I never want to find out I have three months to live.
July 19, 2011 11:21 AM   Subscribe

How do you know when your "not feeling well" is an actual cause for concern? Two people I know have been diagnosed with cancer and then passed away very shortly afterwords after seemingly common/benign symptoms.

One had some back pain, he found some relief using different orthotics and exercise, but it always came back. Then they found out it was because of some wide spread cancer and he was dead within a couple of months.

The second "hadn't been feeling well". She was non-specific, but I got the impression it was some combination of fatigue and pelvic pain, but nothing debilitating, she was at work every day. That is until they found the ovarian cancer that had by that time spread and was terminal and she was dead in a couple of months.

In both these cases, it seems that neither one actually went to a doctor for their ailments, they thought it was nothing more than every day stuff. So what everyone is saying is along the lines of "this is why it pays to get things checked out".

This has me freaking out a little. I'm the allergic to everything girl, so I always have some sort of minor cough or drip. I work 9 hours a day except for two Mondays a month, so yeah, I have some fatigue. I'm a girl, so I get crampy and weird. But how do I know when it is BAD?

I get the regular physical checkup once a year with all the blood and pee tests and pushing around on your neck and abdomen. I get an annual gyn. exam with all that prodding and scraping as well. I try to schedule them so that I am seen by a doctor every six months. Are these regular type screenings most likely enough to detect this kind of sneaky cancer? When should I press harder to investigate with my doctors?
posted by stormygrey to Home & Garden (20 answers total) 7 users marked this as a favorite
IAMAD, but I think annual checkups plus visiting the doctor when something is unusual for you is the best anyone can reasonably do. If you have lots of allergies, going to the doctor every time you have an allergy symptom makes no sense. On the other hand, if you develop back pain that you've never had before, and it doesn't go away right away (or is especially painful), it's time for an appointment.
posted by maxim0512 at 11:29 AM on July 19, 2011 [3 favorites]

posted by maxim0512 at 11:29 AM on July 19, 2011

My mom, who lived with a whole mess of different pain-related "not feeling well" symptoms, went to the doctor with a new one and was immediately sent for scanning or screening or whatever it is that found out it was cancer.

If you don't know what it is and it won't go away (the time scale here being days not years) go see the doctor.
posted by griphus at 11:32 AM on July 19, 2011

Well, you don't know. And sometimes you feel absolutely fine and you'll still die in three months. That's life. A hypochondriac might detect cancer earlier and even treat it a little more often than someone who visits the doctor less frequently but their whole life is paranoid and miserable, so what's the gain?

I think that the best you can do is to have regular checkups -- that's once or twice a year for most people -- and to not live a lifestyle that has a good chance of killing you. And try to keep in mind/not keep in mind that you're a human and you're going to die, and if you're normal it probably won't be on your terms.
posted by michaelh at 11:36 AM on July 19, 2011 [4 favorites]

On the other hand, when I was in seventh grade, I went up to take a shower after dinner and by the time I was going to bed, I had to crawl to bed and was paralyzed with joint pain shortly thereafter. Naturally, my parents zipped my off to the emergency room immediately and I was poked and prodded and bone scanned and EKGd and... nothing. No answers. They told my parents it might be a kind of progressive paralysis that would result in my death. Or not. Then maybe it was Scarlet Fever. Or not. And then, just as a sort of random precaution, they put me on once-monthly penicillin shots. Because why the hell not? It isn't like antibiotic resistance is a problem for society. Years of joint pain and general malaise (not to mention years of being called - and feeling like - a hypochondriac), and it turns out it was a wheat allergy. A. Wheat. Allergy. Which I figured out on my own when my face started swelling after I ate pizza.

A dear friend started developing some symptoms of fatigue right around the time when we went to New York together for a vacation, and promptly looked into it upon her return to be prescribed asthma medication. Her health continued to deteriorate, and doctors kept pumping her full of asthma medication, until she nearly died from the congestive heart failure that was the real problem. She lived not BECAUSE she sought prompt medical treatment, but in SPITE of it.

Your whole outlook presupposes that prompt medical care will find a solution for what ails you, and I'm here to tell you that it may just not. I don't say this to make you more paranoid. Far from it. Rather, I encourage you to keep good track of your health. Know yourself and become a good healthcare advocate for yourself. Develop a good relationship with someone in the medical community based on trust. And don't delay when you sense that something is wrong. That's as much as is in your control. And that's as much as you can reasonably worry about.
posted by jph at 11:46 AM on July 19, 2011 [10 favorites]

I'm sorry, but the answer is that it's really hard. You just have to try to focus on what is typical for you, so you know when something is different.

As for basic screening BEFORE you have symptoms, in general people tend to have TOO many tests and screenings (though of course there are many peopole who have too few). See the specific recommendations from the U.S. Preventive Services Task Force. You'll probably be suprised at how many tests that doctors do regularly are not supported by the evidence. And these tests are not harmless: they can lead to extra unnecessary tests and treatments, which carry their own risks.

