Testing 1, 2, 3

From vaccinations to standard screenings, there are measures every adult should take to stay on top of their health.

A lot of news focuses on vaccines children need, but adults are not off the hook when it comes to shots to keep healthy. So, which do you need and when? And what types of tests should you have to keep on top of your health? Read on for some straightforward advice from Dr. Carolina Fonseca and Dr. Valeria Fabre, internal medicine specialists with a thriving practice in Pawtucket.

Adult Vaccinations

Who: Everyone.
How often: Once every year.  
Why: Prevents flu (all that achy misery) and protects you from complications such as pneumonia and respiratory failure. Some patients — such as pregnant women, infants and seniors — are more at risk for flu complications.

Td and Tdap
Who: All adults, especially pregnant women and those taking care of children.
How often: Td booster every ten years (substitute one of those doses with a Tdap shot).
Why: Td protects against tetanus and diphtheria, which are caused by bacteria. Tetanus bacteria can enter the body through a cut that gets contaminated with soil or an injury, like stepping on a rusty nail. It causes painful muscle tightening, sometimes called lockjaw. You may have had a tetanus shot in the past, but your immunity wanes with time. Diphtheria can lead to breathing problems, paralysis and heart failure. With Tdap, you’ll get protection against pertussis (a.k.a. whooping cough), which causes severe coughing spells and difficulty breathing.

Who: Everyone sixty and older.
How often: One dose.
Why: One out of every three people in the United States will develop shingles. The vaccine prevents development of shingles and complications such as neuralgia postherpetica, which is pain that does not go away, lasting months or even years.

Chickenpox (varicella)
Who: Adults without evidence of immunity.
How often: Two doses, twenty-eight days apart.
Why: It’s a highly infectious viral disease that causes a blister-like rash, itching, fatigue and fever. If you had chicken pox as a child, you’re considered immune. If you didn’t, you should get the vaccine. It’s important for women of childbearing age to get the vaccine before getting pregnant, as chickenpox can cause severe damage to the fetus.

Who: Adults age sixty-five and older, or any adult with certain risk factors.
How often: Depends on type.
Why: Pneumonia causes lung inflammation and may be accompanied by fever, chills and shortness of breath, and can be deadly. There are two types of pneumonia vaccine: PPSV (pneumococcal polysaccharide vaccine) and PCV (pneumococcal conjugate vaccine). PPSV is for all adults aged sixty-five and older and for those younger than sixty-five with risk factors such as diabetes, chronic kidney disease, smokers, lung disease (asthma or COPD), cirrhosis, nursing home residents or HIV. Your doctor will tell you if you need one or two doses. PCV, which only requires one dose, is for patients with chronic renal failure and nephrotic syndrome or who do not have a spleen.

Hepatitis B
Who: Adults with a risk factor, such as diabetes or a sexual partner who is hepatitis B positive, adults who work in health care or those on dialysis.
How often: One series of three doses, unless your response to the vaccine is low, in which case a second series might be needed.
Why: Hepatitis B causes inflammation of the liver, which can lead to cirrhosis or liver failure. This vaccine is especially important if you have a hepatitis C infection, so that you avoid anything that can worsen your liver.

Fabre emphasizes it’s important to talk to your primary care doctor about all vaccines. Patients with certain immuno-compromising conditions might not be able to receive certain vaccines, and some medical conditions may interfere with effectiveness.

Preventive Tests/Screenings

Your first test: Do you have a doctor? Fonseca and Fabre emphasize it’s important to have a relationship with a primary care physician, one with whom you feel comfortable having these conversations.

Medical science is fast-changing, and it’s important to ask which tests you need, Fonseca says. “Something new comes out every day that changes the way we used to do things. And tests needed can vary from patient to patient depending on age and physical condition. We must customize care to each patient’s risks and needs.”

Here’s how to start the conversation.

Abdominal aortic aneurism
Who: Men ages sixty-five to seventy-five who have ever smoked.
How often: One screening with abdominal ultrasound.

Bone density scan
Who: Women age sixty-five and older for osteoporosis screening, or in younger women whose fracture risk is equal to that of a sixty-five-year-old white woman with no additional risk factors.
How often: Once, then as conditions dictate.

Who: Adults thirty-five and older.
How often: Every five years, more often if there is medical management of lipid disorders.

Who: Adults fifty and older, sooner if there is family history of colon cancer.
How often: Depending on the results of your first test, your doctor may recommend coming back in three, five or ten years.

Diabetes screening
Who: Adults with sustained high blood pressure equal or greater than 135/80, those with diabetes and/or hypertension in their family history.
How often: Annually.

Hepatitis C screening
Who: Patients born between 1945 and 1965, and those at high risk of infection (blood transfusions before 1992, in long term hemodialysis, incarceration, intranasal or intravenous drug users or unregulated tattoo). Most people are asymptomatic until serious liver damage is done. An estimated 2.7 million to 3.9 million persons are chronically infected with HCV in the United States, and 45 to 85 percent are unaware that they are infected.
How often: At least once.

High blood pressure
Who: All adults age eighteen and older.
How often: Annually.

HIV Screening
Who: Adolescents and adults ages fifteen to sixty-five years, regardless of lifestyle.
How often: At least once.

Human papillomavirus (HPV) testing
Who: Adult women.
How often: Every five years.

Lung cancer screening
Who: Adults age fifty-five to eighty who have a thirty-year smoking history and currently smoke, or who have quit within the past fifteen years.
How often: Low dose computed tomography annually.

Who: Women age forty and older.
How often: Every two years starting at age forty, then every year when you turn fifty. Mammograms should be performed in conjunction with an annual breast exam by a healthcare provider (and don't forget about monthly self-checks).  

Pelvic exam and PAP smear
Who: Women ages twenty-one to sixty-five.
How often: Every three years, or annually if test results or medical conditions require.

PSA (Prostate Specific Antigen)
Who: Adult men.
How often: There is conflicting evidence regarding the small potential of benefit and significant potential of harm with biopsies and treatments for this slow-growing cancer. Your best bet is to talk to your doctor about family history, benefits and risks so you can make an informed decision.