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Video: Avoiding common medical mistakes

TODAY
updated 9/21/2007 12:32:44 PM ET 2007-09-21T16:32:44


Are you between the ages of 50-60 and concerned about the tests and exams needed to maintain your health? Don’t know where to start? It's difficult to keep up with all the latest medical breakthroughs, but not knowing what's new or available could result in poor health decisions. Dr. Marie Savard, author of "The Body Shape Solution to Weight Loss and Wellness," shares smart tips and recommendations on how to avoid common medical mistakes:

Routine physical exam                       
For women over 50, regular checkups and a few special tests can be one of the greatest gifts you give yourself. Your doctor can tell a great deal about your health by talking to you, looking at you, and examining certain areas of your body. Whether you are seeing a gynecologist and/or a family doctor for your routine check-ups it is important that you know exactly what you need — and what to expect.  Young women tend to see a gynecologist for their regular check-ups as they have been “programmed” to get an annual Pap test and breast exam. 

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. 

Some women, on the other hand, see both a gynecologist for their gynecological exams and a family doctor or Internist for their general check up and screening for chronic conditions such as heart disease and cancer.  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.

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Add to that the fact that no one doctor today can keep up with all the latest information about everything — the importance of the new HPV test along with the Pap test is a case in point.

I know that it takes me at least an hour or more to provide a thorough evaluation to a woman who needs both a comprehensive history and physical evaluation including a pelvic exam.  When was the last time a doctor spent an hour or more with you?  Make sure that you tell the receptionist that you are coming for a complete physical so that they schedule enough time and come as prepared as possible so that you get all care and attention you need.

For women 50 and over you need the following tests and exams to get the best snapshot of your overall health.

General physical exam
This includes taking a detailed history to learn all about you and your family history and a head-to-toe physical exam including an exam of your skin, eye, ears, nose throat, lymph nodes, chest, breast, abdomen, rectum and extremities.  Make sure you get a breast exam and rectal exam and stool check for blood by your family doctor if you are not examined yearly by a gynecologist as well.

Waist circumference (WC): Women with increased WC are at increased risk of metabolic syndrome, diabetes, heart disease and cancer of breast and uterus.

BMI (measure of height and weight): much less reliable estimate of future health risk than WC and body shape.

Blood pressure: According to current treatment guidelines, the blood pressure target is 130/80 or lower for patients with diabetes. Blood pressure readings should be taken at every doctor’s visit.

Pelvic exam
This exam will automatically be done if you are seeing a gynecologist.  If you rely on a family doctor for all of your care you may have to ask – or remind your doctor that you need a gynecologic exam too.  A pelvic exam can check the condition of your uterus and cervix, ovaries, and rectum.   Don’t be afraid to ask for a rectal exam and a check of your stool for blood.  I remember being embarrassed but did ask my gynecologist (the only doctor I was seeing at the time) to do it at one point when I realized it was not part of his routine.  I wasn’t ready to literally “die from embarrassment.”

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.

New information for women
Women over thirty and that means WOMEN 50 and over too should ask for the human papilloma virus (HPV) test along with the Pap test, also called the DNAwithPap™ test or the HPV test with Pap test. This combination of tests is now recommended for women over the age of thirty because a positive HPV test could mean you are a chronic carrier of the virus that is the sole cause of cervical cancer and therefore at increased risk of cervical cancer — and may require additional tests and treatment of any abnormal cells caused by the virus.  Women in their twenties commonly acquire the virus but it doesn’t persist because their immune system fights it off. 

Since cervical cancer is caused by the human papilloma virus, having a negative HPV test and a Pap test is very reassuring and virtually guarantees that you are not at risk for cervical cancer over the next few years.  If both tests are negative which will be the case for 95% of women over 30, then you can safely get the HPV and Pap test every three years instead of annually.

Blood Work:  An overnight fast or fasting sample is critical

Your blood contains a great deal of information about your health.  When your doctor orders the lab to run a complete series of tests, you can find out about the status of your liver, your thyroid, your blood cholesterol, your blood sugar and much more.

Complete blood count: (optional)
This is the most common blood test. Your doctor may order it as part of a complete physical examination. He'll also order it before you have surgery and if you have unexplained and continuing symptoms. The complete blood count (CBC) measures the number, size and shape of the different types of cells in your blood.

Women at increased risk for metabolic syndrome and heart disease (women with waist circumference over 35 inches) should ask for a C-reactive protein test – and important test of blood inflammation and marker of future heart disease risk.

Blood Chemistry Tests: A single sample of your blood serum can be used to run a series of tests quickly and inexpensively. The following explains the most commonly requested tests:

Glucose can indicate diabetes if your level is high or hypoglycemia if it’s low. A fasting glucose of less than 100 is normal, a level of 100 to 125 is abnormal and called “impaired glucose tolerance” and a level of 126 or greater means diabetes.

Blood Urea Nitrogen and Creatinine are tests of your kidney function.

Sodium, Potassium and Chloride are blood salts or electrolytes. These tests are especially important if you are on diuretics (“water pills”) for hypertension or heart disease.

