Questions for Andrew T. Weil, MD

Too many health complaints?
I’m embarrassed to go to the doctor because I have so many complaints – shortness of breath, dry mouth, dizziness, my feet hurt, I get too many headaches, and I feel like a wreck. Won’t the doctor think I’m just whining?

You raise a good point. Sometimes, doctors are too quick to dismiss a multitude of complaints as simply stress-related or perhaps symptoms of anxiety or depression. And sometimes, we are wrong. Writing in the New York Times on Nov. 11, 2010, internist Danielle Ofri, M.D. described an encounter with a patient who came in with a “sea of complaints,” a long list of physical problems written on a piece of paper – headaches, eye pain, pounding in her ears, shortness of breath, dizziness, needling sensations in her chest and trouble sleeping among others.

The physical exam was unremarkable, and the patient had had a normal EKG and cardiac stress test within the past year. However, she clearly was under a lot of stress and described to the doctor tensions stemming from her mother’s illness, her job and her son, 28, who “still can’t support himself.”

Dr. Ofri wrote that she discussed with her patient how stress could lead to physical symptoms and that by treating the stress, some of the pain might diminish. That night, the doctor was called to the emergency room to learn that her patient had just been admitted to the hospital with a pulmonary embolus, a potentially fatal blood clot on the lung. That’s what had caused the chest pain and shortness of breath.

“The truth was (that) any of her symptoms might have masked a life-threatening illness,” Dr. Ofri wrote. “Headaches could have been a cerebral aneurysm. Needling sensations in the chest could have been angina. Pounding in her ears could have been a brain tumor. But I had to rely on my clinical judgment that it was extremely unlikely for her to have all of these serious conditions simultaneously, so I chalked it all up to stress. And I was wrong.”

This experience led Dr. Ofri to devise a system for dealing with patients who come into her office with multiple complaints. She tells them that she will focus on just three issues during each appointment – two selected by the patient and one by the doctor. That way, the patient can choose the two symptoms that are most bothersome while the doctor can zero in on the one that might suggest a serious illness.

Dr. Ofri clearly learned a painful lesson. Her story has ramifications for patients as well as doctors. You may have multiple complaints, and they may all stem from stress, but just in case, it’s always best to check out what’s bothering you and to focus on your most troubling symptoms.

How often should I have a physical exam?
What should a complete physical exam include? And how often should you have one?

I don’t necessarily recommend an annual physical exam for everyone, but if you’ve never had a complete physical, I do suggest that you schedule one.

I believe that a comprehensive medical exam should include a thorough history that details your current health status, any symptoms that concern you, previous illnesses, medical tests you’ve had in the past (with results, if they’re available); medications you’re taking (be sure to note the dosages of any prescription drugs and mention any over-the-counter drugs, vitamins and dietary supplements you take regularly); a description of any allergies you may have; and the health problems of your parents, siblings, spouse and children, if you have them. You should be asked if you smoke or ever did, whether you drink alcohol and, if so, how much, and if you take any recreational drugs. This information is necessary to allow your health care provider to assess your risks of disease, and suggest the most important preventive strategies you should follow. It can also make it easier for you and others to track changes in your health over time and help you avoid unnecessary medical tests and procedures. Create a file for your personal health history and keep it up to date.

The actual physical examination should include measurement of your temperature, height, weight, pulse rate, and blood pressure. The physician should also measure your waist circumference, listen to your heart and lungs, and examine your body, including a good look at your skin for any signs of skin cancer. Men over 40 should have a digital rectal exam to check the size and texture of the prostate; women who have ever had sex should have an annual pelvic exam with Pap smear to screen for cervical cancer. Ask your doctor to record your body mass index (BMI), a number calculated from your height and weight that may indicate excessive body fat and screens for weight categories that might be associated with future health problems.

As long as you’re healthy, you may not need a physical exam more often than every five years. But if you have any chronic health problem or a strong family history of heart disease, cancer, or other conditions, or if your lifestyle choices have not been health-promoting, you should be examined more frequently. That means every two years if you have a chronic health problem or if your diet and level of physical activity put you at risk. I suggest an annual physical only if you have a strong family history of heart disease or cancer or if you worry a lot about getting either disease. Be sure to see the doctor whenever there’s a change in your health status or if you develop new symptoms. (By the way, a clean bill of health from a recent complete physical may help you get health insurance at a reduced premium.)

