Well, Well, Well...Physical Exams for Every Age
July 2019 Issue
Seeking a little of your doctor’s attention when you are well just may prevent having to seek a lot of his/her attention in the future. Most of us understand it’s the little things that eventually band together and gang up on our health. One thing you must know without doubt: A penny of prevention is worth a pound of cure! In other words, early detection is the first line of defense when it comes to staying healthy—at every age! Be wise. Early detection doesn’t just pertain to cancer. By getting your yearly physical exam, early detection can find the beginning of little things before they become big problems. Common conditions that can be stopped, managed, or even reversed include high cholesterol, triglycerides, blood sugars and blood pressure. Other factors can memory blips or weight gain. It’s easy to not give these symptoms that may be lurking inside of you a fighting chance. The fact is: When you regularly stay in touch with your health through physical exams, you are the winner!
Exams for the Decades — What you need now:
In Your 20s and 30s
Tracy Blusewicz, M.D. Advanced Women’s Care
The 20s and 30s are the perfect time for women and men to get a handle on their health! Regularly scheduled physical exams are the time to individualize your health care and set healthy goals. You can set the time to make your health as important as the rest of your daily activities. A baseline of being seen every 2-3 years in your 20s and 30s can be followed, but there is no “one size fits all” in health care. The frequency of your health exams is influenced by your risk factors, family health history and life style. A person taking prescriptions should be seen annually to evaluate the continued need for the prescription and if adjustments would be beneficial or are needed. Risk factors such as smoking or being overweight can increase the risk of high blood pressure and diabetes, so this should be addressed annually, as would a high risk family history for heart disease or cancer. Individualized plans should be made for gynecological care, obstetrics, and skin cancer screenings based on lifestyle. Remember to listen to your body as your guide: New onset pain, changes in your bowel movements, or irregular periods, for example, should trigger a trip to the doctor office. Also, listen to your brain: Changes in mood, sleep patterns, or relationships with others could signal depression or anxiety, which are just as important to get evaluated for!
Tracy Blusewicz, M.D., F.A.C.O.G., compassionate, genuine bedside manner has earned her the trust of many women for their health care needs. She can be contacted at Advanced Women’s Care. 843-341-9700; www.awclc.com
In Your 40s Laura Knobel, M.D.
I’m 40-something, why should I have a physical if I feel fine? A yearly physical with your doctor is a good way to build a relationship with your primary care physician, identify potential risk factors for various diseases and develop preventative measures to minimize those risks. As people enter their 40s, we see more health issues start to develop; some are common between men and women, and others are specific to each sex. Here are some of the common issues we see:
1. Obesity, Diet and Exercise: As a society we have become much heavier than we should be. Identifying this issue, as well as the associated health risks (diabetes, heart disease, etc.), allows your physician to help you develop a plan for getting you to a healthy weight, and to maintain that weight with diet and exercise. Many health risks can be managed, slowed, or even reversed with the proper care.
2. Substance Use: Tobacco and alcohol are the most common substances we see people abuse. There are effective strategies and medications your doctor can help you with when you are ready to quit smoking and control your alcohol use. The physical exam can also be used to identify those people who might be struggling with prescription drug abuse, particularly opioids, and get them into treatment programs that can increase quality of life and, in many cases, save lives.
3. Depression, Anxiety and other Mood Disorders: Your annual exam is a good time to look at your emotional health. How is your home environment, how about work? Are you finding it difficult to get up and go, are you feeling overwhelmed? Has there been any history of physical or emotional abuse? These are all areas your primary care physician can help you work through and get you the services that you need. During our 40s, often we are dealing with both raising children and caring for aging parents. The 40s brings added stress, and your doctor is a great person to turn to for help.
4. Risky Behaviors: This is also the time that you can discuss issues such as unprotected sexual activity and whether you should be tested for HIV. Your doctor should be encouraging you to wear your seat belt, bike helmet and encourage you not to drive while distracted (texting, substance use, etc.).
5. Silent Health Issues: Checking your blood pressure and cholesterol can help identify if you are at increased risk to develop heart disease and stroke later on in life. Identifying and treating people who are at high risk for developing diabetes is also appropriate at this time. Many of these issues don’t present with symptoms initially, so people may not even realize they have a problem.
Screenings important for women in their 40s:
1. Breast Health: During your physical, your physician can determine if you are at higher risk for breast and other cancers based on your personal and family history, and whether BRACA testing may be indicated. Also, it is common for women in their 40s to have their first mammogram, which should be done after your primary care physician has done a breast exam to determine if there are any abnormalities and whether you should have a 3-D mammogram. A normal mammogram doesn’t mean there is not a problem. If there is a palpable abnormality, and the mammogram is read as normal, you need to have further investigation.
2. Cervical Cancer Screening: We have learned much about cervical cancer, which we now know is caused by Human Papilloma Virus (HPV). We once thought that if you had an abnormal pap with HPV, you would have HPV forever. We now know that is not true for most women, though those who don’t clear their HPV infections are at higher risk to develop cervical cancer. Based on this knowledge, the screening guidelines for women in their 40s have changed. Check with your physician to see how this affects you.