For cancer screenings, definitely get a colonoscopy if you are over 50 (maybe earlier if you have family history), and pap smears are helpful (though often done more frequently than necessary). If I remember correctly, nothing else has much of a benefit (though check the USPSTF recs for the definitive answer).

Here are a couple of articles: Annual Physical Checkup May Be an Empty Ritual and See You Later, Speculum: The case for getting rid of annual pelvic exams.

So I think the annual checkups are more than enough - I avoid them completely - but keep them up if it makes you more comfortable. Also, you ask "When should I press harder to investigate with my doctors?" If you feel like your doctor is being dismissive of a question or concern, get another doctor. Now, that doesn't mean that she automatically gives you every test you mention, but she should answer your questions to your satisfaction. (This isn't just a "nice extra"; if you don't feel comfortable with your doctor, you are less likely to give her full information, and without full information, she can't properly diagnose.)

Also, if you're really interested, read How Doctors Think by Jerome Groopman. Doctors, like everyone, have cognitive biases. It gives advice on how to ask questions to encourage them to think through the issues more fully.
posted by Mr.Know-it-some at 11:50 AM on July 19, 2011 [4 favorites]

I was interested to learn in school this year that for the age group of 25-34, you're actually more likely to die from being murdered than having cancer. I don't know how old you are but it may help you to keep in mind that for most young-ish people, dying from cancer is pretty rare. From the ages of 1-44 the leading cause of death is "unintentional injuries" aka, more often than not, car accidents. So being careful while driving and avoiding drinking and driving will keep you a lot safer than worrying about cancer.

Aside from that I agree that all you can really do is keep having your annual checkup and keep track of your health throughout the year so you can update your doc about any new symptoms and things when you have your checkup. And make sure you see the same doctor regularly if you can, it's much more likely that they will be able to spot something unusual if they know your medical history for the past x years. If you see a different doctor every time there's a lot less context for them to consider while determining what your symptoms might mean.
posted by GastrocNemesis at 12:00 PM on July 19, 2011 [2 favorites]


My brain tumor was found by having that instinct that something wasn't right. I was having headaches and the pain was increasing in severity. Despite passing the neurological tests and being told it was a "type of migraine" I refused to ignore it and pressed not to have the symptom of pain managed with heavy medication.

Getting regular checkups is great and excellent for your health. I wouldn't concern yourself with other aliments that may cause death unless you have that strong feeling - something is just not right.
posted by BuffaloChickenWing at 12:06 PM on July 19, 2011 [1 favorite]

How do you know when your "not feeling well" is an actual cause for concern?

My rule: when it doesn't go away after a week or two. Most everything goes away within a week. If it doesn't, see a doctor.

Don't be shy about seeing a specialist, either. I had a pretty basic skin problem that persisted even with the medication my primary care doctor prescribed me, but when I saw a dermatologist, he looked at the systemic problems that were causing it, and helped me address the root issues, making the problem go away completely.

Generally, I think the "one week rule" is better than getting annual checkups (and for me works out to fewer visits to the doctor), overall.
posted by deanc at 12:12 PM on July 19, 2011

"I never want to find out I have three months to live." How long do you want to have for-knowledge of death? While I would never discourage anyone from getting regular exams the data suggests that it does not lead to a significantly longer or healthier life nor does the early detection for many chronic illness--of course there are exceptions--melanoma, colon cancer, breast cancer (maybe), prostate cancer (questionable), heart disease (questionable). What does matter in how long you live is how well you take care of yourself. Exercise regularly, do not smoke, drink only in moderation, maintain reasonable weight, eat a moderate and varied diet, wear a seat belt, avoid alcohol/drug addictions and enjoy yourself. As far as I am concerned the following merit legitimate concern and a visit to the Dr.--unexplained weight loss/fatigue, bleeding other than obvious trauma, chest pain, any significant change in sensoria, pain that is intractable/disrupts major life tasks/persists more than 10 days, significant changes in breathing, etc. However, remember, receiving an accurate and timely Dx does not mean you will necessarily live longer--it does mean that you may experience less discomfort, you may live longer and you are more likely to live more than 3 months knowing you are going to die.
posted by rmhsinc at 12:39 PM on July 19, 2011 [5 favorites]

I think deanc is right on the money. Symptoms that remain longer than a week or any on going pain that is either persistent or regularly reoccurring, go to the doc. Much like jph's friend, I was also feeling fatigued and having trouble breathing. It built up over a month and then one morning over the course of an hour I got to the point where I could no longer breathe (I was driving in heavy traffic at the time). Pulled over, flagged down a cop who got me an ambulance and away I went. I also had undiagnosed congestive heart failure and would certainly have died without going to the hospital. My point being, that I should have had the breathing problems and fatigue checked out after the first week (I was moving at the time, and assumed it was just allergy related). I suspect that this is doubly true once you pass 40, all the stuff that just used to work starts to break down.
posted by doctor_negative at 1:14 PM on July 19, 2011 [1 favorite]

