Some interesting industry surveys have appeared over the last few days which have all confirmed the on going revolution that is the ‘consumerization’ or ‘democratization’ of healthcare.
Philips Healthcare commissioned a survey that showed that 1 in 10 people believe that online health information actually saved their lives. This is an amazing figure and takes a while to sink in and consider the implications.
The survey found that 41% of Americans are familiar with symptom checker websites and are also comfortable using them. This may come as a surprise to many doctors and healthcare institutions that worry whether patients will get unduly alarmed using these tools. It seems that the public is taking to them very quickly!
The survey also found 25% of respondents said that they trust these symptom checker websites as much as their doctor and often use them instead of going to see their doctor. This finding matches a recent survey of consumers conducted in the UK by Isabel Healthcare that showed 30% of the respondents look first at the Internet when they have a medical problem! They turn to their family and friends second and then to their doctor. As online tools improve these figures are only likely to grow.
A recent Wolters Kluwer Health survey showed:
- 80% of Americans believe that this ‘consumerization’ of health is good for America.
- 76% were now prepared to make more proactive decisions about their healthcare, although this was more around researching providers and treatment options rather than diagnosis.
- 86% felt that taking a proactive role in managing their own healthcare was critical to ensuring a better quality of care
The message is clear; there is a huge appetite for consumers to take more control of and become empowered and engaged in their own healthcare decisions.This process will continue to accelerate as the online tools, such as symptom checkers, continue to improve. The healthcare industry needs to be planning how it will operate in this new era.
Insomnia: Other names: sleeplessness, hyposomnia, insomniac, wakefulness, sleep difficulty, dyssomnia, difficulty in sleeping, sleep deprivation, sleep disturbance.
Insomnia is a disorder in which you experience difficulty in falling and/or staying asleep. Due to this lack of sleep you often awaken feeling un-refreshed which affects your ability to function during the day. Insomnia affects your energy level, mood, general health, work performance and quality of life. The amount of sufficient time asleep varies from person to person however, most adults need seven to eight hours of sleep a night. Insomnia is characterized as follows:
- Transient insomnia— can last from one night to a few weeks
- Intermittent insomnia—occurs from time to time
- Chronic insomnia— occurs most nights and lasts a month or more
Some causes of insomnia are:
- Stress - Concerns about work, school, health or family. Stressful life events.
- Anxiety - Everyday anxieties and anxiety disorders.
- Medications - Some prescription drugs can interfere with sleep:
- Heart and blood pressure medications
- Allergy medications
- Stimulants (such as Ritalin)
- Caffeine, nicotine and alcohol
- Medical conditions - Chronic pain, breathing difficulties or frequent urination can cause insomnia.
- Environment - Change in your environment or work schedule
- Poor sleep habits
- 'Learned' insomnia - This can occur when you worry excessively about not being able to sleep well and try too hard to fall asleep.
- Food - Overeating late in the evening
- Aging - Change in sleep patterns, change in activity, change in health
- Sleep apnea
- Restless legs syndrome
- Gender - If you are a woman, shifts in hormones during the menstrual cycle and in menopause can effect sleep and may play a role.
- Age - If you are 60 years of age or more. This is due to the changes in sleep patterns as you age, insomnia increases with age.
- Mental Disorder - Depression, anxiety, bipolar disorder, post-traumatic stress disorder can disrupt sleep. When depressed early-morning awakening is a common.
- Stress. Temporary insomnia can occur during stressful events. Death of a loved one, a divorce or other major or long-lasting stress can cause chronic insomnia.
- Work Habits - Alternating shift work where you work at night at times.
- Travel - Long distances and jet lag can cause insomnia.
How you can help your doctor:
See your doctor if insomnia makes it hard for you to function during the day. This list will help you determine what might be the cause of your sleep problem as well as explore treatments. To prepare for your appointment think about the following:
- Keep a sleep diary - Identify:
- How often do you have trouble sleeping, and when did the insomnia begin?
- How long does it take you to fall asleep?
- How often do you awaken at night and how long does it take you to fall back to sleep?
- What time do you go to bed at night and wake up in the morning?
- How many hours a night do you sleep?
- Do you snore or wake up choking for breath?
- Do you feel refreshed when you wake up?
