Test Time
By Donna Whicher
Sometimes our bodies give us a warning sign to let us know that something just isn’t right. The sign may come in the form of an ominous-seeming lump, a nagging pain, or the inability to do something you once took for granted. Most of us respond to such signs by visiting our primary care physicians, hoping they will quickly diagnose (and cure!) our problems. Oftentimes it isn’t that simple and chances are your physician will have to order one or more medical tests to make a proper diagnosis (and therefore recommend treatment). General consensus is that a majority of these medical tests are dreaded—raise your hand if you like waiting rooms, needles, and probing.
When I moved to the Eastern Shore I’d never thought one of my first explorations of Delmarva would be a tour of several local medical offices. But shortly after settling into my new home I began having trouble breathing. A short stroll along the quaint brick streets of Chestertown left me struggling to breathe, as though I was beneath what felt like a giant boulder on my chest. The previous year I’d been biking and walking everywhere within a 5-mile radius of my northern California home. Now I needed a break to catch my breath between flights of stairs. One morning my husband said, “You need to see a doctor about that cough.”
“What cough?” I asked.
“That terrible-sounding cough you’ve been making every morning,” he explained. “The one that sounds like you had a martini-and-cigarette night out with Kathleen Turner.”
I started to pay attention to myself upon waking and noticed my husband was right: before I got out of bed I hacked away like a barking walrus. The final push to make an appointment came the day my mother called and asked if she was interrupting a workout. “What makes you think I work out?” I asked her.
“You’re so out of breath,” she explained.
Simply crossing the room to get to the phone had left me breathless. It was time to see a doctor.
Today is the First Day of the Middle of Your Life
I spent the hour in my primary physician’s waiting area imagining what he would say about my respiratory problems. Since my cat sleeps next to my head, maybe the doctor would state the obvious: I had cat allergies. But then again, I’d been exposed to California smog for seven years and maybe that had done some damage. Or perhaps my sedentary lifestyle had atrophied my lungs. Maybe I didn’t have any bronchial problems; maybe I had hypochondria problems. Or I was allergic to the East Coast.
My doctor listened to me describe my symptoms and then begged for my indulgence as he jokingly shared his “sexist attitude” about women’s health with me. In his opinion, it’s far more difficult to diagnose heart problems in women than it is in men. So he wanted to be cautious and have my heart looked at. I must have looked skeptical because he reminded this patient, “You’re not 17 anymore,” as if to say that as a 38-year-old I’m now qualified to have what I consider to be middle-aged health problems.
The truth was I didn’t find his theory at all sexist because I was familiar with the alarming regularity of women’s heart problems being underdiagnosed and untreated. But as far as I know my DNA doesn’t pack a high risk for heart disease, so I wasn’t too worried. I felt reassured at the prospect of ruling it out, though.
When I told my editor I was going to have my heart checked out, she suggested I write a story about it.
Another Good Reason to Get into Shape
When I showed up for a stress test a kind woman in scrubs placed one of those paper hospital bracelets with my name on it on my wrist. She asked me a series of questions and typed my answers into a computer. When she got to, “Did you take a pregnancy test within the last 24 hours?” I said, “No, but I know I’m not pregnant.”
“You can’t have your stress test without having a pregnancy test. Didn’t anybody tell you that?”
“Yes,” I said. “But I thought you might take my word for it.”
She sighed and gave me a disapproving look before sending me on my noncompliant way.
“Why do you need a pregnancy test?” my editor asked when I returned to the office.
“I don’t know . . . maybe for liability reasons.”
She wondered aloud if that was unnecessary testing and suggested I look into that and include my findings in the story.
I aced the pregnancy test and a week after my first attempt I was back in the cardiac department. The kind woman in scrubs from my last visit began to glue electrodes to various parts of my body with what felt like slimy ice. A coworker of hers was there, telling a story about a patient who had amputated a finger in a nearby food processing plant.
