Pisgah Family Health News

February 2011

The Physical Exam issue

Office News

Physical Exams

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Office News

Welcome Melissa Godley

Melissa

We are pleased to announce that Melissa Godley will soon join the staff of Pisgah Family Health as a Physician's Assistant.

Melissa Godley, PA-C has been a Physician Assistant since 1999. She worked for 5 years in Florida, practicing in Internal Medicine and Geriatrics before moving to Asheville in 2006. She has been training at our office for several months, to complete her re-entry certification for the state of North Carolina. When her training is complete, she has agreed to join our medical team.

Melissa will be able to see patients will all types of problems, from colds to physical exams. She is bilingual, which will be a great bonus to our Spanish speaking patients. We also hope any of our female patients who prefer a woman provider will take their care to Melissa.

Friday Hours

With the addition of Melissa Godley to our staff, we are pleased to announce the expansion of our hours. We will immediately be open a full day on Friday, for all types of care. We hope this adds convenience for our patients, and prevents visits to the Urgent Care Center.

Physical Exams

During the Spring and Summer parents are often reminded that their schoolchildren need a Physical Exam for camp, sports, or school. The physical exam is intended to assess the child's safety and preparedness for these tasks. The exam also helps to assess age-appropriate development such as growth, learning, motor skills, and social skills. In older children we also try to assess health risks such as smoking, drug use, and school performance.

Here are some tips to streamline you child's physical:

  • Be sure to bring any paperwork from the school or camp.
  • Complete the parents' portion of the paperwork ahead of time.
  • Bring your child's vaccination record.
  • If your child wears glasses, bring them.
  • If your child is a teenager, plan to give them some time alone with the doctor, to discuss issues which they may consider personal.

Now is also a good time for adults to catch up on their physicals. Why? Our office is not overly busy these months, so we can get your physical scheduled more quickly and conveniently.

Here are some tips to streamline your adult physical.

  • Fasting blood work is usually included, so don't eat before your visit. (Do drink plenty of water.)
  • Complete your medical history forms beforehand, or arrive early to do so.
  • Before your visit, talk with your relatives about illnesses that run in the family.
  • Be aware of when you had your last physical and screening tests (blood work, mammogram, colonoscopy, Pap, etc.)
  • Bring all your medication bottles in, including non-prescription medications.
  • Bring your insurance card, and the formulary (drug list) covered by your insurance.
  • If you need papers completed for work, insurance, DOT, or sports, bring them to the visit.

Office Hours

Our normal office hours are 8:30 to 4:30 Monday through Friday. When the office is closed, emergency care is available at the Urgent Care Centers and Mission Hospital ER. 

Our answering service can be reached at 251-4873.  
Telephone calls are handled by Dr. Curran and his call partners.

  • We are now open all day on Friday.
  • April 11-15 we will be closed for Spring Break.

Office Reminders

Bring your medications to each visit. Dr Curran likes to see your medication bottles.

Labs drawn in our office take 7 days to process. We will mail a copy to you.

Test performed outside our office may take 2-3 days to get results to us. When we get the result, we will mail a copy to you.


Medical News

Child Physical Exams and Preventive Care

Physical Exams

As children grow, they undergo great changes every year. That's why it is imortant for them to have a physical exam and preventive visit each year by a qualified professional. At this visit, we assess many aspects of a child's health, including:

Growth

We will chart a child's height, weight, and (in infants) head circumference. We will review growth curves to make sure the child is growing appropriately. We will also calculate the body mass index (BMI) to identify obesity or other weight problems.

Development

We will assess age-appropriate developmental skills. This includes fine-motor, gross motor, language, and social skills. Through age 5, we use a scoring tool called the Ages and Stages Questionaire, which must be completed by a parent. After age 5, the evaluation is less formal.

