Heart Month Health Tips

Check your heart list:

___Heart and vascular exam by health care provider
___Blood pressure, pulse, weight, height
___EKG


For further evaluation especially if symptoms are present, and/ or a strong family history of heart and vascular disease see a cardiologist. Tests may include:
___Doppler echocardiogram
___Stress test - nuclear, doppler or exercise
___Heart MRI scan
___Interventional studies like cardiac catherization


Heart health habits:
Maintain a healthy weight.
Eat healthy small portions.
Exercise regularly - every little bit counts! Just do it regularly.
Keep blood pressure under control.
Keep stress level low.
Get adequate sleep.
Take an aspirin a day if in a high risk group. Check with your health care provider.

Love, laugh, and let go! Have a happy, healthy heart!

Mobile Healthcare:Telemedicine Telehealth

If you could visit your doctor 24/7 how much money and time could you save?  Telemedicine healthcare makes this possible.  Telemedicine makes virtual reality a reality as real as visiting your doctor in the office.  Through your smart phone, tablet or computer you can make a doctor visit.  No travel time. No wait time. Just quality doctor time.

Telemedicine is a billion dollar business that is becoming a trend in our connected world of convenience and crucial time management.  It entails the use of electronic communications to monitor and improve a patient’s health status.  In addition to saving money for patients and all providers (including insurance companies, hospitals, clinics), there is better access for everyone. Studies have shown that overall quality of care improves as patients are given more of the attention they deserve to make their healthcare experience more beneficial. .  It is helpful for patients in remote areas with limited or no transportation and those with chronic conditions that limit their ability to make an in person office visit.   

As telehealth develops, doctors and patients will find even greater access with connectivity via personal electronic health devices and applications (apps, for short).  Telemonitoring allows patient and doctor to check and follow together such parameters as blood pressure, blood sugar, and much more in real time together.  If that noon time blood sugar is too high, your doctor can be aware and advise accordingly at the time of occurrence instead of on the next appointment in 2 weeks.  This alone saves the patient’s health as well as travel time, office visit wait time, and the money to do all of this.  It potentially avoids an emergency room visit and hospital admission. 

In addition to patient care, doctors are able to communicate in a more timely, efficient manner with other doctors and health facilities.  The CT scan you had this morning is can be viewed by your doctor within minutes after completion instead of days after. Mobile collaboration allows your doctor to discuss your health case with other healthcare professionals like specialists (in the same or different locations) to determine the plan for your care.  This can actually happen the same day a test is done!  This eliminates delays in care that could be life threatening to a patient. 

As costs for telemedicine access decrease and more insurance companies/plans reimburse, it will become the portal of choice for many patients, doctors, and other healthcare providers.  Your doctor visit time can be more about you at your convenience in your home.  Best health!

Your Physical Exam: Below the Waist

After the physical exam above the waist is completed, the rest of the exam follows. For females, the pelvic exam and rectal exam are done next. The pelvic exam can also be done by a gynecologist, a doctor who specializes in female medicine. This depends on your preference and/or if your primary care doctor chooses to refer you. It is an examination of the female external(outer) genitalia (parts) and internal (inside)reproductive sexual parts. The first female exam should be done at any age if there are any symptoms. Routinely, the first pelvic exam is done once the female is sexually active (having sex) or 18 years of age. It is recommended that a third person or chaperone who is an authorized health professional should be in the room for this exam. Every health care setting should have chaperone policies in place for gynecology exams. This should always be presented as an option, if there is no policy or law. Furthermore, it should be offered to a patient for the full physical examination, especially if the physician is the opposite sex of the patient.

The assistant will help you get in position. Your legs will be placed in stirrups (foot holders) that are at the end of the table. You will then slide your hips down until the buttocks touch the edge of the table. Your legs will then be able to relax
apart. (Some doctors have more comfortable exam chairs.) For those who might not be able to do this, there is the frog-leg position. The heels are brought together while the legs are bent: the heels are, thus, brought as close as possible to the
buttocks, like frog legs. For persons not able to assume either of these positions, referral to a gynecologist is necessary. Please note also that you should not be put in this position until the doctor is ready to examine you. That’s just good manners on the doctor’s part. Once the exam begins, the doctor will instruct you when to lie down. You should also be informed when and where you will be touched during each part of the exam. The doctor will be wearing latex gloves to do this part of the exam. You may also request that a mirror be placed so that you can watch the exam.

