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Beware Of Signs And Symptoms Of Sepsis
If you've watched enough episodes of "Grey's Anatomy" then you've probably seen that some patients develop sepsis and die.
Dr. Barath Rangaswamy, of the Texas Tech University Health Sciences Center, said the word sepsis itself can provide the warning signs for what can be a mortal condition. S: Shortness of breath; E: Extremely cold hands or feet; P: Palpitations, a racing heart; S: Slurred speech; I: I have never felt so bad; S: Shivering uncontrollably.
"Sepsis is an overwhelming body reaction for any infection and sepsis is a life-threatening condition," Rangaswamy said. "If not diagnosed early and not treated, it can cause significant mortality and morbidity. Some quick facts about sepsis in America: Around 1.47 million people have sepsis every year. Sepsis, when it gets most severe, which we call septic shock, it has a 30 to 60 (percent) of death rate … One in three deaths that happen in a hospital setting is related to sepsis. So, sepsis needs a significant awareness among public as well as the general practitioners (and) health care workers, to prevent the damage."
Any infection can cause sepsis, he said. When a bacterial infection goes untreated, most commonly, it progresses into sepsis. Viral infections, such as COVID-19 and fungal infections can also progress into sepsis.
"Any infection which is uncontrolled can progress into sepsis," said Rangaswamy, who is an assistant professor and assistant clerkship director at the health sciences center.
He added that sepsis can occur at any age.
"Even young and healthy people can have an infection that is uncontrolled. It goes on into severe sepsis and septic shock," he said. "But the most vulnerable patient population is (the) elderly — age 65 and older — and people who have a weakened immune system. For example, patients with cancer, patients who are on chemotherapy for cancer, which weakens the immune system, patients with chronic medical conditions — diabetes, especially when it is uncontrolled, chronic lung conditions — COPD, asthma — (and) chronic kidney disease: These are the patient populations who are at risk for sepsis."
"What happens in sepsis is your normal body's immune response goes into a chain reaction. … It causes a lot of harmful things. (Your) blood pressure is going to drop down to dangerous levels because your blood circulation can be affected, organ systems can get affected," he added. "You can have organ failure, tissue damage. You might have heard about patients with sepsis losing their limbs … so those things can happen due to less blood supply. Those are some of the manifestations of sepsis."
The common symptoms of sepsis are increased heart rate, fever, cold and clammy skin, shortness of breath or rapid breathing, confusion or disorientation. A common misconception among the public is that sepsis means bacteria in the blood, but any infection can cause sepsis, Rangaswamy said.
A skin, lung or urinary tract infection can progress into sepsis. Rangaswamy added that health care providers need to diagnose the ailment as soon as possible and get people into the hospital to prevent death.
"Some of the symptoms mimic a bad flu. So sometimes you may think that I'm just having a bad flu and you may just keep pushing through without getting proper medical attention," he said. "When your flu is not getting better the second day and third day, when you start getting new symptoms — shortness of breath, palpitations, hands and feet becoming cold and clammy and you get confused — those are the warning signs you need to go to the doctor or call 911 to get yourself checked out.
"Why is it so important that we need to get ahead of sepsis? Timely management includes timely antibiotics, every hour counts. Every hour we delay administration (of antibiotics) increases the death rate in sepsis. When the patient comes to the hospital, the doctors are going to give them antibiotics mostly through (an) IV so that it acts faster. They're going to give them IV fluids. They're going to check the blood and test for any bacteria. They may check any of their body fluids to check for any infection. There are some sophisticated blood tests to rule out infection. Those (tests) need to be done in a timely manner and the antibiotics need to be administered in a timely manner to prevent that."
He emphasized that people should take any infection seriously.
"If you have any suspicion (that) the infection is not getting better it's not a good idea to sit on that and push through and wait for a longer time until it gets worse. That's when bad things happen," he said. "So early medical attention is crucial. Prevention is better than cure. Vaccination cannot cure sepsis, but it can potentially prevent the diseases which can progress into sepsis, for example, flu (and) pneumonia shots. Getting those vaccinations helps us (get) ahead of sepsis."
Practicing good hygiene, including handwashing and proper dental hygiene, are also important, Rangaswamy said, adding that when a dental infection occurs, there is a risk it could progress into a dental abscess which could eventually lead to further serious infection.
