When to Call the Doctor for Chronic...

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 health care provider.

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?

Here are some guidelines for when to call the doctor and when to self-treat.

For diabetes

If you have diabetes, rising blood sugar is a reason to call the doctor. 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

• You have an acute illness such as respiratory or intestinal flu

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 an asthma action plan based on peak flow readings the condition is rarely fatal.

Minor shortness of breath can be treated at home or in the doctor's office. If it's major, seek emergency care.

If you have asthma, it's important that you know what your typical symptoms are. Mild cases of asthma may include only some wheezing; more severe cases can rapidly progress from minor shortness of breath to a life-threatening situation.

Call the doctor if you have symptoms such as:

• Trouble breathing, even after you've taken the medications according to your asthma action plan; or you have 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 high blood pressure

Ideally, people with hypertension will be self-monitoring their blood pressure.

Call the doctor if you have the following symptoms and they are new, or, if you have had them before and they become worse:

• Higher than usual blood pressure for three separate blood pressure measurements taken at different times

• Dizziness that doesn't go away or persistent dizziness when you get up from sitting or lying down

• Shortness of breath that occurs when you exercise or when you're lying down on your back

• Tiredness, weakness

• Irregular or rapid heartbeat or pulse

• Coughing or wheezing, particularly at night

• Weight gain from fluid retention

• Difficulty concentrating

• Sleeping problems

Get immediate care for symptoms such as:

• Blood pressure of 180/110 mm Hg or higher

• Fainting (generally associated with low blood pressure, or hypotension) or seizure (generally associated with extremely high blood pressure)

• 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 (malignant hypertension)

Help for chronic illness

These organizations can provide answers to specific questions about living with chronic illness.

• American Diabetes Association

• Asthma, Asthma and Allergy Foundation of America

• American Heart Association

• National Heart, Lung, and Blood Institute

• National Cancer Institute

• American Cancer Society