Checkups and a few special tests can be one of the greatest gifts you give yourself.
What’s Different Now?
You’ll need to see your health care professional more frequently now that you are in your 50s, plus you’ll have to have some new preventive tests and screenings to keep your health in check.
If you are at high risk or have a family history of medical problems, or you have serious medical conditions, you’ll need specialized care and additional tests beyond the basic recommendations.
Checkups and a few special tests can be one of the greatest gifts you give yourself. Your doctor can tell a great deal about your health by talking to you, looking at you, and examining certain areas of your body.
Whether you are seeing a gynecologist and/or a family doctor for your routine check-ups it is important that you know exactly what you need — and what to expect. Young women tend to see a gynecologist for their regular check-ups as they have been “programmed” to get an annual Pap test and breast exam.
After childbearing, many women stop going to a gynecologist (too many women think that after childbearing they no longer need a Pap test or gynecologic exam) and rely on their family doctor to do all the routine exams — both general and gynecologic. Yet too many family doctors are already overwhelmed with “too much to do and too little time” that many important tests can get missed or fall under the radar screen.
Some women, on the other hand, see both a gynecologist for their gynecological exams and a family doctor or Internist for their general check up and screening for chronic conditions such as heart disease and cancer. So for many women, no one doctor takes care of it all — so it is up to you to see that you get all the tests you need — at the right time and on time.
Add to that the fact that no one doctor today can keep up with all the latest information about everything — the importance of the new HPV test along with the Pap test is a case in point.
Have a Complete Physical
It can take a physician at least an hour or more to provide a thorough evaluation to a woman who needs both a comprehensive history and physical evaluation including a pelvic exam. When was the last time a doctor spent an hour or more with you?
Make sure that you tell the receptionist that you are coming for a complete physical so that they schedule enough time and come as prepared as possible so that you get all care and attention you need.
Guidelines For Preventive Health Screenings and Immunizations in Your 50’s
Here are guidelines for preventive health screenings and immunizations generally recommended for healthy women in their 50s:
General Physical Exam
This includes taking a detailed history to learn all about you and your family history and a head-to-toe physical exam including an exam of your skin, eye, ears, nose throat, lymph nodes, chest, breast, abdomen, rectum and extremities. Make sure you get a breast exam and rectal exam and stool check for blood by your family doctor if you are not examined yearly by a gynecologist as well.
Obesity screening is now considered a preventive checkup. Ask your health care professional for more information on healthy weight guidelines or weight-management strategies.
Waist circumference (WC)
Women with increased WC are at increased risk of metabolic syndrome, diabetes, heart disease and cancer of breast and uterus.
BMI (measure of height and weight): much less reliable estimate of future health risk than WC and body shape.
Test forhypertension: Have your blood pressure taken at least every two years if normal; more often if it is at or above 120/80.
Bone Mineral Density Exam/Bone Mass Measurement:
This is recommended for women who have sustained a fracture, are at increased risk due to certain medications or have diseases or conditions that are known to be associated with bone loss.
This test is an x-ray, also called the DXA scan, which measures your bone density. The lower your bone density, the greater your risk for bone fractures. (There is also a much less accurate heel ultrasound test that does NOT diagnose osteoporosis but merely tells your doctor whether you are at risk and should have the more complete x-ray DXA scan test.)
The DXA scan is considered the gold standard for the diagnosis of osteoporosis. The most important score or result to check is your T-score. The T-score tells you how your bones compare to that of a healthy 35 year old woman. If your T-score falls between -1 and -2.5 then you have mild bone loss called osteopenia. If your T score is -2.5 or lower, than you have osteoporosis and a significant increased risk of fractures.
Some health care professionals suggest doing a breast self-examination each month. However, research has shown that BSE plays a small role in finding breast cancer compared with finding a breast lump by chance or simply knowing what is normal. If you choose to perform a monthly BSE, ask your health care professional to show you how to perform one.
