FREQUENTLY ASKED QUESTIONS

1. How do I schedule an appointment?

The appointments and the diagnostic procedures need to be scheduled on the following phone numbers +389 2 3217 016, +389 71 319 208 or via mail on: srce@srce.com.mk, Monday-Thursday, 8 am- 7 pm, Friday 8 am – 6 pm and on Saturdays 8 am – 1 pm. The clinic is closed on Sundays and on national holidays.

2. How do I prepare for the procedure?

It would be very appropriate if you take along any medical documents from previous procedures (RTG, CT, US, MR or similar), laboratory results or medical reports from hospital treatments in order to get a full insight in the medical history of the patient. In case you want to do blood test in the morning (for several parametars) it is best to have had your last meal by 6 pm the previous day, and to have an empty somack in the morning. Drinking water is allowed.

3. What is included in the cardiological check-up?

The cardiological check-up comprises of trials for the assessment of your heart and blood vessels, as well as detection of possible risk factors for cardiovascular diseases. Detailed laboratory test analyses, ECG – electrocardiography, measuring the blood pressure, color Doppler-ultrasound, stress test (ergometrics) and other trials give a possibility for a thorough assessment of the situation and the capacity of the heart and blood system of each individual.

4. What is echocardiography, how does it work and what is the test procedure like?

Echocardiography is an ultrasound check-up of the heart. It is a standard method in the diagnostics of heart diseases. It is a visual presentation of the heart structure and function. The special piezoelectric probes of the ultrasound machine emit ultrasound waves in the body. The prones receive the waves and they are transformed into an ultrasound image of the heart that is visible on the screen. The image can be one-dimensional, two-dimensional or Doppler. The latter further images the specific structures and the blood flow in the heart and the valves. The blood stream can be heard and is visible in color on the screen.

5. What is ultrasound used for and what does this check-up look like?

It helps the doctor get an insight in: the structure of the heart walls and the valves, the width of the heart walls, the size of the heart space, the ability and the strength of the heart muscle. All of these help discover and follow various diseases like:

  • Valve diseases
  • Presence of a thrombus in the heart
  • Assessment of the artificial heart valves
  • Heart muscle diseases
  • Irregularities of the heart walls or the aorta
  • Presence of fluid in the heart

The ultrasound probe is used in the chest area, to which jelly has been applied to improve the waves transmission. The chest is slightly lifted up and the left hand is above the head. During the procedure the doctor directs the probe towards various regions of the heart in order to get a better image of the heart structures.

6. What is a coronary stress test?

This implies monitoring the electrocardiogram during physical stress. The electrocardiogram (ECG) is a record of the electrical activity of the heartbeat, represented as a curve, and results from the flow of the electric impulses in the heart muscle. How is stress test performed and what is it used for? The stress test ECG is obtained in the same way as the basic ECG while resting. The only difference is that the former implies physical activity on the part of the patient and therefore an ergo bike (or treadmill) is used. During the procedure, the intensity is gradually increased. The stress test helps the doctor asses the physical condition of the patients and have an insight in the kind of changes that happen in the cardiovascular system while working under stress. It can help discover and monitor the following diseases:

  • artery coronary disease
  •  increased blood pressure under stress
  • heart arrhythmias under stress
  • assessment of a successful blood pressure or coronary disease treatment
  • assessment of the possible stress level after heart attack or heart surgery

An ECG when resting is made before the stress test. After that, the patient approaches to ride a bike that increases the resistance (in the pedals) every two minutes, during which the blood pressure is constantly measured, whereas the ECG record is permanently monitored. After this, there is a 3-5 minute recovery phase, during which the patient is observed. The aim of the test is to achieve maximum heart frequency (which is individual and depends on each patient’s health individually) so that a precise diagnosis can be made.

7. What is a Carotid Doppler Test and how is it performed?

Carotids are the two big arteria in the neck that supply the greatest part of the blood for the brain. Fatty deposits that obstruct the normal blood supply for the brain can occur on their walls. Tiny bits of the deposits can be drained away by the blood stream into the brain, thus causing obstruction or interruption in the blood supply of certain parts of the brain, which further results in stroke or TIA (Transient Ischemic Attack) – a series of minor strokes. Carotid Doppler Test is a non-invasive method for evaluation of the possible fatty deposits in the artery. The test is performed with a probe applied on the neck and the ultrasound waves create an image of the artery walls, which shows whether they have fatty deposits, and to which extend.

