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Neurology Now:
doi: 10.1097/01.NNN.0000338197.43171.4d
Department: From the Editor

Go Ahead—Complain!

Brey, Robin L. M.D. Editor-in-Chief

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Abstract

Most medical conditions are easier to treat if you get to them early.

Some people just don't like to complain about their medical symptoms. In this issue of Neurology Now, former NFL quarterback Troy Aikman admits to keeping silent about his migraines to avoid showing weakness. Aikman recalls that when he was growing up, complaining about pain was something boys just didn't do. Later, as a pro athlete, Aikman avoided complaining because the culture of professional football just didn't allow it either.

Sometimes people are afraid to find out what their symptoms might mean. Does this headache mean that I have a brain tumor? Does the numbness and tingling in my feet mean that I have a stroke? Easier to ignore it and hope it goes away. Psychologists call this denial.

Other times, as was the case for Nancy Murray (“Hidden Pressure,” page 23), the symptoms are chalked up to “aging.”

However, most medical conditions are easier to treat if you get to them early. And the longer a problem goes undiagnosed and untreated, the longer the person suffers needlessly (and the more time they have to imagine a horrible diagnosis, maybe one worse than what they have).

Aikman suffered for 35 years with migraine headaches that are now under control. “Complaining” finally allowed him to recognize his migraine triggers and receive the proper treatment. Nancy Murray received treatment for her hydrocephalus thanks to her persistence, and she now has a much better quality of life.

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In the 27 years that I have been a neurologist, I have seen both ends of the denial/overly-concerned-about-everything (hypochondriac) spectrum, and just about everything in between. But the most heartbreaking experiences I can remember are the times when people ignored their symptoms, and then by the time they did receive medical attention, it was too late.

I vividly remember a patient who I saw as a neurology resident. He had three episodes of arm and leg weakness and numbness and difficulty speaking. Each lasted about 20 minutes. He ignored them. He came to the hospital by ambulance after the fourth episode failed to improve after two hours. This patient had a large stroke and ended up in a nursing home because he never recovered much function. Those three shorter episodes are called transient ischemic attacks, or TIAs. They are warning signs that unless the proper treatment is administered, a large stroke might occur.

I also remember a patient with Huntington's disease. The symptoms usually begin in a person's 30s or 40s and consist of uncontrollable flinging movements and severe loss of memory and other cognitive abilities. Huntington's is a genetic disorder, and the children of a person with Huntington's have a 50–50 chance of also developing the disease. With a proper diagnosis, however, those at-risk children have options. There is now a genetic test for Huntington's, and some people take the test before deciding whether or not to have children. My patient with Huntington's had all the classic symptoms of the disease for about 10 years before he was diagnosed. In that time, his daughter had given birth to several children of her own. At the time of her father's correct diagnosis, the daughter and her husband had been planning to have another child, but decided against it.

The advice I give to my patients—and to all of you—is this: If you develop a new symptom, whatever it is, ask your doctor about it. That way, it can be diagnosed and treated appropriately. It could save you and your family undue suffering. Please remember, the next time you see your doctor, there really are no “silly” questions. So go ahead and complain—if it's a concern to you, your doctor will want to know about it. Trust me.

Robin L. Brey, M.D.

Editor-in-Chief

©2008 American Academy of Neurology

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