Routine Care

Everyone of all ages should receive routine medical care.  What screening tests a person should have is determined by what problems are most common at a specific age and gender.

The concept of an “annual physical” is outmoded.  Recommendations for current screening are based on extensive research into the ideal timing of specific tests to maximize benefit and minimize risk.

Please review the topics below so we can work together to make sure you are getting the care that is best for you. 

 
 

For Women

Screening for women is directed at early detection of cancer of the breast and cervix, and osteoporosis.

Screening for cancer of the cervix

Cancer of the cervix is relatively common and is easily detected through routine screening, which is a Pap test (looks at cells on the cervix) and a test for HPV (Human Papilloma Virus, a common cause for cancer of the cervix).  The physician removes a sampling of superficial cells during an internal exam which are examined microscopically for any cancerous changes.

Pap tests should be done annually in women after age 21 or the onset sexual intercourse.  If testing is negative for several years, then it may be safe to screen less often.

 

Screening for breast cancer

Breast cancer is relatively common and should be screened for aggressively, since it is most treatable when found early. Breast self exam should be done in women monthly (after the period is over) after age 25.

Doctor breast exam is typically done at the time of a Pap test, i.e. annually.

When to begin screening with mammograms (a special x-ray of the breast) is somewhat controversial, though most authorities would agree that a baseline should be done at age 35, every 1-2 years from age 40-50, and annually after age 50.  Special emphasis is placed on screening women with a family history of breast cancer (mother or sister).  It may be reasonable to stop doing mammograms after age 75. 

 

Screening and prevention of osteoporosis

Osteoporosis is defined as the thinning of bones that naturally occurs after menopause.  This is typically asymptomatic, but can predispose towards fractures. 

Osteoporosis is diagnosed by a specialized x-ray called a bone density or DEXA scan. 

Prevention is begun early in life with adequate calcium, either through the diet or with supplements.  A pre-menopausal women should have at least 1000 mg of calcium per day and a post-menopausal women at least 1500 mg per day.  Is typically most helpful to receive through diet.  Vitamin D 1000 units a day can also be added.

Weight bearing exercise has also been shown to strengthen bones and reduce the chance of fracture.

If osteoporosis is found, there are prescription medications that can reverse this process.    

 

For Men

The major screening that is uniquely for men revolves around the prostate.  Two things happen to a man’s prostate: it always enlarges and it occasionally becomes cancerous. 

Benign Prostatic Hyperplasia (BPH)

Every man’s prostate will enlarge, though not all men will experience symptoms due to this.  Common symptoms include a reduction in the power of the urinary stream, a need to wake up at night to urinate (more than once or twice), and a sudden urge to urinate.  This is a benign process which does not always need to be treated. 

 

Prostate Cancer

The bad news is that if a man lives long enough, he is very likely to develop prostate cancer.  The good news is that most of the time, especially in much older men, this cancer is very slow growing and non-aggressive.  The problem is that it is hard to tell how aggressive the cancer is without invasive testing.  An aggressive prostate cancer that is left untreated will often spread and can be fatal.

 

Recommended Screening

All men over 40:

  • annual prostate examination

All men over 50:

  • annual PSA (prostate specific antigen) blood test and examination

With the combination of these two tests, the vast majority of prostate cancers can be picked up while still very localized and easily treated.

 

For men with a close relative (father or brother) with prostate cancer and African American men, this screening should begin at age 45.

There is some recent data suggesting that it may not be beneficial to screen for prostate cancer at all.  In our practice we recommend screening from age 45-50 until age 75.  Hopefully in the next several years we will have more accurate screening for prostate cancer. 

 

For younger men

It recommended for men age over 18 should regularly (ideally every month) do testicular self exam.  A normal testicle should feel like a hard boiled egg.  Any lump with the tissue of the testicle should be examined by a physician.

 

For Younger People

Medical screening and counseling for younger adults and teenagers is primary geared towards reduction of risky behaviors. 

Sexually transmitted disease (STD’s)

It is absolutely mandatory for all men outside of a long term, monogamous relationship (i.e. married, living together, etc.) to wear a condom while engaged in sexual intercourse. It always acceptable for a women to insist that their partner wear a condom.

 

Substance Abuse

“Recreational” drugs should be avoided at all times with no exception.  

Alcohol, if used, should be taken in moderation.  This means not more than 10-14 drinks per week and not more than 2-3 drinks at any one episode.

 

Risks for accidents

Accidents are a major cause of death for young people.  Care needs to be taken to wear seatbelts while driving, to never drive while intoxicated, to wear a helmet while riding a motorcycle or bike, etc. 

 

Routine Physicals

In days gone by, an adult’s “annual physical” consisted of a comprehensive set of blood test, an EKG, an x-ray of the chest, a few questions by the  doctor, and a basic physical exam.  Like many other things in medicine, the concept of an “annual physical” has evolved along with other medical progress.  Recent data indicates that we had probably been over-testing our patients, but were not spending enough time on the basics. 

Today’s recommendations are for screening tests  appropriate for age and gender   (see the sections list under “routine care”) and counseling about aspects of “healthy lifestyles.” 

