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Category:

Breast Abnormalities and Other Symptoms

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Question:  #7771 5/31/2005		Q:	43yrGr2Para1GoodHealthDxIntraductalCa lt.breast with areas of lymphatic invasion:MultifocLargest2.4cmTotal of six areas 6.6cm:20%tumor burden is in situ.2mm margin from post resectionER84%+PR92+Her2nlKi67445 Lt.mast. Neg 4 sentinal nodes What is ideal treatment?1 remaining ovary
		A:	ideal treatment? no one knows that answer yet.... so see 2 medical oncologists for opinions about what clinical trials your situation fits and decide from there.
Question:  #7772 5/31/2005		Q:	I am 24 years old and i am suffering a strange feeliing in and under my left breast. It is hard to explain but it feels very full almost bunged up. There is also a small amount of pain but nothing major. I have been on a new contraceptive pill for about 4 months and im wondering if that may be the cause?? Also a few months ago i sufered heart palpitations and the other day when my breast was feeling very full my left arm was hurting aswell. When i examined it, it feels rather lumpy and bumpy. Can u help?
		A:	hhmm. whatever is going on it is time to see the gyn again and get it checked out. write down your heart rate too so he knows what the range has been.
Question:  #7773 5/31/2005		Q:	Do our nipples harden as we age? I am 50. A few years ago I noticed my nipples were almost always erect (as if cold or aroused). Now, after a mastectomy in January I only have one, and it is always erect. No discharge -- looks normal, gets irritated when clothing rubs against it.
		A:	each woman's body is different. you may not have even noticed it now had you not had to lose one of them to breast cancer. not unusual. show to your doctor when you next see him. remember to continue to be doing clinical breast exams with your doctor, annual mammograms, and breast self exams.
Question:  #7774 5/31/2005		Q:	in 202 i was diagnosed with ductal carcinoma insitu, stage i, with a tumor of 2.0 cen. ihad a lump. chemo, rad, and 1 lymph node removal, tamoifene, 21/2 yrs and now arimidex. iwent for mammo and blood tests last week and now have some areas of suspicion, going for steotactic core next week, doc thinks necrotic tissue, reviewed all mammo for last 3 years still need test, question would i be wise to complete mastectomy and reconst. to elimate chance of recurrence in future if test is neg. if test is positive even more important to have this done iam 62 yrs old.
		A:	you are well past the bigger window of risk of recurrence. the first two years. risk of local recurrence in the breast is probably around 10%. don't jump into surgery without really thinking this through. right now you are running scared. hope you get good news.
Question:  #7775 5/31/2005		Q:	I stopped Breast feeding my baby 4 months ago & everything is fine with me ...no lumps nothing, except for the fact that a very slight liquid comes out if any of the breast is sucked hard ( though nothing comes out when I press it) Is it normal or should I get checked. Please help me.
		A:	sucking hard usually will produce fluid, especially so close to finishing breast feeding. remember too the more the breast is stimulated the more it will want to resume fluid production.
Question:  #7776 5/31/2005		Q:	I had a DIEP 4 months ago to reconstruct one breast. My recon breast has some fat necrosis in it. My plastic surgeon seems to think it needs to be looked at again in 2 months to see about revision surgery to remove some of it at that time, but basically that it's not going to go away very much. I've seen nothing anywhere on how to help prevent this from occuring other than my surgeon has had me massaging the breast 3 times a day for 10 minutes (not that I can keep up with that schedule because the arm on the same side was exhausted from ROM exercises and the massages), however, I'm doing my best. It has gotten softer, but still has a large hard area. My plastic surgeon stated since it still has some sore areas, my body has not given up on the area so it may get a little softer. Do you agree with this? I did read that the DIEP can have more loss of flap due to the large size of the flap, I have a D-cup. I have looked everywhere for any hints other than these massages to help soften this fat necrosis. Do you have any ideas? I was wondering if taking arnica capsules or using traumeel gel would be helpful to soften the hard fat or if there is swelling still that could be reduced? Also, I saw many times in other answers in the Q&A were it was stated the fat necrosis will actually go away over time. How long could it take for fat necrosis to be eliminated? Is there a point where it will no longer go away or need help? I've always read fat necrosis is dead fat cells, that can not be saved. How could there be different answers about fat necrosis? Thank you for your answer!
