Am I Dying

by Christopher Kelly

  If you experienced a heart attack or stroke, your doctor will likely prescribe aspirin to partially block the function of platelets (clot-forming blood cells). If you had a heart attack, you’ll probably also have to take a second medication to decrease platelet function, such as clopidogrel/Plavix, prasugrel/Effient, or ticagrelor/Brilinta.

  If you have large clots in your legs or lungs, you’ll be prescribed a strong blood thinner to prevent the clots from expanding further and, over time, allow them to dissolve. Unlike aspirin and the other medicines listed above, true blood thinners target chemicals known as clotting factors, rather than platelets. Many people also take blood thinners because they have an abnormal heart rhythm called atrial fibrillation, which increases the risk of forming blood clots in the heart (which can travel to the brain and cause stroke). People with mechanical heart valves also need blood thinners to prevent them from clotting.

  For many years, the only effective blood thinner was warfarin/Coumadin. This medication is highly effective for preventing clots, but predicting the correct dose for each individual patient is challenging. Plus, it becomes less effective after a meal rich in vitamin K (found in leafy green vegetables, broccoli, or cabbage). As a result, people on warfarin typically need regular checks of their clotting function, sometimes resulting in dose adjustments.

  More recently, drugs have been released that are just as effective as warfarin for many conditions, but don’t require monitoring and don’t interact with common foods. You’ve undoubtedly seen television ads for them (and for the lawyers trying to sue their manufacturers because—surprise—blood thinners cause bleeding). The main ones include rivaroxaban/Xarelto, dabigatran /Pradaxa, and apixaban/Eliquis. The only major limitation of these medications is that, as of this writing, it’s not easy to reverse their effect if you experience a major bleeding event. In addition, their effect isn’t strong enough for people who need blood thinners for mechanical heart valves.

  * * *

  Get to the E.R.

  You gashed yourself, and now the room looks like a scene from a horror movie. Perhaps you were trying to open a bottle of champagne with a sword. (It’s harder than it looks.) Or maybe you graduated from juggling balls and went straight to flaming knives. Regardless of the injury, you’ve got a gusher and don’t know what to do. The first step is to wipe off the blood long enough to take a good look at the wound. Then, after you’ve peeked, rinse the injury with clean water and apply firm pressure to stanch the bleeding.

  If the gash is very deep (going into muscle or fat) or extensive (more than an inch or two long), just go to the E.R. Don’t forget to hold firm pressure on the way. If the wound is smaller, apply firm pressure for twenty or thirty minutes, until the bleeding stops. If the edges of the wound gape apart (including during normal movement of the body area), or the bleeding keeps restarting, you probably need stitches. Head to an urgent care center. If the edges of the wound stay together on their own and the bleeding doesn’t recur, just apply some antibacterial ointment to the injury and cover it with a bandage.

  You have persistent nose bleeding that continues after twenty minutes of squeezing your nostrils together. Almost all nosebleeds stop after twenty minutes of continuous, firm squeezing of the nostrils. (By continuous, we mean no peeking.) If the bleeding continues, you may need to hit the E.R. for more drastic measures. The usual options include nasal sprays to shrink blood vessels, nasal tampons (pretty much exactly what you’re imagining), and nasal balloons (which inflate in the nostril to squeeze blood vessels shut).

  You have bright red blood coming out of your bottom. You can bleed to death from your intestines. If your stool is mostly blood, get to the E.R. immediately. One or two drops of blood, or a red streak on your toilet paper, are not as urgent (see here for details).

  You are profusely bleeding and feel lightheaded or weak. When blood loss is slow, your body can create new blood and find other ways to minimize the impact. When blood loss is significant and swift, however, your body can’t keep up and your blood pressure starts to fall. The symptoms include lightheadedness, dizziness, and/or weakness, especially after standing up. Get help before you black out.

