The Secret of Great Health Care
Preventative Testing Free Health Ebook Chapter on Preventative Testing While reading the next section of the chapter refer to the preventative health care worksheet in Appendix. Fill in the dates when you have had the following exams and determine if you are up to date on all of you preventative health care. If you are not in compliance with the recommendations, talk to your doctor. Preventative Health Care Worksheet - General Recommendations The preventative health care worksheet summarizes health screenings for your given age. There are five attached preventative health care worksheets. This is part three of the personal health record. Utilize the form for which you fall into. Depending on your underlying health status there will be some variation to the type and frequency of health screenings. Diabetics, for example, require specialized testing to detect early complications of the disease. Some people may need more frequent or less frequent evaluations. It is important to talk with your health care provider about each of the items listed on the worksheet and determine what your appropriate schedule is. Guidelines are suggested on the sheet but these guidelines are not gospel for each person. Talk to your doctor - communication is the key!Exams Examinations by your health care provided are a cornerstone to good health. Annual exams by your health care provider may include a breast and pelvic exam if you are a female and a prostate evaluation if you are a male. The first years of life are filled with multiple appointments. Infants should have doctor appointments in months: 1, 2, 4, 6, 9 and at one year. In the second year of life appointments should occur at 15 months, 18 months, then on the second birthday and at 30 months. From the age of three on, children should have and annual exams every year up to the age of 18. Adults between the ages of 18-21 should have an exam every 1-3-years. Those between 22 and 49 should have an exam every 1-2-years. After the age of 49, individuals should have annual exams. Skin exams help detect skin cancer or other skin problems. A total skin exam should be done every three years up to the age of 39 and than every 1-2 years. Dental health is important to overall health. Healthy teeth and gums are crucial in maintaining good eating habits. Complications of poor dental health include malnutrition and weight loss. Recommendations for good preventative health include: dental visits every 6 -12 months, brushing and flossing after each meal, not smoking or chewing tobacco, and limiting concentrated sweets. Regular eye exams are a key component to good preventative health care. Vision screens should occur at 3, 4, 5, 6, 8, 10, 12, 15 and 18-years-old. At least one eye evaluation should occur in the 20’s, two in the 30’s and than every 2-4 years between the ages of 40-50. After the age of fifty an exam every 1-2 years is recommended. Some individuals need more frequent evaluations. Speak with your primary doctor and eye doctor about your recommended frequency. The incidence of eye diseases, specifically glaucoma, cataracts or macular degeneration, are much more common in the older population. Glaucoma can cause blindness and if caught early it can be prevented or delayed. Risk factors for glaucoma include severe near sightedness, family history of glaucoma, diabetes, black race or older than 65. If you have vision problems, eyeglasses or contact lenses can improve your vision. Doctors also have other ways to improve your vision and prevent you from losing your sight. Be sure to tell your doctor if you are having trouble with your vision. Those with certain medical conditions are at risk for more problems with the eyes. Those with diabetes may need frequent eye exams as a condition called diabetic retinopathy can result in blindness. Screening tests Diagnostic tests utilize different equipment to screen for disease. Diagnostic tests are available for most disease processes. Some diagnostic tests are better than others at detecting disease. This section looks at recommended diagnostic tests for common diseases that can be detected and have a profound impact of quality and quantity of life. Height and weight should be checked at every exam. The body mass index should be determined (see chapter 1).