		A:	don't know what these substances might or might not do...
Question:  #7777 5/31/2005		Q:	I had a DIEP 4 months ago to reconstruct one breast. My abdomen has been extended and bloated most of the time, it goes up and almost down, I feel pregnant very often (not pregnant). It swells so much at times the stomach muscles get sore, the bottom of my ribs get pushed out and I have a hard time standing straight again. I have made sure my diet includes a variety of fruit, veggies,fiber and not to excess. I am not having gas issues, nor does 1 to 4 bowel movements in a day (no diarreah) make a difference in my pushed out abdomen. I've added a probiotic over the last week with no change. I added back increased calcium and magnesium several weeks ago, as well with no change. Exercises has not effected the situation as well and it does not appear to be a herina. The plastic surgeon finally agrees there is some fluid there and tells me it will go away over a long time, including that most of the extension he thinks is just the change in my body and I have to get used to it. I should also mention I was only somewhere around the 14th patient for this procedure with this doctor. I thought the tummy would be flat after a tummy tuck and I never stuck out like this some 10 years ago before putting on the extra weight. My support group leader believes it could be lymphedema, however, neither of my surgeons or primary care doctor know how to diagnose it or thinks it needs any treatment. Is it possible to have lymphedema in the abdomen area after a DIEP? I want to prevent the situation from being worse or a long term issue, if possible. I talked with some who does MLD and she thought it could be helpful. Do you think MLD be helpful for resolving this situation? Constipation was a huge issue right after surgery, but not now. Could the intestines be messed up and need some help like from a theraputic fasting or taking some kind of enzyme to restore balance? Thank for this opportunity to ask!
		A:	haven't heard of this being related to lymphedema. ask your plastic surgeon if he would agree to an ultrasound to see if this is fluid in the abdomen causing this. it is not unusual to have some swelling that lasts 6 months but in general that swelling is around the waist line and not where the tummy once was.
Question:  #7778 5/31/2005		Q:	I recently had a mammogram which showed "a slight shadow on the left breast proberbly benign process possibly a cyst". I am terribly worried. No hx of breast cancer in family. Could this be cancerous? They have scheduled me for an ultrasound in 2 weeks?
		A:	first focus on the words in the report-- probably benign. so don't start fretting over something that may be nothing to worry about at all. you will just exhaust yourself. additionally, it is common to have to investigate these areas further. the majority of the time the news is good. hang in there.
Question:  #7779 5/31/2005		Q:	Hi, I am 37 years old and recently had my first mammogram.The mammogram report mentions two fibroadenomas in my left breast.An ultrasound was also done on the left breast.Can one conclude that the lesions seen on the mammogram are fibroadenomas?Do fibroadenomas have a very typical appearance on mammograms?Thanks.
		A:	they do have a typical appearance. they can only be definitively proven to be such with tissue sample however. but a trained, skilled radiologist who specializes in breast imaging knows what one typically looks like.
Question:  #7780 5/31/2005		Q:	I just had a fine needle aspiration and the cyst collapsed. I was told it was benign. When I received the pathology report on the fluid, it stated: Cellular specimen with atypical apocrine metaplasia and debris. Biopsy recommended it it is clinically warranted. First, I was told they didn't get enough of a sample. Then they advised that this diagnosis poses an increased risk. I have also heard dense breasts pose an increased risk. My mother died of breast cancer at the age of 45. I am 42. The pathology report states that likelihood of malignancy is extremely low and that it may just represent a form of proliferative changes and therefore more tissue for diagnosis is advised. I am very concerned. They have advised a core needle bioposy and if there is no residual mass I wait or see a Breast surgeon. Should I opt for the core needle biopsy? If they can't do this, should I have a biopsy done of the surrounding tissue/cells?
		A:	with presence of atypical cells already known, the standard of care would be to now do an open excisional biopsy and obtain adequate tissue sample to know what is going on in there. if you wish to come to us just call 443-287-2778.
Question:  #7781 5/30/2005		Q:	Hi there...you have been most helpful in the past, so thank -you. My girlfriend with stage 4 BC, who has mets to liver and diagnosed with brain mets on March 31st, 2005, has been doing well but in the last 2 weeks has been experiencing pain in her right lower back. We hope that she maybe has just pulled a muscle.....is that wishful thinking? Any ideas as to what else could be causing the pain? Thanks so much for your time, Concerned
		A:	once diagnosed with stage 4 disease we look at all aches and pains with a critical eye. if the pain has lasted more than a few days and is chronic there would be a concern that it is new disease. so she needs to let her doctor know about this so he can scan her and make a determination. she also needs to let him know so she can get the pain into control. thanks for being there for her.