3. Ovarian Cancer Screening: There are currently no recommending screening procedures for Ovarian Cancer.
Screenings for men:
1. Testicular/Prostate Cancer: Men in their 40s are actually at less risk for testicular cancer, as it is typically a disease of younger men. It is also early for the development of prostate cancer, however, it’s still appropriate to take time at your physical to discuss your family history and determine if there are risk factors that might lead to earlier, or more directed screening.
2. Erectile Dysfunction: Men in their 40s can certainly develop issues around sexual functioning, and having this discussion with your physician can not only direct therapy, but help to identify other issues, such as lowered testosterone levels. Erectile dysfunction can also be an early warning sign of heart disease or newly onset diabetes, so it is important to discuss these issues during your physical.
So, in summary, your annual health exam can be a good time to reassess your lifestyle issues, identify and modify risk factors and begin to treat some of our “silent” health issues. There are no standard recommendations as to how often you should have an annual physical, or if you should even do it at all, however, developing a relationship with your primary care physician is an important activity. Your doctor can help you navigate through an ever-complex health care system making sure your primary and specialty care needs are met, and answer questions that come up. Also, as you develop that relationship and start to build trust and confidence, it makes it easier to discuss some of the more sensitive issues that can start to develop at this time.
Dr. Laura Knobel is a board certified Family Physician seeing patients of all ages in Plantation Park in Bluffton. She has a direct primary care practice where you can get your primary care for $50 a month or less. Office phone: 843-836-2200. Website: www.knobelmd.com
In Your 50s & 60s
Holly Mlodzinski, MS, RD, LD
Get screened. Early detection can mean you have more treatment options. Some of the regular screenings that both men and women should have include blood pressure, cholesterol and diabetes. The U.S. Preventive Services Task Force recommends biennial screening mammography for women aged 50 to 74 years. Ultimately, women should talk to their doctor and make an informed decision about whether mammography is right for them based on their family history, general health and personal values.
Men and women should have a colorectal cancer screening beginning at age 50 and every 7 to 10 years after that. Men should talk to their doctors about prostate cancer screenings. Other screenings you may want to discuss with your physician include osteoporosis, depression and sexually transmitted diseases.
Holly Mlodzinski, MS,RD,LD; Hilton Head Regional Healthcare
70s Plus Robert Vyge, M.D.
Health maintenance for the Septuagenarian: A periodic health examination is valuable in that it provides time dedicated for assessing your risk for future medical problems, screening for certain medical conditions and counseling, as well as encouraging a healthy lifestyle, updating vaccinations and providing a time for you to get to know your provider in case of any acute illness. A patient enrolled in Medicare should receive a wellness visit once a year, focused on a review of a patient’s health status. The health care provider will determine which health screenings should be performed and also discuss recommended vaccinations.
In addition to screenings and vaccinations, patients in their 70s+ should be encouraged to be physically active and maintain a healthy diet.
Screening for both men and women should include:
Colorectal cancer screening: Options include a yearly fecal occult blood test; Fecal Immunochemical test every 1-3 years; Colonoscopy every 10 years up until age 75 and then individualized screening according to the patient’s life expectancy and overall health condition.
Lung cancer screening for smokers and former smokers (ages 55-77 with a 30-pack year history, asymptomatic of lung cancer, or a current smoker, or having quit in last 15 years). This would include a low-dose CT scan of chest.
Heart: Lipid panel at least every 5 years; blood pressure checks at least every 2 years
Diabetes screen: Fasting blood glucose test every 3 years
Skin cancer screen: Full body annual mole/overall skin exam
Eyes: Eye exam every 1-2 years
Hearing: Hearing test if any symptoms of hearing loss
Teeth: Dental visit 1-2 times a year for cleaning/exam
Depression: Recommended screening with questionnaire
Memory: Recommended screening with questionnaire
Fall prevention: Recommended screening with questionnaire
Screening for substance abuse: Tobacco, alcohol and any illicit substance abuse should be discussed
Sleep habits: Should be discussed
Vaccinations should include: Updated Pneumonia vaccines (both a Prevnar13 and a Pneumovax23 should be given once over the age of 65). A Tdap booster is recommended at age 65, and then a tetanus vaccine every 10 years. A shingles vaccination should be given unless contra-indicated. A yearly influenza vaccine is recommended
Screening specific for women should include:
Breast cancer screening: Mammogram every 1-2 years up until age 75 and then engage in a shared decision-making process with your doctor.
Osteoporosis screening: Bone density every 24 months
Screening specific for men:
Prostate screening: For men in their 70s, the pros and cons of prostate screening should be determined on an individual basis, but most recommendations are against screening.
Abdominal aortic aneurysm: Men ages 65-76 with a history of smoking over 100 cigarettes in lifetime, or having a family history, should have an abdominal aorta ultrasound.
Dr. Robert Vyge is a board-certified internist with Beaufort Memorial Lady’s Island Internal Medicine and also sees patients online through BMH Care Anywhere. A Toronto native, Dr. Vyge earned his medical degree from the Royal College of Surgeons in Dublin, Ireland.