  Postscript

  Turns Out You’re Fine

  So you made it this far without finding any match for your symptoms. Congratulations! You should enjoy your good health for as long as possible. You may rightly be wondering, however, if you should see a doctor each year anyway, just to be safe. After all, books like these can’t exactly perform a physical examination or draw your blood. Perhaps you have some simmering problem that hasn’t caused symptoms yet.

  If you’re under sixty-five, an annual (or regular) checkup may be overkill if you’re not taking any prescription medications, but it’s important for all adults (starting at age eighteen) to undergo routine screening for common diseases and ensure updated vaccinations.

  For example, you should see a primary care doctor at least once every three years to check for conditions that can lead to heart attacks and strokes later in life, such as high blood pressure, high cholesterol, and diabetes. These conditions often do not cause any symptoms and are only detected with screening. If you’re starting a competitive sport or intense exercise regimen, your doctor may ask some additional questions to screen for heart problems. Your doctor may also periodically discuss issues like diet, safety, depression, anxiety, substance abuse, and domestic violence. Finally, you should be screened for HIV infection at least once during your lifetime, even if you don’t have any possible exposures or risk factors.

  If you’re a woman, you should also see a gynecologist every few years. If you’re sexually active, you should be checked periodically for sexually transmitted infections like chlamydia and gonorrhea, which don’t always cause symptoms. Gynecologists can also provide birth control solutions that may not be readily available from primary care doctors, like an intrauterine device, or IUD. Finally, you’ll need to get a Pap smear regularly to screen for cervical cancer (see the list of cancer screenings below).

  Certain populations should also receive periodic counseling regarding issues specific to them. For example, men who have sex with men remain at greater than average risk of contracting HIV and various sexually transmitted infections, and therefore need more frequent screening. In addition, some groups at really high risk of HIV infection (people who have an HIV-positive sexual partner, men who have sex with men and don’t always use condoms, intravenous drug users) may benefit from taking anti-HIV medications to prevent (rather than treat) infection.

  As you get older, you’ll need to start getting regular screening tests for different types of cancer. The purpose of these tests is to detect cancers when they’re early-stage and treatable. Of course, early-stage cancers don’t cause symptoms, so the fact that you’re feeling fine doesn’t affect your need for screening.

  Cervical cancer: Women should have Pap smears at least every three years starting at age twenty-one. After age thirty, Pap smears can be done every five years if they are combined with HPV testing and the results are all normal. Most women can stop getting Pap smears at age sixty-five.

  Breast cancer: Women should begin having mammograms every one to two years starting at age forty or fifty, as described here.

  Colon cancer: You should have your first colonoscopy soon after turning fifty, with repeat studies at least every ten years, as described here. Some groups recommend that routine screening instead begin at age forty-five. If you have a family history of colon cancer, you may need to start at an earlier age.

  Lung cancer: If you’re older than fifty-five and have a history of heavy smoking (whether still active or not), speak to your doctor about lung cancer screening. This type of testing is relatively new but becoming more common.

  Prostate cancer: Men should discuss screening with their doctors. The benefits have not been convincingly proven, but your risk profile may favor screening.

  Skin cancer: If you have light skin or multiple moles, you shoul
d start getting full-body skin exams in your thirties or forties to check for melanoma, a type of skin cancer (see here). You’ll need to strip down for a repeat exam every one to three years.

  Finally, we strongly recommend that everyone older than forty consult with a lawyer to create an advance healthcare directive. This document lays out your wishes concerning medical treatment in case you become unable to speak for yourself. The directive should specifically address your views about whether to continue life support if you are severely ill and unlikely to have a meaningful recovery—a thorny situation that comes up often in the hospital. Unfortunately, you’ll need to define exactly what you consider “life support,” “unlikely,” and “meaningful.” There are no correct answers, but you should discuss your views with your loved ones to avoid surprises later on. You should also designate a healthcare proxy, who will be legally empowered to make decisions on your behalf regarding any issues not covered in your directive. If you don’t specify a proxy, it’s usually your spouse, adult children, parents, siblings, or other relatives by default (usually in that hierarchical order).