Question:  #7782 5/30/2005		Q:	Hello, i'm from Portugal, and i'm a man! But the problem isn't about me. My girlfriend, at the age of 17 or 19 discovered a lump on her left breast, and her dermatologist, told her that was a normal lump. She gave her somekind of medicine and the lump disapeared. Now she is 19, and about 3 mouths ago she started to get an itchy and burning feeling in the nipple and in the areola. She started to bleed from the nipple and the areola also, and she has crusts and nipple redness. This Wednesday she is going to do 2 mammogram and a biopsy. I'm 19 year's old also, so i don't know much about this things, so I went do our cancer organisation (IPO - Instituto Portugues de Oncologia) and asked to speek to a doctor and i discriebed my girlfriends situation. He then told me that she might have Paget’s Disease of the Nipple or Inflammatory breast cancer. But he didn't told me her chances to survive... Can anyone tell me the treatments and how much chances does she has to survive?
		A:	yes, that is what they are going to be testing her for-- pagets disease of the nipple or possibly something even something more serious. she would be very young to develop breast cancer at this age though, unless she has a significant family history of breast cancer in young women in her family. possibly she has something else going on in the nipple area that can explain this. take this one step at a time. don't go too far down the road until a diagnosis is known. i wish you were both closer so you could come to us.
Question:  #7783 5/30/2005		Q:	I am 50 years old; my mother died at 68 of inflammatory carcinoma;I have 15 years of films. Scattered microcalcifications appeared in right breast in'98 and have increased slowly. Current mammography was birads 04 for cluster of mildly irregular calcifications but no mass, asymmetry or architectural distortion. Subsequent breast MRI noted speckled pattern of enhancement bilaterally, right greater than left; was birads 03 for scattered foci of nonspecific enhancement, with follow up exam in 3-6 months. Question: Does the pattern of enhancement (speckled) indicate anything? What does nonspecific enhancement mean? The radiology report on the mammogram recommended a biopsy -- does this MRI cancel that out? I'm seeing a surgeon this week.
		A:	speckled implies they aren't clustered tightly together but we'd need to see the films to verify that. MRI is helpful but primarily for invasive disease-- not early stage like DCIS that appears as microcalcifications.
Question:  #7784 5/30/2005		Q:	Am a young man age 22. I have just started doing jogging on a daily basis. Since some times i have noticed that theres blood spot on my shirt around my left breast. Is there anything alarming in that?
		A:	hhmm. something is going on inside the duct of the breast. so call your doctor and get seen. believe it or not be will probably order a mammogram on you.
Question:  #7785 5/30/2005		Q:	Hi, I am 54 and never had breast troubles before. Nothing in family history or never smoked. My last mammogram came back with a questionable area. I was sent for a cone mammogram and ultrasound. The cone mammogram said the mass was still visible but ultrasound showed nothing. Now in a week I am scheduled for a mammotone. I am scared to death of having cancer and my surgeon would not give me any answers. Report says: lesion appears to be a mass as seen in two views. Benign and malignant mass lesions are in the differential. Bi-rads category 4-suspicous adnormal.How bad does this sound to you? What could it be beside cancer? Thanks for you answer.
		A:	20% of the time these are malignant findings, which means 80% of the time they are not... we hope you land in the 80% group.
Question:  #7786 5/30/2005		Q:	I fell a week ago on a cruise ship. I landed on my right breast on top of a door track that was about 6 inches high and 1 inch wide. I went to the dr 4 days later for a very badly bruised R breast. The dr said I have a very bad bruise and hemotoma (lump) on my breast. Also sent for xray to check for broken ribs. (that was negative) I am scheduled for a 2nd view mammogram on my R breast in 8 weeks (I had to return for 2nd view 6 mo's after 1st mamm because of density) I am concered that this trama will show up on the film. Will they be able to tell the difference?? Should I wait longer. Also can this trama cause any other problems. Thanks for your help!
