Posts Tagged ‘Annual exam’

10 Medical Tests You MAY Be Able To Do Without

May 15, 2014

For years I have been writing and speaking on wellness and taking good care of yourself using preventive healthcare measures. Now with greater understanding of risks and benefits of tests, I am informing you of some tests that you may want to reconsider.

1. Nuclear stress tests, and other imaging tests, after heart procedures
Many people who have had a hear bypass, stent or other heart procedure feel they’ve had a brush with death. So patients — and doctors — understandably want to be reassured through a nuclear stress test or other tests that their hearts are beating strong. But performing these tests every year or even every two years in patients without symptoms rarely results in any change in treatment. In fact, post bypass or stent nuclear stress tests, can lead to unnecessary invasive procedures and excess radiation exposure without helping the patient improve. Instead, patients and doctors should focus on what does make a difference in keeping the heart healty: managing weight, quitting smoking, controlling blood pressure and increasing exercise.
2. Yearly electrocardiogram or exercise stress test
A survey of nearly 1,200 people ages 40 to 60 without any symptoms had an EKG over the previous five years. The problem: Someone at low risk for heart disease is more likely to get a false-positive result than to find a true problem. This could lead to unnecessary heart catheterization and stents. Instead, have your blood pressure and cholesterol checked. And if you’re at risk for diabetes, have your blood glucose level checked as well.
3. PSA to screen for prostate cancer
Cancer is always scary, but the PSA test often finds slow-growing cancers that won’t kill men. As a result of the test, he says, men often have ultrasounds, repeat lab tests and even biopsies for a problem that isn’t there — an estimated 75 percent of tests that show high PSA levels turn out to have negative prostate biopsies. When men do have treatments such as surgery or radiation, 20 to 40 percent end up with impotence, incontinence or both.
The American Urological Association, which supports the use of PSA testing, says that it should be considered mainly for men ages 55 to 69. After age 70, men without any urinary symptoms probably do not need further PSA testing.

4. PET scan to diagnose Alzheimer’s disease
Until recently, the only way to accurately diagnose Alzheimer’s was during an autopsy. In the last few years, doctors have begun using PET scans with a radioactive dye to look for beta-amyloid protein that is found in the brains of people with the disease. Although this test has promising use for research, there are serious questions about whether it should be used on those who complain of a fuzzy memory. PET scans in older people consistently find the protein in 30 to 40 percent of people whose memories are just fine.

5. X-ray, CT scan or MRI for lower back pain
Unfortunately, back pain is incredibly common — 80 percent of people, myself included, will suffer from back pain some time in their lives. It can be both excruciating and debilitating. Naturally, people want to know what’s wrong. Here’s the catch: The best imaging machines in the world often can’t tell them. Many older people with no back pain can have terrible-looking scans.
Most back pain goes away in about a month and imaging tests tend to lead to expensive procedures that often don’t help recovery. However, if your legs feel weak or numb, you have a history of cancer or you have had a recent infection, see your doctor as soon as possible.
6. Yearly Pap tests
The yearly Pap smear is a common part of women’s health checklists, but it doesn’t need to be. Women at average risk only need them every three years, since cervical cancer generally takes 10 to 20 years to develop. If women have also had negative tests for the human papillomavirus (HPV), which is now known to cause the cancer, they only need a Pap test along with the HPV test every five years. And women older than 65 who have had several normal Pap tests in a row can stop having them altogether. Do note, however, that a yearly visit to an ob-gyn stays on the to-do list.
7. Bone density scan for women before age 65 and men before age 70
For the estimated 10 million people — mainly women —in the United States who have osteoporosis, bone-strengthening medications can lower the chances of breaking a bone. But many experts argue that for those ages 50 to 65 who have osteopenia — mild bone loss — testing and subsequent drug prescriptions may be a waste of time and money. Not only is the risk of fracture often quite low, medications such as Fosamax (alendronate) and Boniva (ibandronate) have been linked to throat or chest pain, difficulty swallowing, heartburn, muscle pain, bone loss in the jaw and thigh-bone fractures. And there’s scant evidence that people with osteopenia get much benefit from the drugs.
To help keep your bones strong, try walking and weight-bearing exercises. Get enough calcium and vitamin D in your diet. If you smoke, quit.
8. Follow-up ultrasounds for small ovarian cysts
Many women receive repeated ultrasounds to verify that ovarian cysts have not become cancerous, but current research says that these tests aren’t necessary. For one thing, premenopausal women have harmless ovarian cysts regularly. For another, about 20 percent of postmenopausal women also develop harmless cysts.
The likelihood of these small simple cysts ever becoming cancer is exceedingly low.
In postmenopausal women, only cysts larger than 1 centimeter in diameter need a follow-up ultrasound. For premenopausal women, who typically have benign cysts every month when they ovulate, cysts smaller than 3 centimeters aren’t even worth mentioning in the radiologist’s report, says Levine.