Hearing screens should occur regularly in the young and old. A hearing screen should occur at birth, at age one, 4, 5, 6, 8, 10, 12, 15 and 18-years-old. A hearing screen by your health care provider should be done on an annual basis after the age of 65, but some people are candidates for earlier screening. Common symptoms of hearing loss include turning up the television up, difficulty hearing in a crowded room or difficulty hearing normal conversation. This is a simple office test where the primary care provider evaluates your ability to hear a whispered voice or the sound of her rubbing her fingers together. If this test is deemed abnormal, more extensive testing may be indicated. Autism should be screened for at the age of 2. Screening for sexually transmitted diseases is recommended in sexually active adolescents and young adults. Screening for chlamydia and gonorrhea in those under 26 is recommended. Test individuals at high risk for syphilis and HIV. Hypertension, better known as high blood pressure, is significantly correlated with many chronic diseases and should be screened for at least annually after the age of 3. Blood pressure is often checked much more frequently than once a year. For those with a history of high blood pressure it may be checked once a month or once a week. For those who are getting medications adjusted, it may be check daily. But for those who have no history of high blood pressure, his or her blood pressure should be checked, at minimum, every year. Bone density tests - the most common called dual-energy X-ray absorptiometry (DEXA) – detect osteoporosis. Osteoporosis is a thinning of the bones and increases the risk for fracture. These tests should be preformed as screening at least once in females over the age of 65 and in high-risk individuals at the age of 60. High-risk men who are over the age of 50 should discuss screening with their doctor. For more information on osteoporosis see: Chronic Disease Guide: How to Prevent and Treat Common Chronic Diseases. Abdominal aortic aneurysm screening (one time) by ultrasound is recommended for men age 65-75 who have ever smoked. Abdominal aortic aneurysm is a weakening of the major blood vessel coming off the heart. If this vessel was to burst, it is typically fatal. Evidence has shown that smokers are at increased risk for weakening of this blood vessel. A simple ultrasound can detect this weakening so intervention can be implemented before it bursts. Tuberculosis (TB), an infection that commonly affects the lungs, can be passed from one person to another and is treated more easily if caught early. A tuberculosis screen is recommended for high-risk people. High risk individuals who should be tested for TB include those who have been in contact with someone who has TB; live in very crowed conditions, recently arrived from Africa, Asia, Central or South America; those with have kidney failure, diabetes, Human Immunodeficiency Virus, alcoholism, or have a history of using intravenous drugs. After the age of 65 annual screening for dementia is recommended. The use of the depression screen is controversial. The official recommendation is if there is a method in place diagnose, treat and to follow up, everyone over the age of 12 should be screened. An involved health care consumer will assure that there is follow up and should therefore be screened for depression. Children between the ages of 7-11 may be screened, but the evidence is not as convincing. Blood Tests Blood tests assist the doctor in assessing your health. Basic blood tests such as a complete blood count (CBC), kidney function test and electrolyte testing are not routinely checked in healthy individuals. No national recommendations exist for these tests and the amount of testing will vary depending on your other disease states and risk factors. Some doctors do recommend checking for anemia by checking a hemoglobin/hematocrit every 1-2 years. At a minimum if you had not had these tests evaluated in the past three years, ask your doctor if they should be run. Children have specific blood test recommendations including: The thyroid should be checked once at the age of 35 and then every five years. If you are being treated for thyroid disease, have a family history of thyroid disease or have high cholesterol you may need to be tested more frequently. Not everybody endorses this recommendation. Diabetes screens should be tested for on an annual basis in high risk patients including those who have high cholesterol, high blood pressure, are obese or have a family history of diabetes. All adults with blood pressures consistently greater than 135/80 mm Hg should be screened for diabetes. Otherwise it should be tested for once at the age of 45 and then every three years. The simplest screen and most common way to look for diabetes includes looking at your blood sugar level after an 8 hour fast. For more information on diabetes see: Chronic disease Guide: How to Prevent and Treat Common Chronic Disease. Cholesterol testing includes total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides. High cholesterol is a common predecessor of heart disease – which is the number one killer of Americans - and treating cholesterol can significantly reduce your risk for heart disease and stroke. In those that are healthy, cholesterol levels should be checked in men at the age of 35 and than every five year. Healthy women should be screened at age 45 and than every five years. Some experts recommend checking cholesterol levels every five years after the age of 20. The urine should be checked in children at the age of five and one time between 11-21 years old and than annually on sexually active males and females
Your annual appointment is the time to discuss your preventative health care needs. Health screenings detect common diseases. Health screenings are not meant to pick up every disease possible, but to catch common diseases, that, when detected early can be cured or complications significantly limited. It is important to take responsibility for assuring you receive the proper screening tests. Some common diseases to be screened for include: high blood pressure, high cholesterol, osteoporosis, diabetes, prostate cancer, dementia, depression, thyroid disease, breast cancer, colon cancer, cervical cancer and vision and hearing problems.
Review the preventative health care worksheet (in Appendix) prior to your annual visit. If after reviewing the preventative heath care worksheet you are not within the recommended guidelines as outlined on the form specifically ask your health care provider about that preventative health care activity. After you had a test, record on this form when the testing was performed and any comments that your doctor makes.
