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Issue Date: October 2005 Issue


Family Portraits

Women pass down more to their daughters than outward appearance. Your family's medical history can determine risk for disease. To get the complete picture, have you conducted a background check lately?


Kristen Hampshire

Skinny doesn’t mean healthy, Allegra Prew---itt reminds peo-ple when they wonder why she faithfully exercises and scours food labels for fat content.

“What do you have to worry about?” they ask her.

Prewitt shakes her head in frustration. She’s 32, trim, polished and petite. “So many people in my generation focus on outer appearances, including myself,” she says. “But what good is the outside if you aren’t healthy inside?”

Prewitt’s family medical history and cholesterol count are constant reminders that looks are deceiving. Nine years ago during a checkup, her cholesterol level registered in the high 300s, far past the 200-point line doctors draw between healthy arteries and those that threaten heart attack.

Prewitt, from Shaker Heights, was following in her father’s footsteps. He died last year at 52, suffering for years after a stroke, heart attack and congestive heart failure. That reality check altered Prewitt’s perspective on preventive health.

“I don’t want to die young,” Prewitt says matter-of-factly. Her attitude is similar to other young women who dig for details in their families’ medical histories — asking questions that their grandmothers might consider embarrassing: What medications does mom take? Why did grandma pass away so young? What does this mean for me now?

Doctors need background notes on family history to unravel a patient’s whole story, says Dr. Cheryl Morrow-White, director of the child policy initiative at Case Western Reserve University. “Our family medical histories are intertwined, so our challenge is to tease out the individual risk factors and develop approaches to lessening those risk factors,” she says.

 

•••

Family medical histories connect the dots between generations. In some families, personal matters may be dinner conversation. But in others, they might be stories left untold, so family medical problems might stay buried for generations without mention, says Dr. Julie Adams, D.O., a physician with Family Medicine Specialists in Westlake.

If asking your mother or grandmother to share medical details would make you both uncomfortable, it might help to approach the subject as doctor’s orders, recommends Adams. Say: I made an appointment to see a doctor and I know they will ask some health questions. Is there anything I need to know about in our family history? Or you can share symptoms and ask for advice: Have you ever felt this way?

Adams sees patients of all ages, many of them related. She knows when mothers and daughters talk in detail about osteoporosis, high cholesterol, diabetes or ovarian, breast and other cancers. Rather than just hearing vague references to “female cancer” in the family, these women know what medications their mothers and grandmothers take and why.

“I used to [ask], ‘Are your parents alive and well?’ ” Adams says. “Then, I followed up with, ‘Are there medical problems you know of in the family?’ Now I also ask, ‘Do family members take medication for anything?’

“All of a sudden, I learn they have a history of high cholesterol. Or a young woman says, ‘My mom has been on Celexa [for depression] five years and is doing great with it. She did so well she put my sister on it.’ ”

Patients mention relatives’ heart attacks, strokes, cancers and diabetes without doctors digging too deeply for information, Adams says. But many women don’t think to mention depression, osteoporosis, anxiety disorders, lupus, thyroid disorders and even skin cancer when their doctors ask for history.

Age is one factor in whether women openly discuss medical histories. When Adams asks patients questions about their families, those in their 40s or older often respond, “We just didn’t talk about that.”

“In general, if I see a family that includes a grandmother, mother and daughter, ages 65 and up seem to have a different mindset,” Adams continues. Grandmothers’ visits with doctors are more likely to be purposeful and to-the-point. They are less likely to question their doctors or offer information physicians don’t request.

“You don’t ask questions — you don’t question your doctor,” Adams says of the delicate way older generations approach medical visits. “Your doctor tells you what you have and what medications to take, and you do it.”

Baby boomers, more assertive in general, tend to approach physician relationships as a partnership, Adams notices. They surf the Internet, research symptoms and print out health articles. “They ask, ‘What is it? What is causing this? Is there a name for it?’ ” Adams explains. “And if there is a diagnosis, they want to know more.”

Their daughters in their 20s and 30s, in transition from school to jobs or from different cities to new insurance plans, visit less often, but they are generally more comfortable discussing medical histories with their mothers.