9. Colonoscopy after age 75
Most people should have screening for colon cancer at 50 and then every five to 10 years after that, if the first test is normal. By age 75 — if you’ve always had normal colonoscopies — you can stop taking this test altogether. That should be good news, because a colonoscopy can cause serious complications in older people.
Just the preparation for colonoscopy can be exceptionally harsh. Some patients become incontinent or experience weeks of pain, diarrhea and constipation. In worst cases, the procedure can perforate the colon. Despite such risks, recent studies have found that substantial numbers of people over 75, even over 85, are still getting screening colonoscopies.
To protect your colon, eat plenty of fruits, vegetables and whole grains for fiber. Cut down on fatty foods, red meat and processed meats. Lose weight if you’re overweight and exercise. Sound familiar? It should, because that’s the best advice for protecting the rest of your body — and mind — as well.
10. Yearly physical
There’s little evidence that having an annual checkup can keep you healthy. Many tests that doctors regularly perform — to diagnose anemia, liver disease or urinary tract infections, for example — don’t make sense unless there’s a reason to suspect a problem. A healthy 52-year-old does not need to see the doctor once a year.
Certainly, if you have an illness that needs treatment, you should see your physician. And do talk to your doctor about how often you need to have your blood pressure and cholesterol tested. For these other tests, ask your doctor if they really are necessary and is the screening worth the risk of the procedure and are the benefits greater than the risks.

Advertisements

Medical Tests That You Can Do Without

March 11, 2014

I just had my annual physical examination. I am without any symptoms; take a baby aspirin and a vitamin; have no co morbid conditions. I asked myself did I really need a chest x-ray when I am exposed to so much radiation during my work at the hospital or did I need an EKG with no symptoms and a negative family history? I found my answer in a recent AARP article about “10 Tests To Avoid”.

1. Nuclear stress tests, and other imaging tests, after heart procedures
If you have had heart bypass, stent or other heart procedure, you don’t need nuclear stress test or other tests that their hearts are beating strong and the results rarely change the plan of management. Instead, patients and doctors should focus on what does make a difference in keeping the heart healthy: managing weight, quitting smoking, controlling blood pressure and increasing exercise.

2. Yearly electrocardiogram or exercise stress test
Someone at low risk for heart disease could be 10 times more likely to get a false-positive result than to find a true problem with their heart. The stress test could lead to unnecessary heart catheterization and stents. Instead, it is important to have your blood pressure and cholesterol checked at least once a year. And if you’re at risk for diabetes, have your blood glucose level checked as well.

3. PSA to screen for prostate cancer
Cancer is always scary, but the PSA test often finds slow-growing cancers that won’t kill men. An estimated 75 percent of tests that show high PSA levels turn out to be false alarms.
The American Urological Association, of which I am a member, supports the use of PSA testing, but should be considered mainly for men ages 55 to 69. I also believe that no testing is required in the man without any symptoms if the man is more than 75 years of age. However, men with a positive family history of prostate cancer and African American men should have an annual PSA test and a digital rectal examination.

4. PET scan to diagnose Alzheimer’s disease
In the last few years, doctors have begun using PET scans with a radioactive dye to look for beta-amyloid protein that is found in the brains of people with the Alzheimer’s disease. Even if a PET scan could accurately diagnose the disease, it’s untreatable. If you’re concerned about your memory, the better course is to have a complete medical evaluation by a doctor who specializes in diagnosing and treating dementia.

5. X-ray, CT scan or MRI for lower back pain
Back pain is incredibly common — 80 percent of people will suffer from back pain some time in their lives. It can be both excruciating and debilitating. Naturally, people want to know what’s wrong. Here’s the catch: The best imaging machines in the world often can’t tell them. Many older people with no back pain can have terrible-looking scans.
Most back pain goes away in about a month and imaging tests tend to lead to expensive procedures that often don’t help or shorten recovery. If you don’t feel better in a month, talk to your doctor about other options such as physical therapy, yoga or massage. But if your legs feel weak or numb, you have a history of cancer or you have had a recent infection, see your doctor.

6. Yearly Pap tests
The yearly Pap smear is a common part of women’s health checklists, but it doesn’t need to be. Women at average risk only need them every three years, since cervical cancer generally takes 10 to 20 years to develop. If women have also had negative tests for the human papillomavirus (HPV), which is now known to cause the cancer, they only need a Pap test along with the HPV test every five years. And women older than 65 who have had several normal Pap tests in a row can stop having them altogether. Also, if you have had a total hysterectomy for a benign condition such as uterine fibroids and the entire uterus and cervix have been removed, you do not need any further Pap test. Do note, however, that a yearly visit to an ob-gyn stays on the to-do list.

7. Bone density scan for women before age 65 and men before age 70
For the estimated 10 million people — mainly women —in the United States who have osteoporosis, bone-strengthening medications can lower the chances of breaking a bone. But many experts argue that for those ages 50 to 65 who have osteopenia — mild bone loss — testing and subsequent drug prescriptions may be a waste of time and money. Not only is the risk of fracture often quite low, medications such as Fosamax (alendronate) and Boniva (ibandronate) have been linked to throat or chest pain, difficulty swallowing, heartburn, muscle pain, bone loss in the jaw and thigh-bone fractures. And there’s scant evidence that people with osteopenia get much benefit from the drugs.
To help keep your bones strong, try walking and weight-bearing exercises,. Get enough calcium, 1000mg\day, and vitamin D, 1000IU\day, in your diet. If you smoke, quit.

