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Recent advances in medical technology mean that there are currently an extraordinary array of health care choices available to the public. In this import book, Dr. Savard, a doctor turned patient advocate, equips readers with the techniques for navigating the often confusing world of healthcare, enabling them to take control of their own health.
Recent advances in medical technology mean that there are currently an extraordinary array of health care choices available to the public. In this import book, Dr. Savard, a doctor turned patient advocate, equips readers with the techniques for navigating the often confusing world of healthcare, enabling them to take control of their own health.
Trusting Yourself as the Real Expert About Your Health
"Each patient carries his own doctor inside him.
They come to us not knowing that truth. We are at our
best when we give the doctor who resides within
each patient a chance to go to work."
-Albert Schweitzer, M.D.
The itching began in the middle of a humid summer night. Carol Watkins bolted upright in bed, flicked on the light, and checked for mosquito bites. She had spent the evening on the deck of her condo, sipping a margarita and talking nonstop with her dearest friend about their new status as divorced single moms. The citronella candle hadn't done much good, but the two women ignored the bugs. They were determined to enjoy the lilac-scented breeze and the starry sky. Carol figured she was paying the price. To her surprise, though, there were only a few bites and they weren't where the itching was. It was intense and generalized, making her want to dig at her skin with her nails.
An ominous shiver went through her. Although this was by far the worst episode, Carol had been feeling mildly itchy for several months. She hadn't thought much about it, even when it gradually got worse. Now, though, the words "Something is really wrong with me" popped into her head. She got up and found the calamine lotion. It helped a little and she finally fell into a fitful sleep.
The next morning, the itching was still there. After putting her two daughters on the bus for day camp and driving to her job as an executive secretary at an accounting firm, Carol called her doctor. He told Carol to try a moisturizer, since it sounded as though she had dry skin. Carol hung up the phone and stared out the window for a moment. This time, she said the words out loud: Something is really wrong with me." The itching had gotten worse and now it was everywhere, a deep and urgent feeling unlike anything she had ever experienced before. Still, the doctor hadn't seemed at all concerned. Carol didn't want to come off like a wimp or a hypochondriac and she reasoned that anybody who had been to medical school must know what he was talking about. Anyway, Carol thought maybe the itching was just psychosomatic. She was having a rough time adjusting to the divorce, especially when she had to drop the kids off at her ex's house and see him with the Other Woman.
A week later, though, Carol gave in and called her doctor again. She felt silly, but she told him the moisturizer hadn't helped. He referred her to a dermatologist. Carol heaved a huge sigh, sure she was going to get some relief at last. The dermatologist couldn't find anything specific, however. But he did prescribe an ointment he thought would take care of the problem.
It didn't. By this time, Carol was going out of her mind trying to take care of the girls and pay attention at work on very little sleep. She tried two more dermatologists and one cream after another, but nothing worked. Eventually, fate stepped in. Carol's employer switched insurance plans. She had to choose a new primary care provider and go for a complete physical. She ran her finger down the list of doctors and picked me.
I first saw Carol Watkins for what I thought would be a routine visit on a burnished September afternoon over a year after her first severe bout with the itching. She was obviously embarrassed to tell me her symptoms. I remember her words well. "It's just itching, but it seems like it comes from inside. I've had kind of a bad year, so maybe this is nerves. But I can't help wondering whether there's something really wrong with me." I put my hands on the lymph nodes on either side of her neck. Experienced fingers can feel even a slight enlargement. Carol's right node was swollen, but it wasn't causing her any pain. I ordered blood tests and then a biopsy of the swollen lymph node, but I was pretty sure I already had my diagnosis: Hodgkin's disease, a type of lymphoma that has a distinctive cancer cell. Pruritus, the medical term for itching, is a common symptom. And at thirty-two, Carol fell into the riskiest age group, fifteen to thirty-four.
