 |
Preventive
Medicine Can
Save Your
Life
A Review
For Adults Over
40 |
|
For most us going to the doctor has to rate as one of life’s most unpleasant experiences. To be honest even doctors hate to go to the doctor. With the possible exception of discovering a pregnancy the best result for most of us is that the only good news will be no news. We have to miss work and sit in the medicine filled odorous patient room waiting for the doctor after having sat in the waiting room forever. It’s no wonder we usually just go when we absolutely have to find some type of relief for an offending symptom. Visiting the doctor’s office when we feel fine would seem to have a low priority at best for most of us.
Most of us also live in a state of denial about our health and lives. We do not like to admit we will get older and undoubtedly face some diseases in our lives as time moves forward. However, it’s becoming clearer that early detection of disease by medical screening may have potentially profound effects not only on our lifespan but also on the quality of our everyday lives.
Since most screening procedures are very low risk it would seem rational for everyone to have every screening test possible on a frequent basis to prevent disease. However, the reality is that there is a fixed budget for health care overall in society such that if all the resources were used for screening none would be left for treatment. Therefore due to limited availability of resources medical screening is used where its is seen to be effective in changing the outcome of disease by early detection and is also reliable at detecting the disease process developing.
It is becoming more common place for highly insured CEO’s of major corporations, professional athletes, entertainers, and of course the President of the United States to undergo “executive physicals” looking for hidden disease. Part of these reason this is done for “key” personal is that insurance companies require it for high priced “key man” policies and they know that early detection of disease can in least in these cases save them money. One of the difficult questions to be answered has been however for the general population is whether such screenings would reduce overall health care expenditures and be justified by a financial savings argument. As recently as a report published in the New England Journal of Medicine in February 2008, there is no convincing evidence that preventative medicine will overall for society as whole reduce our health care expenditures. However, and this is very important, “they may still be worthwhile because they confer substantial health benefits relative to their cost.” Most importantly, the ability to detect a disease early enough in its course to save a life or prevent disability may be dramatic for an individual. Continuing medical research has resulted in consensus among physicians that certain preventative procedures may for the individual have significant impacts on their health.
It is beyond the intent of the writer to give every recommendation for every situation to the reader. I strongly advise that every reader discuss preventative measures with his or her own physician but we will review some major points in this article. According to the National Center for Health Statistics the leading causes of death in the United States ranked in order are heart dis-
ease, cancer, stroke, chronic lower respiratory disease (lung), accidents, diabetes, Alzheimer’s disease, Influenza/Pneumonia, Nephritis, nephritic syndrome, and nephrosis (kidney), and Septicemia (blood infection). Lets examine what someone over age 40 can do reduce their risk from these maladies.
Heart Disease and Stroke
A physician at the bedside can listen to the heart for abnormalities in rhythm and sound to detect treatable abnormalities. The measurement of blood pressure can reveal hypertension (high blood pressure), which can be totally without symptoms. Recently it has been shown that even what was thought previously to be only mild hypertension if left untreated can create significant risks over time. Blood pressure should be measured about every two years routinely. A fasting blood test to detect fractionated lipid profiles (meaning fat and cholesterol) may reveal an asymptomatic condition of metabolism, which has increased risk for stroke or heart disease. More recently computer imaging technology of the coronary arteries and other major arteries of the bodies has been advocated by some as a means of detecting risk of heart disease. Although there is no clear-cut consensus on this approach it should be noted that such procedures are essentially low risk. Advocates of these procedures point out that 57% of people who die from their first heart attack had no previous knowledge of their heart disease so that if they had undergone these procedures that might have lead them to more preventative measures. Men over age 40 and post menopausal women should discuss with their physicians the potential benefit of taking low dose aspirin to reduce their risk of heart disease.
Cancer
Mammography every year for women with breast cancer risk factors and every two years can detect breast cancer often in early enough stages to allow effective treatment. Some women may require specialized further testing depending upon their history. One of the greatest tragedies of modern medicine is that many women out of fear or misguided cultural ideas do not undergo this type of screening. Similarly Pap smear screening for cervical cancer should be done in a matter determined by woman’s risk for cancer. If she has normal smears for many years this interval can be increased. Although the risk of cervical cancer is less in elderly women than younger women it is now recommended that women aged 65 years and older who have a new sex partner resume routine screening.