8. Follow-up ultrasounds for small ovarian cysts
Many women receive repeated ultrasounds to verify that ovarian cysts have not become cancerous, but current research says that these tests aren’t necessary. For one thing, premenopausal women have harmless ovarian cysts regularly. For another, about 20 percent of postmenopausal women also develop harmless cysts.
The likelihood of these small simple cysts ever becoming cancer is exceedingly low.

9. Colonoscopy after age 75
Most people should have screening for colon cancer at 50 and then every five to 10 years after that, if the first test is normal. By age 75 — if you’ve always had normal colonoscopies — you can stop taking this test altogether. That should be good news, because a colonoscopy can cause serious complications in older people.
To protect your colon, eat plenty of fruits, vegetables and whole grains for fiber. Cut down on fatty foods, red meat and processed meats. Lose weight if you’re overweight and exercise. Sound familiar? It should, because that’s the best advice for protecting the rest of your body — and mind — as well.

10. Yearly physical
There’s little evidence that having an annual checkup can keep you healthy. Now I they tell me! Many tests that doctors regularly perform — to diagnose anemia, liver disease or urinary tract infections, for example — don’t make sense unless there’s a reason to suspect a problem.
Certainly, if you have an illness that needs treatment, you should see your physician. And do talk to your doctor about how often you need to have your blood pressure and cholesterol tested.

Bottom Line: Use good judgment about your health and your visit to the doctor. Ask the doctor if the test is really necessary and if the results will change how he\she is taking care of you. My message is that patients, including myself, need to become involved in their healthcare.
This article was inspired and modified from AARP, 10 Test to Avoid, by Elizabeth Agnvall, http://www.aarp.org/health/conditions-treatments/info-2014/choosing-wisely-medical-tests-to-avoid.3.html

Medical Testing At Age 50-This Is Test You Can’t Afford to Fail

January 20, 2013

Most men and women do not need the services of the medical profession between the time they leave their pediatricians around age 18-20 until age 50. The exception is women who see their obstetrician for perinatal care and deliverying their children. Around age 50 you should start making regular visists to your doctor. This article will discuss the routine tests that you should consider when you reach middle age.

When you go for your annual physical, make sure your doctor performs or recommends these simple tests that may save your health — and your life — later. (Note that your doctor may recommend additional tests based on your personal health profile.)

Thyroid hormone test. Your thyroid, that innocuous looking gland in your neck, is the body’s powerhouse, producing hormones needed for metabolism. Aging (and an erratic immune system) can wreak havoc causing a variety of problems, especially in women. That’s why women should get a thyroid test at age 50 and then every 5 years.
The rectal exam. Dread it; hate it; joke with your friends about it: Just make sure you get one — every year. Along with other tests your doctor may recommend, it may give clues to treatable problems in your colon (think colon cancer) or prostate for men. Screening colonoscopy is recommended for everyone at 50 years old.
Stepping on the scales. This is the age when most people start gaining weight. Watch this weight gain carefully, and fight back with healthier eating and exercise. Being overweight puts you at high risk for developing a number of diseases — and studies show that weight loss can improve your odds.
Blood pressure. Untreated high blood pressure is an equal opportunity killer: It kills your heart, your brain, your eyes, and your kidneys. Don’t let hypertension sneak up on you. Get the test. It’s simple; it’s cheap; and it’s quick.
Cholesterol profile. Do you have high cholesterol? Find out — at least once every 5 years (more if you’re at risk for a heart attack). Controlling your cholesterol can add years to your life.
Blood sugar. Untreated diabetes can destroy your health, causing heart disease, kidney failure, and blindness. Don’t let it. Get a fasting blood sugar test at least once every 3 years and take control of diabetes early.
For women only: Pelvic exam and Pap smear. You may think you have suffered enough — at least 20 years of pelvic exams and Paps! But you still need these — especially if you’re sexually active. Ten minutes of mild discomfort once every 1 to 3 years pays big dividends in protecting you from cancer and sexually transmitted diseases.
For women only: Breast exam and mammogram. At this age, don’t ever let a year go by without getting a mammogram and having your doctor examine your breasts for any changes. Early detection of breast cancer can save your breast and your life.
Looking for moles: Love your skin. Check your skin monthly for any unusual spots or moles. Be sure to ask your doctor to check your skin once a year, as well.
Protecting your eyes. Vision-robbing diseases become more common as you age. Be sure to get your eyes examined regularly — every 2 years until age 60 and then yearly after that. Go more often if you have vision problems or risk factors for eye problems.
Checking your immunizations. People over age 50 should get a flu shot every year. And don’t forget, even healthy people need a tetanus booster shot every 10 years, and one of those should contain the pertussis vaccine for whooping cough. Be sure to ask your doctor to update any immunizations that you might need. Consider Hepatitis A and B vaccines if you haven’t already had them.