  If you’re over sixty-five, you should see a physician at least once per year, even if you’re in good health overall, just to cover your bases. You’ll need to continue most of the screening tests already mentioned, plus start some additional ones that become relevant later in life (hearing and vision, memory, bone density, fall risk, and so on). It’s also imperative that you create an advance healthcare directive and designate a healthcare proxy, as described in the previous section. We have unfortunately seen many families experience major conflicts because the wishes of their critically ill loved one, who can no longer communicate, were not clearly defined in advance.

  Since your age puts you at greater risk of serious conditions, you should also do some research on the healthcare facilities near your home. When you eventually need hospital care, you don’t want to roll the dice on quality. Several websites provide aggregate information on quality and safety at hospitals, including HospitalSafetyGrade.org and Medicare.gov/hospitalcompare.

  For Further Reading

  If we somehow didn’t answer all of your burning questions, you have some bizarre symptom that we didn’t cover at all (for example, an inexplicable desire to eat ice), or you’re just a good patient and want a second opinion, you may be wondering where to turn next. The correct answer is, of course . . . your doctor. Duh! But if it’s two in the morning, and you truly can’t tolerate the suspense any longer, here is a brief list of online resources we consider generally trustworthy and accurate. (By the way, if you’re craving ice, you’re probably iron deficient.)

  Am I Dying?!: https://www.amidying.com (We’re partial to this one.)

  Merck Manual: https://www.merckmanuals.com

  UpToDate for Patients: https://www.uptodate.com/contents/table-of-contents/patient-education

  Mayo Clinic: https://www.mayoclinic.org/patient-care-and-health-information

  National Institutes of Health: https://www.nih.gov/health-information

  Special Thanks

  We are so thankful for the support and wisdom of our many friends, colleagues, and mentors, including Cassie Jones, Liz Parker, Stacy Rader (who once, while eating sushi with us, quipped, “You should write a funny book”), Andrea Rosen, Shelby Meizlik, Dr. Allan Schwartz, Dr. Shunichi Homma, Dr. Donald Landry, Dr. Leroy Rabbani, Dr. Mehmet Oz, Dr. Gregg Stone, Dr. Steven Marx, and all of our contributing editors. We also thank Dr. David Weiner for reviewing the chapters about men’s reproductive health.

  Most importantly, we thank our families for inspiring and supporting our medical careers, and for allowing us the many long hours spent writing and rewriting this book.

  Index

  The pagination of this digital edition does not match the print edition from which the index was created. To locate a specific entry, please use your ebook reader’s search tools.

  A

  ABCDE checklist, 280–81, 282

  Abdominal cramps, 218

  Abdominal fat, 188

  Abdominal pain. See Belly pain

  ACE inhibitors, 100–101

  Acetaminophen/Tylenol, 4, 5, 6, 59, 72, 110, 238, 256, 267, 269, 271, 293

  Acid reflux, 21, 67, 80, 100, 118–19, 270

  Acrochordons, 277

  Actinic keratosis (AK), 282

  Acute glaucoma, 9, 46, 51

  Adderall, 83, 132

  Advance healthcare directives, 305–6

  Age-related hearing loss, 57, 58

  Aging

  back pain and, 108

  forgetfulness and, 36

  head injuries and, 43

  weight loss and, 131–32

  Air travel, 223

  Alcohol

  belly pain and, 128–29

  dizziness and, 29

  excessive sweating and, 271–72

  fast or irregular heartbeat and, 87

  fatigue and, 12–13

  forgetfulness and, 35–36

  insomnia and, 20

  tremors and, 248, 250

  Allergic conjunctivitis, 47

  Allergies (allergic symptoms)

