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VOL. 5 • NO. 9

Checkup

Annual physical exams are integral to overall health — despite the critics The debate on yearly physicals rages on. Are they the benchmark of good health or an expensive drain on the health care system? Dr. Myechia Minter-Jordan, the chief medical officer of The Dimock Center, is clear on her opinion. “It is one of the more key visits,” she said. “It provides an opportunity to focus on the total patient.” While visits for acute complaints average 20 minutes, Minter-Jordan said she devotes twice that amount of time for a yearly physical. “It’s a more relaxed setting where I can address multiple issues,” she explained. But a study published in 2007 in the Archives of Internal Medicine suggests that, for healthy adults, the benefits of an annual physical may not justify the financial cost. Researchers from the University of Pittsburgh School of Medicine and Harvard Medical School found that preventive health examinations and preventive gynecological examinations account for 8 percent of ambulatory visits at an annual cost to the economy of almost $8 billion. The problem, according to the researchers, is that no professional organization has a set policy on yearly exams and there are no established criteria on exactly what that exam should entail. Physicals vary by doctor and even region of the country. They are most common in the Northeast, least common in the West. Some doctors perform a cursory check, while others examine each system of the body and include blood and urine tests. In addition, critics argue, screening tests — the hallmark of prevention and the chief component of yearly exams — can actually be performed at other medical encounters during the year. A visit for a rash,

Mental

for example, can segue into a check for hypertension, cholesterol or even cervical cancer. Yet, supporters of yearly exams contend that they serve a much broader role than just screening tests. They help establish and cement patient/doctor relationships and set the stage for education and conversation in an unhurried environment. Minter-Jordan added that it is not the best time to offer screenings when someone is not feeling well. Regardless of the debate, an earlier study in the same journal found that 65 percent of roughly 800 primary care physicians in Boston, Denver and San Diego agreed that yearly exams were necessary, a sentiment shared by a large number of patients. The federal government has weighed in. As part of the Medicare Modernization Act of 2003, a “Welcome to Medicare” exam has now been added that consists of seven elements, including functional ability and safety. The lack of a clear standard on yearly physicals is not a reprieve from doctor’s visits. Quite the contrary. The need for certain screening tests has been well established. Several professional organizations, such as the American Cancer Society, have developed protocol for prevention or early detection of particular illnesses based on research findings. The ability to stop a disease before it starts or detect it in its infancy is one of the major advances in health care in this country and instrumental in the drop in deaths of many diseases. Cervical cancer rates have fallen as much as 70 percent since 1955 in the U.S. largely due to widespread use of the Pap smear. Women can now find breast cancer before it spreads and a simple, painless blood pressure measurement can Checkup, continued to page 4

health is equally important When most people think of summer, they conjure up visions of picnics, the beach or outdoor concerts. But Dr. Nina Mitra, a licensed psychologist at The Dimock Center, has other thoughts in mind. “Summer’s a perfect time to do a mental health self-assessment,” she said. “There’s more sunlight, more daylight. If you’ve been thinking about recharging your batteries, now’s the time.” Mental health disorders are often overlooked as a component of a yearly physical. Yet, it is not possible to separate mind and body — the two are inextricably linked. “It’s always good to check up to see how you’re doing — physically as well as mentally,” Mitra said. “It’s a healthy thing for everyone to do.” Healthy — yes — but not so easy to do, particularly for some African Americans. Historically, blacks are resilient and so used to hardships, they often fail to see the signs of a mental disorder. They assume that sadness is “just the blues” and a normal part of life. Furthermore, the stigma associated with mental illness prevents many blacks from owning up to emotional problems let alone receiving care for them. Yet, in surveys conducted by the Centers for Disease Control and Prevention (CDC), blacks admit to feelings of sadness, hopelessness and that “everything is an effort” — typical symptoms of depression — more often than whites. Income is a factor as well. The CDC further reports that the lower the poverty level the higher the percentage of serious psychological distress reported among African Americans 18

