Living Well
Sunday, Jan. 29, 2012
Muskogee Phoenix
Page 8
Too many tests? Routine checks getting second look WASHINGTON (AP) – Recent headlines offered a fresh example of how the health care system subjects people to too many medical tests – this time research showing millions of older women don’t need their bones checked for osteoporosis nearly so often. Chances are you’ve heard that many expert groups say cancer screening is overused, too, from mammograms given too early or too often to prostate cancer tests that may not save lives. It’s not just cancer. Now some of the nuts-andbolts tests given during checkups or hospital visits are getting a second look, too – things like routine EKGs to check heart health, or chest X-rays before elective surgery. Next under the microscope may be women’s dreaded yearly pelvic exams. The worry: If given too often, these tests can waste time and money, and sometimes even do harm if false alarms spur unneeded follow-up care. It begs the question: Just what should be part of my doctor’s visit? If you’re 65 or older, Medicare offers a list of screenings to print out and discuss during the new annual wellness visit, a benefit that began last year. As of November, more than 1.9 million seniors had taken advantage of the free checkup. For younger adults, figuring out what’s necessary and what’s overkill is tougher. Whatever your age, some major campaigns are under way to help. They’re compiling lists of tests that your doctor might be ordering more out of habit, or fear of lawsuits, than based on scientific evidence that they are really needed. “Too often, we order tests without stopping to think about how (if at all) the result will help the patient,” wrote Dr. Christine Laine. She’s editor of Annals of Internal Medicine, which this month published a list of 37 scenarios where testing is overused. Not even physicians are immune when it comes to their own health care. Dr. Steven Weinberger of the American College of Physi-
cians had minor elective surgery for torn knee cartilage about a year ago. The hospital required a pre-operative chest X-ray, an EKG to check his heart, and a full blood work-up – tests he says aren’t recommended for an otherwise healthy person at low risk of complications. Weinberger should know: He led the team that compiled that new list of overused tests. All three examples are on it. “If anyone should have objected, I should have objected, but I took the easy way out. I didn’t want to be raising a fuss, quite frankly,” he says. The college of physicians’ push for what it calls “highvalue, cost-conscious care” – and similar work being published in the Archives of Internal Medicine – aims to get more doctors to think twice so their patients won’t be put in that uncomfortable position. Another group, the National Physicians Alliance, is studying whether training primary care doctors in parts of Connecticut, California and Washington about the most overused care will change their habits. Medical groups have long urged patients not to be shy and to ask why they need a particular test, what its pros and cons are, and what would happen if they skip it. This spring, a campaign called Choosing Wisely promises to provide more specific advice. The group will publish a list of the top 5 overused tests and treatments from different specialties. Consumer Reports will publish a layman’s translation, to help people with these awkward discussions. For now, some recent publications offer this guidance: • No annual EKGs or other cardiac screening for lowrisk patients with no heart disease symptoms. That’s been a recommendation of the U.S. Preventive Services Task Force for years. Yet a Consumer Reports survey of more than 8,000 people ages 40 to 60 found 44 percent of low-risk, people with no symptoms had undergone an EKG or similar screening. Simple blood pressure and cholesterol checks are considered far more valu-
able. • Discuss how often you need a bone-density scan for osteoporosis. An initial test is recommended at 65, and Medicare pays for a repeat every two years. A study published last week found that a low-risk woman whose initial scan is healthy can wait up to 15 years for a repeat; those at moderate risk might need retesting in five years, high-risk women more often. • Women under 65 need that first bone scan only if they have risk factors such as smoking or prior broken bones, say the two new overtesting lists. • Most people with low back pain for less than six weeks shouldn’t get X-rays or other scans, Weinberger’s group stresses. • Even those all-important cholesterol tests seldom are needed every year, unless yours is high, according to the college of physicians. Otherwise, guidelines generally advise every five years. • Pap smears for a routine cervical cancer check are only needed once every three years by most women. So why must they return to the doctor every year to get a pelvic exam (minus the Pap)? For no good reason, the Centers for Disease Control and Prevention reported last month. Pelvic exams aren’t a good screening tool for ovarian cancer, and shouldn’t be required to get birth control pills, the report says. Yes, simple tests can harm. Cleveland Clinic cardiology chief Dr. Steven Nissen cites a 52-year-old woman who wound up with a heart transplant after another doctor ordered an unneeded cardiac scan that triggered a false alarm and further testing that in turn punctured her aorta. A close relationship with a primary care doctor who knows you well enough to personalize care maximizes your chances of getting only the tests you really need – without wondering if it’s all just about saving money, says Dr. Glen Stream of the American Academy of Family Physicians. “The issue is truly about what is best for patients,” he says.
AP file
In this 2009 photo, a man sits on an ergometer during an electrocardiogram in a doctor's surgical office in Stuttgart, Germany. Some of the nuts-and-bolts tests administered during check-ups and non-emergency visits are getting a second look. Think twice about a routine EKG if you have no heart symptoms, or a chest X-ray just because you’re going in for knee surgery.
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Many women do not realize that heart disease kills more women than breast cancer. Routine screenings are part of preventing the onset of the disease.