  belly pain and, 124–25

  cough and, 99

  rash and, 283

  red or painful eyes and, 47, 50

  sore throat and, 67

  Alopecia, 284. See also Hair loss

  Alopecia areata, 288

  Alpha blockers, 22, 179, 190

  Alzheimer’s disease, 34–35, 37, 39

  Amnesia, 43–44

  Amphetamines, 83, 132

  Anal tear, 229

  Androgenetic alopecia, 285, 286

  Anemia

  blood in stool and, 233

  excessive bleeding and, 296

  fatigue and, 15, 16

  hair loss and, 287

  shortness of breath and, 92–93, 196

  Ankylosing spondylitis, 107

  Annual checkups, 303–4

  Antacids, 80, 100, 119

  Antibiotics, 140, 141

  back pain and, 112

  belly pain and, 121–22

  bloating and gas and, 143

  cough and, 101

  diarrhea and, 216, 218, 219, 258

  ear pain and, 56, 57, 58, 59

  fever and, 93

  hair loss and, 289

  headaches and, 4, 8

  joint pain and, 259, 260

  lump in breast and, 160

  lump in neck and, 62, 64

  rash and, 278, 279, 282

  sex and, 190, 205

  sore throat and, 71, 73

  syphilis and, 37

  urination and, 206, 211–12, 213, 258

  vaginal symptoms, 170, 171, 205

  Antidepressants, 13, 22, 110–11, 134, 143, 151, 210, 259, 271, 292–93

  Antihistamines, 13, 47, 50, 67, 99, 210, 239, 277, 279, 283

  Antihypertensives, 13, 22, 188, 209, 223, 244

  Anti-inflammatories, 47, 54, 57, 110, 179, 190, 238, 240, 253, 271

  Antiperspirants, 266

  Anxiety, 42, 186, 270

  Anxiolytics, 13, 209

  Aortic dissection, 80–81

  Aortic stenosis, 30

  Appendicitis, 125–26, 153, 226

  Arm numbness, 106–7, 240

  Arthritis. See also Joint and muscle pain

  overview, 252

  Artificial sweeteners, 217

  Artificial tears, 46, 50

  Asparagus, 200

  Aspirin, 143, 179, 293, 298

  Asthma, 94, 95

  Asthma inhalers, 71, 85, 241, 249

  Asymmetric tinnitus, 58

  Athlete’s foot, 276

  Atrial fibrillation, 88, 298

  Atrophic vaginitis, 168–69

  Auto accidents, 113, 201–2

  B

  Back pain, 104–13

  benign causes, 105

  blood in urine and, 201

  doctor consultation, 105–9

  emergency situations, 109, 112–13

  pa
inful urination and, 206

  Back spasms, 112, 129, 201

  Back stiffness, 107

  Bacterial conjunctivitis, 50

  Bacterial infections, 50, 51–52, 64, 66, 73, 101

  Bacterial vaginosis, 170–71

  Baggy-looking eyes, 48

  Bedbugs, 277

  Bedroom temperature, 19

  Beets, 228

  Belly fat, 188

  Belly pain, 117–30

  benign causes, 118–20

  bloating and gas and, 143, 144

  blood in stool and, 230

  constipation and, 225, 226

  diarrhea and, 218

  doctor consultation, 120–23

  emergency situations, 123–30

  joint and muscle pain and, 257

  nausea and, 153

  nipple discharge and, 164

  shortness of breath and, 97

  unintended weight loss and, 133

  vomiting and, 147

  Benign paroxysmal positional vertigo (BPPV), 30

  Benzocaine, 66

  Benzodiazepines, 25

  Beta agonist, 85

  Beta blockers, 13, 22, 84, 86, 88, 101, 188, 190

  Biliary colic, 121, 125

  Bitter taste in mouth, 67, 118, 270

  Bladder infections, 196–97, 206, 213

  Bleeding disorders, 293–94

  Bleeding or bruising. See Excessive bleeding or bruising

  Blistering rash, 279–80

  Bloating and gas, 138–45

  belly pain and, 119–20, 122

  benign causes, 139, 142–43

  constipation and, 225

  doctor consultation, 143–44

  emergency situations, 144–45

  insomnia and, 21