By Mary Burns, RN, BS
PERF Executive Vice President
Sally 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? We’ll try!
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 can proudly say you have gone a year without smoking! That is a very tough thing to do. Will you feel better if we reassure you that by making that appointment you also are past the second hurdle? If you are still smoking be honest about how many cigarettes a day you smoke and how many years you have done so. There is help available and there are medications that you can take to also help with quitting.
How To Make The Most Of The Visit
Now let’s see if we can give you some 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 say you have a leak and make him guess where it is, or do you have some specific areas for him to work on? You give him all the information you have, don’t you? Do the same favor for your doctor! Doctors have many years training before they get that MD, but none are about reading a crystal ball or playing 20 questions!
Before your visit, prepare for it by bringing along a list of all the medications you take, the dose of each, and the time 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 let the office assistant sort them out.
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 one 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. You deserve one after ten years.
About Your Shortness of Breath
Getting down specifically to shortness of breath (SOB), there are many things that can cause an increase in SOB besides pulmonary problems. Possibilities to rule out include things like heart disease, anemia, and thyroid disease as well as the obvious ones of anxiety, obesity and couch potato syndrome.
Here are some things to think about before you see the doctor, since they are all of interest and worth reporting.
- How far can you walk on a usual day before getting short of breath?
- What else makes you short of breath beside walking?
- When did you first notice the SOB?
- On a scale of 1 to 10, 10 being the worst, how would you rate the SOB that bothers you?
- Has it gotten worse lately? If so, give an example such as, “I used to be able to walk 4 blocks without difficulty. The past 2 weeks I get short of breath walking across the room.”
- Does it wake you up at night? About 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? If you press the swelling with your finger how deep is the depression? Are your feet swollen all of the time, better in the morning, or only present after you have been standing a long time?
- Do you have any pain associated with your SOB? Where is the pain and how would you describe it? A dull ache, constant, intermittent, stabbing, worse when you take a deep breath?
- 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, after exercise?
- 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?
- How many times do you get up during the night to urinate?
- Have you had any recent weight changes or feelings of weakness?
- Have you been under excessive stress lately?
The Doctor May Not Ask You All of These Questions
Will the doctor ask you all of the above questions? No, but he will be considering them, and so should you. It will help him a great deal if you can tell him any of these symptoms or problems that bother you at all. Does your doctor expect you to have considered any of the above questions? Of course not! But notice how very impressed he will be if you have done so!
When you first go into the office for that appointment you have prepared for so well, you may need to fill out an extensive questionnaire about your medical history. They may send the questionnaire to you in advance. That is very nice but doesn’t happen all the time. You will be asked for dates of things like surgeries or major illnesses, which you probably would rather not remember. They also ask for any smoking history including pot and about recent weight gain or loss. You should have the date of your last booster shots, especially tetanus and pneumonia. If you have never had them, that should be brought up also. Congratulations! You now are more prepared than 99.9% of patients your physician will have ever seen! Aren’t you feeling a bit smug?
The Actual Appointment
Let’s get down to the office visit itself. The staff will hand you a lot of paper work with questions to fill out, but you, dear reader, are all prepared for the answers and will zip through them instead of scratching your head trying to remember. Unless they sneak in a few questions we haven’t covered, which is bound to happen.
The staff will measure your height and weight, and check your blood pressure before seating you in the cold waiting room to wait for the physician. When you finally see the doctor, he will look at your chart and ask you a few questions. This is when you can get to present your primary concerns and will be prepared for the other questions that might be asked. Some testing may to be done that day or ordered for a later date. Some will depend on whether you go to an Internist, a Pulmonologist or Gynecologist.
Tests That May Be Ordered
Since it has been many years since your last physical, the physician may then perhaps order:
- A complete panel of fasting blood work to rule out thyroid disease and anemia as well as the usual check of cholesterol levels, etc.
- A urine check
- A check for occult blood in your stool
- An EKG, perhaps done in the office.
- Pneumonia shot if you haven’t had one, though a second one is also sometimes given.
- A herpes zoster vaccine to prevent shingles if you had chicken pox and not yet had the vaccine. If it is not suggested, ask for it. Those shingles are not fun!
- An annual flu shot, usually given around October.
- A tetanus booster, if it has been 10 years since your last one.
- As a woman, depending on your age, you may have a pap smear and a mammogram ordered.
- You may also get a bone scan (densitometry) to check thinning of your bones if your symptoms indicate it. This is rarely ordered in the first visit.
Tests For Patients Who Smoked And Who Have SOB
As someone with a heavy smoking history and SOB you should have:
- Spirometry. This is a simple breathing test that may be 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, chronic bronchitis, or restrictive disease. If 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 is low or drops with activity.
Are you overwhelmed by all of this? Probably, but I hope not. Be pleased instead, that all possible causes of your symptoms are being considered. Please don’t be concerned if all of the above isn’t done the first day! After talking to you, your doctor can better decide what needs to be done now and what can wait another 6 months or so. Or what might not even be needed. Write down the advice or explanations you may get. Even better, if possible bring someone along. They won’t be as nervous as you might be and can help you remember some of the things that you can’t. Request a copy of all of your tests. If this sounds like a lot, it is! About 10 years squeezed into one visit! Aren’t you proud of yourself for finally doing this?
Congratulations on following through with your appointment! And don’t wait so many years for the next one. Good luck, and most important, bring along a book. It can be a long wait in that office.