HealthLeader: The Owner’s Manual (for Your Body)

Posted on Wednesday, August 18th, 2010

STORY BY
Camille Webb
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Change the oil every 3,000 miles. Rotate the tires every 6,000. The owner’s manual for our vehicles is filled with lists and schedules that inform us when to do the routine tune-ups to maximize the life of our cars.

So, where’s our owner’s manual? Below is a maintenance schedule to keep you motoring along at peak performance, maximizing the life of… you.

Read on as Carman Hall Whiting, MD, assistant professor of family and community medicine at The University of Texas Medical School at Houston and UT Physicians family practice physician takes us through our personal maintenance schedule.

Babies and Kids

When does a child need regular/scheduled doctor’s appointments (well-child exams)?
With an emphasis on health maintenance and prevention, a well-child exam is a visit designed to evaluate the overall well-being of the child, Whiting says. Visits include physical examinations, measurements of height, weight and head circumference (in infants), needed immunizations and state recommended screening exams (lead exposure, hemoglobin and hematocrit, as well as cholesterol screening in high-risk children).

As a parent, think of these scheduled appointments as opportunities to ask the doctor questions about your child’s growth, development and milestones. Come prepared with a list of questions.

A child will have more well-child exams in his first year of life than at any other time. The American Academy of Pediatrics (AAP) recommends the following schedule for routine well-child visits:

• 3 to 5 days
• 1 month
• 2 months
• 4 months
• 6 months
• 9 months
• 1 year
• 15 months
• 18 months
• 2 years
• 30 months
• 3 years
• 4 years
• Each year after that until age 21

What are the signs a parent should look for in a sick child that warrant a trip to the doctor’s office?
Taking a sick child to the doctor may seem like a no-brainer, but Whiting says it depends highly on the symptoms of the child, past medical history (i.e. chronic medical conditions) and age. However, she offers a few guidelines to help parents determine whether to make a phone call to the doctor for guidance or an actual visit.

• Infants younger than 3 months should be seen by a doctor if their temperature is greater than 100.4. There are no exceptions to this because babies can have life threatening illnesses.
• For children ages 3 months to 4 years, consider the child’s symptoms and behavior along with the fever.
  • A fever greater than 102.5 warrants a call to the doctor’s office to determine whether a visit is necessary.
  • If the child has a fever but is active when given medication to bring down the fever, eating and drinking normally with cough and symptoms of a cold, then it is likely a viral illness that will run its course in a week to 10 days.
  • If the child is less active, sleepy, not eating or drinking well with even a low-grade fever, a trip to the doctor is warranted.
• In older children, the same general guidelines apply as for children from 3 months to 4 years.
• When in doubt, it is always a good idea to call the doctor’s office for guidance.

When should a child have a hearing test?
It’s likely a child’s first hearing test was as a newborn in the hospital. However, if a newborn did not have this initial screening because of a home birth or other reason, the Nemours Foundation recommends a hearing screening within the first three weeks of life. Beyond that, the Nemours Foundation recommends hearing evaluations for children at routine well-child checkups with hearing tests at ages 4, 5, 6, 8, 10, 12, 15, 18, and any other time if there’s a concern.

Is it safe for children to receive vaccines?
Myths abound about the safety of vaccines for children, often leading to unnecessary anxiety for parents who may question whether to have their child immunized.

According to the AAP, the American Academy of Family Physicians (AAFP) and the Centers for Disease Control and Prevention (CDC), vaccinations have significantly reduced the occurrence of transmittable diseases and reduced the morbidity and mortality associated with these diseases, Whiting says.

“Vaccinations are rigorously tested by the Food and Drug Administration to ensure their safety and efficacy,” she adds. “The data from required testing is again reviewed by the CDC, AAP and AAFP to ensure their safety before they are given to children. There is also a database that collects information regarding serious reactions and side effects associated with their use.”

Whiting says vaccines are indeed safe and one of the best ways to protect children against a number of transmittable diseases that may cause serious illnesses in children.

Most well-child appointments coincide with needed immunizations. The CDC posts an up-to-date schedule of immunizations for children and adolescents.

Teens and Young Adults

When does a girl need her first gynecologic visit and what can she expect?
Once a girl turns 13, it’s time for her to see an adult physician, namely an obstetrician-gynecologist or OB/GYN. In fact, the American College of Obstetricians and Gynecologists recommends girls have their first gynecologic visit with an OB/GYN between ages 13 and 15.

Just like her changing body, a girl may wonder what will happen at this initial visit. Whiting says a girl can expect to have questions answered relevant to her growth and development, including puberty and hormonal changes.

“This is a very good time to have questions answered regarding sexual health, menstrual cycles, the prevention of sexually transmitted infections and pregnancy prevention,” she says. “If a girl has painful periods, unusual vaginal secretions or lower abdominal pain, this visit will be a good time to discuss these issues as well. If a girl is not sexually active and does not have any of these problems, it is very likely a vaginal examination will not be necessary.”

When do teens need a sports physical and why is it important?
Up until high school, a standard physical is probably the norm at an adolescent’s yearly health check. However, once a teen becomes interested in playing sports competitively, the rules of the game change. Before becoming an athlete, a teen needs a sports physical to be free and clear to participate in team sports or sports-related activities.

