See a primary care physician

See a primary care physician regularly, take your prescribed medicine (you will need less if you live a healthy lifestyle), follow prevention guidelines (Cancer screening, vaccinations, etc.) and know your numbers!

According to the CDC, the following were the most common causes of death in the United States in 2021 (most recent data):

Heart disease: 695,547
Cancer: 605,213
COVID-19: 416,893
Accidents (unintentional injuries): 224,935
Stroke (cerebrovascular diseases): 162,890
Chronic lower respiratory diseases: 142,342
Alzheimer’s disease: 119,399
Diabetes: 103,294
Chronic liver disease and cirrhosis: 56,585
Nephritis, nephrotic syndrome, and nephrosis: 54,358

Most of these are preventable and the best way to do this is to identify risk factors and make changes in your life to correct them. Common risk factors for several of these include smoking, elevated cholesterol, high blood pressure (hypertension), risky behavior and obesity. Some can be prevented with vaccination, living a healthy lifestyle and for others, early detection can improve your healthspan even if one of these diseases develops.

Visit and Follow the Recommendations of Your Doctor

The best approach is to see a primary care physician regularly. Depending on your age, you want to do this from every 1-3 years. If you are an adult and have never seen a primary care physician, do so and the frequency of subsequent visits will depend upon your health status.

If diabetes, hypertension or hypercholesterolemia is detected, lifestyle changes alone may be sufficient to treat these conditions. If that is not possible, your physician will prescribe medication that when taken reliably will improve these conditions and prevent the consequences such as heart disease or stroke. Medications work and you should take them. To the extent that you live a healthy lifestyle, you will require less medication.

Screening for Cancer

Although eating healthily, not taking unnecessary risks (smoking or drinking excessively) and exercising can reduce your risk of cancer, screening is another important tool your physician can use to detect cancer in an early stage and improve the outcome and your healthspan. The indications for screening tests will depend upon your age and other risk factors. Here are some of the screening tests that your physician may recommend.

Mammography

Mammography is primarily used for breast cancer screening. It is recommended for women starting at age 40 or earlier if they have a family history of breast cancer or other risk factors. Regular mammograms are vital for early detection, as breast cancer is one of the most common cancers among women. Some women with significant risk for breast cancer my be advised to have genetic testing and more aggressive preventive measures.

Pap Smear (Cervical Cancer Screening)

Pap smears are used for cervical cancer screening in women. Most guidelines recommend starting at age 21, with frequency varying depending on age and prior results. HPV testing is often combined with Pap smears for enhanced accuracy.

Colonoscopy and Other Colorectal Cancer Screening Tests

Colorectal cancer screening is recommended for adults starting at age 45 to 50, depending on the guidelines. Options include colonoscopy, fecal genetic tests and fecal immunochemical tests (FIT). High-risk individuals with a family history may need earlier and more frequent screenings.

Prostate-Specific Antigen (PSA) Test

The PSA test is used for prostate cancer screening in men, typically starting at age 50. Screening may begin earlier for those at higher risk, such as African American men or those with a family history. There is some controversy around prostate cancer screening which deserves more exploration and includes:

The PSA test can yield false-positive results, leading to unnecessary anxiety, follow-up procedures, and treatments, which can have harmful side effects, such as urinary incontinence and erectile dysfunction.

Prostate cancer is known for its slow progression. Screening may detect tumors that may never cause symptoms or harm during a man's lifetime. Consequently, overdiagnosis can lead to overtreatment with unnecessary surgeries, radiation therapy, or other invasive interventions.

The PSA test is not specific to prostate cancer. Elevated PSA levels can result from various factors, including benign prostatic hyperplasia (an enlarged prostate which is a very common condition), infections, or inflammation, leading to further unnecessary tests and anxiety.

Medical organizations provide differing recommendations regarding prostate cancer screening. Some suggest routine screening, while others advocate for shared decision-making and selective screening based on individual risk factors. The potential harms and side effects of prostate cancer treatment, such as surgery or radiation therapy, must be weighed against the benefits. These treatments can result in urinary and sexual dysfunction, impacting a man's quality of life.