Use your birthday as a gentle reminder to schedule a visit to your dentist, and call your doctor to see if there are important tests you should take. By investing an hour or two now, you may be able to add years to your life.

Bottom Line: When you go for your annual physical, make sure your doctor performs or recommends these simple tests that may save your health — and your life — later. Remember of you don’t take time for your health, you won’t have time to enjoy life in your senior years.

For more information on women’s health, I suggest my new book, What’s Going On Down There-Everything You Need To KnowAbout Your Pelvic Health. the book is available from Amazon.com

New book on women's health

New book on women’s health

Time For A Tune Up-Men’s Health Routine Check Ups

January 8, 2013

Men need to treat their bodies like their cars and visit to the doctor to check what’s under
the hood Men do not usually talk about going to the doctor. Most of the time, it takes serious pain or a major concern to get them to schedule a visit. You may be surprised to know that the urinary tract is most commonly responsible for men’s complaints, as it can bring on problems with obstructive or irritative symptoms. “ ‘Obstructive’ means things like slow urinary stream, difficulty getting the stream to start, difficulty emptying the bladder completely and ‘irritative’ means things like urgency or feeling a strong desire to urinate that you may have trouble inhibiting, having leakage of urine with urge incontinence or nocturia or going to the bathroom at nighttime,” says Dr. Sean Collins, an urologist at East Jefferson General Hospital.

Kidneys can bring on troubles of their own. “Kidney stones can develop with back pain or cause blood in the urine, and the biggest risk factor is not drinking enough fluids when it gets hot outside,” says Dr. Benjamin Lee, a urologist at Tulane Medical Center. The majority of stones are made of calcium but can also be due to recurrent urinary tract infections. “We know that lemonade has a chemical called citrate, which helps dissolve calcium to help prevent stones from forming,” says Lee. It is important to be proactive because if you develop a kidney stone, there is a 50 percent chance you will have a second one in the next five years.

Prostate screenings are vital but keep some men far from the doctor’s office. “Men are intimidated by the rectal examination, but it is not a big deal and takes 30 seconds while the doctor puts a gloved finger in the rectum and feels the prostate,” says Collins. The doctor checks the size of the prostate and whether there is a mass, nodule or hard area that would be concerning and warrant a biopsy. The exam is not anything to be scared of. “Most men leave and say it was not that bad and was worth it if we could find something that could save their life,” says Collins.

Lifestyle choices affect the prostate. “The diet that is best for the health of the prostate is the diet we should be on for cardiovascular health: a low-fat diet, rich in fruits and vegetables,” says Collins. There is evidence that lycopene, a substance found in tomatoes, is good for the prostate. Cruciferous vegetables like broccoli and cauliflower are also helpful.

Sexual issues are not often talked about by men but are more common than you may think. “We find that erectile dysfunction is a barometer for a man’s overall health,” says Collins. The risk factors for erectile dysfunction are the same for cardiovascular disease. “The reason is the blood supply to the penis is a very tiny artery about two millimeters in diameter, whereas the blood supply to the heart is four to five millimeters in diameter, so it does not take much blockage of the blood supply to the penis to result in impotence,” says Dr. Neil Baum, a urologist at Touro Infirmary.
Thankfully, a lot of progress has been made in this area. “Viagra, Levitra and Cialis are the big advances that totally changed the way the field is approached and who you can help with it,” says Dr. Robert McLaren, a urologist at Ochsner Health System.

Infertility is a common issue with men being responsible half of the time. “If you have borderline problems with your semen, you can avoid hot baths and jockey underwear and should wear boxer shorts because of the excessive heat of bringing the testicles close to the body,” says Baum. A semen analysis can be done at a urologist or reproductive endocrinologist’s office.
Young men may think they are invincible when it comes to health issues but they aren’t. “In young men, the most common thing we see is prostititis, which is an infection or inflammation of the prostate, and some men who are active or do bicycle riding can have numbness of the bicycle area, which can resolve if they cut back on riding or use specialized seats,” says Collins.

Every man responds differently. “Prostate enlargement is a normal part of aging but not everybody develops problems from it,” says McLaren. Know what to expect. “The prostate is a gland that sits outside the bladder and is normally about the size of a walnut,” says Lee.
Robotic surgery has revolutionized the way prostate cancer is treated and gives men hope as recovery is quicker and less painful. “The da Vinci robot has made the greatest impact and there are medications that can shrink your prostate that were not around 20 years ago,” says McLaren.

It is a good idea to get a blood test to check your testosterone level as well. “It indicates a decrease in production of testosterone by the testicles, which can be treated with hormone replacement therapy,” says Baum. You can do a self-exam of the testicles to screen for testicular cancer, which is common in men between 20 and 45. “They look for a little bump or lump on the scrotum on the testicle. I tell men that if they make a fist and feel the knuckle, that is what the testicle tumor feels like and they can get an ultrasound exam and blood test to help diagnose testicular cancer,” says Baum.