Know your family health history
My family is having a big reunion during the holidays. I suggested that we take advantage of the gathering to put together a family health history, but some of the others argue that genetic testing would do more good. Who is right?

You are. Family reunions provide a wonderful opportunity to learn more about the inherited health concerns that might someday affect you and your children. Ideally, everyone should be able to put together a family health tree, but a government survey found that less than one third of families in the U.S. have one. You can learn how to assemble a family health history – and create it electronically – by going to https://familyhistory.hhs.gov, a free website operated by the Office of the Surgeon General.

As for genetic testing, a Cleveland Clinic study recently compared family health histories from 22 patients and their spouses with results from online genetic testing services that analyze DNA and predict health risks based on the results. When investigators checked results of saliva testing from a genomic service against risks revealed via family history, they found that the DNA analysis missed nine people with a strong family history of colon cancer and erroneously identified eight men at high risk for prostate cancer who had no more than average risk based on the family health history. My feeling is that medical genetics is complex, and that the results require an interpretation that is more complicated than this kind of simplistic analysis. If your family history suggests that you may have inherited a predisposition to a disease, talk to your physician about any potential benefits that genetic testing might provide and the right way to have it performed.

If you decide to put together a family history, be sure to get information from both sides of the family. Many women don’t realize that the risk of breast cancer can come from their father’s lineage as well as their mother’s.

I would encourage you to take advantage of your family reunion to begin pulling together all the information you need to construct a family health tree. The more you know, the better equipped you and your physician will be to determine your health risks and take the appropriate steps to address them.

How about full body scans?
I’m scheduled to get a full body scan, but I just heard that the radiation involved is too high. Should I cancel?

Full body scans are CT (computed tomography) examinations of the entire body that are being offered to healthy people to look for early signs of disease. I’ve had reservations about these procedures since they were first promoted because of the radiation exposure involved. Recent data published in the September 2004 issue of Radiology shows that my concerns are justified. A single scan exposes you to approximately the same dose of radiation received by some survivors of the atomic bombing of Hiroshima and Nagasaki during World War II. We know that these survivors faced an increased risk of cancer.

New calculations from a research team at Columbia University Center for Radiological Research in New York show that with a single full body scan, the risk of developing a radiation-induced cancer later in life is about one in 1,200 – that is, if 1,200 people had these scans, one might be expected to get cancer as a result of the radiation exposure.

That risk is pretty low, but if you continue to have the scans, the risk rises. The calculations show that someone who starts having the scans at age 45 and continues to have one a year for 30 years faces a one in 50 risk of radiation-induced cancer. That’s much too high of a risk to accept for a test that is not medically necessary. The calculations also suggest that having this test on an annual basis – or even having it every two years – may do you more harm than good.

My reservations about full body scans go beyond radiation issue. While there’s a very small chance that the scans will turn up signs of an undetectable cancer years before symptoms would occur, there’s a greater likelihood that it will reveal some blip in the body that probably means nothing. But because the blip has been “seen” on the scan, you may have to get additional, anxiety-provoking tests until the issue is resolved.

Cost is a factor, too. These scans don’t come cheap – prices range from $700 to $1,300, depending on where you live. And they’re not covered by health insurance.

You also should know that the American College of Radiology doesn’t sanction use of full body scans for screening healthy people and that there is no scientific data showing that people will live longer as a result of having the scans.

If a physician recommends a full body CT scan to investigate symptoms you’re having, or to check for signs of a disease for which you’ve been treated, the test may offer benefits that outweigh the risk of the radiation exposure involved. Otherwise, they are best avoided.

“Questions for Andrew Weil, MD” were previously published at www.drweil.com and have been posted on this blog with permission by the author.

Andrew T. Weil, MD is an internationally acknowledged physician and author best known for his work in the field of integrative medicine. He is the founder and Director of the Center for Integrative Medicine at the University of Arizona. For more information, please visit http://www.drweil.com

The articles written by guest contributors are the sole responsibility of the individual writers in terms of factual accuracy and opinion and do not necessarily reflect the views of the publisher of this blog.

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