Cancer screening
Cancer screenings are carried out to detect common cancers that can be treated successfully if caught early (see table 4). Certain cancers, such as pancreatic cancer, which are not common, are not routinely screened for. More common cancers such as breast, colon and prostate cancer are part of routine cancer screenings. Prostate specific antigens (PSA) is a blood test that looks at the amount of protein given off by the prostate gland. It may indicate prostate cancer if levels are elevated. This blood test, in combination with a rectal exam, is the main way to screen for prostate cancer. The PSA and a rectal exam should be checked annually after the age of 50 and earlier if you are at high risk (family history of prostate cancer) for prostate cancer and have a life expectancy of greater than 10 years. Unfortunately, there is some risk with this test. There is a high false positive result rate. This means that many men without prostate cancer will have abnormal results on this test, requiring further intervention. This usually means that many men will need to go through a biopsy to rule out disease that is not there. This will not only cost a lot of money but cause discomfort in a lot of men. Also, a normal or even low level does not rule out prostate cancer. Mammography with or without regular breast exam is recommended every 1-2 years for women after the age of 40. This is used to detect breast cancer. It is most effective for women between 50-69 years old. Mammograms are underused. Sixty-seven percent of women over 40 have had a mammogram in the last two years between the years of 1998 and 2005. Cervical cancer is screened for by a Papanicolaou test. This test should begin by age 21 or within 3 years of the first sexual encounter. . At the age of 50, colon cancer screening should begin, although some high-risk patients may begin earlier. Screening is done by annually checking the stool for occult blood on three different samples, done at home. Sigmoidoscopy and colonoscopy are recommended with the sigmoidoscopy to be done every 5 years and the colonoscopy done every 10 years. Colonoscopy may be recommended if you are found to have blood in your stool when checking it for occult blood. Rates of screening are low; only 24 percent of those over 50 had screening with a home test for occult blood in 2000 and that number dropped to 17% in 2005 . Lung cancer screening is not recommended. Those individuals without symptoms should not be screened by either spiral CT or chest x-ray for lung cancer. Table 4: Cancer screening recommendations
|
Gender/Age |
19-39 |
40-49 |
50-59 |
Over 60 |
|
Men |
Fecal occult blood – annually Sigmoidoscopy/ Colonoscopy –every 5-10 years PSA optional – every year |
Fecal occult blood – annually Sigmoidoscopy/ Colonoscopy –every 5-10 years PSA optional – every year |
||
|
Women |
Pap smear at least every three years starting at age 21 or at the onset of sexual activity |
Pap Smear at least every three years Mammogram every 1-2 years starting at age 40 |
Fecal occult blood – annually Sigmoidoscopy/ Colonoscopy –every 5-10 years Pap Smear at least every three years Mammogram every 1-2 years |
Fecal occult blood – annually Sigmoidoscopy/ Colonoscopy –every 5-10 years
Pap Smear at least every three years (Before age 65 and then there are no strong recommendations Mammogram every 1-2 years |
Table 5: Recommended Preventative Testing for Healthy Males and Females over the age of 50
Colonoscopy every 10 years
Fecal occult blood test every year Flexible sigmoidoscopy every 5 years |
Your Role
Step three in the personal health care record requires that you monitor your preventative health care. Print off the work sheet in the appendix for your personal health care record that corresponds to your age.
Review each line of the work sheet and record the date of the last time you had that test, exam or vaccination. For example, the 45-year-old female should print out the preventative health care worksheet for 19-49 year-old females and record when she had her last complete physical exam (it should have been within the last 1-2 years), her last eye exam (it should have been in the last four years), the last time she had a PAP smear/pelvic exam (it should have been in the last 1-3 year) and the last mammogram (it should have been in the last 1-2 years). She will also notice that this year she is due for a cholesterol test (if she has not had one in the last five years) and possibly a thyroid test.
Each individual should go through each line and determine if they are in compliance with the recommendations. If you are not or are unsure, talk to their doctor. I strongly recommend bringing this worksheet to your annual doctor’s appointment and reviewing what testing needs to be done with the doctor. This will significantly increase the chances that you will be in compliance with recommendations. Complete the form and place it in your personal medical record see the book Improve Your Communication: How Talking Can Improve Health Care.
