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.
BOTTOM LINE:
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.
Sunday, November 22, 2009
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!
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!
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!
Thursday, October 29, 2009
Step Away from the Pumpkin!!
Okay, I should have posted this on October 1st, but here we are staring at Halloween this weekend, so here goes! Let me repeat- "Step away from the pumpkin!" How many of us started purchasing those convenient sized Halloween candies and filling and REfilling our countertop, desk, and break room candy dishes the day they started selling them at the grocery store? I can assure you that they popped up in my office OVER a month ago (I swear they start selling Halloween candy the day school starts these days...)
Now, I always maintain that there is no "bad" food- even my tempting Reese's cups. So what's my issue? When treats and sweets are sitting out, especially in bite-sized offerings, it is very easy to fall into the habit of grabbing one or two every time you pass by. Before you know it, you've added several hundred calories per day, and you're well on your way toward gaining the 7-11 lbs that most Americans add during the holiday season. Of course, if at the same time you've added in an extra hour of aerobic activity each day, it's all a wash. BUT...remember, this is the same season when we run from one activity to the next and unfortunately many people cut back on exercise- tough combo!
So, enjoy some fun Halloween candy, but make some healthy snacks and set those out instead of the pumpkin next week. AND, don't feel the need to polish off all the candy! Homeless shelters and food pantries often welcome your extra bags of candy to pop in a sweet treat in their offerings. Did your child manage to cover the entire state on her tricks and treats? Consider a few days of feasting, then put or give away the rest. Some families invoke the Halloween witch who arrives the Friday after Halloween and replaces left-over candy with a holiday book or other non-edible treat. My "trick" is to buy only one bag of candy that I cannot resist (which I buy on Oct. 30th), and make the rest of the Halloween give-aways fun stickers, pencils, toy skeletons, etc.
BOTTOM LINE: Enjoy Halloween, dress up, play and be safe- but break the candy cycle and try some healthy fall treats instead!
Now, I always maintain that there is no "bad" food- even my tempting Reese's cups. So what's my issue? When treats and sweets are sitting out, especially in bite-sized offerings, it is very easy to fall into the habit of grabbing one or two every time you pass by. Before you know it, you've added several hundred calories per day, and you're well on your way toward gaining the 7-11 lbs that most Americans add during the holiday season. Of course, if at the same time you've added in an extra hour of aerobic activity each day, it's all a wash. BUT...remember, this is the same season when we run from one activity to the next and unfortunately many people cut back on exercise- tough combo!
So, enjoy some fun Halloween candy, but make some healthy snacks and set those out instead of the pumpkin next week. AND, don't feel the need to polish off all the candy! Homeless shelters and food pantries often welcome your extra bags of candy to pop in a sweet treat in their offerings. Did your child manage to cover the entire state on her tricks and treats? Consider a few days of feasting, then put or give away the rest. Some families invoke the Halloween witch who arrives the Friday after Halloween and replaces left-over candy with a holiday book or other non-edible treat. My "trick" is to buy only one bag of candy that I cannot resist (which I buy on Oct. 30th), and make the rest of the Halloween give-aways fun stickers, pencils, toy skeletons, etc.
BOTTOM LINE: Enjoy Halloween, dress up, play and be safe- but break the candy cycle and try some healthy fall treats instead!
Sunday, October 18, 2009
Cough, cough, cough...
Well, it was bound to happen- can't blog about the flu twice and not end up with it, right? Did I get it from our daughters? Doubtful, with the time frame. The incubation period for H1N1 is 1-7 days, typically in the first 4 days. But we're exposed at work (obviously, they come to see us!), the grocery store, and everywhere else. And yes, I wash my hands obsessively! How bad was my case? It's all relative, of course, but I would say "moderate" as I was wiped out in bed for 3 days with 102* fever, headache, body aches, sore throat and the COUGH from BEYOND!! Unfortunately the timing was such that I was speaking at the AAFP (American Academy of Family Physicians) the week following my illness, and though the fever was long gone, the cough only got WORSE! Of course, since I was surrounded with over 4000 other physicians, I was privy to many opinions and suggestions, and I'll tell you, I tried them ALL (with thanks to my peers, especially for the unique home-made concoctions, although sadly, nothing was a miracle cure that I can pass on to you.)
