REGULAR MEDICAL CHECKUPS

Article by Dr. Robin Cowper

Over the past two years, most patients have been very concerned with the Covid 19 pandemic but we must not forget that many other medical conditions are more or just as important as Covid.

Women’s Health

Firstly, let me begin with the ladies: Women’s health is important to keep check on. After the onset of puberty breast checks should be done regularly (young women should be taught how to conduct these simple checks) and should there be menstrual irregularities a pelvic scan checking the uterus and ovaries and bladder is useful. Possible infections or polycystic ovarian syndrome come to mind. When the young patient becomes sexually active an annual PAP (smear) test should be performed. Advice on contraception and Human Papilloma Virus (HPV) vaccination should be discussed and given to girls from 9-15 years old. HPV infection is known to be the major cause of cervical cancer.  It is wise to have breast ultrasound checks regularly, especially at the 6-week post-delivery check-up. These checks should continue until the patient reaches menopause as breast cancer in younger women and those breastfeeding can be much more serious.

Menopause

On reaching menopause women should have a bone density scan and mammogram done.  Bone density (Dexa) scans are then done every 2-3 years thereafter. Osteoporosis and resulting fractures are painful and disabling and should be avoided at all costs. Hormone replacement therapy (HRT) should be discussed and used where necessary. Hormone blood tests and symptoms should be a guide as to whether HRT should be commenced.  As well as these specific investigations, the usual routine blood tests including full blood count, thyroid and lipid profiles, and uric acid are some of important tests.  Post-menopausal women have a higher risk of a heart attack and therefore lipid profiles are important. Women are fortunate in Harare to have excellent facilities for diagnosis and treatment of the women’s issues mentioned.

Men’s Health

And now for the men: Younger men are becoming more aware of their health and often request routine investigations. This is a great step forward. Again the usual blood tests checking Full blood count, renal function, liver function tests and lipid profiles, blood sugar levels, and thyroid function checks should be done on an annual basis.  Diabetes is a major cause of illness and death but if well controlled the outcomes are good. As with the ladies, advice on HPV vaccination is becoming important – after all, HPV is a sexually transmitted condition and vaccination should be given to boys from 9-15 years old.

Life After 40

Once a male patient reaches 40 a prostate blood test (PSA) should be done. Colon cancer is twice as prevalent in males than in females and therefore when the male reaches 45, a colonoscopy should be done. Although not the most pleasant of examinations (it is done under sedation!!), it could save the patient from major bowel problems and early death. During this procedure, we looking for bowel polyps that have a high chance of becoming cancerous and can be removed during the colonoscopy. As I have mentioned earlier, monitoring the prostate PSA levels is important, If the PSA level begins to rise then an ultrasound scan of the prostate should be done. This tells the doctor if the prostate tissue is uniform or if any suspicious areas may need a biopsy sample of the tissue. Many urologists would say that once the man has reached 50 the ultrasound of the prostate should be done every 3-4 years.

Blood Pressure

Most of our patients like to know what their blood pressure is. This is important and should be done at every check-up as well as a check on the pulse. Should the blood pressure be raised a doctor will often do a check exercise electrocardiogram (ECG) Abnormalities on the ECG usually need further investigation such as an echocardiogram to check the heart size, heart muscle efficiency, and heart valves.

My Last Piece of Advice

To maintain good health routine checks such as I have mentioned should be continued into old age. Bone density checks for the ladies and prostate checks for the men should be continued but also it is useful to send older patients for hearing tests. Many of the elderly will not admit to hearing loss but it is now known that hearing loss may be a cause of dementia in the elderly. Doctors should also check on the patient’s sight especially if they are still driving a motor vehicle. Cataract surgery is commonly and well done today and for those with retinal degeneration, there is treatment available to slow down the retinal deterioration. It is also useful to check the patient’s skin for signs of skin cancer and melanoma. Early detection and treatment are vital.

I hope that this article has made you aware of the importance of regular checkups. Just because you feel great make sure that there is nothing untoward that could cause major problems in the future. Due to lockdown rules and the risk of Covid infection many patients have tried to avoid their annual checkups and contact their doctors requesting repeat prescriptions without having been seen at least once in the year. This is a bad medical practice and should be avoided by doctors at all costs. Doctors’ surgeries are well aware of the Covid risk and have usually put preventive measures in place.   Preventive health improves life span and will also cost the medical aid societies far less in the long term.

Finally, since this article has been about annual checkups and preventive health vaccination against the Covid-19 virus is so important. The booster dose ensures higher levels of immunity. We hear from many centres around the world, including Zimbabwe that 90% of patients admitted to intensive care units have not been vaccinated or have not had their boosters. The normal influenza vaccine should be available soon and this further boosts immunity.

Originally published in the 121st Ndeipi Magazine

 

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