There are five basic parts of the pelvic exam. The first part is the exam of the external genital area where the doctor inspects and palpates for any abnormalities. The second part of the exam is done using a tool called a speculum. This is for looking into the vagina and at the cervix. It resembles a fancy pair of tongs (or a pelican beak) and is either plastic or metal. Most doctors
will and should warm the speculum with water before use. This allows for easier passage of the speculum. In the closed position the speculum is then placed gently in the vagina and opened to keep the vagina walls apart. When this is done,the doctor is able to see the cervix. The third part of the exam involves doing a Pap smear, which is a screening test for cancer of the cervix. A thin wooden stick about the size of a popsicle stick(called a spatula) and a stick with a tiny (about quarter-inch) brush on the end are used to do the test. When gently rubbed against the cervix, they are able to pick up cells. The cell samples are then placed on a glass side or in a test tube, which is then sent to the lab. The speculum is then removed.
Part four is the bimanual exam, which includes palpation of the internal female organs. One or two fingers that have been lubricated are placed in the vagina, while the other hand presses
over the pelvic (lower abdomen) area. The uterus(womb) and ovaries (eggs)can be felt for any tenderness or masses. The last part of the exam is the rectovaginal exam. Using a clean lubricated glove, one finger is inserted into the vagina and a
second finger into the rectum. This is an important part of the exam for two reasons: to check the rectum for bleeding and masses, and to further palpate the female organs. A complete
pelvic exam includes a rectal exam. The stool is checked for blood by placing a sample of stool from the gloved finger in the rectum onto a special card (commonly called guaiac or Hemoccult cards). If there is no stool for the specimen, your doctor will give you cards with instructions on how to collect samples at home. Once completed, the cards are returned to the doctor to be checked for blood. This is a very important test. Small amounts of blood in the stool cannot be seen with the naked eye but can
be detected with this test.

The male genital exam is the equivalent of the female pelvic. The doctor inspects first. With gloved hands, the penis glans (tip) and shaft are checked. If the male is not circumcised, the
foreskin (extra skin) should be pulled back. Then each scrotal sac is palpated to check the testicles for any abnormal lumps or bumps. This is a good time for the doctor to show you how to do your own monthly scrotal exam. Next the famous “cough” test is done in standing position. This is to check for hernias and is done with the insertion of the examining finger into the scrotal
and inguinal (groin) area while the patient coughs. It is done on the right and left side. The rectal exam follows and is usually done with the doctor’s lubricated gloved index finger inserted into the rectum. In addition to checking the stool
for blood, the prostate gland (which makes male fluids) is also checked for size, tenderness, and masses. This is an important cancer screening test for men and should be done routinely after age 40.

Examination of the musculoskeletal system(arms, legs, back), nervous system (including mental health), and skin mark the end of the complete physical. The extremities (arms and legs)are checked for symmetry (the same on both sides, and were being checked as you got on and off the exam table, to see if you required assistance or were using an assistive device such as a wheelchair,walker, or cane. Following instructions and answering the doctor’s questions during the exam allows for an indirect check of the nervous system. The skin can be inspected as each of the previous parts of the physical is done. Be sure to
have the doctor show you how to do your own self skin exam.

