So check it out, print it, give it to your family members.
General physical exam
When you get sick and go to see your doctor they treat your sickness. They do not give you a yearly physical exam, which is necessary every year. Why? Because prevention is the part of health care that works best. It tells us where there might be a problem later or shows us the areas of our body that need a little work in order to keep us healthy and strong. So get a physical every year. Make sure you tell the receptionist that you are coming for a complete physical so they schedule enough time. Go to the appointment as prepared as possible so you get the care and attention you need. This means take any immunization or medication or disease treatment information you have.
What your “healthy visit” or “annual checkup” should include:
-A detailed history to learn all about your present and past health (family diseases and such).
-A head-to-toe physical exam including the skin, eye, ears, nose throat, lymph nodes, chest, breast (men and women), abdomen, rectum (men and women), and extremities.
-Blood Pressure: Every time you see your doctor your BP should be checked. Having your BP checked at each visit allows your MD or NP to notice changes and trends.
-Height: Significant loss of height can indicate osteoporosis due to the loss of bone in the spine.
-Weight: Significant weight loss or gain, without trying, can signify serious health problems such as heart disease or cancer.
-Waist Circumference
Your waistline can show the development of obesity-related diseases if you are:
A man whose waist circumference is more than 40 inches.
A woman (not pregnant) whose waist circumference is more than 35 inches.
Excessive abdominal fat places you at a greater risk for developing Type 2 Diabetes, high cholesterol, high triglycerides, high blood pressure, and heart disease.
Measure Your Waist Size-
Place a tape measure around your bare abdomen just above your hip bone. Make sure the tape does not compress your skin and is parallel to the floor. Relax, exhale, and measure.
- Immunizations
There are different reasons to get different immunizations. Traveling abroad is one, living in close quarters with many people is another. Living in NYC is yet another. This is an area where you have to do individual research. I can do this with you.
Annual Blood Tests:
Fecal Occult Blood Test: blood in the stool can be an early indicator of colorectal cancer.
C-reactive protein test – an important test of inflammation and a marker of heart disease risk.
A1C – to test for diabetes (don't settle for a blood sugar level)
Blood Urea Nitrogen and Creatinine - tests your kidney function.
Sodium, Potassium and Chloride - all three are electrolytes. These tests are especially important if you are on medication commonly called “water pills” for high blood pressure/heart disease.
Uric Acid - higher than normal can mean kidney disease/gout.
Albumin - protein produced by the liver. Low albumin can signify liver/kidney disease.
Calcium - Your blood calcium level has nothing to do with how much calcium is in your bones. High levels can point to hyperparathyroidism (excess production of parathyroid hormone), which predisposes you to kidney stones and low bone density.
Lipids-
Often listed together in a separate section on your blood chemistry report. Sometimes only the total cholesterol and perhaps the triglyceride level will be listed if your doctor didn’t specifically request results for the lipid panel. However, you need all your numbers in order to make the best evaluation for heart disease.
Total cholesterol is the sum of your LDL and HDL (see below). High total cholesterol levels are linked to heart disease. The lower your total cholesterol the better. A total below 200 is desirable.
High Density Lipoprotein (HDL) is your “good cholesterol”. Remember, “high density should be high.” The more of this type, the better. Ideally, your HDL cholesterol should be at least 30% of your total amount. In men, an HDL greater than 40 is normal; in women, an HDL greater than 50 is normal.
Low Density Lipoprotein (LDL) is your “bad cholesterol”. Remember, “low density should be low”. A high LDL puts you at risk for heart disease; your doctor will suggest diet and often medication to get your LDL cholesterol below 130. If you have diabetes or heart disease already, your treatment goal for LDL cholesterol should be below 100.
Triglycerides are the other form of fat in your blood. The level will be much higher after a meal. If your level is out of range it should be repeated after an overnight fast. Elevated levels increase your risk of heart disease and could be a sign of early diabetes. Ideally they should be under 150.
Thyroid Function
Under active thyroid is a common condition in women over the age of 50 (younger if it runs in your family. Most women should be tested yearly.
