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Body Check/Annual Physical

Body Check

What is annual physical?

In our clinic, annual physical is defined as part of a high quality, evidence-based preventive care.  This is very different from the packaged annual examination. Research has shown that providing high quality, evidence-based preventive care can help people live healthier (The Guide to Clinical Preventive Services 2006 by The Agency for Healthcare Research and Quality (AHRQ)). http://www.ahrq.gov/clinic/pocketgd/gcps1.htm

What is the basis of annual physical? 

Annual physical (defined as EVIDENCE BASED Preventive Care) should be based on health risk of each individual, as assessed by medical & family history, & medial physical examination.  It should be emphasized that these basis are very different from the that of the commonly available packaged examinations.  In fact, indiscriminate provision or use of commonly available packaged examination may lead to false alarms, necessitating expensive and sometimes risky follow-up tests.  These tests should also DO NO HARM to those being tested.

It should also be strongly emphasized that all tests should be performed by suitably medical professionals.  The accuracy & reliably of all tests depend on who are providing & interpreting these tests.  Radiographic examinations should be interpreted by specialist radiologists with clinical histories provided by the clinicians.  Blood should be tested in certified laboratories.  One should be reminded that there are costs on performing tests.  Most biochemistry tests are done by automated equipment with biochemistry tests kits.  Apart from the costs of the equipment, the test kits costs money.  In fact, there is a minimum cost to each test, due to the cost of the test kits.  Providers who are providing tests at exceptional low fee may be cutting corners.  Similar rationale applies to other tests, including radiologic tests.

Screening tests can find diseases early when they are easier to treat.  There are many screening tests.  There are many diseases.  Fortunately, for any individual, the risk of developing certain disease depends on age, genetics, & environmental factors.  This means that the choice of screening tests should be tailor made to each individual.  This also means that medical history should be the first step before requesting any medical tests.  This also means that packaged examinations are less likely to be effective in finding early disease.

Preventive tests are meant to detect several categories of diseases

l          Cancer

l          Infection

l          Metabolic disorders: including obesity

l          Functional disorders, including hypertension

Cancer

Almost all parts of the body, except hair, may suffer from cancer.  However, only a limited number of cancers account for the majority of cancers in the population.  Also, age, genetic makeup, & environmental factors, largely determine the type(s) of cancer one can get.  So, one should tailor made the screening tests for each individual. 

The frequency or time interval between tests, for a particular screening test is usually determined empirically. However, one can better understand the basis of this frequency with the knowledge of doubling time of cancers.  Doubling time is the time for cancer to double in volume.  One assumes exponential function adequately describe cancer growth.  In the case of cancer, this function is expressed as 2N, where N is the number of doublings.  Doubling times of cancers are generally between 30 and 500 days (median 100 days).  It is generally accepted, for most conventionally available radiographic equipment, that the threshold volume for detection of cancer is about 1 cc. From a single cancer cell, it would take about 30 doubling times to reach a volume of 1 cc. This has important implications for frequency of screening tests, & the time interval from the existence of one cancer cell to a recognizable tumor.  For breast cancer, the average doubling time is about 100 days (in fact, it ranges from 30 to 1000 days), it takes about 8 years for one cell to grow to 1 cc.  Also, with larger cancer, the faster it will increase in volume.   Some cancers grow fast & some grow slow.  Unfortunately, there are variable doubling times or growth rates, even with cancer arising from the same organ. 

Infection

Healthy individuals in developed countries are less likely to become infected, except for sexually transmitted infections.  In developed countries, infections are usually among at risk individuals.  These include immuno-compromised individuals

In Asian countries, hepatitis & tuberculosis deserve serious consideration.  There are a large number of hepatitic infections.  The more common & serious ones are hepatitis B & C.

Metabolic & Functional Diseases

These include obesity, diabetes, hyperuricemia, hypercholesteremia, & hypertension.

