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David Fisher, MD, MPH: Lessons from a Broken Alternator

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Thursday, June 18, 2009

Lessons from a Broken Alternator

About 2 weeks ago, the "Check Engine" light began to appear each time I started my car. When this happens, my emotions go through several stages. First, denial. "There's probably nothing wrong, the light is just malfunctioning." Next, anger. "I don't have time to take my car in! Doesn't it know this is a crazy week for me?!" Then I move into bargaining. "OK, car, if you can hang on for one more week, I'll make sure to never again go over 3000 miles before changing your oil." And finally... well, back to denial. "Hey, the light went off- I knew nothing was wrong."

So I continued in my happy state of blissful ignorance until today. While crossing the mile-long bridge on I-294, the engine died. Uh-oh.

I shifted into neutral, and pulled to the shoulder. My first step was to justify myself for not taking my car in to the mechanic. How could I have foreseen this, right? Next, I called the motor club to arrange for a tow truck.

"What town are you in, sir?" came the voice at the other end. I looked around. I could explain where I was on the interstate, but I had no idea in which southwest Chicago suburb I currently sat. Even my high tech GPS and smartphone couldn't tell me. Then I remembered the old-fashioned Chicagoland map book my wife had given me, "just in case." I opened the book to my current location, and I wasn't sure whether to laugh or cry as I spoke the name of the town to the motor club assistant.

"I'm in Justice," I told her. Though I drive through it (or over it) nearly every day, I never knew there was a Justice, IL. I started to laugh. I happen to believe that God orchestrates all events in our lives, even the most mundane, and I was deeply amused at the thought of God allowing me to break down and land in Justice after ignoring my car's warning signs. Justice indeed. There are consequences to actions and inactions, whether we want them or not.

Waiting for the tow truck, I pondered the other warning signs that many of us ignore. They occur in relationships, in our occupations, and in our health. I'm not usually big on the "your body is like a car" analogies, but there are a number of "Check Engine" warnings that our bodies give us that should not be ignored. Sometimes these warnings will appear for a while and then disappear, like my dashboard light. Don't assume that means the problem has gone away. You should see your doctor if you experience any of these warning signs.

Excessive fatigue. I don't just mean getting tired after a long day or a particularly busy week. If you find yourself feeling unusually tired all the time, it is not normal. It could be caused by a thyroid problem, low blood counts, or other more serious health conditions.

Unexplained weight loss or gain. If you changed your diet or exercise habits and notice a change in your weight, don't worry. But if your lifestyle has not changed and you are suddenly lighter or heavier by more than 10% of your previous weight, you should see your physician.

Bleeding. Occasional nosebleeds are common, especially in the winter. Gums somtimes bleed with brushing, especially in the setting of gingivitis. Hemorrhoids can cause blood to show up on the toilet paper or occasionally on your stool. These types of bleeding are not concerning, but other types are. Blood in the urine, excessive bruising, dark, tarry or purplish stools, or coughing blood are all conditions that require immediate attention.

Sudden change in mental status. If you or a loved one starts behaving in ways that are uncharacteristic, such as forgetting something that was previously second nature, getting confused, or losing inhibitions and behaving completely out of character, it's important to be assessed by your doctor.

Chest pain. There are many causes for pain in the chest. Unfortunately, we cannot easily determine the cause without sophisticated medical tests. A person having some indigestion may feel exactly the same as a person having a heart attack. For that reason, everyone who seeks medical attention for chest pain will receive a battery of tests to rule out a cardiac cause. Chest pain caused by a heart attack, or heart disease, does not always fall into the typical pattern of crushing pressure in the center of the chest radiating to the jaw or the arm with accompanying nausea, sweating, and shortness of breath. Sometimes it can present as simple abdominal pain. This is especially true among women, older adults, and people with diabetes.

Changes in a skin lesion. Most skin abnormalities are benign. They may grow at a very slow rate, but otherwise, benign lesions remain mostly the same in their color, shape, and behavior. Skin lesions that are worrisome have irregular borders, diverse colors, and they will change more rapidly. They sometimes itch or bleed as well. If you notice a skin lesions that exhibits any of these characteristics, see your doctor quickly.

Sudden flashing lights. We all see "floaters" and other visual disturbances throughout our life. This is normal. Sudden, bright flashes of light, especially when moving the head around, could indicate a detached retina. This is an emergency that needs immediate attention.

Persistent fever or night sweats. Fever that lasts more than 3 weeks, as well as night sweats, could be an indication of a serious infection.
Thoughts of suicide. This is often a sign of severe depression. People who are depressed may sometimes wish they could just go to sleep and not wake up, or they may feel like they would not mind if they were in a car accident and died. That is different from suicidal intentions. If you spend time planning how you might kill yourself, seek the help of a doctor or therapist. The worst thing to do is not tell someone.

Worsening exercise tolerance. If you find that you are no longer able to endure the workout that you are used to doing, that could be a sign of a heart or lung problem. Seek attention if you are unable to exercise at your usual pace for no obvious reason.

This is by no means an exhaustive list, but it is a start. I hope this helps you determine when it is important to see your doctor. By the way, while waiting for the tow truck, a rainbow appeared over my head, reminding me that even God's reminders of justice are an act of mercy.

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