- Are you tired during the day?
- Do you doze off or have trouble staying awake while sitting quietly or driving?
- Do you nap during the day?
- Identify or map out your bedtime routine.
- Where do you sleep?
- Is it noisy?
- Too hot or cold?
- Too bright or dark?
- Record what do you eat and drink in the evening.
- Do you smoke or drink alcohol?
- Identify any medications or sleeping pills you take.
- Let the doctor know if you are experiencing a stressful life or work event.
- Do you take sleeping pills?
- What type of work do you do?
- What is your exercise routine?
- Do you worry about falling asleep or staying asleep?
- Are there sleep problems in your family?
- Have you recently travelled?
Approximately 30% of adults experience some level of insomnia, and 10%-15% have more severe or chronic insomnia over the course of a year. Insomnia may effect your day causing tiredness, lack of energy, difficulty concentrating, and irritability. Insomnia is sometimes a symptom of an underlying mental or physical problem such as depression or sleep apnea. Check with the Isabel Symptom Checker for the other possible causes.
Painful periods (Other names: dysmenorrhea, dysmenorrhoea)
Most women will experience some degree of pain during their regular menstrual periods.This is normal and should be expected. The womb (uterus) is a large muscle and contracts continually but these are mild contractions and not usually felt. Around the time of the period (menstruation) the contractions become stronger as the blood supply is temporarily cut off during the contractions and this is what causes the pain. The purpose of the contractions is to enable the womb to shed its lining each month and this is lost as a bleed (menstrual period). This is an essential part of female fertility and the period pain caused by it is a side effect. Occasionally, in some women, the period pain can be extremely intense and the cause should investigated so that treatment can be determined or self-help mechanisms put in place.
If you have experienced severe painful periods (dysmenorrhea) since you began menstruating, then it is unlikely that a cause will be found and it may be just a part of your normal fertility cycle. There are certain things, like stress, which can aggravate the condition. You should speak with your doctor as this could be primary dysmenorrhea and they will be able to recommend lifestyle changes such as swimming or gentle exercise, using medication if necessary, or a trial of a TENS (transcutaneous electronic nerve stimulation) machine to ease the pain.
More serious causes of painful periods (also termed secondary dysmenorrhea) include:
- Endometriosis – this is caused by the cells lining the womb growing in the fallopian tubes or ovaries. When these cells shed and fall away they cause intense pain.
- Uterine fibroids – non-cancerous tumors grow in the womb and can cause heavy and painful periods.
- Pelvic inflammatory disease – the womb, fallopian tubes and ovaries become infected with a bacteria which leads to inflammation. Other symptoms include fever and vaginal discharge.
- Adenomyosis – tissue lining the womb starts to grow within the muscular wall of the womb. This extra tissue causes painful periods.
- Intrauterine device (IUD) – An IUD is a form of contraception, if you have had an IUD recently fitted then this can cause some pain in the first three months.
Period pain is rarely a sign of disease but, as a general rule, you should consult with your doctor if the pain interferes with your life and prevents you from working, or carrying out your normal daily tasks. Also, if you experience any unusual vaginal discharge or pain as a result of sexual intercourse.
Isabel symptom checker showing possible causes of the symptom painful periods
How you can help your doctor:
Before your consultation with you doctor, think about the following questions they may ask you.
When is it an emergency?
- Describe your period pain.
- Do you get pain only around the time of your monthly period or does the pain occur at other times. If so, how frequently?
- Does anything relieve the pain you experience?
- Do you have any other symptoms like fever, vaginal discharge or pain after sexual intercourse?
- Have you recently had an intrauterine device fitted?
You should call you doctor right away if you experience any of the following symptoms:
- Increased or foul-smelling vaginal discharge
- Fever and pelvic pain
- Sudden severe pain especially if your period is more than a week late and you have been sexually active since your last period.
- You pass blood clots or have other symptoms in addition to the pain
You should also make contact with you doctor if you have any of these longer term problems:
- You have experienced pain with your period for three monthly cycles and the treatments do not control the pain.
- You have pain and had an IUD fitted longer than three months ago.
- Your pain occurs at other times besides during your monthly menstrual period.