One of the most neglected screening procedures is screening for colorectal cancer. Early detection of colorectal cancer can reveal precancerous lesions, which can be cured while the cancer if unscreened may not create symptoms until it is very advanced and the prognosis fatal. For people with African ancestry the screening should begin at age 45 for others at age 50. There has been some controversy over exactly what procedures are best but generally speaking a radiological procedure alone is not as good as undergoing a direct examination using a scoped device placed directly in the colon. Although this is uncomfortable, patients can be sedated for the procedure and it only very rarely has complications. New tests detecting specific DNA markers for cancer as well as the older test for “occult” or hidden blood in the stool can also be helpful but do not substitute for direct examination.
|
 |
|
|
Lung Cancer and Lung Disease
Early detection for lung cancer in smokers remains a challenge. Some types of lung cancer progress very rapidly by the time they become detectable while others may be more responsive to treatment. It should be remembered that once a smoker stops smoking, they would over time reduce their risk of lung cancer and lung disease. The overwhelming cause of lung disease is smoking. Remember that you can lose up to 70% of your lung function if you live a sedentary lifestyle before major symptoms of lung disease occur. By that time however every small incremental loss of further function becomes critical so that a person may rapidly go from being short of breath with a brisk short walk to requiring oxygen all the time even when just sitting. The point is to stop smoking before you have any symptoms.
Accidents
Thousands of people die every year in car accidents because they do not wear their seat belts for that little trip down the street to the neighbor store. Not only on the road, however, can people die from an injury. Slips in the bathroom kill many elderly people so it is imperative that safe footing and handrails be installed for any one with any physical impairment that put them at high risk. Alcohol, mishandling of medication, handling of firearms, working on roofs, drowning, and other things which people will continue to do are all needless ways to end a useful life.
Alzheimer’s Disease
Dedicated research by the world’s greatest scientists continues into the causes and treatment of Alzheimer’s disease. I will in a future article go into detail about this disease. What is very important to know is that not all mental problems in older people are due to Alzheimer’s disease. Diseases of the endocrine glands like the thyroid, diabetes, and even depression can be a primary cause of brain dysfunction. Elderly people with brain dysfunction should be thoroughly evaluated by a neurologist to determine the cause. Often a medical condition can be identified which can be effectively treated or at least controlled. Otherwisehealthy people can be expected to have relatively normal brain function into there nineties so one should never just attribute it to “old age”. For those who do suffer from “Alzheimer’s Disease” diagnosed by a neurologist there are effective treatments, which for many patients can slow down the progression of the disease and maybe improve function in the early stages.
Influenza/Pneumonia
The yearly flu vaccine should be given to elderly people over age 65 and many younger people with chronic illness. The flu develops in Asian bird populations every year and then spreads about the world every winter. Scientists make an educated guess about which three viruses will be the dominant ones every year. Since it can vary every year, a new vaccine is required yearly. This protects against a virus. In addition there is a vaccine against bacterial pneumonia caused by pneumococcus. It is recommended that this be repeated every 5 years beginning at age 65. It is important to remember that the yearly viral vaccine and the pneumococcal immunization are two different entities, which do not cross protect. People over age 65 and sometimes younger depending on the circumstances as determined by your doctor need both.
Nephrosis, Nephrotic Syndrome
Diabetes and hypertension play a large role in the development of kidney disease. Hispanics have a much higher incidence of diabetes than is found in the population as a whole. It is very important to tell your physician if there is a family history of diabetes. Many patients unfortunately neglect to follow their doctor’s recommendations for treating diabetes in the early stages because they have minimal symptoms. The price for this can be costly as permanent damage to the brain, eyes, and kidneys can progress without symptoms until significant dysfunction has occurred. Close medical follow up and treatment of diabetes can reduce the risk that a diabetic will suffer kidney failure and require dialysis.
Septicemia
The elderly and chronically ill are especially at risk for bacterial or fungal infection, which can get into the blood stream. Today most patients are diagnosed with infection in early stages before such a severe condition can occur. It is not unusual unfortunately for physicians to see an elderly person with limited transportation and few people checking on them to present to the emergency room in such a state who live alone. Because they do not want to be a bother, lack transportation, or fear medical costs, they may allow a treatable infection to progress to life threatening. The hallmark symptom of this condition is confusion and amazingly there may be no fever.
Of course only providence knows what will happen to each individual in the future, but as you can see, you can reduce your risk of suffering many diseases or at least their severity by proper preventive measures. If you live a healthy lifestyle and follow good preventative measures your chance for long and enjoyable life is greatly enhanced. Do not let feeling uneasy about undergoing a colonoscopy or mammography deny your right to live. Know that if it is discovered that you have diabetes, early heart disease or cancer that in many cases effective treatment can be given that will lengthen and improve your life. Most of us have a loving and caring family for whom our well-being is important. Not undergoing preventative measures is as irresponsible to them as if you were playing the Russian roulette game in the movie “Deer Hunter”.
Tony Barclay Editors Note: Tony Barclay is a retired physician and Harvard graduate who enjoys writing on health and other issues.
|
|
|