Making wise choices is helpful for all ages. “If you want to make yourself healthier, exercise, eat right and do not smoke,” says McLaren. To prevent heart disease, you should stay away from red meat, salt and other high cholesterol-containing foods. Your health may be partly determined by what you eat. “Men who have diets that are low in fiber and do not have regular bowel movements or have firm, hard bowel movements are at risk for colon disease such as diverticulitis and diverticulosis, which is inflammation around the colon that results in cramping, abdominal pain and difficulty with the stool,” says Baum. Foods with omega-3 fatty acids like cold water oily fish, salmon, herring, mackerel, anchovies and sardines are helpful.

Self-care is important for men of all ages. “It is interesting that in the top seven cancers in the United States, number one is prostate, number four is bladder and number seven is kidney,” says Lee. Thanks to screenings, lives are being saved. “The message we are trying to get out is that many of these issues are very treatable at an early stage,” says Lee. The health-care community has adapted guidelines with this in mind. “The American Urological Association and the American Cancer Society are really trying to get the word out,” says Lee.

This month is the time to take charge of your health. “The most common problems men run into are cardiovascular disease, prostate cancer and colon and rectal cancer, all of which can be prevented by visiting the doctor on a regular basis,” says Baum. A few tests can also be useful. “A stress test checks the heart and blood supply to the heart, a prostate-specific antigen and digital rectal exam rule out prostate cancer and a colonoscopy every five years checks for colon and rectal cancer,” says Baum.

Even if you feel fine, it is important to see your doctor. “Early hypertension has no symptoms whatsoever unless you go to the doctor and have your blood pressure taken,” says Baum. It can lead to a stroke, kidney disease or heart disease if it is not adequately treated. If you do experience any new or unusual symptoms, it is important to report them. “Heart disease can manifest itself as chest pain, indigestion, lightheadedness or headaches, which are signs of high blood pressure and decrease of blood supply to the coronary arteries and to the heart,” says Baum.

Self-awareness is an asset when it comes to protecting your health. Men are often consumed with taking care of their loved ones, however, and end up neglecting themselves. “The main point is that men need to take an active role in their medical care and need to treat their bodies as something very special that needs fine tuning just like their car,” says Baum.

How Often Do You Need To See Me?

September 1, 2012

You may wonder how the decision is made to making the next appointment for a patient. Is there a book, or now a website with guidelines, that guide physicians on when to make the patients’ next appointments? No, there is not. It is not something we learn in medical school but is something that is part of the art of medicine. Some patients really need to be seen in a few days or a few weeks such as the patient with a urinary tract infection where the urine has to be checked to be sure the infection has cleared even after the symptoms have subsided. Then there is the asymptomatic patient who is on no medications and probably needs to be seen only for a screening annual or even a biannual exam. Then there is the majority that fall somewhere in the middle of those two extremes.

What if you had diabetes, coronary disease, hypertension, high cholesterol, and sleep apnea, but no symptoms to indicate any acute problems? You’d probably see your primary doctor fairly routinely (mostly for management of diabetes) and maybe your cardiologist every six months or so.

Here’s the big question: When you’re coasting along pretty well with no actively changing symptoms but with chronic medical problems, how often do you need to see your doctors? Let’s take the example above: with those particular problems, should you see your cardiologist yearly, biannually, quarterly, monthly, or what? In the non-hypothetical world a patient’s follow-up is likely to be dictated by the doctor and set at the end of each appointment. “Okay, Mrs. X, it looks like you’re doing well. Let’s plan to see you again in 6 months.”

How does the doctor know when to see you next? There are a few ground rules to take into consideration. The pharmaceutical industry doesn’t allow us to write prescriptions with refills that extend past 12 months, and many clinics have a policy of not providing new prescriptions after the 12-month mark unless they’ve at least laid eyes on the patient (apparently to make sure the patient is indeed alive), and so most people with chronic problems will likely have to be seen at least once a year. It is amazing how many men using erectile dysfunction drugs will keep that annual appointment in order to obtain a refill of their medications! The other ground rule is common sense.

So, routine follow-up will most likely fall somewhere between “less often than weekly” and “at least once yearly or more frequently.” But within those limits, as a doctor I’m pretty much free to choose whatever I like.

I don’t know how other doctors do it, but I like to burden healthy patients with as few doctor visits as possible, so I mostly try to set my return appointments for a year. This works well for most people, but there are clearly exceptions. I see a lot of men with prostate cancer. Many of them are on medications to decrease the testosterone level and receive injections every 3-6 months. If it is possible, I try to convert these men to injections that can be given once a year. Most of the men with prostate cancer like the idea of getting a yearly injection and coming in every six months for a blood test, a PSA level. However, there are some men that want that more often and I allow them to make appointments to be seen more frequently. This, again, is where the art of medicine is used to guide how often a patient returns for an appointment.

There are patients with certain conditions like bladder cancer that should have a cystoscopy or look into their bladder with a lighted tube every 3 months. This guideline is written in all urologic textbooks and is good medicine to see these patients on a frequent basis.

I commonly ask certain patients to see me more frequently. Any patient who is on medications that is having side effects is asked to come back more frequently until I can get the dosage or the medication straightened out that provides them with the beneficial effect and with manageable side effects.