		A:	hopefully 8 weeks from now the hematoma will be gone. but do tell the radiologist and the mammo tech about your injury so they can factor that into the reading of these new images.
Question:  #7787 5/30/2005		Q:	I am 44 and was diagnosed with DCIS this past week and will see the Dr. again on tues. I have done plenty of research the last several weeks, suspecting the daignosis. Er Pr + a 1 on the pathologists report. Now I have to make the decision as to lumpectomy or mastectomy. The Diep flap is the only reconstruction I feel interested in and am wondering if that decision was made, how long it generally takes to have the surgery scheduled for your facility. How long does that actual surgery take? I am not a smoker but am curious why there is so much emphasis on not smoking three months before the surgery. How long is the hospital stay, and is radiation still part of the treatment? Does the reconstruction make reoccurance harder to detect or is that no longer a concern in that breast area. Would my husband be able to stay with me in the hospital and if driving, how soon could I make the drive back to Ohio. How often do woman choose a bilateral mastectomy with DCIS and does insurance tend to cover that decision? There are so many variables and I am trying to gather as much info as possible before my appt. I also wonder if I chose your facility, if the Dr. here would still continue to work with me at this end and if she would be involved in any way with the communication about my case with your faciltiy.
		A:	DO come our way. we can see you within the next few days for consultation. 443-287-2778. DIEP takes about 3-4 hours to do. we use propofal anesthetic which has a 15 second half like. it drops you quick but that also means we can bring you out quick! hospitalization is 3 nights. skin sparing mastectomy is done with it so cosmetic result is awesome. reconstruction does not in anyway interfere with detection of recurrence. and remember risk of recurrence with mastectomy is only 1% over your lifetime too.
Question:  #7788 5/30/2005		Q:	Hello, I am a 32 year old mother of 2,the youngest child 5 yrs old. There is no family history of breast cancer. During my monthy self examination I noticed a clear discharge from my right breast when I squeezed the nipple. It is the first time I have squeezed the nipple during my BSE so I cannot say if it is an unusual finding for me. Is nipple discharge a concern when it only appears after squeezing and is in one side only?
		A:	its worth calling your gyn and discussing with him.
Question:  #7789 5/30/2005		Q:	I found a small lump in my left breast and just received my ultrasound results as follows: "The examination demonstrates an ovoid hypoechoic nodule within the 2 o'clock position, zone 2/3b. This area measures 6.5x3.9x6.1mm and is felt to most likely represent a complex cyst. There is an additional similar appearing structure demonstrated in the subareorlar region of the left breast measuring 6.4x7.4x3.8cm. Given the complex appearance of these structures, further evaluation with a fine needle breast cyst aspiration is recommended to ensure resolution of the finding and palpable abnormality." I scheduled for an aspiration 1 month from now. What is a complex cyst? Why is cyst aspiration chosen as the first intervention versus immediate biopsy? What are the statistical odds that the cysts are malignant? If in fact there is malignancy, isn't waiting a month too long/can a malignancy spread within that time? Finally, I am adopted and do not know anything about my medical history. Is it possible to find out whether I am genetically pre-disposed to breast cancer? I am very nervous about all of this. Thank you for your help.
		A:	not sure if you recorded the measurements correctly-- the one under the nipple is 6.4cm?? maybe you meant 6.4mm (hopefully). a complex cyst contains some debris in it of some sort. 10% of the time there can be cancer cells in it, which means usually there are not. additionally, cysts an be aspirated and made "gone"! not needing surgery to make them go away. hang in there... if they are confident theses are cysts a month is not a long period of time to have it addressed. though anxiety provoking to say the least. ask to be on their "on call list" in case of a cancellation.
Question:  #7790 5/30/2005		Q:	Hello, I had asked a question about my sister yesterday. She had calcifications, biopsy was pos for DCIS, she had an excision. The area removed was 4.5 cm and 5 of 6 margin tests were inadequate. She is comfortable w/her surgeon. I wanted your opinion about whether it makes sense to try the excision again (that is the current plan). Is there any harm in this approach? And, utlimately, if the second excision is successful, do you feel that exision plus radiation is as effective as mastectomy in the long term? Thanks.
		A:	re-excision is usually possible. the key here is what the breast looks like. lumpectomy is only feasible when they cosmesis has been maintained. when half the breast has been removed for the sake of "doing just a lumpectomy" then we have done the patient no favors, and mastectomy with reconstruction would be the smarter approach. so if the breast looks like it can handle a re-excision, its worth a try.