What women should know about heart disease Millions of women around the country live with cardiovascular disease and may not know it. The consequences of being uninformed can be fatal. According to the National Coalition for Women With Heart Disease, heart disease is the leading cause of death in American women. More women die from heart disease than breast cancer in any given year, and the Public Health Agency of Canada says that heart disease is the leading cause of death among Canadian women over the age of 55. That’s a frightening reality that might surprise some.
What puts women at risk? There are a number of factors that can put a woman at risk for heart disease. • Hypertension: High blood pressure can exert extra stress on blood vessel walls and make them more likely to get clogged. • Cholesterol levels: Cholesterol in the blood can build up on the inside of blood vessels and lead to blockages that can cause a number of different problems. • Smoking: Women who smoke have a higher risk of heart attacks than nonsmoking women. Those who smoke and take birth control pills are at an even higher risk. • Obesity: The chance for heart disease increases with a woman’s weight. Even losing a little bit of weight can help diminish the chance. • Diabetes: High blood sugar can damage the ar-
teries that supply blood to the heart. • Family history: A woman with blood relatives who were diagnosed with heart disease is at a heightened risk of developing heart disease. • Lack of physical exercise: Inactivity can promote heart disease. Daily physical activity can go a long way to help the heart and prevent heart disease.
Preventing heart disease Recognizing the risk factors for heart disease is just the beginning when it comes to prevention. Once those risk factors are known, it’s up to women to take steps to live a more healthy lifestyle. Fortunately, there are many ways women can do just that. • Exercise daily. Thirty minutes of exercise per day is recommended. This can improve cardiovascular health by getting the blood moving through the body. It can also help women lose weight, decreasing risk for other ailments as a result. • Quit smoking. Do not use tobacco products. Smoking is one of the biggest risk factors for developing heart disease. Smoking narrows the arteries in your heart and can also contribute to the hardening of arteries, called atherosclerosis. This condition can ultimately lead to a heart attack. Carbon monoxide in cigarette smoke replaces some of the oxygen in the blood, according to the Mayo Clinic. This can raise blood pressure and force your heart to work harder.
• Eat healthy. Eating foods that are low in cholesterol and sodium can help with heart disease risk. A diet rich in fruits, vegetables, whole grains, low fat dairy products, and other sources of whole fiber can help. Consumption of fish, which is high in omega-3 fatty acids, is also beneficial. • Maintain a healthy weight. A doctor or nutritionist can help you determine a healthy weight for your body type and height. Most use calculations to determine a body mass index, or BMI, which considers certain factors, including height and weight, to determine if you have a proper amount of body fat. Waist circumference is also a tool used to measure how much abdominal fat a person has. • Go to the doctor regularly. A doctor can run certain tests to discover any red flags for potential heart problems. He or she will check blood pressure, cholesterol levels, conduct screenings for diabetes, and discuss family history. With all of this information, the doctor will be able to make certain assumptions about heart disease risk and guide you on the path to finding a program that will be effective for you. Although heart disease is the foremost killer of women in North America, it can largely be prevented and risk factors managed with adequate health care. Women living with any of the aforementioned risk factors should make an appointment with their doctor to determine a course of action.
A general guide to heart disease “Heart disease” is a broad term used to describe a number of ailments affecting the heart. When most people think of heart disease, they typically call to mind heart attacks. However, there are a number of conditions that can affect the heart. Here is a listing of common heart conditions, symptoms and treatment. Angina: Chest pain or discomfort that occurs in and around the heart when the muscle doesn’t get enough oxygen-rich blood. It can be brought on by stress, exertion, emotion, extreme cold, or be a symptom of a deeper problem such as clogged arteries. There are three types of angina:stable, unstable, and variant. Stable angina follows a pattern and is generally the most common. Unstable angina doesn’t follow a pattern. Variant angina occurs while you’re at rest and is rare. Angina may be treat-
ed with rest and medicine. All heart pain should be checked by a doctor. Aneurysm: An aneurysm is an abnormal widening or ballooning of a portion of an artery due to weakness in the wall of the blood vessel. Aneurysms are serious, and if not caught early and treated, can lead to death. Arteriosclerosis: This is any hardening or loss of elasticity of medium and large arteries, generally as a result of hypertension. Symptoms of arteriosclerosis vary according to which arteries are affected. Risk factors for arteriosclerosis include smoking, obesity, high blood pressure and/or cholesterol, stress, and diabetes. Atherosclerosis: This is a condition when fatty material collects in the arterial walls. It can harden over time, causing calcium deposits and restriction of blood flow. Avoiding fatty,
high cholesterol foods, exercising regularly, and getting checkups at the doctor are all ways to head off atherosclerosis at the pass. Heart attack: Also known as cardiac arrest, this is the culmination of many heart conditions, such as angina, arteriosclerosis, and atherosclerosis. It occurs when blood and oxygen are not able to reach the heart. High cholesterol:High cholesterol can be a factor in a number of heart conditions. Therefore it is desirable to keep cholesterol levels low. Hypertension: This is a term used to describe high blood pressure. Blood pressure is measured in two readings, the systolic pressure, or the pressure created when the heart beats, and the diastolic pressure, or the pressure in the heart when it is at rest. Blood pressure higher than 120 over 80 is considered high.