Manuscript for Chapter 3 of Family Health for Dummies

by Rob Goldberg

Chapter 3
Preventing Illness

You know it's true: It's far easier to maintain your health than to try to restore it after an illness. This simple fact should give you the motivation to consider taking some of these preventive steps.

This chapter covers:

Also, make sure to check out Chapter 12, Children's Health, Chapter 14, Women's Health, Chapter 15, Men's Health, and Chapter 16, Health for the Elderly for more detail on the conditions touched on in this chapter.

Getting Regular Health Screenings: Men

The key to maintaining health is heading off problems before they occur. How can you detect problems? By waiting for a symptom and then seeking medical help? Wrong answer, friends. You go to your doctor for checkups of different types, known as health screenings.

Men

Let's start with the worst offenders first, men. You know, the guy who says, "We limp to the medicine chest in this family, buddy." That approach becomes a risky toss of the dice as you get older.

Consider that many conditions -- such as high blood pressure, high cholesterol, heart disease, diabetes, and cancer -- often don't cause noticeable symptoms until they have put you at serious risk.

We Didn't Make This Up: A recent survey of 1,500 physicians by the Men's Health Network confirmed the widespread observation that men have more trouble discussing their health, are less likely to see a doctor in the first place, and are more likely to put off treatment until they're in serious trouble.

In fact, many experts think this phobia about doctors may explain why men don't live as long as women -- on average 72 years for men versus 79 for women.

Here's a summary of the screenings you should make an effort to get.

A Basic Physical. How often: every three years for healthy men under 40; every two years for men 40 to 50; every year after 50.

It's not that bad. First, the doctor asks a series of, sometimes uncomfortable questions about lifestyle, occupation, and recent health problems.

Here's a tip. Tell the truth: Why even get the physical if you're going to try to put one over on the doctor? Plus, a good physician can tell when you're not coming clean and will get the truth out of you anyway.

An illustration: A healthy man in his mid-30s hates going to doctors but his wife begs him to get a physical and off to the doctor he goes. The visit begins with a blood-pressure check, and his pressure turns out to be slightly elevated. He tells the doctor it's just "white coat hypertension" (he gets nervous just at the site of the doctor's white coat and so his heart races and his blood pressure climbs).

The doctor then asks, "Do you feel the same way when someone cuts you off on the highway? If your blood pressure rises just because you're getting a physical, it's probably also elevated plenty of other times." The point is, you want to answer such questions honestly, and the two of you, doctor and patient, can team up to head off a problem.

Next, the doctor will check your eyes, ears, and skin; the lining of your mouth and throat; your height and weight; and will perform the familiar whack-on-the-knee reflex test.

Depending on your age, your doctor may also perform the following tests:

Urinalysis. How often: every three years until 40; every two years 40 to 50; and every year after 50. The point here is to watch out for diabetes, urinary tract infections, hormone imbalances, liver condition, and gallbladder health.

Technical Stuff: Don't hold that urine sample out at arms' length -- it's sterile when it first comes out if you don't have an infection. Only after bacteria get at it does it develop that familiar stench.

Blood pressure. How often: At least once per year according to the American Heart Association, but most practices routinely take your blood pressure for any visit. (They know their customer.)

Typically, a nurse wraps a blood pressure cuff around your upper arm, pumps it up to temporarily squeeze shut the main artery in your arm and then slowly deflates the cuff, while listening with a stethoscope for distinctive sounds made by your blood as it rushes back into your arm. He listens for two sounds that match the pressure when the heart is pumping ("systolic pressure") and when your heart is relaxed ("diastolic pressure").

These two numbers, especially the diastolic or lower of the pressures, are really important because they predict blood-pressure related complications like heart attacks. You can buy your own blood pressure cuff and try to take your own blood pressure at home, but take some time to make sure you're on the same page as your nurse and doctor regarding which sounds match which blood-pressure measurements.

Technical Stuff: Impress your friends. The first sounds you hear through the stethoscope as the blood rushes back into your arm are known as the Korotkoff sounds, named after Nicolai Sergei Korotkoff, the Russian scientist who first identified them.

