Posts Tagged ‘physical exam’

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

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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)

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