Prevention is one key to living a long, healthy life. Specific medical tests and procedures, done at various life stages, can help keep your body in sound working order. In this guide, local experts shed light on what you can do now to improve your health in the long run.
Youth has its Advantages
Ages 18 to 25
While youth certainly has its pleasures, adulthood brings responsibilities, and these include being proactive about health. Young adults should take steps (starting at age 18) to make sure they are on the right track to a lifetime of wellness.
During that annual physical, the following tests or procedures should be conducted:
Blood pressure: High blood pressure, often called “the silent killer,” can lead to heart attack and stroke, two leading causes of preventable death in the United States. Studies show one in four U.S. adults has elevated blood pressure. If high blood pressure is discovered early, it’s most often reversible through preventive measures like proper diet and exercise.
Cholesterol: This should be tested by age 20.
Body Mass Index (BMI): Dr. Christine Browning, a cardiologist at Richmond’s Bon Secours Heart Institute, says that at this point in life, a healthy weight is important to pave the way for a future of health. “Know your weight and BMI. A healthy BMI range is 20 to 25,” she says.
Immunization booster shots: In addition to an annual flu shot, young adults should get booster shots for tetanus, diphtheria and whooping cough. Many colleges also require the meningococcal vaccine.
Beyond the annual physical, consider these additional tests:
Testing for sexually transmitted diseases (STDs): According to Atlanta-based Centers for Disease Control and Prevention (CDC), STDs such as Chlamydia, gonorrhea and syphilis are on the rise among young adults. Those who are sexually active should consider STD testing.
Eye exam: Dr. Joel Zaba, an optometrist in Virginia Beach, says many 18- to 25-year-olds are off at college or graduate school this fall, where many hours are spent reading textbooks and using computers. “It is not enough to test whether you can see far away, like the board in the classroom,” he says. “It is also important to know if you can see a computer screen 16 inches away.”
Annual Pap test & breast exam. For women ages 18 to 25, a clinical breast exam needs to be performed annually by a physician, according to Domenick Casuccio, communications director for the American Cancer Society in Virginia Beach. This requires lying on your back with arms up while the doctor examines your breasts for any abnormalities. (An obstetrician/gynecologist typically does this during an annual exam.) Women should also have a cervical cancer screening (Pap test) every year beginning at age 21 or within three years after having intercourse, whichever comes first.
Testicular cancer screening. For men, a clinical testicular cancer screening should be performed by a physician at every physical, according to the American Cancer Society. This is the most common type of cancer among young men, notes the CDC. “It can happen later in life but is [more prevalent] at this age,” Casuccio adds. “It is also a very curable form of cancer.”
While many in this age group are transitioning from high school to college, or from college to the “real” world, and it can be an exciting time, it can also be a mental health challenge, says Dr. Joel Silverman, professor of psychiatry at Virginia Commonwealth University (VCU) School of Medicine in Richmond. Depression can happen at any age, he explains, and if symptoms such as fatigue, sadness, or change in appetite occur, it is important to get help. Silverman stresses the importance of establishing both an exercise and social routine now to set the stage for a lifetime of emotional wellness. “It is important to not become a couch potato [at this age],” he says, because life gets more challenging as we gain more responsibilities. After that happens, it’s “harder to establish a routine,” he says.
Stay on the Right Track, And Make Changes Early
Ages 26 to 39
Glucose: Abnormal glucose tests are an early indicator for diabetes. Along with the tests, your doctor should take into consideration certain other risk factors such as being overweight, having no regular exercise routine and having a family history of diabetes. Even if a glucose test rules out diabetes, people with other risk factors should understand what those factors mean for their health. As Terrina Thomas notes: “You may not have diabetes now, but if you are overweight, don’t exercise and have a family history [of the disease], then it’s time to be aware and make behavioral changes.”
Calcium: Calcium scoring is recommended for adults ages 35 to 45 who are concerned about their risk of heart disease, Dr. Christine Browning says. A calcium score can indicate early stages of plaque in the arteries; if either of your parents had heart disease, you may need this test starting at 35. Calcium scoring does expose the patient to a small amount of radiation, so repeat screening is not recommended year after year. In some cases, though, your doctor may wish to retest in five to 10 years to assess the effectiveness of preventative treatments or to re-evaluate your risk, says Browning.
