Staying Healthy Archive

Peripheral Artery Disease

Questions to Discuss with Your Doctor:

• Do you develop pain, cramps, aches, fatigue, or numbness in your leg muscles when you walk?
• At what distance do you develop symptoms?
• Do they go away when you stop walking?
• Do you ever develop these symptoms at rest?
• Do you have decreased sensation in your feet?
• If you are a man, do you have erectile dysfunction?
• Are you doing everything possible to modify the risk factors that can worsen this disease (smoking cessation, treating elevated blood pressure and cholesterol, and controlling diabetes)?
• Are you exercising regularly and at progressively more strenuous levels?
• Are you taking an aspirin every day?
• If you have diabetes, do you practice meticulous foot care (cleaning, applying moisturizing lotions, and wearing well-fitting protective shoes)?
• Do you know when to seek emergency medical care for peripheral artery disease (if your leg becomes suddenly painful, pale, cold and numb)?
• Do you get chest pain or pressure with exertion or at rest? If so, you may have coronary artery disease.
• Do you have sudden brief episodes of blindness (like a shade being pulled over your eyes) or sudden episodes of weakness in an arm or leg, or difficulty speaking? These could be warning symptoms of stroke.

Your Doctor Might Examine the Following Body Structures or Functions:

• Heart rate, blood pressure, and weight
• Pulses in your feet and groin, and behind your knees
• Listen with the stethoscope over your carotid arteries in your neck
• Heart and lungs
• Neurologic exam (reflexes and sensation in your legs)
• Muscles (looking for atrophy in leg muscles)
• Skin, looking for changes related to reduced circulation

Your Doctor Might Order the Following Lab Tests or Studies:

• Blood tests, including glucose and cholesterol levels
• Ultrasound of your carotid arteries
• Doppler Ankle-Arm Indices
• Exercise Stress Test
• MRI/MRA
• Angiography

Pregnancy: 1st Trimester

Questions to Discuss with Your Doctor:

• Your age and how it will affect your pregnancy.
• Have you been pregnant before? If so, what was the outcome of each pregnancy. Did you have a full-term pregnancy (your baby was born close to your due date)? Did you give birth via a vaginal delivery or a cesarean section ("C-section") surgery? If you had a C-section, what type of C-section was it? Did any of your pregnancies end in miscarriage, voluntary abortion, or an ectopic (tubal) pregnancy?
• Does this pregnancy come at a good time for you?
• When was the first day of your last menstrual period?
• What is the usual length of your menstrual cycle?
• Do you have any medical problems such as diabetes, high blood pressure, thyroid problems, asthma, tuberculosis, epilepsy, or heart disease?
• Have you ever had any sexually transmitted infections such as gonorrhea, herpes, syphilis, or human papilloma virus (HPV)?
• Do any medical problems tend to run in your family such as sickle cell anemia, cystic fibrosis, Down syndrome, or hemophilia?
• Are you taking any medications (including over-the-counter medications)? If so, what are they?
• Do you smoke? If so, how many packs per day?
• In an average week, how many alcoholic beverages do you consume?
• Do you use any recreational drugs?
• Did you have any problems getting pregnant?
• Do you eat a well-balanced diet? Are you taking any vitamins, including folic acid (folate)?
• Do you exercise regularly?
• What is your home situation like? Who do you live with? Is your partner supportive of this pregnancy? If not, has your partner hit or threatened you?
• Are you having any problems with morning sickness (that is, nausea and vomiting)?
• Are you having any bleeding from your vagina?

Your Doctor Might Examine the Following Body Structures or Functions:

• Temperature, blood pressure, pulse, weight
• Chest exam
• Heart exam
• Abdominal exam
• Pelvic exam with Pap smear and cervical cultures
• Leg exam

Your Doctor Might Order the Following Lab Tests or Studies:

• Confirm pregnancy with blood or urine test
• Complete blood count and blood type
• Blood tests for syphilis, rubella antibodies, hepatitis B, HIV
• Urinalysis
• Portable Doppler instrument or stethoscope to measure fetal heart sounds
• Urine culture
• "Triple screen" (also known as "AFP-3" or "Enhanced AFP"
• Genetic testing

Rash

Questions to Discuss with Your Doctor:

• How long have you had the rash?
• Where did it start?
• Has it spread?
• Is the rash only on parts of your skin that have been exposed to the sun?
• Does it itch or hurt?
• Is the rash red, pink, or purple?
• Is the rash smooth or bumpy?
• Have you had sores in your mouth, eyes, or other mucous membranes?
• Have you had blisters on your skin?
• Have you had trouble breathing?
• Have you had a fever?
• Have you symptoms of an upper respiratory tract infection (for example, a cold)?
• Have you had vomiting or diarrhea?
• Are you taking any prescription drugs, over-the-counter drugs, herbs, or supplements? Did you start any of them in the past two months?
• Have you had any new exposures to foods or chemicals?
• Any exposure to insects?
• Have you had any recent sun exposure?