Vaccinations

Vaccinations are one of the most successful preventive health tools of modern medicine. Polio and Smallpox, which once ravaged young children, have been eradicated in America because of our vaccine program. Other once common illnesses, such as Measles and Mumps have been made rare by vaccines. Be sure your child gets all his/her age-appropriate vaccinations. In the first year of life, visits with vaccinations may be scheduled every 2 months. After 18 months, the primary vaccine series should be complete. Boosters are usually necessary at age 5, 12, and 18. For more details, visit http://www.cdc.gov/vaccines/recs/schedules/default.htm

Academics

One of the key predictors of a child's success in life is his/her academic success. We encourage children to stay in school, and achieve their highest potential. This should also include extracurricular interests such as sports, clubs, and religion.

Lifestyle

As children age, their health and wellbeing may be affected by their lifestyle. Peer pressure and their own and choices may sometimes have a negative impact on their health. Older children face risks of violence, tobacco abuse, alcohol and drug abuse, pregnancy, and sexually transmitted illness. These risks should also be addressed at their annual physical.

Adult Physical Exams and Preventive Care

Physical Exams

Like children, adults should have a physical exam on a regular basis. The purpose of a physical exam and preventive visit is to identify medical problems before they cause illness. Your health risks will be assessed based on your age, medical history, family history, demographics, and lifestyle. Everyone should have a physical and preventive evaluation at least every 3 years. Plan an exam every year if you are any of these:

  • a woman or
  • over 50 or
  • taking daily medication

History

Your phsical exam may begin at home. We will ask you to complete forms detailing your personal and family medical history. You may need to review your personal records or consult family members for this information. This will allow us to begin to assess your personal risks.

Lifestyle

Lifestyle choices represent the greatest modifiable risks to most people's health. Smoking, drinking, lack of exercise, and poor diet account for millions of unnecessary deaths each year. At your physical you will be asked about these and other lifestyle risks. We will try to give you honest advice on how to improve your personal health risks.

Weight

Your weight and height will be recorded, and we will calculate your Body Mass Index (BMI). This helps us identify weight problems, including obesity. Obesity is the most rapidly worsening health statistic in America. It contributes to heart disease, diabetes, arthritis, cancers, and disability. We will try to give you a goal weight, and advice on how to achieve it.

The Exam

Examining the body is the basis for getting a physical. We will usually start by measuring your vitals, vision, and hearing. Be sure to bring any glasses, hearing aids, dentures, or other devices you use. The exam will include a head-to-toe exam of all parts and most organs. Family members will be asked to step out to allow for privacy. Breast exam and pelvic are included unless a woman has a separate gynecologist.

Cardiovascular Screening

This category of illness includes heart attacks, strokes, peripheral vascular disease, and aneurysms. Cardiovascular disease is the most common killer of men and women over 50. However, prevention of these diseases should begin in the 20's. Screeing tools include a cardiac exam, cholesterol testing, EKG, Stress tests, and others. Cardiovascular disease can also be prevented by lifestyle measures, such as regular exercise, no smoking, and healthy diet.

Diabetes Screening

Diabetes is increasing rapidly in our country, largely due to poor diet and obesity. Screening tests can include a urinalysis or a blood sugar. These are routine parts of a physical exam.

Cancer Screening

Cancers are easiest to treat or cure if they are detected early. Most cancers increase in frequency with age. However testicular and cervical cancers are more common in young people. There is no universal test for all cancers. A variety of different screening tools for cancers are used, based on an individual's age and risks.

Cervical Cancer in women can be detected by getting regular pelvic exams and pap smears. This is a highly curable cancer, if detected early. This is also the only cancer that can be prevented by a vaccine - the HPV vaccine. Women with a uterus who are sexually active should have pap smears annually. This does NOT require a visit to the gynecologist, and should be included in your annual exam.

Breast Cancer can be detected by a breast exam or a mammogram. Self-exams and physician exams are recommended for women of all ages. Mammograms should begin after age 40, or depending on personal risks. Breast cancer risk increases with age, so mammograms should be performed every year after age 50.

