Time for your wellness exam

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Heritage Heath’s Dr. Anthony Rehil-Crest exams Joe Saffeels of Dalton Gardens during a regular physical wellness exam. Photo courtesy of Heritage Health.

Your doctor wants to see you.

Despite being an included service on many insurance policies, many people opt out of their annual wellness exam. But local doctors say there isn’t any good reason to avoid it.

“We’re trying to promote good health, and we’re trying to identify people who may have a higher risk of getting a disease later in life,” said Dr. Catherine Suriano, of Kootenai Health Family Medicine. “Some people think we want you to come in just so we can get your co-pay, but I’d rather not see you back with an acute illness or in the emergency room.”

What happens at a typical wellness exam depends on your age and risk factors. Exams for children will typically focus on physical and behavioral development, whereas older patients will be screening for dementia and memory-related issues, as well as conditions that occur more frequently later in life, like heart conditions and some cancers. For most adults, the exam focuses on preventative health and general wellness practices.

“Identifying their family history is almost just as important, because people may be at risk for things they aren’t even aware of,” Suriano said.

Getting a complete family history is key to determining what kinds of tests will be done at the visit or things that will be considered at wellness exams in the future, said Dr. Anthony Rehil-Crest of Heritage Health.

“We will typically ask about disease that runs in your family, especially cancer,” Rehil-Crest said. “We like to know who in your family had what disease, how old they were they were diagnosed and how old they were when they passed away.”

The typical physical exam

In addition to reviewing medical history and existing conditions (as well as surgical history and childbirth history for women) a medical practitioner will also review your current medications - what you’re taking, why and how you’re taking them.

A doctor typically listens to the patient’s heart and lungs, listening for any abnormal sounds, such as murmurs or skipped beats, Rehil-Crest said.

“They will examine your abdomen to examine your liver and spleen for enlargement,” Rehil-Crest said. “They might test the patient’s reflexes and also test the patient’s strength in

their arms and legs. Depending on their age they might examine their gait, their ability to

walk, and their balance, especially in older patients who are at risk for falling.”

Dr. Suriano said a Body Mass Index (BMI) screening is typical for a wellness exam, as well as a review of diet to determine if there are things missing in their everyday regime. She said she sees many elderly patients especially who have limited access to fresh fruits and vegetables.

All adults are also screened for depression and any mental health issues, usually through a series of questions.

“Then we go over the not so pleasant part, which is the smoking and the alcohol use,” Suriano said. “We have to point out what the limits are and how that affects their health.”

Blood pressure tests are tied to your heart and kidney function, and shouldn’t be higher than 140 over 90. Suriano said it’s important to identify people close to that limit in order to avoid future problems. Often times the solution is better diet and more activity, which can be a challenging prescription for some patients.

“Some are already fairly sedentary and are limited because of something like arthritis, but just because you have a lot of pain when you move doesn’t mean there aren’t options. We try to work with people with where they are at physically,” Suriano said.

Further testing

A cholesterol screening is a common additional test for many patients at a wellness exam, especially for those with a family history of heart attack and stoke. For elevated levels, the prescription is often diet and exercise related, but medications may also be prescribed. Blood tests for diabetes are also common based on weight, symptoms, family history and age.

Predictably, more tests occur as you get older.

“For most adults over 40 we are drawing blood to check you kidney function and liver function,” Rehil-Crest said. “We also look at blood counts to check for anemia or other blood disorders.”

Blood tests for specific diseases occur more on age and medical history, he said.

“For example, you may be at high risk for prostate cancer because your father was diagnosed with prostate cancer at your age,” Rehil-Crest said. “In that case we might do a test called a PSA, a blood test that can detect prostate cancer.”

For women, cervical cancer screening typically begins around age 21 with a pelvic exam and Pap smear. At age 40, a woman usually starts getting screened for breast cancer with a mammogram, Rehil-Crest said.

“The age to start breast cancer screening can vary depending on the patient’s risk and again, this is why the history is such an important part,” he said.

The ‘But I Feel Fine’ fallacy

Doctors know many people only go to the doctor when something seems seriously wrong.

“A common refrain I hear from patients is, ‘I feel fine, so there is no reason to see my doctor,’” Rehil-Crest said. “The problem with that mentality is that there are a lot of diseases that really don’t have symptoms until it has done significant damage to your body over decades of not being treated.”

The best example of this, he said, is high blood pressure.

“We often call high blood pressure the ‘Silent Killer’ because a person may spend decades of their life with high blood pressure and never have a symptom, and the first time it is diagnosed is after they had a heart attack or a stroke,” Rehil-Crest said. “If you have high blood pressure and it is detected early by a doctor at an annual physical, then that gives them the opportunity to treat it and hopefully prevent a heart attack or stroke in the patient’s future.”

Fear of bad news also extends beyond the wellness exam and when doctors ask for further testing. Many are afraid of the outcome, Dr. Rehil-Crest said.

“What I try to explain to patients is that the earlier we can detect disease the better chance we have at treating it or curing it before it can cause significant damage to your health,” he said. “This is especially true for cancer. If we can detect breast cancer or colon cancer early, before a patient has symptoms, then we have the best chance of curing the patient.”

If something is wrong now, don’t wait

A wellness exam is not necessarily a “free and clear” diagnosis for the next 12 months.

“There are some things that we may not be able to detect in an annual physical,” Rehil-Crest said. “Any new symptoms or concerns should be brought your doctor and not wait until your next physical.”

Dr. Suriano said some patients bring a laundry list of aches, pains and problems into an annual visit, and there may not be time in an appointment to address all those issues in addition to the typical elements of the wellness exam.

“If you only see your doctor once a year, that’s probably not the best time to say, ‘I’ve had back pain for three years,” Suriano said. “Also if someone comes into the wellness exam and says I’ve had new chest pain for the last month.’ Well that could be heart disease, so they need to be coming in sooner.”

Getting ‘wellness’ focused

The term “wellness exam” is much more preferred by doctors than calling the visit an “annual physical,” Suriano said. It’s a time for an overall health check, but it’s also the opportunity to plan what you’ll be doing over the next year to either maintain or improve your health.

Dr. Suriano said it’s also some of the best times to connect with patients and see positive progress.

“I actually have fun going through wellness exams with people because people can share their successes,” Suriano said. “People come in and say, ‘Hey doc, did you notice I lost 25 pounds?’ or ‘Hey, I quit smoking.’ I like to hear people’s success stories and I love sharing those stories with people who may be discouraged by similar issues.”

Patients can get a more detailed background of what is typically included in an annual wellness exam based on your age, as well as the health topics pertinent to your age and family history, by visiting the website for the US Preventive Services Task Force. Visit https://www.uspreventiveservicestaskforce.org/Tools/ConsumerInfo/Index/information-for-consumers

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