October is breast cancer awareness month, as most know. This has become a global campaign with countless participants! And while there is significant debate about fundraising and how much of the money raised goes where. One thing is not debatable. That is the fact that raising awareness and ending the stigma surrounding breast cancer HAS saved lives at least in part because people now know what medical appointments and tests you need for early diagnosis!
However there are many diseases with much higher death rates that don’t get nearly the same attention. There simply aren’t enough months in the year! But, raising awareness of the preventative measures and early diagnostic procedures everyone should be seeking is imperative to long term health! Skipping routine medical appointments and tests could literally be a matter of life and death. However, aside from mammograms after age 40 and well baby visits most people don’t know what their routine screening schedule should be. Follow this simple guide to create your routine medical care schedule!
Finding a Doctor
First things first! Find a primary care doctor! Check to see what options you have through your health insurance or find a doctor who sees and will discount rates for uninsured patients.
New Patient Appointment
Next, make a new patient appointment. Make sure that you take all of your medical records and go a little early so you have time to fill out paperwork. And, when I’m seeing a new doctor I also like to take a list of questions. It is important to me to know what hospital my doctor is affiliated with, what type of medicine they are certified in and I even ask how they feel about alternative care. Have an idea of what you want to hear but keep an open mind. Conventional medicine doctors should be suspicious about supplements for example. They aren’t FDA approved and many people take them with reckless abandon. However, they shouldn’t frown upon chiropractic care for back pain in my opinion.
Additional Things to Consider
When you go to the appointment take good notes. Is the office clean? How do you feel about the staff? What is their billing procedure? Did you have to wait a long time? And, most importantly, did you feel the nurses and doctors were attentive to you? Did you feel comfortable with them?
Be sure to find a doctor who meets your needs but also who you feel comfortable with. Rapport matters!!! Medical care only works if you are 100% honest 100% of the time, even about the most embarrassing details of your life. So find a doctor you trust and who you are comfortable talking to and tell them everything! Believe me, they have heard WAY worse!
Once you have a doctor you like they can refer you to all of the other medical care practitioners you need. Feel free to go through this process with them too (especially gynecologists and urologists). Your primary care doctor will also complete your annual physical exam and often refer you for other medical tests or procedures that are recommended for your age. Problem is, most people don’t see their doctor often enough for this to happen.
Establish Your Medical Care Schedule
Seeing the doctor shouldn’t be reserved for feeling under the weather! There is a lot that can be done to prevent illness, injury and chronic disease. Unfortunately most people don’t know this and often people go years or even decades without seeing a doctor. Instead you should establish a medical care schedule! Here’s what that schedule should look like for adults…
Ages 18 – 39
Everyone: General Physical Exam (Annual*)
I’ll bet you thought you were done with these when you graduated high school! Not so fast! Some doctors prefer to perform physicals every 2 or 3 years instead. This is usually determined by your health and family history. If your doctor recommends a longer gap between physicals though, don’t be surprised. But, this should be determined by your doctor, not you! If you aren’t comfortable with their recommendation you can request a different schedule or look for a new doctor. Don’t let this fester and don’t skip appointments recommended by your physician!
What to Expect
At this exam you can expect to be asked to give a urine sample and have blood drawn. Often you will be scheduled for the physical first thing in the morning because you’ll be asked not to eat so they can do a fasting blood sugar test with the specimens collected. They will also take your weight, vital signs and may even perform an electrocardiogram. These tests are all routine! Be prepared with any questions you may have or health goals you want to discuss. If you’re planning a new exercise or diet routine or taking up a new sport this is a great time to discuss it with your doctor. You should also ask them if there are any other routine exams you should be having done and get referrals for other care providers.
Everyone: Skin Scan
You should have a skin scan done early in your adult life to check for moles and lesions. You can have this performed by your doctor at your annual physical or by a dermatologist. It just depends on what you and your doctor are most comfortable with. The physician who performs this test will make recommendations regarding the regularity of these appointments.
