How to Read Your Body’s Symptoms

Before you race off to the doctor for every lump or discoloration, remember that anomalies you’ve had for years are more likely to be a harmless part of your genetic makeup. Signs and symptoms that are unusual for you, or painful or debilitating, are more likely to be significant. (Signs are external indicators that can be seen or felt; symptoms are internal sensations, such as pain, that only the patient can perceive.)

Signs of diabetes show up all over the body, from bleeding gums to tingling feet to darkened skin patches on the neck and underarms.

Some of the most worrisome body signs are already well known, thanks to extensive education campaigns. Most women know to check their breasts regularly for lumps, dimples, swelling and discharge that can signify cancer, and to have regular mammograms.

Men can develop breast cancer too, with many of the same symptoms. Enlarged breasts in men, known as gynecomastia, generally indicates an imbalance of estrogen and testosterone, which can occur from puberty or aging — or it could be a sign of kidney disease, or a pituitary tumor.

Skin cancers have also gotten significant publicity. When evaluating a spot, remember “ABCDE”: It may be malignant if it has A, for an asymmetrical shape; B for a jagged or irregular border; C for a suspicious color; D for a diameter larger than a pencil eraser; and E for being elevated and uneven. Basal-cell carcinomas and squamous-cell carcinomas tend to be red to pink and crusty, and bleed easily.

Excess belly fat is becoming notorious as a sign of a heightened risk of diabetes, high blood pressure, stroke, heart disease, gall-bladder disease and numerous cancers. Waist-to-hip ratios are especially telling: If a man’s waist is larger than his hips, or a woman’s waist is more than four-fifths her hip circumference, that’s a sign that dangerous visceral fat is surrounding an abdominal organ.

Sudden, unexplained weight loss can also be a sign of problems.

Thyroid disease can manifest itself in dry, brittle hair, brittle nails, and weight gain or loss. Losing hair on the rest of your body could be aging or menopause, or a metabolic disorder or circulatory problems.

Horizontal lines through the fingernails, called Beau’s Lines, sometimes appear when the body is particularly stressed. Nails tell other tales as well. White nail beds — the skin underneath the nail — can signify anemia. Nails that are white near the cuticle and red or brown near the tip can be a sign of kidney disease. Irregularly shaped brown or blue spots in the nail bed can be melanomas. Fingertips that are blue or clubbed can be a sign of lung disease — although generally, there would be more significant signs as well.

Many of the same signs occur in toenails. But the feet are critical for other reasons. Circulatory problems can manifest themselves as numbness and tingling in the feet; so can peripheral neuropathy, or damage to the nerves that often begins at the extremities. Both are signs of uncontrolled diabetes. With circulation compromised, even a minor scratch or sore on the feet can become infected easily; lack of sensation can make it easy to ignore, and gangrene can set in, requiring amputation. That’s why people with diabetes are urged to check their feet every day for any kind of scratch or lesion.

The mouth provides another window into overall health. Bulimia can leave telltale acid marks on the backs of teeth — and missing teeth can be a sign of poor nutrition, advanced gum disease or long-term drug use.

Some body signs are more statistical correlations than causal relationships. Short leg length has been linked to a higher risk for diabetes, atherosclerosis and heart disease, which could all be due to poor nutrition in utero or early childhood. Several studies have found that the shorter a man’s index finger in relation to his ring finger, the more aggressive he’s likely to be. One possible explanation is exposure to testosterone in the womb, but so far, that remains more a curiosity than a clue.

How to Find Clinical Trials

Whether you have a life-threatening cancer, a chronic disease like diabetes, or a relatively minor medical problem, thousands of clinical trials are out there looking to recruit subjects. For patients, participating in a clinical trial can offer hope when existing medical treatments fail, as well as access to promising new treatments and an extra measure of medical attention.

Participation can also help advance medical science; in addition to testing the newest drugs in the research pipeline, trials also recruit patients to find better diagnostic tests or procedures and better ways to screen for and prevent disease. For patients suffering with chronic or terminal conditions, supportive-care trials look to explore ways to improve comfort and quality of life.

