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Cheryl Martin (Host): What role does family medical history play in chronic diseases or illnesses? Dr. Rico Romano is here to answer that question and more, including why it's so important to share family history with your provider. Dr. Romano is an Internal Medicine physician here at Skagit Regional Health.

This is Be Well with Skagit Regional Health. I'm Cheryl Martin. Dr. Romano, delighted you're here to shed some light on this important topic.

Dr. Rico Romano: Likewise, Cheryl. Nice to be here. And I'm really happy to share this sort of sometimes overlooked part of a visit with a physician, the family history.

Host: Great. So, let's get started. So, why is it so important for patients to share their family health history during their annual visit?

Dr. Rico Romano: Yeah. The family history, sometimes it's done in passing. But it actually is a very cheap, high-yield test, if you may, because not only does it capture, you know, the potential for, you know, what you share with your relatives, mostly first-degree relatives and also shared environments. But it can also change how early or aggressive screening we can start at an early age to prevent actual disease. The United States Prevention Guidelines, the USPSTF, a task force usually indicates that a family history of premature heart disease is actually a risk-enhancing factor, just an example, which can push us to do earlier therapy or extra testing. And it also matters for cancers. And also, very predictive for first-time blood clots. So, that's why it's very important.

Host: I'm glad you mentioned that: heart disease, cancer, blood clots. Any other types of conditions or diseases that are most influenced by family history?

Dr. Rico Romano: So, sometimes, autoimmune conditions like type 1 diabetes, celiac disease, you know, where you're intolerant to gluten, and then, rheumatoid arthritis and sometimes autoimmune thyroid disease can also be influenced by family history.

Host: So if someone doesn't know much about their family medical history, what should they do?

Dr. Rico Romano: Well, if they don't know much, well, they should first of all tell us that they're not aware. And it's common to be adopted. Sometimes there's estrangement in families, small families, they happen. So even if they don't know much, we'll look more at them and lean on their personal risk factors and do standard screening. And then, you know, one thing that I encourage them is collect what you can with ages. And sometimes the more specific it is, say, the mom having colon cancer diagnosed at age 52 or a brother with a blood clot at age 29 after a surgery.

And usually, updating this yearly. We're coming up to holiday season here. And usually, that's the time when families gather and it's always a good time to sort of weave that into your conversation to get some information. But the best information really is the condition and what age it came on.

Host: Now, this is great advice. So, how far in your family history should you go? Parents and siblings or extended to aunts and uncles or grandparents?

Dr. Rico Romano: Correct. Yeah, that's always a good question because what our studies-- at least, the traditional teaching is we usually want to look at first-degree relatives. So, it's a sibling, it's a parent or your children. Those are the ones that are usually relevant and meaningful. It doesn't hurt. But if there is a more rare condition, sometimes that can extend to grandparents as well, and sort of first cousins, if you may. So, by rule of thumb, it's always nice to get first-degree relatives, parents, siblings and their children.

Host: How often should patients update their family history with their provider?

Dr. Rico Romano: Usually, at least yearly. Most patients will have an every year examination. And obviously, if it's something important like, say, a heart condition that necessitated aggressive treatment on the first-degree relatives part. I think just telling your physician right after, when you have a time to do it, that's nice. So, we can actually update that.

Host: You mentioned screenings and tests. So, talk more about how family history affects the screenings or tests you recommend for patients.

Dr. Rico Romano: Yeah. So, talking about heart prevention if there is a family history of what we call premature heart disease, and that is any first-degree relative who had a heart attack, usually before the age of 50. What we usually do is we screen them earlier, and we may order more specialized tests to determine their risk so that we can prevent it from happening to the patient.

So, sometimes if a patient's mother, say, had a heart attack at age 57, and they're in their sort of 30s, we might just check a cholesterol panel, which is still the best marker for determining your heart disease risk earlier instead of at usually the recommended age at 40. And then, depending on those results, we may need to do some other testing to look at the heart arteries to make sure that there's no buildup of plaque or narrowing that might necessitate aggressive therapy so that it prevents that patient from having a heart attack. In cancer, for example, if you have a father who had colon cancer at age 47, the current screening recommendations is we screen you at 45. But if you have a first-degree family member who had colon cancer at age 47, then we usually recommend that we screen you 10 years earlier than when that first happened to your relative. So, that changes it for somebody who is still below the age of currently 45. So, we might move that up quicker or sooner so that we can prevent and detect if there is any growing cancer.

