joints along with thinning of the discs between the vertebrae. Your doctor should perform a physical examination to double check for any other potential causes of pain. Try to remain as active as possible, which keeps your muscles strong and stabilizes the lower back. A physical therapist can evaluate your symptoms and recommend specific exercises and stretches. A few sessions of acupuncture or spinal manipulation (from a physical therapist or chiropractor) may also help. Long-term medication use should be avoided, given the numerous side effects, but pills can help in the short-term (see the Quick Consult).
You have gradually (over the course of days to weeks) developed pain, numbness, and/or weakness in your arms or legs. You likely have a compression of the nerves to your arms or legs, which exit your spine through small openings between your vertebrae. This situation typically occurs when a disc slips out of place (and lands splat on a nerve) or the vertebrae get out of alignment. The usual symptoms are tingling, pain, and/or numbness on one or both sides. When the nerves to the legs are affected, the condition is called sciatica. As long as your symptoms aren’t rapidly progressing (over the course of hours to days), it’s not an emergency. Your doctor will perform a physical examination and likely get an MRI of your back. This may show a herniated disc causing nerve impingement, or a condition called spinal stenosis, where the area around the nerves becomes narrowed due to degenerative bone changes and disc bulges. The initial treatment for either condition consists of over-the-counter pain relievers (see the Quick Consult), physical therapy, and time. If symptoms continue or worsen despite medications, your doctor may inject steroids directly into your back to red
uce inflammation around the nerves. If that fails, you may require back surgery to directly eliminate nerve compression.
Your pain is worse at night, and you wake up with back stiffness that improves during the day. Back stiffness is very common and can result from many different issues, including a bad mattress, overexertion the night before (wink wink), and degenerative changes in the small joints in the spine. Most people get better over days to weeks, but if not, you should see your physician. You could have an autoimmune condition known as ankylosing spondylitis. This condition is diagnosed mostly in younger people, usually striking in the twenties or thirties. The main symptoms are lower back pain that worsens at night and back stiffness that peaks in the morning—both of which improve with exercise. Additional symptoms include neck, hip, ankle, and eye pain, and blurred vision. The diagnosis is confirmed with X-rays of the lower back and hips. You should see a rheumatologist and may need medications to suppress your immune system.
You have burning pain on one side of your back. You could have shingles (also known as zoster). After you overcome chickenpox, the virus doesn’t leave your body but rather goes into hiding, like some kind of international warlord. As you age and your immune system starts slacking off, the virus may come back out, causing shingles. People who take immune-suppressing medications may experience shingles at an even younger age. Shingles normally affects one strip of skin on one side of your body; the back is unfortunately a large and juicy target. Shingles causes burning pain followed by a blistering rash. Sometimes, the pain can last for several months. Use over-the-counter pain relievers (see the Quick Consult). In some cases, your doctor will prescribe antiviral medications (like valacyclovir/Valtrex). If you’re over fifty, consider getting the shingles vaccine to help prevent these problems.
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