8. Why Renal Artery Doppler test?

Kidney diseases may be a reason for increased blood pressure or can result from increased blood pressure. Kidney artery ultrasound helps detect the presence or absence of stenosis or narrowing of the kidney blood vessels, which might be a reason for high blood pressure.

9. What is a 24-hour ECG Holter monitoring and how is it performed?

Holter monitor is a small, portable ECG device which records the heart activity over a 24-hour period. 7 small electrodes, connected to a portable ECG (the size of a mobile phone), are attached to the body. The device is attached to a belt, and the patient can do the usual activities, except for shower, swimming, bathing or other activities that cause excessive sweating. It is used to detect irregularities in the heart activity (arrythmias) that can not be recorded with the regular ECG, because arrhythmias are sometimes transitory and can be recorded only during a longer period of monitoring the heart activity.

10. What is a 24-hour monitoring of the blood pressure ABP Holter?

The blood pressure measured in the office is generally taken as your “real” blood pressure level, or the average level within a period of time. But, this is not always the case: many people become tense and upset when visiting the doctor, so their blood pressure increases. This is the so called“doctor induced” hypertension. The 24-hour (ambulatory blood pressure) monitoring is a method that allows measuring the blood pressure outside the doctor’s office, within a period of 24 hours,while the patient is doing his/her regular daily activities. Holter- monitor is as big as a Walkman and is warn on the belt. It is connected to the cuff, on the arm, with a tiny rubber hose. It can be programmed to measure blood pressure in various intervals, usually at 30-minute interval during day time, and 45-60 minute interval at night. It is completely automatic, so it pumps the cuff, measures the blood pressure and memorizes it automatically. During the measuring procedure, the patient should hold the arm still, for better measurement. After the 24-hour period, the device is taken off and the data are transferred on the computer for further analyses.

11. How is garstoscopy performed?

The patient is given local anesthetic for the mouth and the throat, and a sedative to feel relaxed during the procedure, whereas the lips are protected with a special tube. The patient is lying on the left side during the procedure. Since air is insufflated for a better view in the channel, the patient might feel a bit tense in the stomach. The patient can breathe freely during the procedure, without a feeling of pain, the only discomfort being a possible light irritation of the throat and a gag reflex. The entire procedure lasts 10 to 15 minutes. Many patients find it lightly uncomfortable, yet some others even fall asleep during the procedure.

12. Why gastroscopy?

Gastroscopy allows your doctor to evaluate the symptoms for permanent pain in the upper abdomen, nausea, vomiting and/or difficulties in swallowing. Gastroscopy is an excellent method for detecting the reasons for bleeding in the upper digestive tract, and is a more precise method than x- rays in discovering ulcers and tumors of the esophagus, stomach and duodenum. During the procedure the doctor can collect tissue sample (biopsy), that can help differentiate between benign or malign tissue changes.

We must bear in mind that biopsy is taken for many reasons, even without a suspected cancer, for example, testing the presence of Helicobacter pylori, a bacteria that causes ulcer. This procedure is not only diagnostic, but also therapeutic in the treatment of certain diseases.

13. How to prepare for a gastroscopy?

It is best if the procedure is performed on an empty stomach, so the patient should not eat or drink (except for water) 6 hours prior to the procedure. Your doctor will tell you when to restrain from food. You should inform the doctor about the possible therapies you take, (so that the doctor can modify the doses if necessary), possible drug allergies, heart or lung problems. You should also inform the doctor if you are bound to take antibiotics when performing dental procedures, because in that case you will have to take antibiotic treatment for the gastroscopy as well.

14. What happens after the gastroscopy?

After the procedure the patient remains under control until the drugs’ effects fade away. The patient might feel a slight discomfort in the throat or bloating, because of the air in the stomach. The patient is allowed to eat immediately after the procedure, provided the doctor does not recommend differently. Generally speaking, the results are available immediately after the procedure, except for some cases when it might take several days due to further examinations. If the patient has taken sedative prior to the procedure, s/he is not recommended to drive even if s/he does not feel fatigue at all. For this reason, it is good to be accompanied home after the procedure, since the sedative can influence reasoning and reflexes for the rest of the day.