So, what do you do with a cough that wont go away? This is the point of today's blog. "Cough" makes the top ten list every year for reasons to visit your doctor. After many upper respiratory viruses, coughs will linger... for up to SIX weeks! A cough does NOT mean you definitely need an antibiotic- in fact, typically, you do NOT. However, a cough that is not managed with over the counter medicines should be addressed by your physician. Coughing all day long at school or work (or keeping up your spouse with coughing all night) is NOT a good plan!
What can your doctor do? First of all, they do need to rule out any secondary infection such as a pneumonia. More commonly, you may have developed some over-reactive airways and may benefit from some inhalers or other asthma-style of medicines. A prescription cough syrup used at night may help with the nighttime exacerbations, and your doctor can remind you of some traditional home remedies such as cool mist humidifiers that may help. Finally, sometimes a cough comes from other sources, such as acid reflux or sinus drainage, which require different treatments.
BOTTOM LINE: See your doctor to evaluate coughs that get worse after a respiratory illness, or that wont go away- don't expect antibiotics, but know there are other treatment options!!
So, what do you do with a cough that wont go away? This is the point of today's blog. "Cough" makes the top ten list every year for reasons to visit your doctor. After many upper respiratory viruses, coughs will linger... for up to SIX weeks! A cough does NOT mean you definitely need an antibiotic- in fact, typically, you do NOT. However, a cough that is not managed with over the counter medicines should be addressed by your physician. Coughing all day long at school or work (or keeping up your spouse with coughing all night) is NOT a good plan!
What can your doctor do? First of all, they do need to rule out any secondary infection such as a pneumonia. More commonly, you may have developed some over-reactive airways and may benefit from some inhalers or other asthma-style of medicines. A prescription cough syrup used at night may help with the nighttime exacerbations, and your doctor can remind you of some traditional home remedies such as cool mist humidifiers that may help. Finally, sometimes a cough comes from other sources, such as acid reflux or sinus drainage, which require different treatments.
BOTTOM LINE: See your doctor to evaluate coughs that get worse after a respiratory illness, or that wont go away- don't expect antibiotics, but know there are other treatment options!!
Saturday, September 19, 2009
Flu tests- Fact and Fiction
How do you know if your flu is the H1N1 strain? Is there a quick test in the doctor's office?
Well, yes and no. Most primary care offices now have rapid flu tests in their offices that can tell you if you test positive for type A or type B influenza. If indeed you test positive for type A, at this point in the United States, you most likely have H1N1. 99% of samples of known positive type A flu that have been sent to the CDC are testing positive for H1N1. The difficulty is that the rapid flu tests are very specific (meaning if it is positive, you definitely have the flu) but not too sensitive (meaning if you do have the flu, there is a good chance - up to 30%- that the test will not show it.)
So, please understand that flu is primarily a clinical diagnosis. This means if you have high fever, intense headache, sore throat, cough, and body aches, and your doctor doesn't find evidence of any other disease (like strep throat or pneumonia), your doctor will likely conclude that you have influenza- whether or not she has the "proof" of a positive rapid test. It is also no longer necessary to send every positive type A flu test on to the CDC for confirmation that it is H1N1.
The good news is that H1N1 is proving to be primarily more mild than initially feared, and now treatment (meaning antiviral medicines) are only recommended for high risk groups (pregnant women, patients with poor immune systems as in cancer or HIV disease, young children under 5 or adults over 65, people with chronic diseases or people who are hospitalized.)
BOTTOM LINE: See your doctor and get tested if you think you have the flu, but understand the limitations of our current testing. Most importantly, remember GOOD HAND WASHING and STAY HOME if you have a fever!
Well, yes and no. Most primary care offices now have rapid flu tests in their offices that can tell you if you test positive for type A or type B influenza. If indeed you test positive for type A, at this point in the United States, you most likely have H1N1. 99% of samples of known positive type A flu that have been sent to the CDC are testing positive for H1N1. The difficulty is that the rapid flu tests are very specific (meaning if it is positive, you definitely have the flu) but not too sensitive (meaning if you do have the flu, there is a good chance - up to 30%- that the test will not show it.)
So, please understand that flu is primarily a clinical diagnosis. This means if you have high fever, intense headache, sore throat, cough, and body aches, and your doctor doesn't find evidence of any other disease (like strep throat or pneumonia), your doctor will likely conclude that you have influenza- whether or not she has the "proof" of a positive rapid test. It is also no longer necessary to send every positive type A flu test on to the CDC for confirmation that it is H1N1.
