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Your Basic Health Maintenance Plan

Many of us want to improve our health. The most common things I hear my patients say are: "I want to quit smoking, lose weight, exercise, practice safe sex, use seatbelts, eat a healthier diet and be nicer to family and friends."

While these are all great goals, another important but often overlooked goal is to get rid of that two-letter word "If." You know, the one where you say: "Doctor, if I only knew to check my skin for those moles; if I only took the time to get my blood pressure checked; if I only got that mammogram when I should have."

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Knowledge Is Key

The first defense against the "if" factor is to take charge of your health and learn what you need to do, and when you need to do it, to keep your body running at tip-top shape. After all, when you buy a car, you maintain it according to schedule. So why not have a similar schedule to maintain your body?

Sure, making all those appointments may cost some money and be time-consuming, and while it isn't much fun to get poked and prodded and tested, the point is to keep preventable diseases from stealing your time, your health and very possibly your life.

The Starting Line

To get you started, here is a general health schedule for people age 20 and above. Please remember that it is a recommendation only. Your personal health schedule may involve other tests, such as a fasting blood glucose test to screen for diabetes, and it may need to be more frequent if you have a medical condition that necessitates it.

The Complete Physical

People age 20 to 45 should have a physical exam once every five years; those who are 45-65 should have a physical every two years. After 65, a yearly exam is recommended (unless you have a condition that requires you to be examined more frequently).

Dental Checkup

Your teeth should be cleaned and examined every six months to a year. This would change, of course, if a specific problem needed to be addressed. If you smoke or chew tobacco products, these exams may save your life.

Eye Exam

Generally you need to undergo an eye exam every two years if you wear glasses or contacts or yearly if you have diabetes or other eye problems. If you have good vision, get a complete eye exam starting at age 40 every two years. This schedule will be adjusted by your eye specialist based upon your exam.

Colon Exam

Colon cancer is the third most common form of cancer among men and women. Early detection is crucial because colorectal cancer, which runs in families (10 to 15 percent of all colon cancers are inherited), is a very deadly form of cancer, killing about 40 percent of its victims. I know this exam is no fun and makes many people feel embarrassed. But what's to be embarrassed about? After all, we're talking about your life.

According to the American Cancer Society (ACS), age 50 is a key milestone to begin screening for this type of cancer. However, please know that many physicians begin testing at age 40, especially if there's a history of colon cancer in your family.

Here are the recommended screening options:

  • Yearly fecal occult blood test (FOBT), which screens for blood in the stool (even if you can't see blood in your stool it may be there!).
  • A flexible sigmoidoscopy every five years (in addition to an annual FOBT).
  • Double-contrast barium enema every five years.
  • Colonoscopy every 10 years. This test is increasing in popularity due to its reliability and accuracy.

Please don't be scared off by these tests. Your physician may recommend only one or two of these diagnostics to screen for colon cancer. If colon cancer runs in your family, be sure to tell your physician and ask if you need a colonoscopy sooner rather than later.

Skin Check

There are two types of skin cancer: melanoma and non-melanoma. Melanoma, if not found and treated early, is a killer. Non-melanoma skin cancer is not deadly but it can spread and cause a lot of skin damage if it's not caught and treated at an early stage. So clearly, the key to treating skin cancer is early detection.

Every three months, check your skin for new moles or any changes in size, shape or color of existing moles. Look for:

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  • Irregular, notched or ragged looking moles.
  • Moles bigger than a pencil eraser, which is about 4 to 5 millimeters (1/2 inch).
  • Moles that have an inconsistent color or a combination of colors, including shades of tan, blue, black, brown, red or even white. Moles also may fade from their regular color.
  • Asymmetrical moles (each half of the mole looks different from the other).

If you ever notice a suspicious mole, marking, lump, sore or change in the way your skin feels, please see your healthcare professional.

It's also a good idea to have someone check your back, scalp and the tops of your ears for moles. Have a healthcare professional check your skin at least once every two to three years when you're in your 20s and 30s, and then yearly after the age of 40. More frequent checkups may be in order if you have more than 50 moles, a history of skin cancer, fair skin, if you spend a lot of time outdoors or had several bad cases of sunburn as a child.

Healthy Heart Tests

Blood-pressure check: Have your blood pressure checked every other year if it's normal and you don't take any blood-pressure medications. If you have high blood pressure, or if high blood pressure runs in your family, your blood pressure must be measured at least once per year. Also, if you're overweight, African American, have known heart disease or you smoke, you must have your blood pressure checked at least once a year. People often underestimate the dangers of uncontrolled high blood pressure because "they can't feel it or notice any problems." If left unchecked, uncontrolled high blood pressure can increase your risk for heart attack, stroke and liver and kidney damage.

Electrocardiogram: Get a baseline at age 40 or earlier if you have a family history of heart disease or you're experiencing symptoms of heart disease. Your physician will discuss any follow-up screening based upon your personal health assessment.