The tests and biopsy confirmed my educated guess. Carol turned out to have Stage 1 Hodgkin's, limited to a single node on one side of the body. As I always do with my patients, I gave her copies of the test results and helped her understand them. Her complete blood count (CBC) and blood chemistries were all normal, including her liver tests. This reassured me that she probably didn't have advanced disease. However, her sedimentation rate, at 64, was abnormally elevated. The average for women is about 20. The "sed" rate is a tipoff that something systemic and significant is going on-either inflammation, infection, or cancer. In addition, Carol's biopsy showed the typical cell of Hodgkin's, the Reed-Sternberg cell.
"You're lucky, insofar as anyone with cancer can be called lucky," I said gently. "The prognosis is very good. I'm going to send you to a cancer specialist, an oncologist. In most cases like yours, radiation is all that's needed and the cure rate is high." Carol managed a smile, and put the copies of her results in her purse. "Well, at least now I know what's wrong," she said. "Even though it's not the world's greatest news, I feel better already." Throughout her treatment, she saved all her reports, summaries, and test results and shared all the findings with her radiation specialist and oncologist. She didn't have to repeat her story or worry that they didn't have the information they needed. She was truly at the center of her care, not at the periphery.
There's a happy ending. Radiation cured her, as is true in 90 percent of cases similar to hers. But the lesson here is that Carol could have kept ignoring her own instincts, allowing the cancer to spread and her chances of recovery to lessen. When the itching didn't subside after a few months, she should have made an appointment for a physical with her doctor. Checking the lymph glands is a routine part of any examination and he would surely have made the diagnosis. But like most physicians today, he probably had what we call a "panel" of at least a thousand patients and maybe as many as 2,500 or more. He no doubt left it up to the patients to make and keep their appointments and to communicate with him. I'm not making excuses for him, and it's your judgment call as to whether he should have decided that a year was too long for him to keep giving Carol phone referrals to dermatologists without having a look at her. But the point is that he didn't ask to see her. That left the ball in Carol's court. Yet she was afraid to seem pushy or paranoid and she thought her problem might be all in her head, so she never clearly stated the fact that she suspected something serious was going on.
She's certainly not alone. Most people don't trust their "doctor within." They're too humble for their own good. Yet study after study has shown that patients know much more than they think they do about their own health. For example, researchers at Purdue University tracked seven thousand patients ages twenty-five to seventy-four for twenty years beginning in 1971. Dr. Kenneth Ferraro, a sociology professor, headed a team which had the subjects rate their own health from poor to excellent and fill out a questionnaire about their diseases. Then doctors looked at the patients' self-assessments, did extensive examinations, and wrote their own evaluations. The result? In every case, the patient's own report was as accurate or even more accurate than the physician's was. Or as renowned British physician Sir William Osler put it, "Listen to the patient. He is telling you the diagnosis."
Even so, patients are typically cowed by doctors and other health care professionals. They're afraid to have faith in their own instincts. If that includes you, you're actually making your doctor's job harder. Time and again, I've asked patients what they think might be wrong and they have said, "You tell me. You're the doctor." But studies show that 80 percent of what doctors go on when they make a diagnosis is what patients tell them about their symptoms, history, and lifestyle. Technology is wonderful and we have many sophisticated diagnostic techniques that weren't available even a few years ago. Still, there is no substitute for what you know about how you feel-and how it is different from the way you usually feel. Believe it.
Listen to Your Body
First, however, you need to give yourself permission to home in on how you feel and get the message. Aches and pains, bleeding you can't explain, the sense that nothing tastes good anymore, tossing and turning all night-whatever doesn't seem quite right to you probably isn't. Your body is smart enough to send you warning signals. All you have to do is pay attention. And if a symptom turns out not to be serious, so much the better. There's nothing embarrassing about telling your doctor you've been seeing blood on the toilet paper, and finding out the cause is hemorrhoids instead of colon cancer. Your doctor will be as pleased as you are with that diagnosis. And it goes without saying that if you do have cancer, you'll be glad you caught the illness early enough that a cure may be possible. In other words, rectal bleeding is not normal. Your body is telling you that something is wrong. Don't dismiss the symptom just because it might be nothing serious.