Skin Cancer can be detected by a thorough skin exam. This does NOT require a dermatologist, and is usually included as part of your annual exam. Suspicious moles can be removed or biopsied right in our office. Most skin cancers can be cured by early detection and removal.

Testicular Cancer can be detected simply by examining the testicles. This cancer is rare, but strikes young men more than older men. Men should be in the habit of checking themselves regularly, and should also expect an exam at each physical.

Prostate Cancer is very common in older men. Screening should begin at age 50, or younger in African Americans. Screeing includes a prostate exam and a PSA blood test. These tests are a standard part of older men's exams, and do NOT require a urologist.

Colon Cancer is a very common and curable cancer in older adults. Men and Women over 50, or with a strong family history of this disease, should have screening. The best test is a colonoscopy performed by a gastroenterologist. This should be repeated every 5-10 years. As a lesser test, we can also check for blood in the stool annually.

Lung Cancer has become the most deadly cancer in older adults. Unfortunately, it is often detected too late to cure. Lung cancer is mostly related to tobacco use, but can occur in nonsmokers. Smokers should have a chest Xray every 1-2 years, or if they develop symptoms.

Labs

Labs are usually done as part of a physical exam, or ordered to be done later. This may include cholesterol, blood count, kidney, liver, sugar, and thyroid tests. Certain populations may need a PSA, HIV, or other specific tests. Cholesterol testing requires fasting for 8 hours.

Vaccinations

Vaccinations are needed less frequently by adults than children, however, there are a few vaccines to prevent illness in adults. Flu vaccine should be considered annually by people of all ages. Tetanus (TDaP) should be repeated every 5-10 years. Pneumonia and Shingles vaccines should be considered by older adults.

If your last physical was more than a year ago, you should call your doctor to make an appointment. This annual visit can improve the quality and length of your life by preventing illness.

2011 Medicare Preventive Services

Physical Exam

Medicare benefits have changed! Starting January 1, 2011, Medicare will cover a physical exam when you're new to Medicare and one each year after that. This new benefit will allow seniors to discuss and have performed screening measures for cardiovascular disease, cancers, and other risks.

Here is a summary of the services which are now covered by Medicare.

One-time "Welcome to Medicare" physical exam

Medicare covers a one-time "Welcome to Medicare" physical exam, if you get it within the first 12 months you have Part B. It's a review of your health, plus education and counseling about preventive services, and referrals for other care you may need. Before January 1, 2011, you pay 20% of the Medicare-approved amount. Starting January 1, 2011, you pay nothing for the "Welcome to Medicare" exam if the doctor accepts assignment. When you make your appointment, let your doctor's office know you'd like to schedule your "Welcome to Medicare"

Yearly "Wellness" exam

If you've had Part B for longer than 12 months, you can get a yearly wellness visit to develop or update a prevention plan just for you, based on your current health and risk factors. Medicare does not cover this exam before January 1, 2011. Starting January 1, 2011, you'll pay nothing for this exam if the doctor accepts assignment. This exam is covered once every 12 months.

You don't need to get the "Welcome to Medicare" physical exam before getting a yearly "Wellness" exam, but if you do choose to get the "Welcome to Medicare" physical exam, you'll have to wait 12 months before you can get your first yearly "Wellness" exam.

Abdominal Aortic Aneurysm Screening

A one-time screening ultrasound for people at risk. Medicare only covers this screening if you get a referral for it as a result of your one-time "Welcome to Medicare" physical exam. Before January 1, 2011, you pay 20% of the Medicare-approved amount. Starting January 1, 2011, you pay nothing for the screening if the doctor accepts assignment.

Breast Cancer Screening (Mammograms)

A type of X-ray to check women for breast cancer before they or their doctor may be able to find it. Medicare covers screening mammograms once every 12 months for all women with Medicare age 40 and older. Medicare covers one baseline mammogram for women between ages 35-39. Before January 1, 2011, you pay 20% of the Medicare-approved amount. Starting January 1, 2011, you pay nothing for the test if the doctor accepts assignment.

