Sunday, November 22, 2009

Mammograms and Self Breast Exams

The new United States Prevention Services Task Force guidelines came out this week saying we should no longer ROUTINELY order annual mammograms on 40-49 year old women. What?? I am a 40-something year old female with no family history of breast cancer, so this impacts me not only as a provider, but as a patient. Do I want an annual screening mammogram? Well, yes, I do.
I have had too many patients and friends my age and younger get breast cancer, and have already lost one amazing friend to this disease. AND I have had 3 patients find their own breast cancers through self-breast exams, so I also will continue to instruct my patients on this technique, despite the recommendations to discontinue this process. All three of these women detected cancers early enough to have complete cures with minimal surgery/chemo.
Know that there are completely conflicting opinions on this subject (like most every topic in medicine!) We obviously view this recommendation through our very select vision of our patient populations and our specialties. The ACOG (American College of Obstetrics and Gynecology) and the American Cancer Society are dead set against changing our current practice- but remember, they (and I) are coming from seeing real women in their 40s fight breast cancer- and some do not win. When you are sitting around reviewing outcome studies and looking at statistics, it is far easier to be objective, because you are not thinking of "Shannon" but simply looking at numbers.
Are some women being "harmed" by false positive mammograms, resulting in extra cost, mental anguish and unnecessary procedures (biopsies, further imaging)? Certainly. This is what the task force is trying to reduce, and it is an important point to consider as we decide how to best spend our health care dollars. However, on an individual basis, I'd rather do superficial "harm" by false positives than miss the early cancers we might detect and CURE.
Remember, though, that these are GUIDELINES, not edicts, and physicians are encouraged to make individual decisions based on their full knowledge of the patient and her extended history.
The art of medicine is exactly that- not black and white treatments and diagnoses, but many shades of grey. I choose to continue to teach self-breast exams and encourage annual mammograms starting at age 40, and hope our research continues to yield better options for early detection and treatment.

Monday, November 9, 2009

Flying High

As I type to distract myself on this way too bumpy flight, I thought I’d share some health-related flying tips. With all the emphasis on flu these days, I’d be remiss not to start with the basic advice that you should NOT fly if you have a fever or a productive cough (or other flu symptoms such as headache, sore throat, and body aches.) That being said, there are many times that you may need to fly when you have mild cold or allergy symptoms, and there are a few tricks that may be helpful.
The one time that I actually recommend OTC products such as nose sprays like Afrin is if you have a stuffy head/nose/ears and need to fly. Make sure to put it in ziplock bag for security, but then use it when you are seated on the plane to reduce ear discomfort upon takeoff. Gum, mints or any beverage will help clear your ears as well.
I also suggest sucking on the zinc lozenges- any variety- I happen to like the ones combined with vitamin C. Zinc oral dissolvable products have been shown to reduce acquisition of respiratory viruses. Unfortunately, simply taking a zinc supplement that you swallow has not been shown to provide equal benefit.
If you have no contraindication to taking aspirin, a baby aspirin taken the day of your flight will reduce your risk for blood clots that can occur with prolonged sitting. Try to get up every hour or two and walk to the bathroom- that will help, too.
Nervous about flying? Talk to your doctor about a short-acting mild sedative or sleep aid (if the flight is long enough.) No need for embarrassment, as fear of flying is very common. I’d estimate I get this request close to once per week!
Should you wear a mask? I suppose if either YOU have a cough or your seatmate does, that is reasonable. My children and I are not wearing one now- and no one around us appears ill.
BOTTOM LINE: If your travel plans include flying, create your own "flying first aid" kit to take with you!

Tuesday, November 3, 2009

Let's Get Physical(s)!

With apologies to Olivia Newton John, I do want to encourage everyone to “get (a) physical”- schedule a complete exam with your family physician! Since this is my birthday month, I am reminded that many of my patients choose to have their annual exam around their birthday, which I think is a great way to be consistent and to remember to prioritize your health. What better gift can you give yourself?
Why bother having an exam if you have no complaints? Well, the whole point of a complete physical exam is to look you over from head to toe and do preventative health care. So many diseases are silent- high blood pressure, diabetes, hyperlipidemia (high cholesterol), or even cancers such as melanomas, breast, cervical and colon cancer. Let your family doctor learn your family and personal health history, so she can best direct your physical exam and blood work to address your risk factors.
Please don’t wait until you lose those extra 20 pounds or lower that blood pressure of sugar level before you go in! The last thing we want is our patients being afraid we will judge or criticize them. What we family docs do want is to partner with our patients to give them tools to lose that weight or lower that blood pressure or sugar safely. Some times, yes, that means starting medicines, but that absolutely does not mean you will be stuck on that medicine for life. Often starting blood pressure or diabetes medicine helps patients feel better- more energy, less headaches- which then enables them to exercise more and have a more effective weight loss program. The goal is to improve your diet and exercise enough that you no longer need the medicine, and that makes for a truly positive annual exam next year!
BOTTOM LINE: Check your calendar, and if it’s been over a year since your last physical exam, pick up the phone and call your family doctor to schedule one!