Cholesterol check: The timing of this screening test is debatable. What's not debatable is that heart disease is the No. 1 killer of men and women in our country. The National Cholesterol Education Program recommends that cholesterol be checked at age 20, then every five years after that as long as your cholesterol is in the normal range. If it's elevated, your physician will test your triglycerides (another type of fat in the blood), LDL (bad cholesterol) and HDL (the good guy). Your follow-up cholesterol tests will be adjusted as needed, depending upon the treatment plan (diet, exercise, medication) and its results.

C-Reactive Protein (CRP): This may be one blood test you haven't heard of, but according to the American Heart Association, CRP has become a powerful new predictor of cardiovascular risk. Researchers have found that you can still be at risk for heart disease if your CRP is high and your cholesterol levels are normal. The good news is that CRP can be treated with the medications we use to treat high cholesterol, namely, the "statin" drugs, or niacin. This test may become widely used over the next several years.

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Women's Health

Mammogram: This procedure's ability to detect breast cancer is controversial. I recommend a baseline mammogram at age 40, then yearly after that. If you have a family history of breast cancer, I'd recommend a mammogram at age 35, especially since breast cancer is inherited about five to 10 percent of the time.

Remember to do a monthly breast self-exam beginning at age 20 and have a physician perform this exam at least once every two to three years when you are in your 20s and 30s, and yearly after age 40.

Numerous studies have shown that an annual mammogram combined with a breast exam by a healthcare practitioner cuts a woman's risk of dying from breast cancer by more than a third. If you ever notice a change in your breasts, please don't hesitate to visit your healthcare professional. Even if your mammogram is normal, but you feel something isn't right, talk to your doctor.

Pap Smear and Pelvic Exam:

For women 18 and over, this should be done yearly. If you're sexually active at a younger age, these exams should start then. The Pap smear has reduced deaths from cervical cancer by more than 50 percent since it was introduced in the 1940s. Make sure your physician uses a lab that meets the standards set by the College of American Pathologists, and also ask if the Pap smears are rechecked by the new computerized methods, or by using the thinprep technique. Some of these newer methods enable the lab to give more accurate results. If you've reached menopause, it's still important to get both tests.

Healthy Bones

Bone Density: This important screening test for osteoporosis (thinning and weakening of the bone) can detect low-bone density before the bones weaken and fracture. Some 28 million Americans are at risk for osteoporosis, while 10 million of them have the disease (80 percent are women).

In spite of this huge number, the National Osteoporosis Foundation estimates that only 29 percent of U.S. women with osteoporosis are diagnosed, even though osteoporosis is the major cause of at least 90 percent of all hip and spine fractures in older women. It's recommended that women speak with their physicians about bone-mineral-density testing and that they receive a bone-density test by age 65 - at the latest.

Younger women who are very thin, smoke, drink excess alcohol, or who have a bone fracture after age 40 or a family history of osteoporosis, may need to have a bone-mineral-density test at age 50, or earlier. The results of the test will help determine whether medications are needed to halt the progression of osteoporosis.

 

A Real Man's Test

Prostate Exam: Guys, there are many opinions on screening recommendations for the early detection of prostate cancer. Even so, don't be embarrassed to discuss the prostate exam with your physician. The 1997 guidelines by the American Urological Assocation suggest that all men over 50 get a digital rectal exam and a PSA (blood test). If prostate cancer runs in the family, then males at age 40 should get a digital rectal examination and a PSA. Further follow-up screening is based upon the results, your personal philosophy and health history.

The Senior Crowd

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Immunizations: Adults 65 or older should be vaccinated against pneumococcal pneumonia. Those with heart, liver or lung disease, or those with cancer or who take medications that lower the body's natural defense system, may need the vaccination at an earlier age.

It's also important to keep up to date with your other vaccinations, including a tetanus/diphtheria booster (needed at least once every 10 years), and to ask if you need the hepatitis B vaccination, or the influenza vaccine.

Lastly, ask your healthcare professional when you should be screened for diabetes and whether you're due for a thyroid check. A base-line screening bloodtest called a TSH is often recommended at age 50, especially for women.

Follow Up On Your Tests

Don't assume everything is normal if you don't hear from your physician. Take charge of your own health. Follow up on the results of any tests you get, and make sure you understand the results and what they mean for your health.

Remember, you are the CEO of your personal healthcare. The key to a healthier you is prevention. Of course, everyone is different, but the recommendations I've just laid out will get you started on the path to health.

Copyright 2003, Dr. Rob Danoff

Robert Danoff, D.O., M.S., is a family physician. He is program director of Family Practice Residency Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He also is a medical correspondent for The Comcast Network, CN8, contributing writer to the New York Times and writes a weekly medical column for the Bucks Courier Times, Bucks County Pa.

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