We each have an individualized alarm setting.
During fireworks in downtown, the explosions in the sky are sufficient to set off the more sensitive car alarms in the area.
Some of us have our alarm sensitivity set too low. We might wait for the final notice and extra interest payments before we pay our debts. Some children will wait until their parents are screaming before they do their chores.
Some of us have alarm sensitivities set too high. We might awaken with the smallest noise or consider a deadly disease when we have what most might consider everyday symptoms.
One of the challenges of family medicine is the range of alarm settings among our patients. Some people require more investigations than others because they require an extra degree of investigation. The extra concern can be quite understandable if a patient has a personal or family history of cancer, heart disease or other serious conditions.
One of my patients was misdiagnosed with stomach cancer in another country. After her repeat gastroscopy (direct visualization of her stomach) was found to be normal in Canada, she still feared she had a cancer and went to the U.S. for a third gastroscopy. The third set of investigations also proved to be normal, but resulted in excessive bleeding and a transfusion.
On the other hand, some patients have a low alarm-sensitivity setting (or a high threshold for concern). They may ignore serious symptoms for many months.
One of my patients was behaving out of character. For several years, he had blood in his urine but thinking that this was normal, he never reported it to me. He was ultimately found to have bladder cancer that had metastasized (or spread) to his brain.
For this reason, over the past 15 years I’ve posted in each of my examination rooms my list of Alarm Symptoms. These are symptoms that might indicate a serious condition.
- PAIN: Pain that is unexplained, severe, colicky, electrical or persistent; chest pain, especially if it is squeezing or associated with sweating, nausea or radiation into the neck or arm; bone pain, especially if it is unremitting and disturbs sleep.
- LOSS OF FUNCTION: Unexplained changes with speech, memory, emotions, swallowing, bowel movements, urination, heart rhythm, vision, hearing, balance, coordination, sensation or muscle function.
- CONSTITUTIONAL: Unexplained sudden or progressive changes in weight, body temperature, energy, appetite, thirst, leg swelling and exercise tolerance.
- GROWTHS: New or growing lumps felt in the skin, mouth, muscle, breast or scrotum; lymph nodes felt around the neck and under the arms; skin changes, including ugly moles, persistent scabs or sores.
- BLEEDING: in urine, sputum, vomit or stools (which can appear tarry black with bleeding ulcers)
I don’t want to raise my patients’ anxiety. Most of the time, the above symptoms are innocent. But not infrequently, they can be harbingers of serious conditions, including heart attacks, strokes and cancer.
In my office poster, I ask patients to bring these symptoms to my attention at the beginning of a visit. An alarm symptom may take extra time to evaluate, and we may need to defer dealing with less serious problems that might have been the original reason for their clinic visit.
Dr. Davidicus Wong is a family physician. His Healthwise column appears regularly in this paper. For more on achieving your positive potential in life, check out his blog at davidicuswong.wordpress.com.