15. What are the possible complications when performing gastroscopy?

Complications are possible, yet very rare, especially when the procedure is performed by an experienced doctor, especially trained for this kind of examination. Light bleeding at the place of biopsy or when removing a polyp is possible, but it is usually really minor and there is seldom need for further steps. Other potential complications are: reaction to the medicaments that were used, heart and lung complications, and perforation of the area being examined. It is very important to recognize the signs of possible complications as soon as possible, so if the patient feels fever, high temperature, difficulties in swallowing or swallowed throat, chest or stomach pain, s/he should immediately inform the doctor.

16. What is colonoscopy?

Colonoscopy is an endoscopic examination of the large bowel and a distal part of the small bowel. Examination of the large bowel is necessary in cases of occult bleeding and/or presence of blood in the stool, unexplained anemia, irregular stool, sudden constipation, periodic constipation and diarrhea, unexplained stomach pain, bloating, weight loss, family history of colorectal cancer.

17. How do you prepare for a colonoscopy?

The doctor will give you detailed instructions regarding diet restrictions and cleaning the colon, which is essential before the procedure. Generally speaking, the preparations are based on consuming laxatives a day or two before preforming the procedure. The colon must be completely clean so that the procedure can be accurate and thorough, therefore you must follow the doctor’s instructions carefully and precisely.

18. What happens during the colonoscopy?

Colonoscopy is not complicated and it rarely causes heavy pains. The patient might feel pressure, bloating, or cramps in the stomach. Therefore the patient is given pain killers and sedatives before the procedure, to feel more relaxed and cope possible discomfort. The patient lies on the back, or on the side, while the doctor slowly examines the colon. The procedure usually lasts 15 to 60 minutes.

19. What happens after the colonoscopy?

The patient is given and explained the examination results. However, in case of possible biopsy, it will take several days for a final interpretation of the results. If the patient has taken sedative prior to the procedure, s/he is not recommended to drive even if s/he does not feel fatigue at all. For this reason it is good to be accompanied home after the procedure, since the sedative can influence reasoning and reflexes for the rest of the day. The patient might feel cramps in the stomach due to the air insufflated during the procedure. The discomfort disappears after letting the gases out. Generally, the patient can eat after the procedure, however possible reductions might be suggested, especially after a polypectomy.

20. What are possible complications when having a colonoscopy?

Complications are possible, yet vary rare when performed by an experienced doctor, especially trained to perform the procedure. Light bleeding after biopsy or polyps removal may appear, but it is usually minor, and there is no need for further monitoring. Colon perforation is possible, but very seldom complication, which takes surgery to be resolved. Other possible complications might be: intolerance of the therapy (the drugs prescribed), heart and lungs complications. Although the complications are rare cases, it is extremely important to recognize the signs of possible complications as early as possible. The patients should contact the doctor if they feel sharp stomachache, fever and high temperature, notice rectal bleeding, which can sometimes appear several days after the procedure.

21. How do you prepare for a nutritionist investigation or control check-up?

How do you prepare for a nutritionist investigation or control check-up?

It is best if the patient comes to the nutritionist’s appointment with an empty stomach (it is necessary for the blood test not to have eaten anything in the past 12 hours) and not to have had any drinks several hours before the test.

The body composition analyses with InBody takes about 50 seconds, and the patient is in the underwear, without presence of any metal or jewelry. Pregnant women or patients who have pacemaker can not take the test. The preparations are the same as for a nutritionist’s appointment or the check-up. The food intolerance test with MORA takes 30 – 40 minutes. If the patient takes just this test there are no special preparations. If the food intolerance test is a part of the nutritionist investigation, then the patient should come on empty stomach and not to have drank anything for the past several hours.

IMPORTANT: The patient mustn’t drink coffee or alcohol at least three hours prior to food intolerance.

Any further questions?

If so, you can contact us on the phone and we will be happy to help you!