Isabel is used around the world by physicians, physician assistants and nurse practitioners. In the United States, within the hospitals, physician practices, medical and nursing schools that use Isabel, we see the various groups incorporating Isabel into their workflow. Now that Isabel is available on smart phones and tablets such as iPhones, Droids and iPads, Isabel is that much more accessible at point of care. Today we want to talk you about how several residency programs around the country have integrated Isabel into their workflow.
- Residents have adopted the use of Isabel and prepare for rounds by running their more complex cases through the tool. They use Isabel to prepare themselves for the discussion when they are challenged by their teacher or attending to explain why disease “x” should not be considered and disease “y” should be. Isabel is commonly cited in discussions. Attending’s have told us that they are questioned by their residents on a regular basis regarding the inclusion of a diagnosis based on an Isabel search.
- Residents are instructed to use a custom template in order to gather and record data on history and physical. They are then carried through a process of assessment and analysis and must provide a list of potential diagnoses. The process involves a mechanical review of considering all possible diagnosis associated to a list of all body systems. The resident is then instructed to input what they feel is pertinent through Isabel in order to review, validate, broaden and provoke further analysis of the differential list they created for each body system.
- The medical student within the medical team rounding on their patients is tasked with running an Isabel differential on every patient prior to rounds. This helps the medical student understand what some of the potential issues are, as well as be ready for the team if the Isabel checklist is needed for discussion.
- Residents are instructed to consider using Isabel on patients who have been in hospital for 2 days or longer and have no definitive diagnosis. They use 2 days as a trigger to incorporate the use Isabel into their workflow.
- Students have been instructed to integrate Isabel into their simulation labs. Their process involves interviewing and examining the patient, exiting the room after 10 minutes, gather their thoughts and run the case though Isabel. This is followed by a return to the exam room to complete their examination and questions. The medical school teachers discovered that using Isabel has helped the students better focus their questions and create more appropriate differentials.
- During rounds the staff physician will ask if a patient has been “Isabeled” when there is some question from the group as to what is going on with their patient. They will also use the Isabel Knowledge page, where they have access to guidelines and treatments via multiple resources, text books and journals, at POC when discharging a complex case. This is done to ensure they identify all discharge orders and all patient instructions have been covered. They feel this avoids having patients return for missed orders or instruction.
- During resident orientation the chief resident presents the key areas where technology in the form of resources can assist the students. This is done due the large number of resources available to them. This helps the residents zero in on the most effective tools for the various tasks. Four key areas are reviewed (1) Drug reference (2) Library/ Database searches (3) POC evidence based summaries and (4) Diagnostic support tools. The Isabel Knowledge page is identified as a POC evidence based summary and Isabel’s checklist is highlighted as a tool to help them with Diagnostic support.
Sore throat (Other names: Pharyngitis, inflammation of the pharynx, raw throat, pharyngeal inflammation, throat pain).
A sore throat is pain, scratchiness or irritation of the throat. It is associated with the various parts of the throat and named for the specific area affected i.e. the pharyngitis, tonsillitis, laryngitis and the less common but very serious epiglottitis.
Some causes of a sore throat are:
- Viral infections – Most common. Viral illnesses that cause a sore throat include, common cold, flu (influenza), mononucleosis (mono), measles, chickenpox, croup.
- Bacterial infections – less common. Bacterial infections that can cause a sore throat include, strep throat (from Streptococcus pyogenes, or group A streptococcus), Whooping cough, diphtheria.
- Allergies - Allergies to pets, molds, dust or pollen.
- Postnasal drip - This can irritate and inflame the throat.
- Dryness - Dry indoor air, especially in winter. This can be worsened by breathing through your mouth due nasal congestion.
- Irritants - Air pollution, tobacco smoke or chemicals.
- Muscle strain - Yelling or speaking for extended periods of time without rest.
- Gastroesophageal reflux disease (GERD) - A digestive system disorder in which stomach acids back up in the food pipe.
- Tumors - Cancerous tumors of the throat and larynx.
