August 13
, 2004  (STAR) AN APPLE A DAY By Tyrone M. Reyes, M.D. - One recent health study showed that at least more than half of people surveyed do not receive many of the important preventive services they need – that is, immunizations, screening tests for early detection of disease, and education about healthy habits and injury prevention. Why not?

• Many Filipinos have no health insurance.

• Many people do not get continuity of care. They may have to switch doctors as they switch from one insurer to another, making it hard to keep track of what services they’ve had.

• Preventive tests may not be covered by their insurance and patients themselves may be confused about which tests to ask for. They may not know that prevention is usually the most economical form of medicine – well worth budgeting for, even if insurance doesn’t cover it.

• With tests for some cancers, there’s the embarrassment factor. Some people may dread being tested for colon, prostate or breast cancer and be relieved if the doctor fails to mention it. Some people would rather not know.

• Both doctors and patients may be confused by contradictory recommendations. What should a medical checkup consist of? Does everybody need an annual physical? Should all men get a PSA test? At what age should a woman start having mammograms?

• Doctors may fail to ask patients about smoking and drinking, not to mention exercise habits and diet. Some doctors think their job is to treat illness, not prevent it.

How About That Annual Physical?

Yes, it used to be quite simple: People were advised to undergo a standardized annual "complete physical." But in the 1980s, health authorities reviewed all evidence and evaluated the benefits and drawbacks of common screening tests and came up with recommendations. That head-to-toe physical exam has now been discarded for seemingly healthy people, since it yields too few benefits for its cost. Over the long run, it doesn’t pay off in terms of better health and longer life.

Some tests that used to be routinely done, such as chest x-rays, EKGs, urine tests and complete blood counts, are now reserved for people with symptoms or risk factors. In other words, they are not general "screening" tests and are not done routinely in everyone (and as such are not covered in this article).

Health Care : Your Role

You are responsible, in large part, for managing your own preventive care. Your physician should be your partner. If you need any of the tests listed in this article, ask about them. You should, if possible, have a copy of your test results and records.

There are other important preventive measures not listed here – the kind of commonsense steps that could save millions of medical expenses and prevent injury, illness, disability and premature death. Here’s a checklist:

4 Don’t smoke and avoid secondhand smoke.

4 Maintain a healthy weight.

4 Get regular exercise. Brisk walking for just half an hour every day can be a big factor in weight control and in staying healthy.

4 Choose a diet low in animal fat and sodium, and rich in fruits, vegetables, whole grains, and low-fat or nonfat dairy products. Eat at least two servings of fish a week.

4 Keep alcohol consumption moderate: No more than one drink daily for a woman, two drinks for a man. If you are a heavy drinker, seek counseling and cut back or quit.

4 Do self-exams of your breasts or testes, as well as skin.

4 Fasten seat belts, see that kids ride in proper restraints, and obey the law. Drive sober and defensively.

4 Brush and floss teeth to prevent dental disease.

Medical experts may disagree about a lot of things, but they all agree that good health depends on improved access to and increased use of preventive services.

Preventive Services For Healthy Adults

These are the major screening tests (that is, routine tests for people without symptoms) and adult immunizations. This advice is based largely on the recommendations of the US Preventive Services Task Force. Infants, children, and pregnant women need other kinds of preventive care not described here.

Each test includes a discussion on who needs it, how often and other pertinent comments.

• Blood pressure measurement (to detect hypertension). All adults. Once every two years for those with normal blood pressure. More frequent monitoring for those with readings of 130/85 or higher.

• Cholesterol measurement. All adults. Once every five years. More often, if total or LDL ("bad") cholesterol is high, HDL ("good") is low, and/or you have risk factors. Those at high risk for heart disease need medical advice about lifestyle changes and possibly drug therapy.

• Pap smear (for early detection of cervical cancer). All women starting at age 18, or earlier if sexually active. If three annual tests are normal, then once every three years. More often if you smoke or have multiple sex partners or other risk factors. Some experts advise that women who had never had an abnormal result can stop being screened after age 65.

• Breast cancer screening (mammography). All women 50 and over, those 40-49 should discuss risk factors with a doctor. Annually. Clinical breast exams are also important – consult your doctor.

• Colorectal cancer screening (fecal occult blood test, sigmoidoscopy, colonoscopy). Everyone 50 and over; earlier for those at risk. Occult blood test annually, sigmoidoscopy every five years or colonoscopy every 10 years. Digital rectal exam and x-ray with barium enema may also be done.

• Prostate cancer screening (prostate specific antigen or PSA test; and digital rectal exam or DRE). Men with family history, DRE and PSA starting at 40. For others, DRE, and possibly PSA, starting at 50. DRE annually; PSA on professional advice. Usefulness of PSA screening for all men remains controversial.

• Diabetes screening (fasting blood glucose test). Everyone 45 and older; earlier for those at risk. Every three years. Obese people and those with a strong family history need more frequent screening, starting at 30.

• Thyroid disease screening. Women 50 and over; those with high cholesterol or family history of thyroid disease. Frequency depends on professional advice. Routine screening remains controversial. Talk with your doctor about risk factors.

• Chlamydia screening. Women 25 and younger, if sexually active. Annually, or more often. Men and women of any age who are at risk for STDs (chlamydia, gonorrhea, syphilis and HIV) should be tested.

• Glaucoma screening. People at high risk; those over 65, very nearsighted, or diabetic; those with sleep apnea or family history of glaucoma. Frequency depends on professional advice of eye specialist. Many eye specialists advise screening all adults every 3-5 years, starting at age 39.

• Dental checkup. All adults. Every six months, or on professional advice. Should include cleaning and exam for oral cancer.

• Tetanus/diphtheria booster. All adults. Every 10 years. People over 50 are least to be adequately immunized.

• Influenza vaccine. Everyone over 50 and over, people with lung or heart disease or cancer, and others at high risk. Annually. Even healthy young adults can benefit and should consider getting the shot.

• Pneumococcal vaccine. Everyone 65 and over, and others at high risk for complications. At least once. Effective against most strains of pneumococcal pneumonia; lasts at least 5-10 years.

• Rubella vaccine. All women of childbearing age. Once. Avoid during pregnancy.

• Hepatitis B vaccine. All young adults, as well as adults at high risk. How often? On professional advice. All newborns should be vaccinated.

• Chickenpox vaccine. Anyone who has never had chickenpox. Once. But above age 13, it requires two shots. Not recommended for pregnant women or those with compromised immunity.

And here’s my last advice: Clip this article. It may save your life!

Reported by: Sol Jose Vanzi

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