HAPPY NEW YEAR!
It’s the traditional time of year to review life, what we are doing and what we want to do differently. In this issue, I want to share a few ideas on what you can do to continue to create good health this year and for the years to come.
First, consider keeping copies of your lab results and other pertinent medical information in your personal medical notebook. This can help you and your clinicians to be better organized in staying on top of your health needs. A regularly updated list of medications and supplements should be included, along with surgeries and accidents, your medical diagnoses, and family history of illnesses.
Laboratory testing needs to be continued at least annually while on bio-identical hormones.
These tests may include:
- Estradiol
- Progesterone
- Free and total testosterone
- FSH & LH (peri-menopausal)
- Estrone and sometimes, total estrogens
- Prolactin
- SHBG
- PSA (men)
- TSH
- Free T3
- Free T4
- Reverse T3
- Thyroid antibodies
- Fasting lipid profile and metabolic panel
- Complete blood count (CBC)
- Ferritin
- Fasting glucose
- HgA1c
- CRP
- Homocystine
- Vitamin D3
- DHEA-S
- Cortisol
Check your family history and consider getting more specialized screening tests for diseases that present a higher risk for you.
These could include VAP or Berkeley tests for cardiovascular diseases, CA 125 for ovarian cancer (not a totally accurate test), and fasting insulin (sometimes with glucose as a 4 hr challenge test if your waist is greater than 33 inches) to name a few. These tests can identify early trends toward diseases, which can be key in preventing you from progressing into more advanced disease forms. That’s a clear benefit of the Functional and Preventive Medicine approach.
Other specialized tests we find useful in Functional Medicine include Nutritional Status tests to evaluate the levels of vitamins and minerals, fatty acids and amino acids; stool tests to evaluate the gut function; liver detox, estrogen metabolism, methylation pathway function, food allergies, heavy metals, comprehensive adrenal function, neurotransmitters, oxidative stress, inflammation, auto-immune status, viral panels, glucose dysfunction, genomic testing and others that may be of interest.
Yearly recommended exams and procedures include:
- Blood pressure
- Height, weight and body mass index (BMI)
- Breast check, mammogram (frequency depending on age, use of hormones)
- Pelvic exam & pap smear (frequency depending on age, use of hormones)
- Rectal exam, colonoscopy (every 10 years, starting age 50)
- Prostate check for the men (frequency depending on age, use of hormones)
- Skin and general health screening
- EKG (every 3-5 years, starting age 40)
At some point, ladies, pelvic ultrasounds can take the place of pelvic exams depending on your age and circumstances. Also, if you are one of the rare women who can’t take progesterone and are only taking estrogen, the American College of Obstetrics and Gynecology recommends that you get an endometrial biopsy annually. Both of these issues need to be discussed on an individual basis.
An annual mammogram is also recommended when on bio-identical hormones no matter what your age after 40. For women with more dense breast tissue, we now have special breast ultrasounds available that can look through those densities.
To check breast health and track changes that may lead to breast cancer, a thermography exam can be done between mammograms, or at any age before you start doing mammograms. This is particularly helpful if you have a history of breast issues like fibrocystic breast disease, have had breast biopsies in the past, or have a family history of breast cancer. If changes are found, we can then implement protocols to correct those changes before actual disease processes get started. As helpful as thermography can be, however, I do NOT believe that it takes the place of mammography.
By age 40, or earlier if you have multiple risks for bone loss, it’s also time to get an evaluation of your bone density to check your bone health. This can be done as a DEXSA scan of the hip and spine (very low radiation) or an NTX (a urine or serum test to measure bone building compared to bone breakdown). These tests will tell us what risk category you are in for osteopenia and osteoporosis, and we can then create an effective bone health plan (which includes bio-identical hormones). It is recommended that you repeat this screening every two years.
Wishing success to all of us in implementing what is the most important in our lives over this coming year!
Your partner in good health,
Jane Kennedy, CFNP, MN, MPH
