Staying Healthy Archive

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

Thrombocytopenia

Questions to Discuss with Your Doctor:

• What medications do you take (including over-the-counter drugs and herbal remedies)?
• Have you been ill recently?
• What other medical problems do you have?
• Could you be pregnant?
• Have you ever been tested for HIV?
• Have you had fever?
• Have you had rashes?
• Have you had diarrhea?
• Have you had abdominal pain?
• Have you had headache?
• Have you had neurologic symptoms?
• Have you been lightheaded?
• Have you been short of breath with minimal exertion?
• Have you had chest pain or pressure?
• Have you had a cough?
• Do you have any bruises or nosebleeds?
• Do your gums bleed when you brush your teeth?
• If you are a woman, have you had unusually heavy menstrual periods?
• How long have you had symptoms?
• Does anyone else in your family have low platelets?
• How many alcoholic beverages do you drink in an average week?

Your Doctor Might Examine the Following Body Structures or Functions:

• Eyes
• Mouth
• Heart
• Lungs
• Abdomen
• Skin

Your Doctor Might Order the Following Lab Tests or Studies:

• Blood tests, which might include complete blood count with microscopic evaluation, kidney function tests, liver function tests, antinuclear antibody, an HIV test
• Bone marrow biopsy

Insomnia

Questions to Discuss with Your Doctor:

• Are you particularly stressed at work or at home?
• Are you depressed or anxious?
• Do you have any underlying medical problems such as hyperthyroidism or sleep apnea?
• Do you snore?
• Do you have chronic pain or difficulty breathing at night?
• Do you have restlessness or twitching of your legs at night?
• Do you drink caffeine-containing beverages after noon (such as coffee or sodas)?
• Do you use stimulants? Drink alcohol? Take sedatives? Smoke cigarettes?
• Do you take any medications?
• What time do you usually go to bed?
• What time do you get up in the morning?
• Do you eat or work before going to bed?
• Have you noticed changes in your sleep patterns?
• Do you wake frequently at night?
• Do you feel tired during the day?
• How long do you stay in bed before you fall asleep?
• Do you have worries about not sleeping?

Your Doctor Might Examine the Following Body Structures or Functions:

• Blood pressure, heart rate, weight
• General physical exam

Your Doctor Might Order the Following Lab Tests or Studies:

• Complete blood cell count
• Thyroid function
• Sleep study with monitoring of heart rate, respiratory rate, oxygen level, eye movements, and brain waves

Inguinal Hernia

Questions to Discuss with Your Doctor:

• Do you have pain in the lower abdomen or groin area?
• Have you noticed a bulge in your lower abdomen or groin area?
• Does lifting heavy objects, coughing, sneezing, or straining increase the size of the bulge?
• Can you push the bulge back in?
• Do you suffer from constipation?
• Have you had bloody stools?

Your Doctor Might Examine the Following Body Structures or Functions:

• Careful abdominal exam
• Groin exam (including testicular and scrotal exam in men)

Your Doctor Might Order the Following Lab Tests or Studies:

• Stool sample
• Abdominal/Pelvic ultrasound
• Abdominal/Pelvic CT scan

Irritable Bowel Syndrome (IBS)

Questions to Discuss with Your Doctor:

• Do you have pain or cramping in the lower stomach?
• How often do you get the pain?
• Is the pain related to meals?
• Do you suffer from constipation and small bowel movements?
• Do you have diarrhea that alternates with constipation?
• Do you have frequent bloating and gas?
• Do you have a feeling of fullness in the rectum?
• Is there a family history of inflammatory bowel disease?
• Do you have a history of mental illness or depression?
• Are there any things causing unusual stress in your life?
• Please describe your diet in detail.

Your Doctor Might Examine the Following Body Structures or Functions:

• Careful abdominal exam
• Rectal exam

Your Doctor Might Order the Following Lab Tests or Studies:

• Stool testing for blood and cultures
• Conventional abdominal X-rays
• Endoscopy or sigmoidoscopy
• Barium enema
• Complete blood count and other blood tests

Irregular Menstrual Periods

Questions to Discuss with Your Doctor:

• Have you been experiencing high levels of stress?
• How much do you exercise?
• Have you ever had an eating disorder?
• Have you lost weight recently?
• Have you been intolerant of heat or cold.
• Have you had rapid heartbeats, dry skin, hair loss, constipation or diarrhea, or a change in weight (these are symptoms of thyroid abnormalities, which can cause irregular periods)?
• Do you have abnormal body hair?
• Have you gained weight?
• Do you have regular menstrual cycles?
• Is your bleeding always heavy or prolonged?
• How old were you when you started menstruating?
• How long ago did you develop irregular periods?
• When you do have your period, is it accompanied by symptoms such as abdominal cramping, mood changes, and bloating?
• Are you sexually active?
• When was your last period?
• How many times have you been pregnant?
• What was the outcome of each pregnancy (live births, miscarriages, cesarean sections)?
• Have you ever had difficulty getting pregnant?

Your Doctor Might Examine the Following Body Structures or Functions:

• Heart rate, blood pressure, and weight
• Heart and lungs
• Pelvic examination

Your Doctor Might Order the Following Lab Tests or Studies:

• Pregnancy test
• Blood tests for certain hormone levels (thyroid stimulating hormone, cortisol, prolactin, follicle stimulating hormone, 17-hydroxyprogesterone, testosterone, DHEA)
• 24-hour urine collection for free cortisol
• Pelvic ultrasound
• Pap smear (see p. 1066)