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Silent signs your body is in Big trouble

Subtle clues-from handwriting to snoring-can reveal the earliest warnings of illness. Here's how to read your own distress signals.

By Hallie Levine and kathakoli dasgupta  

Your Gut Is in Big Trouble

Damage to your teeth

"I often get referrals from dentists with patients who don't feel heartburn or other reflux symptoms, but their teeth enamel is completely worn down," says Evan Dellon, MD, a gastrointestinal (GI) specialist at the University of North Carolina School of Medicine, USA. Many are shocked to learn they have acid reflux. While sugary drinks wear down front teeth, acid from your oesophagus tends to dissolve enamel at the back, leaving a funny taste in your mouth.
Other subtle but suspicious symptoms of reflux: a persistent sore throat, coughing, unexplained wheezing."We get referrals from ENT specialists for these complaints that don't seem to have a respiratory connection," says Dr Ajay Kumar, executive director, gastroenterology, Fortis Escorts Heart Institute, New Delhi. If you notice any of these warning signs, see a GI specialist promptly. Untreated reflux not only leads to tooth decay but can also increase your risk for oesophageal cancer. 

Itchy, blistery skin rash
This reaction, which breaks out on the elbows, knees, butt, back or scalp, may look suspiciously like eczema, but could be a more serious issue: coeliac disease, an autoimmune condition in which ingesting even the tiniest amount of gluten [a form of protein in grains such as wheat, rye and barley] causes your body to attack its own intestines. This rash is known as dermatitis herpetiformis. Many patients show no digestive symptoms, so it's best not to ignore a rash.

When a coeliac patient consumes gluten, the body releases an antibody known as IgA, which attacks the intestines. Sometimes IgA also collects in small blood vessels underneath the skin, triggering the telltale rash. Unlike people with other forms of coeliac, patients with dermatitis herpetiformis don't have to undergo an endoscopic biopsy for a definitive diagnosis. A doctor can biopsy the rash and look for antibodies that indicate coeliac. "It is combined with a serology positivity blood test. The final diagnosis is done by monitoring the response to gluten withdrawal," adds Kumar. If your itchy skin is a result of coeliac disease, it should disappear once you start a gluten-free diet. You'll protect your body from other long-term, serious damage of coeliac disease, such as osteoporosis or small intestine cancer.
 
Haemorrhoids
About one-third of patients with Crohn's disease-an inflammatory disorder of the GI tract-have a form that affects just the anal region. Known as perianal fistulas, it manifests as sores, ulcerations or fleshy growths outside the area, which can be mistaken for haemorrhoids. "Patients will say sitting is so unpleasant, it's like they're perched on top of a marble," says David Rubin, MD, chief of gastroenterology at the University of Chicago Medical Center, USA. This type of Crohn's disease is often the most painful and has the worst prognosis, says Rubin. If left untreated, Crohn's can lead to bowel obstruction, painful fissures and even colon cancer. If you have what appear to be haemorrhoids that don't respond to treatment, Rubin recommends seeing a GI specialist for a second opinion as soon as possible. A combination of blood tests, colonoscopy and CT scan may be required for a diagnosis.

Your Brain Is in big Trouble

Changes in handwriting
When you think of Parkinson's disease (PD), you probably think of tremors, but a more telling early warning sign is handwriting that gets much smaller. Handwriting analysis identified patients in early stages more than 97 per cent of the time, a 2013 Israeli study found. "I have patients write a sentence such as 'Today is a nice day' 10 times," says Dr Michael S. Okun, national medical director for the National Parkinson Foundation, USA. "As they write, each sentence gets smaller and smaller, and the words become more crowded together." Technically, this is known as micrographia, adds Dr Raghuram G., senior consultant neurosurgeon at Columbia Asia hospital, Bengaluru. PD occurs when nerve cells in the brain become damaged or die. They produce less dopamine, a chemical that sends signals to trigger movement. This causes muscle stiffness in hands and fingers. "This, in turn, affects the smooth movement needed to write properly, resulting in handwriting that looks cramped," says Raghuram.

Other early red flags include difficulty in walking, slurred speech and disturbed sleep. As it mainly affects seniors, it may be hard to tell the difference between stiffness and slowness caused by age as opposed to PD. One way to tell: the movement is jerkier and tends to be uncoordinated, explains Raghuram. PD affects movement in different ways, including that of the tongue. People with early PD may speak slowly or with a slight slur, Raghuram adds. Tossing and turning in bed as well as thrashing, kicking, punching-even falling out of bed-is not uncommon. If you notice any of these symptoms-lasting more than a couple of weeks-see a neurologist. The earlier PD is diagnosed and the sooner you gain control over the symptoms, the better your quality of life will be.
 