Clinical Breast Exam
You should talk with your health care professional about getting this exam. Screening recommendations vary on whether this is beneficial in combination with a mammogram, so talk with your health care provider about whether it’s right for you. If so, your doctor or other health care professional will examine your breasts for any abnormalities, often as part of the annual gynecologic examination.
Colorectal Cancer Screening
Women 50 years and older should be screened for colorectal cancer using any of several screening methods. There are a number of tests that screen for colorectal cancer, and they are divided into two groups: tests that find both colorectal cancer and polyps, and those that mainly find cancer.
The American Cancer Society recommends that women at average risk of colorectal cancer have one of the following screening tests beginning at age 50:
Tests that find polyps and cancer:
Colonoscopy every 10 years
Flexible sigmoidoscopy every five years
CT colonography (virtual colonoscopy) every five years
Double contrast barium enema every five years
(If any of the above tests are positive, a colonoscopy should be done.)
Tests that mainly find cancer:
Fecal occult blood test (FOBT) every year
Fecal immunochemical test (FIT) every year
Stool DNA (sDNA), interval uncertain
Discuss options and procedures with your health care professional to determine the best screening method for you.
A baseline EKG to assess your heart’s electrical activity should be done by age 50. IF you are at increased risk for heart disease, ask for a special CT scan, stress test using a heart ultrasound or special dye to get more accurate pictures of your heart.
Tip: Ask your doctor to reduce the size of your printout on a copy machine. Then carry it with you in your wallet along with your emergency health card. Also keep a copy in your binder or folder for future reference. If you need emergency care, a copy of your old EKG compared to a new one will help your doctors decide how best to treat you.
Make sure you understand the purpose of every exam or test your doctor orders for you. Because everyone is different you must be sure to talk with your doctor about your specific treatment goals.
In addition, keeping an ongoing log of any tests or procedures you’ve had and recording the information in your calendar will help remind you to schedule regular checkups such as mammograms and a cholesterol check.
Visit the dentist regularly. Check-ups can detect early signs of oral health problems and bone loss. Professional tooth cleaning is also important for preventing oral problems and should be done every six to 12 months.
You should be screened every three years; more often or earlier if you’re overweight or have other risks for diabetes.
The American Academy of Ophthalmology now recommends that starting at age 40, adults with no risk factors or signs of eye disease get a baseline screening. Then based on the results of that initial screening, an ophthalmologist will prescribe the necessary follow-up exams.
For people of any age with symptoms of eye disease or risk factors such as diabetes, high blood pressure, or family history of eye problems, the academy recommends they see an ophthalmologist to determine how often they should have their eyes examined.
Beginning at age 40, you may be offered an annual mammography to screen for breast cancer . Guidelines on breast cancer screening vary, so talk to your health care professional about what’s right for you. Some doctors prefer to begin screening at age 50 or only offer it every two years.
A mammogram is an x-ray that can detect breast cancer early; often before a lump can be felt. It is best to schedule this test a week after your period, a time when your breasts will be least tender and glandular.
If you are taking Hormone therapy after menopause your breasts may appear more glandular or dense from the hormones. Ask your doctor about stopping the hormones a few weeks before the scheduled test. Women over 50 should have this test yearly. Women at high risk for breast cancer should ask about a digital mammogram and an MRI.
Pap Test and Pelvic Exam:
Get a Pap test every three years or both a Pap test and an HPV test every five years. The Pap test screens for abnormalities that could indicate pre- or early cervical cancer.
If you have risk factors such as previous abnormal screening results, multiple sex partners, a weakened immune system, DES exposure in utero or HIV infection, you should have a Pap test every year. Talk to your health care professional about what’s right for you.
If you have had a total hysterectomy (removal of both your uterus and cervix), you may stop having cervical cancer screenings, unless the surgery was done as a treatment for cervical cancer or precancer. If you had a hysterectomy without removal of your cervix, you should continue to follow the guidelines above.