I am thinking of the very sad case of Steve White. He had what he called "bowel problems" starting in his early thirties. On his honeymoon, he confessed as much to his bride, Cindy. Back home, he went to a doctor and said he was often constipated and occasionally saw some blood. The doctor put him on a high-fiber diet. Cindy did what she could to keep him on it. But by his own admission, Steve cheated a lot. He was a rising stockbroker and he liked his power breakfasts and power lunches, heavy on the eggs and bacon and meat and potatoes. The bowel problems continued, but Steve never went back to the doctor. Why bother, when he knew the trouble was that he wasn't eating the way he should? But on some level, Steve also knew it was more than that. How could a change in his bowel pattern happen when he hadn't changed any of his lifestyle habits? It just didn't seem right.
It wasn't. Fast-forward to a damp April morning five years later. Cindy got a call at the school where she taught third grade and their twins, Amy and Marla, were in kindergarten. Steve had been taken to the emergency room with a dangerously high fever. The doctors on duty were mystified and by the time Cindy got there, Steve had already been admitted. In the days that followed, tests revealed that Steve had colon cancer. The symptom that got him to the hospital has been dubbed "tumor fever." But long before that, Steve had harbored the fear that he wasn't well. Yet he failed to act
on that fear. Doctors estimated that Steve's cancer, a slow-growing form, had taken over five years to get to the advanced stage they diagnosed that April. If he had believed his visceral feelings and pressed until he got a diagnostic test called a colonoscopy, polyps could have been detected and excised easily before they became malignant. As it was, Steve's chances didn't look good. And in fact, he died a little over a year later at the age of thirty-eight. True, the doctor Steve originally saw could have ordered a sigmoidoscopy or a colonoscopy, but Steve hadn't sounded all that urgent about his symptoms. Also, there was no family history of colon cancer, and Steve never went back to give his doctor a second chance. The only person who really knew, day in and day out, that something was very much amiss was Steve himself. His body was talking and he wasn't listening.
Here's another story, but one with a positive outcome. Tim O'Connor, age thirty-two, did listen when his body talked. Tim is an avid golfer. One Saturday as he lofted the little white ball a respectable distance into the air, he felt a tearing pain in his groin. His foursome had been walking, but the one behind them had an electric cart. They drove Tim back to the clubhouse. By that time, he was also feeling nauseated. He called his "telenurse," a person assigned by his HMO to field phone calls from patients. She was soothing, but didn't seem to grasp the intensity of the pain or the severity of the problem. She suggested an ice pack. "A guy would have understood," Tim said later, sounding exactly like women who complain that male doctors don't get it about menstrual cramps or labor. In any case, Tim believed his body, not the nurse. He asked his buddies to get him to the ER.
Diagnosis: torsion, or twisting of the right testicle around its own spermatic cord. Because Tim got immediate attention instead of sitting in the clubhouse with an ice pack, his testicle was saved via surgery. Had he waited more than twenty-four hours, with the blood supply to the testicle effectively cut off, he would have lost the testicle. "Sometimes you just have to go with what you know," Tim says.
Amen. Here's a list of eighteen symptoms that should send you straight to the doctor, plus a capsule look at what the best- and worst-case scenarios might be. Remember, there are often plenty of other possibilities, and other symptoms-such as Tim's painful testicle-can be emergencies as well. Frequently, a thorough workup by health care personnel is needed in order to get a diagnosis. But what I want to emphasize is the fact that these eighteen symptoms should not be ignored, since they do sometimes signal serious problems requiring immediate medical attention. I developed this list when I taught a course for acupuncture students about how to recognize the red flags that signal the need for evaluation and possible treatment by a physician trained in Western medicine. I used the standard checklist doctors follow when taking medical histories: the review of systems (ROS). The ROS starts with what are called "constitutional symptoms" such as weight loss and fatigue. Then the ROS literally takes it from the top, working from the head down to the feet:
1) Loss of appetite and weight loss
Best-case scenario: Dieting, elderly with decreased interest in meal preparation, mild depression.