years of age and older. Such barriers — lack of awareness, poverty and cultural stigma — are factors contributing to the low rates of mental health treatments in blacks and other minorities, as reported in a recent study published by the National Institute of Mental Health (NIMH). Blacks turn to family, the community and religious leaders more often than mental health professionals. Mental illnesses are not rare. More than 26 percent of the adult population in this country is diagnosed with some sort of mental disorder, according to the NIMH, and 22 percent of these cases are considered severe. Common disorders are depression, anxiety, stress and alcohol or substance abuse. And the symptoms can be so subtle, they often escape attention or correct interpretation. Identifying the problem is a big challenge. People tend to view mental disorders in the extreme — the person talking to people only he or she can see, or an alcoholic down on his luck. These indeed may demonstrate mental disorders, but most of the time, the signs are not as obvious. Mitra ticked off several typical symptoms. Depression can result in loss of energy or concentration, loss of interest in things you previously enjoyed, having a negative attitude, a change in appetite. People who are anxious might experience obsessive worrying about something, are irritable, short-fused

Mental health, continued to page

Back to School Health

Checklist

When you send your children off to school this fall, make sure healthy habits are part of their daily curriculum. “Parents are great teachers,” said Dr. Jan Cook, medical director at Blue Cross Blue Shield of Massachusetts. “Help your children develop lifelong healthy habits by reinforcing a simple message: 5-2-1. Eat five or more servings of vegetables and fruit a day. Limit screen time to two hours a day. Get one hour of physical activity every day.” Our back-to-school checklist expands on these tips to help children stay healthy and grow strong.

For a healthy body • Schedule checkups

A yearly exam by a pediatrician and twice yearly dental visits help children stay healthy. Call today for appointments if needed. Ask the doctor’s office whether your

child’s vaccinations and booster shots are up to date. That’s important. Earlier this year, the national Centers for Disease Control and Prevention reported numerous outbreaks of measles, a disease that can be prevented through vaccines. Yearly flu vaccines are now recommended for children six months and older.

• Be active

An hour of moderate activity a day, such as brisk walking, helps children stay within a healthy weight range and wards off diabetes, high cholesterol and high blood pressure, which are becoming more common in children and may lead to later heart disease. Encourage your child to join school sports teams or clubs and activities designed to burn energy. Remind children to stay safe during sports

by drinking plenty of water before, during and afterward — especially on hot days — and wearing protective gear like helmets, padding and footwear appropriate for the sport. Call a doctor for advice following any head injury. Sports can be pricey, so ask about school-sponsored scholarships and free after-school activities (check your community recreation department, too). Resale stores like Play It Again Sports buy sell and trade good-quality used sports equipment. Thrift stores may be good sources too.

• Curb screen time

Limit screen time — that’s TV, texting, video games, surfing the web or chatting on social networking sites — to two hours daily. Excess weight, unhealthy snacking, less activity and more exposure to ads for fast foods, sugary cereals and unhealthy snacks are associated with more than two hours of TV per day. Move TVs and computers out of the bedroom (park cell phones outside bedrooms at night, too). Decide with your child where and when to spend screen time and whether chores and homework must be finished first.

• Lighten the load

Heavy backpacks can injure backs. First, lighten up. Teachers sometimes have extra texts that students can leave at home. If you have Internet access, ask teachers if any textbooks are available free online with a school password. Libraries offer free fiction and nonfiction books as well as online texts and services. Next, look for back-saving options. Buy a rolling backpack or one with wide, well-padded shoulder straps, a padded back and preferably a waist strap that helps support some weight. Adjust straps snugly.

• Sidestep germs

Schools are an excellent breeding ground for germs. Teach your children to cough or sneeze into an elbow. Remind them to wash hands after using the bathroom, before eating and after coughing or sneezing into hands. Hand sanitizer helps when washing up isn’t possible.

• Stay home when necessary

Sick days happen, so make backup plans now. Can you make up sick time or work from home? Can a relative or responsible neighbor step in when a child is sick? According to the American Academy of Pediatrics, good reasons to keep a child home include persistent fever (above 100.4° F by mouth); severe sore throat lasting at least 48 hours or severe headache, especially coupled with a fever; a significant rash; diarrhea; uncontrolled coughing; or lots of discolored nasal discharge. You should check with your child’s doctor if symptoms persist or worsen. Remember, sending children to school sick exposes others to your child’s illness and can make school an unhealthy place.

