CLINICAL

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Doctor, Heal Thyself: Part 1

It’s time for you to occupy the exam chair for a change.

KIMBERLY K. REED, O.D., F.A.A.O.

Thus far, this column has focused on specific nutrients associated with ocular wellness, so that you can be prepared to counsel your patients on maximizing their visual and ocular outcomes. This month is the first in a three-part series on taking care of your self. That’s right. For the next three months, you are going to occupy the exam chair for a change.

Here, in part one, I discuss systemic preventative health care. Specifically, if you haven’t had a physical examination in the past year, it’s time to schedule one. The exam should cover all the following, along with other reviews of systems and screening tests for your heart, lung and thyroid function.

Routine lab work

This consists of a cholesterol profile, a C-reactive protein test, HgA1c (blood glucose), a complete blood count test and blood hormone levels, including testosterone, estrogen, androgen, progesterone and, after age 35, DHEA sulfate to screen for adrenal gland function.

Body-type data

Identify where you fall on the BMI chart (bearing in mind that BMI is not the best health predictor for those who have a very high or very low muscle mass) and whether your waist circumference puts you in a high-risk category for systemic diseases.

Nutrient level testing

This is comprised of an iron, vitamin B12, omega-3 and omega-6 and vitamin D3 level assessment.

Iron and vitamin B12 levels are easily measured by routine lab blood testing. Deficiencies in either are effectively and quickly remedied with supplementation.

Omega-3 and omega-6 levels can be measured several ways, such as an arachidonic acid-to-eicosapentaenoic acid (AA/EPA) test, which compares one omega-6 fatty acid (AA) to one omega-3 fatty acid (EPA) in the serum. Another specific and comprehensive measure is the omega-3 test (omega3test.com), which provides levels for several omega-3 and omega-6 fatty acids, and is available for home testing or in-office testing, should you choose to incorporate this into your practice (state laws permitting).

Vitamin D3 serum levels are now becoming a routine part of annual wellness exams because vitamin D3 insufficiency is highly prevalent (See “A D-Ficiency,” www.optometricmanagement.com/articleviewer.aspx?articleID=107462.) If your doctor does not request a vitamin D3 level test, you can order one of the many home kits available to test it yourself (seek recommendations from your doctor or another health practitioner, as quality may vary). Daily oral D3 supplementation or weekly D2 injections are an easy fix for this deficiency.

Colon health

A colon cancer screening is recommended starting at age 50, says the U.S. Preventive Services Task Force (USPSTF). These screenings can be done with high-sensitivity fecal occult blood tests, sigmoidoscopy or colonoscopy. Those at high risk for colon cancer (i.e. IBS diagnosis, polyps or family history of colorectal cancer) should begin screenings at a younger age and have more frequent screenings as a result. If you fall into this category, discuss your testing schedule with your doctor.

Gender-specific exams

If you’re a female O.D., make sure you schedule an appointment with your gynecologist. A pap test for the screening of cervical cancer should be performed once every three years, although the majority of women who undergo pap tests do so annually, says a recent Health Information National Trends Survey (HINTS). For women age 30 and older, the preferred testing strategy includes a test for the Human Papillomavirus (HPV) at the time of the pap test. Finally, annual mammograms for women older than age 40 are the standard of care to reduce deaths from breast cancer.

If you’re a male O.D. age 40 or older, you should have a digital rectal exam to screen for prostate gland problems, such as a benign enlargement. The frequency thereafter depends on the various familial and health risk factors. If you’re a male O.D. 50 or older, consider a prostate cancer screening via the assessment of prostate-specific antigen (PSA) levels. If you’re at high risk for this form of cancer (family history or Black race), you should undergo this screening starting at age 45.

In 2012, the USPSTF recommended against routine prostate cancer screenings in patients without symptoms, such as a slow urine stream, to avoid the various negative side effects, such as urinary incontinence, associated with false positive results and with unnecessary biopsies and/or treatment. Not all experts agree, and of course the decision of whether to screen is an individual one.

Well said

Are you taking care of yourself, doc? Be honest. When was the last time you underwent any of the above? Get these items ticked off your to-do list, and stay tuned for the next installment of this column, which will focus on cardiovascular health. OM

DR. REED IS AN ASSOCIATE PROFESSOR AT THE NOVA SOUTHEASTERN UNIVERSITY COLLEGE OF OPTOMETRY IN FORT LAUDERDALE, FLA., A MEMBER OF THE OCULAR NUTRITION SOCIETY AND AUTHOR OF NUMEROUS ARTICLES ON OCULAR NUTRITION, DISEASE AND PHARMACOLOGY. SHE IS ALSO A FREQUENT CONTINUING EDUCATION LECTURER. TO COMMENT ON THIS COLUMN, E-MAIL DR. REED AT KIMREED@NOVA.EDU, OR SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.