Generator in the ear: what problems patients complain about to doctors
"My head is splitting," "my spine is cracking," "my stomach is burning" — patients use these and other "terms" to describe the state of the body in various diseases. An experienced doctor will always understand what problem lies behind a particular complaint. What lies behind the figurative descriptions of the symptoms and why it is impossible to diagnose yourself — in the material of Izvestia.
What depends on the doctor
Patients often describe symptoms outside the box, and sometimes in very simple words, but serious illnesses are sometimes hidden behind any formulations, warns Natalia Gavrilova, chief physician of the Scandinavian Health Center.
— For example, loss of consciousness while working in the garden is not just overheating, but a sign of multifocal atherosclerosis of the vessels feeding the brain. Shaky legs are not fatigue, but a complication of diabetes. And dizziness, with which the patient has been observed for years as a neurological problem, may be the result of dangerous coronary artery stenosis, says Natalia Gavrilova.
Sometimes the complaint turns out to be the only external manifestation of a dangerous disease, and it depends on the doctor to correctly correlate the symptom with possible health problems.
— For example, a patient with dizziness has been observed by a neurologist for many years, but during his hospitalization he was carefully examined by a cardiologist. Thousands of ventricular extrasystoles (abnormal contractions of the heart) were recorded during daily ECG monitoring. Coronary angiography (examination of the heart vessels with contrast) revealed stenosis of the trunk of the left coronary artery, a life—threatening condition. After stenting, the dizziness passed," Gavrilova says.
According to the expert, a similar situation occurred with another patient. The woman complained of pain in her left arm and insomnia, but neurological treatment did not help.
— Then the cardiologist noticed a difference in blood pressure on both arms — 30 mmHg. Ultrasound of the vessels showed stenosis of the subclavian artery (narrowing of the vessel feeding the arm and brain). After stenting, the pain in my arm disappeared," comments Natalia Gavrilova.
Where is the lower back
Natalia Gavrilova emphasizes that it is necessary to ask and clarify complaints in order to correctly interpret the symptoms.
— For example, a complaint of shortness of breath may be characteristic of different conditions. Lack of air, suffocation, difficulty exhaling, or just rapid breathing when climbing stairs — all this requires a different approach. And even if the complaint does not relate directly to the doctor's specialty, he will clarify it in order to understand the whole picture," Gavrilova continues.
Such attention to the patient's words is especially important in cases of chronic diseases and general complaints.
— The doctor should get as much specifics as possible: what exactly the patient feels, at what moment, how long the symptom lasts, what is the nature of the pain or discomfort, how often it repeats and what helps to get rid of it, — adds Natalia Gavrilova. The accuracy of these data depends on the correctness of diagnosis and the effectiveness of treatment.
Vladimir Belash, a neurologist and Candidate of Medical Sciences, also believes that it doesn't matter what words a patient uses to describe their problems. In any case, the doctor asks leading questions to get a complete picture of the disease.
— It happens that patients say that "snowflakes" or "rain is falling" are flashing before their eyes, "flies" or "fireflies" are flying, — says Vladimir Belash. — The noise in the ear was figuratively described as "like a generator humming", "the pump is pumping in the ear". If there are complaints about the spine, they mention crunching and clicking. The numbness in the extremities was described as: "the hands are melting." If an arm or leg is shaking, they complain of "shaking."
Sometimes, even the most standard complaint of lower back pain requires clarification, the neurologist notes. Doctors ask the patient when the pain occurs, in what position (sitting or lying down), where it goes, find out the nature of the pain (acute, pulling, aching, stabbing or shooting), whether there is numbness or tingling, and find out many more points.
— In some patients, the lower back "turns out" to be at the level of the sacrum, while in others, even in the interscapular region, there is a wide range. I ask you specifically to show with your hand where it hurts, as in the joke: "don't be wise, but point with your finger," the expert continues.
According to Vladimir Belash, the worst thing is when patients come to an appointment having already given themselves a specific diagnosis.
— Let's say a person claims to have a migraine, and it can be difficult to convince a patient that he has a completely different disease. In addition to migraines, there are a huge number of headache options, both independently and as a symptom of another diagnosis," the neurologist comments.
Some patients try to use clever terms borrowed from the Internet when talking to the doctor. But Vladimir Belash emphasizes that a person who is far from medicine may not always be able to correctly identify the name of an organ or zone. For example, the "iliac region" is not located under the lungs, as many patients think, but in the lower abdomen and near the upper thighs.
— The patient cannot always correctly relate the term to real sensations. It is much more useful for everyone to describe in simple words where and how it hurts, how often, and then it goes away. Then the doctor will be able to make a more accurate diagnosis," Natalia Gavrilova believes.
Fire in the stomach
The expression "fire in the stomach" will tell the doctor that we are talking about a symptom of acute gastritis or peptic ulcer of the gastric tract, said Denis Prokofiev, a general practitioner with the status of "Moscow doctor."