Shop fall farmers’ markets for fresh veggies and fruits. Hold taste tests at home featuring new choices and old standbys: winners claim a spot in school lunch bags. Boston residents who use SNAP benefits (previously called food stamps) can get 50 percent off farmers’ market purchases up to $20 through the Boston Bounty Bucks Program. Learn more at the market information table or www.thefoodproject.org/bountybucks. Along with a sandwich or yogurt, pack a handful of grape tomatoes, cucumber slices, baby carrots, celery, crunchy salad greens or farmers’ market favorites. Pair with a protein-packed dip like hummus or bean dip or a small amount of salad dressing. Apple slices dusted with cinnamon, orange slices, seedless grapes (preferably red) and berries are easy, healthy fruit choices. Water, skim milk or low-fat milk are great choices for beverages. Why stop at lunch? Try sprinkling fruit on yogurt or whole grain cereal for breakfast. Beware breakfast bars and toaster pastries, which pack a wallop of sugar. Cut back on sugary cereals by alternating days with healthier breakfast foods or allowing children to sprinkle a handful of sweeter cereals, raisins or other dried fruit on unsweetened or very lightly sweetened cereal. At dinner, liven up plates with one or more colorful servings of vegetables and fruit.

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Questions & Answers

1. If a person is in relatively good health is it necessary to have regular physicals? A yearly physical is a good opportunity to have a trained health care professional assess your overall health. Even if you feel that you are in good health there are many diseases that may be silent that would Bela Bashar, M.D. be caught only with routine Internist age and risk appropriate The Dimock Center screening, like hypertension and diabetes. It is also an opportunity for your physician to talk to you about any new health information that may apply to you. 2. Do adults require immunizations? Adults do require certain immunizations and some pediatric immunizations that need a booster. Some examples include the following: A tetanus vaccine would require a booster every 10 years; annual vaccination against influenza is recommended for all persons age 6 months and older, including all adults; a single dose of zoster (shingles) vaccine is recommended for adults age 60 years and older; a vaccine against pneumonia called pneumovax is recommended for individuals with certain chronic diseases as well as all adults greater then 65. 3. Why do teenagers or young adults require checkups since most illnesses occur in older people? Younger people also benefit from a routine annual physical to go over many aspects of their health, like vaccinations, counseling on safe sex, alcohol, tobacco and substance abuse, proper nutrition and screening for mental health issues. 4. Do people over 75 still require regular examinations? People over 75 do require regular examinations for many reasons, in particular age and risk appropriate screening as well as vaccinations and opportunities for general counseling and education. Older individuals also may need extra support to accomplish activities of daily living. If needed, extra support services like elder services can be arranged with your physician. 5. Do men follow a different screening schedule from women? Both men and women should have an annual physical. However, the type of screening in some cases will be different. For example, screening for prostate cancer is specific to men. 6. Is it OK if people get their screening tests at a health fair instead of at the doctor’s office? Health fairs are an excellent way for people to learn more about certain health conditions and get screened for them. However, a trained physician should ultimately help the individual interpret these results, especially if they are abnormal. Also, screening should be performed in a timely, scheduled manner which can be done only with regular visits to your physician.

Mind and body: Your emotions can affect your health When you are stressed, anxious or upset, your body tries to tell you that something is not quite right. The following are physical symptoms that your emotional health may be off kilter: • Back or chest pain • Change in appetite • Constipation or diarrhea • Dry mouth • Extreme fatigue • General aches and pains • Headaches • High blood pressure • Trouble sleeping • Lightheadedness • Palpitations — feeling that your heart is racing • Sexual problems • Shortness of breath • Upset stomach • Weight gain or loss

If these symptoms persist for several weeks and have no known medical cause, you should discuss them with your doctor. Source: American Academy of Family Physicians

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7. During an examination, should patients discuss life changes, such as divorce or stress? Life changes play a significant role in people’s lives and should be discussed since they can cause changes to a person’s health, especially as it relates to blood pressure and emotional well being. Life changes also can make it difficult to reliably take prescribed medications, which can then alter the course of disease treatment. 8. Why is it important to know a person’s family history? Some medical diseases can be passed down genetically, so an individual can have a higher likelihood of also contracting the same diseases. Examples include hypertension, diabetes and certain forms of cancer like breast and colon cancer. In certain cases, this would necessitate earlier screening. 9. What’s the value of keeping a health journal? A health journal enables an individual to track important elements in their health, which can then be more easily relayed to their physician at a visit. Tracking blood sugars in diabetics, blood pressure readings in hypertensive patients and weight measures in individuals looking to manage their body mass are all helpful things to track. Tracking also empowers patients to increase their own health awareness and take charge of their own health. 10. Should doctors ask about lifestyle, such as smoking, exercise and healthy eating? Lifestyle choices play an essential role in overall health. Smoking, substance and alcohol abuse, lack of exercise and poor eating habits contribute greatly to the development of several chronic illnesses, like hypertension, liver and kidney failure, diabetes, obesity and certain cancers. High risk behaviors place people at risk for infectious diseases like HIV, hepatitis and sexually transmitted diseases. Physicians routinely ask lifestyle related questions to understand people in the context of their living situation, which greatly impacts their health.

