Since my diagnosis with MS in 2009, I have often felt like I'm driving a car without a steering wheel. As a chronic disease, MS is, of course, incurable. Unfortunately, the course of MS - one's overall prognosis – also is not very impactable. Other than taking my medications, there is little I can do to stop or slow its progression.
Initially, when I found out that my future with MS was beyond my control, I felt disempowered. I had wanted to find proof that a particular diet – no matter how restrictive – would halt MS in its tracks. Or maybe acupuncture or ten hours of sleep every day would make a difference. But that proof doesn't exist. We still don't know what causes MS or will make it go away.
Over the years, I have regained a sense of control, however, by prioritizing self-care. As a family doctor, I have always tried to practice what I preach. Now self-care is an obsession. It may not make a difference for my MS, but it certainly won't hurt. And I know it will help decrease my odds of other health problems.
I recently had an opportunity to answer some questions from a New York Times reporter (that she did not end up needing for her story) about my own self-care habits and recommendations for others. I thought I would share those answers in a two-part blog - Part 2 will come out next week. You'll notice there are some common self-care beliefs that I dispute (Spoiler: I don't take multivitamins or supplements). I hope this is helpful! Please let me know what you think.
What do you look for in a physician to care for you and your family?
I look for a physician with medical curiosity. I want my physician – and the physician for those I care about – to be smart and thorough and really get to the bottom of any symptoms or concerns. Of course, a good bedside manner and a friendly, caring attitude are essential as well.
How often do you get medical check-ups?
I have to see my neurologist at least twice a year for my MS. Besides that, I'm somewhat lax about getting regular check-ups. I take good care of myself. I monitor my own blood pressure. I do get recommended vaccines (including an annual flu shot) and screening tests, but I also don't overdo it.
What are the benefits and possible disadvantages of seeing a primary care doctor annually?
Annual visits don't really have to be "annual" for everyone. If someone is young and healthy, visiting a doctor every two or even three years might be reasonable. But especially for older adults and those at risk for or who have a chronic disease, regular care is important. I do think everyone – young or old, healthy or not - should be established with a primary care provider, in the event that something unexpected comes up.
Do you get your cholesterol checked every year?
Annual testing is overkill. I'm 44, and I've had my cholesterol checked twice in my life because it was at a healthy level and unlikely to change much over time. Even most national guidelines don't recommend annual cholesterol checks unless someone is on cholesterol medication or has another condition that makes regular testing reasonable. Testing every five years (or even less often) is probably adequate when the initial screening test is normal in those without other cardiac risk factors.
What about tests for prostate cancer screening?
Not applicable for me, but I would not recommend prostate screening for my husband or father. Overdiagnosis and overtreatment are far too common.
Which screening tests do you undergo?
I comply with guidelines for cervical cancer screening (pap smears every three years, or every five years if combined with HPV testing). I have received mammograms, but with more recent guidelines, I have reduced the frequency of screening to every other year. And I had a colonoscopy at age 40 (earlier than usual) due to my family history. I have turned down screening tests offered by my physicians for ovarian cancer and carotid artery thickening (increasing the risk for stroke) because I knew that the evidence did not support such testing.
Do you undergo screening for osteoporosis and vitamin D levels?
I have been tested for vitamin D deficiency because it is linked with MS, but I do not recommend it routinely for healthy people. Similarly, I knew that I was at higher risk for osteoporosis because of my family history and steroid requirement for MS in the past, so I agreed to a bone density test. I strongly support women getting screened for osteoporosis in their 60s, and sooner if they have risk factors, but I am frustrated by the amount of over-screening that occurs.
Which ones do you believe save lives?
Mammograms, pap smears, colonoscopies, and bone density tests all save lives. No question. Many other tests have less evidence of benefit. Overtesting is commonplace, but it results in significant harms. Check out the U.S. Preventive Services Task Force website for excellent, evidence-based recommendations for medical screening tests.