Your Doctor Might Examine the Following Body Structures or Functions:

• Temperature
• Examination of your skin, mouth, eyes, mucous membranes, lymph nodes, liver, and spleen

Your Doctor Might Order the Following Lab Tests or Studies:

• Skin scrapings for microscopic analysis or culture (if the rash looks infectious)
• Complete blood cell count or other blood tests (if you appear sick or have a fever)
• Skin biopsy

Pregnancy: 3rd Trimester

Questions to Discuss With Your Doctor:

• Do you have adequate support at home from family or friends?
• How do you feel? Have you had any problems since your last visit?
• Have you had any vaginal bleeding or spotting?
• Have you had any pain or uterine cramping?
• Have you had any discharge or leakage of fluid from your vagina?
• Have you noticed swelling of your face or ankles?
• Have you had any problems with your vision?
• Are you getting frequent headaches?
• Have you noticed a change in the frequency or intensity of fetal movement?
• Are you planning to breast-feed or bottle-feed?
• Have you selected a pediatrician for your baby?
• Are you taking classes on labor and delivery?
• Have you added health insurance coverage for your new baby?
• Have you purchased a special car seat to hold your baby when riding in your car?
• Have you decided on whether the baby will have a circumcision, if a boy?
• Have you talked with your doctor about the length of your stay in the hospital?
• Do you know the signs of going into labor so that you can call your doctor when labor begins? (These include uterine contractions and rupture of the membranes).

Your Doctor Might Examine the Following Body Structures or Functions:

• Breasts (to see if your nipples are inverted)
• Abdominal exam, including measurement of the height of your fundus (top of the uterus)

Your Doctor Might Order the Following Lab Tests or Studies:

• Culture of the vagina and rectum for Group B streptococcus bacteria
• Fetal ultrasound

Pregnancy: 2nd Trimester

Questions to Discuss with Your Doctor:

• How do you feel? Have you had any problems since your last visit?
• Have you had any vaginal bleeding or spotting?
• Have you had persistent vomiting?
• Have you had any pain or uterine cramping?
• Have you noticed swelling of your face or fingers?
• Have you had any problems with your vision?
• Are you getting frequent headaches?
• Have you had any vaginal discharge?
• Have you noticed fetal movement?
• Are you planning to breast-feed or bottle-feed?

Your Doctor Might Examine the Following Body Structures or Functions:

• Blood pressure, weight
• Abdominal exam including measurement of the height of your fundus (top of the uterus) and using a portable Doppler instrument or stethoscope to measure fetal heart sounds

Your Doctor Might Order the Following Lab Tests or Studies:

• Consider repeat complete blood count
• Fetal ultrasound
• Glucose tolerance test

Your Doctor Might Order the Following Treatment:

• Rhogam (Rh-Immunoglobulin), if your blood type is Rh negative (see p. 920)

Sarcoidosis

Questions to Discuss with Your Doctor:

• Have you had difficulty breathing? For how long? How far can you walk without feeling winded?
• Do you ever have chest pain or tightness? If yes, is it related to activity?
• Have you had a persistent cough? If yes, is your cough dry or do you produce sputum?
• Do you suffer from fatigue or malaise?
• Have you had any fevers?
• Have you recently lost weight? If so, how much?
• Do you have pain in your joints, bones, or muscles?
• Have you noticed any lumps in your neck, armpits, or groin?
• Have you noticed any rashes or changes in your skin?
• Have you had blurry vision or watery eyes?
• Have you ever had red or painful eyes or a past diagnosis of uveitis?
• Do you smoke cigarettes?
• Have you had an abnormal chest x-ray in the past?
• Do you have a family history of sarcoidosis?
• Are you taking any medications?
• Have you ever been on steroids or any other treatment for you sarcoidosis?

