Happy Fall, Everyone!
 
This summer flew by for me, and probably did so for you too! I took a break in August from the newsletter and let my adrenals rest - no, you didn't miss getting an issue.  And now I am writing again in support of my efforts to create a more healthy balance in your lives during these mid-life years. It's a privilege to work with each of you!
 
Many patients are confused about which exams, procedures, and lab tests should be done at this point in life. So, I am dedicating this issue to sharing with you what I believe is important as we focus on good health and prevention.
 
First though, a comment about medical records. This is a great time to start your own personal medical notebook if you haven't already. A 3-ring binder works very well to collect all lab reports, other test results, clinic notes and instructions, drug information from pharmacies, and any other health information. Or you might consider using a Siebens Health Care Notebook, available from me in our office.  This is an organized way to manage your records and plan your care with your provider using a successful health care coordination model. You should also include an up-to-date list of (1) medications and supplements, (2) surgeries and accidents, and (3) family diseases. Try to keep the notebook in chronological order as you accumulate new information. You may also want to create separate sections for ease of reference. This is also the place to collect questions you want to ask at your next medical visit and to keep notes about how you responded to a new treatment. I'd suggest you bring the binder to your medical visits.
 
As for exams and procedures, it is recommended that you get an annual exam including:

• blood pressure
• height, weight and body mass index (BMI)
• breast check
• pap smear
  
• pelvic exam
  
• rectal exam with hemoccult test
  
• prostate check for the men
• skin and general screening
  
•  an EKG every 3-5 years, starting at age 40
  
• in addition, you should be screened for sexually transmitted diseases if you are at risk

 
At some point, pelvic ultrasounds can take the place of pelvic exams depending on your age and circumstances.  Also, if you are one of the rare women who can't take progesterone and are only taking estrogen, the American College of Obstetrics and Gynecology recommends that you get an endometrial biopsy annually. Both of these issues need to be discussed on an individual basis.
 
An annual mammogram is also recommended when on bio-identical hormones. A screening mammogram is generally recommended by age 40-50, or earlier if there is a family history of breast cancer or you are otherwise at high risk.
 
To check breast health and track changes that may lead to breast cancer, a thermography exam can be done between mammograms, or at any age before you start doing mammograms. This is particularly helpful if you have a history of breast issues like fibrocystic breast disease, have had breast biopsies in the past, or have a family history of breast cancer. Thermography is a test that senses heat changes in the breasts due to blood flow patterns, does not involve radiation, and does not require a clinician's order. It is available at the Thermography Center of Sonoma County. If this test raises questions about your breast health, we can often institute measures to reverse or improve the condition. As helpful as thermography can be, however, I do NOT believe that it takes the place of mammography.
 
By the age of 50 you should have a chest x-ray if you are a smoker or have a family history of smoking.  And then every 3-5 years as warranted.
 
By age 50, it is also recommended that we get our first colonoscopy (if not before) to screen for any changes in the bowel that might be associated with cancer of the colon - a very treatable disease if discovered in the early stages.  As much as we groan or joke about this test, it can be a lifesaver. Then, according to my gastroenterologist, you only need one every 10 years as a result of advanced camera and other technology.
 
By age forty, or earlier if you have multiple risks for bone loss, it's also time to get an evaluation of your bone density to check the status of bone health. This can be done as a DEXSA scan of the hip and spine (very low radiation) or an NTX, which is a urine or serum test to measure bone building compared to bone breakdown.  These tests will tell us what risk category you are in for osteopenia and osteoporosis, and we can then create an effective bone health plan (which includes bio-identical hormones) based on their results. It is recommended that you repeat this screening every two years.
 

Laboratory testing needs to be continued at least annually while on bio-identical hormones.  Tests may include:

• estradiol
• progesterone
• free and total testosterone
• FSH (sometimes)
• estrone
• prolactin
• SHBG 
• and for men PSA for the prostate and LH
  

Other tests often ordered include:

• DHEA-S
• cortisol
• TSH
•  free T3
•  free T4
•  thyroid antibodies
•  a fasting lipid profile and metabolic panel
•  CRP
• complete blood count (CBC)
• ferritin
• fasting glucose
• HgA1c
• vitamin D3
• urine or serum testing of NTX
  
• N-telopeptide for bone evaluation as discussed above.  

Check your family history and consider getting more specialized screening tests for diseases that present a higher risk for you. These could include VAP or Berkeley tests for cardiovascular diseases, CA 125 for ovarian cancer (not a totally accurate test), and fasting insulin (if your waist is greater than 33 inches) to name a few.
 
Other specialized tests are available to check metabolites, estrogen metabolism, food allergies, heavy metals, toxins, vitamins and minerals, proteins, neurotransmitters, oxidative stress, inflammation, auto-immune status, parasites, stool analysis, genomic testing and many other factors, if you are interested.
 
Dental exams should be done annually and eye exams as recommended. Tuberculosis screening is recommended if you work in health care or are at high risk. Tetanus shots should be maintained every 10 years, or sooner if you get a nasty wound.  If your bed partner tells you that you snore or gasp while sleeping, you should consider getting a sleep study.
 
Now that I'm at the end of this, I realize it can all seem daunting, but don't go there! Just take your list with you to your annual exam and ask for what you need. Most clinicians are glad you are involved in making decisions about your health care. After all, it's your body and your health!
 
Happy, healthy autumn days to you!
 


Jane Kennedy
Nurse Practitioner

Gordon Medical Associates