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The Physical Truth

by Colleen Patrice Clark

Now is the best time to plan out your annual doctors’ appointments for 2013.

There’s been some chatter among medical researchers in recent years surrounding a surprising question: Are annual exams still necessary? Some see them as required to catch problems early and build a strong patient-doctor relationship, while others see them as antiquated and wasteful in terms of both time and money.

But in asking local professionals, it’s clear they believe that in a world where preventive medicine is key, the annual trip to the doctor’s—whether it’s to listen to your heart, look at your gums or into your eyes—plays a crucial role in health care. So take the start of this new year as an opportunity to look ahead and pencil in all of your annual appointments, and read on to hear what local experts say about what to expect and why it’s not just beneficial to you, but to them as well.

Physical Exams
Pediatric: What Patients (and Parents) Should Know

What to do beforehand: No one likes waiting at the doctor’s office, so make sure that if you’re a new patient—say, you recently moved or had to switch doctors for insurance reasons—that you not only get prior records in order, but that you send them to the office before the visit.

“That’s really the most important thing of all,” says Dr. John B. Tedeschi of Advocare Township Pediatrics in Sewell. “If you can, I always find it helpful to get it to us beforehand so we can review it so you’re not sitting there for 40 minutes while I look at an old chart.”

Also, if there’s been any major changes in medical history, parents should be prepared to discuss the details, along with information about any new medicines. It’s always smart to bring those medicines with you, Tedeschi says, adding it’s a chance for the doctor to review that it’s the proper medication and dosage.

If you’re little one is nervous, there’s a myriad good TV shows and books that will help educate them, and play doctor kits tend to do the trick, Tedeschi says. “For the older kids, when they’re old enough to understand that they’re getting vaccines, it’s important not to hide it. Just be very matter of fact and honest about what’s going to happen. The important thing is to let them know it’s not a choice. Everyone does it and needs to do it to be healthy.”

What to expect during the exam: Expect the basics to be covered—ears, eyes, heart and lungs—but what makes the annual exam so necessary is the screening for emotional and developmental issues. “Obviously we feel their belly and make sure we don’t feel anything,” Tedeschi says. “We usually do a quick neuro exam to make sure their coordination and gait and everything is OK. But with children, the big thing and one of the most important reasons to have an annual exam is developmental screening.”

The patient-doctor relationship is built upon these screenings, in which the doctor makes sure the child is hitting all the proper milestones involving language development, fine and gross motor development, and more. Tedeschi says it delves into how the child is doing in school—whether or not they’re having any emotional issues or trouble concentrating, facing bullying, peer pressure, etc. In many cases, he says, it’s easier for a young child or teenager to talk to their doctor about some issues than it is with their parents.

“With an adult exam, you’re checking to make sure they don’t have hypertension, etc.,” Tedeschi says. “With children, that’s all important and we check all that, but most children are healthy and don’t have chronic illness yet. It’s really about the social, developmental and social aspect of the child and the family. … Parents should be prepared to discuss the family dynamic.”

One of the most important pieces of advice Tedeschi can give any parent? Write your questions down, no matter how silly you think they may be. “We’ve heard them all before,” he says, and you don’t want to walk out of the office wishing you had said more. And don’t be afraid to ask about those behavioral issues.

Why it’s important for the patient: As children age, some parents tend to lose sight of the importance of the annual exam. It’s between the ages of around 8-14 that adolescents don’t get sick nearly as often, Tedeschi explains, and so parents assume they don’t need the regular checkup anymore. “But it is still important because it does give us a lot of insight into the child and the dynamics of the family and the overall physical well-being,” he says.

Why it’s important to the doctor: “It’s the No. 1 thing you can do for preventive care,” Tedeschi says. “Your physical exam is your proactive way of dealing with your health. [As physicians,] we’d much rather be proactive than reactive.”

Adult: What Patients Should Know

What to do beforehand: Your vaccination history is very important. For instance, if you haven’t had the chicken pox vaccine and you didn’t get the virus when you were young, you need it now. Chickenpox becomes more serious in adults and can result in encephalitis, singles, pneumonia and more. You’ll also need the date of your last tetanus with pertussis vaccine, and you should know if you’ve had hepatitis B and A vaccines, according to Dr. S. Jay Mirmanesh, head of the practice at Advocare Pediatric & Adult Medicine in Marlton and Sicklerville. You also may need a pneumococcal vaccine, which is recommended for adults over age 65 as well as adults with certain risk factors, such as chronic heart disease.