Remember: Don’t confuse your annual or semiannual Pap test with a gynecologic examination. The American College of Obstetricians and Gynecologists (ACOG) recommends that all women your age have a gynecologic examination, including a pelvic exam, annually.
Sexually Transmitted Diseases
If you have a history of chlamydia or other sexually transmitted diseases (STDs), or you or your partner have had multiple sex partners, ask your health care professional about whether you need to be screened for STDs, including gonorrhea and HIV.
Skin Exam for Skin Cancer
The American Academy of Dermatology recommends that you have your skin examined by a dermatologist every year. Recommendations include doing a monthly mole self-exam and practicing sun safety to reduce your risk of damaging your skin and developing skin cancer. If you have had skin cancer or have a relative with a history of melanoma, ask your health care professional for guidance.
Melanoma, the most serious form of skin cancer, is reaching epidemic levels thanks to excessive sun exposure and loss of the protective ozone layer. It is important that you get a head-to-toe check of your skin on an annual basis.
An overnight fast or fasting sample is critical. Your blood contains a great deal of information about your health. When your doctor orders the lab to run a complete series of tests, you can find out about the status of your liver, your thyroid, your blood cholesterol, your blood sugar and much more.
A Complete blood count (this is optional)
This is the most common blood test. Your doctor may order it as part of a complete physical examination. He’ll also order it before you have surgery and if you have unexplained and continuing symptoms. The complete blood count (CBC) measures the number, size and shape of the different types of cells in your blood.
Women at increased risk for metabolic syndrome and heart disease (women with waist circumference over 35 inches) should ask for a C-reactive protein test – and important test of blood inflammation and marker of future heart disease risk.
Blood Chemistry Tests
A single sample of your blood serum can be used to run a series of tests quickly and inexpensively.
The following explains the most commonly requested tests:
Glucose can indicate diabetes if your level is high or hypoglycemia if it’s low. A fasting glucose of less than 100 is normal, a level of 100 to 125 is abnormal and called “impaired glucose tolerance” and a level of 126 or greater means diabetes.
Blood Urea Nitrogen and Creatinine are tests of your kidney function.
Sodium, Potassium and Chloride are blood salts or electrolytes. These tests are especially important if you are on diuretics (“water pills”) for hypertension or heart disease.
Uric Acid is a waste product of all cells. An elevated level may mean kidney disease or gout.
Albumin is a blood protein produced by your liver. A low albumin count can be a sign of liver or kidney disease.
Globulin is a blood protein produced by your immune system. A high count can point to chronic inflammation, infection or blood disorders such as multiple myeloma.
Calcium is a component of your blood that helps all the cells in your body function normally. Your blood calcium level has nothing to do with how much calcium is in your bones. A high count can point to a disorder called hyperparathyroidism, which predisposes you to kidney stones and low bone density.
Serum Glutamine Pyruvic Transaminase (SGPT) and Serum Glutamate Oxaloacetate Transaminase (SGOT) are enzymes (proteins) produced primarily by the liver. SGOT is also produced by red blood cells.
Lactate Dehydrogenase (LDH) is an enzyme produced by many cells of the body. If this test is extremely high, your doctor will want to do additional tests, depending on your specific complaints to rule out a malignancy.
Bilirubin is the chemical in bile that gives it the yellow color. If the bile passages from the liver to the intestine are blocked, your bilirubin level will be high. Possible causes include gallstones and liver disease.
Gamma Glutamyl Transpeptidase (GGT) is an enzyme produced by the liver. Obesity and excessive alcohol use are the most common reasons it can be mildly increased. It will also be elevated when there is blockage of bile and with liver disease.
Alkaline Phosphatase is an enzyme produced by the liver and bones. If it is abnormal (elevated), looking at the GGT (see above) will help determine the source. If the GGT is elevated as well, the liver is the culprit.