Special consideration should be given to smoker.  Smoker is increase risk of a lot of diseases

Smoker

Smokers die an average of 13 to 14 years earlier than non-smoker.  Cancers related to smoking include cancer of the bladder, esophagus, larynx, lung, mouth, & throat. Recently, smoking is also linked to acute myeloid leukemia and cancers of the cervix, kidney, pancreas and stomach. Smoking also has been linked to chronic lung disease, chronic heart and cardiovascular disease, reproductive problems, abdominal aortic aneurysm, cataracts, periodontitis and pneumonia.

What are SCREENING TESTS?

Screening tests are designed to find diseases early in the course of their development. These tests should be cost effective.  These tests should also be effective in finding disease when they are present (high true positive rate) & in not finding abnormality when they are not present (high true negative rate).  Most importantly, these screening tests should DO NO HARM to those being examined.

Screening Tests for Cancers

The following is a summary of the commonly prescribed screening tests for cancer

 

Those at Risk

AHRQ recommended Screening Tests

AHRQ recommendations

Special Considerations

Other Tests

Brain

l          Vinyl chloride exposure

l          Tumor suppressor genes abnormality

l          Multiple endocrine neoplasia type 1

l          Neurofibromatosis type 2

l          Retinoblastoma

l          Tuberous sclerosis

l          Von Hippel-Lindau disease

   

Those at risk may need regular MR examinations

l          MR

Bladder

l          Dye factory

l          Rubber factory

l          Smoker

l          Urine tests

l          BTA

l          NMP22

Not recommended

 

l          cystoscopy

Breasts

l          Family history

l          Positive breast biopsy

l          First childbirth after 30

l          Mammography with or without ultrasound

l          Once every or every other year for those over 40

l          Genetic tests: BRCA1 &2 in those with paternal or maternal family history

l          MR

Blood

l          Radiation

l          Chemotherapy

l          Down syndrome

l          Myelodysplasia

l           

l           

l           

l          Blood tests

Cervix

l          Cervical dysplasia

l          High risk sexual activity

l          HPV infection

Pap smear: once every 2-3 years

All sexually active women who are under 65

 

l          MR

Colon & rectum

l          Familial polyposis

l          Ulcerative colitis

l          Family history of colon cancer

l          Colonoscopy: once every 10 years

l          Barium enema: once every 5 years

l          Occult Blood: once every 5 years

All over 50

   

Liver

l          Hepatitis

l          Alcohol abuse

l          Cirrhosis

     

l          Ultrasound

l          CT

l          MR

Lung

Smoker

l          Low Dose CT

l          Chest xray

l          Sputum cytology

Smoker

High radiation dose & high false positive with LDCT

 

Lymphoma

l          EBV infection

l          Immunosuppressed

l          Radiation

     

l          Xray

l          Ultrasound

l          CT

l          MR

l          Blood Tests

Nasopharynx

l          EBV infection

l          Nitrates exposure

     

l          Serology

l          Endoscopy

l          MR

l          CT

Oral

l          Tobacco users with or without alcohol use

l          Direct oral examination

     

Ovary

l          Family history of ovarian cancer

l          Ca 125

l          Pelvic ultrasound

l          Pelvic examination

   

l          MR

Pancreas

l          Hereditary pancreatitis

l          Ultrasound

l          Serologic markers

   

l          CT

l          MR

Prostate

l          Family history of Prostate cancer

l          Digital examination

l          PSA

 

Maybe PSA once every 1 or 2 years

l          Ultrasound

Skin

l          Intermittent intense sun exposure

l          Self examination

     

Stomach & Esophagus

l          Helicobacter infection

l          Gastroesophageal reflux

l          Obesity

     

l          Barium study

l          Endoscopy

Testes

l          Undescended testis

l          Atrophic testis

l          Self examination

   

l          Ultrasound

Thyroid

l          Radiation

     

l          Ultrasound

Uterus

l          Early menarche (beginning menstruation before age 12)

l          Hormone replacement therapy (HRT) with exogenous estrogen (i.e., without progesterone)

l          Late menopause (after age 52)

l          Presence of an estrogen-secreting tumor (e.g., some types of breast cancer)

l          Nulliparity (having never given birth) or low parity

     

l          Ultrasound

l          MR

Screening Tests for Metabolic & Functional Tests

 

