When an Apple a Day Isn't Enough

If you have signs or symptoms that seem to defy explanation or have resulted in conflicting opinions from different doctors, you may want to see a specialist. Ditto if you have an unusual condition or one that has caused complications and doesn’t get better despite treatment with your primary care physician.

Most patients are referred to the appropriate specialist by their primary care physician, particularly in cases such as cancer or other serious conditions beyond the purview of most primary care doctors. But some people may seek one on their own if they feel they’re not getting the help they need from a regular physician or if they read or hear about particular procedures that only a specialist can perform.

If you think seeing a specialist would be beneficial for you, ask your primary care physician for his or her opinion and perhaps a referral. Good doctors like to work with good doctors, and he or she probably knows of an appropriate specialist with a strong reputation. If you are considering making an appointment without a referral, check with your health insurance carrier to make sure the visit will be covered.

Below is a sampling of the symptoms of some common maladies, and the types of specialists who may be able to help.

Case Study #1
For a month each spring, you have a runny nose, swollen and watery eyes, sneezing, coughing when you lie down at night, and fatigue. Over-the-counter antihistamines and decongestants just aren’t enough to soothe the symptoms of hay fever and get you  through the day.

Stopping the Sneezing
Many people simply tolerate their allergies because their symptoms are mild or they don’t know help is available. Others, who have a more severe condition or one that interferes significantly with their lifestyle, seek care with an allergy or asthma specialist. “People have different tolerances,” says Harold Kaiser, MD, an allergist and the founder of Allergy & Asthma Specialists in Minneapolis. “Is it a nuisance, or is it a disability?”

Allergists evaluate signs and symptoms in everyone from infants to adults by conducting skin and breathing tests, X-rays, nasal smears, and blood tests. Then they discuss options for therapy, such as medication or allergy shots. Typical complaints range from hay fever, asthma, sinusitis, drug allergies, insect hypersensitivity, anaphylaxis, skin problems, and food allergies to immunodeficiency and lung diseases.

Allergy and asthma specialists must complete a residency in internal medicine or pediatrics followed by a two-year fellowship in allergy and clinical immunology. They are certified by the American Board of Allergy and Immunology.

Kaiser says about half his patients are referred by primary care physicians or ear, nose, and throat specialists; the other half are self-referred or referred by friends. “(Patients) can always ask their primary care physician, ‘Should I see a specialist?’” he says.

Case Study #2
You’re out walking the dog or mowing the lawn when you notice tightness in your chest and a shortness of breath. When you stop to rest, the pain goes away, but then it comes back again the next time you’re physically active.

Taking Care of Your Heart
If you have unexplained chest pain—even if you have an electrocardiogram and it’s normal—you should see a cardiologist, says Kenneth Baran, MD, cardiac catheterization and medical laboratory director at United Hospital’s John Nasseff Heart Hospital. “That’s the time people should see their doctor and get it evaluated,” he says. Exertional angina, or chest pain while physically active, is one of the most common reasons people seek out cardiologists like Baran.

Cardiologists treat problems involving the heart, arteries, and veins. They perform diagnostic tests such as magnetic resonance imaging (MRI) and fast-computed tomography (CT). Cardiologists also formulate treatment plans and offer follow-up care. They are proficient in diagnosing and treating problems such as coronary artery disease, arrhythmias, hypertension, cardiomyopathy, chronic congestive heart failure, and heart attack.

Baran, who is an interventional cardiologist, also does some specialized procedures that involve stretching a narrowed mitral valve or closing a hole between the upper chambers of the heart. It isn’t unusual, he says, for people needing those procedures to call him directly, but most of his referrals come from other cardiologists or primary care physicians.

Cardiologists must complete a three-year residency in internal medicine, undergo three years of specialized training in their field, and pass the American Board of Internal Medicine cardiology examination. They may subspecialize in four fields: interventional cardiology (perform procedures such as catheterization and stent insertion), electrophysiology (treat the electrical system of the heart), nuclear cardiology (evaluate pump function, blockages in coronary arteries, and damage to the heart), or echocardiography (perform echocardiography and transesophageal echocardiography).