Pap Smear and Pelvic Exams (includes clinical breast exam)

Checks for cervical, vaginal, and breast cancers. Medicare covers these screening tests once every 24 months, or once every 12 months for women at high risk, and for women of child-bearing age who have had an exam that indicated cancer or other abnormalities in the past 3 years. No cost to you for the Pap lab test. Before January 1, 2011, you pay 20% of the Medicare-approved amount for Pap test specimen collection, and pelvic and breast exams. Starting January 1, 2011, you pay nothing for Pap test specimen collection, and pelvic and breast exams if the doctor accepts assignment.

Bone Mass Measurement

Helps to see if you are at risk for broken bones. This service is covered once every 24 months (more often if medically necessary) for people who have certain medical conditions or meet certain criteria. Before January 1, 2011, you pay 20% of the Medicare-approved amount, and the Part B deductible applies. Starting January 1, 2011, you pay nothing for this test if the doctor accepts assignment.

Cholesterol Screening

Helps detect high cholesterol that may lead to a heart attack or stroke. This service is covered every 5 years to test your cholesterol, lipid, and triglyceride levels. No cost for the tests, but you generally have to pay 20% of the Medicare-approved amount for the doctor's visit.

Colon Cancer Screening

Colorectal cancer is usually found in people age 50 or older, and the risk of getting it increases with age. Medicare covers colorectal screening tests to help find pre-cancerous polyps (growths in the colon) so they can be removed before they turn into cancer. Treatment works best when colorectal cancer is found early.

One or more of the following tests may be covered. Talk to your doctor.

  • Fecal Occult Blood Test-Once every 12 months if 50 or older. You pay nothing for the test, but you generally have to pay 20% of the Medicare-approved amount for the doctor's visit.
  • Flexible Sigmoidoscopy-Generally, once every 48 months if 50 or older, or 120 months after a previous screening colonoscopy for those not at high risk. Before January 1, 2011, you pay 20% of the Medicare-approved amount at your doctor's office, 25% of the Medicare-approved amount if you get it in an outpatient hospital setting or an ambulatory surgical center. Starting January 1, 2011, you pay nothing for this test if the doctor accepts assignment.
  • Colonoscopy-Generally, you can get this procedure once every 120 months, or 48 months after a previous flexible sigmoidoscopy. If your doctor says you're at high risk, you can get it every 24 months. There's no minimum age required for you to get a colonoscopy. If you get the procedure before January 1, 2011, you'll pay no Part B deductable, plus 20% of the Medicare-approved amount at your doctor's office or 25% of the Medicare-approved amount if you get it in an outpatient hospital setting or an ambulatory surgical center. If you get the procedure on or after January 1, 2011, you'll pay nothing for the procedure if your doctor accepts assignment.
  • Barium Enema-Once every 48 months if 50 or older (high risk every 24 months) when used instead of a sigmoidoscopy or colonoscopy. You pay 20% of the Medicare approved amount for the doctor's services. In a hospital outpatient setting, you also pay the hospital a copayment.

Diabetes Screenings

Checks for diabetes. These screenings are covered if you have any of the following risk factors: high blood pressure (hypertension), history of abnormal cholesterol and triglyceride levels (dyslipidemia), obesity, or a history of high blood sugar (glucose). Tests are also covered if you answer yes to two or more of the following questions:

  • Are you age 65 or older?
  • Are you overweight?
  • Do you have a family history of diabetes?
  • Do you have a history of diabetes during pregnancy, or did you deliver a baby weighing more than 9 pounds?

Based on the results of these tests, you may be eligible for up to two diabetes screenings every year. No cost for the test, but you generally have to pay 20% of the Medicare-approved amount for the doctor's visit.

