Annual physical exam ought to focus on prevention
To Your Good Health
Q#1: What can an 80-year-old woman expect to have checked as part of an annual physical examination?
A#1: The annual physical exam has gotten bad press lately. Some of it is well-deserved: The actual exam occasionally finds unsuspected problems, but such a result is uncommon — and no proof shows that the annual physical saves lives.
That argument misses the point. The annual physical offers a scheduled time for important conversations about screenings and prevention. The exam includes checking blood pressure and considering a cholesterol screening (with cholesterol a less important risk factor in 80-year-old women than in men and younger adults). Similarly, it provides a time to reach a mutual decision on whether a mammogram should be done (again, with the evidence at age 80 unclear).
Most important, your doctor should do a depression screening, discuss ways to reduce the risk of falls and give advice on diet and exercise. People at high risk might need to have other labs checked or advice given. (People with high blood pressure, for example, should be screened for diabetes.)
The list is long; therefore , a dedicated visit for health promotion makes sense to me.
Q #1: An 80-year-old has as much right as any other age person for a complete ‘exam’ because flexibility and mobility are often a problem in the 80’s and 90’s. A disrobing should be standard procedure for a cursory visual examination, palpating any abnormalities which can be seen. A complex and thorough blood draw to reveal the working of all inner organs and systems should be part of the Gold-Standard at least annually. The medical profession as a whole is pretty firm in suggesting that mammograms really should have far less usage among the aged, all things c0nsidered.
So discussions of mammograms and over-hyped importance of cholesterol to my mind are a non-issue or can we say, an unnecessary drain on cost factors. Chest X-rays are also unnecessary if the stethoscope and the patients breathing appear to be normal. . why do it?
But first, before any of this starts, a fully clad patient aught to have the doctor’s attention, seated and comfortable to have a chance to tell the doctor of any new developments or changes recently noticed. OR, the doctor should open up this dialog to ascertain the possibility of a problem if patient hasn’t offered it. (One can get so used to the hurried doctor coming in late to waiting patient, standing, smiling, asking “what can I help you with?” This is not conducive to a good visit that might accomplish anything. Where is the caring, courtesy and time to build the trust which is necessary?
Since it’s pretty evident that “You are what you eat,” a whole lot of people aren’t eating right; how do I know that? Look at the visual evidence. We are a nation of sick, fat and frustrated people. Our food source is making us sick. The majority of the average middle-class people can’t afford to buy “organic food,” so they’re stuck between a rock and a hard place. Just today I heard the determination that the toxic chemical which MONSANTO uses to make ROUNDUP, which has now covered the entire earth, is finally being curtailed with this pronouncement. It IS a CARCINOGENIC! Tho it is without doubt, one of the worst – it is but one of thousands which our Big Shots in Washington have turned a blind eye to. Between all these ‘chemical companies’ and BIG PhRMA’s toxins — most don’t have a chance at health. We don’t need chemicals – we need natural and organic for health. We need to understand the logical rules for health, how and what to eat and why. This is and was always the domain of physicians, but not for 50 and more years now. STUFF CHANGES. Only a very few doctors have gone on to learn the basics of “nutrition” and it’s application in usage. . . and that one can’t have health without that knowledge. Yes, I dearly wish that doctors could discuss diet and nutrition with their patients — it could solve most of our problems. But Medicine is just another big business now, isn’t it?
As to questions of screenings and prevention – – really at age 80? Why? Flu shots? (to hasten their Alzheimer’s disease?) Breast tumors, cholesterol, diabetes, and now, ‘depression’ screening? At this age the spouse is generally gone, the kids have moved on and so many friends are are gone. So isolation is a major factor with the elderly. It should be criminal to ply folks who are lonely with pharmaceuticals and call this help. Only the medical profession is helped. All need others to care about them – that’s the way we are built. We each, no matter the age, need to find a purpose, a reason to be alive. Many find a new outlet, activity or endeavor to pour their energy into. All need motion and activity and a little pleasure and/or fun. Not everyone is inclined or able to give this precious gift to themselves, and in fact, would prefer to move on. But mostly, people do want to live. . .and even count for something. They just have to learn to how to think the happier thoughts, not dwell on the past which is gone, but live for today and to feel good about that. People need to do this for themselves – it’s a mind thing, attitude, and a whole lot of gratitude. JT
Q#2: I am a healthy, energetic 63-year-old woman who has had elevated RDW (red-cell distribution width) levels for the past few years. My doctor looked into the problem and did a ferritin panel. Although my B-12, folic acid, hemoglobin and hematocrit are normal, my transferrin saturation is low, at 6 percent, and my iron and ferritin are also slightly low. I give blood regularly and have stopped doing so for now.
What are some causes of my type of anemia, in which the red blood cell looks pale and undersized? We are treating it with iron supplementation and will retest it in three months, but I’m eager for any information to correct my numbers.
A#2: You have low iron, low ferritin and very low transferrin saturation (transferrin is a protein that moves iron around in the body, and a low “saturation” means that little iron is attached to the transferrin) — all of which are consistent with iron-deficiency anemia.
A high RDW number means that the cells in the blood are of many sizes. That happens with an iron deficiency.
Giving blood regularly could certainly explain an iron deficiency, especially if you don’t take in much iron through your diet. (Vitamin C, in food or as a supplement, enhances the body’s ability to absorb iron.)
Every time I see an iron deficiency in a man or postmenopausal woman, however, I ask myself whether the problem could be colon cancer or another form of gastrointestinal blood loss. I’ve written columns about people who were told they have colon cancer despite a normal colonoscopy.
A few weeks or months of iron should bring you back to normal. If it doesn’t, I would recommend that you look for a source of iron loss.
Q #2: One can’t quarrel with Dr Roach’s medical explanation of how this condition seems to develop which he says is consistent with iron deficiency anemia. What I do take issue with is the oral supplementation of iron which it is believed within a few weeks or months will restore the iron balance taking care of the problem. . . and if it doesn’t – – start looking for the source of iron loss. That of course could take a whole lot of tests and still not resolve the issue. Of course, I have a different opinion on what to do with this. We can’t expect to keep doing the same ole, same ole and then get a different result. Maybe the synthetic iron is not what the body is hankering for! I learned this for myself many years ago, with my experience with a with a widely-known healer I was lucky enough to be consulting.
When she told me to eat some beets every day, I protested – but I hate beets!. . .can’t I have some kind of pill? No she admonished, only fresh beets, eat some every day. You are iron deficient and synthetic supplements will not get the job done – it doesn’t work. I needed to be resourceful as I never ate beets, hated liver, but Mother made me eat it. So I learned how to make beet borscht from my mother-in-law (Oh my Gawd – it was sinfully delicious) I even eat it for breakfast when I make it as it is so yummy. I try to keep julienne sliced beets on hand. My latest good idea is to put about 1/2 a beet into a morning smoothie. Just scrub well and if not organic – peel it as well and add smallish chunks to your A.M. shake along with maybe a protein powder (I use a Pea Powder) and spinach or kale, and/or some kind of seeds (sesame, hemp, chia) – – the 1 T chia should be soaked about 15 – 20 ” to turn to gel, as according to David Wolfe – it greatly maximizes the effect because it absorbs water big time — and better to do that in a bit of water than from your body.
So if the body can’t utilize synthetics, but does recognize the real mc-coy (natural food), accepts and quickly, hungrily uses it, it should be no time to see results. It worked for me. JT
Dr. Roach answers letters only in his North America Syndicate column but provides an order form of available health newsletters. Write him at P.O. Box 536475, Orlando, FL 32853-6475; or ToYourGoodHealth@ med.cornell.edu .