These common aches could very well be nothing -- or something far, far worse. Plus three things you really don't have to worry about.By Allen St. John
Most of the time, it's good that the little Vince Lombardi sitting on our shoulder tells us to shut up and play through the pain, otherwise we'd never get anything done. On the other hand, there are a few instances in which we can actually talk ourselves out of existence.
That's what happened to NBC reporter David Bloom. While covering the war in Iraq from his specially outfitted armored vehicle, he began to feel pain behind his knee. He reportedly sought out medical advice by satellite phone, decided not to follow the advice -- "Go to a doctor" -- popped a few aspirin, and kept right on going. Three days later, Bloom died of a pulmonary embolism caused by deep-vein thrombosis. He was 39.
The ache that Bloom blew off is one of seven pains that no man should ever ignore. And no, this isn't negotiable.
1. Sudden Groin Pain
Not as severe as a shot to the crotch, but pretty close. Sometimes accompanied by swelling.
The condition: Odds are it's something called testicular torsion. Normally, a man's testicles are attached to his body in two ways: by the spermatic cords, which run into the abdomen, and by fleshy anchors near the scrotum. But sometimes, in a relatively common congenital defect, these anchors are missing. This allows one of the spermatic cords to get twisted, which cuts off the flow of blood to the testicle. "If you catch it in 4 to 6 hours, you can usually save the testicle," says Jon Pryor, M., a urologist with the University of Minnesota. "But after 12 to 24 hours, you'll probably lose it." Another possible cause of the pain in your pants: an infection of the epididymis, your sperm-storage facility.
The diagnostics: A physical examination, possibly followed by an ultrasound. Antibiotics can stifle an infection.
And if your testicles are doing the twist? A surgeon will straighten the cord, then construct artificial anchors with a few stitches near the scrotum.
2. Severe Back Pain
Similar to the kind of agony you'd expect if you'd just tried to clean-and-jerk an armoire. The usual remedies -- heat, rest, OTC painkillers -- offer no relief.
The condition: "If it's not related to exercise, sudden severe back pain can be the sign of an aneurysm," says Sigfried Kra, MD, an associate professor at the Yale school of medicine. Particularly troubling is the abdominal aneurysm, a dangerous weakening of the aorta just above the kidneys. But don't worry; eventually, the pain subsides -- right after your body's main artery bursts. A less threatening possibility: You have a kidney stone. More pain, but you'll only wish you were dead.
The diagnostics: A CT scan using intravenous radiopaque dye does the best job of revealing the size and shape of an aneurysm. Once its dimensions are determined, it'll be treated with blood-pressure medication or surgery to implant a synthetic graft.
3. Persistent Foot or Shin Pain
A nagging pain in the top of your foot or the front of your shin that's worse when you exercise, but present even at rest. It's impervious to ibuprofen and acetaminophen.
The condition: It's probably a stress fracture. Bones, like all the other tissues in your body, are continually regenerating themselves. "But if you're training so hard that the bone doesn't get a chance to heal itself, a stress fracture can develop," explains Andrew Feldman, MD, the team physician for the New York Rangers. Eventually, the bone can be permanently weakened.
The diagnostics: Radioactive dye reveals the fracture in the X-ray, and you'll be told to stop all running until the crack heals. Worst case, you'll be in a cast for a few weeks.
4. Sharp Pain in the Abdomen
All the metaphors apply -- knife in the gut, bullet in the belly, skewer in the stomach -- except this attack is from within.
The condition: Take your pick. Since the area between your ribs and your hips is jam-packed with organs, the pain can be a symptom of either appendicitis, pancreatitis, or an inflamed gallbladder. In all three cases, the cause is the same: Something has blocked up the organ in question, resulting in a potentially fatal infection. Exploding organs can kill a guy. See a doctor before this happens.
The diagnostics: If the pain is in your lower-right abdomen and your white-blood-cell count is up, says Dr. Kra, it's probably appendicitis (out comes the appendix). Pain in your upper abdomen with high white blood cells usually spells an inflamed gallbladder (goodbye, gallbladder). And if it hurts below your breastbone and certain enzymes in the blood are elevated, then pancreatitis is probably the culprit. (The pancreas stays, but a gallstone may be blocking things up. If so, the stone and the gallbladder may have to come out.)
5. Transient Chest Pain
Not a type of pain that strikes only homeless people, but a heavy ache that comes on suddenly and then goes away just as quickly. Otherwise, you feel fine.