— Figuratively speaking, there are two opposing sides in the stomach: one is aggressive, and the other is healing. And in medical terms, it is hydrochloric acid, which is part of the gastric juice, and the mucous layer that envelops the stomach wall, protecting it from an aggressive component. When an aggressive factor in the form of hydrochloric acid prevails in a person, he begins to feel a burning sensation in the stomach, in the epigastric region, explains Prokofiev.
Accordingly, fire or burning in the stomach means an "attack" of hydrochloric acid on the mucous membrane at a time when the protective layer of this mucosa can no longer withstand aggressive action. This means that we are talking about inflammation or a chronic stomach disease.
Why does my head hurt?
The common expression "splitting head" will tell the doctor about many factors.
— In medical language, a headache is called cephalgia. Its most striking manifestation is a migraine. As a rule, during these attacks there is an abundant blood supply to the brain. In fact, his blood vessels are simply bursting with a lot of blood. This pressure gives a person the feeling that the head is splitting due to the huge amount of blood in the vessels and the swelling of the vascular wall," says the expert.
The second possible option, which is indicated by the complaint, is that the brain is in free fluid, and its increase is the so—called increase in intracranial pressure. The doctor emphasizes that an increase in intracranial pressure also causes very severe bursting pains.
"Flies" in front of the eyes
According to Denis Prokofiev, complaining about "flies" flashing before the eyes is even a diagnostic criterion when collecting medical history from patients. However, these are not exactly "flies", but more black dots.
— Two optic nerves go from the eyeballs, which then combine into one and stretch to the brain. When innervation (communication with the central nervous system) is disrupted and, consequently, the transmission of nerve impulses along this nerve, a person sees like flickering flies. But in fact, such a feeling occurs in those fractions of a second when the nerve impulse does not pass through the optic nerve," explains Denis Prokofiev.
The reasons for this flicker are different: hypertensive crisis, vascular crisis or the consequences of serious injuries.
— If this is a short-term phenomenon, then it passes quickly enough and no longer bothers. In the event that the "flies" flash periodically or for a long time, you need to contact a neurologist and an ophthalmologist so that doctors can diagnose and prescribe treatment, the expert suggests.
The ground is falling out from under my feet
When a patient complains that "his head is spinning," then, accordingly, we are talking about dizziness, but the causes of this phenomenon may be different.
— We have a vestibular apparatus, which is responsible for the position of the body in space. Its work is disrupted by certain chronic diseases, such as Meniere's disease, or by disruptions related to brain function. Dizziness can also be a consequence of problems with the brachiocephalic arteries," comments Dr. Prokofiev.
Against the background of dizziness, when the vestibular balance system does not work, there is a feeling that "the ground is falling out from under your feet."
— In medicine, this is called vestibulopathy. It can be systemic or non-systemic, when the vestibular apparatus itself is affected or when dizziness occurs against the background of a certain disease. Special drugs are used to stop this process, and if we are talking about a serious chronic disease, then more systematic treatment is required," says the expert.
Why are your hands shaking
Complaints that the hands are shaking indicate a classic tremor, Prokofiev notes.
— Tremor can occur as a result of neurological disorders, toxic damage to the body. It is extremely easy to diagnose, but in order to choose a treatment method, it is important to determine its genesis (origin). The most unpleasant reason is Parkinson's disease, which can also be stabilized, although it is difficult to do so," the general practitioner comments.
Hands often shake as a result of the toxic effects of ethyl alcohol on humans. Such poisoning leads to a deficiency of vitamin B in the body, toxic effects on nerve endings, resulting in tremor, notes Dr. Prokofiev.
But tingling in the fingertips can draw the doctor's attention to possible blood flow disorders.
— The upper extremities are well supplied with blood, but still the fingers are a very remote area from the heart, and the length of the vessels is large. Therefore, tingling indicates problems with blood flow," explains Denis Prokofiev.
There are many factors that cause blood vessels to be squeezed. The most common is the so—called scalenus syndrome, that is, muscle spasm. Because of this spasm, blood flow is redistributed in such a way that a person feels unpleasant tingling in the area of the fingers, the doctor summarizes.
"Broke the paralysis"
It happens that a person, describing his feelings, says that he felt like he was "paralyzed." But if there is no question of a complete loss of all or some movements, then a spinal pathology may be suspected, in which the patient temporarily cannot turn or it is painful for him to do so.
— As a rule, these are the so-called degenerative-dystrophic diseases of the spine, which lead to the development of radicular syndrome in the lumbar, thoracic and cervical spine. And a person experiences severe pain with any movements, or the so—called habitual dorsopathy of the lumbar spine (pain radiating to other parts of the body), explains the doctor.
Usually, such sensations are associated either with overexertion of the back muscles, or with an already formed hernia, which compresses the radicular end of the spine, the expert warns. The patient's condition is characterized by inactivity, severe pain, and movements are constrained.
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