Bring this list of key questions to your next doctor’s appointment. Also, read the companion article, Questions You Must Ask Your Doctor.
Ten minutes: That’s often all the time you have with your doctor. Whether you’re seeing an internist, pediatrician or specialist, during that brief period the physician needs to listen to your complaints, make an assessment and clearly explain a recommended treatment.
To make the most of your time, even in the ER, you have to be prepared. By asking the right questions, you can direct the doctor’s decision making. Your MD is morally obligated to address your concerns honestly and directly. That might mean running an extra test, taking a second look or even getting another, more senior opinion on your symptoms or treatment.
In my career as a surgeon, I have found there are key, little-known questions about specific symptoms and life situations that could make a difference in the outcome of your care–and potentially save your life. Here, ten common conditions and the questions you need to ask.
Back Pain and Joint Pain
Back and joint pain are often thought of as an inevitable result of injury or getting older. But pain is usually your body’s way of telling you that something is very wrong. Don’t ignore it. There are life-threatening diseases that mimic these aches, and it’s important to catch them as early as possible. If you’re experiencing constant pain in your back or joints, ask your doctor:
“Besides arthritis or injury, what could be causing my back pain or joint pain?”
Here are some possibilities.
Prostate cancer and other abdominal problems. Prostate and pancreatic cancers and kidney stones can create back pain, often with a sharp, knifelike sensation in the middle or lower back. These diagnoses may be missed because most people don’t associate back pain with cancers or stones, so they may not even mention it. There are specific diagnostic tests for these diseases, including PSA (prostate specific antigen) tests and CT scans. Ask your doctor to be sure you get the right tests and, if necessary, a referral to a specialist.
Osteoporosis. Thinning and weakening of the bones is often age-related, but it’s now happening to younger people too. It can lead to small fractures in the spine and other areas, causing pain. Bone density screening is a painless, noninvasive test that’s often recommended for postmenopausal women or those with a family history. Standard treatment includes an increase of calcium and vitamin D in your diet, as well as medications like Fosamax, Actonel and Boniva.
Lyme disease. It often presents as joint pain with or without the famous “bull’s-eye” rash. Up to 25 percent of Lyme victims never see a rash and consequently don’t connect their joint pain with the disease. Lyme and its associated conditions are usually transferred by deer ticks. If caught early, Lyme disease can usually be easily treated with antibiotics. If it’s caught late, the treatment can be complex and the effects devastating.
Lupus (systemic lupus erythematosus, or SLE). This chronic autoimmune disease typically appears as a dark “butterfly” rash on the face, accompanied by severe joint pain. It is diagnosed with blood tests and a careful evaluation of symptoms and history. Treatment includes anti-inflammatory medicines.
Swollen joints. This can be a sign of a joint infection. Often, a sample of the joint fluid is taken for testing. If an infection such as staph is present, antibiotics are prescribed. Remember, infections can be lethal if not treated quickly, so don’t take a wait-and-see approach with swollen, aching joints.
Bone cancer. Pain can be caused by bone cancers as well as other cancers that spread to the bones. Common targets are the spine and rib cage. People who have had cancer anywhere in the body may be at risk for bone cancer.
Karen (not her real name), 37, called her brother to tell him about her terrible headache. She’d suffered bad ones before, and that night she went to bed in severe pain. Her brother called to check on her in the morning but couldn’t reach her. He tried her husband at work. A neighbor was sent over and, tragically, found Karen dead on the floor. She had died from a lethal brain aneurysm.
Aneurysms can be successfully treated if they’re caught in time. If you’re experiencing horrible, recurrent headaches or even one episode of the single most painful headache you’ve ever had, see a doctor and ask:
“This is the worst headache of my life — could it possibly be an aneurysm?”
There are many different types of headaches: cluster, sinus, migraine. An aneurysm isn’t a type of headache; it’s an abnormal widening or bulging of a blood vessel. Aneurysms cause severe, debilitating headaches when the blood vessel ruptures and blood enters the brain.
Aneurysms can occur as a birth defect or may develop later in life. It’s estimated that five percent of the population have some type of aneurysm in the brain; these could rupture at any time. If you have a severe headache accompanied by nausea, vomiting, or seizures or any other neurological symptoms, go to the ER or call 911 immediately.
For most people, the flu is a nuisance. But for the immune-compromised, chronically ill, and aged, it can be deadly. Every year, 36,000 Americans die of the flu or its complications, and more than 200,000 are hospitalized.
