DEAR DR. DONOHUE: I am a healthy, 68-year-old male. I have always had a yearly checkup. This always included blood work, urinalysis, blood stool test, listening to my heart, sometimes an EKG, a digital prostate check and a general touch and visual exam of my whole body. I have recently moved. My new doctor just does blood tests and goes over the results with me. I don’t even take off my shirt. He says the rest of the exam is just a waste of time. What should people expect in a routine physical? — W.V.

ANSWER: The standard yearly physical exam isn’t what it used to be. The United States Services Task Force, a committee of respected doctors who set policy for such things, issued new directions on what a physical exam should comprise.

The exam should be adapted to the patient’s age, family history of illnesses, gender-specific conditions and an exploration of whatever symptoms the patient has.

Blood pressure, weight and listening to the heart and lungs, while not demanded every year in an otherwise healthy person, don’t take long and merit a yearly check. If a person doesn’t have an eye doctor, then the examining physician should check for glaucoma, cataracts and macular degeneration. Some blood tests ought to be a yearly affair: cholesterol, triglycerides, hemoglobin A1c (diabetes check) and a stool test for blood. A yearly PSA test is a matter of debate. Women need to have mammograms and PAP smears done in accordance with official directions.

At age 50, people need a colonoscopy. An ultrasound check of the abdomen for aortic aneurysm is a suggestion for those in their mid-to-late 60s who smoked.

The rest of the exam is directed to a patient’s specific complaints.

The doctor should make sure people have had their vaccines: yearly flu, pneumonia vaccine, tetanus booster (every 10 years) and the shingles vaccine for older patients.

The stethoscope has not been thrown out.

DEAR DR. DONOHUE: Will you comment on fish oil, specifically Lovaza, for control of cholesterol and triglycerides?

My doctor is reluctant to change my medications from Lipitor and Tricor to Lovaza. I am concerned that my present meds could damage my liver and muscles. — K.P.

ANSWER: Statins — your Lipitor (atorvastatin) — are probably the most powerful and popular drugs for lowering cholesterol. Tricor (fenofibrate) works in a different manner to lower cholesterol and triglycerides. Some caution has to be used in combining the two, because Tricor can raise the risk of muscle damage coming from Lipitor.

Lovaza is a prescription formulation of omega-3 fatty acids — the material in fish that lowers cholesterol, increases HDL cholesterol (good cholesterol) and lowers triglycerides. Whether it achieves the same results as statin drugs isn’t clearly answered. It does work, and it is safe. Why not strike a bargain with your doctor? Ask to try it for two months. Have your cholesterol and triglycerides checked before and at the end of the two-month trial. Then you and the doctor can determine if Lovaza alone controls your cholesterol/triglyceride problem.

DEAR DR. DONOHUE: I carry medicines in my handbag: Singulair, prednisone, Ventolin and occasionally eyedrops. Does carrying a cell phone in the handbag in close proximity to the medications affect them in any way?

Also, can a cell phone affect food or water if placed together, for example, in a tote bag? — G.G.

ANSWER: Cell phones are not emitting any dangerous radiations in the situations you describe.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.


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