Health Maintenance: A Practical Guide

Here’s an easy reference for the various tests you should get done at different stages in your life.


In the past few decades, the medical field has shifted from a treatment mode that is reactionary to a preventive mode that is disease preventing. We used to solely treat diseases as they came up.  As new data and tests have been developed, we have started to move more towards prevention.  Now, not every test should be done on every person as this is not cost effective and even dangerous.  It is dangerous because some tests can find things that are not significant and lead to procedures that can cause significant adverse effects.  With this in mind, I want to lay out the various tests you should get done at different stages in your life. You can either scroll down directly to your age range or peruse through all age levels to be more acquainted with the various tests and immunizations warranted.

Newborns and Children to Age 17

Routine office visits should be done according to a set schedule  Children should have well child visits at 1, 2, 4, 6, 9, 12, 15 and 18 months of age. Annual wellness visits are suggested from ages 2 to 6 and then from age 6 to 17 every other year.

Screening Tests:
There are not many routine screening tests needed but vision should be checked at least once before age 5. Children should also be monitored for obesity with BMI calculated at each of these visits after age 6.
For teens over age 15, Chlamydia and Gonorrhea should be checked yearly if sexually active up to age 24. Teenagers should be counseled about safe sexual practices starting at 13.  In my case I stress that the only completely safe practice is abstinence.  Sexuality is a beautiful thing and should be saved for marriage in my mind.  Lastly, HIV should be screened for at least once between ages 15 and 65.

Immunizations:
See the graph below from the CDC.  I agree with these recommendations.  I’ll have to write a post later on why I do and try to tackle some of the myths and misinformation about vaccines.



Age 18-39

Quick note: How often wellness visits should be done is not defined but my general rule of thumb is you should have a physical every 4-5 years in your 20s, every 3 years in your 30s, every 2 years in your 40s and yearly after age 50. This should be done more often in certain medical conditions or if taking medications. Also, women may need to be seen more often for well woman exams.  At these visits you should have your blood pressure checked.  You weight should be taken and your BMI will be calculated.  You and your doctor should work together to come up with a plan for healthy living in the future. You should discuss any alcohol and tobacco use, signs of depression, risk of diabetes, domestic violence, safe sex practices and skin cancer.

Screening Tests:
If not done yet, men and women should be checked for HIV.  Men have it easy and the only recommended test is cholesterol every 5 years starting at age 35.  This may need to be done more often if abnormal or if the person is obese.  If overweight, you should also be checked for diabetes. Women unfortunately have it more rough.  The cholesterol and diabetes screening applies to women as well. Chlamydia and Gonorrhea should be screened yearly for sexually active females ages 15 to 24 years with a urine test. A Pap test should be done every three years for all women ages 21 to 29. After age 30 until age 65, a Pap test with HPV should be done every five years.  If the pap test is abnormal further testing will be based on the result.  Lastly, if you are a woman who is pregnant or trying to get pregnant you should be taking a prenatal vitamin with at least 0.4 mg of folic acid.

Immunizations:

  • Influenza (Flu): Should be done yearly.
  • Varicella (Chickenpox): A repeat booster is recommended for all adults born in 1980 or later.
  • HPV (Human Papillomavirus): If not vaccinated yet, females ages 15 to 26 and males ages 15 to 21 should receive the three-dose series.
  • MMR (Measles, Mumps and Rubella): Adults 19 to 59 should have at least one dose of the vaccine. If not, then they should receive a booster.
  • TDaP/TD (Tetanus, Diphtheria and Pertussis/ Tetanus and Diphtheria): Everyone should receive a tetanus vaccine (Tdap or Td) every 10 years.



Ages 40-49

A Wellness Check should be done every 2 years. At these visits you should have your blood pressure checked.  You weight should be taken and your BMI will be calculated.  You and your doctor should work together to come up with a plan for healthy living in the future.  You should discuss any alcohol and tobacco use, signs of depression, risk of diabetes, domestic violence, safe sex practices and skin cancer.

Screening Tests:
If not done yet, men and women should be checked for HIV.  Again men have it easy and the only recommended test is cholesterol every 5 years starting at age 35 and diabetes screening if overweight.  This may need to be done more often if abnormal or if the person is obese.  Women unfortunately continue to be more involved.  After age 30 until age 65, a Pap test with HPV should be done every five years.  If the pap test is abnormal further testing will be based on the result. Also, if you are a woman who is pregnant or trying to get pregnant you should be taking a prenatal vitamin with at least 0.4 mg of folic acid. Lastly, breast cancer screening: a mammogram is optional and should only be done every other year if done. This should only be done in those who are at increased risk and you should have a discussion with your doctor if this is appropriate for you.