Bottom Line: How often should you be seeing your doctor? I have no clue. Between you and your doctor you’ll come up with some type of balance that works. Just understand that none of this is written in stone….i.e., a kidney stone!

This blog was inspired and modified from a blog by Dr. Eric Van de Graaf, which appeared in Patient on January 17, 2011.

Health check ups for men

December 21, 2011

Health check ups for men

I am often asked about what tests or procedures men should have even if they are enjoying good health.  I am providing you with a suggested health checkups for men beginning at age 20-70. 

 Age 20

Blood pressure every 2 years or annually if elevated

Cholesterol every 5 years

Dental exam annually

Vision examination every 2 years

Immunization (tetanus-diphtheria at age 19)

Sexually transmitted diseases

Skin cancer (look for marks or changes on your skin)

Testicular cancer-testicle self-examination

 

Age 30

Blood pressure every 2 years or annually if elevated

Cholesterol every 5 years

Dental health annually

Eye examination every 2 years

Immunizations (tetanus-diphtheria every 10 years)

Sexually transmitted diseases

Skin cancer (look for marks or changes on your skin)

Testicular cancer-testicle self examination

 

Age 40

Blood pressure every 2 years or annually if elevated

Cholesterol annually

Dental health annually

Diabetes (blood sugar test at age 45, or earlier if overweight or other risk factors are present)

Heart health (EKG every 4 years to screen for abnormalities)

Immunizations (tetanus-diphtheria every 10 years)

Prostate cancer (baseline PSA test if African American or there is a family history, age 50 otherwise)

Skin cancer (look for marks or changes on your skin)

 

Age 50

Blood pressure every 2 years or annually if elevated

Cholesterol annually

Colorectal cancer or annually

Dental health annually

Eye health every 2 years if you have vision problems

Heart health (EKG every 3 years to screen for abnormalities)

Immunizations (tetanus-diphtheria every 10 years, annual flu vaccine)

Osteoporosis (if risks factors are present)

Prostate cancer annually

Skin cancer (look for marks or changes on your skin)

 

Age 60

Abdominal ultrasound (if you have smoked over 100 cigarettes in your lifetime)

Blood pressure annually

Colorectal cancer annually

Dental health annually

Diabetes (every 3 years or as doctor recommends)

Eye health every 2 years if you have vision problems

Hearing annually

Heart health (EKG every 3 years to screen for abnormalities)

Immunizations (tetanus-diphtheria every 10 years, annual flu vaccine, shingles/herpes zoster vaccine once after age 60)

Osteoporosis if risks factors are present

Prostate cancer annually

Skin cancer (look for marks or changes on your skin)

 

Age 70+

Abdominal ultrasound (if you have smoked over 100 cigarettes in your lifetime)

Blood pressure annually

Cholesterol annually colorectal cancer annually dental health annually diabetes (every 3 years)

Immunizations (tetanus-diphtheria every 10 years, annual flu vaccine, pneumococcal vaccine after age 65)

Osteoporosis if risks factors are present

Prostate cancer annually

Skin cancer (look for marks or changes on your skin)

MOVEMBER – THE MONTH FOR MEN’S HEALTH

October 31, 2011

Moustache Season is finally upon us and just in time for Mo Bros everywhere to get their annual health check up. Lets face the facts, most men are known to be more indifferent towards their health, and studies suggest that 24% of men are less likely to go to the doctor compared to women. Maintaining a good diet, smart lifestyle choices, and getting regular medical check-ups and screening tests can dramatically influence your health. Regardless of age or background, stay on top of your health by following these very important steps:

HAVE AN ANNUAL PHYSICAL
Find a doctor and make a yearly appointment each Movember for a general health check. Getting annual checkups, preventative screening tests, and immunizations are among the most important things you can do to stay healthy. By regularly visiting your doctor, you can greatly minimize your risk level for a number of conditions, from high blood pressure to diabetes to cancer. What better way could there be to celebrate Movember than calling your doctor to schedule a check-up?

KNOW YOUR FAMILY HEALTH HISTORY
Start a discussion with your relatives about health issues that have affected your family. Men with a family history of prostate cancer are twice as likely to be diagnosed with prostate cancer, so know your family history.

DON’T SMOKE!
If you do smoke, stop! Compared to non-smokers, men who smoke are about 23 times more likely to develop lung cancer. Smoking causes about 90% of lung cancer death in men.

BE PHYSICALLY ACTIVE
If you are not already doing some form of exercise, start small and work up to a minimum of 30 minutes of moderate physical activity most days of the week. If you’re already there, set your sights on 60-minute days.

EAT A HEART HEALTHY DIET
Fill up with fruits, vegetables, whole grains; include lean meats, poultry, fish, beans, eggs, and nuts; and eat foods low in saturated fats, trans-fats, cholesterol, salt (sodium), and added sugars.

STAY AT A HEALTHY WEIGHT
Balance calories from foods and beverages with calories you burn off by physical activities. Over two-thirds of U.S. adults are overweight or obese! The USDA and leading cancer researchers suggest that we all fill up on vegetables, fruit, and whole grains, and choose lean proteins like fish and legumes over fatty ones like red meat. Evidence suggests that about a third of the 571,950 cancer deaths expected to occur will be related to obesity, physical inactivity, poor nutrition and thus could be prevented.

