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10 Things Your Primary Care Doctor Does That Should Make You Run for the Hills
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Dr Orrange received her BA in Biology at the University of California San Diego and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health She received her MD from the USC Keck School of…
FAST FACTS
Top 10 Things I am Asked About in my Practice:
1) Do I need an annual physical?
As many of you know Medicare does NOT cover annual physicals... so the question is do you really need one?
For females over 40 you need to come in for an annual mammogram, and either a once a year or every three years (in low- risk folks) Pap smear.
For men and women over 40 I say you need to come in and this is why: KNOW YOUR NUMBERS!!!! All of us should know: our weight (and body mass index), fasting blood sugar (you want this less than 110), LDL cholesterol, HDL cholesterol, and SYSTOLIC AND DIASTOLIC blood pressure (120/80 being normal).
2) Should I be taking an aspirin a day?
Yes but only if you have 2 or more cardiac risk factors: high blood pressure, high cholesterol, diabetes, family history, male sex, postmenopausal woman, or tobacco abuse. Take 81 mg of an enteric coated aspirin (ECASA) a day if that is you, otherwise the risks of bleeding from your gut may outweigh the benefits from a once a day aspirin (covered in more detail in another blog http://www.dailystrength.org/blog/95-awesome-power-aspirin.)
3) Should I be taking fish oil?
Yes, probably, and I do. Fish oil supplements are something all of us should consider and discuss with our physicians. They are not risk free as we have been hearing more reports from surgeons about the anticoagulant effects of fish oil causing problems after surgeries with increased bleeding. For most folks there is little evidence that the pharmacologic doses of n-3 polyunsaturated fatty acids found in fish oil supplements (approximately 10 to 20 times the nutritional dose from fish) provide more protection than the intake of one to two servings of fatty fish (eg, salmon) per week..but some of us don't eat that much dietary fish. The beneficial effects of fish oil supplementation keeps piling up including use for joint pain, inflammatory bowel disease, mood , asthma, cognitive decline, and high triglycerides. When a fish oil supplement is used, it should contain both EPA and DHA; a 1 g daily supplement (containing 200 to 800 mg of EPA and DHA) is a reasonable option and you do not need to worry about mercury exposure.
4) What other vitamins or supplements should I be taking? In general, simple multivitamins (containing 0.5 to 1.5 DV of all vitamins) are probably not beneficial for most adults who eat a balanced diet and get regular sun exposure or drink vitamin D-fortified dairy products. More specifically, though......
Folic acid: Women of childbearing age should be taking 400 mcg a day to decrease the risk of neural tube defects in your baby. Folic acid has not been shown to be beneficial for prevention of heart disease or cancer and is not recommended for that use.
Vitamin B-12: Patients after gastric bypass (or other malabsorptive GI conditions), vegans, alcoholics and the elderly must take Vitamin B12 supplements. Subtle B12 deficiency may account for some cases of dementia and for deteriorating balance in some elderly people. The recommended dose for the elderly is 50 to 100 mcg a day but much higher in those after gastric bypass.
Vitamin E: You don't need to take it. Vitamin E supplements do not appear to be beneficial in preventing cancer. We do not recommend supplementation for this purpose, particularly given the possible increase in all-cause mortality found in studies with doses ≥400 IU/day. With respect to cardiovascular disease prevention, randomized trials provide strong evidence against a benefit for supplementation with vitamin E for primary and secondary prevention of heart disease and stroke. Vitamin E is also not recommended for the prevention of Alzheimer disease or infections.
Vitamin A and the carotenoids (beta-carotene): No, you don't need these. Vitamin A and beta-carotene have shown no benefit for prevention of cardiovascular disease in studies. There is also no evidence that Vitamin A and carotenoid supplements reduce the risk of cancer. The results of two recent randomized controlled trials of beta-carotene showed an increase in lung cancer risk and this has dampened enthusiasm for further clinical trials of antioxidants to prevent cancer.
Vitamin B6: Current evidence does not support vitamin B6 supplementation, alone or in combination with vitamin B12 and folic acid, for the purpose of lowering risk of stroke and heart disease.
Vitamin D: I'll touch on this only briefly since I've done a previous blog on it (http://www.dailystrength.org/blog/32-vitamin-d-and-me). In patients with osteoporosis, or previous fracture, we suggest an additional supplement of 800 IU of vitamin D with calcium, particularly if dietary intake is inadequate and sun exposure on the skin is poor. As mentioned in my previous blog Vitamin D supplementation of 400 to 800 IU a day should be considered in elderly patients.
CoQ10: Most of us probably don't need to take this. The best evidence is for neurodegenerative disease (ALS, Parkinson's,) and in a recent study looking at CoQ10 for muscle aches from statins there was no benefit.
5) "My joints hurt when I get up in the morning, is that just old age?"
If your large joints (knees, hips, shoulders) are achy and sore when you get up and the soreness IMPROVES after you get up and move around then yes...it is likely osteoarthritis or "wear and tear" arthritis. Stretching and staying flexible, Tylenol 500 mg tablet at night, over the counter glucosamine, and NSAIDS (motrin, advil, ibuprofen) all help for the joint pain. This is different than an inflammatory arthritis (rheumatoid arthritis, lupus, psoriatic arthritis, etc) which is usually SYMMETRIC, affects the small joints of the hands and wrists, and worsens throughout the day. Specific treatments for osteoarthritis of the knee were touched upon in another blog as well (http://www.dailystrength.org/blog/383-oh-my-aching-knee).
