Amen. Here's a list of eighteen symptoms that should send you straight to the doctor, plus a capsule look at what the best- and worst-case scenarios might be. Remember, there are often plenty of other possibilities, and other symptoms - such as Tim's painful testicle - can be emergencies as well. Frequently, a thorough workup by health care personnel is needed in order to get a diagnosis. But what I want to emphasize is the fact that these eighteen symptoms should not be ignored, since they do sometimes signal serious problems requiring immediate medical attention. I developed this list when I taught a course for acupuncture students about how to recognize the red flags that signal the need for evaluation and possible treatment by a physician trained in Western medicine. I used the standard checklist doctors follow when taking medical histories: the review of systems (ROS). The ROS starts with what are called "constitutional symptoms" such as weight loss and fatigue. Then the ROS literally takes it from the top, working from the head down to the feet:

1) Loss of appetite and weight loss

Best-case scenario: Dieting, elderly with decreased interest in meal preparation, mild depression.

Worst-case scenario: Cancer, liver disease such as hepatitis, severe and possibly suicidal depression, chronic infections such as TB, anorexia nervosa, Crohn's disease.

2) Severe headaches

Best-case scenario: Acute viral infection, tension, migraine.

Worst-case scenario: Sudden onset of your worst headache ever could signal an aneurysm in the brain (thinning of an artery, which may then balloon and rupture). Sudden onset with fever and stiff neck could signal meningitis. Gradual onset with escalating intensity on awakening could signal a brain tumor. The antibiotic minocycline, which is used to treat acne, can cause increased intracranial pressure and blindness if left untreated. This complication is extremely rare.

3) Redness in the white of the eye

Best-case scenario: Conjunctivitis (pink eye) from contagious virus or staph bacteria, or an allergic reaction to pollen or contact lens solution. The eye could also simply be bloodshot from fatigue or alcohol use.

Worst-case scenario: Acute glaucoma or uveitis or a foreign body in the eye. Note that in these instances there will usually also be pain and decreased vision.

4) Persistent cough

Best-case scenario: Postnasal drip, asthma, acid reflux (heartburn), or the vicious cycle of a continued cough caused by irritation from coughing.

Worst-case scenario: Severe asthma, tumor such as lung cancer, lymphoma, heart failure or fluid in the chest. Note: A chest X-ray can help rule out serious problems.

5) Shortness of breath

Best-case scenario: Obesity, sedentary lifestyle, hyperventilation from anxiety.

Worst-case scenario: Sudden onset can signal a pulmonary embolism (blood clot in the lung). If the episode happens while you're lying down or exercising, the cause may be angina (blockage in the arteries, which may result in heart failure). If you have a history of allergies or asthma, this may be a serious asthma attack.

6) Chest pains

Best-case scenario: Esophageal spasm from acid reflux (heartburn), unexplained "stitch," inflammation of lining of lung or rib cartilage.

Worst-case scenario: If the pain is of recent onset and is coming in episodes of five to fifteen minutes each with tightness that doesn't get worse when you breathe deeply but does get worse with exercise, the cause may be angina (see number 5). If you're also experiencing shortness of breath, this could signal a pulmonary embolism (blood clot in the lungs). Other possibilities are a collapsed lung, a dissecting aorta, or an aortic aneurysm.

7) Persistent abdominal cramps or pain

Best-case scenario: Spastic colon, viral infection, intolerance to lactose (a substance found in milk and milk products), gas from beans or from sugar substitutes.

Worst-case scenario: Especially if accompanied by nausea, vomiting, weight loss, and change in bowel habits, the cause could be a tumor, a ruptured organ or ovarian cyst, diverticulitis (inflammation of a diverticulum, or pouch, in the lining of the colon), a gallbladder or pancreas attack.

8) Rectal bleeding

Best-case scenario: Bright red blood on toilet paper or in the bowl is important but can wait until a routine doctor's visit. The cause may be hemorrhoids or a fissure (tear in rectal tissue from straining).