Age - Children and teens are more vulnerable. Tobacco - Smoking and secondhand smoke is irritating to the throat. Allergies - Allergies or ongoing allergic reactions to dust, molds or pet dander can make you more prone to develop a sore throat than are people who don't have allergies. Exposure to chemical irritants - The air from the burning of fossil fuels or common household chemicals and cleaners can cause throat irritation. Chronic or frequent sinus infections - Sinus infections increase the risk of sore throat due to the irritation caused by drainage from the nose. Close quarters - Living and working in small space especially in winter when more time is spent inside and less fresh air is available. Areas such as child care centers, classrooms, offices, prisons and military installations are examples. Lowered immunity - You are more susceptible to a sore throat when you have HIV, diabetes, are taking steroids or chemotherapy drugs, are under stress, fatigued, and/or have a poor diet.
How you can help your doctor:
- Prepare a list of medication that you take. Be sure to include bout the OTC (over the counter) as well a prescription drugs.
- Document what symptoms you have besides a sore throat.
- Identify when the symptoms began.
- Did the symptoms begin quickly or gradually?
- Is there, or was there fever associated with the sore throat?
- If yes, what was the temperature and how long did it last?
- Has there been any difficulty breathing?
- How have you treated the sore throat in order to lessen the symptoms?
- Can you associate any action that makes the sore throat worse, such as swallowing?
- Is a sore throat a recurring problem?
- Have you identified any other symptoms or problems that seem unrelated to your sore throat but occur at the same time?
- Are you a smoker?
- Are you regularly exposed to second hand smoke?
- Do you have any food allergies?
- Do you have any drug allergies?
- Do you have any environmental allergies?
- Do you take allergy medication?
When to make an appointment with your doctor
You should see a doctor when you have a sore throat for more than a week or is associated with difficulty swallowing or breathing, difficulty opening your mouth, joint pain, earache, rash, fever over 101 F (38.3 C), blood in saliva or phlegm, have frequently recurring sore throats, a lump in your neck or hoarseness lasting more than two weeks.
When is it an emergency?
If you experience a sore throat with difficulty breathing, drooling, leaning forward to breathe, taking rapid shallow breaths, "pulling in" of muscles in the neck or between the ribs with breathing, high-pitched whistling sound when breathing, and/or have trouble speaking you should seek emergency help. This could be epiglottitis which is the inflammation of the epiglottis (this the tall semi tubular structure at the back of the throat). This type of sore throat is rare and is an emergency as the airway can close or block.
On Dec 3rd 2012 the New York Times published a fabulous article entitled “For Second Opinion, Consult a Computer?”. Science writer, Katie Hafner, also followed it up with a podcast.
Katie Hafner did a great job with this article as it shows how the really smart doctors, like Dr Dhaliwal, use tools like Isabel. I hope that Dr Dhaliwal can be a role model for the “most of us (who) don’t think we need help at diagnosis”.
The quality of the 200 plus comments has been outstanding and is a testament to the NYT and its readership. However, much of the discussion still revolves around the issue of whether the computer is or will be better than the doctor. I believe that the real issue here is not the ‘competition’ between doctor and computer but when the medical profession as a whole will embrace these tools to make them collectively smarter.
Over the 12 years that we have developed Isabel, we have never once thought about whether Isabel could replace the doctor – that was never our intention. We built it as tool to help doctors build a differential diagnosis in the very limited time they have. We wanted to reduce the burden of memory and buy them time to think which, as Dr Dhaliwal says, is their “most important procedure”
For the record, I don’t believe that computers will ever replace the doctor’s role of diagnosis. What I do believe is what has happened since the beginning of human history which is that humans design tools which make them better at doing what they were doing before. So doctors, using computers, will become much better and more reliable diagnosticians. As Don Berwick once said “Genius diagnosticians make great stories, but they don’t make great health care. The idea is to make accuracy reliable, not heroic.”.
I get the greatest pleasure from hearing, for example, how a nurse practitioner using Isabel has diagnosed two patients with cancer that her physician colleagues didn’t think of. The computer, in this case, Isabel has extended her capabilities. Imagine how this could help in places where there is a shortage of medical expertise? It’s wonderful to hear Dr Dhaliwal using Isabel to second check his conclusions even though most of the time he was right and didn’t need to. The important point was that he recognizes the importance of double checking his diagnosis; he is not too proud to check as he knows how easy it is to miss something.
