It has always been challenging for healthcare consumers to navigate the shoals of legitimate concern and needless worry as they figure out when to rush to the doctor. “It’s tough stuff,” acknowledges Tom Delbanco, an internist at Beth Israel Deaconess Medical Center in Boston, US.
That’s never been truer than today. There’s more medical information available from more sources of varying credibility than ever before, and that information can both enlighten and frighten. At the same time, out-of-pocket medical expenses are rising and the ranks of primary care physicians are shrinking, meaning that false alarms can have very real consequences for cash-strapped consumers and overworked doctors.
How to tell the signs
One of the best ways is strikingly simple: Listen to the basics of your body: temperature, weight, sexual interest, menstrual cycles. “All these things are pretty good barometers of good health, and when they go awry, it might be a soft alert that you should look into the reasons,” says Delbanco. Still, he assures, usually the changes are not “associated with a terrible disease”.
While there’s no one-size-fits-all answer, there are some other broadly relevant guidelines. It often comes down to the severity of symptoms, their duration, and whether they progress. And history (both the distant past and more recent developments) can definitely be prologue when it comes to health. An episode of influenza A(H1N1) in a healthy person is something entirely different from the same viral illness in someone with a disease-fighting system hobbled by long-standing medical problems.
Sometimes the best tools for understanding and reassurance are the simplest: the bathroom scale (Delbanco calls it “one of the best lab tests we have”) to detect sudden weight loss or gain; the eye, to observe changes in colour or shape of a skin lesion; the phone, to call a doctor or nurse who, in a brief chat, may be capable of turning down the drone of fear.
“I can offer a lot of reassurance over the phone,” says Elizabeth Roth, an internist at Massachusetts General Hospital. “It’s hard for people to come in, it’s time- consuming, it’s expensive. We never want to bring people in unnecessarily. But there are some times when it’s just not possible to say over the phone that a symptom doesn’t warrant further evaluation.”
We’re all subject to that ‘What if...’
Even health reporters aren’t immune. Days after I’d written about a young man with the condition commonly known as Lou Gehrig’s disease, I became utterly convinced that twitching leg muscles meant I had the disease too. Of course, I didn’t.
“It’s important for everybody to realize that’s a natural phenomenon,” says David Elvin, medical director of Cambridge Family Health, a satellite of Cambridge Health Alliance, US. “Sometimes patients will come in and say, ‘Well, a friend of mine at work was just diagnosed with cancer and he didn’t have symptoms, so I thought I should come in and be checked’.”
The arrival of influenza A(H1N1) in the past month offers a case study in how patients respond to health threats. With news of the novel virus blaring from headlines, sniffling patients have been streaming into clinics. More often than not, patients didn’t have telltale flu symptoms (fever, body aches, chills) and instead were suffering from run-of-the-mill allergies or a cold.
Anita Barry, top disease detective at the Boston Public Health Commission, says that when it comes to influenza A(H1N1) as well as the seasonal variety, it’s important for patients to assess their overall health status while considering whether a trip to the doctor is necessary. Pregnant women and patients with faulty hearts, ailing lungs, diabetes and compromised immune systems all need to be particularly vigilant. ”Those people,”says Barry, “should call sooner rather than later.” Other patients should try symptomatic treatments first, such as fluids and pain relievers.
Sometimes you can just treat the symptoms
“If they don’t have risk factors that put them at increased risk from influenza, then they should stay home and take care of themselves,” says Larry Madoff, director of epidemiology and immunization at the Massachusetts department of public health.
But if they don’t feel better after a few days, or can’t keep liquids and food down, or experience breathing or mental problems, then a visit to a clinic is clearly warranted. That’s true, too, for other ailments that don’t respond to home remedies.
When Raj Krishnamurthy, outpatient medical director at Boston Medical Center, is on night shift, calls inevitably arrive from patients frantic with concern. Heads ache, stomachs churn. “So I ask: ‘Can you function? What else is going on? Are you able to continue your bodily functions like eating and drinking?”’ says Krishnamurthy. “If you’re able to do what you need to do and what tasks you have to do for the day, that’s a good marker that it’s not something emergent or serious.”
What’s truly alarming?
“Things that are worrisome,” Dr Krishnamurthy says, “are those that are getting stronger and stronger over time, (where) the intensity of the pain is getting worse and worse.” For example, a lump that keeps getting bigger. And when it comes to neurological pain and worries about a brain tumour? “Typically, the classic thing we think about in medicine is ‘the worst headache in your life’,” says Lisa Owens, medical director of the Brigham Primary Physicians group. If that accurately describes what someone is experiencing, a trip to the clinic is warranted. If it doesn’t, try a pain reliever.
Generally, patients should be concerned if they experience chest pain, shortness of breath, and the unexpected appearance of blood in stool or saliva. But even then, there are no foolproof rules.
