No matter what age you are or at what stage of life you became an amputee, it is important for all women to make a commitment to their health by taking the time to schedule regular medical examinations and health screenings. No matter the cause for the amputation, be it trauma, cancer, complications of diabetes or vascular disease, you should never forget that you are a woman first, and an amputee second. Instead of concentrating on what you have lost, you should concentrate on taking care of what you have left.
The three leading causes of death for women in the United States are heart disease, cancer and stroke. Amputation is nowhere on this list. You may be missing limbs, but there is more than enough left to care about and maintain in order to function at the best of your ability. Granted, it may be more inconvenient, awkward and difficult to schedule appointments, hop up on an exam table for a GYN exam or balance during a mammogram, but please, do NOT use your amputation as an excuse to avoid taking care of yourself.
Health is not just the absence of disease; it’s the cornerstone to a happy life. It’s what gives us the ability to get out and about, to live and to work, to enjoy our families and friends. Women’s health risks vary depending on age, family history, personal health history and habits, lifestyle, and work and home environments.
These issues are certainly different in our teens and 20s, our childbearing and motherhood years, after menopause and beyond. Since our bodies are constantly changing as we age, our health concerns and the tests we need will also change. Therefore, it’s important to partner with your physician or healthcare professional to determine an appropriate health-screening schedule based on your individual health issues, risk factors and needs. The routine tests, physical examinations and screenings for women fall into some general categories:
- General health
- Heart health
- Endocrine (hormonal) health, whichwould include diabetes, thyroid, the reproductive organs and sexually transmitted diseases (STDs)
- Breast health
- Bone health
- Sensory health: vision, hearing
- Colorectal health
- Skin and oral health
- Mental health
Basic recommended health screenings for women of all ages
- Obtain a complete, general health examination at least every 1 to 2 years, including height, weight, blood pressure check and Pap smear.
- Be sure all your immunizations are up to date. This should include the usual childhood vaccinations.
- Get cholesterol, diabetes and thyroid checks, depending on your personal or family medical history.
- Obtain regular eye exams, oral health exams, skin checks and hearing exams, depending on your personal or family medical history.
Note: All age-specific recommendations apply to succeeding age groups as well.
Recommendations for women in their teens and 20s
- Pelvic exams, including Pap tests, should begin at age 18 or at the onset of sexual activity.
- Breast self-exam should begin at age 20 and continue once a month (one week after your period). Clinical breast exams by a trained healthcare professional should start at age 20 and be repeated every 3 years until age 40.
- If sexually active, consider birth control options. If multiple partners are involved, STD screenings should be done, and should be continued no matter what age. (The incidence of HIV infections is increasing in the over-60 population that does not use appropriate protection.)
- Check baseline cholesterol level at age 20.
- Check urine or blood sugar for diabetes.
- Get a tetanus-diphtheria booster (every 10 years) and vaccinations for human papillomavirus (HPV) and meningococcal disease (which is becoming a more common reason for amputations, particularly in the high school- and collegeage population).
- A monthly mole self-exam should start at age 20 and should be done by a doctor every 3 years.
This is the best time in your life to set good health habits that will prevent problems in the future. To develop strong bones and maximum bone density, which will protect and prevent the development of osteoporosis, eat a low-fat, high-calcium diet. If necessary, use calcium supplements. Find activities and regular weightbearing exercises that you can do. Maintain a normal weight. If you smoke, quit, and consume alcohol only in moderation.
Recommendations for women in their 30s
- Discuss with your physician when you should receive a baseline mammogram. Depending on your family history, you should also discuss how often you should obtain a routine screening mammography.
- Thyroid test (TSH) should start at age 35, then be done every 5 years.
- Have a Pap test and pelvic exam every 1 to 3 years.
- Is it time for your tetanus booster?
This is sometimes referred to as the “pregnancy decade.” If you are planning to get pregnant, be sure to talk to your doctor about supplementing your diet with key vitamins and minerals. Folic acid, omega-3 amino acids, iron and vitamin C are beneficial for both you and the growing fetus. Avoid alcohol and excessive use of caffeinated beverages, particularly diet colas.
- Annual screening mammograms should begin at age 40.
- Check blood pressure every 2 years.
- Start blood glucose tests at age 45, then every 3 years (if not a known diabetic).
- Have a rectal exam.
- Have an eye test every 2 to 4 years and a hearing test every 10 years.
- Keep immunizations up to date. Get hepatitis A and B vaccinations and others if you travel.
Menopause can occur any time from the mid- to late-40s and 50s. During this time of transition, the hormonal levels are fluctuating, causing irregular periods. It may take up to 5 years for menstrual cycles to cease completely; this time is called the peri-menopause. The decline in estrogen is a major factor in the development of heart disease in women. Bone loss also accelerates during peri-menopause, which can lead to osteoporosis. Therefore, it’s important not to wait until you’ve gone through menopause but to assess your personal risks and begin treatment early.
Recommendations for women in their 50s
- Have a complete general physical examination, which should include a baselineEKG, chest x-ray, blood glucose, cholesterol and lipid panel.
- Know your blood pressure.
- Have a bone mineral density test.
- Colonoscopies should begin at age 50. Discuss with your healthcare provider how frequently this should be repeated. A flexible sigmoidoscopy or double-contrast barium enema may be indicated as an alternative.
- Have a rectal exam and fecal occult blood test annually. (Screening for colorectal cancer and osteoporosis should start at a younger age if you are at a high personal risk.)
- Immunizations: Flu and pneumococcal are recommended starting at age 50 if you have diabetes or renal disease or if you are in an immuno-compromised state.
Recommendations for women age 60 and older
Continue with all recommended screenings, as well as annual mammography, routine bone density testing and colorectal cancer screening as determined by your personal health risks and your doctor, plus:
- Have a routine pneumoccocal and flu vaccination over age 65.
- Have a herpes zoster vaccine (Zostivax).
Anyone over the age of 60 who had chickenpox as a child is at risk to develop shingles because the virus hibernates in nerve cells for decades until erupting again. Shingles can be an excruciatingly painful skin and nerve condition, which can now be prevented by a new vaccine, Zostivax.
These medical examinations, tests and health screenings will not only help to safeguard your health today, but will also help to improve your quality of life in the years to come.
About the Author
Christina Skoski, MD, is a retired clinical anesthesiologist with 30 years experience and an active member of Amputee Coalition’s Medical Advisory Committee. She has been a hemipelvectomy amputee since she was a teen-ager.