Those at Risk

AHRQ recommended Screening Tests

AHRQ recommendations

Special Considerations

Other Tests

Aortic aneurysm

l          Male over 65

l          Smoker

l          ultrasound

Male over 65

 

l          MR

l          CT

Cholesterol

l          Obesity

l          Diabetes

l          Hypertension

l          Family history of heart disease.

l          Smoker.

l          Blood Tests

     

Coronary artery disease

l          Obesity

l          High cholesterol

l          High uric acid

l           

     

Diabetes

l          Obesity

l          Family history of diabetes

l          High blood pressure

l          High cholesterol

l          Blood glucose

     

Hypertension

         

Obesity

 

l          BMI

     

Osteoporosis

  • thin and small body frames;
  • Family history of osteoporosis
  • Personal history of fracture as an adult;
  • Excessive alcohol consumption;
  • Lack of exercise;
  • Diet low in calcium;
  • Low estrogen levels
  • Amenorrhea
  • Chronic inflammation,
  • Immobility
  • Vitamin D deficiency;
  • heparin (a blood thinner), phenytoin (Dilantin) and phenobarbital, and long term use of oral corticosteroids (such as Prednisone).
     

l          DEXA

Peripheral arterial disease

l          Diabetes

l          High cholesterol

l          High Blood Pressure

l          ankle brachial index

   

l          Ultrasound

l          MR

l          CT

Stroke

l          Diabetes

l          High cholesterol

l          High Blood Pressure

     

l          MR

Uric Acid

       

l          Blood test

Screening Tests for Infections

 

Those at risk

AHRQ recommended Screening Tests

AHRQ recommendations

Special Considerations

Other Tests

Chylamdia

l          Under 25 sexually active

 

l          Under 25 sexually active

   

Gonorrhea

l          Sexually active females with sexually transmitted disease

 

l          Sexually active females with sexually transmitted disease

   

Hepatitis

l          Sexual partner with hepatitis

l          Living in endemic areas

       

HIV

·         Male homosexuals.

·         Unprotected sex with multiple partners.

·         Injection Drug Abuse

·         Exchange sex for money or drugs or have sex partners who do.

·         HIV-infected sex partners ].

·         Had sexually transmitted diseases.

·         blood transfusion between 1978 and 1985.

       

TB

l          Immunocompromised

l          TB contact

     

l          Sputum tests

l          Chest xray

l          CT

What are the present recommendations?

For generally healthy individuals, after consultation with their doctors, the following screening tests should received priority

 

Adult male

Adult female

Children

Special Situation

Abdominal Aortic Aneurysm, Screening

+

+

 

Present of Past smoker 65 years or over

Alcohol Misuse Counseling

+

+

   

Aspirin for the Primary Prevention of Cardiovascular Events

+

+

 

All with risk for coronary artery disease

Bacteriuria, Screening for Asymptomatic

     

All Pregnant Women

Breast Cancer, Chemoprevention

     

Women at high risk for breast cancer and at low risk for adverse effects of chemoprevention

Breast Cancer, Screening

 

Over 40 years old

   

Breast and Ovarian Cancer Susceptibility, Genetic Risk Assessment and BRCA Mutation Testing

 

+

 

Women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes for genetic counseling and evaluation for BRCA testing.

Breastfeeding, Behavioral Interventions to Promote

 

+

 

Pregnant & Nursing Women

Cervical Cancer, Screening

 

+

 

Women who have or had sex

Chlamydial Infection, Screening

 

+

 

Sexually active women

Colorectal Cancer, Screening

Over 50

Over 50

   

Depression, Screening

+

+

 

Where clinically indicated

Diabetes Mellitus in Adults, Screening for Type 2

+

+

 

Those with hypertension or hyperlipidemia.

Diet, Behavioral Counseling

+

+

 

Adults with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease.