But how do you know when you really have it? Flu is caused by a virus and typically lasts three to four days, with symptoms including fever, chills, aches and pains, stuffy nose and dry cough. But if they last more than a few days without improving, you need to see your doctor and ask:
“I’m still feeling terrible. Considering my medical history, what else could be wrong with me?”
You’re directing your doctor to narrow the list of possible diseases, tests and treatments. The details of your history and symptoms should lead the investigation to the right answer, helping your MD catch the problem and possibly save your life. For example, your doctor might recommend a chest x-ray or CT scan to spot pneumonia or the early stages of lung cancer. Or she may run blood tests to find infections like mononucleosis, strep, staph and Lyme disease.
If you experience sudden chest pain that radiates to the left arm, are cold and clammy and feel horrible, you could be having a heart attack. These symptoms appear more often for men than women, whose heart attacks frequently go undiagnosed.
If you don’t have the classic symptoms but are experiencing chest pain on the right side, mild chest pain in the form of an ache, a general lousy feeling with shortness of breath, or heartburn and/or indigestion that won’t go away, whether you’re a man or a woman, call 911 or have someone drive you to the ER and ask a doctor:
“Am I having a heart attack? Let’s not wait — can we please be sure and ‘draw the enzymes’?”
When heart muscles don’t get enough blood, the damaged muscle releases its enzymes into the bloodstream. You may be given other tests in the ER as well. But a simple blood test can quickly measure the levels of these enzymes and clearly indicate if you’re having a heart attack.
Bottom line: Coronary heart disease is the leading cause of death among American men and women. Nearly twice as many die from heart disease and stroke than from all forms of cancer. Take your symptoms seriously and get immediate help.
Lorie Levy’s previous mammograms were difficult to interpret because of her dense breasts. Her mother had died of breast cancer, so Lorie, 49, was anxious and wanted to cover all the bases. Although her mammogram was deemed normal, she asked:
“Can I have an ultrasound even though my mammogram was negative?”
Sure enough, the ultrasound showed a suspicious lesion that was missed on the mammogram. Further tests confirmed it was indeed cancer. Today, five years later, Lorie knows that because she caught the tumor in its earliest stages, she received the right treatment and is now cancer free.
The lesson here is not that ultrasounds are better than traditional mammograms. In fact, it’s the combination of the two that yields the best results. Mammography is still the gold standard for screening, and new technologies, such as breast ultrasound and MRI, may enhance the effectiveness of screening and diagnosis.
“Breast cancer screening is not one-size-fits-all,” says Freya Schnabel, MD, chief of breast surgery at Columbia University Medical Center in New York City. “It needs to be individualized–to the particular patient, her risk of breast cancer and the density of her breasts. Mammography alone is not always the most sensitive test for a woman with dense breasts, and ultrasound can be a useful additional test. If a woman is at very high risk, an MRI may be appropriate. But this is an expensive resource that has lots of false positives, so it’s not for everyone.”
Before your internist or gynecologist schedules your mammogram, make sure to discuss your health situation and ask about ultrasound. Together, you can determine if additional, more sensitive testing is required. And before you have a biopsy, ask for hard copies of your test results and get a second opinion.
After the onset of a stroke, you have a three-hour window of opportunity in which clot-busting drugs could save your life and reduce damage. Stroke symptoms can occur all over the body, but most strokes occur in the brain. Signs include sudden difficulty speaking or mental confusion, inability to use an arm or a leg, and facial paralysis, usually on one side. You can also have a mild stroke with less dramatic symptoms, but it’s just as important to treat. As soon as you think you or someone you know might be experiencing a stroke, call 911 and at the ER ask:
“Could my mother be having a stroke? What about giving clot-busting drugs right now?”
Every 45 seconds, someone in the country has a stroke. Clot-busting medication called tissue plasminogen activator (TPA) dissolves the clot so that further damage is prevented and existing symptoms may be reversed. Unfortunately, this medication must be used within the first three hours of a stroke, so don’t dawdle: Be an impatient patient, get to a hospital ASAP and ask for this lifesaving medicine. Make sure you’re thoroughly screened afterward so you can find out why this happened in the first place.
Walter Johnson, 54, felt abdominal discomfort one evening at his weekend retreat in upstate New York. The next morning, even though he didn’t have a temperature, he couldn’t stop shaking. His wife drove him 40 miles to see his doctor, who couldn’t determine a definitive diagnosis and sent Walter to the local ER.
