ST. PETERSBURG — One Friday morning Alex Actis went to the bathroom and was surprised to see that his urine was the color of cola.
"I figured, this can't be right," he said.
Then he did something that not all 13-year-old boys would do: He told his mom.
Tipped off by the blood in his urine, within days doctors at All Children's Hospital diagnosed Alex with kidney cancer.
"We were very lucky. It was caught early and hadn't spread," said his mother, Sandi Wessel.
Doctors wish that all their patients had Alex's forthrightness. When it comes to bodily functions, many of us clam up.
"I've had seemingly mature, well-adjusted patients fall apart when you have to examine their private areas," said Dr. Hugo Narvarte, a clinician and assistant professor of internal medicine and pediatrics at USF Health.
Not speaking up about awkward symptoms like excessive gas after meals or discomfort during sex might mean delaying treatment and relief. But silence can be life threatening when, for example, there's a lump in the breast or blood in the urine or stool.
What topics cause the most anxiety in patients? It all depends on age and gender.
Men don't want to talk about impotence — but given that this can also be a sign of heart disease, doctors really wish they'd speak up. Women are unnerved by genital itching, burning or rashes — which may be minor or a serious infection.
Both genders shy away from talk of depression and anxiety, both of which, again, can have serious implications.
"They think it's a sign of weakness to bring it up," said Narvarte.
Young kids are usually pretty open about their bodies, as parents can testify.
But as puberty approaches, they start getting shy about "anything having to do with private areas of the body: testicles with boys, breasts and vaginal discharge with girls," said Dr. Kelly Hildebrand, a pediatrician at All Children's Hospital in St. Petersburg.
Girls and boys also tend to blanch when asked about constipation and painful urination. But that's not all.
"They also have trouble talking about diet, being overweight or obese, bullying and feelings of insecurity," said Hildebrand, who like most pediatricians makes detailed personal questions part of routine checkups when kids reach school age.
To encourage openness, she starts talking with patients about their bodies around age 4 or 5, when they're naturally less embarrassed. "I open that line of communication early to make it easier for them to talk about personal issues" later, said Hildebrand. "I want to make it normal for them to talk about any changes they may notice and I tell them there are some things where somebody has to know."
When youngsters reach 12 or so, many pediatricians, including Hildebrand, ask parents to step out of the room, in hopes kids will talk more honestly about things they may not want their parents to know about, or that they think will only upset them. Sex, sexually transmitted diseases, drugs, alcohol, weapons, inappropriate touching, self-harm and causing harm to others, personal safety, and bullying at school and at home are all on the list.
"They need to feel they aren't going to be judged or punished for what they say," said Hildebrand, adding that some information, especially if it involves personal safety, has to be shared with parents. But if parents encourage truth telling by saying the child won't be punished, "they have to keep their promise,'' she said. "Kids have to feel safe."
So do adults. Narvarte will often ask family members or caregivers to step out of the room so he can cover sensitive topics. He asks direct questions about subjects he knows make patients squeamish — sex for older patients, changes in bowel habits for younger patients.
"If I don't ask about it, they won't bring it up," said Narvarte. "By asking, we give them permission to talk about it."
And if you can't talk about it? Write it down, says Narvarte. Describe your problem simply. If you'd rather speak to a physician of your own gender, say so or write a note.
Alex took the direct approach, and spent the first weekend of spring break at the hospital having tests. They found that he had renal cell carcinoma, which is rare in children.
The following Monday, surgeons removed his right kidney. Though he'll be followed closely, he won't need radiation or chemotherapy.
He's back at school now, gradually getting back to normal activities. His mother — who says she always has urged her children to be open with their parents — couldn't be more relieved, or more proud.
"My child saved his own life because he spoke up," she said.
Contact Irene Maher at firstname.lastname@example.org.