Worst-case scenario: If the blood is black or maroon and tarlike, this is a medical emergency such as a bleeding ulcer, bleeding diverticulitis, or other colon problem, or colon cancer. Note: The iron in vitamin supplements and in certain vegetables can color the stool black. So can Pepto-Bismol.

9) Vaginal bleeding after menopause

Best-case scenario: Atrophic (dry) vagina, irritation from intercourse, side effect of hormone replacement therapy (HRT).

Worst-case scenario: Cancer of the uterus.

10) Pain, lump, thickening, or any change in breast tissue

Best-case scenario: Breast cyst, normal changes during menstrual cycle, infection, or inflammation.

Worst-case scenario: Breast cancer.

11) Frequent episodes of dizziness

Best-case scenario: Inner ear viral infection, naturally low blood pressure (which is good even though it causes the dizziness), or anemia.

Worst-case scenario: Warning of a stroke because of blockage of blood to the brain, heart arrhythmia, heart failure (if accompanied by low blood pressure), or, rarely, acoustic neuroma (a benign tumor which can cause hearing loss unless it is surgically removed).

12) Sudden weakness or numbness of one side of your body

Best-case scenario: Hyperventilation from anxiety, migraine.

Worst-case scenario: If separate episodes lasting less than twenty-four hours occur, this could be the warning sign of impending stroke. If weakness or numbness is persistent, a stroke may have already occurred.

13) Confusion or change in mental or thinking status

Best-case scenario: Mild depression, aging, stress, low blood sugar, or fasting.

Worst-case scenario: Severe depression, brain tumor, adverse drug reaction, drug interaction, or drug overdose.

14) Numbness or pain in feet and legs when walking on inclines

Best-case scenario: Arthritis of spine (stenosis), improper shoes.

Worst-case scenario: Circulatory blockage (claudication), neuropathy from diabetes, or exposure to toxins such as metals, paint, or lead.

15) Jaundice

Best-case scenario: Eating too many carrots or taking too many supplements with carotene.

Worst-case scenario: If accompanied by abdominal pain, this could signal gallstones or a gallbladder infection. Without pain, this could mean a tumor or a viral inflammation of the liver (hepatitis).

16) Changing mole or dark spot on the skin

Best-case scenario: Aging spots called seborrheic or senile keratosis.

Worst-case scenario: Melanoma or other skin cancer.

17) Profuse sweating

Best-case scenario: Anxiety, exertion, hot room, hot flashes, or high fever breaking.

Worst-case scenario: Especially when unexplained and accompanied by a feeling of doom, this could signal a pulmonary embolism (blood clot), a heart attack, or a ruptured aneurysm (see number 2).

18) Insomnia

Best-case scenario: Stress, worrying, uncomfortable mattress, light or noises, caffeine, or side effect of medication.

Worst-case scenario: Severe depression, adverse reaction to medication.

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Tags: Health

About the Author

MARIE SAVARD, M.D., is an internationally known internist, women's health expert, and patients' rights champion. She is the creator of The Savard Health Record. Dr. Savard is also a medical writer and seminar provider who has lectured throughout the world on the principle of taking charge. She serves as medical director of the Cabrini Nursing Home. Her past highlights include: Director of the Center for Women's Health and associate professor at the Medical College of Pennsylvania/Hahnemann University; World Health Organization's technical advisor to the United Nations Fourth World Conference on Women (Beijing); Women's Day magazine “Your Health” columnist; Philadelphia Magazine “Top Doctor” since the 1980s and a host of the popular radio show Medical Frontiers. More

Sondra Forsyth is a 1999 recipient of a National Magazine Award for an article on colon cancer, as well as the winner of an award from the American Digestive Health Foundation. Ms. Forsyth has served as executive editor of Ladies' Home Journal, and is the author or co-author of seven books. She has written extensively about health and medicine as well as other topics for the major magazines. More