Breast health: Most women are advised to have a baseline mammogram starting at age 40 (see next section), but women considered to be at high risk due to a family history of breast cancer may be urged by their physician to begin screening in their 30s.
Pap test: For some women, the need for an annual Pap test might wane. Current guidelines set forth by the American College of Obstetricians and Gynecologists (ACOG) say women age 30 and older can limit screenings to once every three years if three consecutive tests appear normal and there’s no history of abnormal results.
Lordy, Lordy, Your Body Changes at 40
Ages 40 to 49
A stress test is recommended if you are tired throughout the day and easily get short of breath, Browning says. “It is not normal for people at this age to be short of breath or frequently tired.” People with these symptoms may need to consider lifestyle changes and should talk with their doctor about how to make those changes, she says.
Because the eyes begin to change around 40 or 50, an eye exam is recommended. “You start to lose being able to focus close up,” says Dr. Joel Zaba. Because computers are so prolific, many people are focusing daily on three levels: close up (12 inches away, such as reading this article), computer viewing (about 16 inches) and distance viewing. Bifocals are useful for the two traditional levels of close-up reading and distance, but not computers. “If you are focusing on three levels, then it is time to consider a separate prescription for just computer viewing,” Zaba says.
Don’t ignore your mental health. Family, work and other obligations can cause much stress during this time. Sometimes long-term goals or expectations have not been reached. “This can lead to people feeling like failures,” Silverman says, leading to the proverbial mid-life crisis. “People get desperate and do things like quit their jobs or end their relationships,” he notes. “They take risks and do things that are not [well thought out]. However, [these are] often [signs of] a mental health problem, and these individuals need to have a psychiatric evaluation and treatment.”
Get a baseline mammogram at age 40. In late 2009, the U.S. Preventive Services Task Force released new guidelines suggesting mammograms could be delayed until age 50 for some women. The backlash from physicians was huge. Women should remember this: the American Cancer Society, and an overwhelming majority of U.S. doctors, still recommend that all normal-risk women have a baseline mammogram at age 40. “Our position is based on research and data that we have examined,” asserts Casuccio. “We are always reviewing our position and so far we have not found enough evidence to change it.” Dr. Angela Parsons, an obstetrician and gynecologist with Bon Secours DePaul Medical Center in Norfolk, agrees. “The [ACOG] still believes that 40 is the proper age to have a [baseline] mammogram unless there is a first-degree relative (parent or sibling) who has had breast cancer. Then [the patient] should have it sooner.” (See our coverage of the mammogram screening controversy in the March 2010 edition, available online at thehealthjournals.com.)
Incontinence can become an issue for women at this age, especially those who have had a baby, and it does not have to be, says Dr. David Glazier, a urologist with Virginia Urology in Richmond. “People expect it is a normal part of aging, but it is not,” he says. “There is a lot you can do to help it.” Before talking to your doctor about it, he suggests keeping a three-day diary on what you drink, how much and how many leaks you experienced. “Sometimes it is just a matter of too much caffeine,” he says.
Your thyroid produces hormones needed for metabolism. Aging, especially in women, can wreak havoc on these hormone levels, causing a variety of problems. Women should get a thyroid test at age 45 unless there is a problem earlier in life such as an irregular menstrual cycle and repeat it every five years.
At age 45, African-American men specifically, and any man with a family history of prostate cancer, should begin early screening for prostate cancer. (Refer to next section for the exact type of tests.)
When It Comes To Medical Tests, 50 Isn’t So Nifty
Ages 50 to 65
When you hit the big 5-0, the poking and prodding begins.
Tests for colon cancer should happen now. There are several options to screening for colon cancer. During a colonoscopy, the doctor uses a long, thin tube with a camera attached to search the colon for polyps and other abnormalities. If polyps are found, they can often be removed during the colonoscopy. Unless there is a history of certain types of polyps or a family history of colon cancer, this test isn’t necessary again until age 60.