As she listened she connected the electrodes to equipment. Once I was on the treadmill the pace started out slow and gradually increased and she measured my blood pressure. As I paced I hoped for a break in the amputation story so I could start interjecting questions for my writing assignment. As I waited and walked my confidence in being too young for cardiac problems wavered. I thought about how this test at this moment would tell me whether my physical and financial future were being launched onto a new trajectory. I began to worry. Then I worried that my worrying would taint the results and I would have to come back for another stress test—after another pregnancy test. I also worried that the amputation story would never end. A man who looked like a pharmaceutical rep passing through stopped in and chatted with the women.
They talked about an upcoming party, about why they should each bring beer. But no, wine is better than beer. Yes, red wine is. No, white wine is. And isn’t funny that you like Coors Light, which happens to share its nickname with a kind of sex toy?
According to the United States Preventive Services Task Force (USPSTF), which was founded and is funded by the federal government, screening for these conditions is effective and highly recommended:
Cervical cancer
The USPSTF recommends women age 65 and under be screened. Pap smears should be carried out at least every three years.
Colorectal cancer
The USPSTF supports several screening methods, including periodic fecal occult blood testing (FOBT) and sigmoidoscopy (a procedure involving a flexible viewing tube through which the doctor sees the colon’s inner walls) alone or in combination with FOBT.
High blood pressure
The American Heart Association recommends screening for high blood pressure every two years and the USPSTF finds that recommendation to be “prudent.”
Lipid disorders
According to the USPSTF men over 35 and women over 45 who have diabetes, hypertension, or a family history of cardiovascular disease should have their cholesterol tested.
Breast cancer
Women age 40 or older should get a mammogram every one to two years and women with an increased risk for breast cancer should be screened early, according to the USPSTF.
Osteoporosis
Women 65 and over need routine screening for osteoporosis. Screening should begin at age 60 for women identified as being at increased risk for fractures.
If you’re a typical patient you’re probably unfamiliar with the phrase fee for service. According to Consumer Reports magazine, “The vast majority of doctors and hospitals are paid on a piecework basis, [thus] the more services they provide, such as blood tests, surgeries, MRIs, and CT scans, the more money they make. Experts estimate that the nation’s $2 trillion annual health-care tab is one-third to one-half higher than need be, in part because of overuse of expensive treatments and unnecessary care.” According to Consumer Reports the tests below are the most overused:
Whole-body screens: These CT scans, at a cost of $1,000 or more, have no proven benefits for healthy people, according to the FDA. Plus, CT scans expose patients to far more radiation than X-rays do.
High-tech angiography: Using a CT scan to noninvasively check coronary arteries for narrowing costs an average of $450, according to data from HealthMarkets, which sells health and life insurance through subsidiaries in 44 states. But standard angiography is sometimes still needed to confirm blockages that might require aggressive treatment.
High-tech mammography: Using software to flag suspicious breast X-rays would add $550 million a year to national costs if used for all mammograms. A 2007 study found it failed to improve cancer detection rates significantly while resulting in more needless biopsies.
Virtual colonoscopy: A study in 2007 concluded that standard colonoscopy is better at spotting smaller suspicious polyps. While less costly than the standard procedure, virtual colonoscopy isn’t cost-effective because any suspicious finding requires retesting with the real thing.
Consumer Reports recommends that you designate one doctor, typically a primary care physician, to coordinate your care. Also ask which treatments have been shown by research to be best for a given condition. And when tests are performed ask what the consequences are if the results are positive.
When will they stop ignoring me? I wondered. Or is that part of the stress test—to see how long you can endure a locker-room conversation while simultaneously being treated as though you don’t exist?
After I’d been on the treadmill awhile the man approached me and asked how I was. I was perplexed, worried, bothered, in culture shock. “Fine,” I replied.
“You’re doing fine,” he cheerily informed me.
He came back later and looked at what I assumed was an EKG screen. Then he left.
