Keep Your Family Healthy
Advice from the Best Doctors in Hawaii.
(page 3 of 3)
The Middle-Age Male
You’ll be pleased to know that as far as Dr. David McEwan, who practices at The Queen’s Medical Center (537-2211) is concerned, middle-age begins at age 50, not 35 or 40. “Most of the screenings you would do on people begin at 50,” he explains. “If you’re in your 40s, fit and healthy, you probably don’t need much unless there’s a family history of major diseases.”
How often should a man come in?
McEwan: If a man hits 50 without ever having had a comprehensive physical, it’s time to get one, even if he has have no health complaints. “A complete physical takes 40 to 60 minutes and covers family history, blood pressure, diabetes, the colon, the prostate—all the systems in the body. The history is the most important part of the physical; if doctors are allowed the time to do it, they’ll learn a profound amount about their patient,” says McEwan.
What do people hide from you the most?
McEwan: Concerns about their emotional and sexual health. “People aren’t used to talking about these,” says McEwan. “But people in their 50s may have issues in both areas so doctors are trained to ask about these and to listen. The doctor should also ask about alcohol and drug use and should be able to tell from your answers if there is really something more to share. Medical records are private, no one can ask for them without permission and you hurt yourself if you don’t disclose things.”
Which screenings should a man get?
McEwan: For men, there is no off-the-shelf schedule for exams or screenings; it all boils down to family history. “Assume that you’re well and turning 50, we need to look into your blood pressure, cholesterol, diabetes, prostate health, cardiac health, update your shots, check your stool for blood,” and so on, says McEwan. A baseline physical at 50 will also include blood work looking at 20 different things, from testosterone levels to thyroid function to lipid levels and even some cancer markers. “The workup will guide the monitoring. Depending on what we find, we may want you to come back every year for a comprehensive physical or other screening, or, if you’re fit and healthy, maybe every three or four years.”
Any common myths?
McEwan: “The incredible misconceptions that people have about food. They often think they’re eating well and they’re actually harming themselves immensely. A lot of people need serious guidance for that and the lab tests will direct the physician as to what guidance to give.”
For McEwan, the main issue is cholesterol, which is in more foods than people realize. “One of my sadnesses is watching the food industry, which has not been kind to the American public. Why do we think we have morbid obesity? It’s because of what we’re eating and the exercise we aren’t doing.”
“We think about heart disease all the time but what we really need to think about is vessel disease, all from cholesterol—in the brain, the neck, the limbs. Controlling it can vastly improve your life.”
Watch your diet, be compliant and take your meds if you’ve been prescribed any, minimize your alcohol intake, avoid all illegal drugs and get serious about exercise—it cures almost everything.” --David Mcewan, M.D.
Older people, generally grouped as those age 65 and older, are much more heterogeneous than any other age group. For example, an 83-year-old woman may still be working actively in a family business and living independently, while another 83-year-old woman is bedridden in a nursing home. As the baby boomers turn 65 in 2011, it is important for everyone to remember, “We all have a certain amount of control over our futures through our lifestyle choices—judicious exercise and dietary approaches,” says Dr. R. Gary Johnson, of Straub’s Department of Geriatric Medicine (522-4000).
Nothing is routine
The general health of geriatric patients will vary a great deal, so talk to your doctor about the recommended number of times to visit and what type of screenings you should be taking.
Johnson notes a few screenings: “I recommend annual mammograms for women, annual bone-density tests for osteoporosis, annual flu vaccines, making sure the pneumonia vaccine is updated every 10 years, screening for colon cancer at least every five years, annual skin assessment for possible skin cancers, and screening for prostate cancer in men.”
Dr. Marianne Tanabe, of the University of Hawaii John A. Burns School of Medicine Department of Geriatric Medicine and Kuakini Center (523-8461), says that frailty and memory loss are common concerns among patients, but often misunderstood. For those patients who have become frail, Tanabe notes that it is often a common thought that it would be easy to go back to a previous level of health and functional status, but points out that “this may be difficult to achieve with successive medical problems that may occur.”
For all elderly patients it is wrong, however, to believe that “progressive memory loss is inevitable and that frailty is inevitable,” says Johnson. “We know now that there are only minor memory changes associated with normal aging and that the elderly can benefit as much from exercise as any other age group.”
On Your Next Visit
Bring in all of your medications. “One of the most critical parts of geriatrics is monitoring medications for toxicities and interactions. In my experience, most people are over-medicated, especially in the skilled nursing facilities. I usually end up stopping more medications than I start,” says Dr. R. Gary Johnson, of Straub’s Department of Geriatric Medicine.
- Bring in all of your medications. “One of the most critical parts of geriatrics is monitoring medications for toxicities and interactions. In my experience, most people are over-medicated, especially in the skilled nursing facilities. I usually end up stopping more medications than I start,” says Dr. R. Gary Johnson, of Straub’s Department of Geriatric Medicine.
- Have a list of questions and concerns written down beforehand.
- Bring along a family member or friend. “An extra pair of ears hearing concerns and recommendations is always helpful,” says Johnson. “Many older people minimize symptoms, because, ironically, they don’t want to bother the doctor. I often have to rely upon a third person to get a real picture of the situation.”