How to Talk to Your Doctor About Heartburn
If you have or think you have heartburn and want to talk to your doctor about it, there are some things you can do or say to make the process easier and more efficient.
Also, if you have gotten to the point where heartburn bothers you enough to ask for professional help in managing it, then you are doing the right thing. Get a professional opinion or advice.
Don't be discouraged if the doctor asks you to try something that you've already tried. Sometimes, taking the same medicine in a different strength or on a different or more regular schedule really can help.
Here's how to be best prepared to talk to your doctor about heartburn. And, of course, the Internet and its contents should not be used to make a diagnosis or select a treatment. This hub is written as if heartburn is the presumptive diagnosis for the sake of discussion. This may or may not be true in your case and only a doctor who actually sees you and does a proper history and physical can help you confirm this conclusion if you aren't sure.
Keep a Symptom Journal
Your doctor will ask you questions that are pretty predictable for the most part. These questions help narrow down the diagnosis. Even if heartburn is an obvious conclusion, your doctor will want to assess the severity and rule out other problems that could be contributing.
The best way to have the answers to these questions is to keep a symptom journal. Use a small notebook or notepad or a computer or smartphone app. Just make sure all the info is in the right place. When you begin to experience symptoms, write down the following.
- When it started- date, time
- What you were doing, eating or drinking when it started
- What you were doing, eating or drinking before it started
- What it felt like (more on this in the next section)
- What made it stop - medicines or time (how long)
Describe Your Symptoms
Describing your symptoms in as much detail as possible will help you and your doc make a diagnosis and help determine which treatments are most likely to help. This is really a continuation of the above concept of journaling your symptoms.
Here are some specific things to note about your pain/discomfort/symptoms that can be helpful.
- Quality of the pain: Is it sharp, stabbing, dull, achy. Does it start off mild and increase in intensity or does it come on suddenly in its most severe form?
- Intensity: Health care professionals often ask you to rate your pain on a scale from 0 to 10. Zero would be no pain and 10 would be the worst possible pain you could endure. Generally, a pain level of 2 or 3 is bothersome, but not debilitating. Often you can still rest at these levels. Above these, rest is difficult. Around a 6, you can no longer focus on anything else. Above this is pretty bad pain often leading to immediate need for relief. Of course this scale is quite subjective, but we get it if you say the pain is an 8, that it is quite bad. Numbers such as 12 or 20, while often reported, won't help much.
- Location and radiation: Where does it start and where does it go? Where is the worst pain?
Some people use a memory aid to remember what to record about the pain. There are several- this one uses the letters O, P, Q, R, S, T
Letter stands for...
What does it mean...
Examples (not limited to these)...
When did the pain start? Time?
What are you eating, drinking, doing at the time of onset of pain?
PROVOCATIVE AND PALLIATIVE FACTORS
What seems to bring on the pain or make it worse? What makes the pain better?
eating, drinking, exercise, sleeping on your back
QUALITY OF PAIN
Description in your own words
stabbing, burning, aching, constant or intermittent
REGION OF BODY AFFECTED
Where does it start? Where does it go?
Can you point with one finger to the location, or is it more spread out
How bad is the pain?
Annoying or disabling? Can you use a 0-10 scale to rate the pain?
When does it usually occur?
Random, during or after eating?
Explain What You Have Already Tried
Keep a list of remedies that you have already tried. Note when you took the meds and whether or not they helped.
As a patient, I find it extremely frustrating when a doctor tells me to try something I've already tried. As a doctor, I realize there is often (but not always) good reason for this. One of the most common reasons is that a patient was taking a medicine only when symptoms strike when it doesn't work that way. Some meds are meant to be taken as preventative, and not therapeutic. In other words, they are using it wrong. If you have tried taking Prevacid for example when the symptoms of acid reflux strike, you might be convinced that that med won't work for you. However, Prevacid only works to block acid production and prevent symptoms. It does nothing to relieve the symptoms when taken after they start.
So, if your doctor suggests something you have already tried, ask why they want to try it again. Is it on a different schedule? Is there something new or different about it since you last tried it? Don't dismiss the doc out of hand just because they suggest repeating a therapy. If you have already used the medicine in the proper way and dosage and it really didn't work, do ask if there is an alternative you could try.
Come Up with a Treatment Plan Together
Your doctor may very well recommend lifestyle changes (decreased caffeine and alcohol consumption, limiting spicy or fatty foods, etc) along with medications.
Commit to trying the course of treatment for a given period of time. Continue to keep your journal during this time so that treatment can be assessed. If symptoms get worse during this time, call your doctor and ask for advice. Don't abandon the treatment until you talk to him/her. Sometimes, adding a medicine or changing the timing of administration can help.
Also, if you have severe pain in the chest and you haven't had it diagnosed as heartburn, please get immediate medical attention. It is amazing how much alike severe heartburn and heart attack symptoms can be. Without proper testing, doctors can't always make the distinction based only on symptoms, so get the proper care, please.
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