And he said if you have an underlying health condition like uncontrolled diabetes, you're at even higher risk.
"So preventing infection in the first place, and if the infection happens, taking care of the infection, timely and (correctly)," he said. "Do not self-administer or self-medicate yourself with antibiotics. I've seen this sometimes — self medicating, with leftover antibiotics and self-medicating with antibiotics which are acquired from unauthorized resources. In the United States, you cannot get an antibiotic without a prescription from a licensed medical provider. It is not so in other places outside of the United States."
Rangaswany said improper use of antibiotics can not only cause risk of infection, but it can also put the community at risk for antibiotic resistance and "superbugs."
If you have a wound, keep it clean until it heals.
"When you have an infection, ask yourself is this going to progress to sepsis?" and ask your healthcare provider, he said, adding those with chronic conditions need to take care of them.
Rangaswamy noted that these are things patients can follow to avoid sepsis.
"If we get ahead of sepsis, and if we create enough awareness among the general public and general practitioners about sepsis, we can together conquer sepsis," Rangaswamy said.
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Recognizing The Signs And Symptoms Of Shingles
The hallmark symptom of shingles is a painful rash that blisters. But symptoms such as tingling, pain, fever, and headache can occur before a rash appears.
Shingles (herpes zoster) is a viral infection that affects the nerves. Reactivation of the chickenpox virus (varicella-zoster virus, or VZV) causes shingles. VZV remains dormant in your nerves after infection.
Shingles is most common in people who are immunocompromised or over 50 years old. You can get shingles even if you were vaccinated against chickenpox or had chickenpox as a child.
There's no cure for shingles, but early diagnosis and treatment can help reduce the severity of symptoms and lower your risk of complications. Keep reading to learn how to recognize some of the early symptoms.
Around 1–2 days before a shingles rash appears, you may experience these early symptoms in the affected area:
You may also have these overall bodily symptoms:
At first, a shingles rash may look like small, red bumps or spots. These spots will appear on one side of the body following the path of the affected nerve. The spots will soon turn into fluid-filled, oozing blisters.
The skin underneath the blisters will look pink or red if you have white or light skin. Black or brown skin may take on a purplish hue or have no discoloration.
The blisters typically crack open, bleed, and start to scab over within 7–10 days.
To prevent infection, avoid scratching or picking at the scabs. They will fall off on their own within 2–4 weeks.
Where shingles rashes occurUnlike chicken pox, which can affect your entire body, a shingles rash usually erupts only on one side. You can get shingles anywhere, but the most common sites are the torso or the face.
If you have shingles on your torso, the painful rash it causes may wrap around one side of your body, from your stomach or chest to your spine.
If you have shingles on your face, it may affect the forehead, eye area, mouth, and ears.
During an active shingles outbreak, you may experience these symptoms in addition to a painful rash:
You may confuse shingles for other conditions, especially at first. Once the shingles rash fully forms, its location and one-sided appearance may be enough to rule out other diagnoses.
Shingles can sometimes be mistaken for:
It's important to contact a healthcare professional as soon as you notice symptoms or suspect that you may have shingles. Antiviral medications are most effective if started within 3 days of rash.
A healthcare professional can provide a diagnosis and prescribe or recommend treatments to reduce your symptoms and the risk of ongoing pain and other complications.
Shingles on the face is a medical emergency because it can affect your sight or hearing. If you get shingles anywhere on your face or neck, let a healthcare professional know immediately or go to an urgent care facility.
Is shingles contagious?Shingles is not contagious. It's due to reactivation of the virus within your own body.
However, if you have not had chickenpox, you may get it from someone with shingles. This will only occur if you come into direct contact with fluid from the shingles rash.
What are the stages of shingles?The first of three stages of shingles is the preeruptive phase, also known as preherpetic neuralgia. This causes early symptoms like tingling before blisters appear.
The second stage is the acute eruptive phase, characterized by a blister-filled rash. Other symptoms, like pain, may worsen and become severe.
Most people with shingles don't enter the third stage, which is the chronic phase known as postherpetic neuralgia (PHN). With PHN, you experience ongoing pain and nerve symptoms after the rash and blisters have disappeared. These symptoms can last for months or even years.