The American College of Sports Medicine notes that generally high school, college and professional sports teams have a formal requirement for annual sports physicals for athletes.

Whiting says a sports physical protects the health and safety of the player. “The sports physical focuses on family history of heart disease that resulted in early death or other risk factors that may require additional examinations before one is cleared for participation,” she explains. “These may include dizziness, shortness of breath or fainting after sports related activities. The physical exam portion of a sports physical focuses primarily on the vital signs, cardiac, musculoskeletal and neurological exams to detect abnormalities that require further testing.”

Should young adults have their cholesterol screened and when?
Because high cholesterol increases a person’s risk for heart disease, the National Heart, Lung and Blood Institute recommends cholesterol screenings at age 20 and older for everyone. Adults should continue to monitor their cholesterol levels with screenings at least once every five years.

Adults

How often does a woman need a Pap smear?
By looking for changes in the cells lining the cervix, a Pap smear can identify if a woman has an infection, abnormal cervical cells or cervical cancer. Just like a pelvic exam, a Pap smear (or Pap test) often is part of a woman’s routine well-woman exam with her OB/GYN.

Most women can follow these guidelines from the National Women’s Health Information Center about the frequency of a Pap smear:

• Starting at age 21, have a Pap test every two years.
• If you are age 30 and older and have had three normal Pap tests for three years in a row, talk to your doctor about spacing out Pap tests to every three years.
• If you are over age 65, ask your doctor if you can stop having Pap tests.

When does a woman need her first mammogram?
The American Cancer Society recommends women have a mammogram (x-ray pictures of breast tissue at different angles and magnifications) to screen for breast cancer at age 40 and once a year thereafter, as long as they are healthy and well. Screening mammograms help detect breast cancer early in women with no signs or symptoms of the disease and at a time when it is most treatable. While screening mammograms start at age 40 for most women, women with risk factors for breast cancer should start earlier.

Whiting notes the difference between a screening mammogram and a diagnostic mammogram. “A screening mammogram consists of four views of the breast and is done as a method to screen for abnormalities that are undetected on clinical and self breast exams,” she explains. “A diagnostic mammogram consists of six views of the breast and is usually ordered if there is an abnormal finding in the breast such as a lump, pain or as a result of an abnormal screening mammogram.”

When does a man need his first PSA test?
Just as a screening mammogram helps find breast cancer early in women, a PSA test serves that same purpose for a man but by detecting prostate cancer in an early and treatable stage.

Prostate-specific antigen, or PSA, is a protein produced by cells of the prostate gland. A problem such as a cancerous growth in the prostate causes more PSA to be released into the bloodstream, so that it reaches a level where it can be easily detected in a sample, according to the Prostate Cancer Foundation. By measuring the level of PSA in a blood sample, a PSA test helps to identify if prostate cancer is present.

The medical community differs widely as to when a man should have his first PSA test. The National Cancer Institute says some practitioners advocate yearly screening for men over age 50, and some advise men who are at a higher risk for prostate cancer to begin screening at age 40 or 45. However, most medical experts would agree that the best decision to begin PSA screening is the one that’s made between a doctor and his patient.

When do adults need their first colonoscopy?
For some adults, the mere mention of the word “colonoscopy” makes them cringe. Be it the fear of the procedure itself or the dreaded prep work, it’s hard to feel comfortable with a procedure that brings the large intestine up close and personal.

Despite the stresses that may go along with having a colonoscopy, it still serves as a person’s best defense in finding colon cancer. Whiting agrees.

“The most valuable information regarding a colonoscopy is its ability to detect precancerous polyps or cancerous polyps early to aid in the diagnosis and treatment of colon cancer,” she says.

Whiting suggests having a consultation with the physician performing the test to help alleviate some anxiety. “It also may be a good idea to talk to others who have had a colonoscopy to help answer some questions regarding your experience,” she adds. “It may help to have a friend schedule his or her test around the same time. Going through the experience together may make it less anxiety provoking.”

The National Institute of Diabetes and Digestive and Kidney Diseases recommends adults have a routine colonoscopy at age 50. Screening for colon cancer should begin earlier in those with a family history of the disease, a personal history of inflammatory bowel disease or other risk factors.

When do adults need a bone density test?
By measuring calcium and minerals present in bone mass, a bone mineral density (BMD) test is the preferred diagnostic for osteoporosis – a condition marked by weak, fragile and porous bones often leading to a person’s increased risk of fractures.

Women have a greater risk of developing osteoporosis due to the rapid bone loss that occurs following menopause, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. A person’s risk for osteoporosis is linked to other factors, too, including old age, being small and thin, being a white or Asian woman, a family history of the disease, diets low in calcium and vitamin D and sex hormone deficiencies.

The National Osteoporosis Foundation recommends a bone density test for those thought to be at increased risk for osteoporosis:

• Postmenopausal women under age 65 with one or more risk factors
• Men ages 50-70 with one or more risk factors
• Women age 65 or older and men age 70 or older
• Women or men over age 50 with a broken bone
• Women going through menopause with certain risk factors
• Postmenopausal women who have stopped taking estrogen or hormone therapy

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