Recommended Screenings for Awareness

While Health Screenings Proliferate, the Number of People Getting the Right Ones isn't Keeping Up

Orlando Sellers found out he had high blood pressure while posing as a patient for a videotape being made by the Department of Veterans Affairs.

"I didn't know. But when the doctor took my blood pressure, it was extremely high -189 over 112," said Sellers, a 58-year-old human re-sources specialist at the VA Medical Center in Washington, "He said, `That's high, let me check St again.' It was the same."

Despite strong evidence that tests like a blood pressure check every two years are worthwhile, barely 50 percent of U.S. adults receive the diagnostic and preventive screenings that many medical experts recommend.

Several factors explain why many Americans remain unaware that they have hypertension, colorectal cancer, high cholesterol and oth er lethal conditions: the proliferation of recommended tests, doubts about the value of some once-standard exams and time demands that keep many doctors from performing systematic screening.

Recommended Screenings

Cholestarol cheaks

At least every five years, starting at age 35. If you smoke, have diabetes or if heart disease runs your family, start at age 20.

Blood pressure

Check for hyper-tension at least every two years.

Fecal occult blood testing

The U.S. Preventive Service Task Force says this method of screening for colorectal canceris supported by stronger evidence than sigmoidoscopy, colonoscopy and other tests. Periodic screening starting at age 50.

Blood sugar tests

Every five years; more often for those who are significantly overweight and those with a family history of diabetes.

Depression if you've felt down, sad or hopeless and have felt little interest or pleasure in doing things for two weeks straight, talk to your doctor about screening.

STDs Talk to your doctor to consider screening far sexually transmitted diseases such as HIV.

All Men

A one-time screening far abdominal aortic aneurysm for men aged 65 to 75 who have ever smoked.

Prostate cancer

The task force says the evidence is insufficient to recommend for or against routine screening using prostate- specific antigen testing or digital rectal exam.

All Women

Cervical cancer Annual screening in women who have been sexually active and have a cervix.

Mammography, with or without clinical breast examination (CBE); every one to two years far women aged 40 and alder to detect breast cancer.

Screening of all pregnant women for hepatitis B, syphilis and HIV.

Yearly screening of all sexually active women aged 25 and younger and other women at increased risk for chlamydial infection.

What to do? Experts say people should find a doctor who will schedule screenings as they become due - or they should take over the scheduling themselves.

Too much of a Good Thing?

The merits of early detection and prevention of disease became especially clear in the 1950s and '60s, when childhood immunizations nearly eradicated a number of diseases, including measles.

This success has had an ironic side effect: "As we have more entrenched screening, the risks seem less imminent, less of an immediate threat," said Amy Compton-Phillips, Kaiser Permanente's physician director for care management in Roclcville. As a result, "it's harder to convince healthy patients that a screening is important."

Today's physicians are encouraged to screen patients for literally hundreds of conditions and diseases. This advice comes from specialists.

A further complication: The task force sometimes downplays screenings -like breast self-exams and the prostate-specific antigen (P5A) test for prostate cancer - that the medical establishment once sup-ported enthusiastically.

The Doc and You

The annual physical, long associated with a standard battery of tests that almost always produced a bill of good health, has fallen from favor in an era of managed care, evidence-based medicine and too-too busy physicians.

When David Sobel, a Kaiser Permanente physician, started practicing medicine 25 years ago, the routine exam was, well, routine. "Patients were tested annually - chest X-ray, EKG, blood tests," he I says. 'But what it did was falsely reassured people and distracted them from the real things, much bigger things that have an impact on health, like stopping smoking."

Kaiser Permanente now stresses a preventive medicine package that varies based on each patient's age and sex. People with chronic conditions such as diabetes and hypertension get extra monitoring. "The notion that one size fits all is not appropriate," Sobel said.

This individualized approach calls for patients to play a larger role in their own care. Since learning of his high blood pressure, Orlando Sellers has enrolled in a pilot version of My HealtheVet, an Inter-net-dependent program that allows him to react quickly when he senses he may have eaten too much chocolate, fried food or soda.

"I've got a blood pressure cuff," said Sellers. "I enter the reading into the computer and it charts it. The graph gives me a good idea of where I am, and if I eat a very salty meal, I will notice that. . . . It lets me see I can't do certain things."

Along with providing online medical records, the program alerts patients when tests are due and paints them to information about each test. "It's all about the patient taking responsibility," said Sellers.

Emotional Health

The foods we eat can affect our emotional state in several ways, and vice versa. We all know this, at least subconsciously, from our observations of how hunger makes people bad-tampered, or how people use food to cheer themselves up.

Popular images of "comfort food" are not all in the mind: connections between food and mood are increasingly backed by research, suggesting that many of us subconsciously choose certain foods for their effects on our mood and emotions.

Diet & Emotions

The most direct way that food influences mood is via its effect on blood sugar. Many people's mood deteriorates as their blood sugar level falls. The type of food eaten matters too.

There is increasing evidence that low in protein, such as candies and chocolate, can lift mood and increase calmness and drowsiness, it is thought that, as long as there is not much protein present, the insulin released by eating carbohydrates triggers an increase in the level of the calming neurotransmitter, seratonin, in the brain. Carbohydrate foods that contain tryptophan, the precursor of serotonin, are most likely to have this effect, and a few foods contain serotanin itself.

Mood and emotions may also be affected by a shortage of certain nutrients; for example, iron deficiency can result in depression. Individual sensitivity to certain foods can cause behavioral changes and mood changes, such as hyperactivity.

General Advice

You may improve your emotional balance by observing how your mood affects what you eat and vice versa.

Restrict "comfort" eating to carbohydrates that are unrefined and low in fat.

Otherwise, you risk becoming overweight, which affects heart health.

If your mood slumps after eating, steady your blood sugar level by spreading food over 5 - 6 light meals a day rather than 2 - 3 heavy ones.

Moodiness, Restlessness, Nervousness & Sleep Problems

You can help relieve these symptoms, usually thought to be "ail in the mind." By eating to obtain a high intake of iron, vitamins B1, B2, niacin, vitamin B6, folic acid, vitamin C, zinc, and magnesium, and by stabilizing your blood sugar level.

Iiver, wheat germ, green leafy vegetables, peas, shellfish, game, oily fish, nuts, and seeds are rich in nutrients, above, related to mood end emotional state.

Try to eat more of them when under stress, after illness, or taking medication, all of which can affect digestion, reducing the absorption of some nutrients.

Bananas contain same seratonin, and are a more nourishing way of improving mood than confectionery or sugary pastries. Eating 1-2 bananas without other food has been shown to increase serotanin in the body.

Oats are used by Herbalists as a "nerve nourisher," but it is not known how it works.

Lettuce, celery, and asparagus have traditionally been eaten to produce a sedative effect. A sedative substance has been found in celery, and a soporific one in lettuce.

Unrefined carbohydrates, especially oats and barley, legumes, fruits, and vegetables are high in soluble fiber and help stabilize blood sugar levels.n

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