Will shingles go away on its own?Shingles resolves on its own without medical treatment. However, seeing a healthcare professional can reduce its duration, severity, and risk of complications.
Shingles is characterized by a painful, blistery rash. Early symptoms often include sensations like tingling, pain, and burning, where the rash will appear.
If you think you may be getting shingles, see a healthcare professional. They can provide an early diagnosis and recommend treatments to relieve symptoms.
Signs And Symptoms Of Perimenopause
Medically reviewed by Soma Mandal, MD
Perimenopause, or the transition phase that occurs right before menopause, develops in your mid-to-late 30s and causes symptoms like irregular periods, hot flashes, and fatigue. Menopause occurs when a person with a uterus stops having a menstrual cycle for 12 consecutive months. It's worth noting that perimenopause can last anywhere from four to ten years. This phase is typically a natural aging process, but perimenopause and menopause can sometimes also develop earlier due to underlying health conditions, treatments, or surgery.
Period ChangesMenstrual cycle or period changes are the most common symptoms of perimenopause. These changes occur due to fluctuations in estrogen and progesterone, the primary female reproductive hormones. These hormones affect ovulation (when the ovary releases an egg) and the thickening of the uterine (womb) lining that sheds during period bleeding.
During perimenopause, you may notice the following changes to your period:
Hot FlashesLow estrogen disrupts blood vessel dilation and body temperature regulation, which can cause hot flashes. These are sudden, intense waves of heat, that typically affect your upper body, face, and neck. Hot flashes can last anywhere from a few seconds to several minutes. You may also notice sweating, a rapid heartbeat, or anxiety. Most people who experience hot flashes have them for four to five years, but they can occur for up to 10 years.
Night SweatsNight sweats cause you to sweat profusely while you sleep. Severe episodes drench your pajamas or linens. You may also notice a racing heart or anxiety upon waking up.
Heart PalpitationsEstrogen affects the autonomic nervous system, which regulates your heart rate. Hormonal changes can cause fluctuations in your heart rate, which may result in heart palpitations (or, feeling like your heart is beating rapidly, irregularly, or more forcibly). Stress, anxiety, and caffeine can contribute to heart palpitations during perimenopause.
Sleep DisturbancesMany people who go through perimenopause experience changes in their sleep patterns. Insomnia, difficulty falling or staying asleep, and restless legs syndrome are common disturbances that can occur during this period. Not getting enough or good quality sleep can also cause fatigue, irritability, and difficulty concentrating.
Mood ChangesAs your hormones fluctuate during perimenopause, mood changes are likely to occur. You may experience more stress, anxiety, emotional sensitivity, irritability, depression, and mood swings when undergoing perimenopause.
FatigueThe demands of daily life, lack of sleep, and a decline in estrogen can cause mental and physical fatigue. Your body may feel sluggish and less resilient—even despite getting enough sleep or drinking your daily cup of coffee.
Problems with Memory and ConcentrationMental fatigue and hormone fluctuations can cause difficulty concentrating, memory lapses, and weariness. You might hear people refer to these symptoms as "brain fog".
Decreased LibidoEstrogen plays a large part in your libido (or, sex drive), and having lower amounts of estrogen can decrease your sex drive. But mood changes, stress, and fatigue—all of which are common symptoms of perimenopause—can also reduce your interest in or desire for sex.
Vaginal DrynessAs estrogen levels decline, your vaginal tissues may become dryer, thinner, and less elastic. This can cause itching and vaginal pain. Left untreated, vaginal dryness can contribute to pain during sexual intercourse, making intimacy less enjoyable.
Genitourinary ChangesGenitourinary changes are any changes that occur in the female genitalia and urinary tract system. A lower estrogen level can:
Changes in the pH (acid-base) balance of the vagina and urethra (the tube where pee comes out)
Thin vaginal and urethral tissues
Bladder weakness
Weakened pelvic floor muscles
With genitourinary changes, you may also have a higher risk of:
Urinary tract infections (UTIs)
Using the bathroom more frequently
Urinary incontinence (bladder leakage that worsens with coughing, sneezing, or exercising)
Genitourinary syndrome of menopause (GSM), vaginal atrophy, or atrophic vaginitis are other names for vaginal and urinary changes. Up to 70% of people with GSM do not discuss their symptoms with a healthcare provider. If you are in this position, consider consulting a provider to get the treatment you need to improve your quality of life. If you have genitourinary syndrome and oral estrogen is not an option for you, it can also help to ask your provider about vaginal estrogen and dilators.