It is estimated that 40,000 to 80,000 Americans die each year from, almost certainly preventable, misdiagnosis. Countless more will experience unnecessary discomfort, pain and worry about an unnecessarily delayed diagnosis. Much of this could be prevented if tools, like Isabel, were widely adopted into routine practice. We need to move the debate on from whether a computer will replace the doctor to asking why these tools aren’t in common use today. Dr Dhaliwal has shown us how easily they can be used, even as an app on the phone. The stakes are too high to worry about whether doctors will be replaced by computers. We will always need doctors and, as medicine gets ever more complex, we need them to be consistently smart - which they can be by using computers. Without them, they have little chance and will be letting us all down just when we need them most.
World AIDS Day is on Saturday 1st December 2012 and the theme for this year is “Getting to Zero: Zero new HIV infections. Zero deaths from AIDS-related illness. Zero discrimination”.
The first recognized cases of AIDS (Acquired Immunodeficiency Virus) occurred in the USA in the early 1980’s where people were developing rare opportunistic infections that were resistant to any treatment. The Human Immunodeficiency virus (HIV) was discovered soon afterwards and it was found HIV causes AIDS.
What is HIV/AIDS?
HIV is a virus most commonly caught by having unprotected sex, sharing infected needles and other injecting treatment to inject drugs. The virus attacks the immune system and weakens your ability to fight infections and disease. AIDS is the final stage of HIV infection when your body can no longer fight life-threatening infections. There is no cure for HIV but drugs are available which enable most people to live a long and healthy life.
How is HIV/AIDS spread?
HIV is found in the bodily fluids (semen, vaginal fluids, blood, inside the anal passage and in breast milk) of an infected person. HIV cannot be spread by saliva alone but it can be spread if the saliva contains other bodily fluids or blood. The most common way of getting HIV in the UK is from unprotected sexual contact with a person who has HIV. Other ways include sharing needles and drug equipment, transmission from a mother to baby during birth or from breast feeding if the mother is HIV infected.
Statistics of HIV:
There are 33.3 million people in the world infected with HIV. 22.4 million of these people are in sub-Saharan Africa and the Caribbean is the second most affected region in the world. In the developed world, the USA has the most severe HIV epidemic.
Symptoms of HIV:
80% of people who become infected with HIV experience a short flu-like illness or known as a seroconversion illness that occurs 2 to 6 weeks after infection. Symptoms of this seroconversion illness can include:
- sore throat
- body rash
- joint pain
- muscle pain
- swollen glands
These symptoms can be seen in many other illnesses like flu and colds but if a patient experiences several of these symptoms and feels they have been at risk of HIV infection then they should be tested for HIV. It should be remembered that once a person has been in contact with HIV it can take up to 3 months for the HIV test to show a positive result if the person is infected. Once the seroconversion illness has happened a person may not show any other symptoms for up to 10 years.
Differential diagnosis of diseases occurring with similar symptoms to those the seroconversion illness can present with.
If left untreated HIV weakens the ability to fight infection and a person becomes vulnerable to serious illnesses. This stage of illness if known as AIDS or late-stage HIV infection. A person experiencing late-stage HIV infection may exhibit symptoms of:
- persistent tiredness
- night sweats
- weight loss
- persistent diarrhea
- blurred vision
- dry cough
- shortness of breath
- swollen glands for longer than three months
At this stage the person is at risk of developing life-threatening diseases like tuberculosis, pneumonia and some cancers. Many of these can be treated and if the person is on HIV medication then this increases their ability to fight these infections.
Where are we in 2012?
- In the UK the number of gay and bisexual men being diagnosed with HIV has reached an all-time high according to the Health Protection Agency. There has been a worrying trend since 2007 with more and more new cases each year in this transmission group. In 2011, nearly half of the new cases diagnosed in the UK which amounted to 6,280 people were from the men who had sex with men group.
- The United Nation’s has recently said it believes there has been a further drop in new HIV infections among children worldwide. In 2011, there were 330,000 new cases worldwide which was 24% lower than the new infection rate in children in 2009. Some countries within sub-Saharan Africa have made impressive efforts in reducing new infection rates among children as programmes being implemented to help this problem are having some effect.
However there is no room for complacency as there is still plenty more to do across reducing HIV infection in all transmission groups and age populations to reach “Zero new HIV infections. Zero deaths from AIDS-related illness. Zero discrimination”.
