Important health care questions

No Buts About It

When it comes to the last word in health care, here’s an easy acronym to remember: ART.

A Ask questions.
R Research
T Take control of your health care.

State-of-the-art health care requires the input of an experienced and conscientious doctor, of course. But the recent experience of a friend of mine illustrates just how important it is to stay alert, ask questions, and ultimately rely on yourself for important health care decisions.

And in this case there’s one essential question that everyone should be aware of.

ART of the Deal

My friend Sarah is in her late 30s and has been having some gastrological problems. Her doctor referred her to a specialist whom he described as “widely recommended.” So far so good.

Sarah liked the doctor well enough. He examined her and ran some tests and was surprised when one of the tests came back positive; a fecal occult blood test (FOBT) to determine the presence of blood in the stool. He explained that most people her age don’t test positive to an FOBT and that it could be a false positive. But he was concerned enough to recommended a colonoscopy. He also assured her there is no risk to the procedure.

Over the past decade, colonoscopy has become the renowned standard procedure for detecting cancer or precancerous polyps in the colon. But even though we may be familiar with the usefulness of colonoscopy, it’s still an invasive procedure, requiring sedation while a flexible, tubular instrument is inserted into the colon.

In short, it’s no day at the beach. But this highly regarded doctor felt it was necessary, so Sarah set a date to have it done.

Positive feedback

Even though she had resigned herself to having a colonoscopy, Sarah went home and kept hearing, “It could be a false positive,” in her head. She spoke to her other doctor and found that there are several reasons an FOBT sometimes brings back false positive results. This made her start to think a colonoscopy might actually be unnecessary. So she asked her doctor to refer her to another gastrologist for another test and a second opinion (since the first also wasn’t able to determine the cause of her original complaint). And when she called the second doctor to schedule an FOBT, she got a shock.
The doctor’s assistant gave her a list of things she should avoid for three to five days before the test in order to prevent a false positive result:

* Eating red meat, fish, broccoli, potatoes, mushrooms, cantaloupe, grapefruit, carrots, cabbage, cauliflower, radishes, Jerusalem artichokes and turnips.

* Eating iron-rich foods or taking iron supplements.

* Taking acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen.

In addition, a daily supplement of 200 mg or more of vitamin C can cause a false NEGATIVE result, which could potentially be even more dangerous.

Sarah was amazed (not to mention quite angry) that the first “widely recommended” gastrologist would: A) Have her take the test without informing her of the very common things that can alter the result, and B) recommend an invasive procedure based on what she now regarded as an extremely suspect test result.

Previous to her first FOBT, Sarah had not only eaten some of the foods on the list, but her multivitamin contained about six times the amount of Vitamin C that could alter the outcome.

She sees the second opinion next week, but feels confident that her positive was a false one based on the list above and her relative health.

ART for ART’s sake

Sarah’s story illustrates an important rule of thumb: If your doctor suggests a test of any kind, ask him to be specific about foods, medications or other factors that might affect the results. For instance, a blood test to determine cholesterol levels requires nine to 12 hours of fasting before the blood is drawn. Without the fast, levels could easily be high enough to prompt many doctors to prescribe a statin drug.
By applying a little ART, Sarah took control of her health care, just as we all should do. Because you never know when a highly regarded doctor might be rushed or inexperienced or simply overly comfortable with a procedure, then end up taking a short cut at your expense.