“If a guy is 55 and he’s a smoker and he’s on high blood pressure medicine and he has cholesterol, if he’s having chest pain, it’s probably not going to be heartburn,” says Raul Seballos, vice-chairman of preventive medicine at the Cleveland Clinic. “But if the guy is 22 and he just spent a weekend drinking six beers with his buddies at a Red Sox game, he probably just has irritation.”
Similarly, if a pimple sprouts and doesn’t erupt into a rash, there’s little reason to fret that it might be the first indication of a hard-to-treat bacterial infection known as Methicillin-resistant Staphylococcus aureus (MRSA). First detected in hospitals, the germ is now circulating more broadly and has found fertile terrain among abrasion-prone athletes.
“So if your son is a wrestler and he was just ground into the mat by his opponents and comes back with a bunch of abscesses on his shoulder, you might want to be a little bit more concerned,” says Stephen Erban, a general internist at UMass Memorial Medical Center.
For patients such as Tom Hill, whose doctor is Delbanco of Beth Israel Deaconess, there is a recognition that their own aches and pains fall against a backdrop of a healthcare system struggling to tend to an ageing population.
“On any given day, there is, I figure, someone sicker than I am,” Hill, a 61-year-old who lives in Cambridge, writes in an email. “So this is what I balance: the notion that probably it’s OK to try to get well, tempered by asking myself how likely is it that I can get there on my own?”
Rule of thumb: Symptoms that persist and become chronic, or ones that recur episodically, should be evaluated by a health professional. Sometimes, not always, such symptoms suggest serious underlying illness.
Symptoms that are not severe, resolve on their own, and do not recur probably do not need further evaluation. Note: Chest pain is an exception; do not wait to see if it goes away on its own.
Keep a look out for these:
• Persistent swollen glands, especially if the lymph nodes are hard but not sore
• Recurrent night sweats
• Breast lumps
• Chest pain, pressure or shortness of breath
• The “worst headache” of one’s life, or a headache accompanied by vision loss, fever and/or a stiff neck, confusion, nausea/vomiting, or pain sufficient to wake one from sleep.
• Nasal or sinus pressure, with upper respiratory symptoms typical of colds
• Crampy abdominal discomfort relieved with bowel movement
• Mild muscle ache or back pain, especially in the wake of a new exercise and heavy lifting that isn’t accompanied by fever or weakness
• Itchy rashes as the only symptom
• Pink eye (in patients who do not wear contact lenses) that is not accompanied by eye pain, vision loss or light sensitivity
• Tick bites. If the tick has clearly been on less than 24 hours ago, the area is not engorged and no “bull’s eye” rash is seen, wait and watch. See your doctor if a rash, fever or joint aches develop, though.
This list is by no means exhaustive, and there are always exceptions to the rule. Use it as a general guideline only. If your condition is not clear, get the advice of your doctor or nurse: Reassurance goes a long way towards feeling better.
Source: Elizabeth Roth, department of medicine, Massachusetts General Hospital, US.
©2009/The New York Times
Reducing childhood obesity may lower food allergies
Reducing childhood obesity may also lower incidence of food allergies. Researchers studying around 4,000 children (ages 2-19) enroled in a survey of childhood health found a significant association between being overweight and obese and allergic reactions to eggs, peanuts and other common allergens. For example, overweight or obese children were around 50% more likely to be allergic to milk. Overall, obese and overweight children were about 25% more likely to have a food allergy. The study was published in the May issue of ‘The Journal of Allergy and Clinical Immunology’.
©2009/The New York Times
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Antidepressants, sedatives may raise risk of suicide
Sedatives and sleeping pills prescribed to ease depression, anxiety and sleep problems appear to increase the risk of suicide among the elderly. Antidepressants, antipsychotics, sedatives and hypnotics had been linked to suicide in younger people, but there had also been evidence that they may reduce risk in the elderly, Anders Carlsten and Margda Waern of Gothenburg University, Sweden, reported in the journal ‘BMC Geriatrics’.
However, after adjusting for psychiatric conditions, Carlsten’s team found that patients who took sedatives and hypnotics were four times more likely to commit suicide. “Clinicians need to be aware of this as these drugs are widely prescribed to the elderly,” they wrote. According to WHO, 877,000 people worldwide kill themselves each year. For every suicide death, 10-40 attempts are made, the UN agency estimates.
As with all information online, less than authentic sources abound in healthcare too. Here’s how to stay safe:
• Verify the provider’s credentials. “Until we have a full-fledged regulatory authority that oversees online medical services, users will have to look closely at objective, standardized user ratings,” says Pervez Ahmed, CEO and MD, Max Healthcare.
• For medical records submitted online, ensure access is only obtained through individual user codes.
• Do not substitute online consultation for medical check-ups.
• Do not use prescription drugs without in-clinic consultation.
• Distinguish between complaints arising from a faulty lifestyle and a medical problem.
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