 

Blood Tests. How often: Every three years until 40; every two years from 40 to 50; and every year above 50.

A thorough test would include complete blood cell count (CBC), a cholesterol test of your blood, a more complete test of your blood called a blood chemistry survey, and sometimes a test for the virus HIV that causes AIDS (depending on the answers you truthfully give in the history part of the exam).

Electrocardiogram (ECG or EKG). How often: every three years after 30 if your doctor thinks you're at risk for heart disease; every three to four years after 50. (Some doctors suggest you get a baseline ECG test at 40 to compare to later results.)

The ECG involves electrodes pasted to your chest that, believe it or not, actually pick up your heart's electrical activity right through your skin. The heart is a big muscle and the way your nerve impulses travel through it reveal a lot about how good a job it's doing. If you can step back from the situation, those electronics freaks among you guys might actually find this test pretty cool.

YOUR FAVORITE: The Digital Rectal Examination. How often: Every year after the year of 40, but many doctors may perform it an earlier age.

She's going to do what? Yes, guys, get over it, your doctor is going to have to put a glove over her hand, lubricate it, and then insert her finger into just the lower part of the rectum, but it's for a very good reason. This exam picks up problems with your prostate gland, including the very common prostate cancer. This test probably has done more to keep squeamish men from getting physicals than any other, but you should realize it causes no pain and is over in a minute.

Others. If you're a smoker, your doctor may want to take a chest x-ray to screen for signs of lung cancer and other conditions. Some patients may warrant a test for Tuberculosis, a disease once on the run but now back in circulation. After the age of 50, your doctor may suggest a sigmoidoscopy, which uses a flexible scope inserted into the rectum to check for colon cancer and other diseases in the digestive tract. Also after 50, you may be asked for a stool sample (Oh, joy) to check for blood in the stool, which can indicate colon or rectal cancer and other problems.

There's also a blood test to check for prostate cancer called the prostate specific antigen test (PSA). But not all doctors agree about the course of action to take with a positive result on the PSA because roughly a third of the time it either misses the disease or says a person has it who doesn't.

 

Getting Regular Health Screenings: Women

Because women need special tests, we won't go into a step-by-step summary of the typical physical for a woman. Instead, we'll take the time to focus on three crucial topics: mammograms, breast self-exams, and Pap tests.

Mammography. How often: That's a tough one. Many experts disagree on the value of early mammograms. But a rule of thumb is that women 50 and over can benefit by having a mammogram. Younger women with a family history of breast cancer or women who discover lumps the doctor deems suspicious also can get mammograms.

A mammogram is nothing more than an x-ray of the breast to detect breast cancer. A technician places your breast between two flat plates which are then gently squeezed together as the x-ray picture is taken. In terms of comfort, it's not a barrel of laughs, but then again it's not as bad as, say, a trip to the dentist.

The results of a mammogram aren't a clear-cut yes or no diagnosis of breast cancer. Rather, a radiologist who has looked at a lot of x-rays in her time makes a judgment call based on the appearance of the picture. For example, a cancerous tumor tends to have irregular edges, while a benign one will have clear edges.

If the mammogram calls for it, you may have to get a biopsy, which is the removal of enough tissue for cancer lab tests. The biopsy can take the form of a small surgical operation or can be done with a hollow needle that samples a smaller amount of tissue.

Other ways of trying to see what's happening inside the breast include using sound waves (ultrasound), a sensitive heat detector (thermography), and even bright light (transillumination). None of these are as accurate as the biopsy.

Breast self-exam. How often: Once every month, usually two to three days after the end of your period.

This is one test you do yourself, and is a woman's first line of defense against breast cancer. In fact, about 80 percent of breast cancers are detected through women checking their breasts themselves.

We can't stress strongly enough the value of breast self examination. When caught early, breast cancer can be cured. When caught late, you can die. Enough said.