Large medical centers are developing their own Web sites to help inform and recruit trial patients locally, so if you are close to a big university with a teaching hospital and research center, check there first. And nonprofit health organizations are reaching out to community groups to educate residents about clinical trials and help them navigate issues such as getting insurance companies to pay the costs of participation. While some trials cover medical and travel expenses, not all do, and insurers will often pick up basic medical costs such as lab tests.

Of course, clinical trials have also become big business, with pharmaceutical companies paying recruiting firms to find subjects. Medical ethics experts warn there are still concerns when it comes to protecting participants, with alarming reports in recent years about deaths in clinical trials and persistent questions about conflicts of interest among researchers who have financial stakes in drugs or treatments. Patients who are recruited for trials should be told if there are any such conflicts.

Once you’ve agreed to take part there is no obligation to participate if you decide it isn’t right for you or if you are uncomfortable or dissatisfied once the trial is underway. It is important to ask about the risks and benefits, including how patients will be informed of any new risks identified during the trial, and to ask if the results of the trial will be provided to the participants.

Sometimes, your doctor will be the one to tell you about a clinical trial, especially if he or she is participating in a large study. And if you do decide to participate in a trial, you should discuss it with your physician, who may have good advice about the pros and cons. Patient support groups and disease organizations often put the word out to members about new trials that night help advance the state of knowledge in a specific disease. But there are also a growing number of other resources to help patients find clinical trials on their own, including websites sponsored by the federal government.

Here are the best places to find information about clinical trials.

ClinicalTrials.gov –- The largest registry of federally and privately supported clinical trials conducted in the United States and around the world, with tens of thousands of trials with locations in more than 100 countries. Sponsored by the National Library of Medicine, the site allows users to search by medical condition or other criteria for trials testing the effect of experimental drugs, devices and procedures for many diseases and conditions. The site offers information about a trial’s purpose, who may participate, locations, and phone numbers for more details. Users can also view studies added in the last 14 days or the last 60 days. There is a good primer on understanding clinical trials and news about trials, such as decisions to discontinue a trial or the announcement of new results or findings.

CenterWatch –- This Boston-based company has trial listings from more than 1,200 companies, including many of the top 10 pharmaceutical companies worldwide, searchable by medical area, geographic region, disease, or keyword. A free patient notification service automatically e-mails users who sign up as soon as a clinical trial is posted that matches the medical and geographic area they specify. It also allows users to find results from completed clinical trials, such as how a drug performed, and what a trial’s objectives and methodology were.

EmergingMed — This for-profit service connects patients to cancer clinical trials, enabling users to create a detailed profile to see if they match the eligibility requirements of more than 10,000 trials in the United States and Canada. EmergingMed also provides the clinical trial search engines for a number of disease organizations such as the nonprofit Multiple Myeloma Research Foundation, and gets paid through fees it charges advocacy groups, medical centers, and research sponsors. The company doesn’t get paid to recruit patients, and doesn’t disclose personal information gathered on its site. One advantage to the service is that it helps narrow searches by disease stage and prior treatments. EmergingMed consultants call patients who have registered with the service when new trials come up and work by phone with patients to help connect them with doctors and nurses running trials.

The Center for Information and Study on Clinical Research Participation — A non-profit group that aims to raise awareness about the benefits of clinical trials offers free educational brochures on how to evaluate a clinical trial and questions to ask before participating as well as a social networking site where patients can connect with others who have participated in clinical trials and share experiences and advice. It also offers its own search site, searchclinicaltrials.org, and a toll-free line, 1-877-MED HERO; staffers will help conduct custom searches for patients who need additional assistance.

How to Read a Drug Label

If you’re prescribed a new drug, your doctor and pharmacist should give you the basic facts – why you’re taking it, its major side effects and what other medications or foods to avoid while on it.

