Ask the Doctors: Yearly physicals set health baseline
Dear Doctors:
I am baffled that what used to be a thorough and comprehensive physical exam is now just a few questions, taking some vital signs and a few blood tests. No checking your eyes, throat, glands or reflexes. No breast exam. Why has this changed? What constitutes a complete physical these days?
The annual physical exam has long been considered a cornerstone of preventive health care. But as surprising as it may seem, there are no official guidelines as to what it should entail. At the same time, some doctors and medical practices have recently begun to move away from offering their patients a yearly checkup. This change has been prompted by several studies that, in parsing large troves of health care data, have questioned the efficacy of this yearly ritual. However, for both of us, the annual physical exam continues to be an important part of our practices.
Absent the existence of official guidelines for the annual physical, we can only discuss the specifics of our own approaches. We see it as an overall assessment of someone's general health and as a chance to reconnect with the patient. It's an opportunity for both the patient and doctor to take stock of the previous year and to assess any changes. It's also an opportunity to set new goals and plan for the future.
In our practices, the annual exam begins with a review of the person's medical history, along with any updates that are needed. This includes illnesses or injuries, vaccinations, medications prescribed by other doctors and mental health updates. Family medical history, including new instances of diseases such as certain cancers, coronary artery disease or Alzheimer's disease get updated as well. Patients often deal with smaller, less pressing medical issues on their own. Adding information about these to their medical history can prove to be important for future visits.
When we conduct a physical exam, we review each patient's blood pressure, heart rate, weight and body mass index. If there have been significant changes, we address them. We explore possible causes and discuss changes to diet, medication or behavior that may be needed. When it comes to diagnostic tests, we order a complete blood count; tests that analyze liver, kidney and thyroid function; as well as diabetes and cholesterol screenings. We also check vitamin D levels. We review those results, discuss them with the patient and offer mitigations if needed.
When screening tests such as mammograms, Pap smears and bone density tests are called for, we recommend them to our patients. We also discuss the risks and benefits of the PSA test, which screens for prostate cancer. In keeping with newly updated guidelines, we recommend colon cancer screening with a colonoscopy for patients 45 and older.
The information collected in an annual physical exam can help patients get a better understanding of their physical wellbeing. It also provides a useful baseline against which future changes or anomalies can be evaluated. In our view, this yearly screening empowers patients, strengthens their relationship with their health care providers and paves the way to better health.
A recent blood test showed my creatinine levels are a bit high. My doctor said it's something we need to watch because that can be a symptom of chronic kidney disease. Is high creatinine really that big of a deal? What can you do to take care of your kidneys and get lower numbers?
When it comes to general health, kidney function isn't the first thing that comes to mind. Factors such as blood pressure, blood sugar, cholesterol and cardiovascular health all get top billing. But those two bean-shaped organs, each about the size of a fist, play an integral role in keeping us alive.
Located just above the hips, one on each side of the spine, our kidneys have multiple roles in keeping us healthy. Among the most important is to remove waste from the blood. More than 7 gallons of blood pass through the kidneys' intricate filtration system every hour. They also remove excess water from the tissues of the body, manufacture and excrete urine, release hormones that help regular blood pressure, play a role in bone health and the production of red blood cells, and maintain electrolyte balances that allow nerves, muscles and other tissues to function properly.
Dear Reader: Dear Doctors: Dear Reader:
Creatinine, which is a waste product produced by the muscles, gets filtered out by the kidneys. Your blood test result got flagged because a buildup of creatinine in the blood can be a sign of impaired kidney function. This can lead to chronic kidney disease.
The Centers for Disease Control and Prevention estimates that about 15% of people in the United States are living with chronic kidney disease. And because this can be a silent disease with no symptoms until the condition becomes severe, up to 90% are not aware of it. As you can tell from these numbers, your question about how to improve and maintain kidney health is an important one.
The good news is that some easy lifestyle choices can help you maintain kidney health. The top two causes of chronic kidney disease are high blood pressure and Type 2 diabetes. That makes managing blood pressure and blood glucose levels a top priority. Someone diagnosed with these conditions should be vigilant about any medications they have been prescribed to manage them.
As with so many areas of good health, food also plays an important role. To keep your kidneys in top form, you should make it a priority to eat a diet high in fresh vegetables, fruit, leafy greens, lean proteins, beans, nuts, legumes, oily fish and healthful fats, and low in processed foods and added sugars. Regular exercise is important, as is staying adequately hydrated.
Some over-the-counter pain meds and anti-inflammatories can adversely affect kidney health. So can certain nutritional supplements and herbal remedies. Discuss the use of any of these with your doctor. It's also important to stop smoking and limit the use of alcohol.
While a single high creatinine reading doesn't automatically equal kidney problems, it's important to listen to your doctor and keep this on your radar.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.