Immunizations:

  • Influenza (Flu): Should be done yearly.
  • MMR (Measles, Mumps and Rubella): Adults 19 to 59 should have at least one dose of the vaccine. If not, then they should receive a booster.
  • TDaP/TD (Tetanus, Diphtheria and Pertussis/ Tetanus and Diphtheria): Everyone should receive a tetanus vaccine (Tdap or Td) every 10 years.



Ages 50-74

A Wellness Check should be done every year after this point. At these visits you should have your blood pressure checked.  You weight should be taken and your BMI will be calculated.  You and your doctor should work together to come up with a plan for healthy living in the future. Starting at age 65, if you have medicare you can start to get a medicare wellness exam yearly.  At this visit, your doctor will go over your recommended screening tests, ask a list of questions to gauge your functional capacity and assess risk factors for depression.  You should also have an advanced directive (living will) by this time and your doctor can help you with any questions you have.  You should discuss any alcohol and tobacco use, signs of depression, risk of diabetes, domestic violence, safe sex practices and skin cancer. Lastly, you will be assess for any early signs of dementia or alzheimer’s.

Screening Tests:
If not done yet, men and women should be checked for HIV up to age 65.  Those born between 1945 and 1965 should have a one time screening for Hepatitis C given the increased incidence in this population.  Age 50 is where tests start to get invasive.  Screening for colon cancer should start at age 50.  The best test for this is a colonoscopy which, if normal, can be as infrequent as every 10 years.  Other acceptable tests, if low risk (no family history), are yearly fecal immunochemical tests (stool test for blood) or a cologuard test every 3 years.  Cologuard is a stool test for colon cancer DNA and not always covered by insurance so it can be costly. Make sure your check with your insurance first if you want to do it.
For men, cholesterol should still be checked every 5 years if normal and diabetes should be screened for.  Prostate cancer should also be screened for.  Recommendations for getting a PSA have changed in recent years.  The recommendation used to be against doing the test but it has now changed to having a conversation with your doctor about the risks and benefits of the test.  The PSA test, unfortunately, has it’s flaws.  It can be elevated in conditions that are not cancer (this is also called a false positive). On the other hand the PSA does find cancer.  Here’s the caveat: Despite our ability to find cancers, the rate of death from prostate cancer has not decreased. Men are getting treated for prostate cancers that likely would not have killed them.  All that to say, have a conversation with your doctor about the usefulness of the test.
Women should still get their pap test with HPV screening every 5 years until age 65.  Mammograms should be done in all women at least every 2 years.  Your doctor may recommend more often if you are at higher risk.  All women should be screened for osteoporosis after age 65 and then every 2 years if abnormal.

Immunizations:

  • Influenza (Flu): Should be done yearly.
  • MMR (Measles, Mumps and Rubella): Adults 19 to 59 should have at least one dose of the vaccine. If not, then they should receive a booster.
  • TDaP/TD (Tetanus, Diphtheria and Pertussis/ Tetanus and Diphtheria): Everyone should receive a tetanus vaccine (Tdap or Td) every 10 years.
  • Zostavax (Shingles): This vaccine is optional.  It is recommended for anyone over age 60 who wants it and some insurances will even cover it down to age 50.  I always present this one to my patients but have them check with their insurance if it is covered.  It is unfortunately an expensive vaccine at almost $300.  For some people it is worth it because they have seen how awful Shingles can be.  Have a conversation with your doctor about this one.
  • Pneumococcal (Pneumonia): There are 2 separate pneumonia vaccines that recommended starting at age 65 separated by 1 year.



Age 75 and older

Things get a lot easier after turn 75.  The usefulness of all the above screening tests drops off.  You should get your medicare wellness exam yearly.  At this visit, your doctor will go over your recommended screening tests, ask a list of questions to gauge your functional capacity and assess risk factors for depression.  You should also have an advanced directive (living will) by this time and your doctor can help you with any questions you have.  Lastly, you will be assess for any early signs of dementia or alzheimer’s.

Screening Tests
From ages 75 to 85 you should have a conversation with your doctor about the risks and benefits of screening for colon cancer.  It is not needed after age 85.  For men, PSA and prostate cancer screening is not recommended for men of average risk.  For women, Mammograms are optional after age 75.

Immunizations

  • TDaP/TD (Tetanus, Diphtheria and Pertussis/ Tetanus and Diphtheria): Everyone should receive a tetanus vaccine (Tdap or Td) every 10 years.

Resources

The above was adapted from the guidelines set out by the United States Preventive Services Task Force (USPSTF), the governing body that accumulates all of the data on the above tests, analyzes it and make evidence based recommendations of which ones are appropriate.  It is not comprehensive. If you want to go to their website and put in your age and gender to get recommendations specific to yourself, click here.  All vaccine recommendations are based on CDC guidelines and can be found here.

 


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