“Next, you should have the list of all your medications and directions on hand,” Mirmanesh says. “Any past medical history that is significant, have it available so you won’t forget to discuss it with the doctor.”

What to expect during the exam: This of course differs for men and women, other than the general examination of the head, ear, nose, lungs, heart and abdomen. For men, Mirmanesh says they should expect exams for hernia, prostate and genitals, including checking for testicular lumps. For women, the checkup might include a breast exam and an examination of the lymph nodes underneath the arms.

Plus, a laboratory examination may include a complete blood count looking for anemia and any other abnormalities, Mirmanesh says, and a chemistry panel to look for diabetes, kidney problems and bowel problems. A lipid panel also checks for high cholesterol—which is done every five years after age 20 to help prevent heart attacks and strokes.

Questions to ask: What types of physical activity are recommended? What type of diet should you follow? What types of vitamins are recommended? “Smokers may want to ask the doctor if a lung screening is appropriate, especially if they are experiencing shortness of breath,” Mirmanesh suggests.

Why it’s important for the patient: Your health care needs change as you get older depending on your health and family history, along with lifestyle choices. What you need to be screened for also changes as you get older. “For example, at age 50, it’s time to begin regular screenings for colorectal cancer,” Mirmanesh says. “If you have an immediate family member with colorectal cancer, then screenings should begin earlier. For women age 40, it’s time to start the annual mammogram to screen for breast cancer.”

Why it’s important to the doctor: It all comes back to preventive care and how regular visits can help find problems before they’re actually problems. “They help find problems early when your chances for treatment and cure are better,” Mirmanesh says. “The routine annual checkup is important because it provides a great opportunity to focus on prevention and screening.”

Eye Exams
Pediatric: What Patients (and Parents) Should Know

What to do beforehand: Taking your child to the eye doctor, especially for the first time, is a gamble: You never know what the result’s going to be—or what version of your child you’ll see. Basically, will everything go smoothly, or will it be a tantrum-inducing visit? But with the proper precautionary steps, that doesn’t have to be a concern.

“Parents may want to schedule an exam for themselves first and have their child observe so the child knows what to expect,” suggests Dr. Sally Halim of Village Eyecare in Woolwich. “Also, parents can explain that the doctor is going to evaluate his or her eyes just to make sure they are healthy.”

Even better, if you have a school-aged child who has had health screenings with the school nurse, you can simply explain that the trip to the eye doctor will be very similar. The key, Halim stresses, is not just to make the child feel more comfortable, but also to get them excited about the visit before they come in.

What to expect during the exam: Did you know that a pediatric eye care visit is about way more than determining how well your child sees in the classroom and whether or not they need glasses? It’s true: Along with looking for conditions such as congenital cataracts or glaucoma, an eye exam can catch conditions like diabetes or leukemia, which cause bleeding in the back of the eye, Halim says.

Of course, the exam evaluates near or farsighted vision, but it will also check how well the eye focuses, peripheral vision (which involves the function of the nerve in the back of the eye), and depth perception (which screens for a lazy eye). “With school-aged children, I inquire how the child is performing in terms of reading and/or math,” Halim says. “If a child can see well but there is a disconnect between what their eyes see and what their brain comprehends, the child can have what are called perceptual issues. These conditions often manifest as trouble with tracking (losing their place as they read), reversing letters and skipping letters.”

Perceptual issues can lead to learning problems, but they can be treated with vision therapy, Halim adds.

Questions to ask: How often a child should return to the eye doctor along with how often they should wear their glasses and when—if prescribed—depends on the health of the eye and whether vision is diminished. So be sure to ask your child’s optometrist, Halim says.

Why it’s important for the patient: If anything about “What to expect during the exam” surprised you, that’s exactly why it is important. People don’t often realize how closely general health is linked to the eyes. They say the eyes are the window to the soul, but in many ways, they’re the window to your health. “Patients will learn how their eyes work, how their eyes and their general health are closely linked, and the things their optometrist can treat (i.e. pink eye, dry eye, foreign body removal, etc.).”

Why it’s important to the doctor: “The doctor can learn how evaluating a child is much different than evaluating an adult,” Halim says. “Many of the focusing issues that affect children do not affect adults. There is an art to examining children that only comes from experience.”

