When to See the Doctor

With RA it seems like there is always something going on: pain, swelling, even the occasional fever. So how do you sort out what’s “normal” and when you need to see a doctor (outside your normal checkups)?

First of all, just let me say that in case of any doubt, seek medical attention immediately. This includes severe things like profuse bleeding, vomiting, symptoms of heart attack or other life-threatening signs.

But beyond those things that are clearly emergencies, I use a series of “check-boxes” to decide if something is outside the norm enough to warrant a doctor visit.

• Persistent. First, give it some time. I’ve found that many things will resolve themselves if given a bit of time to do so. During this time, I use common-sense home treatments like ice, pain relievers, and anti-inflammatories. If the problem gets worse or persists more than a week or so, I start paying more attention to it.
• Consistent. If a new symptom consistently appears when I do an activity (and it persists), it may warrant attention. For example, if my shoulder starts hurting consistently when I raise my arm over my head, this is a sign that something has changed or may be damaged.
• Interferes. With RA you tend to get used to a certain level of aches and pains, but I draw the line when something interferes with my daily activity. If my shoulder bothers me occasionally, it’s one thing. If the pain interferes with my ability to reach the top shelf in my kitchen or fold sheets, then it’s something else. If it also consistentlyinterferes with my ability to either fall asleep or is bad enough to wake me from sleep, it also bears investigation. As an example, a classic symptom of rotator cuff tears is pain that wakes you at night. (https://www.nlm.nih.gov/medlineplus/ency/article/000438.htm)
• New. I’ve added this not because every new symptom rises to the standard of needing immediate medical attention, but because we need to be aware of changes in our health and new symptoms are the indicators of these changes. Even if we don’t seek near-term medical attention for new symptoms, it’s a good idea to discuss them with our rheumatologistor primary care physician during regular checkups. In response to the usual, “How have you been?” question, I generally reply, “Since my last visit, X has gotten better, but I’ve noticed that Y now occurs when I first get out of bed in the morning. This has been going on for about Z weeks.”

While our health care team members are the experts in their fields, we are the experts when it comes to our bodies and how we feel. With a chronic illness, it’s impractical to run to the doctor every time we don’t feel well, but we can use this expertise to determine what’s new, what’s urgent, and what’s just background noise.