Q: I’m going for a routine physical. What do I need to know beforehand?
—Nora C., New York
A:When I give an exam, I often start with a little chat. I ask about the patient’s sleep, food, and exercise habits, family history, and stressors. Then it’s time for a urinalysis, which is a quick way to get a lot of information. For example it can rule out diabetes or point to liver problems.
Once the patient is sitting on the table, I start by tapping her knees with a reflex hammer. This deep-tendon reflex is indicative of nervous system health. I also take her blood pressure and listen to the heart and lungs. I thoroughly check the skin on the back, looking for suspicious moles or growths. Then I look in the ears, mouth, throat, nostrils, and eyes, and gently check the lymph nodes and the thyroid gland. I also do the seated portion of the breast check—for both men and women—and take the patient’s temperature (a low temperature can indicate a thyroid problem).
Then I have the patient lie down, and check the appendix, spleen, liver, and gallbladder. I also look at the skin over the abdomen. Lots of spider veins or broken capillaries can signify liver distress. And, of course, I check any moles or growths.
Then I perform the lying down portion of the breast exam. For women, I make sure they know how to perform a good breast self-exam. Then it’s time for the pelvic exam. In a sexually active woman, a PAP is important because she is at risk for cervical cancer caused by the STD Human Papilloma Virus (HPV). For women in long term, mutually monogamous relationships, the PAP is usually less important. PAPs can be done every 5 years on a low-risk woman, but may need to be done every 6 months for other, high-risk women.
For men, I offer the digital-rectal exam (DRE) to check the prostate for lumps or asymmetry. In the younger man, age 15–30, I give a testicular exam and make sure he knows to regularly perform testicular self-exam.
Finally, I measure her height and weight and calculate her BMI. I also take her waist measurement, because it’s a reliable assessment of abdominal fat, which burdens the internal organs. For men, I prefer waist size to be 40 inches or less and their BMI to be 26 or less. For women, I prefer waist size of 34 inches or less and a BMI of 27 or less. Ideal BMI is around 22.
I always allow time at the end to review what my patients are eating. I ask them what comprises a typical breakfast, lunch, dinner, and snacks. I find out how much water, and other fluids, they drink. Up to two beers or two glasses of wine per day for men, and one for women is okay, but less alcohol is better.
Be sure write down any questions or concerns you have before visiting your doctor, and get the answers during your exam. To find a licensed naturopath in your area, visit naturopathic.org or call 866-538-2267.
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Emily A. Kane, ND, LAc, has a private practice in Juneau, Alaska, where she lives with her husband and daughter. She is the author of two books on health, including Managing Menopause Naturally. Visit her online at dremilykane.com.