Your Medical Tests Explained
What to expect before, during, and after six common procedures.
July 30, 3008—, 2008 -- It's a fact of midlife: After 40, we're more likely to need certain medical tests to preserve our health. Learning that you have to undergo something with a hard-to-pronounce name (what is a colposcopy, anyway?) can be unsettling, but it doesn't have to be. Here's what to expect during some of the most common procedures, and what doctors would demand for themselves if they were on the table.
Colonoscopy
You need it if: You turn 50, to check for growths in your colon (called polyps) that can become cancerous.
How it works: The day before your appointment (usually at a hospital or outpatient endoscopy center), you'll clean out your colon with the aid of liquid laxatives--what many people consider the most unpleasant part of the procedure. The next day, after you're sedated through an IV, the gastroenterologist will ease a thin, flexible tube into your rectum that gently expands your colon with air. The doctor will pass the scope, which is fitted with a camera, through your entire colon, searching for and removing polyps. The procedure is painless. The examination takes 15 to 30 minutes; you can go home after a 45-minute recovery period.
Essential tips: Watermelon and sesame seeds can obscure the view of the bowel lining, so don't eat either for a few days beforehand. After the procedure, you'll be very hungry, so have food ready to eat as soon as you get home.
You should get results: Immediately; if the doctor removed polyps, a test to check them for cancer can take a week.
Colposcopy
You need it if: You've had an abnormal Pap test.
How it works: As in a regular pelvic exam, you lie on a table in your gynecologist's office with your feet in the stirrups, the walls of your vagina expanded with a speculum. Your doctor will use an instrument to keep your cervix open, which can pinch, and swab the area with a mild acid to clear mucus and make the cells easier to see. A colposcope is used to illuminate and magnify the area up to 60 times to examine cervical cells. If there are any abnormal spots, a small sample of the tissue is sent for testing. Any soreness is minor for most patients after a biopsy, but don't have sex or use tampons for at least a week. Wear a sanitary pad, because spotting or a dark discharge is normal for a few days. You can usually resume everyday activities immediately.
Essential tips: Ask your doctor to apply some benzocaine gel to numb the area before the exam.
You should get results: In 5 to 7 days.
Endometrial Ablation
Consider it if: You're among the 20 percent of premenopausal women who have extremely heavy menstrual bleeding and for whom medication is ineffective.
How it works: Although this hospital (or outpatient surgery facility) procedure doesn't usually end periods, it can lighten them; many patients still have a menstrual cycle and experience some discharge and bleeding. After sedating you, the gynecological surgeon expands your uterus, usually by filling it with fluid. Next, a lighted viewing instrument and an electrical, laser, or thermal tool are inserted to burn away a thin layer of the uterine lining. You should be able to go home the same day.
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The procedure can irritate your bladder, causing you to pee more than usual. Minimal pain, some cramping, and a light, watery discharge are common for 1 to 3 weeks; take an NSAID painkiller and wear a sanitary pad. Don't use tampons, have sex, or exercise until your doctor says it's okay.
Essential tips: If you're perimenopausal or have never been pregnant, your cervix may be extremely tight. Ask your doctor for a cervix-softening medication.
You should get results: If it works (it provides significant relief for 90% of women), within several months.
Mohs Micrographic Surgery
You need it if: You have skin cancer.
How it works: After numbing the lesion with local anesthetic, the surgeon removes the cancer one layer at a time to preserve the greatest amount of healthy skin and examines the tissue under a microscope. The surgeon keeps removing layers until there are no more cancerous cells. Small and shallow wounds heal without stitches; larger ones may need sutures or even skin grafts over several months. Excising each layer takes about 15 minutes; repairing the skin can take from 30 minutes to several hours. With local anesthetic, pain is minimal. Afterward, expect some swelling or bruising, which can be lessened by icing, and moderate pain, eased with acetaminophen or an NSAID. For a day or two, some clear or pinkish-yellow liquid might drain from the site.
Essential tips: Avoid alcohol and aspirin, which can increase bleeding, for several days. Your surgery could take all day, with long waiting periods, so bring snacks, water, something to read, and any meds you take during the day. Ask for dissolvable stitches so you don't have to return to have them removed.
You should get results: You'll leave the doctor's office cancer free. Scarring is minimal, even when grafts are needed.
Stereotactic Breast Biopsy
You need it if: A mammogram or sonogram turns up a lump.
How it works: During the procedure, you lie facedown on an exam table, your breast protruding through an aperture. The radiologist compresses your breast in a mammogram-like machine and numbs it with local anesthetic. Then the doctor makes a tiny nick, inserts a needle, and vacuums out some tissue. Don't panic if you feel a lump at the site after the procedure. A little blood sometimes collects there, but it should go away in a few days to a few weeks. Don't exercise or lift anything heavy for a day or two.
Essential tips: If you have a cold, you may want to reschedule; the radiologist can't do the biopsy if you're coughing.
You should get results: In 2 to 3 days.
Stress Echocardiogram
You need it if: You've been experiencing chest pains or shortness of breath, or you're over age 50, sedentary, and have diabetes, high blood pressure, or high cholesterol.
How it works: In his office, your cardiologist first screens your heart with an ultrasound machine to measure how well it works at rest. If you check out okay, you hop on a treadmill with the doctor standing beside you; electrodes attached to you monitor your heart rate on an electrocardiogram machine (EKG), and a cuff measures your blood pressure. The treadmill starts off slowly and speeds up every few minutes until you are tired or the doctor stops the test because you have symptoms or an abnormal electrocardiogram. A technician screens your heart by ultrasound again, and the doctor monitors your blood pressure and heart rate to see how long they take to return to normal.
Essential tips: Don't apply body lotion beforehand; the electrodes will slide off. Wear comfortable clothes and don't forget your sneakers. Avoid big meals and caffeine before your appointment. Note: You can't wear a bra during the test, so expect to bounce around a little.
You should get results: Immediately for the blood pressure and EKG.
Soothe the Waiting-for-Results Jitters
Try these natural anxiety relievers recommended by Shelley Wroth, MD, director of clinical services at the Duke Center for Integrative Medicine.
Studies show that listening to music you love will help keep you calm both before and during a procedure.
Concentrating on your breath elicits a relaxation response. Sprinkle a piece of cloth with lavender oil and use it during the breathing exercise.
Much research has proven acupuncture effective for post-op pain and nausea. For best results, start 3 to 4 weeks before your procedure and continue with a few sessions afterward when cleared by your physician.
Anxiously awaiting medical results? Journaling about your experience for 20 minutes can calm you and help you better process the experience.
THE EXPERTS
Jennifer Christie, MD, director of gastrointestinal motility, Emory University School of Medicine
Nieca Goldberg, MD, medical director of the Women's Heart Program, New York University
Cheryl Iglesia, MD, director of female pelvic medicine and reconstructive surgery, Washington Hospital Center, Washington, DC
Carol H. Lee, MD, chair, American College of Radiology Breast Imaging Commission, and attending radiologist, Memorial Sloan Kettering Cancer Center, New York City
Tri H. Nguyen, MD
Jill Maura Rabin, MD, chief of urogynecology, Long Island Jewish Medical Center, New Hyde Park, NY
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