Weight GainLow estrogen reduces your metabolism (how your body burns, stores, and distributes fat). As a result, this can increase the tendency to store fat in the abdominal area and lose muscle mass—which can contribute to weight gain. Other factors that may influence your weight during perimenopause include:
Low estrogen causes an imbalance in your hunger hormones and makes you eat more
Fatigue makes it challenging to maintain previous levels of activity
Stress and sleep disturbances affect eating patterns
Low progesterone causes less regulation of cortisol (the stress hormone), which may cause you to eat more than normal
Emotional eating due to mood changes
Estrogen protects your joints and connective tissues by stimulating collagen production and joint lubrication. Low estrogen can diminish these protective effects, which may cause joint stiffness, muscle pain, and a higher risk of osteoporosis (loss of bone density).
You might also experience joint or muscle pain due to:
Lack of sleep, which reduces muscle recovery
Stress, which causes muscle tension
Reduced physical activity levels, which lowers strength and flexibility
Low calcium and vitamin D, which affects your overall bone health
Estrogen helps maintain collagen and elastin fibers in the skin. Collagen is a protein that provides structural support for your skin and elastin helps with elasticity and flexibility. Less collagen and elastin can cause changes in your skin tone and make your skin less supple or bouncy.
HeadachesFluctuating hormones during perimenopause can trigger blood vessel dilation (widening), pain perception changes, and stress—all of which contribute to headaches. Some people can also experience hormonal migraines (headaches with nausea, vomiting, or light sensitivity) as a result of these hormonal fluctuations.
Breast TendernessWith hormonal fluctuations, breast pain, sensitivity, tenderness, fullness, or heaviness can occur. It's often cyclical (occurs in patterns), similar to how breasts can increase or decrease in tenderness throughout your menstrual cycle.
When to Contact a Healthcare ProviderIf you're experiencing persistent, severe, or disruptive symptoms of perimenopause, now is a good time to contact your healthcare provider for support. You should especially talk to your provider if you experience any of the following symptoms during perimenopause:
Menstrual bleeding that lasts for more than seven days
Soaking through a pad or tampon every hour for several hours in a row
Having to use double protection (tampon and pad)
Passing large blood clots
Needing to change pads or tampons at night while you sleep
Cramps that interfere with daily life or last more than three days
The following symptoms also warrant a healthcare provider consultation:
Persistent pelvic pain
Pain during sex
Frequent urination
Abdominal swelling
Severe back or leg pain
High blood pressure
A resting heart rate that is consistently over 100 beats per minute
Frequent heart palpitations
Anxiety or depression
Seek emergency medical care if you experience:
Sudden or intense pelvic or abdominal pain
Dizziness, fainting, fever, or chills
Severe headaches
Chest pain or shortness of breath
Blood pressure that is 180/120 or higher
Should you choose to consult a healthcare provider, the following questions can help initiate a productive conversation about perimenopause:
How do I know if I'm going through perimenopause or menopause?
Which treatments are available to improve heavy menstrual bleeding?
Are there any lifestyle changes that can help me manage the symptoms of perimenopause?
What risks do perimenopause treatments pose to my overall health?
How can I maintain heart and bone health during perimenopause?
Perimenopause, or the transition phase before menopause can cause a host of symptoms irregular menstrual cycles, hot flashes, night sweats, mood swings, fatigue, sleep disturbances, vaginal dryness, urinary changes, and decreased libido. You may also experience heart palpitations, weight gain, and skin, muscle, or bone changes. If symptoms are affecting your daily life, it's important to talk to your healthcare provider for proper treatment and support.
Frequently Asked QuestionsAt what age do perimenopause symptoms start to develop?
Perimenopause typically starts in your mid to late 40s and can last up to ten years before you enter menopause.
How can I get my energy back during perimenopause?
Getting enough exercise (about 150 minutes per week), eating nutritious foods (like fruits, vegetables, and lean protein), prioritizing sleep, and managing stress (such as through yoga or meditation) can help you improve your energy levels.
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