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The information presented in BE HEALTHY is for educational purposes only, and is not intended to take the place of consultation with your private physician. We recommend that you take advantage of screenings appropriate to your age, sex, and risk factors and make timely visits to your primary care physician.

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Checkup, continued from page 1

and abnormal kidney function. Screening warn of the risk of stroke. for diabetes and kidney function is critical Yet, one size does not fit all — the for African Americans. The prevalence of guidelines do not necessarily apply equally to diabetes is higher in blacks than in any other all patients or all clinical situations. Family racial group, and diabetes is the leading cause history or race may dictate earlier or more of chronic kidney failure, which can result in frequent screening. For instance, because of dialysis or kidney transplantation. the higher incidence and lower survival rates There’s a common misperception that of colorectal cancer in African Americans, immunizations are just for kids. Not so, the American College of Gastroenterology according to Minter-Jordan. Adults require (ACG) now recommends that blacks begin protection against tetanus, pneumonia for screening at 45 instead of the general guidethose over 65, the flu and even the mumps, line of 50. The ACG further recommends a measles and rubella. colonoscopy that alThough a lows examination of healthy lifestyle the entire colon rather — weight control, than a sigmoidosexercise and healthy copy, which provides eating — may be only a partial view. It difficult to manage, has been found that it is essential to good blacks have a higher health and a key part risk of polyps or of her discussion and tumors on the right education. Minterside of the colon, a Jordan has become a section missed by cheerleader of sorts. sigmoidoscopy. She knows how hard Minter-Jordan it is to change certain stressed the need to lifestyles, but “I try tailor the visits to age to boost their confias well as race and dence,” she said. Myechia Minter-Jordan, M.D., M.B.A. family history. For Emotional health instance, a discussion Chief Medical Officer does not escape The Dimock Center around establishing notice. “I do a mental good health practices health checkup, may be more appropriate for a 20-year-old, looking for signs of depression and stress,” while an exam for those 50 years and older she commented. She checks for mood changes will be structured around cancer screening. or indications of substance abuse and refers Elderly people may be more concerned about patients to mental health counselors as needed. Alzheimer’s disease, arthritis or limited She is quick to point out that the exams physical ability. are not one-sided. “It’s a collaboration,” she Thoroughness is the issue here. “I exam- said. “I like patients to question me. They ine from head to toe,” Minter-Jordan said. shouldn’t be afraid to speak up.” She goes system by system, asking For those who say they do not need a questions as she goes: “Do you get headyearly exam because they feel well, she has aches, have you gained weight, have you had a ready response: “You don’t feel high blood chest pains?” Peeling back layer by layer pressure until it’s too high.” helps people recall episodes they may have The key to the exam is trust, accordhad and dismissed. ing to Minter-Jordan. It provides an avenue Urine tests checks for protein in the to establish a partnership with the patient. urine, a sign of diabetes and kidney funcAfter all, she said, “You’re trusting someone tion. Blood tests look for anemia, cholesterol with your life.”

Get the right number Blood Pressure Cholesterol

Blood Glucose

• Normal Less than 120/80

• Total Less than 200

• Pre-hypertension 120 to 139 / 80 to 89

• HDL — “Good” Cholesterol • Random (after eating) Greater than 40 Less than 140 • LDL — “Bad” Cholesterol Less than 100 Waist Circumference Triglycerides • Women Less than 150 under 35 inches

• Stage 1 hypertension 140 to 159 / 90 to 99 • Stage 2 hypertension 160/100 and above

• Fasting Less than 100

Body Mass Index (BMI) 18.5 - 24.9

• Men under 40 inches

Health

South End Community Health Center

RoxComp

Health Care Revival

screenings 435 Warren Street, Roxbury Date: August 10 Time: 4 - 7 p.m. 617-442-7400 x2278

