ONCE YOU’VE BEEN DIAGNOSED WITH A CHRONIC ILLNESS, such as asthma, heart disease or diabetes, one of the best things you can do to help keep your condition under control is work closely with your physician.

That means regular appointments, of course. But between office visits, symptoms may flare or new ones may crop up. How do you know if you’re experiencing “just the usual,” or if a headache, chest pain or shortness of breath is worthy of an immediate call to the doctor?

“When in doubt, call — most physicians would rather hear from you sooner than later,” says Stephen J. Spann, M.D., professor and chairman of the department of family and community medicine at Baylor College of Medicine in Houston. “People sometimes ignore mild symptoms and wait until they become bothersome before consulting a doctor, but anyone with a chronic illness should be under the ongoing care of a physician.”

Spann offers the following guidelines for when to call the doctor, and when to self-treat.

For Diabetes
If you have diabetes, “rising blood sugar certainly is a reason to call the doctor,” says Spann. “Patients with diabetes also have a high risk of heart disease and strokes. For this reason, they should get immediate emergency care for any symptoms of heart attack or stroke such as chest pain, sudden onset of weakness or paralysis and a loss of ability to speak.”

Call the doctor if you have symptoms such as:

• Increased thirst, urination or weight loss
• High or low blood sugar that doesn’t respond even though you’re adhering to prescribed treatments
• A change in vision

Get immediate care for symptoms such as:

• Indications of very low blood sugar (hypoglycemia), including confusion, weakness, paleness, sweating and rapid heart rate; or in severe cases, seizures or coma
• A sweet, fruity odor on the breath, slowing or speeding up of breathing and a very sleepy feeling (symptoms of ketoacidosis)
• Vomiting or diarrhea for more than six hours
• Tingling, numbness or burning pain in hands or feet
• Chest pain, sudden onset of weakness or paralysis and a loss of ability to speak
• Problems that worsen despite your following your doctor’s advice, which may indicate long-term complications of diabetes; for example, dizziness or weakness when you suddenly sit or stand up; a wound that appears infected or doesn’t heal; or vision problems, such as seeing flashing lights or large floating areas or spots

For Asthma
As long as a person with asthma follows doctor’s orders, the condition rarely is fatal.

“Minor shortness of breath can be treated at home or in the doctor’s office. If it’s major, seek emergency care,” says Spann.

Call the doctor if you have symptoms such as:

• Trouble breathing, even after you’ve taken the medications normally used to treat your asthma; shortness of breath combined with tightness in the chest and wheezing
• Persistent, dry hacking cough
• Yellow, green, gray or bloody sputum, or thick sputum that you can’t cough up
• Itching, swelling, rash or difficulty breathing, which may be caused by a reaction to your medication

Get immediate care for symptoms such as:

• Sweating and severe difficulty breathing, which may be combined with pale or blue lips and fast heart rate and anxiety; call 911

For Heart Disease
Coronary artery disease can lead to heart attack. If you think you might be having a heart attack, call 911. Call the doctor if you have:

• Chest pain that doesn’t subside with rest or use of your nitroglycerin
• Symptoms of heart failure, which include shortness of breath, weight gain and swelling of the legs

Get immediate care for:

• Any heart attack symptoms, including chest pain that’s crushing or squeezing or feels like a heavy weight; that radiates to the jaw, back or one or both arms or shoulders; or that’s accompanied by trouble breathing, lightheadedness or dizziness, sweating, nausea or vomiting, fast or irregular pulse, or signs of shock

For High Blood Pressure
“Ideally, people with hypertension will be self-monitoring their blood pressure,” says Spann.

Call the doctor if you have symptoms such as:

• Higher than usual blood pressure
• Dizziness that doesn’t go away
• Chest pain during exercise
• Vomiting or diarrhea, or fever accompanied by dizziness

Get immediate care for symptoms such as:

• Blood pressure of 180/110 mm Hg or higher
• Fainting or seizure
• Chest pain that doesn’t go away with rest or medication
• Increasing blood pressure combined with headache, sleepiness, confusion, visual difficulties, numbness and tingling in the hands and feet, coughing blood, nosebleeds or trouble breathing. These are signs of a hypertensive emergency.

Polly Turner spoke with Stephen J. Spann, M.D., professor and chairman of the department of family and community medicine at Baylor College of Medicine in Houston.

Help for Chronic Illness
These organizations can provide answers to specific questions about living with chronic illness.

• CHRONIC ILLNESS IN GENERAL — visit www.healingwell.com. In addition, information about a wide variety of chronic illnesses can be found at WebMD, www.my.webmd.com.
• DIABETES — call the American Diabetes Association at 800-DIABETES, or visit www.diabetes.org.
• ASTHMA — contact the Asthma and Allergy Foundation of America at 800-7-ASTHMA, or visit www.aafa.org.
• HEART DISEASE AND HIGH BLOOD PRESSURE — call the American Heart Association at 800-AHA-USA-1, or visit www.americanheart.org. Or, check the white pages of your phone book for an American Heart Association local chapter. Another helpful resource is the Web site of the National Heart, Lung, and Blood Institute, www.nhlbi.nih.gov.
• ARTHRITIS — call the Arthritis Foundation at 800-283-7800, or visit www.arthritis.org.
• CANCER — call the Cancer Information Service of the National Cancer Institute at 800-4-CANCER, or visit www.cancer.gov. Or, visit the Web site of the American Cancer Society, www.cancer.org.

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