The condition: It could be indigestion. Or it could be a heart attack. "Even if it's very short in duration, it can be a sign of something serious," says John Stamatos, MD, medical director of North Shore Pain Services in Long Island and author of Painbuster. Here's how serious: A blood clot may have lodged in a narrowed section of a coronary artery, completely cutting off the flow of blood to one section of your heart. How much wait-and-see time do you have? Really, none. Fifty percent of deaths from heart attacks occur within 3 to 4 hours of the first symptoms. You're literally living on borrowed time.
The diagnostics: A blood test checks for markers of damaged heart tissue. Treatment: angioplasty or bypass.
6. Leg Pain with Swelling
Specifically, one of your calves is killing you. It's swollen and tender to the touch, and may even feel warm, as if it's being slow-roasted from the inside out.
The condition: Just sit in one place for 6 or more hours straight and wait for the blood that pools in your lower legs to form a clot (a.k.a. deep-vein thrombosis, or DVT). Next thing you know, that clot will be big enough to block a vein in your calf, producing pain and swelling. Unfortunately, the first thing you'll probably want to do -- rub your leg -- is also the worst thing. "It can send a big clot running up to your lung, where it can kill you," warns Dr. Stamatos.
The diagnostics: A venogram, in which dye is injected into the vein and then X-rayed, is the definitive way to diagnose DVT. They'll try to dissolve the clot with drugs, or outfit vulnerable veins with filters to stop a clot before it stops you.
7. Painful Urination
Relieving yourself has become an exercise in expletives. Also, you could swear (and you do) that your yellow stream has a rusty tint.
The condition: Worst case? Bladder cancer, according to Joseph A. Smith, M.D., chairman of the department of urologic surgery at Vanderbilt University. The pain and the blood in your urine are symptoms of this, the fourth most common cancer in men. Smoking is the biggest risk factor. Catch the disease early, and there's a 90% chance of fixing it. Bladder infections share the same symptoms.
The diagnostics: It's a sick joke, but true nonetheless: They'll diagnose by process of elimination. Urinalysis first, to rule out bugs, followed by inserting a scope to look inside the bladder. A tumor will be treated with surgery, radiation, or chemotherapy.
Most of the time, it's good that the little Vince Lombardi sitting on our shoulder tells us to shut up and play through the pain, otherwise we'd never get anything done. On the other hand, there are a few instances in which we can actually talk ourselves out of existence.
That's what happened to NBC reporter David Bloom. While covering the war in Iraq from his specially outfitted armored vehicle, he began to feel pain behind his knee. He reportedly sought out medical advice by satellite phone, decided not to follow the advice -- "Go to a doctor" -- popped a few aspirin, and kept right on going. Three days later, Bloom died of a pulmonary embolism caused by deep-vein thrombosis. He was 39.
The ache that Bloom blew off is one of seven pains that no man should ever ignore. And no, this isn't negotiable.
1. Sudden Groin Pain
Not as severe as a shot to the crotch, but pretty close. Sometimes accompanied by swelling.
The condition: Odds are it's something called testicular torsion. Normally, a man's testicles are attached to his body in two ways: by the spermatic cords, which run into the abdomen, and by fleshy anchors near the scrotum. But sometimes, in a relatively common congenital defect, these anchors are missing. This allows one of the spermatic cords to get twisted, which cuts off the flow of blood to the testicle. "If you catch it in 4 to 6 hours, you can usually save the testicle," says Jon Pryor, M., a urologist with the University of Minnesota. "But after 12 to 24 hours, you'll probably lose it." Another possible cause of the pain in your pants: an infection of the epididymis, your sperm-storage facility.
The diagnostics: A physical examination, possibly followed by an ultrasound. Antibiotics can stifle an infection.
And if your testicles are doing the twist? A surgeon will straighten the cord, then construct artificial anchors with a few stitches near the scrotum.
2. Severe Back Pain
Similar to the kind of agony you'd expect if you'd just tried to clean-and-jerk an armoire. The usual remedies -- heat, rest, OTC painkillers -- offer no relief.
The condition: "If it's not related to exercise, sudden severe back pain can be the sign of an aneurysm," says Sigfried Kra, MD, an associate professor at the Yale school of medicine. Particularly troubling is the abdominal aneurysm, a dangerous weakening of the aorta just above the kidneys. But don't worry; eventually, the pain subsides -- right after your body's main artery bursts. A less threatening possibility: You have a kidney stone. More pain, but you'll only wish you were dead.