Random bursts of anger
For many people, depression doesn't translate to weeping or lying listlessly on the couch. More than half of patients with depression have irritability and anger. In fact, those symptoms are associated with a more severe, longer-lasting form, according to a 2013 study by the University of California, San Diego. "A classic case: Someone never suffered from road rage before, but now if they get cut off, they get so furious, they go crazy blaring their horn," says Dr Philip Muskin, a professor of psychiatry at Columbia University Medical Center. Women are found to have depression more often than men, but men are more likely to experience the disease through irritability and anger, according to a 2013 study by the University of Michigan.

If you're constantly snapping at your spouse or the slightest annoyance gets your heart racing-and these reactions have lasted for more than two weeks-there's a real chance that depression is the culprit. Many cases of major depression respond well to a combination of antidepressants and cognitive behaviour therapy, a short-term therapy that teaches skills to avoid damaging thoughts or actions. A British study published in April 2015 found that mindfulness-based cognitive the-rapy, which helps increase awareness of negative spirals, was as effective as medicines in preventing a recurrence of depression over a two-year period.

Difficulty managing finances
When University of Alabama researchers followed 87 seniors with mild memory problems, the 25 who went on to develop Alzheimer's showed a decline in skills like managing bank statements and paying bills over a year-long period. "As part of the screening, we often use what is known as the serial seven score: we ask the patient to subtract seven from 100, and then to keep subtracting seven from the result. People in the early stages of Alzheimer's might struggle with it," says Dr Guruprasad Hosurkar, consultant neurology in Columbia Asia hospital, Bengaluru. While everyone has an occasional senior moment, it's a red flag if these issues persist on a regular basis.

As Alzheimer's develops, the brain's cortex begins to shrivel up. "Different symptoms show up depending on which area of the cortex succumbs to damage first. The left parietal lobe, for example, plays a role in reading, writing and processing numbers. Damage to this part will make managing day-to-day finances increasingly difficult," explains Hosurkar. As the disease spreads to the frontal lobes-the centre for executive functions, attention, concentration and abstract thinking-you may find it difficult to complete other daily tasks like following a favourite recipe, making plans for the day or even struggle with decision-making. Consider these early warning signs.

Your Heart is in Big Trouble

Snoring
It's a commonly known symptom of sleep apnoea, which is associated with risk of increased heart disease. But snoring may play a bigger role in cardiovascular disease than experts thought. A 2013 study found that even among patients without sleep apnoea, snoring was linked with the thickening of carotid arteries in the neck. Such damage is a precursor to stroke and heart attack. Snoring was more strongly associated with this (arterial) wall damage than smoking, high cholesterol or being overweight. Why? Snoring may damage the carotid arteries, which supply blood to the brain. "We think the arteries react to the vibration of the snoring, since they're very close to the throat," says study author Dr Kathleen Yaremchuk, chair, department of otolaryngology, head and neck surgery at Henry Ford Hospital in Detroit, USA.

Because snoring may signify some sort of obstruction in the airways, it can lead to reduced oxygen supply to the heart and brain, upping the risk of cardiac failure and strokes. Moreover, if your snoring is interfering with deep sleep, over time, it increases blood pressure, affecting your ticker, adds Dr Vikas Agrawal, senior ENT surgeon and sleep specialist, and former president of the Indian Association of Surgeons for Sleep Apnoea (IASSA). So, instead of dismissing snoring as a mere annoyance, seek medical attention, especially if you find yourself waking up tired even after eight hours of sleep. "Sometimes treating snoring can be as simple as changing your sleep position-avoiding sleeping on your back where gravity aids in creating obstructions. At other times, you may need CPAP [continuous positive airway pressure]-a mask that helps you breathe easily, or a minor corrective surgery to tackle the obstruction," Agrawal adds.
 
Impotence
Men over age 45 who weren't found to have heart disease but had moderate to severe erectile dysfunction were up to 60 per cent more likely to be hospitalized for heart problems, according to a 2013 Australian study conducted over a four-year period. Why? "Because atherosclerosis (a blockage in the arteries due to plaque build-up) doesn't just affect the arteries supplying blood to the heart, but also blood vessels throughout the body, including the pudendal artery to the penis," says Dr Nilesh Gautam, senior interventional cardiologist and head, preventive cardiology and rehabilitation, Asian Heart Institute, Mumbai. As arteries to the penis are smaller than elsewhere in the body, they may become blocked even before a man has any other signs of heart disease. Gautam adds that it is important for men who have problems getting or maintaining an erection, to consult a doctor and be evaluated for heart disease.
   
Inflamed gums
A preliminary University of Florida study found that the same bacteria that cause gum disease also promote heart disease. Other research shows that older adults with high levels of certain bacteria in their mouth have thicker carotid arteries, a predictor of stroke and heart attack. "The link has to do with the body's response to inflammation," says Dr Stuart Froum, director of clinical research at NYU College of Dentistry. 

Frequent cleaning (every three to six months) by a dentist can control early-stage gum disease. Treating gum disease was associated with fewer hospitalizations among people with heart disease or type 2 diabetes, according to a 2014 American Journal of Preventive Medicine study.
   
