Michelle L. Smith

Freelance Writer, Novelist, Humorist

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An Ounce of Prevention, Health Matters, Winter 2008


With an aging Baby Boomer population, longevity is at the forefront of everyone's mind. Yet chronic medical conditions such as obesity and diabetes make the enjoyment of those "Golden Years" difficult for some.

"Obesity is the hub of the wheel that creates so much chronic disease," says Dr. Lawrence Barcelo, a Family Practice physician with Santa Lucia Medical Group in Salinas. "And we seem to be losing the battle...."

With the arrival of the New Year, however, optimism abounds. Never before has "an ounce of prevention" been worth more, especially with health care guidelines designed to improve your chances of "aging gracefully."

With the assistance of a primary care provider, assessing your health risks can help you implement changes to improve your health forecast.

Cardiovascular Diseases are the number one cause of death for men and women and are responsible for almost twice as many deaths among women as all forms of cancer combined. Fortunately, most of the risk factors (please see sidebar) can be modified with lifestyle changes.

Most women don't need mammograms until they reach age 40. Breast Cancer screening for average-risk women ages 40 to 49 is recommended every one to two years. Mammograms should be performed annually for women 50 and older.

Colorectal Cancer screening with colonoscopy--the screening test of choice, says Dr. Barcelo--should begin at age 50 for the average-risk person. (Please see sidebar for alternative procedure options.)

Cervical Cancer screening with Pap smears should occur within three years of becoming sexually active, but no later than age 21. If a woman has had a hysterectomy for benign disease, a Pap smear should be offered every five years, Dr. Barcelo notes. "I'm much more aggressive" if the hysterectomy was performed as a treatment for cancer or pre-cancer.

Prostate Cancer screening with the prostate-specific antigen (PSA) blood test and a digital rectal examination should be offered to men annually, beginning at age 50 (American Cancer Society). This recommendation is met with significant controversy, however, due to the uncertain benefits and harms of early detection and treatment of prostate cancer.

Dr. Cassandra Ohlsen, an Internist who has practiced medicine in Monterey since 1994, advises her patients to obtain the test. "Even if it's within normal range, and it goes up significantly, I'll usually refer to urology and have them evaluate what's happened," she says.

While Dr. Barcelo believes that the PSA test has merit, he cautions that it does not have the sensitivity and specificity that the medical community would like.

"Despite a normal PSA you still have to remain vigilant," says Dr. Barcelo.

Given that one-half of all postmenopausal women will have an osteoporosis-related fracture, Dr. Ohlsen utilizes bone density testing after menopause as a preventative tool--"unless there's a predisposition when they're premenopausal."

Dr. Barcelo agrees that younger women who have gone through surgical menopause deserve a bone density study earlier than the average-risk woman.

So how often should you get a routine check-up? That depends. Both Dr.'s Ohlsen and Barcelo base their recommendation for a physical on the age and health status of their patients.

"I think it's a nice idea for women of the age where they need a Pap smear and a breast exam," says Dr. Ohlsen, "and for men when they need ... a prostate exam."

For those "who [have a normal blood pressure and cholesterol] and no risk factors," Dr. Barcelo says, "to drag them in and have them go through a physical every year is a little bit much. If someone is healthy, I think that every two years is really very appropriate."

Selected Works

While thyroid cancer represents a minority of new cancer diagnoses, the rate at which it's being diagnosed appears to be on the upswing. But is that apparent rise in incidence a reflection of new disease or better detection?
Joining a women's golf league may seem intimidating at first glance. But if you do your research, you may find that club membership is the ticket you need to furthering your game.
A personal trainer can help you achieve a healthier body through greater accountability and motivation.
Cancer clinical trials may be the answer for those in need of cutting-edge research to help fight their disease.
Trade in your glasses for LASIK or PRK
When it comes to a friendly round of golf, who's more competitive, men or women?
The transformative power of an enhanced smile can have an enduring impact on self-esteem.
Local fashion experts provide fashion advice for women 50 and older.
Workplace Wellness is enhanced with physical therapy programs designed to prevent injury, restore function and minimize disability.
Working out with a trainer helps 80-year-old newlywed Annie Garnero-Richerts overcome a debilitating flare-up of Rheumatoid Arthritis.
The trend in cancer treatment is progressing towards a more comprehensive approach in which Comprehensive Cancer Centers are playing a greater role.
With proper evaluation and therapeutic intervention, the autistic individual can optimize his or her chances for leading a productive life.
Healthcare guidelines are designed to improve your chances of aging gracefully.
African American women are less likely to develop breast cancer, but they are also less likely to survive it.
This profile of Michelle Wie explores the making of a 13-year-old golf phenom
Waiting till age 40 for that first mammogram may not be a wise decision