A reference book like Body Signs can be helpful to have around. I'm sure there are others, but this one is quite good for figuring out which symptoms are OK to ignore and which need a medical evaluation or a trip to the ER.
posted by Corvid at 2:08 PM on July 19, 2011

Most things that make you sick, esp. the kind of being sick that results in death, affect your blood count, liver enzymes, skin color, blood pressure, and all sorts of other stuff. If you are deeply scared, and I can understand that you might be, find out if you can get a full body scan, which you'll probably have to pay for. BUT. There's a lot of medical data that basically says that it's statistically unlikely to make you live longer or better.

My brother, in his early 60s, had back problems, they gave him pain meds, ran tests but didn't run the more expensive tests. After 6 months of increasing back pain, he insisted, got the right tests, and had metastatic cancer. He died 6 weeks later. I miss him terribly. BUT. Even if it was caught earlier, he'd have likely had lots of horrid treatment, and maybe had his life extended a little. maybe.

Ovarian cancer is really hard to detect and treat. Thankfully, it's not common.

Eat well, get cardio and weight-bearing exercise, have good friends, don't smoke, and drink the occasional glass of red wine. Get your mammogram, Pap smear and flu shot. Wear your seat belt, check the battery in your smoke detector. If you hear hoofbeats, it's hardly ever zebras. The fact that a few people you know got killed by the unexpected is very sad, but probably not a sign. That sounds kind of snarky, I don't mean it that way. All you can do is life life reasonably safely, following the best advice you can get. Good luck
posted by theora55 at 2:37 PM on July 19, 2011

nthing pretty much all that has been said above.

I'm an englishman with the *benefit* of access to the NHS - and was diagnosed with testicular cancer five months ago. The odd thing was the cancer was found by blood tests and scans after an apparently unrelated series of backpains and leg aches, caused by kidney problems and DVT, that was caused by the tumour. I'm cured now.

I suppose the point I'm trying to make is that I'd felt really, truly awful for about a month and after several visits to the doctor he sent me for a battery of tests at the local hospital to work out what the hell was going on. If you are used to feeling general illness (as you mention, you frequently suffer minor coughs and drips), you'll probably more than most recognise when you really do feel ill.

Please don't worry about major illnesses striking you down. These days, I'm confident that modern medical systems can diagnose major illnesses quickly - the main driver is the patient bringing it to a doctors attention early enough!

good luck, and good health in the future.
posted by jjleonard at 2:42 PM on July 19, 2011

My rules of thumb:

- the faster the onset, the worse trouble you are in.

- the more the problem affects "normal" life, the more trouble you are in. If your time running that 10k goes up a little, probably not a big deal. If walking across the room winds you, trouble is looming.

- discoloration is bad.
posted by gjc at 3:08 PM on July 19, 2011

Aside from the dramatic onset of symptoms, the sinking feeling that "something is not quite right" from my experience with people I've known and supported by BuffaloChickenWing and jjleonard, along with persistent symptoms is definitely your first alarm bell with cancer. No one should think you're a hypochondriac for going to the doctor based on symptoms you've had for 2-3 weeks.

Unfortunately, the only cancers that have screening tests supported by evidence reviews are breast, cervical and colorectal/bowel. For all others, doctors can only respond to symptoms and patients advocating for themselves.

IANAD, but I work in cancer screening policy.
posted by waterandrock at 3:50 PM on July 19, 2011 [2 favorites]

Actually, maybe I shouldn't have said alarm bell, but "cause for concern."
posted by waterandrock at 3:51 PM on July 19, 2011

the sinking feeling that "something is not quite right"

As a counter point, I had this feeling dialed up to an 11 for about four months. I literally thought I was dying, but all my tests came back normal except for a "recent but not current mono infection." It has receded almost to zero.

This feeling is un-ignorable. I was not able to ignore it. Everything in me screamed "you're dying." But I appear to be fine.

So, if you get this feeling? Hell yes, get it checked out. But it's not an automatic death sentence. Sometimes evolution has some messed up alarm systems.
posted by zeek321 at 4:03 PM on July 19, 2011

Agreeing with zeek321. It probably is kind of like that feeling you get just before you get a cold or infection, but definitely worth getting checked out.
posted by waterandrock at 4:08 PM on July 19, 2011

If you are in a situation where you don't feel well and your dr. tells you there is nothing wrong with you, and particularly if he/she tells you it is all in your head, get yourself to another doctor (don't accept a second opionion from someone in the same practice). You know your body better than anyone else.

Also, slightly off-topic, but remember that your medical insurance pays for you to see a DOCTOR, you do not have to accept seeing a nurse practitioner, especially if it's something that's been bugging you for a while.
posted by vignettist at 7:02 PM on July 19, 2011

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