A breast self exam involves checking your breasts for lumps regularly so that you get an idea of what your breasts feel like under normal conditions. They aren't absolutely lump free because, let's face it, they're mammary glands made for making milk. Breasts include a series of gland lobes for milk production which give the breast a lumpy feel even when normal.

For you to be able to feel an abnormal lump, it would have to be about three-eighths of an inch in diameter or a little bigger than a pea.

Don't put off by the complicated diagrams on those shower cards your gynecologist may have given you. It's more important to regularly check your breasts for strange new lumps than to worry about your "technique." The idea is just to feel all parts of the breast, and the shower is a good place to do that because the soap and water may give you more sensitivity in your exam.

Many women skip the self-exam because the thought of doing it makes them worry about breast cancer -- not a welcome thought. One way to get past this mental block might be to buddy up with a girlfriend so that you can stay on each others' cases about consistently doing the test.

Gynecologists will also perform a breast exam as part of the annual visit.

Pap test. How often: Every year for women who are sexually active, who have reached 18, or have developed a type of herpes called human papilloma virus. (Some women who get a clean bill of health from a pap test three times in a row may be able to get the test less frequently.)

Trivia: Have you ever wondered why they call it a "Pap" test and why the P is capitalized? Because it's named after its inventor Dr. George Papanicolaou.

A Pap test is nothing more than a special way of sampling cells from a woman's cervix (the part of a woman's uterus closest to the vagina) for an early detection of changes that could turn into cancer.

The gynecologist uses a small wooden spathula and often a small brush to collect the cells, which are then examined under a microscope.

Tip. Staying relaxed during the Pap test (or any other gynecologic exam) greatly reduces discomfort during the procedure.

When you schedule a Pap test, make sure to ask your gynecologist about anything to avoid before the visit such as douching, contraceptive foams and gels, and unprotected sex.

The interpretation of Pap tests is an extremely complex subject, but what we want to get across to you here is that an abnormal result does not always mean you have cancer. Many non-cancer conditions, such as vaginal infection, can produce the abnormal result.

Perhaps the best advice we can give you is to seek out a gynecologist who can clearly explain the Pap test results and her planned course of action.

Colposcopy and cervical biopsy. How often: These two tests are performed as follow-ups to an abnormal Pap smear in some cases.

A colposcopy uses a magnifying scope to view up close areas of the cervix to be removed in a biopsy.

For more information:
Planned Parenthood Federation of America, Inc.
810 Seventh Avenue
New York, NY 10019
800-230-PLAN

http://www.ppfa.org/ppfa

 

Getting Regular Health Screenings: Children

Chapter 12, Children's Health, provides a lot of detail on keeping your kids healthy, but we want to stress just a few tips about regular health testing specifically for children.

Metabolic screening. When: soon after birth. By law, your child will be checked for certain disorders of the body's chemistry called metabolic disorders, for example, phenylketonuria (PKU), an inherited disease that interferes with the body's ability to eliminate substance found in many foods.

The point is that parents should know as soon as possible about such conditions so that, as in the case of PKU, they can make sure the child avoids consuming the problem substance in the first place.

Weight. New parents, especially with their first child, agonize about whether their child is gaining enough weight in the first few months. Here's a tip: Pop into the doctor's office for a spot weight check whenever you need some reassurance. Most practices won't require a prior appointment and the nurses will smile indulgently as they help you place that precious bundle onto the scale.

Hemoglobin test for infants. The American Academy of Pediatrics also suggests testing your child's blood at nine months through a finger prick test of your child's hemoglobin level, which is a molecule in the red blood cells that helps your blood carry oxygen.

This test reveals anemia most commonly from a lack of iron, which is more prevalent in children under a year than you might expect. Anemia in children interferes with their proper development.

Even though you might see that formula and cereal are fortified with iron by reading their labels, this type of iron cannot be absorbed as easily by the baby's body as the type found in mother's milk. And even mother's milk by itself may not provide enough iron in all cases.

Depending on the mix of formula, solids, breast milk and other foods you give your baby, there's always the chance the baby may not have received an adequate amount of iron.