Worst-case scenario: Cancer, liver disease such as hepatitis, severe and possibly suicidal depression, chronic infections such as TB, anorexia nervosa, Crohn's disease.
2) Severe headaches
Best-case scenario: Acute viral infection, tension, migraine.
Worst-case scenario: Sudden onset of your worst headache ever could signal an aneurysm in the brain (thinning of an artery, which may then balloon and rupture). Sudden onset with fever and stiff neck could signal meningitis. Gradual onset with escalating intensity on awakening could signal a brain tumor. The antibiotic minocycline, which is used to treat acne, can cause increased intracranial pressure and blindness if left untreated. This complication is extremely rare.
3) Redness in the white of the eye
Best-case scenario: Conjunctivitis (pink eye) from contagious virus or staph bacteria, or an allergic reaction to pollen or contact lens solution. The eye could also simply be bloodshot from fatigue or alcohol use.
Worst-case scenario: Acute glaucoma or uveitis or a foreign body in the eye. Note that in these instances there will usually also be pain and decreased vision.
4) Persistent cough
Best-case scenario: Postnasal drip, asthma, acid reflux (heartburn), or the vicious cycle of a continued cough caused by irritation from coughing.
Worst-case scenario: Severe asthma, tumor such as lung cancer, lymphoma, heart failure or fluid in the chest. Note: A chest X-ray can help rule out serious problems.
5) Shortness of breath
Best-case scenario: Obesity, sedentary lifestyle, hyperventilation from anxiety.
Worst-case scenario: Sudden onset can signal a pulmonary embolism (blood clot in the lung). If the episode happens while you're lying down or exercising, the cause may be angina (blockage in the arteries, which may result in heart failure). If you have a history of allergies or asthma, this may be a serious asthma attack.
6) Chest pains
Best-case scenario: Esophageal spasm from acid reflux (heartburn), unexplained "stitch," inflammation of lining of lung or rib cartilage.
Worst-case scenario: If the pain is of recent onset and is coming in episodes of five to fifteen minutes each with tightness that doesn't get worse when you breathe deeply but does get worse with exercise, the cause may be angina (see number 5). If you're also experiencing shortness of breath, this could signal a pulmonary embolism (blood clot in the lungs). Other possibilities are a collapsed lung, a dissecting aorta, or an aortic aneurysm.
7) Persistent abdominal cramps or pain
Best-case scenario: Spastic colon, viral infection, intolerance to lactose (a substance found in milk and milk products), gas from beans or from sugar substitutes.
Worst-case scenario: Especially if accompanied by nausea, vomiting, weight loss, and change in bowel habits, the cause could be a tumor, a ruptured organ or ovarian cyst, diverticulitis (inflammation of a diverticulum, or pouch, in the lining of the colon), a gallbladder or pancreas attack.
8) Rectal bleeding
Best-case scenario: Bright red blood on toilet paper or in the bowl is important but can wait until a routine doctor's visit. The cause may be hemorrhoids or a fissure (tear in rectal tissue from straining).
Worst-case scenario: If the blood is black or maroon and tarlike, this is a medical emergency such as a bleeding ulcer, bleeding diverticulitis, or other colon problem, or colon cancer. Note: The iron in vitamin supplements and in certain vegetables can color the stool black. So can Pepto-Bismol.
9) Vaginal bleeding after menopause
Best-case scenario: Atrophic (dry) vagina, irritation from intercourse, side effect of hormone replacement therapy (HRT).
Worst-case scenario: Cancer of the uterus.
10) Pain, lump, thickening, or any change in breast tissue
Best-case scenario: Breast cyst, normal changes during menstrual cycle, infection, or inflammation.
Worst-case scenario: Breast cancer.
11) Frequent episodes of dizziness
Best-case scenario: Inner ear viral infection, naturally low blood pressure (which is good even though it causes the dizziness), or anemia.