Blood clots, a strong family history of a blood clot in a first-degree relative. We usually tend to counsel them around high-risk moments. So, high-risk moments are situations where they're prone to developing blood clots, like major surgery, immobility, that long haul flight. Also, cautioning them, if they're female, about taking estrogen so that, if they do have suggestive symptoms, we do tests quicker than needed. And the last one is usually the autoimmune ones.

We generally don't shotgun screen, so to speak, healthy relatives with antibody patterns. But if there is a first-degree relative who has celiac disease, type 1 diabetes, we'll screen them unless they have other symptoms. But we generally ask for that in first-degree relatives, especially regarding autoimmune conditions.

Host: Now, can lifestyle changes help reduce the risks that come with a strong family history of certain conditions?

Dr. Rico Romano: Absolutely. You know, genes aren't our destiny. To use an analogy, genes sort of load the firearm, but it's lifestyle that triggers it. So, it doesn't mean that you have the gene or you have a family member that had that, that you're going to have it. Lifestyle influences a lot of how this disease will develop in you.

Host: And what are some of those lifestyle changes in general that can help reduce the risk?

Dr. Rico Romano: Lifestyle changes, obviously, a good diet that is mostly whole food-based and with not a lot of ultra processed foods. There've been studies in the past two or three years about the risks of taking ultra processed foods. The current understanding is that if you take a lot of ultra processed foods, it causes a lot of whole body inflammation that can affect a lot of these and activate some of your genes that predispose you to these conditions.

Host: Name a couple of foods in the ultra processed category.

Dr. Rico Romano: Lunch meat is one of those. Those high-calorie, sugary drinks are ultra processed. So, anything that's processed a lot that involves a lot of sugar, salt and nitrates. So, that's one. And then, the other one that's really a lot of sugary beverages. In fact, a lot of soda and a lot of these high sugary drinks that are available. So, the other lifestyle changes is diet, and then there's exercise.

So, exercise usually is helpful, because it has a lot of benefits not only for cardiovascular fitness, but just for overall wellbeing in general. And then, those are the two lifestyle changes to help you not develop some of these, even if you have a strong family history.

Host: You have given us great advice in terms of updating family history and checking with your family members to get this information. Are there any tools or resources that can help patients track and then share this information?

Dr. Rico Romano: Yeah. So at the CDC, there is an actual app called the My Family Health Portrait. So, it's available at the CDC website. So, it's free, it's online, it's like a history collection tool that lets you share family history information, and then you can print that out. I tested it this morning and it actually is pretty good. It's free. It's on the CDC website. So, you can use that to keep track of your family history. Then, you can even save it onto that. Obviously, they'll ask you for create an account and then you'll be able to print that out and share that with your provider.

Host: Oh, that makes it so much easier when you go for an appointment. Dr. Romano, what would you say to patients who feel nervous about discussing serious health conditions that run in their family? And they may even feel nervous about, you know, asking others, but they're nervous about discussing this.

Dr. Rico Romano: So like I said, our genes are not our destiny. A lot of that is also influenced by lifestyle. I think, in talking to relatives or talking to your physician, just if you're talking to your provider, express your concern, definitely tell us. Because the most common thing that I encounter is patients that I want them to feel comfortable telling me that, you know, "I'm worried about this." To me, it may not be significant, but it's important that they bring it out so that we can talk about it.

And then, a lot of people have gotten either reassurance or earlier testing because of just that concern. You know, I always say there are no trivial questions in a medical visit. And hopefully when the patient brings that up, then the provider can collaborate with the patient and come up with a good answer. You know, in talking to family members, just keep it short, and it's a way of keeping track of everybody to make sure that everybody's getting the right screening. It's a way of caring. That's why I always try to frame it that way.

Host: Dr. Rico Romano, thank you for educating us on the importance of sharing our family medical history with our providers. Great information. Thank you.

Dr. Rico Romano: You're welcome.

Host: To find a healthcare provider and to learn more, visit SkagitRegionalHealth.org. If you found this podcast helpful, please share it on your social media and be sure to check out our entire podcast library for other topics of interest to you. Thanks for listening to Be Well with Skagit Regional Health.