Guidelines Are Just Guidelines
If feels like every week some respected health organization comes out with updated guidelines. Then the “experts” chime in about the pros and cons of whatever the changes are.
You may have heard about the new recommendations for high blood pressure this year. This is a big issue for women, as more than 30% in the United States have high blood pressure. One key point is that for adults 60 and older, the blood pressure goal is higher now, 150/90. More women than men have high blood pressure in this age group, so it’s important women get this message.
The bottom line: What does this mean for you? Well, it depends. Are you a young 60-something who is active and healthy? Are you already on blood pressure medicine? Are you struggling with many medical problems? This is where the doctor-patient relationship matters.
I want you to know about the guideline changes and wonder, “Does this apply to me?” And if you think it does, check in with your doctor. Nothing drastic, no reason to panic; this is not about second-guessing your current medical care. This is about being proactive in your health. This is about fine-tuning your treatment and asking your doctor the right questions.
A Link Is Not Cause and Effect
Every day a new study is published. Some studies are small; others are massive. Some look back in time; others look forward. They give one group the “new drug” and another the “usual drug” and then watch what happens over the months and even years. Some ask specific questions, like “Are lives saved with this treatment?” Other studies look for patterns to show up. Take the case of Vitamin D. It’s popularly called the “sunshine vitamin” and is known for its importance in bone health, a key issue for women concerned about osteoporosis. Vitamin D has been in the news with study after study linking low levels of it with multiple medical conditions including diabetes, multiple sclerosis, cancer, heart disease, and depression. Researchers (and everyone else) wondered why so many people with illnesses also have low vitamin D. Would treating the low vitamin D help everything get better? Maybe vitamin D was part of the “cause” of all these medical issues. Maybe taking more vitamin D is better.
This is where I caution you. When the research shows a “link,” that means there’s a relationship, but we don’t know if one “causes” the other or vice versa. So taking more is not better.
The research is ongoing for vitamin D. It is important for bone health. And for most people, the recommendation of a daily vitamin D supplement of 600 to 800 international units is on target. For those with a vitamin deficiency, their doctor may recommend more. In the meantime we’ll wait for answers and not jump to conclusions.
You Still Need Real Time With Your Doctor
The American College of Physicians announced this year that most women do not need yearly pelvic exams. Hold on before your start cheering: The American College of Obstetrics and Gynecologists doesn’t say the same thing. But, both agree, for most women the Pap smear to screen for cervical cancer is needed every 3 years. The HPV test is needed less frequently. And the pelvic exam is not a good screening tool for ovarian cancer. What does all this mean for you? Can you skip your appointment this year? No, not yet, anyway. Ask your doctor — make sure there isn’t a reason you need to get a pelvic exam. And if you don’t, that’s great. You now have extra, valuable time with your doctor. Use that time to get advice and guidance.
Maybe you need to lose weight, or can’t sleep, or think you might be depressed. Maybe you just need more time taking care of other medical issues. Whatever it is, make a list, and use that time wisely. The steps of the traditional doctor’s visits are changing, but the doctor-patient relationship is just as important as ever.
By Arefa Cassoobhoy, MD, MPH
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