But that’s just the beginning of the story, and you should consider doing more research, particularly if you’re planning to take the medication for an extended period. The best place to start is the drug’s official label, approved by the Food and Drug Administration when it went on the market and updated regularly with new findings reviewed by the agency.

This “label,” sometimes called a “package insert,” is not the little sticker that comes attached to a pill bottle. Instead, it’s a long document that can stretch on for dozens of pages. You may get a copy with your prescription, printed in mini-script that likely requires a magnifying glass, or you can find one online.

These labels are written primarily for doctors, so they are not easy to understand. They also don’t always contain the absolute latest in research, since the FDA and drug makers can take months or even years to get new data into labels. But they are also the most comprehensive source of information on a drug, chock full of important facts about the stuff you’re putting in your body. Among them: the proper dosage, the FDA-approved uses of the drug, its scientific name, the full list of possible side effects, and the full evidence backing the drug’s effectiveness.

To find a label, you can start by going to the FDA’s web site, fda.gov. Click on “drugs,” on the left, and then go to “Healthcare professional resources.” Then, under “Drug Information,” click on Drugs@FDA. You will get an alphabet. Click on the letter for the drug you’re taking (“L” for Lipitor, for instance) and then find it in the list that comes up. Click on “Label information,” then pull up the most recent approved label.

A simpler way to find a drug label is often to go to the drug maker’s official site for the medication. Click the links that say “for medical professionals only,” even if you aren’t, and look for the professional labeling, sometimes called the full description. There’s no prohibition on a non-professional reviewing drug labels.

Because the FDA started requiring a new format for drug labels in 2006, recently-approved drugs and newly-updated labels will look different than older ones. The newer format is easier to understand, with key facts highlighted at the beginning of the label. But the information is the same, regardless of the format.

Some labels also have patient counseling information, which is what your doctor is supposed to tell you. It tends to be at the bottom of the label. This may be worth examining as well, but if you can, you should also try to read the actual label text.

A good place to start is with the name of the drug. You’ll notice that the brand name you’re familiar with is at the top of the label, along with the drug’s true scientific name next to it in parentheses. In the case of Lipitor, this is “atorvastatin calcium.” It’s helpful to know the name of your drug for a number of reasons. For one thing, doctors often use it in conversation, particularly with another medical professional. For another, a generic version might not go by the brand name. And if you decide to do further research on your drug for any reason, you will find that medical journal articles always use the scientific name, not the brand.

Next, you’ll want to look at “indications and usage.” A drug’s “indications” are its approved uses – meaning, the things the FDA has agreed it’s useful to treat, based on evidence from studies. This is important because you want to know whether the reason you’re taking the drug is on this approved list.

Often, doctors prescribe drugs for so-called “off-label” uses that the FDA hasn’t approved. This is legal and often appropriate, but you may want to ask your doctor about why she feels this unapproved use is proper for you, and check that your insurer covers the drug under such circumstances.

In the summary at the top of the Lipitor label, for instance, you’ll see a long list of uses, topped by “Reduce the risk of MI, stroke, revascularization procedures, and angina in patients without CHD, but with multiple risk factors.” This is typical medical-speak, and you may want to turn to an online medical dictionary for help. There’s one at Medterms.com, and many others are available at sites such as WebMD. To start you out, MI stands for myocardial infarction, or heart attack.

You’ll find a longer version of the indications (and the rest of the label) after the summary at the top. This is sometimes easier to understand, because it has fewer acronyms and spells things out in a bit more depth.

Another good thing to check in the label is the “dosage and administration.” This is pretty straightforward. It explains how much of the medication a patient is supposed to take. There’s plenty of research showing that dosage errors occur fairly regularly. You should check that the dose you’re taking is actually in the approved range, and that someone hasn’t added an extra zero or made some other basic mistake. It’s also good to know if you’re taking a relatively large or a small dose of a drug, so that you can have an educated conversation with your doctor about whether you might need more or less.