Adult: What Patients Should Know

What to do beforehand: Getting your medical records in order is always helpful when visiting your family doctor, and the optometrist is no different. It’s also wise to have a list of medications you are taking with the dosage and condition being treated, recommends Dr. Robert Spivack of Sterling Optical, with locations in Deptford and Turnersville. Also, “make a note of any signs or symptoms that may be related to the eyes or vision,” he says, “such as headaches, squinting, rubbing eyes, blurriness, a sandy or gritty feeling, etc.”

What to expect during the exam: All parts of the eye are evaluated, and that means way more than the cornea. The cornea is of course checked for clarity and smoothness, Spivack says, adding tears over the cornea are checked as well for the quality and quantity, important “to keep the ocular surface moist and healthy.”

The conjunctiva, covering the white part of the eye, is evaluated for dryness and imperfections, and the lens is looked at for cataracts, “a clouding of this part of the eye which gradually causes a decline in vision,” Spivack says, adding—much like the childhood eye care visits—the exams serve as a screening for several serious issues. “The retina and posterior part of the eye is evaluated for diseases such as glaucoma, retinal holes and tears, vitreous floaters, and blood vessel abnormalities, which could be attributed to diseases such as high blood pressure and diabetes as well as some neurological conditions.”

Everything down to the pressure of the fluid within the eye is checked, which determines if excess pressure buildup is causing damage to the optic nerve. Also, Spivack says, tests for depth perception, color deficiency, visual acuity and refractive error (near/farsightedness, astigmatism, presbyopia) are performed.

Questions to ask: There’s the surface questions—“How’s the health of my eye?” or “Is my vision as good as it can be?”—but there’s also deeper questions patients can ask, Spivack says, such as “What kind of changes can I expect as my eyes get older?” and “Is there anything I can do to protect my eyes and slow the aging changes?” The answers may surprise you, as your optometrist can ensure you’re taking the proper steps to maintain healthy eyes and optimal vision for as long as possible.

Why it’s important for the patient: By getting a look at your overall general health, eye exams maximize visual acuity and improve comfort and clarity, Spivack says.

Why it’s important to the doctor: It’s simple: “It’s best to find disease or changes early to intervene early for the best long-term outcome,” Spivack says, and the only way to do that is through regular visits.

Dental Exams
Pediatric: What Patients (and Parents) Should Know

What to do beforehand: Considering dentists recommend a child visit for the first time by age 2 to 3, one of the most important things to remember is to make the visit fun and exciting—and not just for your child. “Parents do not realize how easily they transfer their fears and anxiety to their children,” explains Dr. Mary Farren, DMD, of Cherry Hill.

So what should you do? “Parents need to make it something their kids will look forward to,” Farren says, adding honesty is key. They should tell their child that they are going to see the dentist, someone who’s there to look out for them and make sure their teeth are healthy and their smiles are the best they can be.

What to expect during the exam: Along with checking to make sure teeth are breaking through properly, the dentist will also be looking for developmental abnormalities such as problems with enamel formation, which is important because that can ultimately make teeth more prone to decay.

“We are looking to see how the hygiene is so that proper instruction can be given,” she says. “Sometimes, the dentist may also detect problems in the mouth that are indicative of general health issues, which is another reason why this first visit is so important.”

The good news is that X-rays are not typically taken the first time, so it’s as comfortable as possible. The dentist will, however, use an explorer tool to see if there are any cavities. And of course, at the end, the brave patient will receive a new toothbrush, floss, toothpaste, and stickers or toys. As Farren says, “The first visit helps the child get used to the dentist and their staff.”

Questions to ask: Parents will want to be sure their child is getting off to the best start possible, so be sure to ask how strong and healthy the enamel is; how adequate their oral hygiene is; and if they should be taking fluoride supplements. “Most areas do not have fluoride in the water and most children do not drink tap water anyway,” Farren says. “Flouride supplements are extremely important for strengthening both the teeth that are in the mouth and the teeth that are developing.”

Why it’s important for the patient: Unlike some other exams, the dental exam should be done twice yearly because it doesn’t take long for things to change. And, unfortunately, baby teeth develop cavities easier, and they worsen faster. “That is why it is very important to get them checked when appropriate and not put it off,” Farren stresses. “The best place to learn how to take care of your teeth is from your dentist and hygienist.”

Why it’s important to the doctor: The dentist learns how well they are brushing/flossing, what problems with diet are leading to oral disease, and if there is any developmental and/or skeletal problems that may require further treatment. If patients are seen regularly, the dentist will notice patterns and if your child is prone to problems. “If we only see a patient when there is a problem,” Farren says, “then we only see a very small part of the picture.”