Gonorrhea, Screening

 

+

 

All sexually active women

Gonorrhea, Prophylactic Medication

   

ocular topical medication for all newborns against gonococcal ophthalmia neonatorum

 

Hepatitis B Virus Infection, Screening

 

+

 

Pregnant women at first prenatal visit

High Blood Pressure, Screening

+

+

   

HIV, Screening

+

+

+

All adolescents and adults at increased risk for HIV infection and all pregnant women

Lipid Disorders, Screening

Over 35

Over 45

 

Younger adults with other risk factors for coronary disease

Obesity in Adults, Screening

+

+

   

Osteoporosis in Postmenopausal Women, Screening

 

Over 65

 

Over 60 for those women at increased risk for osteoporotic fractures

Rh (D) Incompatibility, Screening

     

Blood typing and antibody testing at first pregnancy-related visit.

Syphilis Infection, Screening

     

Persons at increased risk and all pregnant women.

Tobacco Use and Tobacco-Caused Disease, Counseling to Prevent

+

+

+

 

Visual Impairment in Children Younger than Age 5 Years, Screening

   

+

 

What should one do to improve one’s well being?

The most important things you can do to stay healthy are:

  • Get recommended screening tests.
  • Be tobacco free.: See the following websites: http://www.smokefree.gov & http://www.healthfinder.gov/
  • Be physically active: Start small and work up to 30 minutes or more of moderate physical activity most days of the week.
  • Eat a healthy diet: Take more fruits, vegetables, whole grains, & fat-free of low-fat milk & milk products.  Lean meats, poultry, fish, beans, eggs, & nuts are preferred.  Saturated fats, trans fat cholesterol, salt, & added sugars should be avoided
  • Stay at a healthy weight: Reduce food & beverage calories gradually.  Also, increase physical activity gradually

·         Drink alcohol in moderation: Have no more than two drinks a day. (A standard drink is one 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits.)

  • Take preventive medicines if needed

Screening Tests for Men: What You Need & When

The U.S. Preventive Services Task Force recommends, based on scientific evidence, testing for the following conditions. It is important to consult your doctor on which & when these tests should be taken

·         Obesity: body mass index (BMI) (BMI is a measure of body fat based on height and weight.) Normal BMI is listed in the National Heart, Lung, and Blood Institute website at: http://www.nhlbisupport.com/bmi/.

·         High Cholesterol: Check cholesterol regularly starting at age 35.  Check should be done on younger at risk individuals

o        diabetics.

o        high blood pressure.

o        Family history of Heart disease

o        Smoker.

·         High Blood Pressure: Check blood pressure checked at least every 2 years. High blood pressure is 140/90 or higher.

·         Colorectal Cancer: Check for colorectal cancer tarting at age 50. Earlier, if one has a family history of colorectal cancer

·         Diabetes: Those with high blood pressure or high cholesterol are at risk.

·         Depression: Feeling of "down," sad, or hopeless over the last 2 weeks or have felt little interest or pleasure in doing things, may be an indication of depression

·         Sexually Transmitted Infections: These include HIV, gonorrhea, syphilis, chlamydia, or other sexually transmitted infections.

·         HIV: at risk individuals include

o        Have had sex with men since 1975.

o        Have had unprotected sex with multiple partners.

o        Have used or now use injection drugs.

o        Exchange sex for money or drugs or have sex partners who do.

o        Have past or present sex partners who are HIV-infected, are bisexual, or use injection drugs.

o        Have or had sexually transmitted diseases.

o        Had a blood transfusion between 1978 and 1985.

·         Abdominal Aortic Aneurysm. For those over 65 & had smoked

Should one take medicines to prevent disease?

  • Aspirin: For prevention of heart disease, consult your doctor for those:
    • Older than 45
    • Younger than 45 with
      • Have high blood pressure.
      • Have high cholesterol.
      • Have diabetes.
      • Smoke.
  • Immunizations: Stay up-to-date with your immunizations:
    • Annual flu vaccination for those over 50 years
    • Pneumonia vaccination for those over 65 years
    • Immuncompromised: pneumonia vaccination & annual flu vaccination

The Centers for Disease Control and Prevention provide more information on immunizations at: http://www.cdc.gov/nip/recs/adult-schedule.htm.

