Five questions to ask your health care provider

By Diana Bitner, MD, Spectrum Health Beat

Even if your yearly physical isn’t scheduled for several months, there are questions you should ask your doctor, physician assistant, or nurse practitioner during your appointment.

Here are five questions you should ask at your checkup:

1. What is my risk for a heart attack?

It’s important to know what factors are in your control and which ones are out of your control when it comes to your risk for a heart attack. I recently saw a patient for her annual exam and she told me she had experienced a scare with chest pain since her last yearly physical.

A visit to the ER revealed a problem with her gallbladder instead of a heart issue. She knew she had high cholesterol and her weight put her at risk for heart disease, but she wasn’t too concerned about her numbers. After her recent scare with chest pain, she began to care a great deal more. So, she asked me what she needed to do to keep her risk as low as possible.

First we looked at her family history. Her father had experienced a heart attack but not until age 72, and her mom was healthy, with no heart disease. She didn’t have pre-eclampsia during pregnancy and had not experienced gestational diabetes. All of this showed that the things she could not change were in her favor—good news!

Next, we looked at things she could change: cholesterol (overall 240—high), triglycerides (180—high), HgA1C level used to test for diabetes (5.7 percent—borderline high), CRP level (2.5—indicates an average risk for heart disease), waist circumference (39—very high), and blood pressure (142/89—high).

The reality was that the factors she could control were increasing her risk of heart disease. In addition, her health habits could be improved. She walked three days a week but didn’t do any strength training, and her diet was mostly meat and potatoes with a salad thrown in once in a while.

So, together, we mapped out a plan to include some dietary changes and add at least two Zumba classes each week, plus water aerobics on the weekend. She also promised to buy the book Sugar Busters to help her learn about healthy versus unhealthy sugars.

2. What is my risk for breast cancer?

We use a scale called the Gail Model to measure breast cancer risk. It includes your family history, your age when you started your period, whether or not you have been pregnant, whether you ever had breast biopsies, and how old you were with your first pregnancy.

Other risk factors we study include your alcohol intake, Body Mass Index (BMI), and current activity level. I recently had a patient who had a significant risk of developing breast cancer based on the following factors: her sister had breast cancer, she had early onset of periods, and she had chosen to not have children. She made an appointment at the high-risk breast clinic and made the personal choice to have a mastectomy. The results revealed extensive DCIS (Ductal Carcinoma In Situ), which indicates pre-cancer in many women.

For this patient, understanding her risk saved her life and early treatment allowed her to continue taking hormones. Even if your risk of developing breast cancer is low, it’s important to talk to your physician about the risks and follow the guidelines suggested for mammograms. If it’s time, get it done.

3. What is my risk for osteoporosis?

Bone health starts early—in the womb, to be exact.

Our bones begin to be formed based on the amount of Vitamin D and Calcium our mothers take when they are pregnant. After we are born, our bone health depends on our diet and activity level. By age 32 our bone mass reaches its peak, and we experience overall loss the rest of our lives.

Our bones are constantly being remodeled. Over time, breakdown occurs more rapidly than buildup. During menopause, if there is no estrogen replacement, the bone loss accelerates to a rate that increases the risk of fracture.

Several factors can make us lose bone even faster than normal aging: smoking, inactivity, consuming large amounts of soda water or pop, drinking more than two alcoholic beverages per day, hyperthyroidism, and conditions such as rheumatoid arthritis.

Long-term use of birth control hormones such as Depo, as well as taking drugs used to fight breast cancer, can also increase bone fragility. Of course, there are medications to improve bone strength, but the most important way to prevent fracture is to live a healthy lifestyle and eat a balanced diet.

4. What is my risk for colon cancer?

Colon cancer is very common, and the strongest risk factor is aging. Everyone needs a screening colonoscopy at age 50, but some of us need it sooner. If you have a family member who has had large colon polyps or colon cancer before 50, you are at high risk of having the same. Ask your doctor about early screening if you fit into this category.

Also, if you are experiencing persistent, unexplained symptoms such as lower pelvic or abdominal pain, a persistent change in bowel habits (lasting more than two weeks) or blood in your stool, you might need a colonoscopy to see what is causing these issues.

You can reduce your risk by living a healthy lifestyle: consuming less than two alcoholic drinks a day; eating a maximum of two servings of red meat per week; eating a high fiber diet; and exercising at least five days per week. Remember—a colonoscopy is much less stressful than colon cancer. If it’s time, get it done.

5. What immunizations do I need?

There are several immunizations that are recommended, and I encourage you to discuss these with your healthcare provider:

A flu shot before winter arrives.
The Hepatitis A and Meningococcus vaccines if you are heading off to college soon.
The Gardasil vaccine if you are under 29 and have not had this series yet.
The Gardasil vaccine if you are newly single, over 29, and HPV negative.
The Tdap (including Pertussis) once in your lifetime.
A Td (tetanus) vaccine every 10 years.
The Shingles vaccine at age 60.
The Pneumococcal vaccine at age 65.

Be sure to ask your doctor to look at your immunizations record and confirm that you are up to date on all of these.

The bottom line is that it is your responsibility to maintain your health and keep a journal or record of your health history. As you send your kids off to school each year, use that time as a reminder to pull out your book and make sure you are on track.

Reprinted with permission from Spectrum Health Beat.