The inspection of the extremities continues as the doctor looks for scars, skin color change,edema (swelling), and effusions (joint swelling). The joints of the arms and legs are then tested for range of motion (actual movement) actively (movements done by patient) and passively (extremities are moved by the doctor). They are also checked for any tenderness, swelling, and
warmth or coolness. The strength, reflexes, and sensation(feeling)in the extremities are usually tested at this time or can be included in the neurologic(nervous system) exam. Strength is tested by resisting the doctor’s strength. Pushing the hand against the doctor’s hand, kicking the leg out, and gripping a finger with your hand are all relative tests of strength. The reflexes are checked with a reflex hammer at several places on
the arm (front and back of the elbow, above the wrist) and leg (below front of knee, back of ankle on Achilles’ tendon). Sensation can be checked using different items but is usually checked by light touch on the same parts of the arm or leg at
the same time. A sterile pin touched lightly on the area to be checked can also be used. Different areas of the body are touched while the patient’s eyes are closed and the doctor asks whether the touch feels the same on both sides or if a sharp or
dull feeling is experienced with the pin. Position sense is checked by being able to tell if your finger or toe is being held up or down with eyes closed. Vibration sense is tested on a finger or toe joint with a tool called a tuning fork (a six-inch
or so steel piece that vibrates when tapped lightly). Your job is to tell the doctor if it’s vibrating and when it stops. Finally, the extremities are checked for the pulses(circulation) in the arm and leg and for any vein abnormalities.

The rest of the neurological exam involves checking the way you walk, talk, and answer a few questions designed to check the mental state(such as where you are, the date, ability to identify a simple object). The cranial nerves(nerves involving the face and neck area) can also be checked now, if they were not included in the head and neck exam. During the back exam the doctor first looks at your posture. The shoulders and hips are checked for symmetry and deformities. The muscles of the neck, posterior thorax (chest), and lower back are palpated to check for any tenderness or spasm. Likewise, the bones of the spinal column are also checked. Movement of the neck and lower back is
done actively and passively in all directions of movement.

Please be reminded that the way the physical exam is done may vary from doctor to doctor. This is unimportant as long as a complete physical exam is done. Please note that the above
description of the CPE is quite generalized and does not include every specific detail. Book references for more detail include: "Bates Pocket Guide to Physical Examination and History Taking" by Barbara Bates, M.D., et al. (also available on CDROM
and VHS tape), and "Bedside Diagnostic Examination" by Drs. Elmer and Richard DeGowan. Many medical school curricula use
these references.

Once the physical exam is complete, the doctor and assistant will leave the room so you can get dressed. If an EKG (electrocardiogram — heart tracing) and X-ray are going to be done, you may be asked to get partially dressed (bottoms only) and keep the gown on. If blood has not been taken, that can be done at this time, too. Following these tests you will be able to get fully dressed. The doctor will then sit down with you in the office or exam room and discuss your symptoms,the physical findings (normal vs. abnormal), diagnosis, and whether any further tests or treatments are needed.

This is also the time for obtaining any prescriptions and to be told about any further tests or specialists whose expertise will be required. The doctor may also counsel you with information about your diagnosis and treatment, as well as any number of preventive healthcare topics. You may also be given handouts and booklets. Doctors may refer you to pertinent medical and patient education websites such as www.webmd.com. Email is becoming another way to talk with your doctor, in addition to phone calls, regular mail, and faxes. Prescriptions for medication are usually given to the patient at the end of the visit. Prescriptions are written orders for medicine that the doctor
has chosen for you. The patient should take these to the drugstore as soon as possible to stay well or to hasten recovery. Prescription medication must be dispensed by a licensed pharmacist. Some doctors fax or call the prescription in to your drugstore. Asking the doctor to do this for you will ensure you receive your medication promptly and will save you a trip to the drugstore. Some doctors are now using e-prescriptions
over the computer to send in patient prescriptions. By giving your doctor the number for the druggist you use, you will be able
to get a prescription filled in less time. You may also get prescriptions for medicine that can be bought over the counter—that is, without a pharmacist. Your pharmacist is the best person to help you with obtaining your medicine, discussing side effects and interactions, what the medicine is for, and so on. Be sure to discuss this with your doctor, too.

Best health!



Patient Handbook to Medical Care: Your Personal Health Guide http://amzn.to/13m51UU FREE with Kindle unlimited!

Your Health & Medical History

One of the first things your doctors and healthcare providers want to know is why you made your appointment. Once you answer this question (hopefully before interruption) there will be questions about your general health and wellness, as well as more information about your reason for the visit. For specific concerns you may be asked:

• How long has this been going on?
• What have you done for it?
• Have you had it before?
• Where does it bother you?
• How often does it occur?
• What makes it better or worse?
• Are there any other symptoms?

