September 15, 2006

Doctor’s Corner:

Health Maintenance

By Eduardo Grunvald, M.D.

Most people use good judgment when it comes to caring for their automobiles, tuning them up regularly to keep them in good shape.

Many however, don’t visit their physician or medical provider regularly - especially if they feel well - for a “human tune-up” so that they can live longer, healthier lives.

You don’t hear this very often: “I feel great, I need to see my doctor.”

A health evaluation allows you to take advantage of today’s medical advances in diagnosing, treating, and preventing many conditions that previously were chronic or fatal. Medical knowledge, through scientific and clinical research, has provided tools to help us live longer and better.

A major report from the nation’s leading cancer organizations has just been released documenting that over the last three decades the risk of dying from cancer has declined. It also found that between 1999 and 2003, although Hispanics had a lower risk of developing cancer compared to non-Hispanic whites, they were more likely to be diagnosed with the disease at more advanced stages, when it is more difficult to successfully treat.

Unfortunately, in many Latin American societies preventive medical care is not prioritized. Why would anyone spend the time, money, and effort to go to a doctor’s office if they feel well? It has been my experience that many in the Latino community simply are not aware of preventive healthcare guidelines or do not think it is important to keep up to date with them.

Preventive medicine deals with identifying problems that can be cured or treated if caught early, or intervening to decrease the risk of health problems in the future. There is one fundamental concept to understand: most diseases that we screen for do not cause symptoms in their early stages.

Studies have proven the utility of screening tests in decreasing morbidity and mortality of cancer, cardiovascular disease, and other maladies. Most people in middle age, especially after age 50,  can benefit from seeing a primary care doctor or other medical professional periodically, usually once a year if one is healthy, for recommendations and guidance.

For example, most women should be screened for breast cancer. Besides performing self-breast exams once a month, they should have a mammogram and a breast exam by a medical provider once a year, usually starting at age 40.

Colon cancer can be prevented by detecting and removing polyps - benign growths in the large intestine - before they can transform into the deadly disease. Generally starting at age 50, your doctor can refer you for a colonoscopy or a sigmoidoscopy, a procedure where a camera can look at the lining of your colon and use instruments to remove any growths.

Women should have pap smears starting at age 18, or when they first become sexually active, whichever comes first. This test can detect abnormal cells in the cervix before they become cancerous. The frequency of this exam is determined by your physician based on your medical history and risk factors. Recently, a new vaccine called Gardasil has been developed for girls and young women between the ages of 9 and 26 to protect against the virus that causes the majority of cases of cervical cancer.

Your personal doctor can also check out your skin yearly to screen for any abnormal moles that may be precursors to skin cancers.

Men older than 50 should be screened yearly for prostate cancer with a blood test called a PSA (Prostate Specific Antigen) and a digital rectal exam performed by a doctor.

Diabetes is a chronic illness that is very prevalent in the Hispanic community. It can be present for years before symptoms develop, but can be easily detected by a simple blood test.

Cholesterol, if elevated, greatly increases one’s risk of cardiovascular disease, including heart attacks, strokes, and other circulation problems. If detected and lowered - either through lifestyle modifications, medications, or both - you can greatly reduce your chances of developing life-threatening illnesses, especially if you have a family history of heart disease.

Lastly, immunizations are not just for children. There are vaccines that adults should have updated, protecting against such diseases as tetanus, pneumonia, hepatitis A and B, and others depending on your age. As medical research presses on, there will be more developed to help us stay as healthy as possible.

As you can see, a single visit to the doctor for a general check-up can accomplish multiple goals. There are many other health maintenance issues a personal doctor can help you with, depending on your family history, personal history, and individual risk factors. Those listed above are general guidelines. Examinations that must be done earlier, or with more sophisticated techonolgies, may be recommended because of high risk profiles. 

Unfortunately, having a personal doctor and going through all these exams is not inexpensive. Not everyone has the right kind of insurance, or any insurance at all, to access this type of care. What if you want to invest in your health but don’t think you have the resources?

There is a network of non-profit community clinics available throughout San Diego County, most with services in Spanish, to serve the uninsured or underinsured. Even if you are undocumented you can access these services.

Some resources to start with: Council of Community Clinics (, 619-542-4300); Family Health Centers of San Diego (, 619-515-2300); UCSD Free Clinic Project (; 858-534-6110).

Stay healthy for yourself, for your family, and for the benefit of society.

Enjoy life! 

Dr. Grunvald is Assistant Clinical Professor, Department of Medicine at the Perlman Internal Medicine Group, UCSD Medical Center.

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