Worst-case scenario: Warning of a stroke because of blockage of blood to the brain, heart arrhythmia, heart failure (if accompanied by low blood pressure), or, rarely, acoustic neuroma (a benign tumor which can cause hearing loss unless it is surgically removed).
12) Sudden weakness or numbness of one side of your body
Best-case scenario: Hyperventilation from anxiety, migraine.
Worst-case scenario: If separate episodes lasting less than twenty-four hours occur, this could be the warning sign of impending stroke. If weakness or numbness is persistent, a stroke may have already occurred.
13) Confusion or change in mental or thinking status
Best-case scenario: Mild depression, aging, stress, low blood sugar, or fasting.
Worst-case scenario: Severe depression, brain tumor, adverse drug reaction, drug interaction, or drug overdose.
14) Numbness or pain in feet and legs when walking
Best-case scenario: Arthritis of spine (stenosis), improper shoes.
Worst-case scenario: Circulatory blockage (claudication), neuropathy from diabetes, or exposure to toxins such as metals, paint, or lead.
Best-case scenario: Eating too many carrots or taking too many supplements with carotene.
Worst-case scenario: If accompanied by abdominal pain, this could signal gallstones or a gallbladder infection. Without pain, this could mean a tumor or a viral inflammation of the liver (hepatitis).
16) Changing mole or dark spot on the skin
Best-case scenario: Aging spots called seborrheic or senile keratosis.
Worst-case scenario: Melanoma or other skin cancer.
17) Profuse sweating
Best-case scenario: Anxiety, exertion, hot room, hot flashes, or high fever breaking.
Worst-case scenario: Especially when unexplained and accompanied by a feeling of doom, this could signal a pulmonary embolism (blood clot), a heart attack, or a ruptured aneurysm (see number 2).
Best-case scenario: Stress, worrying, uncomfortable mattress, light or noises, caffeine, or side effect of medication.
Worst-case scenario: Severe depression, adverse reaction to medication.
Denial Is Not Just a River in Egypt
Now that I've given you some common warning signs and encouraged you to heed them-along with any other symptoms you suspect spell trouble-I could technically end this chapter right here. But I know better. Simply having information about what might be a red alert doesn't always push people to act. Here's a perfect example. My husband, a doctor who is an infectious disease specialist, once insisted that an infection in his leg was not a problem. I had to plead with him to let me take him to the emergency room! If a doctor can deny what is obvious, you can, too-and probably do. It's human nature not to want to face the fact that something is wrong with you. Magical thinking takes over, as in "If I ignore this, it will just go away. Anyway, I don't have time to be laid up right now, so this can't be happening." Jenny, a forty-year-old wife and mother who almost let denial kill her, talks about how her mind worked on the night she was infected with a virulent combination of the staph and strep bacteria:
"It was my daughter Sarah's tenth birthday and she had invited ten of her friends for a Friday night sleep-over. The plan was to let the girls sleep late the next day, since they would obviously be up giggling until all hours. I was going to make a pancake brunch after they woke up, and then drive them to the beach in our new van. Sarah was so excited she could hardly stand it and I wanted everything to be perfect for her. I'm a lawyer so sometimes I have to work long hours. That's why whenever I get the chance, I really go all out for Sarah. Maybe it's guilt or maybe it's just that I wish I could be in two places at once and not miss so much of her growing up. Whatever it is, I get really intense about stuff like the plans for that birthday weekend.
"Anyway, by about eleven p.m. the girls were all settled in their sleeping bags in the family room watching a video. My husband was already asleep. I was just getting around to looking at the mail. I tore open an envelope and happened to get a paper cut on my right thumb. It started to bleed a little so I sucked on it. When I finished with the mail, I went to bed.
"At three a.m., I woke up with a terrible, throbbing pain in my thumb. I turned on my little reading lamp. My thumb was all purple and swollen. My first reaction was annoyance. I had forgotten about the paper cut and just assumed that I had somehow banged my thumb in my sleep. Why would something so stupid have to happen on a weekend when I was so busy? I got up to go put some ice on my thumb. The family room is adjacent to the kitchen, and Sarah came in to get a drink of water. When she saw my thumb, her eyes got really big, and she said, 'Mommy! What happened?' But I just shrugged and told her it was a little bruise.
