July 9, 2008

Given the rising costs of health care these days, the best investment in your health is in preventive maintenance. Insurance companies and Medicare recognize this and will cover most of the proven, worthwhile preventive tests that your doctor recommends. You get better health for less money!

There are many tests that are offered in the name of preventive health. My recommendations for all patients are based on age, family history, personal history and personal habits. Screening tests are offered to all persons who do not have signs or symptoms of a problem- they are healthy and we are looking to head off or find problems early. A good test is reliable every time it is performed and gives results that we have a treatment or preventive measure to offer. These are also affordable when appropriately used.

Cancer screening

Breast cancer

Mammogram every 1-2 years after age 40

Cervical cancer

PAP smear every 1-3 years, after age 19, or when sexually active

Prostate cancer

Prostate check annually at age 40 and PSA testing also, after age 50

Colon cancer

Colonoscopy every 10 years after age 50, alternatives include annual stool sample for blood analysis, and barium enema

There is no valuable screening test for lung cancer(chest x-ray is not useful), though studies are ongoing to use CT scan

Cardiovascular risk assessment

Risk factors assessed by blood testing include cholesterol panel and glucose for diabetes

Blood pressue check

Advice to stop smoking

Advice regarding diet, exercise and weight loss

Immunizations

Tetanus every 10 years

Influenza annually, especially if one has asthma, diabetes, HIV, congestive heart failure or over age 50

Pneumonia shot once after age 65

Preventive testing continued in next column...

Nancy D. Doering

Photograph courtesy of Webster University,St. Louis, Missouri campus, 2008 

A recent experience  gave cause to reflect on the wisdom of finding suitable specialists who practice at the same facility as one's family doctor. My primary care physician practices at the second largest medical center in St. Louis, Missouri, St. John's Mercy Medical Center.  There are many reasons this facility is the hospital of choice for my family, beginning with the confidence level we share for our physician, along with a number of  positive outcomes of our hospitalizations, national awards earned by the facility and individually by many of our physicians who practice there,  superior  testing facilities, a long  history of cleanliness and aggressive protocols for communicable diseases to keep patients out of danger, a good safety record for patients and their visitors, and convenience that spans many decades. In addition, this facility has established a mission to continue offering better sevice to patients and their families. All of these facts support the logical conclusion that it helps in many ways to seek physicians within a common facility whenever possible.

Very recently, a specific example supporting the habit of utilizing the same facility came to light. Last fall and into the winter, I waged a rather nasty battle with pneumonia. In the midst of the testing required to properly diagnose and assess treatment options for this condition, it was discovered that a small lesion was present on my liver. In addition to completing appropriate treatment  and follow up for the pneumonia, additional testing was ordered to determine the nature of the lesion and if it required treatment.  Subsequently, in tracking the  history of this particular problem, an earlier CT Scan was found in the records from five years earlier, due to an earlier visit and admission through the Emergency Department for a life-threatening condition. When the second CT Scan in 2008 showed no change over several months, coupled with the film from years earlier, it was determined that a five year history with no change in this lesion  rendered it harmless and requiring no further diagnosis.  Although I had long forgotten the presence of this lesion, the tests did not lie and spared both me and my family the agony of waiting it out for four more years until a five year history could be established.  Had the test been completed at a different facility , it might have necessitated more testing, more cost, and more emotional trauma to rule out the possibility that this was of serious concern. .Since we had all testing completed at the same medical center, I am happily playing with a new grandchild this fall instead of worrying over a possible cancer in my liver.  Thanks, St. John's, for such excellent records; and Dr. Sanders, for a thorough review of the test results!

"If God sends you down a stony path,may he give you strong shoes."

Irish blessing