6) "How can I lose weight? I've gained weight over the last couple years"
This is the MOST COMMON thing I hear from patients that I covered in more detail in a previous blog (http://www.dailystrength.org/blog/31-i-want-lose-weight). Briefly, for quick weight loss the low carb diets work: South Beach diet, Zone and Sugar-Busters. Weight watchers has the best LONG TERM data for sustained weight loss. Save the meds (Meridia, Xenical, Alli, and Phentermine) for use only if dietary changes have not worked. As a last resort Gastric Bypass is worth thinking about but only for those with body mass index (BMI) above 30. The lap Roux- en- Y is the current procedure of choice and in the right hands is worth considering. You MUST also move around...20-30 minutes 3 times a week of a brisk walk to start and increase as you tolerate.
7) What vaccinations do I need as an adult?
- A pneumonia vaccine (pneumovax) between 50 and 60 years should be repeated once after the age of 65.
- Annual flu shot is debated and you can discuss that on an individual basis.
- The Shingles vaccine (Zostavax) if recommended for those over 60 and unfortunately Medicare doesn't cover it.... but here is a tip....if you get a prescription from your doctor you can find a pharmacy giving them out for under 100 bucks in some places.
- Tetanus booster is recommended every 10 years (one of these should be a TDap so you get pertussis as well).
- If you are going to be travelling in any less developed countries the HepA/B vaccine series is a great idea.
- HPV vaccine (Gardasil) is given to those 26 or younger who have not yet been exposed to HPV.
8) If I take birth control pills will I hurt my chances of getting pregnant later? NO
9) Why am I so tired?
Here I wish there were more easy fixes. There are rarely medical explanations for fatigue but they are worth checking (anemia, hypothyroidism, adrenal insufficiency). Look at your sleep HYGIENE and make sure you are getting enough sleep and that it is not interrupted. If it is interrupted think about less alcohol, less caffeine, and make sure you are not snoring which could be a sign of sleep apnea (see my blog on steps to better sleep http://www.dailystrength.org/blog/90-10-easy-steps-better). PAY CLOSE ATTENTION to mood as mild mood disorders (mild depression or anxiety) declare themselves with fatigue. A regular exercise regimen has been shown over and over again to improve fatigue.
10)" I have no libido (interest in sex)":
As with fatigue, pay close attention to the connection between mood disorders (depression and anxiety) and decreased libido. Women going through hormonal flux (menopause) also have a high incidence of decreased libido. In men who have no libido and problems with maintaining or achieving erections a testosterone level should be checked among other things. There aren't many great "treatments" for decreased libido...some studies show some benefit for testosterone replacement in women but with side effects. Again read more about this issue in my previous blog http://www.dailystrength.org/blog/20-decreased-interest-sexdoes-testosterone.
What did I miss......
Dr O.
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Displaying comments 21-2 of 21
Got a Question?
You never come out and answer the question you are asked re: NEED FOR AN ANNUAL PHYSICAL. The answer to this is YES you do! It has to be paid for by the party responsible and there is no reimbursement for it from Medicare which is a HUGE flaw in this system!
It is nice to talk about mammograms, etc., but a routine physical exam is very necessary. Many things can be wrong and missed, i.e. diabetes, high blood pressure, CANCER, etc. etc. ad infinitum.
I just had my annual physical exam and it was discovered I have virtually NO vitamin D in my system. This would have never been caught without the annual exam.
Don't try to soft soap this over and not answer this very important question! The answer to this very direct question to you should be YES, not a bunch of other stuff.
http://ezinearticles.com/?Best-Ant...
Assuming I had a daughter between nine & 26, how lucky for her I hold no false illusions of a perfect world in which there's no possibility she'd ever mis-step, get involved w/ a wrong person, or have anything done to her against her will ~ of course I'd take advantage of a vaccine raises the odds of her being at risk for cervical cancer.
i'm very sorry for what you have been through and hope this is past for you. brava for your bravery to speak out as a survior! you are, indeed, a great inspiration!
Bottomline is that it takes money (in addition to the life-changing dynamics) to fix many health concerns that most people face in this republic. And good folks don't have that much many (or coverage) anymore.
Probably what most honest, hard-working people need is home remedies or resources to get well without the bankruptcy blood-letting of a typical visit to a doctor.
Ah well.. at least DS is free -for now.
my other point being, as in your case. men are the carriers. why not treat THEM? treat/vaccinate the carriers and we won't have to worry about HPV in women, or the consequences thereof. thanks for your comments.
she is off of her diabetic meds(controlled by diet now). she can sleep now without having to sleep in a chair. she can walk much better now, no more knee trouble.her energy level is much better now. she's alot happier now.
she has to watch how many carbs per meal & can only eat like a 5 yr old.
my sister n a few friends have lost weight by limiting carb intake.
the extenze pill does help rejuvinate a sex life for loss of sex drive.
a PAP smear will show initial cell abnmormalities and there are other methods that are very reliable for the treatment of HPV (like coninization or LEEP) done during a colposcopic exam that also screens for all forms of cervical cell abnormalities, that DO kill all cells, very limited invasiveness, and can also treat other gyn. problems, as well. oh, and since men are the carriers, TREAT THEM instead of injecting our young women with something that hasn't been proven long-term. women are STILL having to 'carry the bag' when it comes to sexual health though men are usually the more promiscuous. how sad!