Sorting out screenings.
With so many health screenings available, which are the right ones for you? Some preventive tests are for men or women only, while others become more important with age. Having a doctor, nurse practitioner or physician assistant who asks pertinent questions, guides you through choices and stays on top of results is crucial. Here are some signs, symptoms and screenings to discuss with your health care providers, along with expert tips for making office visits more meaningful.
Tracking shrinking stature
Stepping on the doctor’s scale isn’t just about watching weight. Monitoring height over time can show significant decreases from original height as people get shorter. “As you get older, to see your height going down is not a happy thing,” says Dr. Barbara Levy, vice president of health policy with the American Congress of Obstetricians and Gynecologists. With age, the spine can curve more or spinal discs can compress. Fractures can result from loss of bone density. Recent, rapid shrinking of 0.5 inches or more or a total height loss approaching 2 inches is problematic, studies show. If you’re shrinking, ask your doctor about testing for osteoporosis.
Blood pressure basics
“It’s a straightforward, simple thing, but tracking blood pressure is important throughout our lives,” Levy says. High blood pressure is a risk factor for heart attacks, strokes, heart failure, kidney disease and other disorders. During a checkup, you can talk about lifestyle changes to lower your blood pressure, such as exercising and following the DASH diet. If that’s not enough, medication is the next line of treatment. Because blood pressure can gradually creep up, routine wellness visits let clinicians detect gradually rising trends. That way, they can address hypertension earlier and help you reach your individual blood pressure goal, based on your age and overall health.
Are you sleeping?
“We know that seven to eight hours of sleep a night is really important to long-term health,” Levy says. However, she adds, women who multitask to meet everyone else’s needs may shortchange themselves on sleep, and that can impact long-term health. For men and women alike, lack of sleep contributes to weight gain and mood changes. On the other hand, a good night’s sleep enhances short-term memory, boosts the immune system and helps people process any aches and pains. Health providers should be asking you about sleep problems. If you have signs of sleep apnea, like severe snoring, you might need a sleep workup.
Prostate cancer screening decision
“All men over 40 should talk to their doctor about the pros and cons of prostate cancer screening,” says Dr. Stacy Loeb, a urologist with NYU Langone Medical Center. Routine blood work offered in her practice involves a prostate-specific antigen blood test (a PSA test) and a prostate exam. While Loeb acknowledges that the PSA test is not perfect, she says, “It has been shown to reduce the death rate from prostate cancer and reduce advanced disease.” In addition to men over 40, others at higher risk, such as African-American men and men with a history of prostate cancer, should discuss screening with their doctor.
Testicular lump evaluation
A man who finds any kind of lump in his testicles should see a doctor right away, says Loeb, who heads the technology and publications committee for the Urology Care Foundation of the American Urological Association. “Testicular cancer is most commonly found in men aged 20 to 40,” she says. “So it’s young men who wouldn’t expect to have something like that going on.” A painless lump that a man detects by self-evaluation is the most common presentation, she says. “There’s often a delay in diagnosis because the man doesn’t seek attention right away.” The foundation’s website offers more patient information on urologic conditions and symptoms.
Birth control questions
As an OB/GYN, Levy says, when it comes to talking about contraception during routine visits, it’s “every woman, every time,” regardless of whether they’re sexually active. With nearly half of pregnancies unintended, she says, that discussion is essential. Women should be taking folate for three months before pregnancy to prevent birth defects of the brain and spine, known as neural tube defects. It’s also important to make sure a woman’s medical conditions, such as diabetes or high blood pressure, are under control before pregnancy, she says: “So the conversation is about: ‘Are you intending to be pregnant in the next year? And, if you are not, would it be OK if you became pregnant?'”
Mammogram update
It’s a hot-button topic, but in December, a coalition of health professional organizations made new recommendations on breast cancer screening for women who are not at higher risk because of genetic or other factors. “The Women’s Preventive Services Initiative recommends that average-risk women initiate mammography screening no earlier than age 40 and no later than age 50,” according to the U.S. Health Resources and Services Administration website. “Screening mammography should occur at least biennially and as frequently as annually. Screening should continue through at least age 74 and age alone should not be the basis to discontinue screening.”
Cervical cancer prevention
Every three years, young women ages 21 to 29 at average risk for cervical cancer should receive a Pap test, according to the Women’s Preventive Services recommendations. Women ages 30 to 60 should receive both a Pap test and testing for the human papillomavirus every five years, or a Pap test alone every three years. “The great thing about cervical cancer screening is we’re preventing cancer,” Levy says, not just detecting existing disease. Girls and young women who get the HPV vaccine may also lower their risk for cervical cancer.
Dental care timing
Twice-yearly dental checkups for thorough cleaning is necessary for good oral health, according to conventional wisdom. But for people without risk factors for gum disease (which can lead to tooth loss), dental visits once a year may be enough, according to a 2013 study in the Journal of Dental Research. However, you need to practice rigorous brushing, flossing and oral self-care to match the benefits of a thorough cleaning by your dental hygienist every six months.
Senior wellness
If you’re 65 or older, you’re entitled to a “Welcome to Medicare” preventive visit during your first 12 months with Part B coverage. Your health care provider will review your medical and social history and counsel you regarding a variety of preventive services. These include vital sign measurements, a calculation of your body mass index, a simple vision test and a review of your potential risk for depression. You’ll receive a written plan for screenings, vaccines and services you need. From then on, yearly wellness visits allow you and your provider to develop your personalized health plan, including updating prescriptions. You may receive a brief screening for cognitive or mental status, which involves answering a few questions and a short pencil-and-paper exercise.
Pro tips for office visits
If you’re seeing a doctor for the first time, bring your medical records, Loeb advises. That includes vital sign measurements to detect dramatic changes and copies of test results and imaging studies to avoid duplication and help your doctor better help you. Shared decision-making is an important value for the American Urological Association, she notes, as it is with many medical groups. On a similar note, establishing a relationship with your doctor is really important, Levy emphasizes: “So much of the visit is about counseling and getting to know and trust each other as a team, to work on [your] individual health.”
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