Ultimately, men should be aware of the uncertainties and potential consequences associated with prostate cancer screening and engage in shared decision-making with their physician to determine the best course of action based on their individual risk factors and preferences.

Lung Cancer Screening (Low-Dose CT Scan)

An annual low-dose computed tomography (CT) scan is recommended for individuals with a significant smoking history who are between the ages of 50 and 80.

Skin Cancer Screening

Skin cancer screenings are generally recommended for individuals with a history of excessive sun exposure, family history of skin cancer, or a personal history of skin cancer. Self-examination and regular dermatologist visits are needed for early detection.

Ovarian Cancer Screening

Currently, there is no widely accepted routine screening test for ovarian cancer. Screening and aggressive prevention may be considered for women with a strong family history or specific genetic mutations. Screening of the general female population is a subject of ongoing research and discussion.

Testicular Cancer Self-Examination

Testicular self-exams are recommended for young men, usually beginning in their late teens or early twenties. Regular self-exams can help detect testicular cancer at an early, highly treatable stage.

Pancreatic Cancer Screening

Pancreatic cancer screening is typically reserved for individuals with a significant family history of the disease or specific genetic mutations associated with a higher risk. It is not widely recommended for the general population due to limited effectiveness.

Screening for Other Conditions

Blood pressure

Regular blood pressure checks are recommended for all adults, as hypertension is a common risk factor for heart disease and stroke. Early detection of high blood pressure allows for lifestyle modifications and medications to control it.

Cholesterol

Cholesterol screening is recommended for all adults and especially those with a family history of heart disease. Identifying high cholesterol levels can lead to dietary changes, exercise, and medications to reduce the risk of cardiovascular disease.

Blood Glucose and Hemoglobin A1C

Screening for diabetes is important for individuals with risk factors such as obesity, family history, or sedentary lifestyles. Early detection and effective management of diabetes can prevent complications and improve overall health.

Bone Density Scan (DEXA)

DEXA scans are recommended for postmenopausal women and adults with risk factors for osteoporosis to assess bone health. Early detection of osteoporosis allows for interventions like calcium, vitamin D supplements, and lifestyle changes to reduce fracture risk. Medications will reduce fracture risk for those found to have osteoporosis.

Eye Exams

Regular eye exams can detect eye conditions such as glaucoma, macular degeneration, and diabetic retinopathy. Early detection and treatment can preserve vision and eye health.

Abdominal Aortic Aneurism

Complications of this condition often results in death. One time screening for abdominal aortic aneurism should be considered in all men and women aged 65 to 75 years with a history of tobacco use, men 55 years or older with a family history of AAA, and women 65 years or older who have smoked or have a family history of AAA.

Vaccinations for Adults

I will not be reviewing vaccinations for children and the information below pertains to people who have had all their childhood vaccinations. A vaccination is an excellent primary prevention intervention; it prevents a disease before it starts in contrast to screening which detects a disease after it starts but improves the outcome based upon early detection. You are no doubt familiar with Flu and COVID vaccines but there are others that your doctor may recommend. In addition to Flu and COVID vaccines, these include:

Pneumococcal vaccines,

These include PCV (Prevnar 13, 20) and PPSV23 (Pneumovax), are recommended for adults over 65 and those with specific medical conditions. Pneumococcal bacteria can cause pneumonia, meningitis, and bloodstream infections. Vaccination helps protect against these potentially life-threatening illnesses.

Tetanus, Diphtheria, and Pertussis (Tdap) Vaccine

A single dose of Tdap vaccine is recommended for adults who have not received it previously and a booster dose every ten years. Tdap vaccination ensures ongoing protection against tetanus, diphtheria, and pertussis (whooping cough). Pertussis can be especially dangerous for infants so new grandparents, be aware that your kids will not let you near your grandchild unless you are up to date on this one!

Shingles (Herpes Zoster) Vaccine

The shingles vaccine, including Shingrix, is recommended for adults over 50, even if they have had shingles before or have received the older Zostavax vaccine. Shingles is a painful skin rash caused by the reactivation of the chickenpox virus which lives in almost the entire older population. The vaccine helps prevent shingles and its complications which can include ongoing neuropathic pain which can be disabling.