Question:  #7791 5/30/2005		Q:	I had a lumpectomy in August, 2004. The sentinel node was negative and I had 6 weeks of radiology, but no chemo. In March, 2005 and again in May, 2005, my breast became inflamed. This month the rash continued below the breast about 6 inches and I had two round spots on my back as well as chilling and a fever over 100. After taking antibiotics, the first episode completely cleared and is improving this time (I still have 4 days to take). My questions are will this keep happening? is it in any way associated with my type 2 diabetes? I am 70 years old.
		A:	the breast may still be "reacting" to the radiation, causing what sounds like mastitis. it may happen again... don't know. time will tell.
Question:  #7792 5/30/2005		Q:	I was diagnosed with multiple breast cyst in both my breast. (ranging from 1cm to 2.5cm) One had small amount of echoic debris (.7cm). I got two cysts aspirated. However i am worried about the rest. Keep hearing that sometimes they appear as cysts on ultrasound but turn out to be something else. My mamo confirmed that they were cysts and it was normal. (no other abnormality was seen) Should i get all of them aspirated to be on the safe side. My doctors have advised me to leave them alone and do an ultrasound after 3 months. I keep worrying about these lumps. Is it common to have breast cysts. I am only 35 years old and worry that i may have breast cancer. keep hearing about late diagnoses etc Appreciate your help
		A:	relax. cysts usually ARE cysts and nothing more. sounds like they are following you closely. don't lose sleep over this.
Question:  #7793 5/30/2005		Q:	43 yr gr2 para1Good general health Left mastectomy- multifocal intra ductal ca-largest mass 2.4cm- total of 6 foci 5.8cm including uoquadrant involvement Chest wall 2mm clear margin Stage 2-B Ideal Rx: chemo? x-ray? Remaining ovary? Hormone supp?
		A:	these questions really require a formal consultation. it isn't as simple as it sounds. prognostic factors like hormone receptors, her2neu and such all play a role here. get 2 opinions about chemo and about radiation.
Question:  #7794 5/30/2005		Q:	hi, my breast has been discharging a lot of yellow sort of sticky liquid, and it's also itchy. The worrying part is that my breast (after the discharge started) looks different from my right normal breast. The outerpart of my breast looks like it lost the darkness it should have (lowerpart), and the inner part of my nipple on the upper area, has a condensed mass of blackness that rises above the other areas like it sticks out or something (the texture is different-it's rougher). It's different to my other nipple, but it wasn't like this before this yellow discharge started happening.How do i get rid of this black mass, stop the yellow stuff, the itch, and get my nipple back to normal? prescribed ibilex capules and a antifungal cream canestan. i've been applying that for a bit more than a week, but i feel a bit worried because i t
		A:	you need to see your doctor and get this diagnosed. sounds like several things going on in there. get it checked out.
Question:  #7795 5/30/2005		Q:	my daughter is 15 years old and has had her period for over 1 year. She also has inverted nipples which present as a slit where the nipples should be. It seems in the last few months prior to her period she has been leaking fluid which only shows up during sleeping hours on her pajama tops. The peditrician has suggested seeing an endocrinologist should we be worried.
		A:	don't worry but take her doctor's advice and see an endocrinologist.
Question:  #7796 5/30/2005		Q:	Hi, I'm 26 and I had a mole on the left side of my left breast for about 6-7 years. it has doubled in size over these years. Now it is dark-red colored, about 3mm in diameter and a bit uneven on the edges. It doesn't hurt and the tissue undeneath it seems normal. Do you think it is anything to worry about? Also, sometimes I get pain in my breast(right or left) that lasts for few seconds. On scale 1-10 the pain is arund 4. It doesn't bother me at all, but I wanted to make sure if I should check with doctor.
		A:	time to see a dermatologist. might not be breast related but definitely needs to be checked out. call your doctor for a referral soon.
Question:  #7797 5/30/2005		Q:	I have silcone breast implants and for the past 6 months i have tiny inverted pimple like bumps around my left nipple. Do you think that it is related to the silcone possibly leaking? thanks for your time
		A:	something abnormal is going on and needs to be checked out NOW. call your doctor and get seen and get a diagnostic mammogram.