"By six a.m., after taking three Advil, I was still wide awake. I decided I might as well make the pancake batter. About eight a.m., my husband came down for his morning coffee. He looked at my thumb and said, 'What the hell is that?' I mumbled something about being a klutz even in my sleep. But he wasn't buying it. He insisted that I call my doctor right away. I said it could wait until Monday. He said, 'So why are you dancing around like that and gritting your teeth?' Then he picked up the phone and dialed the doctor himself.
"To make a long story short, I had a contracted a serious infection in the thumb, apparently from germs in my own saliva. Because I had let it go for hours, a potentially lethal blood poisoning called septicemia had developed. I ended up in the hospital. When the crisis had passed, the doctor asked me why I had waited so many hours before reporting something so clearly out of the ordinary and painful. I just shrugged. I was too embarrassed to say that I had been planning to drive my daughter and her friends to the beach and didn't want to be interrupted. It seemed so ridiculous in retrospect. But that is how my mind was working at the time. I like to think I'm pretty smart, but I had behaved like a total fool."
Jenny shouldn't be so hard on herself. As I've said, denial is all but universal. But you can conquer it. Here's how:
Problem: Whether you're faced with an acute symptom such as Jenny's abscessed thumb or a progressive one like a breast lump, there's a tendency to get caught in the trap of telling yourself "this isn't a good time for me to be sick." There's never a good time. Either your desk is piled with work that you were hoping to finish before the boss found out how far behind you had gotten, or your child's school play is the next day, or it's Christmas Eve, or your long-awaited vacation with the nonrefundable airline tickets is at hand, or . . . you get the idea. Dwelling on how there is no way you can be having appendicitis or a heart attack or a systemic reaction to a bee sting at this particular moment will jam your health radar. You'll miss the signals and put yourself in danger-maybe grave danger.
Solution: Get off the hamster wheel of negative thinking. Start by making actual plans for how you would manage if you found out you really were going to be out of commission for days, weeks, or months. Yes, you are unique and invaluable, but you are not indispensable at the expense of your health. Could a trusted colleague at the office go through the pile of work on your desk and minimize it enough so that the boss wouldn't think you've been slacking? Could someone videotape the school play for you? Could you send flowers to your budding thespian with a note saying how proud you are? Could your sister have your husband and kids over for Christmas dinner if you end up in the hospital? Can you change those airline tickets to a later date by paying a fairly nominal fee? The answer is almost always affirmative to each of the above. And once you've reassured yourself that people will cover for you in an emergency or that you can make contingency plans, you can let down your defenses. You can admit that, yes, you're doubled over in excruciating pain and it's no joke. Or if your symptoms don't constitute an emergency but they've been going on for some time, acknowledge that and say it out loud. You've moved from "This can't be happening!" to "This is happening, and I'm not thrilled, but I can handle it."
Problem: You engage in the magical thinking I mentioned earlier: This will go away if I just wait awhile. In fact, I think I'm feeling better than I did a minute ago (or yesterday, or last week)." What's happening here is that you're relying on past experience. You've always gotten better sooner or later until now. Why would this situation be any different? Surely, as the old chestnut goes, this, too, shall pass.
Solution: Write down your symptoms. Pick up a pen or go to your computer and make a note such as "The right side of my head feels like it's going to explode" or "I have a mole on my chest that keeps getting bigger." Now read the note out loud to yourself. Whether this is an emergency situation or a progressive problem, the written statement will jolt you into accepting the fact that something is definitely awry. Incidentally, this exercise may be harder than you think. However, the more you resist writing down the symptom, the more likely it is that you are very worried. This is a kind of litmus test for denial. You don't want to face what's happening so you certainly don't want to see it in black-and-white. But force yourself. Your health may be at stake.
