I Can't Ask My Doctor That!
Have you ever sat on a doctor’s table with a question rolling around your gut, practically burning a hole through that flimsy exam gown, and felt too scared to ask it?
We did the hard part for you, posing five embarrassing questions to top cardiologists. Here are their frank answers—no blushing necessary!
Q: I’ve tried to quit smoking but can’t. Is there hope?
One of the top contributors to heart disease is smoking. When people quit, they reduce their risk of heart disease, lung cancer and breast cancer.
Yet quitting is the single most difficult challenge for many patients, says Martha Gulati, M.D., co-author of the book Saving Women’s Hearts: How You Can Prevent and Reverse Heart Disease with Natural and Conventional Strategies.
“They might quit for a short term and go back to it. It is an addiction and something they should never go through alone or give up on,” she says. “When they are ready to quit, they can do it.”
There are many resources for smokers, including medication, hypnosis and smoking cessation counseling. But what really matters is your personal commitment. Studies show that unless a patient is truly motivated to kick the habit, success is rare, adds Thomas C. Gerber, M.D., a spokesman for the American Heart Association.
To get started, set a quit date, download the No-Smoking Contract at heart.org, and sign it in front of friends and family who will help you keep your vow. Don’t be shy about talking to your doctor about quitting smoking. He or she wants to help!
Q: When can I have sex after a heart attack?
This is one of the most pressing questions after a heart attack or bypass surgery. Yet, patients don’t always ask it.
“Patients don’t feel that they get counseling on this very important topic that affects their quality of life after a heart attack, and affects not just the patient but their partner,” Gulati says.
To make matters more confusing, until recently, heart experts had little research on the subject, making it difficult to advise patients. But this year, the American Heart Association released new guidelines about sex after a heart attack, and urged cardiologists to discuss them with every patient.
The good news? If you can handle moderate activity like household chores without experiencing chest pain or shortness of breath, then your heart is strong enough for sex.
“There is a fear of having sex and how vigorous it should be,” Gulati says, “but the risks are actually quite low.”
The guidelines revolve around the metabolic equivalent of task (MET), or the amount of energy we expend during a given activity. For example, we use about four METs to bathe or get dressed, Gulati says. And it takes three to five METs to have sex.
Recovery time after a heart attack varies depending on age, physical condition, severity of the heart attack and level of emotional stress, Gerber says.
Talk with your doctor about cardiac rehabilitation, which strengthens your heart and restores energy.
“We want our patients to have a healthy life,” Gulati says, “and part of that is helping them safely resume sexual activity.”
Q: Will you know if I don’t exercise?
While blood tests offer a precise look at your eating habits, they reveal far less about your exercise routine.
Doctors rely on your word, and common sense.
“I can’t look at someone per se and tell they haven’t been exercising,” Gulati says. “I have a hard time if patients tell me, ‘I’m eating right and exercising this much,’ and their weight is exactly the same. It won’t add up.”
Dr. Gerber checks blood pressure, cholesterol, blood sugar, height, weight and body mass index. Also, a stress test can reveal a sedentary lifestyle, which is a major factor in heart disease.
Ultimately, lying to your doctor = cheating yourself.
“There isn’t any reason to lie to your doctor,” Gulati says. “They want to help you achieve optimum health and prevent diseases, so it’s better to be honest with them so they can help you achieve healthy practices.”
Q: Why can’t I shake this sadness?
Cardiologists are experts on the physical heart. But sometimes, they delve into the metaphorical heart, too.
“That’s truly a hard one,” Gerber says. “I’ve seen patients in the practice who have been tearful when they talk about life after a heart attack. I suspect that sadness has to do with loss—the feeling of invincibility that is lost.”
It’s common to feel depressed and anxious after a heart attack or bypass surgery, Gulati says. It’s vital that you seek treatment for depression, because patients who don’t are more likely to have repeat heart attacks.
“Patients don’t often bring it up, and physicians don’t do enough to screen for it,” she adds. “We cardiologists may not be equipped to give you the medication or the counseling you need, but we can refer you to someone who can help.
“You shouldn’t suffer in silence.”
Q: Is it possible to ‘cram’ for my checkup?
It’s tempting to scarf salads and pop fish oil pills the week before a cholesterol test. But will your cardiologist know you haven’t maintained a healthy diet?
The answer is yep—you’re busted.
Your body is full of clues that help doctors piece together a picture of your health. The most telling clue is a little thing called the hemoglobin A1c test, which measures the average amount of sugar in your red blood cells over the past 90 days.
“It’s like a picture of what you did the last three months,” Gulati says. “You can’t do anything about that. It’s one of the ways we can make sure you are eating right.”
There are other clues. “If someone hasn’t been adhering to a diet, their cholesterol and blood pressure will be proof,” Gerber says.
Cardiologists check your lipid panel, otherwise known as your fasting cholesterol panel. This test shows what is circulating in your blood right now. That’s why it’s important to fast at least 10 to 12 hours beforehand.
“If you eat a really bad meal right before coming to the doctor, those numbers will be awful,” Gulati says. “If you eat a diet very high in fat, cholesterol or a heavily carb-related diet, we will see that.”
High-carbohydrate foods such as beer and chips make your triglycerides spike. And fasting glucose, which can signal diabetes, rises with poor eating habits.
“If you’re consistently eating diets high in sugar or carbs, you most likely have a high fasting glucose, particularly if you’re an apple-shaped person rather than a pear-shaped person,” Gulati says. “If your abdomen enters the room before you do, your risk of diabetes is higher.”
How Gwinnett Medical Center Can Help
Since the Strickland Heart Center opened in 2012, bringing open heart surgery to the region, Gwinnett Medical Center has been steadily adding even more state-of-the-art heart procedures and treatments, like electrophysiology for A-fib conditions.
Now, GMC is offering the most advanced -- and minimally invasive -- heart valve procedures. With the most up-to-date equipment and a stellar team of integrated, multidisciplinary specialists, patients with heart valve conditions can now be treated close to home. Learn more at gmcheart.com. Or find a cardiologist near you at gwinnettmedicalcenter.org/physician.