Hepatitis B Vaccine

The hepatitis B vaccine is recommended for adults at risk, including healthcare workers, individuals with certain medical conditions, those engaging in illicit drug use, men having sex with men and other high risk behaviors. Hepatitis B can lead to chronic liver disease, cirrhosis, and liver cancer. Vaccination provides immunity against this viral infection.

Hepatitis A Vaccine

Similar recommendations as above

Meningococcal Vaccine

The meningococcal vaccine is recommended for individuals with certain medical conditions, travelers to high-risk areas, and college students living in dormitories. Meningococcal disease can result in a life-threatening bacterial infection, including meningitis and bloodstream infections. Vaccination helps protect against these potentially fatal diseases.

Human Papillomavirus (HPV) Vaccine

The HPV vaccine is recommended for adults up to age 26. In some cases, healthcare providers may recommend it for individuals up to age 45. HPV is the leading cause of cervical and other cancers. Vaccination can prevent HPV-related cancers and genital warts.

Know Your Numbers!

Being aware of your health is the first step in making it better. Biometric measures and test results offer valuable insights into various aspects of your health. A healthy person should be aware of specific biometric measures and test results to gauge their current health status and take proactive steps towards a healthier lifestyle. Here are some of the crucial biometric measures and test results that a healthy person should monitor.

Blood Pressure

Healthy blood pressure typically falls within a range of 90/60 mm Hg to 120/80 mm Hg. Monitoring blood pressure helps assess cardiovascular health. Elevated blood pressure can be a precursor to heart disease and stroke, while low blood pressure may indicate other underlying issues. Elevated blood pressure is by far more common and can lead to serious consequences years down the road.

Body Mass Index (BMI)

BMI, or Body Mass Index, is a numerical measure used to assess an individual's body weight relative to their height. It provides a quick and simple way to estimate whether a person is underweight, normal weight, overweight, or obese, which can be useful for assessing health risks related to weight and overall fitness. It is derived by calculating a person's weight in kilograms divided by their height in meters squared. A BMI between 18.5 and 24.9 is considered normal for adults.

Cholesterol Levels

Desirable levels include total cholesterol less than 200 mg/dL, LDL (low-density lipoprotein aka bad cholesterol) less than 100 mg/dL, and HDL (high-density lipoprotein aka good cholesterol) greater than 40 mg/dL for men and 50 mg/dL for women. Cholesterol levels are critical for assessing cardiovascular risk. High LDL cholesterol and low HDL cholesterol levels are associated with an increased risk of heart disease. Diet, exercise and if necessary, medication can improve your HDL and LDL levels.

Blood Glucose and Hemoglobin A1C

Fasting blood sugar (no food for 8 hours before the blood test) levels should typically be below 100 mg/dL. Monitoring blood sugar levels helps detect prediabetes or diabetes. Elevated levels can increase the risk of various health complications. Hemoglobin A1C should be less than 5.7%. Higher levels are seen in diabetes and prediabetes.

Waist Circumference

For men, a waist circumference of less than 37 inches is typically considered healthy. For women, it is less than 31.5 inches. Waist circumference is a measure of abdominal fat and can indicate the risk of obesity-related health issues, including heart disease and type 2 diabetes.

Resting Heart Rate

A resting heart rate between 60 and 90 beats per minute is generally considered healthy.

Resting heart rate reflects cardiovascular fitness. Higher resting heart rates may suggest stress, lower fitness levels or other medical conditions that can increase heart rate such as anemia or hyperthyroidism. Heart rates below 60 can be seen in those who are very physically fit or those with rhythm disturbances. Individuals with an unexplained heart rate out of range should see their physician.

Bone Density (DEXA Scan) in Post Menopausal Women and Those with Risk for Osteoporosis

Bone density is assessed through a T-score, with values above -1.0 indicating healthy bone density.

Monitoring bone density helps in assessing the risk of osteoporosis, a condition characterized by weakened bones.

Comprehensive Metabolic Panel