Julian from northern Victoria writes:
I have just turned 50 and have just read an article on the internet which says that people with HIV need to get regular health checks when they get to my age. What should I ask my GP for, if I wanted such a check?
Dr Louise replies:
Hey, isn’t 50 the new 40? Well, we might still feel young but, as you suggest, Julian, it is a time to reflect on your health and lifestyle and set yourself up for the best health you can have in the years to come.
Often a visit to the doctor is filled with your current issues, which may include a current illness, repeat prescriptions, blood tests and STI checks. It is worth considering organising a visit specifically for an annual check-up. For the over-50s this is essential. For any PLHIVPerson (or people) Living with HIV. This term is now preferred over the older PLWHA., I think it’s great to look at the overall management of your health every year or so from a preventative perspective.
Let’s look at some of the issues that might come up.
Many of these we have mentioned in articles before and they won’t come as a surprise to you. The first group relates to prevention of chronic diseases such as diabetes[Diabetes mellitus] A disorder in which sugars in the diet cannot be metabolised into energy due to a lack of the enzyme insulin. Late-onset diabetes mellitus may be a long-term side effect of some anti-HIV drugs., and illnesses related to smoking and excessive alcohol consumption.
The recommendations for these conditions are usually lifestyle-related: try to exercise three times a week, maintain a healthy weight, quit smoking and have three alcohol-free days a week and only the recommended standard drinks at other times — i.e., avoid binge drinking!
More specifically, let’s look at prevention of cardiovascular disease — again, obesity, high blood pressurePersistently high blood pressure, an outwardly symptomless condition which carries an increased risk of serious illnesses such as stroke, heart disease and heart attack., smoking and diabetes are risk factors. So this part of the consultation involves measuring your weight, blood pressure and ordering blood tests for diabetes, cholesterolAn essential component of cell membranes and nerve fibre insulation, cholesterol is important for the metabolism and transport of fatty acids and the production of hormones and Vitamin D. Cholesterol is manufactured by the liver, and is also present in certain foods. High blood cholesterol levels have been linked to heart disease and may be a side effect of some anti-HIV medications., liverA large organ, located in the upper right abdomen, which assists in digestion by metabolising carbohydrates, fats and proteins, stores vitamins and minerals, produces amino acids, bile and cholesterol, and removes toxins from the blood. and kidney function. Most of these blood tests are routinely done for our PLHIV anyway.
What about cancer screening? For women, this includes PAP smears — women living with HIV should have annual smears, and breast-screening mammograms (available for women over 40 years of age but particularly recommended for over-50s).
Women with breast symptoms, including pain or a lump, need to see a doctor before having any further tests and should not go straight to the screening service.
Skin cancer screening is usually on an opportunistic basis, certainly if you have any moles or sunspots you are concerned about, ask your doctor.
Bowel cancer screening is available free for 50 and over! This is a simple test designed to detect microscopic bleeding from the bowel. It is a simple, ‘at home’ test that is sent directly to the laboratory; it is recommended to have this every two years. While there are other causes of bleeding from the rectum, this is a very important one not to miss! So don’t ignore it.
Please tell your doctor if you have symptoms or a family history of bowel cancer, as it may be more appropriate to have a screening colonoscopy.
Controversy exists about the role of anal PAP smear screening for anal cancer.
There are a number of large centre trials looking at the acceptability and accuracy of these tests and we will have more definitive recommendations in the near future.
Now we get to the difficult one, the prostate cancer screening debate. The risk of developing prostate cancer increases with age.
However, because prostate cancer is usually slowgrowing, men over 75 years of age or with a life expectancy of less than 10 years are at reduced threat of dying from a diagnosis of prostate cancer.
In the medical community, there has not yet been a consensus about recommending a PSA (prostate specific antigen blood test) along with a DRE (digital rectal examination) as routine screening. Many GPs support routine prostate screening from around the age of 50, but some are still debating the issue. While there is currently good evidence that PSA screening can detect early-stage prostate cancer when curative treatment can be offered, it can also lead to ‘over detection’.
This means that there is sometimes detection of disease which will not impact on the health of a man during his lifetime. It is important to have the discussion with your doctor and consider the pros and cons about having the tests and the implications of further investigations of a raised PSA level, if that occurred.
Having a chat about social and mental health issues is really important too. How is your sleep, mood and energy? Are you suffering from anxiety or depression? The lifetime incidence of major depression in the population is up to 30% and is twice as common in women than men. This is quite a large number and it is higher in PLHIV.
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