Lead: You should ask that your child's first blood lead level test be performed at nine months, even though some practices will only want to give the test to kids living in older houses. The problem with skipping the test is that, if you're like most families today, you have patched together a mix of babysitting, daycare, and other childcare providers all in different buildings. It's impossible to know whether or not lead-based paint has been used in all of these different structures. Play it safe, ask for the test.

Vision and hearing. The American Academy of Pediatrics recommends that at age three your child receive his or her first standardized test of hearing and vision. Before that, a subjective test will do. If three years old sounds early, remember that hearing and vision problems can be confused with learning problems and your child could needlessly experience serious developmental problems if he or she can't see or hear well.

Getting the most out of the visit. In these days of cost containment, there's a good chance your pediatrician will seem hurried, but you should feel entitled to take the time you need to ask the questions for which you need answers. So prepare a list of questions in advance, and remind yourself that you are your child's best advocate.

If the checkup uncovers a problem, consider asking the following questions:

Wait a Minute, Doc

What's the exact name of my child's illness?

What causes it?

How long does it last?

Is it infectious? Can my child go to daycare or school?

What should we be doing at home?

If it gets worse, what symptoms should I look out for?

Should we schedule a follow-up visit to make sure my kid's ok?

 

Getting Regular Health Screenings: The Elderly

Chapter 16, Health for the Elderly, includes more information on staying healthy as you get on. Here we'll touch on some of the important issues on checkups for older folks.

First make sure your doctor has some expertise in geriatrics, caring for the elderly. The problems of the elderly are unique - requiring a mix of diplomacy, psychiatry, and even detective work on the part of the doctor.

Aging is a natural process that affects all parts and systems of your body; for example, causing conditions such as diabetes, heart disease, decreased lung function, and brittle bones ("osteoporosis"). For this reason, there's no room here to give a complete rundown of the checkup tests to expect, but older people and their care givers should keep the following points in mind.

Polypharmacy. No, that's not the name of the latest drug store chain. That's what experts call the problem of the complicated mix of over-the-counter and prescription drugs many older people need. Because both the kidneys and liver become less effective at ridding your body of toxins in advanced age, it's especially important that your doctor know all of the medicines you are taking. They can interact harmfully, and just could be the cause of the problem that sent you to the doctor in the first place.

"Non-medical" issues. Accidental falls, burns, and driving accidents all pose a major risk to older people. Embarrassing and uncomfortable conditions such as incontinence might be solved with a simple adjustment of medications. Don't think a doctor nosy if she asks about such problems.

Poor nutrition. Young older people can eat too much for their own good, and really old folks can find it hard to get enough nutrition. Say, it's hard to get out to buy food or your having problems with your teeth. A good checkup for the elderly will focus on nutrition, both in terms of amount and type of food.

How to get the most out of the visit. Make sure you can see and hear what's going on. So check your hearing aid if you need one and bring your glasses. Prepare a list of questions. Don't hesitate to remind the doctor to speak slowly. Don't expect the doctor to read your mind: Let her know what's working and what isn't, and how you're doing in general.

Looking Into Your Family History

Why dig into your family's medical past? Because, to borrow a cliche, to be forewarned is to be forearmed in your quest to keep your family healthy.

First a genetics lesson. We know (unless you're a biology geek, in which case you won't be reading this book), your eyes glazed over when your junior high biology teacher started babbling about Gregor Mendel, his pea plants, and the wonderful history of genetics. Well, now you're a responsible parent, and guess what, you have to try to understand the basics of genetics. Let's start from square one: Everybody on this planet started from a single fertilized egg made up of an egg cell from the woman and a sperm cell, you guessed it, from the man.

What's cool is that single fertilized cell contains the complete blueprint for a person, with half of the blueprint information coming from the mom and half coming from the dad.

Those two parts put together form a super complex substance called DNA, or deoxyribonucleic acid, which itself forms a spiraling structure called a chromosome that sits inside the center of our cells.

