By Mary Burns, RN, BS
PERF Executive Vice President
Ginger writes that it has been more than 10 years since she has seen a doctor. Even though she quit smoking a year ago, she has been feeling short of breath lately. Reluctantly, and rather nervously, she has made an appointment with a physician. She wonders if we can tell her what to expect, or if we have any suggestions that will make it a little easier to face that physical?
First of all, congratulations on taking charge and doing something about your symptoms. You’ve already accomplished the most difficult part of that upcoming physical. You’ve gone a year without smoking! Will you feel better if we reassure you that by making that appointment you also are past the second hurdle?
Now let’s see if we can give you a few tips to help you make the most of this visit as well as others you will have in the future. One of the first mistakes people often make is to minimize their symptoms or even ignore them. No one likes to be thought of as being a complainer, or heaven forbid, a hypochondriac! How many of you have answered, “Just fine.” when asked how you were feeling? If you were “just fine”, you wouldn’t be in the office! If a plumber comes to your house, do you make him guess what the problem is, or do you have some specific complaints for him to work on? You give him all the information you have, right? Do the same favor for your doctor! He has many years of training but is not too good with a crystal ball or playing 20 questions!
Organize your visit by preparing a list of all the medications you take, the dose of each, and the times of day that you take them. This includes over the counter meds and even eye drops. If this is too difficult for you, dump them all in a paper bag (or suitcase) and just bring them along.
Next, think carefully about what your problems are, and how they concern you. List them on a piece of paper starting with the most serious symptom first. It may be difficult to cover more than 3 big problems in your allotted time. If you have many more, it might be good to warn the staff in advance and see if you can get a double appointment.
When you first go into the office, you may need to fill out an extensive questionnaire about your medical history. They may even send the questionnaire to you in advance. You will be asked for dates about things like surgeries or major illnesses, along with a smoking history and recent weight gain or loss. You also should have the date of your last booster shots, especially tetanus and pneumonia. The staff will measure your height and weight, and check your blood pressure before you see the physician.
Getting down to shortness of breath (SOB) specifically, there are many things that can cause an increase in SOB besides pulmonary problems. Possibilities to rule out include things like heart disease, anemia, thyroid disease as well as the obvious ones of anxiety, obesity and couch potato syndrome. Since it has been many years since your last physical, the physician may order:
- complete panel of fasting blood work to rule out thyroid disease and anemia as well as the usual check of cholesterol levels, etc. This means that you shouldn’t eat anything for at least 12 hours, though you can have that morning a cup of coffee if it isn’t loaded with 3 teaspoons of sugar and 2T of half and half.
- A chest x-ray
As someone with a heavy smoking history and SOB you may also have:
- Full spirometry (with a flow loop). This is a simple breathing test done in the office to see if there is a decrease in lung function. A decrease can be temporary, as during an asthmatic flair-up or pulmonary infection, or more permanent because of emphysema or chronic bronchitis, or restrictive disease. If very abnormal, it may later be followed up with a full pulmonary function test (PFT).
- A 6-minute walk with an oximeter to see if your oxygen level drops with activity.
Pneumonia shot in addition to the annual flu shot, usually given around October. Anyone over 65 should have these preventative measures, even without a smoking history. Since it has been more than a year since your last physical, as a woman you will get:
- a pap smear;
- a mammogram;
- a check for occult blood in your stool (everyone)
- Ask about:
- a bone scan (densitometry)
- tetanus booster, if it has been 10 years since your last one.
If this sounds like a lot, it is! About 10 years worth squeezed into one visit! Since your most annoying symptom is shortness of breath, think through some of the following questions that the physician might ask. If you have answers, it will help a great deal in coming to the correct diagnosis and getting the help that you need.
- How far can you walk on a usual day before getting short of breath?
- When did you first notice the shortness of breath (SOB)?
- What were you doing at the time?
- How often does it occur?
- What are you doing when you notice it?
- On a scale of 1 to 10, 10 being the worst, how would you rate it?
- Has it gotten worse lately? If so, give an example such as, “I used to be able to walk 4 blocks with out difficulty. The past 2 weeks I get short of breath walking across the room.”
- Does it wake you up at night? At what time?
- How many pillows do you need to sleep?
- Have you noticed irregular heartbeats, a fluttering feeling in your chest, or rapid heartbeats?
- Have you gained, or lost, much weight recently, and if so, how much?
- Do your feet swell? If so, when and how much? Are they swollen all of the time or only after you have been standing?
- Do you have any pain associated with your SOB? Where is the pain?
- How much salt do you have in your diet? Have you noticed that it affects the swelling of your feet?
- Do you ever hear yourself wheezing?
- Do you cough? How often and when, e.g. only at night?
- Is your cough productive of sputum? If so, how much sputum do you bring up, a teaspoon, tablespoon or cup every day? How thick or thin is it?
- What color is it? White, creamy, yellow, streaked with yellow, green or blood tinged?
- Has there been a recent increase in sputum or recent change in the color?
- Have you coughed up any blood, vomited blood, noticed blood in your stool, or had any black tarry stools?
- Have you had any recent weight changes or feeling of weakness?
- Have you been under excessive stress lately?
Will the doctor ask you all of the above questions? No, but he will be considering them, and so should you. Are you overwhelmed by all of these questions that run through the mind of your doctor? Be pleased, instead, that all possible causes of your SOB are being considered. Think about the questions above before going in for your appointment. Don’t be afraid to admit that you have a problem. That is the only way you are going to be able to take care of it! Give the significant answers to your physician or be prepared for some of these questions.
Write down answers, or questions, that you are afraid you might forget. Bring someone with you if you are nervous about going alone or forgetting what is said. Request a copy of all of your tests.
Congratulations on following through with your appointment, good luck, and most important, bring a book! It can be a long wait in that office!