Post by Mark Hannaford, physician’s assistant for U.S. HealthWorks in Muncie, Indiana
“My wife has had these same symptoms,” he says as he struggles to sit up from a reclined position on the bed in the exam room. “I’ve tried Tylenol and Mucinex like she did, but I’m just not kicking it. I just can’t get comfortable, especially at night.”
Reviewing the chart again and confirming that he is an otherwise healthy male without a history of surgeries or prior serious medical ailments, I look at the wife who states, “He’s hardly ever sick,” with a concerned, empathetic expression and tone that only a wife can express when she knows something is amiss with her husband. The patient states that these symptoms gradually began while he was at home a couple of days ago, shortly after his wife was prescribed over-the-counter medications by her family physician for similar symptoms. The patient denies eating anything out of the ordinary. He also denies any recent travel or prolonged immobilization in a car or airplane, which can sometimes increase chances of blood clots in certain populations and mimic similar complaints.
A physical exam revealed an ill-appearing male who was struggling to sit in our office instead of his comfortable bed at home. Pulse, blood pressure, and fever were slightly elevated, but not abnormal for someone with “just the flu.” His head, neck, heart, respiratory, abdominal, and extremity exam were not grossly abnormal.
An in-office strep test and a flu test were both negative. An EKG was performed due to my concern for underlying cardiovascular compromise that sometimes mimics flu-like symptoms. The EKG was not grossly abnormal, but there were a few irregularities in it.
When I walked back in the room, the patient was on his left side curled up in a ball moaning while his wife was rubbing his head giving him sips of water. “I just can’t get comfortable,” he says again and again. “Just give me something for this flu and body aches and let me go home.” He again says that he has not taken any new medications or supplements. He also confirms no new exercise routines that might contribute to abnormal renal function. I had also screened for kidney function because some kidney conditions break down muscles, which can mimic flu symptoms.
After discussing the results of our tests and physical exam, I directed his wife to take her husband to our local emergency department where blood tests could be drawn and closely monitored. These sometimes hourly blood tests can indicate if the heart is under acute distress from lack of oxygen and/or muscle breakdown.
As it turns out, the patient was found to have elevated cardiac enzymes and subsequently underwent a cardiac catheterization that same day by a cardiologist. This specialized procedure allows the cardiologist to look at the arteries of the heart under an X-ray machine while using a special dye and wire. This exam revealed a completely blocked coronary artery, which required angioplasty and several stents. The patient was kept in the hospital for another day and was started on multiple heart medications.
“I feel like a new man and 100 percent better,” the patient later said over the phone in a much stronger, enthusiastic voice.
This patient had complaints that are commonly experienced by millions of sick patients, especially during the winter months. Most presume that they have a common cold or influenza virus, especially with influenza normally peaking in late December or early January of any given flu season. However, until examined by a medical professional, one is not safe to presume that the symptoms are merely a viral syndrome that will resolve with time, OTC medications, and/or hydration.
Misconceptions of aches and pains can be easily confused with more serious medical conditions such as heart attacks, pneumonia, blood clots, and more. These more serious conditions are life-threatening and need immediate attention by a medical professional. When an individual presents with “cold or flu” like symptoms, we are always evaluating the patient with the aforementioned medical conditions and more in mind. There are subtle differences between symptoms, history, and physical exam that can aid in the correct medical diagnosis.
Thus, when feeling ill or concerned about your health not only in the winter, but anytime of the year, it is imperative to be seen by a medical professional.
Images courtesy of freedigitalphotos.net