You will be asked about how the other parts of the body are working, such as your eyes, ears, heart, breathing, and so on. This is called the “review of systems” (ROS). If there are any problems not related to your main problem, now is the time to let the doctor know.
This will be followed by your past medical history (PMH), which includes:

1. Diseases you have (high blood pressure, sugar diabetes, arthritis, cancer, depression,
   etc.), or have had that are better or gone (including childhood diseases such as
   measles, mumps, and inherited disease)
2. Operations and times you were in the hospital (including accidents)
3. Medication, including prescription, over-the counter (don’t forget about vitamins),
   natural (garlic, aloe), and herbal
4. Allergies and reactions to anything and what it did to you (for example: breaking out in a
   rash, swelling, itching, upset stomach, etc.)
5. Smoking, alcohol, drug use (how much,
   how often)
6. Shots (childhood, flu, last tetanus, etc.)
7. Sexual (active, using protection, number of partners, diseases)—in females this will also
   include menstrual period, pregnancy, last mammogram, and Pap test
8. Family history (conditions that run in family
   such as cancer, high blood pressure, etc.)
9. Social history—your job or jobs; family; marital status; living arrangement (house,
   apartment, alone, etc.); transportation (drive self, public transport, walk); ambulation
   (use walker, wheelchair); disability (deaf, blind, amputee, etc.) Religion, ethnic customs, and traditions

If there is anything left out or that you feel the doctor should know, now is the time to speak up. It is sometimes hard to get someone’s full attention, so take advantage of it while you have it. Some doctors’ offices will have you fill out forms asking the above questions or will ask you the questions and fill out the form for you. This is not a substitute for the doctor’s personalinterview and questions.

Writing or typing this information is a sure way to keep all of your PMH. Make a copy for your doctor. While talking you both can refer to this vital source of health information. This is part of your medical record.

Best health!

Use this handy form to get you started http://bit.ly/bEvHk6

Women's Health Checkup

Ladies, schedule your routine screenings and appointments to include:

1. mammogram/ MRI for breast cancer
2. PAP smear & HPV test for cervical cancer
3. stool check for blood (fecal occult blood test, FOBT) for colorectal cancer
4. cardiology doctor for cardiovascular prevention(get EKG, ECHO, and thallium stress test if indicated)
5. bone density scan to check for osteoporsis
6. counseling for smoking cessation, alcohol/drug dependence, and domestic violence
7. evaluation for depression and other mental disorders if necessary
8. complete physical exam, and routine blood tests.

Get in 5 to 10 minutes of exercise a day at least and eat healthy! Laugh a lot and love a lot!

by J. L. Richardson, MD, family practice doctor and author of Patient Handbook to Medical Care: Your Personal Health Guide.

Your Personal #Health Guide on Google Books

Read excerpts at Google Books http://books.google.com/books?id=kPmXiNrg1pYC&printsec=frontcover&dq=patient+handbook+to+medical+care

Patient Handbook to Medical Care: Your Personal Health Guide is written for patients by a medical doctor "to inform and educate patients about medical care". Health maintenance, prevention, early detection, and early treatment are the foundation for great health.

This Writer's Digest International Self-Published Book Award winner informs patients about
basic medical care. By reading this how-to reference book you will learn:

• how to keep a medical diary
  
• how to get your medical records
  
• how to document your complete medical history
  
• what the physical exam should include
  
• about preventive tests and when to get them
  
• about tests your doctor orders
  
• about specialists and other medical providers
  
• about health care plans and coverage
  
• how to seek quality health services.

Also featured are "My Health Notes", blank pages for you to write your medical history, questions, and things to discuss with your health care team!

Great health is true wealth!

Doctor Visit Tips

Going to the doctor can be quite a challenge. These tips will help you make the most of your doctor visit.

One of the first things you want to do is make a written or typed medical history* to take with you, especially if this is your first visit to a new doctor. Make a copy for you and your doctor. You both will be able to refer to it as needed. This will save valuable time, and give you and your doctor more time to talk instead of flipping through your medical record. It can be difficult trying to "remember" what test or procedure you had 10 years ago.