Blood fats or blood lipidsAlso called lipids, these are often listed together in a separate “panel” on your blood chemistry report. Sometimes only the total cholesterol and perhaps the triglyceride level will be listed if your doctor didn’t specifically request results for the lipid panel. However, you need all your numbers in order to make the best evaluation for heart disease.
Total cholesterol is the sum of your LDL and HDL (see below). High total cholesterol levels are linked to heart disease. The lower your total cholesterol the better. A total below 200 is desirable.
High Density Lipoprotein (HDL) is your “good cholesterol”. Remember, “high density should be high.” The more of this type, the better. Ideally, your HDL cholesterol should be at least 30% of your total amount. In men, an HDL greater than 40 is normal; in women, an HDL greater than 50 is normal.
Low Density Lipoprotein (LDL) is your “bad cholesterol”. Remember, “low density should be low”. A high LDL puts you at risk for heart disease; your doctor will suggest diet and often medication to get your LDL cholesterol below 130. If you have diabetes or heart disease already, your treatment goal for LDL cholesterol should be below 100.
Triglycerides are the other form of fat in your blood. The level will be much higher after a meal. If your level is out of range it should be repeated after an overnight fast. Elevated levels increase your risk of heart disease and could be a sign of early diabetes. Ideally they should be under 150.
Recommendations vary. The American Thyroid Association recommends having a TSH screening test at age 35 and then once every five years.
Note that mood changes (anxiety or depression) can indicate that your thyroid is out of whack. Also, according to the Mayo Clinic, an elevated blood cholesterol level can be a symptom of hypothyroidism. The American Thyroid Association explains that “When thyroid hormone levels are low and TSH levels are increased (hypothyroidism), cholesterol levels are increased.” So treatment for hypothyroidism may also help to lower cholesterol levels.
Ask your health care professional for guidance.
This vaccine is recommended for adults who live, work or travel in areas where hepatitis A is endemic and periodic outbreaks occur, or users of injection or street drugs, military personnel, institutionalized persons and those working in those institutions.
The Hepatitis B vaccine is recommended for all adults at high risk for infection; high-risk individuals include injection drug users and their sexual partners; anyone with a history of multiple sexual partners in the previous six months or who has recently acquired a sexually transmitted disease; recipients of certain drug products; individuals with a health-related job with frequent exposure to blood or blood products; and travelers to countries where hepatitis B virus (HBV) is of high concern.
Have a yearly influenza vaccination.
You need one to two doses if you smoke or if you have certain chronic medical conditions.
You should have tetanus-diphtheria booster shots every 10 years.
An advisory panel of the U.S. Centers for Disease Control and Prevention recommendes that all adults 50 and older receive the new two-shot vaccine, Shingrix, which is 97 percent effective in preventing shingles in people 50 to 69 years old, and 91 percent effective in those 70 and older. Check with your doctor to see if this vaccine is recommended for you.
New – The HPV Test Now For Women Over 30
Women over thirty and that means women 50 and over too, should ask for the human papilloma virus (HPV) test along with the Pap test, also called the DNAwithPap™ test or the HPV test with Pap test.
This combination of tests is now recommended for women over the age of thirty because a positive HPV test could mean you are a chronic carrier of the virus that is the sole cause of cervical cancer and therefore at increased risk of cervical cancer — and may require additional tests and treatment of any abnormal cells caused by the virus. Women in their twenties commonly acquire the virus but it doesn’t persist because their immune system fights it off.
Since cervical cancer is caused by the human papilloma virus, having a negative HPV test and a Pap test is very reassuring and virtually guarantees that you are not at risk for cervical cancer over the next few years.
If both tests are negative which will be the case for 95% of women over 30, then you can safely get the HPV and Pap test every three years instead of annually.
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Women over 50 should maintain good relationships with their doctors and keep regular medical appointments. Early detection is key for the successful treatment and management of health concerns, so get screened and be proactive.
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