Microsoft word - ages 65& up

Preventive Health Maintenance and Risk Reduction THE BASIC WELL WOMAN EXAM Breast exam, pelvic exam and pap smear Breast exam should be done yearly. Pelvic exam may not need to be done yearly if you have had your uterus and ovaries removed. Pap test is not needed if your cervix was removed with a hysterectomy. Please ask for specific advice. Pap smear can be done every 2 years as per Medicare guidelines if you are low risk. A low risk woman has had regular normal paps and has not recently changed sexual partners. If you prefer to continue to have yearly paps and do not mind paying for this test yourself, we will be happy to do the test. See Medicare Waiver below. If you are sexually active you may be at risk for sexually transmitted diseases (STDs). Testing for STDs is not a routine part of the pelvic exam. Please tell us if you need testing. Recommended laboratory testing Dipstick urinalysis: ask for a micro urine if you think you have a urinary tract infection Hemoglobin Cholesterol-every 5 years if last value was under 200. Fasting values are more accurate. Fasting blood glucose-every 3 years. Fasting means nothing by mouth except water for 12 hours before the test. TSH every 5 years to screen for thyroid disease. If you have blood or urine tests done at another office please let us know so that we do not waste your money on tests that are not needed. HORMONE REPLACEMENT THERAPY The health benefits of HRT are greater than the risks for most women. The lack of estrogen after menopause affects bones, cholesterol, the urinary tract, and sexual function. Many women also have hot flushes, sleep difficulty, mood swings, and “mental fuzziness” that are improved or eliminated with HRT. There are alternate therapies such as non-hormonal prescription medications, soy products, black cohosh for treatment of some of the symptoms. SERMs such as Evista are prescription medications that have estrogen-like effects in some areas of your body and anti-estrogen effects in other areas. Fosamax and Actonel, Boniva, Reclast, and Prolia are very effective treatments for osteoporosis that are non-hormonal. There are lots of options and each woman deserves an individual assessment and plan. Please see WHI Key Points for a summary of the results of the Women’s Health Initiative study published July 2002. SCREENING I advise a yearly mammogram. I advise periodic bone density testing (DXA) for osteoporosis detection and to monitor the response to treatment for osteoporosis. I recommend periodic colon screening with a colonoscopy. Colonoscopy is done with sedation by general or colorectal surgeons and gastroenterologists and does require a referral. Ask for more information about screening for colon cancer. WELLNESS It is important to maintain your weight in the normal range. Please see the attached chart for normal weight ranges. Overweight and obesity increase your risk for health problems such as diabetes and high blood pressure. Regular physical exercise is important in maintaining wellness for your body and for your emotional health. Walking for 30 minutes 3 to 5 days a week is good exercise, but other forms of exercise such as working out at the gym or playing a sport are also good. If you need more advice about nutrition or exercise please ask. Remember to maintain your immunizations. You need a tetanus booster once every 10 years. A yearly flu shot is advised. You should have had a pneumonia vaccine. Consider a shingles vaccine (Zostavax). Ask for a brochure on immunization if needed. I advise a daily multivitamin and adequate daily calcium+ vitamin D intake (1000 mg and 1000 units). RISK AVOIDANCE Keep in mind that falls are a risk factor for fractures. Use common sense and fall-proof your home as much as possible. Please do not drive if you have health problems or are on medications that may contribute to an accident and cause harm to you or someone else. Please avoid tobacco in any form. Nicotine in tobacco is one of the most addictive drugs that we know. Smoking is one of the biggest preventable factors in the development of many health problems such as heart disease, lung disease and cancer (including cervix cancer). Use alcohol in moderation. Please avoid street drugs. YOUR RESULTS All tests done in this office will be resulted to you by phone. If you have not received results after 10 days please call 482-2360 and ask for the nurse. MEDICARE WAIVER If Medicare covers you, there are very specific guidelines on what they will and will not pay for. The rules are complex and are revised frequently. Despite our best efforts it is difficult to know everything that is or is not covered. You will be asked to sign a Medicare Waiver in this office before care is rendered. This basically means two things: 1) If we recommend and do a test that Medicare does not pay for you will be responsible for payment 2) If you request a test be done without a diagnosis, you will be responsible for payment. Dr. Carol W. Shuler updated 07/05/11

Source: http://oconeephysicianpractices.org/sites/www/Uploads/files/Form/BRWC%20Patient%20Forms/ages_65_up_revised.pdf