A few weeks ago, I compared health care maintenance to scheduled car maintenance. I urged people not to wait until something goes wrong. Your car has a list of things to check at major tune-ups, and you do, too. So let’s get down to what is necessary and when. Just as with a car, you can change your tires every year but that would be expensive, and in most cases unnecessary.
There isn't one schedule that works for all ages, genders and lifestyles. I'll stick to recommendations I feel have the most bang for the buck.
When you visit your health provider, expect to discuss smoking cessation if you smoke or methods of safe sex if you are sexually active. Regular exercise (at least 30 minutes a day, preferably one hour) of walking—at a minimum—is great. If older, or unstable, fall prevention is wise. Depression screens and a risk assessment for diabetes are prudent. A brief screening for substance use (starting with alcohol), and other risky behaviors (HIV) is good in the form of a questionnaire. Seat belt and helmet use (bicycle, skateboard and skiers) should be encouraged. Some people older than 45 are advised to take a daily aspirin (81mg) to reduce heart disease.
Update the tetanus and pertussis booster (Tdap) every 10 years. Everyone should get annual flu shot. Hepatitis A and B can be considered, as can MMR (measles, mumps, rubella), varicella and shingles vaccines. HPV vaccines (Gardisil) are good for younger women to prevent cervical cancer. Pneumovac should be considered for health care workers and patients over 65 or who have a chronic disease.
Testicular self-exams for men (especially teens through 20s), skin checks for new or growing moles/spots, breast exams (for new dimples, masses, etc.) are debated, but any new or changed symptoms should prompt a discussion with your health provider.
Height, weight, blood pressure and body mass index (a measure of obesity) should be checked yearly. A focused history, based on risk patterns can lead to additional tests or a more specific physical.
Teachers, health care workers and immigrants should receive a tuberculosis test. Check cholesterol at age 40, or earlier if a family history exists. Also screen for colon cancer (fecal occult blood, sigmoidoscopy or colonoscopy all can be used).
Start PAP screens at age 21 or within three years after sexual intercourse. Cervical cultures for infection (chlamydia and gonorrhea) can be helpful. Start mammograms at 50, or 40 if there is a family history. Osteoporosis screening usually begins around age 50 or 60, but depends on risk factors.
Aortic aneurysm screening for smokers or men with hypertension usually begins around 65. Prostate screening can be discussed at age 40 or older (most studies fail to show that treatment yields appreciable benefit in longevity).
Health providers might vary in what they recommend. As with owning a car—there is a responsibility to do upkeep. I encourage you to bring this list to your next appointment. People with special conditions may require more—or less—so always check with your health provider. Inquire if there are other recommendations, and do your part to keep your vehicle running as safely and smoothly as possible.
Dr. Pepper practices family medicine at the Martinez Health Center.
Healthy Outlook is written by the professional staff of Contra Costa Health Services, the county health department. Send questions to series coordinator Dr. David Pepper at firstname.lastname@example.org. For more health information, go to www.cchealth.org.