Nose bleed (Other names: Epistaxis, nasal haemorrhage).
Nosebleeds involve bleeding from the inside of your nose. Nosebleeds can originate from the front of the nose or from the back of the nose. Bleeding typically will be seen from only one nostril. If the bleeding is heavy, blood can fill up the affected nostril and overflow into the nasopharynx, this is the area inside the nose where the two nostrils converge. This can then lead to blood flow from the other nostril as well. Nose bleeds can sometime cause blood to drip into the back of the throat. Blood can then accumulate into the stomach, causing you to spit up or vomit blood (hemoptysis).
If the blood loss is significant enough it can cause dizziness, weakness, confusion, and fainting.
- From the front of the nose. This type of nosebleed is seen in more than 90% of all nosebleeds. The blood vessels in the nasal septum usually cause the bleeding. This occurs where a network of blood vessels converge called the “Kiesselbach plexus”. Anterior (from the front) nosebleeds are usually easy to control and treatments be done at home or by a health care practitioner.
- From the back of the nose. These nosebleeds are much less common than from the front of the nose. They are more often seen in elderly people. It is an artery in the back part of the nose that the bleeding usually originates from. This type of nosebleed is more complicated and often necessitates admission to the hospital where it can be management by an ear, nose, and throat specialist.
Some causes of nose bleeds are:
- Dryness (often caused by indoor heat in the winter) - this is the most common cause
- Nose picking - Together with dryness nose picking occurs more often when mucus in the nose is dry and crusty.
- Very vigorous nose blowing
- Cocaine use
- Foreign object in the nose – Small children may stick small objects up the nose
- Atherosclerosis (which is the hardening of the arteries)
- Nasal and sinus infections
- Nasal surgery
- Deviated or perforated septum
- High blood pressure and blood clotting disorders
- Drugs that interfere with blood clotting, such as aspirin.
- Liver disease
- Sometimes, the cause of nosebleeds can't be determined.
- Local irritation
- Injury to the face
- Medications/supplements, including aspirin
How you can help your doctor:
Before your consultation with you doctor, think about the following questions they may ask you.
- Describe the frequency and length of time you have nosebleeds - Frequent nosebleeds are those that occur more than once a week.
- When was your last time you had nosebleed?
- How long do your nosebleeds usually last?
- Have you swallowed blood during your nose bleed?
- Have you vomited any blood?
- Do you have any other symptoms when the nose bleed occurs?
- What do you think may be causing your nosebleeds?
- Have you had a nose injury recently?
- What home treatments have you tried to stop the nosebleeds? Did they help?
- What nonprescription medicines have you used to help stop nosebleeds? Did they help?
- What prescription and nonprescription medicines (not related to your nosebleeds) do you take?
- Do you have a family history of bleeding problems?
When is it an emergency?
- Involves a greater than expected amount of blood
- Makes it difficult for you to breathe
- Does not stop after 30 minutes even with compression
- Occurs after an injury, such as a car accident or serious blow to the face.
Do not drive yourself to an emergency room if you're losing significant amounts of blood. You should call 911 or have someone drive you to seek medical attention.
The advent of a new generation of symptom checker finally empowers patients to make sense of medical information using their own pattern of symptoms and take greater control of their health. In this new era the patient will be able to work more collaboratively with their doctor rather than be a passive recipient.
The Internet has made vast amounts of medical information available to the general public and is viewed by some as one of the greatest changes that has happened in medicine. However, making information available does not mean that consumers become medical experts. In order to be that, you have to be able to make sense of the information and know what you are looking for. Up until now, this information has only really been useful for patients with a firm diagnosis who have known what to look for. For those who have not had a diagnosis or have not felt confident in their doctor’s diagnosis, the vast amount of information at their finger tips often proves to be overwhelming and frustrating: somewhere amongst the pages of answers provided by Dr Google is the diagnosis….but where?