Problem: You're embarrassed to tell anyone what's going on because you're in public-maybe at work or in a restaurant or on an airplane. After all, from the time you were a little child you've been learning how to be on your best behavior when you're in certain settings. In large measure, that means overriding your body's urges. You stifle a burp, you don't pass gas, you muffle a sneeze, you control a cough, you swallow a yawn, you don't scratch yourself. A natural extension of that training is that you try to conceal anything your body is doing that wouldn't be acceptable in polite company. That stabbing pain in your gut, which could be appendicitis or an ectopic pregnancy, just isn't something you want to announce in the middle of the annual meeting of the board of directors.
Solution: Since this overly civilized reaction could cost you life or limb, correct for it ahead of time by imagining yourself in embarrassing situations. Then diffuse the bomb of false pride by learning to laugh at what's going on. Remember when President Bush threw up on the Emperor of Japan at a state dinner? The unplanned photo op resulted in front-page pictures around the world, plus endless jokes and snickers. Mentally insert yourself into Bush's place in that incident. Go ahead and laugh. Now mentally rehearse some similar scenes, always with you as the hapless protagonist. In so doing, you're preparing yourself to handle with good grace and prudent haste any threat to your well-being that might overtake you in the future.
Problem: You blame yourself, so you want to keep your condition a secret. We've all read and heard so much information on prevention by now that we've come to believe we should have been able to stave off pretty much any disease or disorder just by eating right, exercising regularly, getting enough sleep, quitting smoking, drinking in moderation, lowering stress levels, and so on. Getting sick can feel like a stigma, so you try to keep your condition to yourself.
Solution: Even if you are somewhat at fault for whatever ails you, concealing your condition out of shame or embarrassment will only make things worse. Remember, nobody's perfect. So pay attention to your symptoms. Then get thee to the doctor and 'fess up about your two-pack-a-day habit or your penchant for red meat or your couch potato status. Relax. This is about helping you get well. It isn't Judgment Day. Yet. But it could be soon if you keep putting off getting a diagnosis and treatment. Believe me, you won't be the first person your doctor has seen who has some bad health habits. The doc may even have a few of his own!
Problem: Even if you confide in someone close to you or if someone notices that you're in pain although you're trying to hide it, you don't believe the person's feedback about the possible urgency of your complaint. Jenny, for example, shut out the shocked reaction of her daughter when Sarah saw the abscessed thumb. Jenny also played down her pain when her husband pressed her. This is very common because none of us wants to worry those we love. We want to be strong for them, not vulnerable-and certainly not a burden. Consequently, we turn away from them just when we need them most.
Solution: Flip the scenario around in your head so that your husband (son, mother, maiden aunt) is the one with the worrisome symptom and you are the one trying to get through to that person. In this role, you want to be needed and heeded. You want to help. And you feel angry at this person for being so stubborn. After all, if the worst should happen, you'd be the one left to grieve. Now, do 180 degrees back to reality. You're the one who's being stubborn. You're the one who's taking a chance on your own life while your nearest and dearest is powerless to help.
So stop insisting you're just fine. Be grateful people care and that you don't have to go it alone. Let somebody be what I call your "health buddy." Whoever you pick will serve as a confidant and a coach who encourages you to do what you should to take care of yourself. If you have written about your problem, let your health buddy read your "confession." This person can also come with you to the hospital or to office visits-a boon when you're too sick or frightened to speak for yourself. And when the crisis has passed, the two of you can team up to reach health goals such as losing weight, sticking with an exercise regimen, or quitting smoking. Misery and good intentions both love company!