“Contraindications” is another important area of your drug’s label, and it’s just what it sounds like – the exact opposite of the FDA-approved uses. If any of these contraindicated situations matches your circumstances, you should almost certainly not be taking the drug. Call your doctor right away to ask if he might have made a mistake or been unaware of something about your status. For instance, Lipitor is contraindicated for nursing mothers and women who are pregnant, among other groups.

Next is perhaps the most important part of the label for the consumer to check – the warnings and precautions. These are the safety concerns that the FDA wants to flag. “Warnings” are more serious than “precautions,” but all are worth a read. There’s no need to become a hypochondriac, attributing every little twinge to your medication, but drug side effects can be serious and even fatal. You should be aware of safety issues that have been linked to your drug, and watch for them. Among the most serious potential drug side effects are liver damage and, in the case of Lipitor and similar cholesterol-reducing drugs, muscle problems.

Finally, you will see “drug interactions.” These are also important to check, because they tell you what other medications, herbal remedies, or foods may have side effects when combined with your drug. Some of these may be unexpected: grapefruit, for one, interacts with certain medications.

How to Create a Family Health History

Researchers are increasingly focused on the hereditary nature of health risks. Ailments ranging from heart disease to Alzheimer’s to macular degeneration and schizophrenia are all tied to genetics.

But if you want to understand what’s lurking in your genes, you probably shouldn’t start with a barrage of high-priced, often-unproven genetic tests. Instead, you can do your own research by creating a family health history – it’s free. And, once you have it, you can consult with your doctor or a genetic counselor about what action you should take, including possibly one of those genetic tests.

You can start your research online, with sites that offer advice and interactive tools for creating a family health history. For tips, the nonprofit Genetic Alliance and the Centers for Disease Control and Prevention are good places to start.

There are also sites that will help you create records that you can share with doctors and relatives. The Office of the Surgeon General’s online family history tool is available at familyhistory.hhs.gov. It allows results to be emailed or integrated into digital health records. NorthShore University HealthSystem also offers a family history tool. Researchers at Ohio State have a tool for assessing risk of heart disease and cancer.

But the heart of your research will be the questions you will ask your own relatives. You want to gather information about at least three generations of your family, and more if possible. Seek out older relatives. You should be asking about health problems, including conditions that may not seem serious such as benign colon polyps, and causes of death. Diagnostic information such as the date of onset or the type of cancer can be important. You may also want to check death records, if information isn’t available or older family members’ memories are limited.

When gathering family health histories, stay alert for patterns that may signal undiagnosed conditions, such as a history of unexplained sudden deaths. Among other things, this can signal heart problems such as hypertrophic cardiomyopathy, a thickening of the heart muscle. Repeat miscarriages may be a sign of a chromosomal condition that, while not obvious in a parent, can result in a fetus that isn’t viable.

To be sure, family health histories can be tough to gather. Often, relatives with important knowledge have passed away. Older kin who are still living may be reluctant to discuss health issues, or they may simply be hard to reach. Family gatherings such as reunions can be good settings to broach these subjects. In addition, relatives can sometimes jog one another’s memories.

Once you’ve gathered the information, you should bring a printout to your next doctor’s appointment. Though physicians often lack the time to gather an in-depth history, it’s easier for them to glance at something you’ve already created, or answer specific questions you may raise. Based on that information, a physician may decide to check your blood sugar or do other tests that could pinpoint an undiagnosed condition.

Research has shown that many primary-care doctors aren’t confident about their ability to advise patients about genetic issues, so you may also want to seek out a genetic counselor. They can help identify patterns in the family records and suggest additional questions to ask to fill in blanks. Counselors can be found through the National Society of Genetic Counselors.

One thing to keep in mind is that a federal law passed in 2008 is supposed to protect Americans against genetic discrimination. The law prohibits employers and health insurers from forcing people to answer questions about genetic-test results or family health history. It also blocks them from using such information in hiring or coverage decisions. Information about the law can be found online at genome.gov.

But the law didn’t cover life insurance, long-term-care insurance or disability insurance. Companies that offer such coverage can use information about potentially inherited health risks in setting your rates.