Now there can problems in this genetic blueprint: Little bits of information can get thrown out of whack and can cause a problem down the line, which gets called a genetic disorder. (To really blow your mind, consider that some "errors" also cause a creature to do better, which is the basis of evolution, but that's a whole other book.)

But the tricky part is that you can have a normal bit of information, or "gene," from one of your parents and an abnormal gene from another. In many cases, the good one hides the bad one, and you can be walking around a hidden, or "recessive," carrier of a problem.

This is precisely the reason for some pre-birth testing of the parents; for example, Tay-Sachs testing of Jewish people.

If this disease discussion is making you tense, let's consider eye color instead. In the world of eye color, a brown eye gene trumps a blue eye gene. So two brown-eyed parents can be walking around with no idea that they're secret carriers of a recessive blue eye gene. In this case, no one cares, and it's just an interesting surprise when that blue-eyed cutie pops out.

But think of other genetic traits that cause crippling diseases, wouldn't you want to know as soon as possible? The argument for early detection becomes even stronger for the many conditions that medicine can cure if caught early enough such as certain types of leukemia.

Dominant and recessive: I'm so confused.

When a genetic disorder is caused by just one defective gene, it's called an autosomal dominant disorder. So if you've got it, there's a 50-50 chance your child will too. When the disease requires two copies of the defective gene, then it's called an autosomal recessive disorder, and there's a 25 percent chance of your child being affected.

Just to confuse you even more, there's a third major category called an X-linked recessive disorder, in which the gene defect occurs in the gene that determines if a child is a boy or a girl. (Think back to that junior high biology class: Right! Girls get two X chromosomes and boys get an X and a Y chromosome.)

In this case, the girl lucks out because she has two X chromosomes and so has a chance to have a normal copy to trump the defective one. So, if the mother carries an X-linked recessive disorder and the father doesn't, there's a 50 percent chance each male child will be affected by the disease, and a 50 percent chance each female child will be a carrier.

 

A first step. Check into the disease history of your family, starting with your parents and siblings, and then moving out on the family tree. If a disease occurred early in a relative's life or if you see it popping up in several places, that may be a warning sign.

Then, consider the following screening tests to nip the problem in the bud:

Cancers

Breast cancer Mammograms beginning at about age 35
Cervical and vaginal cancer Yearly Pap smear and pelvic exam
Colon cancer Yearly test for blood in the stool plus follow-up blood tests and physical examinations
Leukemia Complete blood count, chromosome analysis, bone marrow biopsy
Lung cancer Yearly chest x-ray and sputum (lung mucus) beginning at age 50, NSE blood test
Oral cancer Yearly dental exam. Biopsy
Ovarian cancer, cysts, and tumors Yearly pelvic exam, ultrasound, CA 125 blood test
Pancreatic cancer CA 19-9 blood test
Prostate cancer Digital rectal exam, PSA blood test
Stomach cancer Endoscopic exam
Testicular cancer AFP blood test, regular self-exam, ultrasound
Cancer of the uterus Endometrial biopsy

Other Diseases

Cystic fibrosis Regular tests of lung dysfunction, stool, and sweat of infants and young children who may have inherited it
Diabetes Regular blood sugar tests, urinalysis
Glaucoma Glaucoma exam at age 40
Heart: heart attack, heart disease, clogged arteries, stroke Regular blood pressure, serum cholesterol, and triglyceride tests. ECG test. Exercise-tolerance test
Mood disorders Psychiatric evaluation if serious symptoms such as chronic depression appear
Osteoporosis Bone density test before menopause
Polycystic kidney disease,

kidney tumors

Urinalysis, ultrasound, CAT scan
Schizophrenia Psychiatric evaluation if serious symptoms such as hallucinations appear

 

Selected inherited diseases and some that just run in families:

Thalassemia. A blood disease occurring in people of Italian or Greek descent, but can also affect people from other nearby regions. If untreated, this type of anemia can cause death.

Marfan syndrome. This disease of connective tissue is seen in tall, slender, loose-jointed people. The syndrome can affect the heart and blood vessels, sometimes causing sudden death in those unaware they have the disease.