The good news is that H1N1 is proving to be primarily more mild than initially feared, and now treatment (meaning antiviral medicines) are only recommended for high risk groups (pregnant women, patients with poor immune systems as in cancer or HIV disease, young children under 5 or adults over 65, people with chronic diseases or people who are hospitalized.)
BOTTOM LINE: See your doctor and get tested if you think you have the flu, but understand the limitations of our current testing. Most importantly, remember GOOD HAND WASHING and STAY HOME if you have a fever!
Is that the FLU??
Picture your child miserably sick, teeth chattering, shaking chills, complaining of a sore throat, body aches, cough and headache. When you touch her forehead, she is burning up- sure enough, her temperature is 104.8*! As your brain is trying to process all this, she suddenly tries to jump out of bed and push past you but starts vomiting before she ever leaves her room. What is this? What should you do??
Well, this is no imaginary scene, but one I simply can recall from a few nights ago in our house, when our 12 year old daughter's flu symptoms first showed up...at 2am (of course ;0) What did I do? Well, with a fever that high, the first thing I did was to give her some liquid ibuprofen. (I picked liquid so it would be absorbed more quickly, and because she was more likely to gag and vomit again if she tried to swallow a pill. And yes, I got the ibuprofen in her before I cleaned up the mess.) We put a cold, wet washcloth on her forehead and I read to her (as a distraction) for the next half hour while the medicine was kicking in. By 3am, her temperature was out of the scary range, and "just" 102*.
What I want to emphasize, though, is not the care of a high fever. I want to make it clear the difference between a common cold and the flu. A cold can cause headache, stuffy/runny nose, and sore throat, but generally does not cause intense body aches and high fevers. The flu is not so subtle! It often comes on suddenly, and the flu victim typically feels (and looks) like they've been hit by a Mack truck, with serious aches and pains in their muscles, bad headache, intense sore throat worse with swallowing, high fever, and often a cough.
So, what did she have? The flu. What type? Presumably H1N1 as 99% of type A influenza being tested right now is H1N1, and she had repeated exposure to friends & classmates with confirmed type A. She became ill on Saturday, missed 3 days of school, and is now 7 days later she is feeling back to normal, although easily fatigued.
BOTTOM LINE: Recognize that a stuffy nose, low grade temperature (99*) and sore throat are uncomfortable but very unlikely to be the flu. High fever, chills, headache, cough, sore throat and body ache at this time is most likely influenza- see your doctor and try to limit your exposure to others to slow the spread of this year's flu!
Well, this is no imaginary scene, but one I simply can recall from a few nights ago in our house, when our 12 year old daughter's flu symptoms first showed up...at 2am (of course ;0) What did I do? Well, with a fever that high, the first thing I did was to give her some liquid ibuprofen. (I picked liquid so it would be absorbed more quickly, and because she was more likely to gag and vomit again if she tried to swallow a pill. And yes, I got the ibuprofen in her before I cleaned up the mess.) We put a cold, wet washcloth on her forehead and I read to her (as a distraction) for the next half hour while the medicine was kicking in. By 3am, her temperature was out of the scary range, and "just" 102*.
What I want to emphasize, though, is not the care of a high fever. I want to make it clear the difference between a common cold and the flu. A cold can cause headache, stuffy/runny nose, and sore throat, but generally does not cause intense body aches and high fevers. The flu is not so subtle! It often comes on suddenly, and the flu victim typically feels (and looks) like they've been hit by a Mack truck, with serious aches and pains in their muscles, bad headache, intense sore throat worse with swallowing, high fever, and often a cough.
So, what did she have? The flu. What type? Presumably H1N1 as 99% of type A influenza being tested right now is H1N1, and she had repeated exposure to friends & classmates with confirmed type A. She became ill on Saturday, missed 3 days of school, and is now 7 days later she is feeling back to normal, although easily fatigued.
BOTTOM LINE: Recognize that a stuffy nose, low grade temperature (99*) and sore throat are uncomfortable but very unlikely to be the flu. High fever, chills, headache, cough, sore throat and body ache at this time is most likely influenza- see your doctor and try to limit your exposure to others to slow the spread of this year's flu!
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