Wednesday, 03 September 2008

What questions you should ask your doctor??

The other day, I outlined to a patient the diet and exercise changes I advised her to make to lower her risk of having a heart attack. Eventually, our conversation drifted to her new job, her new son-in-law, and a recent trip to Africa. Suddenly, she remembered she had another appointment and jumped up to leave. "You've made me late, Doc!" she said, laughing. "You must be the only doctor in town who spends too much time with his patients."

That's a luxury I do have, thanks to good fortune in my other career — writing books. I can practice medicine the way I like, which means taking however long is necessary to explain to my patients why I may ask them to undergo a particular test, take a medication, or change their diet. Of course, most doctors don't have this much time. That is why I recommend that you become familiar with new advances in heart screening and treatment before your visit. To ensure you engage your doctor in a conversation about cardiac prevention, ask these three leading questions:

Should I get a CT scan of my heart?

I consider a computerized tomography heart scan one of the best tools we have to assess a patient's risk of having a heart attack in 5, 10, or 20 years. The test yields what's called a coronary calcium score, a measurement of the amount of calcium in your arteries and a good indication of the amount of plaque buildup in the arteries' walls. You can have low cholesterol and a lot of plaque buildup, or high cholesterol and squeaky clean arteries. Only a screening can tell.

Should I get specialized cholesterol tests?

Some doctors may not be familiar with the benefits of advanced blood testing for heart risk. It's often not enough simply to know your HDL (good) and LDL (bad) cholesterol levels; I also want to know the size of those particles. You could have a very desirable total cholesterol level, but if you have small particles, your risk of having a heart attack is higher than your total blood cholesterol might lead you to conclude. This test is particularly important for people who have moderately high or borderline triglycerides and low HDL; they tend to have more dangerous small particles.

Should I take a drug to lower my cholesterol levels?

Statins very effectively lower LDL cholesterol, and niacin — in large, prescription-strength doses — can increase HDL cholesterol by 20 to 30%. But at least half of patients who take niacin experience flushing — it causes blood vessels to dilate — so, to save time explaining this minor side effect, some doctors don't prescribe it. Fortunately, there are ways to diminish flushing — such as swallowing an aspirin a half hour before and taking niacin with food. By asking these questions, you'll be sure to cover heart prevention strategies, including lifestyle changes, that will keep your heart strong. You may make your doctor run late, but he probably already is anyway.