Your Hormones Are in Big Trouble

Frequent bathroom trips
When you start developing type 2 diabetes, your body becomes less efficient at breaking food down into sugar to use as fuel for energy. As a result, sugar builds up in the bloodstream, where it does silent but significant damage to blood vessels and nerves, says Dr Ashita Gupta, an endocrinologist at Mount Sinai Roosevelt Hospital in New York City. Your body reacts by frantically trying to dump the glucose build-up: your kidneys work harder to flush it out through your urine. Result? You are going to the bathroom more frequently-and producing much more when you go, adds Dr Ambrish Mithal, chairman and HoD, division of endocrinology and diabetes, Medanta-the Medicity, Gurgaon. You may find yourself getting up to pee quite a few times at night. Since you're urinating so much, you may be thirstier.

Consult your doctor if you find yourself emptying your bladder frequently over several days even when your fluid intake hasn't increased, says Mithal. In addition to checking your blood glucose level, your doctor may ask for an HbA1c blood test, which measures your average blood glucose over the course of three months (other tests, such as the fasting blood glucose, measure blood glucose levels only on the day of the investigation) for diagnosis. "The sooner type 2 diabetes is diagnosed, the likelier you are to tackle it with lifestyle changes, such as weight loss and exercise," explains Gupta.
   
Forgetting people's names
Spaced out on your neighbour's name at the grocer's? It may be due to stress or fatigue, but forgetfulness about little things such as names or grocery lists could indicate hypothyroidism, or low levels of thyroid hormone. "Functional imaging studies show decreased brain blood flow and reduced brain metabolism in hypothyroidism. Thus, overt hypothyroidism has been linked with a wide range of cognitive dysfunction including memory issues," says Mithal. "Patients complain that their brain feels 'fuzzier'. Without the thyroid hormone, everything just slows down," says Gupta. "I ask whether they still feel tired after a full night's sleep. If they do feel foggy, it may signal that something hormonal-like an underactive thyroid-is the culprit." Other signs include feeling tired and cold all the time, dry skin, brittle nails and a low libido. Because these symptoms are often vague and seemingly unrelated, it's easy to blow them off. A 2013 study done across eight cities in India, found that approximately one in 10 adults had hypothyroidism, with women three times more likely to be affected. Yet a more recent survey conducted by the Indian Thyroid Society concluded that the awareness about it ranked ninth as compared to other common conditions, such as asthma, cholesterol issues, diabetes, depression, insomnia and heart disease. If you experience any of the symptoms, it's worth getting tested. "When patients are treated with thyroid medication, they're always amazed at how much sharper they feel-that their memory lapses and difficulty concentrating weren't due to just menopause or ageing," adds Gupta.

8 EASY-TO-IGNORE CANCER SIGNS

Thanks to advances in screening and diagnosis, early detection is possible, but initial symptoms can be subtle enough to overlook.

1. Unintentional weight loss. If you have lost more than 4.5 kilos with no diet or exercise, get it checked, says Richard Wender, MD, American Cancer Society. This happens most often with pancreatic,stomach, oesophageal or lung cancer.  

2. Fatigue. "This means being more tired than what you'd expect for what's going on in your life," says Dr Dale Shepard, a Cleveland Clinic oncologist. If you're under short-term stress, feeling more tired than usual is understandable, but if you're struggling to get through work or can't make it through every day without a nap, that's a warning sign. Fatigue can indicate some colon and stomach cancers as well as certain blood cancers like leukaemia.

3. Unexplained bleeding. Anything strange-coughing up blood (lung cancer), unusual vaginal bleeding (cervical or endometrial cancer), blood in stool (colon or rectal cancer), blood in urine (bladder or kidney cancer) or bloody nipple discharge (breast cancer)-should be brought to your doc's attention.  

4. Pain. Pain owing to cancer usually means the disease has already spread and become advanced, but it can be an early symptom of bone or testicular malignancy.

5. Persistent sores or bug bites. They may be early-stage skin cancers. A long-lasting sore in your mouth could be oral cancer.A sore on your penis or vagina could indicate penile, vaginal or vulvar cancer.

6. Nagging coughs.
If you develop a cough that won't disappear, even though you've never had allergies, asthma or sinus problems, take note. Watch out for shortness of breath, wheezing and difficulty swallowing.It could indicate lung cancer or, if accompanied by hoarseness, cancer of the larynx, oesophagus or thyroid, says Dr Vineet Talwar, unit head, Medical Oncology, at Delhi's Rajiv Gandhi Cancer Institute and Research Centre.

7. Bowel or bladder changes. Peeing more or less than usual could indicate bladder or prostate cancer. Constipation or diarrhoea may signal colon or ovarian cancer. You may attribute gassiness or bloating to diet, but talk to your doctor if it lasts more than a week.

8. Frequent fevers or infections. These can be signs of leukaemia, a cancer of the blood cells. Often, doctors diagnose leukaemia only after the patient has been complaining of fever, achiness and flu-like symptoms over an extended period of time, says Talwar.

 

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