When Treatment for a Common Condition Does Not Help

This page is for people whose treatment for a common problem, such as heartburn, anemia, hemorrhoids, or IBS, is not working. It covers when to get help right away, why a treatment that fails is a useful clue, and how to tell your doctor so the plan changes.

• Call 911 or go to the nearest emergency department if you have confusion or disorientation, shortness of breath, a fast heart rate or weak pulse, clammy or sweaty skin, extreme pain, or fever with shivering, and an infection may be the cause. CDC calls sepsis a life-threatening medical emergency. Do not drive yourself.
• Call 911 or go to the nearest emergency department if heartburn treatment is not helping and your chest feels tight or heavy, or pain spreads to your arm, shoulder, neck, jaw, or back (MedlinePlus). Do not drive yourself.
• Call 911 or go to the nearest emergency department if you have a lot of blood in your stool, feel lightheaded or dizzy from the bleeding, or have severe belly pain along with bleeding (MedlinePlus). Do not drive yourself.
• Call 911 or go to the nearest emergency department if your stool is black and tarry (MedlinePlus). Do not drive yourself.
• Call 911 or go to the nearest emergency department if you vomit blood or material that looks like coffee grounds (MedlinePlus). Do not drive yourself.
• Call your care team right away if you notice blood in your stool, a change in stool color, or bloody diarrhea (MedlinePlus).
• Call your care team right away, day or night, if you are on chemotherapy, had a stem cell transplant, or have low white blood cells, and you have a temperature of 100.4°F (38°C) or higher. Do the same for chills, a sore throat, mouth sores, burning when you pass urine, or redness where a catheter enters the skin, even with a normal temperature. NCI lists these among the signs of infection.

Most treatment for common conditions is based on the most likely cause. A doctor recognizes a familiar pattern, prescribes the usual remedy, and expects it to work. That is efficient and correct most of the time.

The system depends on you closing the loop. When the expected response does not happen, tell your care team. NIDDK says that if heartburn symptoms will not go away with medicines you can buy over the counter, you should talk with your doctor. The failure only becomes information if it is reported. A repeat prescription without a rethink is the pattern to watch for.

NHLBI says mild or moderate iron-deficiency anemia may cause no symptoms. More serious anemia may cause tiredness, shortness of breath, or chest pain. Other symptoms include dizziness or lightheadedness, cold hands and feet, and pale skin.

NHLBI lists blood loss as one cause. That includes bleeding in the digestive tract. It says iron pills are the most common treatment, and that they often take three to six months to restore iron levels. It also says iron-deficiency anemia may be preventable if the causes of blood loss or poor iron absorption can be treated.

So two questions are worth asking. Was the cause of the iron loss looked for? And if the hemoglobin does not rise on iron, what is the plan besides more iron?

If you have chest pain or trouble breathing, call 911 or go to the nearest emergency department.

NIDDK says you can buy many heartburn medicines over the counter. If your symptoms will not go away with them, talk with your doctor. Doctors may prescribe stronger medicines. H2 blockers and proton pump inhibitors (PPIs) both lower the amount of acid your stomach makes.

NIDDK says that if antacids, H2 blockers, and PPIs do not improve your symptoms, a doctor may recommend other medicines. Surgery may be considered if symptoms do not improve with lifestyle changes and medicines.

NIDDK also lists symptoms that call for a doctor's visit. They include:

• Chest pain.
• Persistent vomiting.
• Problems swallowing, or pain when you swallow.
• Vomit that contains blood or looks like coffee grounds.
• Stool that contains blood or looks black and tarry.
• Weight loss you cannot explain.

Call your care team right away for persistent vomiting, trouble swallowing, or weight loss you cannot explain. Use the 911 lines above for chest pain, blood in vomit, or black tarry stool.

Also note that symptoms returning as soon as you stop the medicine is a specific thing to report. It is not a reason to quietly buy more over the counter.

NIDDK says hemorrhoids can cause bright red blood on stool, on toilet paper, or in the toilet bowl after a bowel movement. The trouble is that having hemorrhoids does not protect you from anything else.

NIDDK says bleeding from the rectum may be a sign of other problems. These include bowel diseases such as Crohn's disease and ulcerative colitis, and cancer of the colon or rectum. So NIDDK says to seek a doctor's help if you have bleeding from your rectum. It also says to seek help if symptoms last after 1 week of treatment at home.

MedlinePlus says black or tarry stool, a lot of blood in the stool, and vomiting blood are emergencies. See the 911 lines at the top of this page. Blood in the stool covers what the workup involves.

NCI states that ovarian, fallopian tube, and peritoneal cancers may cause no early symptoms. It says that when signs do appear, the cancer is often already advanced.

The symptoms it lists can look like irritable bowel syndrome. They include:

• Pain, swelling, or pressure in the abdomen or pelvis.
• Sudden or frequent urge to urinate.
• Trouble eating or feeling full.
• A lump in the pelvic area.
• Gastrointestinal problems such as gas, bloating, or constipation.

NCI adds the sentence that matters here. These signs can have other causes. But if they get worse or do not go away on their own, check with your doctor.

NIDDK says IBS is a chronic disorder that lasts a long time, often years, and that symptoms may come and go. Bloating that is getting worse or is not going away deserves a fresh look. Persistent bloating covers what tests are used.

Vague dissatisfaction produces a repeat prescription. Specifics produce a rethink. Bring these five things:

• The exact treatment, how much you took, and how many days you took it.
• What happened: no change, partial improvement, improvement then relapse, or worse.
• Any new symptom that appeared during treatment.
• What has changed in the meantime: weight, appetite, energy, bowel or bladder habit, sleep.
• One sentence stating what you want: "I would like to know what the next test is, rather than another course."

Follow the prescription your own team gave you.

If the answer is another prescription, it is reasonable to ask what would change the plan, and by when you should report back. Agreeing on a review date in the room is more effective than leaving it open. A symptom is not a diagnosis covers holding that uncertainty without panic.

NIDDK lists unexplained weight loss among the symptoms that call for a doctor's visit. Unexplained weight loss and appetite changes covers how much matters and over what period.

• CDC: About Sepsis
• MedlinePlus: Gastrointestinal bleeding
• MedlinePlus: Black or tarry stools
• MedlinePlus: Heart attack
• NIDDK: Symptoms and Causes of Acid Reflux (GER and GERD) in Adults
• NIDDK: Treatment for Acid Reflux (GER and GERD) in Adults
• NIDDK: Symptoms and Causes of Hemorrhoids
• NIDDK: Symptoms and Causes of Irritable Bowel Syndrome
• NHLBI: Iron-Deficiency Anemia
• NCI: Ovarian, Fallopian Tube, and Primary Peritoneal Cancer Treatment (PDQ)
• NCI: Infection and Neutropenia during Cancer Treatment