A Warning for Women

Don’t let fear of COVID-19 make you neglect your annual physical exam and regular screenings, says an internist.
Girl In Respiratory Mask


We hate to generalize. But even in normal times, women are famous for putting their own health care concerns on the back burner while tending to other family members. Add to that dish a dollop of pandemic procrastination, and you’ve got a stew of trouble.

Don’t take our word for it. Listen to board-certified internist Kristen J. Schwall, M.D. Affiliated with Saint Barnabas Medical Center (SBMC), she’s a member of the RWJBarnabas Health Medical Group. Dr. Schwall recommends annual routine physicals for women and stresses that the vital role of preventive care goes on no matter what’s in the headlines. In a recent interview, she filled Morris/ Essex Health & Life in on the whys and wherefores:

What do you say to patients who are nervous about visiting their doctor in the office due to COVID-19?

“I emphasize not ignoring health symptoms during this crisis because of a fear of getting COVID. At my office and at Saint Barnabas Medical Center, we are using the utmost precautions to ensure our patients’ safety. Don’t neglect an acute medical condition—or a regular physical or screening—out of fear of contracting the virus!”

What are you looking for during a physical exam?

“We do a cardiovascular risk assessment (checking blood pressure, cholesterol, etc.) and a general exam in which we look for abnormalities such as a heart murmur, an abnormal mole on the skin, a lump in the breast or anything else that might trigger the need for me to do further evaluation. We also go over lifestyle and behaviors such as exercise and healthy eating; psychological health is a part of the visit as well, especially during this crazy time. Rarely does someone come in who is not expressing anxiety, fear or some sort of depressed mood with this pandemic. Offering support and psychological help is a big part of being a primary care doctor.”

What preventive cancer screenings do you perform for women, and at what age is each recommended?

“In addition to a complete physical exam and age-appropriate lab work, the bulk of cancer prevention for women covers breast cancer, cervical cancer, colorectal cancer and skin cancer. Breast cancer screening includes a breast exam by a clinician and age-appropriate imaging. It’s recommended that people with average risk factors start screening at age 40. For cervical cancer, average risk women ages 21-29 should get a pap every three years; ages 30-65 should get a pap every three years or have pap/HPV co-testing every five years. And the recommendation for over age 65 is that if there has been adequate negative screening for years, no further paps are needed.

“No ovarian cancer screenings, other than pelvic exams, are recommended for asymptomatic, average-risk women who are not known to have a high-risk hereditary cancer syndrome. Colorectal screening for average-risk patients is for those 50 and over. Finally, for skin cancer, high-risk people and those with a family history of melanoma need a full-body exam by a clinician with full expertise.”

How do you work in tandem with specialists at SBMC to follow up on patients who have abnormal screenings or scans?

“We have an array of excellent physicians to whom we can refer these patients. There’s a gastroenterology and colorectal team for colon cancer screenings, and several gynecologists for cervical cancer. We work with The Breast Center here to get people assistance rapidly. And I and other internists have a liaison who helps us with scheduling; he or she reaches out to the patient and gets the test that I ordered scheduled, so there is no delay.”

What vitamins and supplements do you advise female patients to take and why?

“Both calcium and vitamin D are recommended for skeletal homeostasis. The general recommendation for calcium is 1000 milligrams a day for premenopausal women and 1200 milligrams for postmenopausal women—the supplement dosing changes with every patient. The idea is to reach your calcium goal with diet, if you can, by consuming dairy products and dark, leafy greens. It’s a balancing act: Too much calcium can cause plaque in the arteries, your heart and your peripheral vascular system and trigger kidney stones, while too little calcium can lead to fractures, bone loss and osteoporosis, a common disease marked by low bone mass and skeleton fragility.”

Osteoporosis is increasingly common in women as they age. What’s the key to preventing it?

“First is a healthy lifestyle starting in adolescence, when the bones are still forming, coupled with proper nutrition, weight-bearing exercises, calcium and vitamin D intake and avoiding smoking and alcohol use. The U.S. Preventive Services Task Force recommends that all women over age 65 have a bone density test. We have a bone density center in our ambulatory care center.“

How can we know if we’re consuming the right amount of calcium?

“Follow the recommendations. Many food labels won’t tell you how many milligrams you’re eating: They tell only the percentage of the daily recommended value (DRV). But, starting with the daily recommendation of 1000 milligrams, you can take that percentage of daily value they give you and add a zero. So, if your yogurt is 30 percent of DRV, add a zero and you get 300 milligrams.”

What about vitamin D supplements?

“Vitamin D works together with calcium: Generally, we want an average of 600 individual units (IUs) per day. But most people are vitamin D-deficient, so I check a female patient’s level at least once. The recommended dose of a supplement will change based on what the patient’s vitamin D level is. Whole milk and some orange juices contain vitamin D, but few foods are natural sources of it. Even dermatologists are having to counsel on vitamin D deficiency, because sunblock prevents the production of the vitamin. Generally speaking, we don’t get as much vitamin D from the sun as past generations did, so for many people, supplementation is imperative.”

What else should otherwise healthy female patients keep in mind?

“Immunizations are important. People ages 6 months and over should get their annual flu shot, those over 65 should get the pneumonia vaccines, and there is a new shingles vaccine for age 50 and over. Seeing your doctor for your annual wellness visit is vital for catching things early. Early treatment and early prevention are keys to longevity.”

To schedule an appointment with Kristen J. Schwall, M.D. at Barnabas Health Ambulatory Care Center, call 973.322.0220 or go to rwjbh.org/medgroupprimarycare.

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