Adult: What Patients Should Know

What to do beforehand: Anything that saves time. Beginning with your first phone call to the doctor, you’ll want to make sure they have all your insurance information and any specific health-related questions you may have, suggests Dr. Howard Lassin, DMD, of Lassin Dentistry in Cherry Hill. Also, if it’s a first visit to a new dentist, make sure they have all prior dental records and X-rays.

What to expect during the exam: Along with a comprehensive dental examination that includes a thorough look at the teeth, an adult dental exam may also include a periodontal evaluation as well as TMJ and oral cancer screenings, according to Lassin. A periodontal evaluation will include numerous aspects such as an exam for oral disease, the presence of plaque, checking dental restorations and prosthetic appliances, assessing the need for dental implants, as well as checking for risk factors—such as diabetes, smoking or cardiovascular disease—when it comes to periodontal disease. “Also, any esthetic or cosmetic issues can be reviewed,” Lassin says. “A complete series of digital X-rays may be required and would be taken at that time. We devote quality time to review and address any patient concerns and questions.”

Questions to ask: When it comes to your teeth, and the fact that oral health is so closely connected to overall health, nothing’s off the table. “All questions are appropriate,” Lassin says. In fact, according to the Mayo Clinic, good oral health can lead to a lower risk of heart disease, reduced risk of infection, stable blood sugar and more—even possibly reducing the risk of Alzheimer’s.

Why it’s important for the patient: It’s essential that a patient understand the close connection their teeth and gums have to the health of the rest of their body, and that understanding comes through a positive relationship with the dentist. “The interaction of questions and answers help not only in understanding a problem or procedure and what they are to expect, but discussion helps create and establish the doctor-patient relationship,” Lassin says. “It builds trust and confidence.”

Why it’s important to the doctor: The communication goes both ways in the dental chair; so the patient should ask a list of questions just like the doctor. According to Lassin, a more informed patient equals a more informed doctor. “The better our patients are informed and understand the issues, the better our service is,” he says. “It is all about our relationships and understanding our patients’ needs.”

OB/GYN Exams
What Patients Should Know

What to do beforehand: There are several important steps to take to ensure you’re well prepared, especially if it’s a new practice. For instance, make sure you have copies of any abnormal pap smear reports, plus records of obstetrical or gynecologic surgery, especially if there were complications, notes Dr. Francine Siegel of Advocare Burlington County Obstetrics & Gynecology. Bloodwork and radiology reports, particularly if they were done in the past year, should also be brought along.

“It’s also very important to bring in a list of current medications and a list of allergies to medications or foods as well as the reaction it caused,” Siegel says, adding patients should get together a list of health concerns in the family, especially specific cancers and age of diagnosis. “If not on any hormonal contraception, [have the] dates of last menstrual cycles over the last three to six months, especially if they are irregular.”

What to expect during the exam: “The gynecologist will most likely perform the same type of physical exam as your regular doctor—feel your thyroid and front of neck, listen to the heart and lungs, feel your belly,” Siegel says. “But then they will also perform a breast exam as well as a pelvic exam.” During the pelvic exam, the doctor will discover any abnormalities with the cervix or ovaries.

Questions to ask: There’s a multitude of personal questions a patient might want to ask and now is the time. If you’re interested in contraception, Siegel uses as an example, then ask what your options are. Not sure exactly how to do a self-exam? Ask. Let your doctor know if you’re thinking about becoming pregnant within the next year; bring up cycle irregularities or any health concerns you may have; ask about the HPV vaccine, the prevention of STDs, and discuss any menopausal/perimenopausal concerns.

Why it’s important for the patient: While women are screened for breast and cervical cancer, they also learn about proper vulvar hygiene, the normal menopausal/perimenopausal symptoms, and what one should be doing to get their body healthy prior to getting pregnant.

Why it’s important to the doctor: Siegel explains that the benefits to the doctor are no different than the benefits to the patient. The doctor’s No. 1 goals revolve around preventive care and early diagnosis, which is why, whether it’s screening for certain cancers and STDS, making sure menstrual cycles are within the range of normal, or preventing unwanted pregnancies, the regular checkup is essential to a woman’s health.

Published (and copyrighted) in Suburban Family Magazine, Volume 3, Issue 10 (December, 2012).
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