Six Important Questions to Ask Your Doctor During Your Next Visit

From brain health to the power of aspirin, here are the conversations you must have with your doctor…

Originally published in the Fall 2015 issue of Robb Report Health & Wellness as “Intelligent Questions to Ask Your Doctor Fall 2015

1.  Aspirin is regularly prescribed to prevent heart attacks in men. 

Q: Does it also have beneficial health effects for disease prevention in women?

A: We have guidelines for only primary prevention in women and men, so let me be clear on heart disease and aspirin. What we do know today is that if women have known heart disease and diabetes—if you have type 1 or type 2, you also have vascular disease—aspirin is absolutely indicated because it is for secondary prevention, not primary prevention. And we know that for secondary prevention, women receive as much benefit as men by taking aspirin. (With primary prevention it is different, because that means it is intended to prevent the disease.) When it comes to vascular disease—we do not understand why—the trials show that giving women an aspirin a day does not prevent heart attacks but does decrease the risk of stroke in women over 65. If you have a lot of risk factors, there is a gray area where we do not have good data, so talk with your doctor. When it comes to other disorders, there are signals that aspirin could help, but the evidence is not strong enough to say that taking aspirin will prevent breast cancer, for example.

—Paula Johnson, MD, MPH, Executive Director, Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital

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2.  After deep chemical peels, the face often looks very raw. 

Q: How long does it take for skin to heal and patients to return to work? Is there a recommended age to begin these peels? 

A: Deep peels can help restore uneven skin tone from sun-damaged skin. With a deep peel, patients can go back to work in two weeks, but they will likely be wearing makeup to hide the skin for six weeks. For the best results, begin treatments with a gentle bleaching cream a few weeks before a peel, under the supervision of a cosmetic surgeon or dermatologist. As far as a recommended age, there is not a one-size-fits-all answer. Many people will never need a deep chemical peel. For some, light chemical peels are all that is ever needed. I see women and men of Middle Eastern or Asian descent, for example, who are in their sixth or seventh decade of life and have no uneven skin discoloration or even fine lines and wrinkles. But I may see someone of Northern European descent who starts to show that [kind of aging] in his or her 20s. There is tremendous variability.

—Lisa Ishii, MD, Associate Professor of Otolaryngology–Head and Neck Surgery at Johns Hopkins Medicine 

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3. Approximately one in five fatal car accidents can be attributed to drowsy driving. 

Q: Could napping prevent some of these tragedies?  

A: Since we are such a sleep-deprived country, I am a big believer in naps. If someone is having trouble with insomnia at night, some of the things most sleep physicians will do are restrict sleep, eliminate naps, and get sleep on a regular schedule. Once sleep is consolidated, doctors will begin to add back more time to sleep. But that is not the problem most people in our 24-7, burned-out society are facing. Most people do not have enough time for sleep. They are getting five or six hours a night and are exhausted, then they rely on caffeine to get them through the day and that midafternoon increase in melatonin. I am a big fan of naps for those who do not have trouble sleeping at night. In fact, we recently designed a special nap room for the Boston Red Sox in Fenway Park that has proved to be very popular with the players.

—Charles Czeisler, PhD, MD, chief of the Division of Sleep and Circadian Disorders in the Departments of Medicine and Neurology at Brigham and Women’s Hospital

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4. Studies show that the brain can grow new cells even as we age. 

Q: How early should one begin preventive care for brain diseases? Is there one exercise everyone should do?

A: Begin as early as possible: The brain span starts at birth. We counsel people to begin a healthy brain plan through diet and physical activity whether they are teenagers, midlife adults, or elderly. The magnitude of the effect will be much greater if one can maintain a brain-healthy lifestyle throughout the entire life from childhood; we see the risk factors for all kinds of diseases go down. Major risk factors of cognitive decline include midlife hypertension and midlife diabetes. For a 65-year-old patient, we would like to have had her on a brain-healthy diet for 30 years. There is no one magical exercise or activity, but rather an integrated group of behaviors that include eating a Mediterranean diet with fish and lots of fruits and vegetables, getting regular exercise, learning new skills, sleeping well, and enjoying a rich social life.

—Kate Zhong, MD, Senior Director of Clinical Research and Development and Jeffrey Cummings, MD, Director, Cleveland Clinic Lou Ruvo Center for Brain Health

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5. In August, the FDA approved Addyi, a new drug meant to boost the libido in women. 

Q: I have heard there are some serious side effects. Is it safe to use? How effective is it? 

A: Addyi, or flibanserin, has received a lot of press and has been touted as the female Viagra. This is a drug that was actually rejected by the FDA three times. It was first submitted for approval as a possible antidepressant. It did not work as such, but researchers found that one of the unanticipated side effects seemed to be a slight increase in sexual desire, so that’s how the journey began. But it was rejected twice more by the FDA because of questions about both its effectiveness and safety. It has been called the female Viagra, but I want to tell you why it is not. Viagra is a drug a man takes when he thinks there will be sexual activity. It is locally acting, improving blood flow to the penis. It’s a mechanical drug. That is not true for flibanserin, which works centrally by acting on the brain. It must be taken every day. What scientists found in the studies—which were done on premenopausal women—was that the number of sexually satisfying events increased somewhere between 0.5 times and once per month. I am not going to make a value judgment, but that was the result. The side effects included somnolence, fatigue, nausea, depression, and loss of consciousness, among other things. Flibanserin can make the blood pressure go down, which is why some women have experienced fainting. Interestingly, 15 percent of the women dropped out of studies because of these side effects. We also know that combining flibanserin with alcohol is a real problem. Somnolence, which is fatigue and lethargy, increases significantly, as does severely low blood pressure. In fact, almost 80 percent of women in the trials experienced these symptoms. There is also an interaction with oral contraceptives. The last time flibanserin was in front of the FDA, the drug’s developers were told to do a study with alcohol. This is critically important: The randomized trial included 25 participants, 23 men and only two women, for a drug meant to treat a lack of sexual desire in women. Despite this, the drug was approved in August for use by premenopausal women with a label that has a boxed warning—the strongest type—cautioning against using alcohol while taking flibanserin. The FDA is also requiring Addyi’s manufacturer to conduct three well-designed studies in women to better understand the risks regarding the interaction between flibanserin and alcohol.

—Paula Johnson, MD, MPH, Executive Director, Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital 

6. The American Academy of Pediatrics declared last fall that children should start school after 8:30 am. 

Q: How would this improve children’s health?

A: This is an institutional challenge, and it is ironic because a century ago school started in the U.S. around 9:00 am. About that same time, a psychologist at Stanford, Lewis Terman, PhD, did extensive studies that showed children in the U.S. were getting 1 to 2 hours more sleep than children in England and Germany, where school started earlier, about 7:30 am. Somehow, everything has flipped: European children are starting later and our kids are starting earlier, about 7:00 or 7:20, particularly in high schools and middle schools. It has had a deleterious effect on learning and SAT scores, has caused absences from school and tardiness, and it increases the risk of depression. In contrast, some schools in England delayed start times recently and saw it had a major effect on improving standardized test scores. It is a tremendously important issue.

—Charles Czeisler, PhD, MD, chief of the Division of Sleep and Circadian Disorders in the Departments of Medicine and Neurology at Brigham and Women’s Hospital

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