If a colonoscopy is not done at 50, then either a flexible sigmoidoscopy or a CT colonoscopy (also known as a virtual colonoscopy) should be performed every five years. The flexible sigmoidoscopy allows the doctor to see bleeding, inflammation, unusual growths and ulcers in the lower third portion of the colon. (It does not reach the other two-thirds of the colon.) CT colonoscopy requires no sedation and is similar to a regular colonoscopy in that the entire colon can be viewed. However, this method doesn’t show bleeding. While these two tests are less invasive than a colonoscopy, if a possible problem is detected, then a colonoscopy will be performed regardless. It is for this reason that some experts recommend the colonoscopy above other tests.
In addition to the above tests, a double contrast barium enema may be performed every five years (starting at age 50) to help screen for colon cancer.
The best way to decide which test or combination of tests is right for you is to discuss the options with your physician, taking into account your family history and lifestyle. Notes Casuccio: “If you do not smoke, but do eat healthy, exercise often and have no family history of cancer, then one of these two tests might be an option. The best approach is to talk with your doctor and be honest about your lifestyle.”
Consider Vascular screening starting at age 50. This is a real-time ultrasound of the carotid arteries in the neck and the abdominal aorta (the large blood vessel in the belly), and it also checks blood pressures in the legs to look for signs of peripheral vascular disease. It is quick, simple and painless and can alert you to early disease before you have symptoms. This can be done with your local cardiologist or a traveling company, typically around $150 to $200 out of pocket. People with peripheral arterial disease have a three-fold increase of risk for heart attack and stroke, Browning says.
His and Hers
>Women should continue with annual
mammograms as well as Pap tests (as directed by their physician). Thyroid tests should be repeated at this age, Parsons says. Women with certain risk factors may also need to be screened early for osteoporosis (see next section).
>Men should have a baseline prostate specific antigen (PSA) blood test by age 50, according to most sources. However, some doctors recommend that men at higher risk of prostate cancer—African-American men or men with a family history of prostate cancer—start screening earlier. (Note: The American Urological Association released new guidelines last year recommending a first-time test at age 40, with the schedule of follow-up testing to be determined by the patient’s physician.) Using a scale of zero to four, men with a PSA level 2.5 or lower may only need to be retested every two years. Screening should be done yearly for men whose PSA level is higher than 2.5. Notes Glazier: “We look to see if [a patient’s] number…is rising over time. If it does, then we can conduct further tests.” (September is Prostate Cancer Awareness Month; see our related article online at www.thehealthjournals.com.)
Ages 65+
Immunizations: Seniors should receive a pneumonia vaccine, according to the CDC. They should also have the one-time Zostavax vaccine, which reduces the risk of shingles, a long-term painful condition that stems from the reactivation of the varicella zoster virus, the same one that causes chicken pox.
Be heart healthy: Your heart will be in its best shape if you continue to get your cholesterol, blood pressure and body mass index checked at least once a year, and also avoid tobacco use and maintain regular physical activity, Thomas says.
Review your medications. Browning says this is the time to keep medications in check to insure the doses meet the body’s changing needs. For instance, if you are taking medication for high blood pressure, have your doctor evaluate the dosage at every visit.
See your eye doctor. For your eyes, continue with regular exams, unless your optometrist sees a problem. It is also time to check for cataracts, Zaba says.
Check your balance. “This is the age that many seniors suffer from broken bones due to falls,” Thomas says. For this reason a balance test should also be administered.
Get screened for depression. According to the American Psychological Association, depression is not a normal part of aging, yet it is not uncommon among the elderly. Often it occurs with other illnesses such as heart disease, stroke, diabetes, cancer and Parkinson’s disease. Many older adults face these types of illnesses along with social and economic issues. Remember: depression is a treatable disease. Lack of treatment may delay recovery from those serious illnesses or even worsen them. Says Silverman: “I have seen people in their 70s who have not needed to seek help [for depression] before, but need to now because of the changes in their lives, such as limited physical abilities and other aging issues.”
Screen for osteoporosis. The bone-density test, called dual-energy X-ray absorptiometry (DXA), is needed to screen women for osteoporosis. If the results are good, then women 65 years and older can wait two years before the next one. However, women who have a family history of osteoporosis or low body weight should consider this test earlier than 65 under the direction of their physician. Women who do not use hormone therapy are at increased risk for osteoporosis, Parsons says.
Written By Susan Smigielski Acker
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