Your Health Checklist
by Roberta Lee, MD (topic expert: health)

Signs of spring often bring to mind new beginnings and assessments of what you'd like to accomplish in the next few months.

My colleague, Dipti Itchhaporia, a cardiologist and Director of Disease Management at Hoag Memorial Hospital Presbyterian in Newport Beach, Ca., makes a point that just as we maintain and check our cars, we should maintain and check our bodies.

As our guest writer this month, she asks, what is the maintenance checklist to keep in mind when you see your doctor? Keep in mind, that when your doctor performs each of these screenings, make sure you ask him the results and what they mean so you can become more aware and in charge of your health.

With regards to heart disease screening, the doctor will test your blood pressure, cholesterol, and blood sugar. The blood pressure should be screened starting at the age of 18 and then should be evaluated annually. BP comes in 3 categories: Normal is 120/80; pre-hypertension (HTN), or high blood pressure is 120-139/80-89. Stage I HTN is 140-159/90-99, Stage II HTN is 160/100 and above.

Beginning at the age of 20, the blood cholesterol should be tested. If normal, it should be tested every 5 years. Normal cholesterol is as follows: total cholesterol of 200 or less, HDL of 40 or higher, LDL of 130 or lower.

Diabetes Screening is routinely performed starting at the age of 40-45 and is done by checking a fasting blood glucose (sugar) level. Diabetes screening should be done at an earlier age in someone who is overweight or has a strong family history of diabetes. Normal blood glucose is 100mg/dl. Pre-diabetes is blood glucose of 110-125. Diabetes is blood glucose of 126mg/dl or greater. There is no consensus as to the age or frequency of testing for diabetes.

In screening for colorectal cancer, colonoscopy is performed starting at the age of 50 and then every 10 years. Colonoscopy is done earlier or more frequently in those with a history of polyps or those with a family history of polyps or colon cancer.

Total body skin examination is important for skin cancer screening. In general, screening starts at the age of 50. It is performed earlier in those with family history, excessive sun exposure, fair skin, or if a change in moles or freckles is seen. The American Cancer Society suggests a total body skin exam every three years from ages 20-40, and then annually from 40 up, though there is not a consensus on screening.

Review of vaccinations is important. A tetanus booster is given every ten years. A pneumonia vaccine is given beginning at the age of 65 and should be repeated.

If you are female, screening for breast cancer and cervical cancer is important. The American Cancer Society and the American College of Obstetrics and Gynecology advise that mammogram screening for breast cancer should be done initially at the age of 40 and then annually. But the National Cancer Institute suggests starting at age 50. Breast exams should be started at the age of 20 and done annually. Pap smears and Pelvic exams screen for cervical cancer and should be done annually beginning at the age of 18. If you are over the age of 30 and have had three consecutive normal paps, you can decrease screening to every three years.

For the males, testicular exams are important for the young men ages 15-40.  Beginning the age of 50, digital rectal exam is done to screen for prostate cancer. A prostate-specific antigen (PSA) blood test is done starting at the age of 50 and then annually. A PSA is recommended at the age of 40-45 for black men (because of the higher frequency of prostrate cancer in this group) or men with a family history of prostate cancer.

This is a brief guideline of health care maintenance that most physicians follow. This is a good starting-point for routine examinations, but these need to be tailored based on an individual's history, complaints and family history.