Other Regular Exams
-Dental
A dental exam checks for decay and plaque buildup and to look for signs of inflammation and infection. Women at risk for heart disease, metabolic syndrome or diabetes (women with waist circumference over 35 inches or apple-shaped women) should be particularly concerned about regular every 6 month checkups.
-Vision
Everyone should have their eyes checked on a regular basis. This exam can check for vision, cataracts and even glaucoma. Patients with metabolic syndrome or diabetes should also have an annual opthamology exam by an opthamologist to check the retina as well.
-Total skin exam
Excessive sun exposure and loss of the ozone layer has created an excess of melanoma cases. It is important that you get a head-to-toe check of your skin every year - don't forget the scalp. This cancer grows fast and is hard to fight.
Women - If it runs in your family, go now.
I'm planning to do this asap, as I just found out I should have done it a long time ago.I'm not sure my insurance will cover it and the physician or insurance may disagree with how young a person should have a bone scan so I will do a follow up here later with what I find out. The medical industry says women should have this test at 65, but any woman who is in menopause or has a fracture should go as well. If you don't need a test yet, start preparing your bones for the loss of calcium - do it now.
Bone Density Test (DXA scan)
This is an x-ray which measures your bone density. The lower your bone density, the greater your risk for bone fractures. (There is also a much less accurate heel ultrasound test that does NOT diagnose osteoporosis but merely tells your doctor whether you are at risk and should have the more complete x-ray DXA scan test.) The DXA scan is considered the gold standard for the diagnosis of osteoporosis. The most important score or result to check is your T-score. The T-score tells you how your bones compare to that of a healthy 35 year old woman. If your T-score falls between -1 and -2.5 then you have mild bone loss called osteopenia. If your T score is -2.5 or lower, than you have osteoporosis and a significant increased risk of fractures.
You can also look at your Z-score, which tells you how you compare to a similarly matched group of women your age and ethnic background. It is not unusual for an 80 year old woman to have a normal (for her age) Z-score but have severe osteoporosis (her T-score could be much lower than -2.5). I often hear women tell me their DXA scan is normal yet when I got the actual report I found that their Z-score was normal for their age but their T-score was low and they needed counseling about prevention for further bone loss.
Do:
Consume 1000 mg Calcium and 600 IU of Vitamin D daily
Walk 30 minutes daily and lift weights 3 x’s/week
Reduce intake of sugar, caffeine (especially cola/pop which is high in phosphates that reduce calcium levels), reduce red meat intake, reduce pork products, reduce salt.
Eat calcium fortified foods
Decrease alcohol intake
Stop smoking!
Weird Note: It turns out spinach is not good for you is you have osteopenia or osteoporosis. It contains an acid that reduces the calcium in your body.
Women with osteopenia or osteoporosis should take 1200mg Calcium and 800 IU vitamin D.
*In the first 10 years of menopause women can lose 10-20% of their bone due to the drop in estrogen levels.
Everyone 50 and over should:
Have a waist circumference under 35 inches
Have blood pressure below 120/80
Have blood lipids: LDL cholesterol below 100, HDL above 50, TG (triglycerides) below 150
EKG: baseline and CRP blood test if your waist circumfrenceis over 35 inches
Eat fruits, vegitables, whole grains and good fats
Not smoke and reduce alcohol consumption
Exercise/walk 30 minutes or more daily
Have a fasting blood glucose below 100
-EKG: It is recommended that a baseline EKG be done for both men and women around age 50. It should then be done at least every two to three years, or more often if necessary.
Note: Ask your doctor to reduce the size of your printout on a copy machine. Then carry it with you in your wallet along with your emergency health card. If you need emergency care, a copy of your old EKG compared to a new one can help your doctors decide how best to treat you.
Colon Cancer Screening: Colon Cancer is Treatable if Found Early!!
Talk to your doctor about colon cancer screening at the age of 50 – or sooner if colon cancer, colon polyps, inflammatory bowel disease or other cancers such as breast, ovarian, endometrial or prostate run in your family. At the least, you should have an annual rectal exam and check of the stool for occult or hidden blood. Ideally you should also have a look inside of your entire colon once at age 50 (called a colonoscopy) and if it is normal, perhaps this test could be repeated no more often that once every 5-10 years depending on your history.