MANAGE YOUR STRESS
Stress, particularly long-term stress, can be the factor in the onset or worsening of ill health. Managing your stress is essential to your health & well being should be practiced daily.

DRINK ALCOHOL IN MODERATION
Alcohol can be part of a healthy balanced diet, but only if it’s in moderation, which means no more than a few, drinks a day. A standard drink is one 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits. Alcohol consumption is ok, but should be kept to no more than two drinks per day for men, and one for women.

Ready to be proactive about your health but not sure where to start? Download Movember’s health poster for a checklist by age of what to ask your doctor about.

Do you know the facts? Check out the Movember site for more information on men’s health.
http://us.movember.com/mens-health/resources/

WSYDD-What Should Your Doctor Do?-Suggestions For Dialog With Your Primary Care Doctor

June 21, 2011

According to the National Physicians Alliance, these are five guidelines that your primary care physician should follow:

 

1. Don’t do imaging for low back pain within the first six weeks.  Although low back pain is the fifth most common reason for all physician visits, X-rays of the lumbar spine before six weeks does not improve outcomes but does increase costs.

 

2. Don’t obtain blood chemistry panels (glucose, calcium, uric acid) or urinalyses for screening in asymptomatic, healthy adults.  It is recommended to do lipid screening (cholesterol, triglycerides) which yields significant numbers of positive results even among asymptomatic patients.  It is appropriate to screen for diabetes with a glucose test in asymptomatic adults with hypertension

3. Don’t order annual ECGs or any other cardiac screening for asymptomatic, low-risk patients.  There is little evidence that detection of heart disease in asymptomatic patients at low risk for coronary heart disease improves health outcomes.  False positive results are common and false-positive tests are likely to lead to harm through unnecessary invasive procedures, over-treatment, and misdiagnosis

4. Use only generic statins (Mevacor® (lovastatin) Pravachol® (pravastatin),Zocor® (simvastatin) when initiating lipid-lowering drug therapy.  All statins are effective in decreasing mortality, heart attacks, and strokes when dose is titrated to effect appropriate LDL-cholesterol reduction.  It is acceptable to switch to more expensive brand-name statins (atrovastatin [Lipitor] or rosuvastatin [Crestor]) only if generic statins cause clinical reactions or do not achieve LDL-cholesterol goals

5. Don’t use DEXA screening (test for bone mineral density) for osteoporosis in women under age 65 or men under 70 with no risk factors.  This test is not cost effective in younger, low-risk patients, but is cost effective in older patients

Bottom Line: So What Should Your Doctor Do?  He or she should weight the potential harms of routine annual screening to make sure the harms are much less than the potential benefit.  Only with a meaningful dialog should routine testing and screening be performed in asymptomatic young men and women.

Choosing a Family Physician-One of the Most Important Decisions You Will Ever Make

May 11, 2010

People are not just an amalgam of their body parts.  Men are not composed of large prostate glands, sclerosed coronary arteries, and rusty libidos, although sometimes it feels that way. We come in complex packets of various sizes, shapes and colors, and attached to families, jobs, communities and cultures. Just like everyone else, we need primary care physicians as our allies and advocates in staying healthy, and getting the best possible health care.

Your primary care doctor — either a family physician or a general internist — should be the captain of your healthcare ship. Primary care physicians not only can handle the majority of illnesses that you may experience, but they can work with you to keep you healthy. They can help you decide what makes sense in a world where numerous entities are hawking remedies for life’s ills, from pills to diets to operations. The primary care doctor can help you select from this bewildering array of options, and then be your advocate when you do need specialized care beyond his or her repertoire.

So what should the average man do to get the most out of the health care system? The following are my suggestions distilled from over 30 years of being a doctor:

1) Select a primary care doctor.

The time to choose a primary care doctor is before you need one. Ask your friends whom they go to. Check with local clinics and hospitals and see which primary care doctors work near your home or your job. Check and see if your wife or significant other or child has a family doctor who would take you into his or her practice.

Then go and interview the doctor, find out whether their philosophy of medical care jibes with yours. Discuss your approach to health and illness, and see whether they will support you in your quest. Check their training and references to make sure that they have the training and skill that you need. Make sure that they are board certified in their respective specialty. There are advantages to seeing the same doctor as other members of your family. But probably the personal chemistry between you and your doctor is the most important factor in this choice.

2) Visit your primary care physician before you’re sick.

Almost all doctors have health maintenance protocols that are aimed at men your age, and consist of a schedule of regular visits and diagnostic tests designed to catch important problems as early as possible. Make sure your health maintenance protocol is up to date. For most patients, this will involve a visit every year or two, depending on your age, back­ground, and the medical problems you may have accumulated along the way.

3) Negotiate a plan with your doctor.

