Big Health Check-up

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When Sue Shaw turned 50, she decided it was time to see her doctor. Not that there was anything wrong – she had always taken good care of herself and felt fabulous at 50. Rather, Sue had resolved that she would spend as many of the next 50 years as she could enjoying the best possible quality of life and knew a health check-up was the place to start. She had recently begun seeing a new GP with whom, she says, she felt immediately comfortable. “I just knew I wanted her to be my family doctor and I had no hesitation in seeing her for my first big health check” she says. Sue was right: it is extremely important to have a full check-up once you reach 50, not only to identify potential problems, but to establish baseline readings for a number of different measures. Annual health checks are then recommended. The Australian Medical Association (AMA) affirms the value of regular checkups, citing well-controlled trials that have resulted in a long-term reduction in mortality through early detection of some diseases.

At the GP

So what constitutes a health check? Generally, four basic elements: a medical history, physical exam, counselling on risk factors and a referral for further tests if required. Your medical history, particularly when seeing a new GP, should

be as comprehensive as possible. Information provided should include diet and exercise habits, alcohol and tobacco use, sexual behavior, family history of diseases and illnesses such as cancer, diabetes or heart problems as well as any symptoms you may be experiencing related to any health issue. The physical exam itself involves taking measurements of height, the loss of which can indicate an acceleration of osteoporosis. Weight is also noted, as unexplained gains may indicate heart, liver or kidney disease while losses can point to infection or even cancer. In combination with a measurement of waist circumference, height and weight produce a body mass index (BMI) which can then be monitored on an ongoing basis. A blood pressure reading will also be taken. Sue felt fortunate to have had her check-up when she did, as she was diagnosed with high blood pressure, requiring medication and some immediate lifestyle changes. It was relatively easy to take action and far better than waiting until it became a much more serious issue. Prevention is indeed better than cure. Expect your GP to check your mouth, ears, lymph nodes, thyroid, skin and abdomen for any abnormalities. They will most likely also listen to your heart, lungs and the carotid artery in your neck to identify problems such as a heart murmur or an obstruction in the lung. Women will have a breast examination and pap smear, which screens for cervical cancer, at which time the ovaries may also be checked. The influenza and pneumococcal pneumonia vaccination (two injections, five years apart) are recommended, particularly for anyone over the age of 65 or anyone over 50 who could be deemed high risk. After 50, you may also need the tetanus vaccine. Your annual health check provides an opportunity for your doctor to review any medications you may be taking, including those obtained ‘over the counter’. Before you go to your appointment, make a list of everything you are taking, including the doses, so nothing is forgotten. Your GP will order blood and urine tests to test cholesterol levels, vitamin D and iron deficiencies, diabetes, kidney problems or thyroid dysfunction. If you are a diabetic, your doctor should examine your feet and order additional tests for your blood sugar. Busy Melbourne GP, Dr Katrina Philip, estimates 50 per cent of her patients are over 50 and says many of the health checks she conducts for them are opportunistic. “Often if someone is seeing me with an ailment and I know they are due, I’ll do a full check as well,” she says. A good relationship with a GP, she says, is important. “Continuity of care over the years can be a real blessing – the GP will immediately notice if something in your appearance or demeanor has changed.” Your annual check-up is also an opportunity to discuss any emotional problems you are having. It is important to inform your GP of any feelings of sadness or lethargy. Do not underestimate the importance of your emotional health. In its submission to the 2008 Preventative Health Taskforce, the AMA highlighted the fact that GPs routinely incorporate prevention into their patient consultations as part of providing comprehensive ‘whole-of-patient’ health and medical care. It says GPs are uniquely positioned to provide patients with relevant information and advice when risk factors become apparent and to know when to refer, or recommend further action to their patients, in order to address risks early.

Other recommended tests

A baseline electrocardiogram (ECG) is recommended for both men and women around age 50. It should then be done at least every two to three years. In most circumstances there will be no out-of-pocket expense for this test. In the case of breast care, BreastScreen Australia is targeted specifically at women without symptoms aged 50-69, and is free. Mammograms should be conducted every two years after the age of 50. Annual screenings may be required for those with a personal or family history of breast cancer. The faecal occult blood test (FOBT), which began arriving in letterboxes around the country in 2008 as part of the Federal Government’s National Bowel Cancer Screening Program, tests for blood in stool samples. Research has shown that the risk of developing bowel cancer rises significantly in people over 50. Those turning 50 between January 2008 and December 2010, and those turning 55 or 65 between July 2008 and December 2010 have been or will be invited to screen at no cost; otherwiseexpect to pay around $30 for the test. If you’re over 50 you should undertake the FOBT once every two years; a positive test will require investigation via a colonoscopy. Menopause is a significant risk factor for women. A bone density test helps to determine the health of your bones. It is most often used when people have concerns about osteoporosis, any spinal deformity or a previous fracture. The first-line test simply involves placing your heel in an ultrasound machine and costs around $45. An annual dental visit will have long been part of most people’s heathcare routine, but its significance increases after the age of 50. The long-held belief that tooth loss is an inevitable part of the ageing process is a myth. Rather, it is simply the result of oral disease. The majority of people these days turn 50 with most, if not all, of their own teeth. Again,

prevention is always a better and cheaper option than cure. Unfortunately, the cost of dental treatment can be an issue for many Australians aged 50-plus. Commonwealth Seniors Cardand Health Care Card holders are entitled to free or low-cost dental care, however waiting times can be extremely long. If you have access to these services don’t wait until problems arise. Join the waiting list and use your visit as a preventative check-up. Another important component of your healthcheck should be a visit to a podiatrist. President of the Australian Podiatry Council, Brenden Brown, says research supports the view that more needs to be done to educate people about foot health. “The feet really are the ‘workhorse’ of the body, but many people forget that if they don’t care for their feet and overall health, their mobility will suffer and as a consequence, so will their ability to meet their work and family commitments,” he says. Podiatrists can treat skin disorders, corns and calluses, foot injuries and infections. Your eyes also require a check every two years if your vision is good, and annually if you are diabetic, have high blood pressure, or a family history of glaucoma. Glaucoma, a disease in which the optic nerve is damaged, is the leading cause of irreversible blindness worldwide and is more common as we age. Because it is irreversible, it is critically important to detect the problem as early as possible. A glaucoma test involves a check of the optic nerve with an ophthalmoscope, an eye pressure check and a visual field assessment test to determine the sensitivity of side vision, where glaucoma first strikes. Medicare covers an annual comprehensive eye exam for those at high risk for glaucoma.

Looking forward

Sue Shaw now knows she has fallen arches (treated with orthotics), high blood pressure (treated with medication) and a renewed determination to hold onto as many of her original teeth as possible (crossed fingers, floss and a good toothbrush). She also has the peace of mind brought by a relatively clean bill of health. Sue is adamant that she will continue to have the recommended annual check-ups – plus her next ‘big check’ in 50 years’ time.



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