Highly Sensitive People

People with neurologic symptoms that require an excessive number of terms to describe them are not having a stroke. Patients who are actually having a stroke most often have one extremity that simply doesn’t work. It is functionally weak, paralyzed, or flaccid—it simply does not move. Speech is slurred, and the face often droops, most noticeably at the corner of the mouth.

I had a patient last night with a history of migraine headaches. With this particular headache, she complained of pain that radiated down her neck into her right arm and hand. She described her hand as “hot” and provided an excessive number of additional descriptors for her arm: tingling, “not there,” fuzzy, warm. I’ve heard other patients use similar terms like “off” or “buzzing.”

My concern for patients who use an excessive number of descriptors is inversely proportional to the number of words they use. There are exceptions, but generally: the more words it takes to describe what you’re feeling, the less likely it is that something serious is wrong. Instead, the likelihood is higher that you’re a highly sensitive person (assuming that’s a legitimate clinical concept). You’re hyper-tuned to your body, and—despite what TikTok might claim—this isn’t actually helpful. Rather than recognizing when something is truly wrong, you believe everything is wrong, all the time.

I have asked patients plenty of times if they feel short of breath. Maybe they came to the ER with chest pain or at least told the triage nurse that they felt short of breath. This is usually in the context of sitting there talking to them when they appear well and calm. I do not ask people who are obviously short of breath if they feel short of breath—it’s obvious to me; no one needs to talk about it.

But when you are sitting there calmly, speaking in full sentences, not gasping, not panting, not hyperventilating, and looking perfectly still, and I ask you if you are short of breath—if you have to pause and think about it—you are not. As soon as you pause, I have my answer. If it is not something you would notice immediately when someone asks you, it is not of concern to me.

Maybe you hear your heartbeat in your ears. I am perfectly healthy, and if I am in a calm, quiet space and focus my attention even just a little bit, I can count my heartbeat without feeling my own pulse. I can feel it in my ears; I can feel a pulsing in my chest. That does not mean I am dying. It does not mean I have a brain aneurysm or am going to have a heart attack. It simply means I can feel what is going on physiologically.

Maybe you feel your stomach gurgling, churning, making noise, or you can hear it rumbling. I have never had a patient tell me that—and I recall ever having anything serious going on—at least nothing that was diagnosed simply because they heard or felt their stomach rumbling. Most people at some point hear their stomachs do all of that. It may not be a common occurrence for you, but it does not indicate anything interesting.

There is an old-school textbook teaching that certain bowel sounds indicate something. It was very imprecise, I’m sure it was never studied, and this was before the days of modern diagnostic testing. Regardless, a gurgling stomach is a meaningless thing to tell your doctor about.