United for Elders Expo Central Boston Elder Services Boston Sheraton Hotel 39 Dalton Street, Boston Date: August 11 Time: 8 a.m. - 3 p.m. 617-267-2244

1601 Washington Street, Boston Date: August 13 Time: 11 a.m. - 2 p.m. 617-425-2000 x3088

Mattapan Community Health Center 294 River Street, Mattapan Date: September 10 Time: 9:30 a.m. - 3 p.m. 617-296-0061

Upham’s Corner Health Center

Strand Theatre 543 Columbia Road, Dorchester Date: October 15 Time: 11 a.m. - 2 p.m. 617-740-8128

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Take a good look at yourself Even if you’re feeling well, you should regularly see your health care provider to check for potential problems. The visit serves to screen for diseases, assess health risks, update immunizations and encourage a healthy lifestyle. Also key is establishing and maintaining a relationship with your provider. The following are general guidelines for adults 18 years and older that can be personalized to one’s risk and health status.

Screenings for men (M) and women (F) ages 18 and above M

Screening Test

Cardiovascular

Frequency

Starting Age

Blood Pressure*

Every 1 to 2 years

Cholesterol*

Every 3 to 5 years

Glucose (diabetes)*

Every 3 years

Abdominal aortic Aneurysm

65-75

Cervical (Pap test)

Every 1 to 3 years

Breast (Mammogram)**

Every 1 to 2 years

Prostate (PSA)***

Yearly

Colorectal***

Every year - fecal occult blood test Every 5 years - sigmoidoscopy and fecal blood test Every 10 years - colonoscopy

Skin

Yearly

Head and Neck

Yearly

TdAP/TD (Tetanus Diphtheria booster)

Cancer

Immunizations

One time for men who have ever smoked

Every 10 years

Flu

6 months

Yearly

HPV

9 to 26

3 shots

Shingles

One time only

Pneumonia

One time only

Others Dental exam

Yearly

Eye exam

Every 2 years

Osteoporosis

65 70

As needed As needed

HIV

Based on sexual activity

Chlamydia

Sexual activity

Yearly based on sexual activity

*Those with a blood pressure exceeding 120/80 or those with diabetes, heart disease or kidney problems may require earlier or more frequent monitoring. **Women at high risk of breast cancer may start screening at a younger age. ***African Americans are advised to start screening at 45 rather than 50. Sources: U.S. Preventive Services Task Force, National Institutes of Health, American Heart Association

Mental health, continued from page

or lashing out. are significantly different and last longer, it’s If you find that you’re not sleeping well best to take a closer look,” she said. There is at night, that you are unable to fall asleep or less concern about a problem that is shortyou keep waking up, that signals a problem, lived, she added. said Mitra. But if the stress is disrupting life or causStress takes a physical toll as well. ing other difficulties, it is probably time to see “You feel it anywhere in your body. It’s someone — your primary care physician or a where you keep your stress,” she explained. mental health specialist. For instance, some are more prone to There are things a person can do to try backaches or headto maintain sound aches while others mental health. Being suffer upset stomachs physically healthy when under undue is one of them. stress. For some Exercise and healthy blacks, the problem eating are key. Keep may be more serious things in balance and go beyond mild and take time to aches and pains. In a enjoy yourself, recent study conducted recommended Mitra. at the University of Sometimes just the California at Los little things can help, Angeles, the researchlike reading a good ers concluded that high book, watching a levels of stress resultcomedy or getting ing from discriminatogether with friends. Nina Mitra tion may be a factor “Make a personal Licensed Psychologist behind higher rates of mental health check The Dimock Center hypertension, diabetes list,” she added. “And and obesity in blacks. take stock of yourself.” Self-assessment Several factors can upset the emotional questionnaires have some value. They can help cart — finances, family relationships, work or point you in the right direction, but they cannot living environment. “Juggling too many things diagnose a problem. causes stress,” Mitra said. “Sit back and take a Mitra warned against letting things go on look at yourself. “How am I handling this?” too long. “You have to take the time to take Mitra offered advice. “If you think that care of daily life stresses,” she said. “It sneaks you are experiencing emotional symptoms that up on you.”

Comments on Be Healthy? Contact Health Editor Karen Miller at kmiller@bannerpub.com.