 

Other specifics that need to be checked regularly are:

  • Blood pressure. If its normal, it should be measured at least every 5 years in younger adults, and every 1-2 years in older adults      

  • Cholesterol.  If its normal, it should be measured at least every 5 years. 

  • Thyroid function.  Should be measured every 5 years, especially in women.  

  • Blood counts.  Should be measured periodically to look for anemia.  

 

Colonoscopy

Cancer of the colon is one of the most common and most preventable forms of cancer.  We know that all colon cancer comes from colon polyps (polyps are benign, small growths of tissue coming from the lining of the colon).  Most colon polyps, however, do not become cancerous.  The process of a polyp growing, and becoming cancerous, takes approximately 10 years.  Therefore, we have ample opportunity to screen for this problem.

People who are at risk

A person’s risk for developing cancer of the colon is elevated if:

  • there is a close relative (parent or sibling) who has had colon cancer or certain types of colon polyps.

  • the person has had previous colon cancer or certain types of polyps.

 

Immunizations

1. Tetanus (combined with whooping cough/pertussis as of 2007) 

Booster every 10 years

2. Flu shot  

Every fall (mid-October to late December).  Should be given to all over 65 years, or with chronic problems such as asthma, heart disease, or any lung disease.  For maximal effectiveness, it should be given before the second week of December.

3. Pneumonia Shot

Given to people over age 65 or with certain chronic diseases (e.g. asthma, emphysema, diabetes, congestive heart failure, etc.) to specifically prevent "pneumococcal" pneumonia .  Can be given once in a lifetime, or if other respiratory risk factors, every 10 years. There are currently 2 distinct shots for pneumonia, the Prevnar, and Pneumovax.  Prevnar is given at age 65 and Pneumovax at age 66.  The combination of these 2 shots will cover all of the strains of this aggressive bacteria.  

4. MMR (Measles, mumps, and rubella)        

Given to young children.  Booster needed as a late teen if born after 1957.

5. Hepatitis B       

Given to anyone at risk to contact blood products. Since Hepatitis B can be transmitted sexually, the injection is recommended for all young people (often given by pediatricians).

6. Hepatitis A         

Given to anyone traveling to an endemic area (i.e. underdeveloped countries).

7. Meningitis vaccine       

Given to people living in crowded areas, e.g. military barracks or college dormitories.

8. Shingles Vaccine (Zostavax)

Given to adults over age 50 even if you have had shingles.  The current shingles vaccine is the "Shingrix."  It is given as a series of 2 shots, the second approximately 2-6 months after the first.  It is very effective in preventing the painful nerve rash of shingles.  It may cause aches and pains, but this goes away after 1-2 days.  

 

Healthy Habits

1. Don’t Smoke

  • Smoking has been clearly shown to cause lung cancer, emphysema, heart attacks, stroke, blockages in blood vessels in the legs which eventually can cause gangrene, impotence, and many others.

  • It is best not to begin smoking, but even if you’ve been a long time smoker, it is never too late to quit.

  • Please make an appointment to discuss various ways to quit.

2. Don’t take Drugs

  • Taking “recreational” drugs are clearly linked to many health problems, including AIDS, emotional problems, and many others.

  • People who take drugs are much more likely to be homeless.

  • Addiction happens much more quickly than you think.

  • Do you think you can trust the suppliers of recreational drugs to maintain the quality control of  their products?

3. Alcohol

  • It has been clearly shown that people who drink more than 2 drinks per day (or more than 14 per week) have a much higher incidence of liver disorders, which can be fatal.

  • It has recently been shown that people who drink “moderately”, meaning approximately 5-10 drinks per week appear to have a reduced risk of stroke.

  • Excess alcohol is linked to automobile accidents and fatalities.

  • Alcohol can cause an elevation in blood pressure, blood glucose, and triglycerides.

4. Diet

Have lots of:

  • Fruits

  • Vegetables

  • Whole grain

  • Fiber

  • Water

Minimize:

  • Red meats

  • Simple carbohydrates such as sweets, bread, pasta, etc.

  • Saturated fats

  • High fat dairy (e.g. cheese, cream, etc.)

  • Deep fried foods

  • Total calories

5. Exercise

  • Ideally, everyone, of every age and condition should get 30-45 minutes of aerobic exercise 4-5 times per week (more is better).  Aerobic means that your heart rate is elevated with the exercise.

  • Examples of aerobic exercise are:

    • Walk (briskly) 

    • Jog

    • Swim

    • Equipment at a health club such as a stationary bike, stepper, Nordic Trak, treadmill.

    • Heavy work around the house counts as aerobic, such as pushing a lawnmower, raking leaves, etc.

  • Activities that are “active” but not aerobic include: light gardening, housework, shopping.

  • Active is better than sedentary, but aerobic is better than active.

6. Seatbelts/Helmets

 

Wear seatsbelt all the time, even with local driving.  It saves lives (and its the law).

 

Always wear helmets when riding a:

  • Motorcycle

  • Bicycle

  • Skateboard

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