Questions for Your Heart Doctor: A Patient's Guide
Your doctor has spent many years studying the way the body works in health and disease. You may be able to benefit more from that knowledge if you ask questions that are important for your individual health. The doctor may be able to correct some of your misapprehensions and unnecessary worries, and make your life better. Some sample questions that may be pertinent to your individual health are listed below. You may have many more. If you don't understand the answers that are given to you, don't be afraid to ask for a further explanation. It serves no one well for you to be confused about your own health.
I understand that I can't change certain risk factors for heart disease such as my family history, gender, race or age, but there are things that I can do to lower my individual risk. I also understand that you can estimate my risk of having a heart attack or stroke in the next 10 years using the Framingham risk assessment tool. If I don't change my behavior, am I at high risk for a heart attack or stroke?
What can I do to lower my risk of being incapacitated from a cardiovascular event?
Can I get help in controlling the risk factors that can be modified such as diabetes, smoking, high blood pressure, elevated cholesterol or other lipids, and obesity?
With respect to diabetes: how often should I check my blood sugar? What would a weight loss down to an ideal weight do for me? What medicines should I take? How often should I have my eyes checked? How often should by glycohemoglobin and kidney function be rechecked? Did you check the pulses in my feet?
With respect to smoking: will cutting down over time be better, or stopping "cold turkey"? Can you give me some help in stopping? How much difference will it make if I stop smoking? I smoke a cigar or pipe not cigarettes, is that the same? How much damage has already been done to my lungs?
With respect to high blood pressure: how often should my blood pressure be checked? At what levels should I be concerned or let you know? What medications should I take? How often should my electrocardiogram be taken, should my kidney function be tested?
With respect to cholesterol: how much weight do I need to take off to get it down without needing to use medications? What medications should I take? What are the side effects of the medications that I need to look out for? What are the goals of therapy? How often does my lipid profile need to be checked? How often does my liver function need to be checked?
With respect to obesity: How much weight do I have to lose? What is the target goal for me to get to an ideal weight for my height and size? What is my body mass index? What body mass index would be appropriate for my size, shape and age? Can you help me get the weight down? Do I need a nutritionist or an exercise program?
What can I do to decrease the stress in my life?
I have heard that there are tests that may further help determine if I am at worse risk for incapacitation or death, should I have any of the following?
Blood tests such as homocysteine levels, Lp(a), fibrinogen, high sensitivity C-reactive protein, and apoprotein E levels. Laboratory and radiology tests such as stress test (with or without imaging), echocardiogram, carotid non-invasive studies, ultrafast CT angiography, electron beam CT, or MRI.
In order to best understand you results, you should know them. Therefore you should ask what your result of any test is, and what the normal is for that particular test.
Your doctor may give you a general sense of his/her impressions regarding the tests below; however, be certain to request and understand the results of each test. You should also know when these were last done, and whether they have gotten worse or improved. This is especially important with cholesterol and LDL. If the numbers get better when you lose weight and exercise, this will be an incentive to continue. If the numbers get worse if you gain weight and stop exercising, it will encourage you to recommence. As much as we doctors like to think that we control everything, which is not the case. You have more control than we do with medications that we may order (and you may not take).
Depending upon your age and estimated risk of heart disease actions to reduce the risk should be considered and you may want to ask your doctor about:
Aspirin, Vitamins, Weight and Exercise programs. There are many questions that you can ask regarding alcohol use or limitations, alternative or additional medications and how to know whether these each change that you make is helping.
Many articles and theories appear in the press each day. These can drive most people to distraction. This is especially true at a time in which we are making rapid strides in understanding many of the new technological advances. Even the risk of taking oral contraceptives or of estrogen therapy after menopause become subject to further evaluation. Feel free to have the doctor critique some of these observations or suggest which ones may be helpful. These may range from garlic tablets, to chelation "therapy" to fish oil. If you have a question about any of these, research it through reliable sources then ask your doctor.