But when he arrived, Walter wasn’t experiencing any symptoms other than fatigue and acute uneasiness: His temperature was normal, and he’d stopped shaking. The triage team in the ER turned their attention to other patients with more severe issues. A little while later, though, Walter was feeling worse. His temperature spiked to a scary 104, and his case was moved to high alert.
An ER doctor examined him and pressed on his abdomen, but Walter didn’t feel any pain. The doctor was concerned because of the fever and began to think of the most likely diagnoses. He ordered an abdominal CT scan with contrast, a type of x-ray that shows not only bones but also all the organs and other structures inside the body. Walter drank a dye that highlighted his GI tract. It showed that he was suffering from appendicitis and that his appendix was not in the classic location. You can learn from his experience and remember to ask:
“Should I have an abdominal CT scan or other tests before going to the OR?”
The doctor was surprised it was appendicitis, because Walter wasn’t suffering from the usual severe abdominal pain on the lower right side. But if the test had not been ordered with contrast, his appendix would likely have ruptured and his condition could have been life threatening. Walter was quickly wheeled into surgery for an emergency appendectomy.
Every year, more than 250,000 Americans get appendicitis. Yet many of them are misdiagnosed. Other serious medical conditions can mimic appendicitis, including an ovarian cyst, tubal pregnancy, certain forms of diverticulitis (a type of inflammation in the intestines) and sexually transmitted pelvic inflammatory disease (PID).
Other culprits: inflammatory diseases stemming from an ulcer, gallbladder disease, or a liver abscess–and even kidney disease and colon cancer. So before any surgical procedure, make sure your doctor has utilized every available test to determine the right diagnosis before you are wheeled into the operating room.
No one plans to have an obstetrical emergency, but it does happen every day. Childbirth is often quite complicated and can put both mother and newborn in jeopardy. So if you’re pregnant and trying to decide where to deliver your baby, ask your obstetrician:
“Which types of doctors are always physically present in my hospital, in case I need them to take care of me and my baby in an emergency?”
Anesthesiologists are doctors who prescribe and administer anesthesia during surgery. They will be present in an operating room in the case of a cesarean section or premature labor or other serious complication. If possible, you should make sure there’s an anesthesiologist in the hospital at all times: reachable on the golf course or while out for dinner may not be good enough.
Newborns are patients, too, and have special requirements. Babies need to have a pediatrician working on-site. Your baby may need emergency treatment directly after birth, even if the delivery went smoothly.
The gold standard is a hospital with a neonatal intensive care unit or reasonable access to one. This facility is used for all newborns with critical problems, not just for preemies. So shop around for a medical center with these services, and make sure your doctor is affiliated with the hospital where you want to deliver. (If you don’t have access to a hospital with all these features in your area, be sure to talk to your OB about an emergency contingency plan.)
We’re not always present every time our kids trip, get hit in the head or fall off the junglegym. Yet injuries from sports, minor accidents or even child abuse can cause eye and brain damage. They show up as a range of behavior changes that can signal a life-threatening problem from head trauma. If your child isn’t acting like himself and is unusually sleepy, inattentive or agitated, take him to the doctor and ask:
“Could a head injury or trauma account for my child’s symptoms?”
Every year, at least 1.4 million Americans sustain a traumatic brain injury, making it a leading cause of death and disability in children and young adults. The symptoms, subtle or severe, can point to a range of problems. Concussions happen when the fluid surrounding the brain and spinal cord has been throttled. A more serious problem occurs when there is progressive pooling of blood from a torn vessel on the surface of the brain (subdural hematoma) — a medical emergency requiring surgery. Retinal hemorrhages (bleeding in the eye) are easily visible changes, helping doctors diagnose shaken baby syndrome and significant repetitive injuries from sports.
Other signs on a doctor’s exam: slight weakness in the arms and legs, or abnormal pupil responses. Testing should include a CT scan and a full eye and neurological exam. The best prevention? Helmets.
Macular degeneration, which affects the center of your vision and can begin as early as age 50, is reaching crisis levels: It is the leading cause of blindness in America. More than ten million people have reduced vision due to the disease, with 200,000 new cases every year. If you’ve been diagnosed with macular degeneration, talk to an ophthalmologist and ask:
“Can the new medications I’ve heard about, Lucentis and Avastin, apply to me?”
In June 2006, two important drugs made headlines and quickly improved the lives of patients. Lucentis, which was approved by the FDA, not only halts the progression of macular degeneration but also can reestablish better vision. A second medication, Avastin, was already approved for treatment of colon cancer and is now being used by ophthalmologists to help those with macular degeneration. Talk with your eye doctor to see if they might be right for you.