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Alyne Ellis (Host): Every person should have an annual physical for overall review of health concerns, chronic medical conditions, and most importantly, preventative health measures. This visit is so important, that insurers do not require a copay and it allows more time for the doctor and the patient to communicate. We're here today to talk with Dr. Ellen Rich, the Medical Director of the Internal Medicine Center at Erie County Medical Center. This is True Care HealthCast the official podcast from the Erie County Medical Center. I'm Alyne Ellis. Welcome Dr. Rich. Nice to have you with us today.

Ellen Rich, MD, FACP (Guest): Thank you.

Host:  Let's start with the categories of preventative health measures and begin with immunizations and why they're so essential.

Dr. Rich: So, I think if nothing else, the current pandemic has demonstrated that community acquired illnesses can have a big impact on day-to-day life. And I think we've learned a lot about immunizations and protecting adults with underlying medical conditions from things like pneumococcal pneumonia, shingles, influenza, tetanus, pertussis are all things that we have learned how to do very, very well over the years. And the annual visit is a perfect time for that to be reviewed, to make sure that the individual's immunization status is up to date so that they aren't susceptible to things that might still be circulating in the community.

Host: And then of course there's also the flu shot that, I think you're possibly still giving this year, at this point.

Dr. Rich: So, typically the flu shot is given any time from August through the end of March. And depending on how the season is, we might even extend it longer than that. So, we sort of play it by ear as the season progresses. At least in New York state, we're notified about flu rates3 weekly by the department of health and it helps guide our practice. It's never too late in my opinion, to get the flu shot. And I think what older adults in particular don't realize is that while they might still get the flu if they've had the flu shot, they're less likely to die from influenza. And they're less likely to be hospitalized with complications of influenza if they get the shot.

And I think there's a lot of misinformation about side effects of the flu shot. I think with the current COVID vaccine, we're recognizing that as your body responds to the shot to give you good immunity, you might not feel great. And that's part of the shot doing its job. It doesn't mean that there's something wrong with the shot that it's bad for you or that it truly is making you sick. It's asking your body to prepare itself. And I think that we need to do a better job of informing patients of that.

Host: Now another thing that happens when we go in for our annual physicals is cancer screening, perhaps. Is that done usually, when there's a regular appointment and what kind of screening are we talking about?

Dr. Rich: I think there's sort of categories that you described of preventive health is something that I'm very careful to address at each annual visit. If a person hasn't had an annual visit, these things still need to be identified. And so the things that we look for, the cancers that we look for in particular, are those that if we find them early, we're pretty sure that we can treat them early. And that people will survive and have a good quality of life if it's handled earlier. And those are typically mammograms for breast cancer. And there's very good evidence that finding an early breast cancer makes it relatively easy to treat. And that what a person has to go through to be cured, is less, if you find it real early. There are certain populations where prostate cancer should be looked for and that is a blood test called the PSA test. And that's a conversation that someone should have with their doctor. And those patients are people who are African American, have high risk because someone in their family might've had a prostate cancer or families where some of the genetic predispositions to breast cancer also can predispose men to prostate cancer.

And those are the BRCA 1 and BRCA 2 gene types that run in some families. The other thing of course is colon cancer. And I know a lot of people are concerned about having a colonoscopy, because it is a project. You have to take medicine. You're uncomfortable for a day or so and you have to get a ride there and back and you have to have a procedure, which is scary. It also is highly effective. If polyps are found during a screening colonoscopy, that's actually preventing cancer down the road. It's sort of like in a way, an early cure, if you will. And there's a lot of evidence that doing this for many people results in less late stage colon cancers, which are very, can be very difficult to treat.

Host: But now one doesn't have a colonoscopy every year for an annual physical.

Dr. Rich: Right. The nice thing about colon cancer is it develops slowly, generally speaking. And so, depending on what they find during the colonoscopy, different intervals of repeat testing will be recommended. So, for example, if your colonoscopy is totally normal and no one in your family has any problems that make you at risk for colon cancer, then you probably can go 10 years between tests. If they find some polyps, they'll probably recommend anywhere from two to five years for the next test. So, it really depends on what the findings are and also what your risk is based on your family history.

Host: So,, let's move on to talk about bone health. And I know particularly in women, this can be an issue as you age.

Dr. Rich: Yeah. So, bone health is something I put on my sort of annual review list. I care for a lot of aging women, a lot of aging women whose quality of life is quite good. So, first I guess what I would say is that for people who develop osteoporosis, which is a thinning of the architecture of the bone that predisposes to fractures of the hip, the wrists, the spine, that those fractures if they occur make it sometimes difficult for people to continue to care for themselves as they age. And for anybody who's listening, who's an older adult, maintaining independence in the community is usually the main goal of an aging person and breaking something makes that challenging. The development of osteoporosis can be normal as part of aging. Women have menopause, for example, men have reduced testosterone in their systems as they age. Men can get osteoporosis as well. And that process needs to be evaluated. There are also some conditions where certain medications or underlying medical conditions can make people lose bone integrity faster.