Start keeping a list of things you want to talk to your doctor about. Update the list before each visit. This way you will be able to keep track of what has been discussed, and what needs to be discussed. Try to talk about the most important things first especially those that need immediate attention. Each time you go for your visit, you can refer to your list and take up where you left off. Be sure to express your immediate concerns first. We all know how short a doctor visit can be.

Request copies of your medical records from all your doctors. "The medical record is the cornerstone of keeping track of everything pertaining to your health." You will be able to check the accuracy of your records, and bring any errors or absent information to your doctor's attention. Let your doctor know about anything you do not understand, or if there is something you are unable to read due to legibility. It is surprising to see how many doctors are often unable to read their own handwriting.

Stay on top of your health care with these tips. After all, great health is true wealth!

Click on "Comments" below and add your tips, and ask questions.

by J. L. Richardson, MD, author of "Patient Handbook to Medical Care: Your Personal Health Guide", the perfect tool for helping you make your medical visits worthwhile.

http://www.mypatienthandbook.com - *medical history form on website. Click on this link.

Fiscal Physical Health of America

America's fiscal physical health is failing. You are part of that body. Have you done your part to make America healthy?

President Obama addressed this issue today. It is great to finally hear more things like "lower your premium" quality healthcare coverage. Health insurance premiums should be capped. What if everyone paid the same amount regardless of present, pre-existing, or future conditions?

Genome genetics will help us live longer and better, but it will also help insurers predict your pre-existing conditions. Your family history is an accurate predictor, but much less so.

Maintaining good health and prevention of disease are the top priorities in keeping America healthy. Early detection of disease makes America stronger. America's health team has the tools you need for medical maintenance. The best in the world, it is often said. It is up to you to build good health.

America's fiscal physical health is a team effort. Do all you can do to lower your chances of becoming a chronic disease liability.

Save you and your money. Put prevention first.


J.L. Richardson, M.D. is the author of the award winning book,
Patient Handbook to Medical Care: Your Personal Health Guide.
http://mypatienthandbook.com/

Medicare Physical

Medicare Part B coverage includes an initial preventive physical exam (IPPE) to all new enrollees. This "Welcome to Medicare" physical exam is good for the entire year. In 2009 you have 12 months to get your physical. You are paying for it. You deserve it.

Call your doctor for an appointment before the schedule gets more filled up. Many doctors already have their schedules filled up to March especially specialists. There are less primary care physicians, and fewer are taking Medicare. It is an extremely prudent thing to do.

For more details go to www.medicare.gov
and/or call 1-800-633-4227.
(1-800-MEDICARE).

Self Check You - Be the Healthiest You Can Be

Congratulations, President Obama. You are healthy for this nation.

We the people of this mighty fine country vow to take the absolute best care of our most important asset - US. A nation is as great as its assets. We have so many. As long as us Americans stay healthy, we will stay wealthy.

True wealth is great health. It is time for you to take responsibility for your health. It is time for you to know what your health numbers are. It is time for you to know your medical conditions, risk factors, and family medical history.

Give yourself a medical checkup. Start by writing or typing or recording your medical history - medical conditions, surgery, treatments, family history. Add your medication. Save it. Update it. Add to it. Correct it. Keep it current. Keep a copy in a secure place.

Examine as much of yourself as you can. Look at your skin, hair, nails, eyes, teeth, and every part of your body that is visible to you. Make note of any abnormalities. Make note of any symptoms you have - new, old and ongoing. Go through each body system. Add this information to your medical history.

Add to this your doctors' and health care providers' names, phone number, land address, and email address.

Call your doctor for an appointment for a comprehensive CPE (complete physical exam). Take your information and notes with you on your appointment. Review everything with your doctor. Take notes.

Sign a medical record release to obtain a copy of your medical record from each doctor you see at the time of the visit.

Be sure to schedule a follow-up appointment within a month or less to go over everything with your doctor. Get copies of your information including blood tests, and any other tests as well as medical notes.

Take charge. Be the healthiest you can be - as a person, as a nation.

Great health is true wealth!


J. L. Richardson, M.D., family physician patient advocate, is author of Patient Handbook to Medical Care: Your Personal Health Guide.

www.mypatienthandbook.com

The website offers a FREE excerpt from the book about the information for your medical history. Check it out.