We recently carried out a survey of 2,000 consumers in the UK; one of the questions we asked them was whether they were confident in challenging their GP or family doctor if they thought the diagnosis was wrong. Over 40% said that they weren't confident and a staggering 66% of normally super confident 18-24 year olds said that they would not be confident either. These findings were backed up by an international survey of attitudes to health by Bupa, which showed that almost a third of patients overall do not feel confident about challenging their doctor about advice or treatment recommendations. In the UK this figure rose to 45%. Confidence is founded on knowledge so this shows that, despite the vast amounts of medical information available, patients still lack the essential skills to make sense of this information and from it research their own diagnoses. Something must be missing.
The missing piece has been the tools that enable patients to extract a diagnosis or understanding from the depths of the information overload. This is where the new symptom checker plays a key role and provide patients with a real opportunity to narrow the current huge knowledge differential between them and their doctor.
It’s a curious situation in healthcare where the patient is the expert in how their body feels yet whose expertise is often ignored or not made good use of. The new online Isabel Symptom Checker will enable patients to enter their symptoms and find the possible causes of the combination of symptoms they are experiencing. It will allow them to effectively put together their own personal differential diagnosis which they can research and then discuss with their doctor.
Now, more than ever, patients must become better informed and take greater control of their health, even if they don’t want to. As old-fashioned text books and diagnosticians will tell younger doctors, the patient will ‘tell’ you their diagnosis through their story. Around 75% of the diagnosis is revealed by the presenting symptoms and confirmation is then made through appropriate tests. With the Isabel Symptom Checker patients can now start making full use of that expertise which they have within them and, therefore, help them to assist the doctor to look after them.
Nocturia or night-time urination frequency. (Other names: night-time urination, excessive urination at night, night frequency, micturition night).
Nocturia is the need to wake up and pass urine more than once at night. This is different to nocturnal enuresis where urine is passed unintentionally during sleep. One episode of nocturia a night is considered normal. It is a common symptom in men and women and can have a significant impact on quality of sleep and therefore quality of life as you can feel tired and irritable during waking hours. As you get older the incidence of waking at night to pass urine increases, in under 60 year olds the incidence overall is 28%, in over 60 year olds this rises to 41%.
Some causes of nocturia include:
- Producing a lot of urine/polyuria: If you produce more than 2 litres of urine a day this is called polyuria.
- Nocturnal polyuria: Your body produces a lot of urine whilst you sleep.
- Poor sleep: You wake often at night and will frequently go to the bathroom at night when awake. This is normally a habit and not because you actually need to pass urine.
- Excessive drinking before bedtime: If you experience nocturia it can be due to drinking too much in the evening before going to bed. Excessive caffeine and alcohol consumption can also cause the nocturia symptoms to be exacerbated.
- Low nocturnal bladder capacity: You produce more urine at night than your body is able to hold.
- Benign prostatic hyperplasia/BPH: This is a common condition in men over 50 which results in nocturia due to obstruction of the urethra (the tube that connects the urinary bladder to the genitals so the urine can be removed from the body. Other symptoms of this include changes in urine stream, low back pain, fatigue and fever.
- Diabetes insipidus and diabetes mellitus: Other symptoms include excessive urination day and night, weight loss, weakness, excessive thirst.
- Urinary tract infection: This can cause you to wake at night and pass urine several times during the day; you will also experience some other symptoms which may include fever, pain when passing urine or strong smelling urine.
- Medications: Some medications used in treatment of heart conditions called diuretics can cause nocturia as well as some medications used in the treatment of dementia.
Factors that may increase your chances of developing nocturia include advanced age, if you are on certain medications, or if you have urinary tract problems or cardiac disease, obesity or sleep apnea.
How you can help your doctor:
Before your consultation with you doctor, think about the following questions they may ask you.
- How long have you been experiencing the symptom of nocturia?
- On average how many times a night do you wake up and pass urine?
- Do you drink large volumes of fluid before you go to sleep? It's a good idea to keep a fluid intake diary where you record what type of fluid and how much you drink every day and at what time. Keep the diary for 7 days and take to your appointment.
- Have you changed your medications recently?
- Have you also had any pain or burning whilst passing urine or any other symptoms like stomach pain and stomach tenderness?
Nocturia is a symptom which, for many older people, adversely affects their quality of life and has been linked to increased morbidity problems due to the elderly falling more often especially when tired but, with help from your doctor and understanding what the cause of your nocturia is, then it can often easily be rectified.