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Preparing for your appointment
By Mayo Clinic staffYou're likely to start by seeing your family doctor if you suspect you have a bleeding problem. However, in some cases when you call to set up an appointment, you may be referred to a doctor who specializes in the diagnosis and treatment of bleeding disorders (hematologist).
If you're in the middle of a severe bleeding episode, your doctor may recommend immediate medical care.
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared. Here's some information to help you get ready, including what to expect from the doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance. You may need to follow dietary restrictions or fast for eight to 10 hours if blood tests are scheduled.
- Write down any bleeding signs or symptoms you've had, including how often, its severity, and for how long. For example, your doctor will want to know if you had a history of nosebleeds or easy bruising since childhood, or — for women — if your periods have been extended and heavy since you first started menstruating.
- Write down key personal information, including any major stresses or recent changes — both positive and negative — in your life. Include a short description of your typical daily diet. Also mention any contact sports you've played and whether you ever developed excessive bruising after playing.
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Make a list of your key medical information, including other medical problems for which you're being treated. Be sure to mention if any close relatives have a history of easy bleeding.
Also write down the names of any medications, vitamins or supplements you're taking, including aspirin, ibuprofen (Advil, Motrin, others) or naproxen (Aleve, Anaprox). If possible, bring all your medications with you in their original containers.
- Take a family member or friend along. Sometimes it can be difficult to absorb all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out.
For von Willebrand disease, some basic questions to ask your doctor include:
- What is likely causing my symptoms or condition?
- Are there any other possible causes for these symptoms?
- Do you think my condition is temporary or chronic?
- What kinds of tests do I need?
- What treatment do you recommend?
- Will I need to take medications long term?
- What are the possible side effects of the medications you're prescribing?
- How will you monitor whether my treatment is working?
- Does this condition increase my risk of any other medical problems?
- What steps will I need to take to prevent problems from surgery or dental procedures?
- Does this condition increase my risk of health problems during pregnancy and childbirth? Are treatment options available to reduce that risk?
- Are my children or other close relatives at increased risk of this condition?
- Do I need to avoid certain physical activities or types of exercise?
- I have these other health conditions. How can I best manage them together?
- Should I see a specialist? What will that cost, and will my insurance cover it?
- Are there any brochures or other printed material that I can take with me? What websites do you recommend?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to talk about in-depth. Your doctor may ask:
- When did you first begin having episodes of prolonged or heaving bleeding?
- How often do you have an episode of heavy or prolonged bleeding?
- How long does the bleeding typically last?
- Do you bruise easily, or have recurrent nosebleeds? Did these symptoms begin in childhood?
- Have you ever had bleeding from a small wound that lasted more than 15 minutes, or recurred during the week following the wound?
- Have you ever had a nosebleed that lasted more than 10 minutes or needed medical attention?
- Have you ever had bruises with lumps?
- For women, for how many days do your menstrual periods last? How often do you have to change your tampon or sanitary pad during a period? Do you ever notice blood clots in your menstrual flow?
- Have you ever had blood in your stool that wasn't explained by a known medical problem, such as a stomach ulcer or colon polyp?
- Have you ever needed medical attention for a bleeding problem during or after surgery, dental procedures, childbirth or injury?
- Have you ever had a tooth extracted? If so, did you have excessive bleeding after the procedure?
- Have you ever had anemia or needed a blood transfusion?
- Have you been diagnosed or treated for other medical problems, including liver or kidney disease, a blood or bone marrow disorder, or an abnormal blood platelet count?
- Do you take pain relievers such as aspirin, ibuprofen or naproxen?
- Do you take or have you recently taken blood-thinning medications such as clopidogrel (Plavix), warfarin (Coumadin) or heparin?
- Do you take an antidepressant such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR, Pexeva) or sertraline (Zoloft)?
- Does anyone in your family have a history of bleeding problems?
- Are you pregnant or are you planning to become pregnant?
What you can do in the meantime
While you wait for your appointment, avoid pain relievers that may increase your risk of bleeding episodes, such as aspirin, ibuprofen and naproxen. If you need relief for routine aches and pains, try acetaminophen (Tylenol, others) instead.
Steer clear of contact sports associated with a high risk of bruising or injury, such as football and hockey. If you have any medical or dental procedures scheduled, tell your doctor or dentist about your history of heavy bleeding from minor injuries. If a scheduled procedure is not urgent, reschedule it until after you've been evaluated for a possible underlying bleeding disorder.
- Von Willebrand disease. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/vWD/vWD_WhatIs.html. Accessed Dec. 17, 2010.
- Rick ME. Clinical presentation and diagnosis of von Willebrand disease. http://www.uptodate.com/home/index. Accessed Dec. 17, 2010.
- Rick ME. Treatment of von Willebrand disease. http://www.uptodate.com/home/index. Accessed Dec. 12, 2008. Accessed Dec. 17, 2010.
- Noel P (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 14, 2011.
- Rosenow EC (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 20, 2010.
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