Prewitt knew her visits to her doctor were critical, but she says the importance of diet, exercise and medication didn’t “click” until her father’s health was irreparable.

“At first, I stopped eating red meat, and that was the extent of [my health changes],” she says. “I was 23, and diagnosed with hypercholesterolemia, but I still ate what I wanted and didn’t take it too seriously.”

Prewitt’s mother, grandmother, father and siblings all have high cholesterol, she says. But Prewitt is the only one who takes aggressive steps to keep levels below 200. In October 2004, she hit her record low: 188.

“If you begin a wellness regimen as a young person and keep up your activity level, you will have decreased chances of developing heart disease,” Morrow-White says. “You are what you eat,” she adds. “Or you could better say, you will be what you eat.”

 

•••

Jennifer Ricica takes this mantra quite seriously. “The way I eat and do things is very different from my family,” says the 22-year-old Lakewood woman.

Her family expresses their Czechoslovakian heritage through hearty meals with red meat and mashed or fried potatoes. You’ll find granola bars and apples in Ricica’s home, but not in her mother’s kitchen in Jewell Township, an hour outside Toledo.

Meanwhile, Ricica’s family shares another tradition: daily insulin shots. Ricica’s mother, father, both grandmothers and a great-grandmother have diabetes. “We’ve nearly lost my grandmother four times now,” she says.

Ricica knows the symptoms: chronic fatigue, frequent urination and blurred vision in later stages. When Ricica detects even a slightly scratchy throat or a bout of sleepiness, she doesn’t think of dehydration or a late night studying for an exam. “I’ll get a dry mouth and think, ‘Uh, oh,’ ” Ricica says. “I’m not a hypochondriac, but diabetes does come to mind.”

As a staff accountant at the YMCA, Ricica is immersed in wellness — she participated in a triathlon and she consults staff members about ways to maintain a low-fat diet.

“Everyone is catching the spirit of prevention,” Morrow-White says. Already, the medical community is sending the message that prevention costs less than treatment, she adds. Dollar signs register with patients of all ages.

The up-front price tag for Ricica is worth avoiding her family legacy. Prewitt, meanwhile, would like to strike prescription drug payments from her monthly budget. Even with insurance, her mail-order cholesterol drugs cost about $400 every three months. But she knows she’s investing in her life.

“It comes down to knowing,” Prewitt says simply. “When I was 23, I took medication because my doctor said I had to do it. The older I got, the more I wanted to know, and the more educated I became, the more I realized, ‘OK, it’s time to do something about this.’ ”

 

•••

Diann Rucki worries that her sister, Anna, wrote the first pages of her family’s medical history when ovarian cancer swiftly took her life almost two years ago at age 54. Until then, no one in the family had discussed “female cancer.”

In fact, most grandmothers figured talking about these matters was inappropriate. But politeness comes with a price when women gloss over their medical backgrounds. To Rucki’s knowledge, her family medical history contained no record of ovarian cancer until her sister was diagnosed in September 2003. Anna died in January 2004.

“It is a cancer that buries itself deep,” she says. “Once it surfaces, there is little you can do. Your survival rate is just not going to be that great. And if you talk to women who have ovarian cancer, many of them will tell you it was discovered by accident.”

The symptoms of ovarian cancer are normal feelings a woman might experience on any given day: bloating, excessive urination, fatigue, weight gain or loss. “Many people would simply feel silly going to a doctor and complaining of these things,” Rucki recognizes. Her sister, Anna, never assumed these feelings were signs of ovarian cancer.

Today, Rucki, 48, from Bainbridge, doesn’t slough off these signals. She and her sisters talk about what their doctors should screen and scrutinize.

“Until time marches forward, we are not going to know whether this is the type of cancer that might be the beginning of a history,” she says.

Rucki also reminds her nieces, who range in age from pre-teen to 30, to give doctors details and tell them that their aunt died from ovarian cancer at an early age.

“We are more assertive about health care and health history,” Rucki says. “We pay more attention to how we feel on a daily basis.” She and her sisters have even taken an interest in ovarian cancer research.

Do you have a family history of medical problems? “That question should be a reminder that you need to know your past,” Morrow-White emphasizes. “It should incite us to go back and ask questions of our family members.” 


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