A sigmoidoscopy should be done every four years or a colonoscopy every two years for anyone with a higher risk of colorectal cancer.
A risk factor is anything that affects your chance of getting a disease such as cancer.
Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Researchers have found several risk factors that may increase a person's chance of developing colorectal polyps or colorectal cancer.
Risk factors you cannot change:
Age - Younger adults can develop colorectal cancer, but the chances increase markedly after age 50.
Personal history of colorectal polyps or colorectal cancer If you have a history of adenomatous polyps (adenomas), you are at increased risk of developing colorectal cancer. This is especially true if the polyps are large or if there are many of them.
History of colorectal cancer
Personal history of inflammatory bowel disease Inflammatory bowel disease (IBD) Inflammatory bowel disease is different from irritable bowel syndrome (IBS), which does not carry an increased risk for colorectal cancer.
Family history of colorectal cancer
Lifestyle-related factors you CAN change :
Diet high in red meats (beef, lamb, or liver) and processed meats (hot dogs and some luncheon meats) can increase colorectal cancer risk. Cooking meats at very high temperatures (frying). Diets high in vegetables and fruits have been linked with a decreased risk of colorectal cancer. It's not clear if other dietary components (fiber, certain types of fats, etc.) affect colorectal cancer risk.
Physical inactivity
Obesity raises the risk of colon cancer in both men and women, but the link seems to be stronger in men.
Smoking
Heavy alcohol use Colorectal cancer has been linked to the heavy use of alcohol. At least some of this may be due to the fact that heavy alcohol users tend to have low levels of folic acid in the body.
Type 2 diabetes
Night shift work
Previous treatment for certain cancers
Tests For Older Men
Prostate Exam: Staring at age 50, a man should have a digital exam of his prostate. The physician uses a gloved finger in the rectum to determine if there is any enlargement of the prostate. Enlargement could indicate benign enlargement or even cancer.
Prostate Specific Antigen (PSA): Prostate Specific Antigen is a blood test that can indicate prostate cancer. If the level is high, a biopsy of the prostate may be needed. Routine PSA screening is recommended by some doctors, but not by others. This is controversial because there isn’t enough conclusive info yet.
Tests For Older Women
Mammogram
A mammogram is an x-ray that can detect breast cancer early; often before a lump can be felt. It glandular. If you are taking Hormone therapy after menopause your breasts may appear more glandular or dense from the hormones. Ask your doctor about stopping the hormones a few weeks before the scheduled test. Women over 50 should have this test yearly. Women at high risk for breast cancer should ask about a digital mammogram and an MRI. Monthly self breast exams should also be done, and you can be taught this technique during your yearly checkup.
Pelvic Exam
A regular Pap test to examine the cells of your cervix to diagnose cervical cancer and changes that could signal cervical cancer is important too. Find out whether your doctor does the more sensitive liquid-based Pap test.
Menopause - After childbearing, many women stop going to a gynecologist (too many women think that after childbearing they no longer need a Pap test or gynecologic exam) and rely on their family doctor to do all the routine exams —both general and gynecologic. Yet too many family doctors are already overwhelmed with “too much to do and too little time” that many important tests can get missed or fall under the radar screen.
So for many women, no one doctor takes care of it all — so it is up to you to see that you get all the tests you need — at the right time and on time.
Other Concerns
-You should review all medications with your doctor, even over-the-counter medications.
-If you are a diabetic, your doctor should examine your feet and order additional tests for your blood sugar.
-Your annual checkup is also the time to discuss any emotional problems you are having. If you feel sad or lack energy, tell your doctor. Your emotional health is just as important as your physical health.
-Make sure you understand the purpose of every exam or test your doctor orders for you. Because everyone is different you must be sure to talk with your doctor about your specific treatment goals.
In addition, keeping an ongoing log of any tests or procedures you’ve had and recording the information in your calendar will help remind you to schedule regular checkups such as mammograms and a cholesterol check.
-Make sure you ask for copies of all your test results and keep them in chronologic order in your health record.
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