Achondroplasia. A type of dwarfism where the child has a normal sized trunk but short arms and legs, and other problems such as with the spine.

Neurofibromatoses. Disorders of the nervous system revealed by six or more large tan spots on the skin, often present at birth. Tumors can grow on nerves, the brain, and spinal cord. Although most cases are mild, some can cause learning and speech problems, and even seizures.

Wilson's disease. A rare liver disorder that causes an intolerance to copper. This disease can cause mental problems if untreated. It does not appear until between the ages of 8 and 20.

Gaucher's disease. A rare metabolic disorder that affects liver and spleen function, and bone growth. Can appear in childhood on through adulthood. Seen most commonly in Jewish people of central or eastern European descent.

Tay-Sachs Disease. A rare inherited brain disorder that leads to an early death. Can be detected before birth and also through blood test screening of the parents. Also seen in Jewish people of central or eastern European descent.

High blood pressure. Even high blood pressure can be inherited, but exactly how is up in the air. Causes include how the body process sodium and sensitivity to stress.

High cholesterol. Some people can inherit a gene that interferes with their body's production of the different types of cholesterol. If untreated, can cause a heart attack in a person's 30s or 40s.

Glaucoma. An abnormally high pressure within the eye that can blind you. Although not always inherited, glaucoma can strike people of African ancestry more often than Europeans.

Diabetes mellitus. This is the common type of diabetes that affects so many people. An estimated 25 percent of the U.S. population may have a genetic tendency to develop this metabolic disorder. Untreated, diabetes can lead to heart disease, blindness, and even death.

A Word of Caution About Screening Tests. Not every screening test is 100 percent accurate. They can produce false positives (saying you have the disease when you don't) of false negatives (giving you a clean bill of health when you have a problem). So, because many medical procedures are inherently risky, you shouldn't charge off and get serious treatment such as an operation or chemotherapy on the basis of limited testing.

The key is to ask for repeat testing, or a different type of test, to confirm the initial scary result.

Checking Your Medical Records

If you're reading this book straight through, then it must have dawned on you that it would be a good idea to keep a family medical record. But very few us do.

Aside from a natural tendency to not want to dwell on disease, there are some structural reasons for this record-keeping cluelessness.

First, it's not always easy to obtain your medical records. Fewer than half of the states have laws specifically giving you the right to your records. And because so many of us move so often, it can be easy to lose track of which doctor gave you which treatment.

That's why it makes sense to start to keep your own records, either in a book published just for that purpose or in your own notebook.

For your reference, the 24 states that allow direct access to your medical records (and those of your children) are:

Alaska, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Indiana, Louisiana, Maryland, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New York, Oklahoma, South Dakota, Virginia, Washington, West Virginia, and Wisconsin. In Maine, Massachusetts, and Texas, your doctor has the option of giving you just a summary of your records.

What if your state isn't among the above? Don't give up. States without the access law aren't prohibiting access just remaining silent on the issue. Many medical practices will respond to a written request for records even if there's no state law calling for their release. Offer to pay a reasonable per page copying fee, say up to 50 cents per page. If you run into a roadblock, ask the office manager to put the denial in writing.

If you have a doctor willing to be your ally in this quest for records, there's a trove of information in the Medical Information Bureau, an organization that provides information to insurance companies. Unfortunately, the Bureau limits your access to nonmedical information, such as the names of the insurance companies that received a copy of your file within the last six months. But doctors can see the complete record, so if you have a doctor ally, ask her to write to the Bureau and request a copy of the form, "Request for Disclosure of MIB Record Information." Here's their address:

Medical Information Bureau
P.O. Box 105, Essex Station
Boston, MA 02112
(617) 329-4500

If you were treated by the military or a Veterans Administration hospital, then your right to see your records is guaranteed by the federal Freedom of Information Act.

Finally, if you have a really pressing need for a medical record, you may even want to pursue legal remedies such as hiring a lawyer to try to obtain a court order for the release of your records.

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Copyright 2008, Robert C. Goldberg