Uric Acid is a waste product of all cells. An elevated level may mean kidney disease or gout.

Albumin is a blood protein produced by your liver. A low albumin count can be a sign of liver or kidney disease.

Globulin is a blood protein produced by your immune system. A high count can point to chronic inflammation, infection or blood disorders such as multiple myeloma.

Calcium is a component of your blood that helps all the cells in your body function normally. Your blood calcium level has nothing to do with how much calcium is in your bones. A high count can point to a disorder called hyperparathyroidism, which predisposes you to kidney stones and low bone density.

Serum Glutamine Pyruvic Transaminase (SGPT) and Serum Glutamate Oxaloacetate Transaminase (SGOT) are enzymes (proteins) produced primarily by the liver. SGOT is also produced by red blood cells.

Lactate Dehydrogenase (LDH) is an enzyme produced by many cells of the body. If this test is extremely high, your doctor will want to do additional tests, depending on your specific complaints to rule out a malignancy.

Bilirubin is the chemical in bile that gives it the yellow color. If the bile passages from the liver to the intestine are blocked, your bilirubin level will be high. Possible causes include gallstones and liver disease.

Gamma Glutamyl Transpeptidase (GGT) is an enzyme produced by the liver. Obesity and excessive alcohol use are the most common reasons it can be mildly increased. It will also be elevated when there is blockage of bile and with liver disease.

Alkaline Phosphatase is an enzyme produced by the liver and bones. If it is abnormal (elevated), looking at the GGT (see above) will help determine the source. If the GGT is elevated as well, the liver is the culprit.

Blood fats or blood lipids
Also called lipids, these are often listed together in a separate “panel” 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
Underactive thyroid is a common condition in women over the age of 50 and therefore most women should be tested.  A thyroid function test measures the level of two hormones produced by the thyroid glands: thyroxine 3 (T3) and thyroxine 4 (T4). They regulate your metabolism. The brain keeps levels normal by sending thyroid stimulating hormone (TSH) to the thyroid gland if your T3 and T4 are low. The TSH level is the best indicator of the condition of your thyroid and the effects of thyroid medication.  For example, if your thyroid hormone levels (T3 and T4) are low, the TSH level will be high.  If the thyroid hormone levels are too high, then the TSH level will be low or immeasurable. 

Bone Density Test
This is an x-ray, also called the DXA scan, 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.  I can’t say it enough, “Get a copy of your report and learn what your results mean for you.”

Mammogram
A mammogram is an x-ray that can detect breast cancer early; often before a lump can be felt.   It is best to schedule this test a week after your period, a time when your breasts will be least tender and 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.

Colon cancer screening:
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. 

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 opthalmology exam by an opthalmologist to check the retina as well (see below for apples).

Total skin exam
Melanoma, the most serious form of skin cancer, is reaching epidemic levels thanks to excessive sun exposure and loss of the protective ozone layer.  It is important that you get a head-to-toe check of your skin on an annual basis.

EKG 
A baseline EKG to assess your heart’s electrical activity should be done by age 50.  IF you are at increased risk for heart disease, ask for a special CT scan, stress test using a heart ultrasound or special dye to get more accurate pictures of your heart.

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. Also keep a copy in your binder or folder for future reference. If you need emergency care, a copy of your old EKG compared to a new one will help your doctors decide how best to treat you.

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.

Immunizations
Don’t forget your annual flu shot starting at age 50 AND at age 65 get a pneumonia vaccine once only.  Also every 10 years tetanus/diphtheria shot.

You know you are healthy at 50–60 if you have…

  • Waist circumference under 35 inches
  • Blood pressure <120/80
  • Blood lipids: LDL cholesterol <100, HDL > 50, TG (triglycerides) <150
  • Fasting blood glucose <100
  • EKG: baseline and CRP blood test if WC over 35 inches
  • Sleep 7-8 hours at night
  • Eat fruits, veggies, grains and healthy fats
  • Don’t smoke
  • Reduce stress in your life
  • <1 glass wine daily
  • Exercise/walk 30 minutes or more daily
  • Discuss daily baby aspirin and multivitamin (silver or no iron variety) with doctor

Cancer risk

  • Negative PAP and HPV test (repeat every 3 years)
  • Normal rectal exam and colonoscopy (repeat in 5-10 years)
  • Normal breast exam and mammogram yearly

Osteoporosis

  • Bone density test: T-score of lumbar spine and hip <2.0
  • Consume 1200 mg Calcium and 600 IU of Vitamin D daily
  • Walk 30 minutes daily and lift weights 3 x’s/week

Mental health

  • Strong friendships
  • Sleep 7-8 hours at night
  • Relaxation/reduce stress      

Menopause assessment

  • Weigh pros and cons of hormone therapy
  • Assess menopausal status and risk with practitioner

Make sure you ask for copies of all your test results and keep them in chronologic order in your health record.  For more information or to download Dr. Savard's special health form titled “test results at-a-glance (for women),” visit www.DrSavard.com.

© 2013 MSNBC Interactive.  Reprints

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