Diabetes Self-Management Training

For people with diabetes. Your doctor or other health care provider must provide a written order. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Flu Shots

Helps prevent influenza or flu virus. Generally covered once a flu season in the fall or winter. You need a flu shot for the current virus each year. No cost to you for the flu shot if the doctor or other health care provider accepts assignment for giving the shot. Note: Medicare Part B also covers administration of the H1N1 flu shot. You pay nothing if your doctor accepts assignment for giving the shot.

Hepatitis B Shots

Helps protect people from getting Hepatitis B. This is covered for people at high or medium risk for Hepatitis B. Your risk for Hepatitis B increases if you have hemophilia, End-Stage Renal Disease (ESRD), or a condition that increases your risk for infection. Other factors may increase your risk for Hepatitis B, so check with your doctor. Before January 1, 2011, you pay 20% of the Medicare-approved amount, and the Part B deductible applies. Starting January 1, 2011, you pay nothing for the shot if the doctor accepts assignment.

Pneumococcal Shot

Helps prevent pneumococcal infections (like certain types of pneumonia). Most people only need this preventive shot once in their lifetime. Talk with your doctor. No cost if the doctor or supplier accepts assignment for giving the shot.

HIV Screening

Medicare covers HIV screening for people with Medicare who are pregnant and people at increased risk for the infection, including anyone who asks for the test. Medicare covers this test once every 12 months or up to 3 times during a pregnancy. You pay nothing for the test, but you generally have to pay the doctor 20% of the Medicare approved amount for the doctor's visit.

Medical Nutrition Therapy Services

Medicare may cover medical nutrition therapy and certain related services if you have diabetes or kidney disease, or you have had a kidney transplant in the last 36 months, and your doctor refers you for the service. Before January 1, 2011, you pay 20% of the Medicare-approved amount, and the Part B deductible applies. Starting January 1, 2011, you pay nothing for the test if the doctor accepts assignment.

Prostate Cancer Screenings

Helps detect prostate cancer. Medicare covers a digital rectal exam and Prostate Specific Antigen (PSA) test once every 12 months for all men with Medicare over age 50 (coverage for this test begins the day after your 50th birthday). You pay 20% of the Medicare-approved amount, and the Part B deductible applies for the doctor's visit. You pay nothing for the PSA test. In a hospital outpatient setting, you also pay the hospital a copayment.

Smoking Cessation (counseling to stop smoking)

Includes up to 8 face-to-face visits in a 12-month period if you are diagnosed with an illness caused or complicated by tobacco use, or you take a medicine that is affected by tobacco. You pay 20% of the Medicare-approved amount, and the Part B deductible applies. In a hospital outpatient setting, you also pay the hospital a copayment.

Note: Medicare coverage of smoking cessation counseling is now considered a covered preventive service if you haven't been diagnosed with an illness caused or complicated by tobacco use. Starting January 1, 2011, you pay nothing for the counseling sessions.

Glaucoma Tests

Helps find the eye disease glaucoma. Covered once every 12 months for people at high risk for glaucoma. You are considered high risk for glaucoma if you have diabetes, a family history of glaucoma, are African-American and age 50 or older, or are Hispanic and age 65 or older. An eye doctor who is legally authorized by the state must do the tests. You pay 20% of the Medicare-approved amount, and the Part B deductible applies for the doctor's visit. In a hospital outpatient setting, you also pay the hospital a copayment.

http://www.medicare.gov/navigation/manage-your-health/preventive-services/preventive-service-overview.aspx

Health Links

For local health events, check out these links:

A few of the most-trusted health information links:

  • WebMD.com A web service with health advice on hundreds of topics.
  • FamilyDoctor.org Patient-oriented information from the American Academy of Family Physicians.
  • CDC.gov The Center for Disease Control features credible information on almost every health topic.

About our Newsletter

Dr. Curran and the staff at Pisgah Family Health are proud to publish the Pisgah Family Health News to our patients.  Our goal is to provide regularly updated information about the office and current medical topics.  We plan to publish a new issue each quarter with breaking news.  The newsletters will also be archived on our website, http://www.pisgahfamilyhealth.com/

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