Question:  #7798 5/30/2005		Q:	I am not sure how to proceed. After my annual mammogram (clear)I noticed a discharge when I squeezed my nipples. It was yellowish and slightly sticky. I mentioned this to my gynecologist (she checked for blood-none; and prolactin levels were normal). She sent me to an oncologist. After examining me he said he found a discharge from only one nipple. I was able to get a discharge with very little pressure and showed him. He told me that if enough pressure is applied you can get a discharge. He said wait 3 months, not to touch my nipples with any rigor (I followed his advice) and come back. When I returned he again said it was only the right side and ordered a mammogram and sonogram of my right breast. After that mammogram (clear)I again checked and found the discharge from the left nipple was darker, sort of brown. At the visit following the mammogram and sonogram I told him that the left nipple discharge that he said I didn't have was dark. He checked for blood and said there was some. Went for a third mammogram and sonogram of my left breast(clear). He said that he recommends a biopsy to see if there is a benign papilloma or some form of cancer. He said that 90% of the time it is benign. I asked about ductogram (read about it online) that would be less invasive than a biopsy. He said it wouldn't be usefull. Should I see another physician for a second opinion rather than have a biopsy? Could it be jsut an infection? I know I have elevated DHEA levels (loosing a lot of hair), but a MRI for adrenal tumor was negative. Should I ask for a less invasive test such as the ductogram? Thank you.
		A:	ductogram may be useful and may provide the answer. get another opinion.
Question:  #7799 5/30/2005		Q:	I am a 50 year woman who recently had a screening mammogram which showed two densities in the left breast. Previous mammograms in 2003 and 2004 did not show these densities, however my past reports indicated there was density. I returned for special views and an ultrasound. My report states the following: The initial mamaogram and ultrasonographic examination were done on April 19,200t and reultrasound was done on April 25, 2005. The concerned densities in the 1-2 o'clock portion of the left brest are further evaluated with craniocaudal and deiolateral oblique compression magnification views. The two densities are confirmed on the craniocaudal magnification view, but only one density is identified on the mediolateral oblique compression magnification view. The largest one measures about 1.5 cm, located posteriorly. Slightly anterior medial to this desnity, a second lesion is seen measuring about 1cm in size. On compression view, about 40-50% surface margin is identified.Ultrasongraphic examination of htis are was performed and demonstrates abour 11.2x11.4x9.8 mm sized simple cyst at the 2 o'clock position corresponding to the larger density. Very slightly anterior to the above-described lesion, an additional about 5.9x6.6x6.2mm sized cyst is noticed corresponding to the somewhat smaller density seen on the mammogram. The size discrepancy between the mammogram and ultrasound is probably due to overlapping tissue and compression technique. Because of the additional ultrasonic finding adjacent to the smaller cyst, the patient was brought back on 4/25/05 and re-examination confirms an additional about 3.7 x 4.8 x 4.3mm sized cyst. Incidentlly, noticed at the 2 o'clock direction 5 cm from the nipple is a a 10.2 x 13.0 x 5.6mm size mildly hypoechoic well defined lesion appearing to be either lipoma or normal fatty lobulation. Fibroadenoma is very unlikely. CONCLUSION: 1. The two densities in the posterior outer upper portion of the left breast which were seen on screening mammogram are most likely simple cysts. 2. Incidentally noticed is a 13mm sized well defined mile hypoechonic oval shaped lesion at 2 o'clock, 5 cm from the nipple. This appears to be either small lipoma or normal fatty lobulation. Fibroadenoma is very unlikely but as a precautionary measure a six month follow-up re-ultrasonograph evaluation is recommended. BI-RADS 3, probably benign findings. Please not that the mammogram was read and interpreted by a second radiologist. Can you provide your opinion regarding this report, as I am not sure if I should be concerned.
		A:	always reassuring when a second set of eyes has read the films. based solely on the report, it sounds okay, but without being able to see the films ourselves we can make no real comments. if worried, consider then taking them to a third radiologist who specializes in breast imaging.
Question:  #7800 5/30/2005		Q:	i 5 white spots on my breast. it literally looks like someone took bleach and flicked it on my skin, like you would an old shirt. one of the spots has a small red bump in the middle, that one is under my breast. all of these spots are on my left side...should i be concerned?
		A:	well, you need to figure out what they are. so go see your doctor about it.