The two women were dressed as medical employees, so it was easy to figure out who they were. They were medical employees. I didn’t know who the man was or what he was doing there, so I asked one of the women.
She said, “He’s your doctor.”
“I wish he had introduced himself because I would have liked to ask him some questions,” I said. I had to write about what just happened and I had no clue.
“Can I speak to him?”
Turning to rush down the hall, she said, “You need an appointment to do that.”
Clearing the Air
My primary physician now had a file thick with test results. I wasn’t pregnant, the stress test results were normal, and my blood work—tests for thyroid, cholesterol, etc.—was stellar. I had a lung x ray (clean) and since stomach acid that travels up to the throat can cause coughing, I was tested for acid reflux (negative). The spirometry (a test that entails blowing into a tube attached to equipment to measure the amount and speed at which you can move air out of your lungs) had revealed a difference between my normal exhalations and exhalations after receiving a dose of a medication. This warranted a visit to the allergist.
While I sat in the allergist’s office I read brochures, magazines, catalogues, and wall posters—one of which described a wonderful topical anesthesia that renders the allergy test pleasantly painless. On the exam table I lay on my belly while a technician applied drops of 25 substances to my back. Next she pricked my back 25 times to make sure each drop penetrated my skin. The process was ticklish in a painful way. I giggled, I yelped, I wondered where my wonderful topical anesthesia was. She left the room, promising to return in 20 minutes, and I commenced squirming, whimpering, and resisting the all-too-tempting desire to scratch.
The tech returned and misted my back with a magical anti-itch spray that returned me to feeling normal. Next 11 substances were skin tested on my arm. This round set my skin on fire and I cried. “That’s the glycerin in them to preserve them. It stings,” explained the technician.
Afterward I met with the allergist, who informed me (finally!) of the source of my breathing problems: I had a reaction to 33 of the 36 things tested for! “You’re not allergic to horses, dogs, and cockroaches,” she began before bringing me up to speed on all things allergy and asthma related, including how to reduce exposure to mold, grass, weeds, trees, dust mites, and cats. She gave me written prescriptions as well as some medicine samples and literature to take home and read.
Back in my primary physician’s waiting room I tried to think of a subtle, polite way of broaching the topic that my editor had assigned: over testing.
Near the end of the appointment he asked if I had any questions.
“Well, yes. My editor instructed me to write about this experience and . . .”
“You’re having trouble coming up with an angle?”
“Well . . . um,” I didn’t know how to mention “unnecessary testing” without sounding like I didn’t trust or appreciate what he ordered. Truth is I was a content and grateful patient, a much wiser patient now committed to avoiding cardiac problems.
“Here’s what you want to write,” he said helpfully. “Put that ‘I had shortness of breath that was hard to describe. I had vague, subjective symptoms and obtuse complaints that my doctor had a hard time making sense of.’”
Vague? Obtuse? No way. That wasn’t going to show up in print unless my editor gently suggested that I might want to include it.
“The doctor showed concern,” he continued. “He didn’t want to miss something catastrophic. These could be early warning signs of something neither of us would want to miss. We’re building a [doctor-patient] relationship. The goal of all these tests is not to rule things in but to rule things out. These are all simple lab tests that can do that. You want to be healthy; I want you to be healthy. We’re working together to find a treatment or therapy plan to make that happen.”
The tests themselves didn’t take long, but waiting for them usually did. I’m fortunate to have health insurance, so they weren’t a huge financial burden. I’ve since moved to a newer, more modern house where it is easier to keep dust and mold in check and begun to take medications. These are teeny costs in exchange for keeping my shortness of breath and morning coughs in check. And that makes my husband happy because now he’s not worried about the state of my lungs and he no longer has to wake up beside a hung over Kathleen Turner–walrus in the morning. Looking at the tests in that light, they aren’t so bad!
Donna Whicher is a recent transplant from California. She resides in Chestertown.