A Woman’s Perspective: Patients Shouldn’t Fear Telling Doctors Their Health Concerns
When it comes to giving preventive health-care advice, it’s always important to consider a patient’s age and risk factors, including family history, environmental and work exposures, being from a certain ethnic group, and already have a health condition. Today, patients are increasingly encouraged to form a strong, honest, and communicative partnership with their health-care practitioner, one where both actively participate in the health-care process and collaboratively find the right solutions for the patient’s personal health. For example, all health-care providers agree that the most important preventable cause of premature death in the United States is smoking. Smoking is not an easy habit to stop, but studies show when patients ask their health-care practitioners for help and suggestions on ways to quit, their success rate dramatically increases. It may sometimes be difficult, embarrassing, or even awkward to talk to your health-care provider about specific symptoms, injuries, or issues that are putting your health and well- being at risk — especially those involving mental health, sexual intercourse, abusive behavior, or misuse of drugs and alcohol. In my women’s health-care practice, for example, some patients find it initially uncomfortable to ask about vaginal laxity, vaginal dryness, urinary incontinence, and painful intercourse. All are common and treatable situations, but some patients are unaware of this fact and do
not ask about these specific issues. All patients need to be encouraged to ask bold questions to their health-care providers during their annual health-care assessment. Most important, they need to come prepared and be proactive. Make a list of your concerns, even if you do not think they are important or possible to achieve. The American Heart Association recommends men and women receive the following screenings for managing their cardiovascular disease risk factors:
Blood Pressure
After age 65, women have a higher risk of high blood pressure than men, and African-American adults of all ages have a higher-than-average risk. High blood pressure usually has no symptoms and greatly increases your risk of heart disease and stroke. If your blood pressure is below 120/80 mm Hg, be sure to get it checked at least once every two years, starting at age 20. If your blood pressure is higher, your doctor may want to check it more often. The good news is that high blood pressure can often be controlled through lifestyle changes or medication.
Lipoprotein Profile
Older women tend to have higher triglyceride levels than men. Lifestyle changes and education can often help you control your cholesterol and triglycerides levels. Starting at age 20, a fasting lipoprotein profile should be taken every four to six years. This is a blood test that measures total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol, and triglycerides. You may need to be tested more frequently if it is determined that you’re at an increased risk for heart disease or stroke.
Body Weight
It is estimated that two out of every three adults are obese or overweight. This condition puts a person at higher risk for health problems, including stroke, high blood pressure, heart disease and diabetes. Starting around age 20, your body mass index (BMI) and composition should be taken to determine whether you’re at a healthy weight and if you’re facing a higher risk of obesity-related illnesses, like type 2 diabetes and heart disease. BMI becomes less useful as you age. Most people lose muscle mass and gain fat as they get older, so you have a higher risk of being “skinny fat” at a healthy BMI the older you get. BMI isn’t always a good fit for healthy and muscular people either—your BMI might be considered overweight or obese, even though you have low-fat levels. According to the Centers for Disease Control and Prevention, a healthy BMI ranges from 18.5 to 24.9 (That’s 125 to 168 pounds for a 5-foot, 9-inch person.) Ideal body composition goals depend on gender; women need more body fat than men for childbearing. In general, a body composition that’s more than 32 percent fat is considered obese for women; for men, the cutoff is 25 percent body fat.
Blood Glucose
High blood glucose levels put you at greater risk of developing insulin resistance, prediabetes and type 2 diabetes. High blood sugar usually comes on slowly. It happens when you don’t have enough insulin in your body, if you eat too much, or if you don’t get enough exercise. Sometimes medicines for other problems may cause high blood sugar. Blood glucose levels that remain high over time can damage your eyes, kidneys, nerves, and blood vessels. Starting at age 45, you should have your blood glucose level checked every year with a fasting plasma glucose test and a hemoglobin A1c test (this measures the amount of glucose on your red blood cells and gives an average of your blood glucose control over two to three months). Using the fasting plasma glucose test, a level between 100 and 125 mg/dl indicates prediabetes, while a level between 70 and 99 mg/dl is considered “normal.” For someone who doesn’t have diabetes, a normal A1c level is below 5.7 percent. Today there are many avenues to health care and preventive health care, including conventional medicine offering standard practices, integrative medicine offering a whole person approach, Ayurveda practices, acupuncture, nutraceuticals, and homeopathy. Whatever option or approach you take, remember that preventive health care always includes good nutrition, sleep, and exercise habits. The Buck Institute for Research on Aging recommends a low-glycemic, low-grain diet to minimize inflammation, as well as to maximize antioxidants in your diet through fresh vegetables and fruits, including blueberries. The Buck Institute also recommends being tested for specific vitamin levels including Vitamin D—long known to strengthen bones and prevent rickets, vitamin D may also be important for preventing age-related diseases, according to ongoing Buck Institute research. Also recommended — taking a multivitamin as directed on bottle each day, getting eight hours of sleep a night, and 30 to 60 minutes a day of exercise four to six days a week. What are some ways to get the most out of your annual health assessment and physical? One way is to keep copies of your past lab reports and results. Having this kind of information readily available helps you see what things are changing in your body. If you see any shift is occurring, for example in your blood sugars or cholesterol levels, you and your doctor can address them together. Another way to get the most of your annual health examination is to simply expand your knowledge. Empower yourself to research and have a deeper discussion about your own health situations with your health-care provider. Probably the most important way to get the most of your annual health assessment is to clearly communicate your personal healthcare preferences; it does not matter what your preferences are, it matters that you discuss them with your practitioner and feel comfortable doing so.