What to Expect
During a skin scan you will be asked to undress and be given a gown. Your doctor will check your skin for lesions or moles and document any that they notice. You may be asked to return or a small sample may be taken of a lesion or mole. This is done by numbing the area and removing a small piece. The doctor may also freeze a skin abnormality using liquid nitrogen on what looks like a long q-tip. Both of these procedures are uncomfortable but not painful. Later the area may be a little sore but shouldn’t hurt. If it does be sure to contact your doctor.
Women: Gynecologist (Annual*)
Typically speaking gynecological exams are performed annually. They begin within a year of being sexually active or when you are 18 (whichever comes sooner). Even if you don’t have all of the tests run every year it is still important to see your gynecologist. You will discuss some of the most private and intimate details of your life with this physician so make sure you are extremely comfortable with them!
What to Expect
You will be asked to entirely undress and be given a gown and the privacy to do so. Your doctor and a female nurse or assistant will both come into the exam room when you are ready (they will knock before entering).
You can expect a manual breast exam (which is the same as a home breast exam) and you can also expect a manual pelvic exam. This means that they palpate the internal reproductive organs by placing a lubricated, gloved finger inside the vagina and pressing on the abdomen with the other hand. If you experience pain or intense discomfort be sure to let your physician know. This test is extremely important. They are feeling for masses, scar tissue buildup or anything unusual.
Often your doctor will also perform a pap smear. The scheduling of this is determined by many factors including sexual activity, family history and having had the guardicil vaccine. Be sure to make your doctor aware of all of these factors (especially the vaccine as they might not ask). During this test they insert a metal tool to gently open the vagina and then use what appears to be a long q-tip to collect a cell sample from the cervix. Again if you experience discomfort or pain let your doctor know.
You can expect a thorough discussion about your sexual history and menstrual cycle since your last visit. You will certainly be asked for the date of your last menstrual period and if you could be pregnant. Answer all of these questions honestly and to the best of your knowledge. Be sure to go prepared with your questions as well. Your gynecologist is the go to person for any questions you have about sex or birth control. Again, don’t worry… they have seen and heard everything… you won’t shock them at all!
All in all, the visit to the gynecologist is usually considered more embarrassing or uncomfortable than anything else. It shouldn’t be painful. Occasionally your gynecologist may want to draw blood. That would be the most painful part!
- Do NOT avoid seeing a gynecologist because of sexual assault or trauma. Make an office appointment to talk to them without an exam (specifically request a no exam appointment). Talk to them about your concerns. It is VERY important that you see a gynecologist after an assault or trauma and they are specially trained to work with you. Oftentimes women use their gynecologist as their primary care doctor after an experience like this.
- Male or Female: the great debate. Neither gender is innately better as a gynecologist. There are commonly believed pros and cons to both. I assure you there is nothing even remotely sexual about a gynecological exam (even when you’re talking about sex) so from that perspective gender is irrelevant. Choose what makes you most comfortable, there’s no wrong answer!
- Gynecological appointments should continue after menopause and also after a hysterectomy or mastectomy. Speak to your doctor about whether the frequency needs to change. If you have concerns or any family history of reproductive cancer be sure to get a second opinion before decreasing visit frequency.
Men: Testicular Exam (Annual)
Discussion surrounding testicular cancer screening is what led to me writing this post! My father in law suggested this content. He was VERY surprised to hear about testicular cancer screening for the first time in his 60’s when he actually should’ve been screened long before!
To be honest, that is unfortunately not uncommon! Despite the recent media attention surrounding this disease most men don’t know that they should be screened and most skip their annual physical as well!
Men should also be performing monthly manual self exams. To do a self exam, feel each testicle individually and make sure there are no lumps or changes since your last exam. If there are, contact your primary care physician immediately.
What to Expect
Testicular exams should be performed at your annual physical. The exam is essentially the same as a self exam but performed by a medical professional. Testicular cancer is most common in men ages 15 – 40 with over 80% of cases occurring in men 18 – 55. For unknown reasons it is on the rise over the past 40 years. So, don’t ignore this! Regardless of any discomfort you may feel, it is imperative to be screened for testicular cancer and to perform regular self exams!