The diagnostics: A CT scan using intravenous radiopaque dye does the best job of revealing the size and shape of an aneurysm. Once its dimensions are determined, it'll be treated with blood-pressure medication or surgery to implant a synthetic graft.
3. Persistent Foot or Shin Pain
A nagging pain in the top of your foot or the front of your shin that's worse when you exercise, but present even at rest. It's impervious to ibuprofen and acetaminophen.
The condition: It's probably a stress fracture. Bones, like all the other tissues in your body, are continually regenerating themselves. "But if you're training so hard that the bone doesn't get a chance to heal itself, a stress fracture can develop," explains Andrew Feldman, MD, the team physician for the New York Rangers. Eventually, the bone can be permanently weakened.
The diagnostics: Radioactive dye reveals the fracture in the X-ray, and you'll be told to stop all running until the crack heals. Worst case, you'll be in a cast for a few weeks.
4. Sharp Pain in the Abdomen
All the metaphors apply -- knife in the gut, bullet in the belly, skewer in the stomach -- except this attack is from within.
The condition: Take your pick. Since the area between your ribs and your hips is jam-packed with organs, the pain can be a symptom of either appendicitis, pancreatitis, or an inflamed gallbladder. In all three cases, the cause is the same: Something has blocked up the organ in question, resulting in a potentially fatal infection. Exploding organs can kill a guy. See a doctor before this happens.
The diagnostics: If the pain is in your lower-right abdomen and your white-blood-cell count is up, says Dr. Kra, it's probably appendicitis (out comes the appendix). Pain in your upper abdomen with high white blood cells usually spells an inflamed gallbladder (goodbye, gallbladder). And if it hurts below your breastbone and certain enzymes in the blood are elevated, then pancreatitis is probably the culprit. (The pancreas stays, but a gallstone may be blocking things up. If so, the stone and the gallbladder may have to come out.)
5. Transient Chest Pain
Not a type of pain that strikes only homeless people, but a heavy ache that comes on suddenly and then goes away just as quickly. Otherwise, you feel fine.
The condition: It could be indigestion. Or it could be a heart attack. "Even if it's very short in duration, it can be a sign of something serious," says John Stamatos, MD, medical director of North Shore Pain Services in Long Island and author of Painbuster. Here's how serious: A blood clot may have lodged in a narrowed section of a coronary artery, completely cutting off the flow of blood to one section of your heart. How much wait-and-see time do you have? Really, none. Fifty percent of deaths from heart attacks occur within 3 to 4 hours of the first symptoms. You're literally living on borrowed time.
The diagnostics: A blood test checks for markers of damaged heart tissue. Treatment: angioplasty or bypass.
6. Leg Pain with Swelling
Specifically, one of your calves is killing you. It's swollen and tender to the touch, and may even feel warm, as if it's being slow-roasted from the inside out.
The condition: Just sit in one place for 6 or more hours straight and wait for the blood that pools in your lower legs to form a clot (a.k.a. deep-vein thrombosis, or DVT). Next thing you know, that clot will be big enough to block a vein in your calf, producing pain and swelling. Unfortunately, the first thing you'll probably want to do -- rub your leg -- is also the worst thing. "It can send a big clot running up to your lung, where it can kill you," warns Dr. Stamatos.
The diagnostics: A venogram, in which dye is injected into the vein and then X-rayed, is the definitive way to diagnose DVT. They'll try to dissolve the clot with drugs, or outfit vulnerable veins with filters to stop a clot before it stops you.
7. Painful Urination
Relieving yourself has become an exercise in expletives. Also, you could swear (and you do) that your yellow stream has a rusty tint.
The condition: Worst case? Bladder cancer, according to Joseph A. Smith, M.D., chairman of the department of urologic surgery at Vanderbilt University. The pain and the blood in your urine are symptoms of this, the fourth most common cancer in men. Smoking is the biggest risk factor. Catch the disease early, and there's a 90% chance of fixing it. Bladder infections share the same symptoms.
The diagnostics: It's a sick joke, but true nonetheless: They'll diagnose by process of elimination. Urinalysis first, to rule out bugs, followed by inserting a scope to look inside the bladder. A tumor will be treated with surgery, radiation, or chemotherapy.
