In medicine, there is a saying that “common things are common”, meaning that most conditions seen by doctors are not obscure, nor is the manner in which they present themselves. On occasion, however, illnesses present in unusual ways and it is up to the doctor (with the help of informed patients) to be aware of some of these unusual presentations.

1. Cough – Asthma. The most common symptoms of asthma are wheezing and shortness of breath, particularly during exertion. In some people, however, a dry cough is the predominant symptom. Cough-variant asthma can be suspected in someone who has a cough lasting for more than six to eight weeks and characteristically occurs during exertion or exercise. A second condition, gastroesophageal reflux (GERD) can also be suspected in someone with a chronic cough, particularly if it occurs while sleeping. GERD is caused by the regurgitation or reflux of gastric fluid into the esophagus which triggers the cough.
2. Toothache – Sinusitis.
   Sinuses are spaces within the facial bones that connect to the nasal passages and are in close proximity to the upper, rear teeth. Fluid build-up that occurs during a sinus infection or from allergies can put pressure on the nerves that enter the roots of the teeth. This simulates the type of toothache caused by dental problems such as cavities or abscesses. If dental evaluation rules out the possibility of a dental cause for the toothache, sinusitis should be suspected.
3. “Wrinkled Sock” – Nerve Entrapment. The sensation of a sock being wrinkled underfoot may be due to reasons other than the sock. Morton’s neuroma, a condition in which the sensory nerves that supply the toes becomes compressed is a possible cause for this symptom. Although rarely reported in medical texts, I have also heard this complaint from two patients who eventually were discovered to have herniated discs in their lumbar spine. The herniation was apparently applying pressure to the nerve root that supplies sensation to the lower leg. In most cases, herniated discs will also be associated with lower back discomfort, shooting pain into the back of the leg (sciatica) and tingling (“pins-and-needles” sensation) in the leg.
4. “Tutti-frutti” breath – Diabetes. A fruity odor to the breath can occur in Type 1 (insulin-requiring) diabetics as the body is getting rid of excess acetone. Acetone is generated when the body has inadequate amounts of insulin to use in the metabolism of sugar and is instead using fat as an energy source. “Tutti-frutti” breath could also be called “nail-polish” breath since acetone is found in some nail polish remover. A very serious form of acetone breath is seen in uncontrolled Type 1 diabetics when they enter a state called ketoacidosis. A similar odor to the breath can be seen in the much less serious state of ketosis that occurs with people on very low carbohydrate diets, such as the Atkins diet. Unless the person is diabetic, this form of “tutti-frutti” breath is not serious.
5. Jaw pain – Angina. Temporomandibular joint syndrome (TMJ) and dental problems are some of the most common causes of jaw pain. One cause for jaw pain, however, is quite serious and should be considered in someone suspected of having heart disease. Angina is chest discomfort that is seen in people with coronary heart disease that occurs if an area of the heart does not get enough oxygen-rich blood. The most common description of angina is as a squeezing or heaviness of the chest that often spreads to the left arm. In some people, angina will be noted as a discomfort in the jaw. “Atypical” presentations of angina or heart attack, such as jaw pain, appear to be more common in women.
6. “Brain fog”, rashes, and hair loss – Celiac disease -. Some of the most common symptoms of celiac disease are diarrhea, abdominal pain, and bloating. But, depending on the individual, celiac disease can be responsible for many other symptoms, including some that don’t seem to be related to the gastrointestinal tract. Less common symptoms of celiac disease include a rash known as dermatitis herpetiformis, unexplained hair loss, and neurological symptoms such as memory loss or confusion. In someone with unexplained or unusual symptoms, particularly if some of them are gastrointestinal in nature, celiac disease should be a consideration.
7. Snoring – Obstructive Sleep Apnea. Up to 50% of the adult population of the U.S. snores, but in a certain percentage of these people, snoring is a symptom of a medical condition known as obstructive sleep apnea (OSA). In OSA, the airway collapses or becomes blocked during sleep. This impedes normal air flow, resulting in snoring. Other clues to the presence of OSA include pauses in breathing (apnea) when sleeping, excessive daytime drowsiness, restless sleep, and gasping or choking during sleep. OSA in most common in overweight adults, but children with enlarged tonsils or adenoids can be affected also.

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