Diagnosing complex chronic conditions or degenerative diseases requires detective work from medical professionals because symptoms can vary from individual to individual and some common complaints (eg constipation or anxiety) can be early symptoms of neurodegenerative disorders whose more commonly known symptoms only appear years later.
This is why diagnostic appointments can be long and arduous both for the patient and the clinician.
Here we look at some of the lesser-known symptoms of very well-known conditions that can be a sign that all is not well and further investigations are required.
Diabetes is a common chronic condition affecting approximately 300,000 people in Ireland. A disorder of the endocrine system, it results in the pancreas not producing enough insulin to regulate blood sugar levels, causing Type 1 diabetes, or the body becoming unresponsive over time to the insulin that the pancreas produces, causing Type 2 diabetes.
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The common symptoms of diabetes are extreme thirst and/or feeling of hunger, excessive unexplained tiredness, frequent urination and unexpected loss of weight. “We call them the 4Ts for Type 1 diabetes — thirty, toilet, tired and thinner and then people with Diabetes can be hungrier too because the sugar is not getting to their cells,” explains Dr Derek O’Keeffe, endocrinologist at University Hospital Galway.
However, there are several lesser-known symptoms of diabetes which are also important to recognise. “People with diabetes can have unexplained nausea and vomiting and a distinctive fruity smell. High glucose in the fluid of the eyes can also lead to blurry vision,” explains Dr O’Keeffe. Wounds that are slow to heal are another sometimes unacknowledged symptom of diabetes.
Untreated diabetes affects many organs in the body, including the heart, blood vessels, eyes, feet and kidneys so if you have any concerns, your GP can carry out a urine test and a blood test to check blood sugar levels.
Meanwhile, it’s also important to know that risk factors for developing diabetes include being physically inactive, having a close relative with diabetes and/or high blood pressure, high cholesterol, a history of heart disease or a medical condition which requires long-term steroid use.
Parkinson’s disease is the second most common neurodegenerative condition after Alzheimer’s disease, according to Parkinson’s Ireland. Approximately 18,000 people are living with Parkinson’s in Ireland.
While it is most associated with slowed movements, tremors, muscle rigidity or stiffness and balance problems, there are other symptoms which can develop years before motor symptoms which are sometimes overlooked.
“Symptoms of Parkinson’s vary from one individual to another but there are non-motor symptoms such as constipation due to lower dopamine levels slowing down the normal peristalsis movements in the bowel,” explains Brian Magennis, advanced nurse practitioner in medicine for the older person at the Mater hospital in Dublin.
Magennis points out that other possible early symptoms of Parkinson’s include depression, loss of sense of smell and sleep disturbances — particularly REM [rapid eye movement] sleep behaviour disorder where the person may act out their dreams — kicking, punching or shouting out in their sleep.
“People with Parkinson’s may also have anxiety or be clumsy in their movements for many years before diagnosis,” he adds. The clinical checklist of symptoms at a diagnostic appointment for Parkinson’s also includes excessive sweating, small handwriting, a soft-speaking voice, mask-like facial expression, and trouble swallowing.
“It takes a lot of detective work to tease out the symptoms and it can be a case of not getting information unless you ask specific questions. The first clinical appointment for new patients can take an hour,” he explains.
Dementia is the umbrella term for all kinds of conditions associated with memory loss of which Alzheimer’s disease is the most common. Early signs of Alzheimer’s include having difficulty forming new memories of recent events, difficulty finding the right words or the right way to familiar places and figuring out problems or making decisions.
Other forms of dementia include vascular dementia (caused by damage to blood vessels following a stroke or series of small strokes), Lewy body disease (with movement issues similar to Parkinson’s disease as well as periods of severe confusion, swallowing difficulties and sleep problems) and frontotemporal dementia (a less common form of dementia whose symptoms include personality changes, lack of social and personal awareness, difficulties speaking or understanding others).
“There is a view now that Lewy Body dementia is under-recognised and under-diagnosed and that it may be more common than vascular dementia which is currently considered the second most common form of dementia after Alzheimer’s,” explains Magennis. Individuals can also have a mix of Lewy Body dementia and vascular dementia or vascular dementia and Alzheimer’s.
“People with Alzheimer’s typically have difficulty finding words. They can be less articulate and make grammatical errors or struggle to comprehend what someone else is saying. While someone with Lewy body dementia may have low motivation and will sit around watching television all day long,” he explains.
Poor orientation like not being able to find the bathroom in the middle of the night or having poor table manners or emotional swings from being giggly to being tearful are some symptoms of the common types of dementia. “Many people with dementia become more anxious, irritable and agitated while some become paranoid and delusional accusing their partners of stealing their money or even having an affair,” adds Magennis.
Heart disease is one of the leading causes of death in Ireland, accounting for about one in four deaths here. The most common symptoms of coronary heart disease (also known as ischemic heart disease) are chest pain or tightness or pressure in the chest known as angina. However, one of the concerns that cardiologists have is that angina pain can be mistaken for heartburn or acid indigestion.
“If you are having these symptoms, I advise people to assume that it is the heart until proven otherwise. So, get it checked out and if it’s not the heart then the appropriate investigations for indigestion can be done,” says Dr Angie Brown, cardiologist and medical director of the Irish Heart Foundation.
Also, women can experience angina as nausea, abdominal pain or stabbing pain rather than chest pain. “Symptoms vary from individual to individual but nausea seems to be commoner in women. And although chest pain is the commonest symptom of a heart attack, some people get left arm pain or jaw pain and others don’t have any pain, particularly those with diabetes,” explains Dr Brown.
Other symptoms of heart disease are shortness of breath, sweating, nausea, lightheadedness or extreme unexplained tiredness. The sudden onset of severe persistent pain in the arms, neck, jaw, shoulder or back could also signify a heart attack that is a medical emergency if the pain doesn’t go away within a few minutes. “If this happens, it’s crucial to call an ambulance,” says Dr Brown.
High blood pressure and high cholesterol are deemed to be the more hidden risk factors of heart disease. The Irish Heart Foundation recommends that anyone over 30 should have their blood pressure checked every five years and if it is borderline high to have it checked more often. People who smoke and/or have diabetes are also at greater risk of a heart attack. “Pre-eclampsia, high blood pressure during pregnancy, gestational diabetes and premature menopause are other risk factors for women. And diabetes and smoking are associated with a much greater risk of developing cardiovascular disease in women than in men,” adds Dr Brown.
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