Yes, It Can Happen to You
As we have just seen, denial is a psychological coping mechanism which gives you a specious sense of well-being when you're confronted with actual symptoms, whether acute or persistent. But there's a cousin of denial which can also put your health in jeopardy. It comes into play when you have no symptoms and feel just fine. I call it "risk blindness." Let's say your father died of heart disease in his fifties. You are approaching the Big Five-Oh. You've put on a few pounds since you were at your fighting weight in college, and your desk job is so demanding that there's no time to go to the gym. You know you should quit smoking, but you can't concentrate on those piles of paperwork without puffing away. All of this adds up to a heart attack waiting to happen, but you don't think it can happen to you. You're not alone. That sense of being invincible is just about universal, and it's good, in that it keeps us from being chronic worrywarts. We get up every morning and go about our business feeling pretty darn sure we're not going to come down with a horrible illness or get hit by lightning or slip and break a leg. However, the innate panic protection turns against you when you have good reason to expect you might succumb to any given disease, but you ignore that probability and go on pushing your luck.
A perfect example of risk blindness is the case of TV talk show host Regis Philbin. Speaking to a reporter for Reader's Digest, he said: The first time I felt chest pains was early in 1993. They would come and go, so like an idiot I never went to a doctor. My father died in his mid-sixties of heart disease, but I thought it couldn't happen to me." Regis, who was fifty-nine in 1993, went on to describe a subsequent heart attack and angioplasty, and mentioned the fact that his cholesterol level remained at a precariously high 300. Then he talked about the day he had his second attack. "I was scheduled to do a high-wire act with the circus that was in town, and I went ahead with the stunt. I know it was crazy. The minute I got down off the wire, I said to Gelman, my producer, 'Drive me to the hospital.'" Regis went on to say they did an atherectomy, a "Roto-Rooter" to break up the clog, and added: Then I got really serious about my diet and exercise.. . . I tell people that even with the medication, I have to work out and eat right. And to cope with stress, I listen to Dean Martin. Dealing with Kathie Lee and Gelman every day, I have to have a way to calm myself down! It must be working because it's been over five years since the last heart scare and I've never felt better."
Regis got not one but two extra chances to save his own life. However, if you suspect you have any risk factors for a disease, particularly a family history, don't gamble. Ask your doctor to go over your health profile with you while you're still feeling great, and then do everything you can to outsmart your genes.
How Your Health Radar Can Work for
Those You Love
Until now, we've been talking about how to tap into your instincts about your own health. But you know deep inside that you have a sixth sense about your family's health as well. If the baby's crying sounds different and distressing, trust your fears and call the doctor. If your wife or husband has chest pains and the emergency room personnel say it's nothing, don't accept that conclusion if your gut says it's the wrong diagnosis. I testified for the prosecution in a malpractice case like this in which a man had subsequently died. At the deposition the wife said she didn't argue or get a second opinion because she thought the doctor knew better than she did. I couldn't help but flinch when I heard that. Talk about suffering from the White Coat Syndrome! Respect for authority and expertise is one thing, but to place all the accountability for decision making in the doctor's hands is a terrifying prospect. Doctors are only human. Doctors are often overburdened. Doctors can be sleep-deprived. Blind faith in everything a doctor says about the condition of those you love amounts to abdicating all responsibility for their welfare. You don't want that and neither does your doctor. So let yourself believe that you almost always know best when it comes to your children, your spouse, your aging parents, anyone close to you. Then act on their behalf when you feel they're not getting the attention they need-or for that matter, when you feel they are being given too many tests or too much medication. Have the courage to ask questions when your instincts tell you something may not be right.
As an ancient proverb puts it, "A journey of a thousand miles begins with a single step." Congratulations. You have taken the first step in the journey toward saving your own life. You now know that your doctor needs your expertise as much as you need hers. You also know that you, and only you, can say where it hurts and how much and when. Most important, you know that without your input, your doctor will have a much tougher time figuring out why it hurts.
You're ready to take the next step. It is at the very core of my philosophy and my plan for teaching you how to save your own life. This key step moves out of the realm of introspection and into the concrete world of your medical records. When you finish Step 2, you will have in your own hands the history of your health-and with it, the power to protect yourself from clerical or computer errors, prevent misdiagnoses, and make certain that everyone involved in your care is fully informed. That kind of power, in an era of ever-increasing depersonalization and fragmentation in our health care system, is nothing short of revolutionary. Follow me . . .
Copyright (c) 2000 by Marie Savard"