A few years ago, I experienced fatigue that got worse and worse. I ignored it for a long time then my heart stopped. I needed emergency by pass surgery. Fatigue had been the only symptom of a serious heart condition.

Symptoms we all experience occasionally, such as upset stomach or headache, are rarely cause for concern. Yet even mild symptoms may be a sign of serious underlying illness. The challenge is knowing when you can treat yourself and when you need medical attention.

Common symptoms-and when they may be dangerous...

Abdominal Pain

This is one of the most difficult symptoms to evaluate because it can be caused by hundreds of conditions.

Usual causes: Gas, stress, viral or bacterial infections (such as food poisoning).

Warning: Abdominal pain that lasts more than a day or two...causes severe cramps...or is accompanied by other symptoms, such as persistent nausea or vomiting, should be evaluated by a physician. The problem could be...

Appendicitis. Patients often experience fever. oi nausea as well as intense stomach pain. The pain typically begins around the navel and shifts to the lower-right abdomen over six to 12 hours. If the appendix isn't surgically removed before it ruptures, it can cause a life-threatening infection called Peritonitis.

Gallbladder disease, gallstones, ulcers and stomach cancer can cause abdominal pain ranging from sharp and intermittent to dull and constant.

Back Pain

Back pain is a leading cause of lost work days. Even minor back injuries can sometimes cause excruciating pain.

Usual causes: Muscle pulls or spasms cause 90% of back pain.

Apply an ice pack as often as possible during the first 24 hours after pain starts...switch to heat after 24 hours...and take a nonsteroidal anti-inflammatory drug (NSAID), such as aspirin or ibuprofen, to control pain and swelling.

If back pain does not improve after a week, see your doctor.

Warning: Back pain that is accompanied by fever and neurological symptoms, such as tingling, numbness or shooting pains down one or both legs, is potentially serious. These symptoms may indicate a spinal infection, which is relatively rare but can cause permanent damage. See your doctor or go to an emergency room immediately.

Chest Pain

Any pain that is in the chest should be taken seriously because it is a common symptom of heart attack.

Usual causes: Musculoskeletal injury that is caused by overexertion. Working all day in the yard or pushing yourself too hard at the gym can result in a muscle pull between the ribs or in the upper chest. This may cause a dull ache or shooting pains.

If pain occurs only when you move your body in a certain way, it is probably caused by a strained muscle or inflammation in the ribs (costochondritis). The pain usually subsides in a day or two.

Warning: Suspect a heart attack if the pain is accompanied by a pressing or crushing sensation, radiates out from the chest to other parts of the body (such as the breastbone, jaw, arms or, neck) and/or is accompanied by heavy sweating, nausea or vomiting. Call 911 immediately. Then take an aspirin, unlock your door and wait for help to arrive.

Severe chest pain that occurs in patients who have had surgery recently or have been bedridden due to illness or injury may be caused by a pulmonary embolism (a blood clot in the lung). Again, get medical assistance immediately.


The frequency of bowel movements is highly variable-from twice a day to several times a week may be normal. Any change in your usual habits deserves attention.

Usual causes: Most constipation is due to insufficient fiber and/or water in the diet.

Try to get at least 25 grams (g) of fiber daily. Start the day with a high-fiber cereal, such as oatmeal...snack on fresh fruits...and eat more beans, whole grains and vegetables. Drink two quarts of liquid daily-water is best.

Also, exercise for at least 20 minutes most days of the week. Exercise stimulates intestinal contractions that promote bowel movements.

Warning: Sudden constipation or alternating bouts of diarrhea and constipation may be a sign of colon cancer. Call your doctor-you may need a colonoscopy to determine if cancer is present.


It's normal to be exhausted after a hard. day, but persistent fatigue is not normal, especially when it suddenly worsens.

Usual causes: A combination of inadequate sleep and bad diet, such as loading up on coffee or junk food, can cause fatigue. Caffeine ls a stimulant-but after the initial stimulation, people often experience rebound fatigue. Junk food is usually high in carbohydrates, which can cause a surge in blood sugar followed by a drop, resulting in fatigue.

Limit your intake of caffeinated beverages to one or two servings daily. Go to bed and get up at the same times most days of the week. Eat nutritious meals and exercise regularly-it promotes deeper sleep.

Warning: Fatigue can be a symptom of almost all acute and chronic diseases, but people who experience significantly more fatigue than usual-in the absence of any lifestyle changes should suspect underlying heart disease and get an immediate checkup. This is especially true for women because fatigue, not chest pain, often is the first symptom.


Anyone who gets headaches more often than once a month or is incapacitated by a headache needs to go to a doctor for a complete medical workup immediately.

Usual causes: Approximately 9O% of headaches are tension headaches, caused by fatigue or emotional stress.

Aspirin, ibuprofen and acetaminophen ate effective at relieving pain-see which works best for you. Stress-reduction techniques, such as yoga, can also help.

Migraine headaches are more severe, but they usually can be controlled or prevented by using ibuprofen or prescription drugs, such as sumatriptan (Imitrex).

Warning: Headaches that increase in frequency...are unusually severe...or are accompanied by other symptoms, such as nausea' slurred speech or vision changes, should be brought to a doctor's attention immediately. They could be a sign of stroke, infection in a brain blood vessel, meningitis or even a brain tumor.

Important: Call 911, if you suspect a stroke or experience an excruciating headache that comes out of the blue. This is known as a thunder clap headache, and it may be due to a potentially fatal ruptured blood vessel in the brain.


Most of us have experienced this burning sensation behind the breastbone.

Usual causes: Indigestion, often from eating fatty or spicy foods.

Warning: Gastroesophageal reflux disease (GERD) is a common cause of heartburn. Mild cases can be treated with antacids, but GERD that occurs more than once a week can cause serious damage to the esophagus. There also is an association between chronic GERD and esophagus cancer.

Patients usually require acid-blocking medications, such as omeprazole (Prilosec) or ranitidine (Zantac).

Helpful: If you need antacids more than once or twice a week, see your doctor.

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