Friday, June 15, 2012

The Physical Exam in Context of Aging
For me context is the key – from that comes the understanding of everything.
Kenneth Noland (1824-2010), American Artist
June 15, 2012 -   Lately there’s been a movement to do away with everything deemed unnecessary and not statistically  related to maintaining and prolonging health. 
Failing into this category are the physical exam,  an annual electrocardiogram, an annual check on lipids and other blood chemistries  on ostensibly healthy  asymptomatic individuals.
This may be true to some extent, but in the context of the aging individual,  it avoids a fundamental problem.    With aging, bad things begin to happen, and they are often hidden,  subterranean,  insidious,  and unknown to those harbor the harbingers of advancing age.
A case in point is the following example.  
A woman in her 70’s was in robust health all of her life.  She had no complaints, other than a slight unsteadiness of gait.
She went to see her primary care physician, who detected a previously unrecognized hypertension  of 190/100,  an high blood glucose and total cholsterol, an elevated  glycosylated hemoglobin,   atrial fibrillation,  and blood chemistries consistent with mild hyperparathyroidism.     She was unaware of any of these things,  and at the advice of the physician,   began to monitor her blood pressure at home, went on a daily walking regimen,  started on a diabetic diet. took a medication for atrial fibrillation,  and otherwise became conscious  of what it takes to stay healthy within the context of her age,   her family history of a predisposition to diabetes, the value of a daily walking routine, the importance of diet, and a referral to the a relevant cardiologist and endocrinologist.
For me, the context of an appropriate physical examination is everything.   That context includes an understanding of genetic predisposition, the necessity of physical activity,  the importance of an appropriate  right diet,  the monitoring of blood pressure and pulse, and advice from a generalist physician who can put it all in the proper perspective.
Tweet:   For the aging individual who is ostensibly healthy and asymptomatic, an annual physical can be a godsend for a longer and healthier life.

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