So, for example, women who have breast cancer who take a certain kind of medication called in an aromatase inhibitor, those medicines make the bone density fall faster. And so, those patients need to be evaluated more frequently and often treated for osteoporosis earlier. So, this is something that needs to be reviewed at all these visits.

Host: So, are you recommending for example, that your patients have an annual bone scan?

Dr. Rich: So, the bone density recommendations for people who don't have an increased risk of osteoporosis, for women it's age 65 and for men it's age 70 and then based on those results, you would decide how often after that you would want to get a bone density test. And that interval could be anywhere from two to 10 years, depending on what the first one shows. And then the, why do we check? I mean, because we can treat it with medication, we can reduce the risk of fracture for someone whose risk of fracture is high, with certain medications.

Host: So, let's move on to the final screening thing that you check for at least the most important four. And that is things like hypertension and diabetes and high cholesterol.

Dr. Rich: So, for people who don't already have these diagnoses, seeing the doctor once a year, it's important for us to evaluate an individual's risk of common medical problems that we see that we know can result in significant problems for people if they're not treated. So, actually the most cost-effective screening tests that we have is the blood pressure. And it's common for people who are sedentary or have a strong family history, are overweight, and also just as people age, you have a pretty high risk of developing hypertension. So, you go in to get your blood pressure checked. And if we treat blood pressure effectively, we reduce the risk of heart attack and stroke anywhere from 30 to 50%, which is fantastic. And also we know that diabetes if untreated, can be very harmful to individuals, so periodically either every one or every three years, someone should have their blood sugar at least checked, to make sure that they don't have diabetes, because this is also very treatable and very treatable early.

And finally, we know that cholesterol contributes to overall risk of heart attack and stroke. And understanding an individual's cholesterol profile can help us understand their risk of heart attack and stroke. And of course, many people are aware, we have a lot of cholesterol medicines that can help reduce that risk. And they're very affordable. They're very well tolerated and very safe to be used for a very, very long period of time. And they definitely, definitely the risk of heart attack and stroke when used properly. So, we that's something that should be addressed in all individuals. It's not necessarily the blood test every year, but an assessment of whether the blood tests needs to be done every year.

Host: And finally one more question. And that is, I know sometimes now doctors aren't necessarily doing a urinalysis. Is that part of your annual check?

Dr. Rich: So, urinalysis has gone by the wayside as a screening test. The number of problems that can be treated early based on urinalysis are very, very small and very, very rare, that's number one. The other thing is a lot of women have what we call asymptomatic bacteria in their urine, and it might make the urine test positive and lead to unnecessary additional tests or unnecessary antibiotics. So, we don't normally do that as a screening test anymore. No.

Host: And it certainly seems like this is a really good time to sit down with your doctor and have that kind of meaningful chat too, if you haven't already, about having a power of attorney or healthcare proxy or any of those sorts of paper details you need to protect yourself.

Dr. Rich: Yeah, I think that can be an uncomfortable conversation for a healthy person to talk about what would happen if you couldn't make your own healthcare decisions, or if you got really sick. So, my approach is to discuss it with everyone at every annual visit, just as a check-in and make it as routine as possible. So, that people don't think, for example, that I'm saying something bad is going to happen to them in the next year or so, because I don't believe that's true. I also think that, in particular, in the area of healthcare proxy, if something catastrophic were to happen to a person, their family or their designated person would need to step in and make decisions on their behalf.

And while it's difficult to have the conversation, it's a lot easier for the person who is making the decisions, to know what to do if they've had a conversation with their loved one. And so, I do think it is helpful to understand the wishes of each other, if something very bad were to happen to you. And I think that and hopefully they're in the room as a guide for that during these annual exams.

Host: Well, I always find it reassuring when you know, everything's sewed up tight and you can just kind of move on to being healthy. Thank you so much, Dr. Rich for joining us today. You make that annual physical seem like just a very easy thing to get through.

Dr. Rich: Well, hopefully if everyone gets one and we're all focused on staying well before we get sick, then, you know, quality of everyone's life is better for it. Thanks for having me.

Host: Dr. Ellen Rich is the Medical Director of the Internal Medicine Center at the Erie County Medical Center. To schedule your annual physical with your primary care physician call EC Internal Medicine Center today at (716) 898-3152. Or visit ecmc.edu. Thank you for listening to this podcast. This is True Care Health podcast. The official podcast from Erie County Medical Center. I'm Alyne Ellis. If you found this podcast helpful, please share it on your social channels and be sure to check in for the full podcast library. You'll find that website@ecmc.edu. Thanks for listening and see you again next time.