Ages 40 – 64:
In addition to all of the above tests and visits, there are several tests that are necessary in mid-life. The screening tests performed between the ages of 40 and 64 are for early cancer diagnosis. This is extremely important because the prognosis for all of these forms of cancer is very good if it’s caught early and often fatal if not. Diagnosing cancer early can also significantly change treatment protocols making them less life altering. What you don’t know CAN hurt you!
Everyone: Skin Scan (Annual)
This is the same test as is referenced above. It is highly recommended that this be done every year past the age of 40, where prior to age 40 it is discretionary. Skin cancer rates dramatically increase in middle age so it is very important to be screened on a regular basis!
Women: Mammograms (Annual 40+)
Women typically begin receiving mammograms at age 40 and continue to do so every year. If you have any risk factors for breast cancer mammograms may be started younger. Usually your gynecologist will order this test when you go for your annual exam. You will likely have to schedule it at another location, often a hospital. Don’t worry, this is a non-invasive procedure but it requires expensive large equipment and specially trained staff so it is easier to perform this test at a centralized location.
What to Expect
Be sure to go early for your mammogram. There will be paperwork to complete and oftentimes you have to go through an admission procedure for the hospital. This just means they want to see your identification, insurance information and doctors order. They then have you sign a consent form and give you a hospital bracelet. This is simply hospital procedure related to how they keep their records.
Once this is done you will be shown to a private “women only” waiting area, locker room or exam room and given a gown. They will ask you to entirely undress from the waste up and put the gown on with the opening in front. You may also have more paper work to fill out.
When it’s your turn you will go into a private room with a large machine. The technician will usually undrape one breast at a time and place your it on what looks like a plastic tray. They will then adjust another tray on top to press on the breast tissue and squeeze it to flatten it out. This is uncomfortable but should not be painful. After they have finished taking these images they will often have you go back to the women’s only waiting area or exam room while they are reviewed.
Don’t be freaked out if they ask you to come back for more images or to do an ultrasound. This isn’t uncommon. Sometimes women have scar tissue or dense breast tissue and they are simply being thorough. You may even be sent a letter requesting that you come back. This is normal! No need to panic!
- Try to avoid scheduling your mammogram when you are experiencing PMS or menstruating. Your breasts are likely to be more sensitive and the test will be more uncomfortable.
- Do NOT wear deodorant or lotion to your appointment. Anything that effects the texture of your skin will make it more difficult and possibly prevent them from performing the test.
- Even if you have breast implants, reduction or other breast surgery you still need a mammogram! Do not skip this important screening test! If you have concerns or aren’t sure if you need this test speak to your doctor and consider getting a second opinion if they say no.
- They should have thyroid guards available. You may ask for one to prevent x-ray radiation exposure to the thyroid, but they are often not offered.
Men: Prostate Exam (Annual – Every 4 years 50+)
Prostate cancer is the second most common form of cancer in men after skin cancer. However it can be diagnosed and treated early! If you have an immediate family member who has been diagnosed with prostate cancer prior to the age of 65 or you are African American you are likely to be referred for this screening early. You should also let your doctor know if you have any urinary problems or discomfort. Prostate exams are performed by a urologist. Your doctor can give you a referral at your annual appointment.
What to Expect
Oftentimes men are very nervous to have a prostate exam because they are concerned about having a digital rectal exam (DRE). However this test can be very important to early diagnosis of cancer and overall good health.
You will be taken into an exam room and given a gown or drape and asked to completely undress from the waist down. The doctor will knock and re-enter the room when you are ready. You will then be asked to stand facing the exam table and lean over with your arms resting on it. The doctor will insert a lubricated, gloved finger into your rectum. This may be uncomfortable but shouldn’t be painful. If it is, let your doctor know immediately. They will then palpate the prostate, pressing to gauge size and rigidity of the gland and checking to be sure there aren’t any lumps or abnormalities. Then they will remove their finger. The entire process takes 5 minutes or less. That 5 minutes may save your life (or your sex life). Yes, it’s uncomfortable but it’s worth it!