Your Doctor Might Examine the Following Body Structures or Functions:

• Temperature, respiratory rate, oxygen saturation, blood pressure, heart rate
• Heart and lung exam
• Joint exam
• Skin exam
• Lymph node exam

Your Doctor Might Order the Following Lab Tests or Studies:

• Plain chest x-ray
• Chest CT scan
• Pulmonary function tests
• Bronchoscopy with lung biopsy
• Blood tests
• Formal eye exam

Recurrent Urinary Tract Infections

Questions to Discuss with Your Doctor:

• With each of the bladder or urinary tract infections that you have you had, as far back as you can remember:
  • What were the dates of each?
  • Was a urine culture done to prove you had an infection?
  • What treatment was given, and how quickly did you get better?
  • Did you have a fever, pain in your back, or nausea and vomiting?
• Have you ever been told that you have abnormalities in the way your kidneys or bladder, or the tubes connecting them, are built?
• Do you frequently develop bladder or urinary tract infections after sexual intercourse?
• Do you have any chronic medical problems (for example, diabetes or neurological disease)?
• Are you on any antibiotics to prevent recurrent bladder or urinary tract infections? If so, which one?
• If you are a woman, what type of contraception do you use (for example, a diaphragm, spermicide)?

Your Doctor Might Examine the Following Body Structures or Functions:

• Abdominal exam
• Genital exam
• Back exam for the presence of tenderness in the area of the kidneys

Your Doctor Might Order the Following Lab Tests or Studies:

• Clean-catch urine specimen for urinalysis and culture
• Ultrasound of the bladder
• Full pelvic/renal ultrasound
• Abdominal CT scan
• Cystourethrogram

Shingles

Questions to Discuss with Your Doctor:

• Do you have a history of chicken pox?
• Does your skin hurt, itch, or feel numb?
• Is the pain sharp, dull, or piercing? How long have you had it?
• Do you have a rash? If so, for how long?
• Is the rash in more than one place on your skin?
• Is the rash on one side of your body only?
• Has the rash at any time looked like small blisters?
• Do you still have pain even if the rash is gone?
• What triggers the pain (for example, a light touch)?
• Do your symptoms interfere with your ability to sleep or perform activities of daily living?
• Are you taking any medications?

Your Doctor Might Examine the Following Body Structures or Functions:

• Skin exam almost always confirms the diagnosis

Your Doctor Might Order the Following Lab Tests or Studies:

• Skin scraping to examine under the microscope, or for viral culture, immunofluorescence, or polymerase chain reaction testing (rarely needed)

Vaginitis

Questions to Discuss with Your Doctor:

• How long have you had this vaginal discomfort?
• Does it itch or burn?
• Do you have vaginal discharge? Does it have a bad odor? What is the consistency?
• Are you pregnant?
• Are you sexually active?
• Is sexual intercourse painful?
• Do you have pain or burning with urination?
• Are you urinating more frequently?
• Do you have urinary incontinence?
• Are you post-menopausal?
• Do you have vaginal dryness?
• Do you have diabetes?
• Have you recently taken antibiotics or corticosteroids?
• Is your immune system suppressed in any way?
• Do you take birth-control pills?
• Do you wear tight pants or synthetic fabrics (nylon)? (These are all predisposing factors for yeast infections).
• Have you or your partner ever had a sexually transmitted disease?
• Do you have fevers, chills, abdominal pain, joint pain, or a rash?

Your Doctor Might Examine the Following Body Structures or Functions:

• Abdominal examination
• Pelvic examination

Your Doctor Might Order the Following Lab Tests or Studies:

• Sample of the vaginal discharge to examine under a microscope (wet smear)
• Cultures of the vaginal discharge

Spinal Stenosis

Questions to Discuss with Your Doctor:

• Where is the pain in your back?
• Does it radiate to your legs?
• Is it worse when you walk?
• Does the pain from walking occur suddenly or gradually?
• Is it relieved by standing?
• Is it relieved by sitting or lying down?
• What bothers you more, the pain in your back or the pain in your legs?
• Does the pain worsen when you cough or sneeze?
• Do you have numbness or decreased sensation in your legs?
• Have you had problems with your balance?
• Have you had any changes or difficulty in your ability to urinate?
• How long have you had the pain?
• Is it getting worse?
• How much does it limit your usual activities?
• How is your quality of life affected by the pain?
• Have you ever had spinal surgery?
• Have you ever injured your back?
• Have you ever had hip surgery?
• Do you have diabetes?
• Do you have poor circulation, such as peripheral artery disease?
• Do you have foot ulcers?
• Have you ever had vascular surgery?
• Do you have any sort of neuropathy (nerve damage)?
• What are you doing to treat the pain?
• Have you seen a physical therapist?
• Are you interested in an injection of a cortisone-like medication into your back? Do you know anything about this procedure?

Your Doctor Might Examine the Following Body Structures or Functions:

• Spine
• Hip
• Pulses in the feet, behind the knee and in the groin
• Neurologic exam

Your Doctor Might Order the Following Lab Tests or Studies:

• X-rays of the spine
• CT scans of the spine
• MRI scans of the spine