Screening tests checklist for Men

Test

Last Test
(mo/yr)

Results

Next Test Due
(mo/yr)

Questions for the Doctor

Weight
(BMI)

       

Cholesterol
Total:

       

   HDL
   (good):

       

   LDL
   (bad):

       

Blood pressure

       

Colorectal cancer

       

Diabetes

       

Sexually transmitted diseases

       

HIV infection

       

Abdominal aortic aneurysm
(one-time test)

       

Screening Tests for Women: What You Need & When


Screening tests can find diseases early when they are easier to treat. Health experts from the U.S. Preventive Services Task Force recommend, based on scientific evidence, testing for the following conditions . Consult your doctors

The U.S. Preventive Services Task Force recommends, based on scientific evidence, testing for the following conditions. It is important to consult your doctor on which & when these tests should be taken

  • Obesity: body mass index (BMI) (BMI is a measure of body fat based on height and weight.) Normal BMI is listed in the National Heart, Lung, and Blood Institute website at: http://www.nhlbisupport.com/bmi/.
  • High Cholesterol: Check cholesterol regularly starting at age 35.  Check should be done on younger at risk individuals
    • diabetics.
    • high blood pressure.
    • Family history of Heart disease
    • Smoker.
  • High Blood Pressure: Check blood pressure checked at least every 2 years. High blood pressure is 140/90 or higher.
  • Colorectal Cancer: Check for colorectal cancer tarting at age 50. Earlier, if one has a family history of colorectal cancer
  • Diabetes: Those with high blood pressure or high cholesterol are at risk.
  • Depression: Feeling of "down," sad, or hopeless over the last 2 weeks or have felt little interest or pleasure in doing things, may be an indication of depression
  • Sexually Transmitted Infections: These include HIV, gonorrhea, syphilis, chlamydia, or other sexually transmitted infections.
  • HIV: at risk individuals include
    • Pregnant
    • Have had unprotected sex with multiple partners.
    • Have used or now use injection drugs.
    • Exchange sex for money or drugs or have sex partners who do.
    • Have past or present sex partners who are HIV-infected, are bisexual, or use injection drugs.
    • Have or had sexually transmitted diseases.
    • Had a blood transfusion between 1978 and 1985.
  • Breast Cancer: Have a mammogram every 1 to 2 years starting at age 40.
  • Cervical Cancer: Pap smear every 1 to 3 years for those who are:
    • sexually active.
    • between the ages of 21 and 65.
  • Osteoporosis (Thinning of the Bones): First bone density test at age 65 to screen for osteoporosis. For those of ages between 60 and 64 and weigh less than 158 lbs, first bone density may be done earlier
  • Chlamydia and Other Sexually Transmitted Infections:
    • sexually active 25 years or younger females.
    • For those over 25 years old: consult your doctor

Should one take medications to prevent disease?

  • Hormones: Do not take hormones to prevent disease. Consult your doctor if you need relief from the symptoms of menopause.
  • Breast Cancer Drugs: If your mother, sister, or daughter has had breast cancer, conult your doctor about the risks and benefits of taking medicines to prevent breast cancer.
  • Aspirin: For prevention of heart disease, consult your doctor for those:
    • Older than 45
    • Younger than 45 with
      • Have high blood pressure.
      • Have high cholesterol.
      • Have diabetes.
      • Smoke.
  • Immunizations: Stay up-to-date with your immunizations:
    • Annual flu vaccination for those over 50 years
    • Pneumonia vaccination for those over 65 years
    • Immuncompromised: pneumonia vaccination & annual flu vaccination

Women’s Screening Test Checklist

Test

Last Test
(mo/yr)

Results

Next Test Due
(mo/yr)

Questions for the Doctor

Weight
(BMI)

       

Cholesterol
Total:

       

   HDL
   (good):

       

   LDL
   (bad):

       

Blood pressure

       

Mammogram

       

Pap smear

       

Colorectal cancer

       

Diabetes

       

Sexually transmitted infections

       

HIV Infection

       

Bone density

       
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