Medicine is a team sport, you and your doctor share the quarterback duties. Your doctor has a set of guidelines that are based on medical science and the evidence it produces. You have a set of values and preferences that will determine which of those guidelines make sense for you. Work with your doctor to come up with an approach that makes sense for you.

4) When you do need specialty care, work through your primary care physician.

Specialists will give you their honest opinion about the best therapy for your problem, but your primary care physician will help you put it into context. Primary care doctors can also help to coordinate care among multiple providers, watch out for interactions among drugs or therapies, and will still be available to care for you after a more specific problem is resolved.

Bottom Line: It is almost impossible these days to sort out the best approach to health care. Your primary care physician is the strong­est ally in choosing a path that makes sense for you.  The few minutes you take to make this very important selection may just be the most important decision of your life.

The Annual Physical Exam-10 Steps to Having a Better Interaction With Your Doctor

March 7, 2010

A few years ago I went to the Cooper Clinic in Dallas, Texas for a comprehensive physical examination.  The exam last nearly eight hours and every opening and structure on my body was probed and explored.  Are these costly and lengthy “extreme physicals” necessary or useful?

The main benefit of these extensive examinations is the convenience of one stop shopping or to provide you with an opportunity for a physician to give you a comprehensive exam at one time rather than forcing a you to piece together appointments with a half-dozen different experts.  Many patients say it is worth the expense to get a one-stop, comprehensive look at their health.

For those who aren’t willing or able to spend big chunks of time, there still is a lot to learn from these exams with your primary care physician. A savvy patient can always ask their own physician to perform a selection of such tests. Any doctor can order the blood work, such as C-reactive protein tests or advanced cholesterol screening, that is standard fare during a superphysical. Your family doctor should be able to refer you to a nutritionist or exercise physiologist for additional counseling.

Getting regular physical exams is a great start. To get the most benefit from your visits, you must communicate clearly with your physician, understand the exam’s results, and know what actions you and your healthcare team need to take. Here are some more steps to help you make the most of your physical exam.

1. Be honest with your physician about your behaviors and symptoms. Don’t just tell the physician what he or she wants to hear. For example, if you smoke, say so.  If you don’t exercise, mention that.  If you are sexually active and have multiple sexual partners, indicate this to your doctor even if he\she doesn’t ask.  If you are suffering from erectile dysfunction (ED), volunteer this as there is treatment for this condition and it may indicate other more serious illnesses such as diabetes mellitus, hypertension, high cholesterol levels and even coronary artery disease.

2. Don’t be shy. Many people don’t tell their physicians about depression, incontinence, and sexual problems because they are embarrassed to discuss these issues. It is natural to feel reluctant, but it is not in your best interest. Your physician can give you the best treatment only if he or she knows what is really going on.

3. Tell your physician about changes in your life and any new symptoms you’ve experienced, even if you think that they may not be significant. For example, mention changes in your appetite, weight, sleep, or energy level. Also let your physician know about major changes or stressors in your life such as a divorce, significant financial problems or the death of a loved one.

4. Ask questions. This is crucial to getting the most from your annual examination. If you don’t understand a test, a word or medical term the physician has used, or want more information about your condition, you must ask for clarification. When you don’t ask questions, your physician will assume you understand.  Also ask for educational materials.  Most physicians have brochures and forms related to the most common medical conditions and will be happy to provide it to you.  Also, ask for relevant or credible Web sites so that you can learn more about your condition and learn about healthy habits and life styles.  Whenever possible, have the physician or staff provide you with written advice or instructions.

5. Come prepared.  Write down questions or topics you want to discuss before your appointment. For example, include a new symptom you want to mention or a question about a new treatment.

6. Take notes and/or bring someone along with you. If you think that you may not remember what your physician says, taking notes will help. Bringing a family member or friend to your appointment will also help. If you tell your family member of friend what you want to get from your visit, he or she can help you stay on track.

7. Share your point of view about the exam, tests, and treatment. Your physician needs to know what works well for you and what doesn’t, but he or she can’t read your mind. If you feel rushed, worried, or uncomfortable, say so.  If you feel you need more time with your physician, ask when you can return or schedule another appointment to review what is important to you.

8. Before agreeing to proceed with a medical test, ask your physician to explain why it is important for you and what it’s designed to show. When the results are available, make sure your physician explains them and answers your questions. Ask for a copy of the results. If a specialist does the test, ask to have the results sent to your primary care physician.

9. If your physician suggests a treatment and especially a surgical procedure, be sure you understand what it is and what it will and won’t do. If your physician suggests a treatment that makes you uncomfortable, ask about other treatment options and even about getting a second opinion.

10. Ask about your medication’s side effects.  Be sure to let the doctor know what medications, vitamins, herbs and over the counter medications you are taking.  Then ask if the newly prescribed medications have any interactions with food or drugs you are currently using.

Bottom Line:  I can’t insure that every experience with your doctor will be positive.  But I can promise you that if you use these 10 action steps and become pro-active regarding your health care, you will have a more meaningful dialog with your doctor and be on your way to good health.

Dr. Neil Baum is a urologist at Touro Infirmary and can be reached at (504) 891-8454 or through his Web site, http://www.neilbaum.com