Your urologist might also order a blood test. This should be the most painful part of your exam. They will also discuss the frequency of future exams with you based on the results of your exam, your demographic and your family history.
Not only is the urologist your go to person for prostate exams and urinary problems. They can also answer any questions you may have about sex and perform vasectomies.
Erectile dysfunction (ED) can be a symptom of prostate issues or serious cardiac problems. It is vitally important that you tell your doctor immediately if you are experiencing ED.
Everyone: Colonoscopy (Every 10 Years 50+)
Colonoscopies are used to diagnose colon cancer. It is recommended that you have a colonoscopy at age 50 and every 10 years after. If anyone in your family has been diagnosed with colon cancer you should begin testing 10 years prior to the age they were when diagnosed. While colon cancer is easily treated when caught early it is deadly and difficult to diagnose without a colonoscopy!
What to Expect
The procedure it’s self is painless and usually done using a sedative so you sleep through it and don’t remember a thing. The preparation for a colonoscopy is the most challenging part.
At Home Preparation
In order to have a colonoscopy your colon needs to be empty. Your doctor will ask you to fast and prepare for the test. The day before you will only be able to consume clear liquids. You may also eat jell-o, gummy bears or jolly ranchers as long as you avoid anything red. They will give you powder to mix into a sports drink and specific instructions about when and how much you will be required to consume. Follow the instructions carefully. You will be in the bathroom a lot and can expect loose, urgent bowel movements during prep. It is likely that you won’t sleep well so don’t be surprised.
Your procedure is likely to be scheduled for early morning. You will need to have a driver who will stay throughout and take you home. Preferably they will take you out to breakfast on your way home. You’ll be very tired and hungry! When you get to your appointment you’ll have some paperwork to do. Then you’ll be asked to come back into a room, undress and change into a gown. You’ll have a gurney and be asked to lay down. An IV will be started and soon you’ll be off to sleep. Your doctor may come in and ask you some questions or have you re-position yourself. You won’t remember much of it.
While you’re sedated the doctor will insert a small flexible tube with a camera into your rectum. They will film and photograph the inside of your large bowel, looking for abnormalities.
When you awaken they will review the results with you (and your driver usually). They will also give you any follow up instructions. You will feel groggy tired and hungry. Grab a hearty meal and head to bed. You’ll feel back to normal after you eat and get some rest.
If you’re over 65 you still need to follow the health schedule above. There is only one more test you’ll need to add and a couple vaccines you should talk to your doctor about.
Everyone: Bone Density Test (Every 2 – 5 Years)
If you are part of a high risk population you might be advised to start these at 60 (or even younger). Bone density tests are used to diagnose osteoporosis, and help doctors to know how to treat or prevent bone loss and fractures.
What to Expect
Bone density tests are often done at your doctor’s office during your annual exam. They can be done using a portable device or a machine that passes over your entire body while you lay on a padded table. You should wear loose comfortable clothes and avoid zippers or buttons. Take all metal out of your pocket since it can interfere with the test.
Everyone: Additional Vaccinations
Be sure to check with your doctor at your annual exam about vaccinations. It is common for people over 65 to receive shingles, flu, and pneumococcal vaccines among others.
Routine Medical Appointments & Tests Could Be the Difference Between Life and Death!
While I’m sure that some of these tests and medical appointments sound inconvenient or even scary and uncomfortable you can’t just skip them. I guarantee you that finding out too late that you have the diseases and conditions these tests and appointments are designed to catch early is FAR worse. Because, what you don’t know can hurt you! These appointments, tests and procedures save countless lives every year! Don’t wait another year or even another month! Start scheduling your routine exams and tests today!
If you’ve ever considered seeing a functional medicine doctor find out more here!
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