Stroke Awareness: Know Your Risk Factors

As more people are diagnosed with hypertension the incidence for stroke increases.  Currently about 1 in 3 persons worldwide has been diagnosed with hypertension.  This indicates that the incidence for stroke is more likely than ever before. Diabetes, high lipids, obesity, and cigarette smoking are also risk factors.

Strokes are cerebrovascular accidents, CVA for short.  Strokes may occur from uncontrolled high blood pressure, but may also occur when blood clots block the major arteries to and in the brain cutting off oxygen.  Hemorrhagic strokes may cause bleeding in the brain secondary to a ruptured artery.  The most common cause is from severe hypertension.  Other causes include aneurysm and malformations of arteries and veins in the brain.  Ischemic or thrombotic strokes happen when blood clots block the carotid arteries or arteries in the brain because of fat deposits in the vessel lining (atherosclerosis).  This cuts off or decreases blood flow to the brain.  Embolic strokes usually result from blood clots elsewhere in the body like pulmonary embolism (PE) or deep vein thrombosis (DVT).  Clots from the area involved migrate to the brain and block blood flow. 

Mini strokes called transient ischemic attacks, TIAs for short, usually last a few hours.  If longer than 24 hours, it is considered a CVA.  The impairments that occur are not permanent.  TIAs signal that one is at risk for a potential stroke with lifelong impairment. 

Signs and symptoms of strokes include:

• Dizziness, lightheadedness
• Weakness or loss of function  in arm, leg, face on one side
• Slurred speech or loss of speech
• Blindness 
• Mental  confusion or loss of consciousness
• Unsteady gait

 

The pseudonym FAST is a simple way to recognize general stroke symptoms. Face droops; Arm weakens; Speech difficulty; Time to call 911. 

Risk factor reduction is a good way to protect yourself and prevent strokes.  Keep your blood pressure in normal range.  Eat low fat dpet to keep lipids low.  Refrain from smoking.  Stay active with regular exercise.  Make less stress a priority as well. Best health!

Personalized Precision Medicine

As we look forward to medical breakthroughs of the future, precision medicine becomes more of a reality in your medical care. Precision medicine uses treatment and intervention based on a person’s genetic and non-genetic (e.g. lifestyle, environment).  Unlike the present but ever changing protocols for wellness and disease management that are used on everyone, precision medicine is individualized just for you.  It will be your own prescription for staying well and treating your ailments. 

The basis of precision medicine is genomics.  Sequencing of your genome is done.  This molecular process identifies normal and abnormal genes.  Genomic mutations are studied and tested for different characteristics.  The results of this testing allows for prevention, diagnosis, and treatment based on your molecule makeup within your genes that have been influenced by family history, lifestyle, and environment.  DNA analysis of your genes in addition to a thorough history and physical will help your doctor determine what you have and what health risks may be present.  This information will then be used for further diagnosis and treatment.  Prevention of conditions that you are prone to develop may be less likely to develop if at all.

Precision medicine has become prevalent in drug treatment as well as disease diagnosis.  Clinical pharmacogenetics makes use of patient’s genetic data as a guide for drug therapy.  This information can then help your doctor pick the right medication for you. Pharmacogenetic information for blood thinners like coumadin and clopidogrel can be helpful in choosing which will work best for you with least complications.  Neonatal (newborn) diabetes and mature onset diabetes of the young (MODY) are rare causes of diabetes.  The cause of these types of diabetes is from an inherited mutation of one gene (monogenic).  Genetic testing can make the correct diagnosis that would otherwise be missed or misdiagnosed.  Some cancers have specific gene mutations that can be detected and treated successfully based on this information.  Drugs are made to target these and eradicate the cancer.

Thousands of disease genes and genetic tests have been discovered since the Human Genome Project of 2003.  As costs go down and precision medicine improves, personalized medicine will get more precise.  Prevention instead of treatment will be more likely.  Genetic tests and treatments for the individual will be precisely what the doctor orders for you.  Best health!

How You Can Save on Health Costs

Rising health care costs are one of the biggest reasons many people refrain from getting medical care when they need it.  Medical care costs deter many from doing what is best for their health. The following suggestions will help you spend your health dollars more wisely.

1. Eat proper foods. This is more healthy and less expensive especially if dining out or ordering in is eliminated.  Deleting junk food reduces expenses as well.  Home cooking is better for you and less costly.
2. Keep weight stable. It is the healthy thing to do. This will save on grocery and clothing expenses as well as long term savings on medical expenses.
3. Get prescription medicines in bulk quantity of 100 versus thirty day supply especially if you are paying outright. Buy nonprescription medication in bulk when on sale. You will be amazed at your savings when you buy a six to twelve month supply on sale. This tip is also effective for emergency preparedness.
4. Talk with your doctor by phone, fax, and email to save on the cost of an office visit payment. Just think about the number of office visits you have been to where all you did was talk (after waiting for a long while). This will save your time and money.
5. Monitor blood pressure at home.  Call in, email, or fax your readings to your health care providers. Many doctors will discover that your blood pressure is actually stable when the stress of the doctor's white coat is absent. For diabetics, a home glucometer is very useful for monitoring blood sugar.
6. Maintain healthy lifestyle changes long term.
7. Do routine health maintenance check-ups and testing.  Prevention and early detection have proven cost effective and good for overall health.

Invest in your most important asset - YOU. Maintaining your good health is one of the best ways to prosper into longevity.  Best health!

Family Health: Continuity of Your Care

Your family's health is of utmost importance.  Continuity of care is disrupted all to often due to lack of communication and follow-up.  Make sure your family members have accurate information for each person,  These suggestions will help you continue your health care communication continuous with less stress:

• call your doctor's office, testing center prior to appointment to be sure all is on time as scheduled
• reschedule appointments that are over an hour late especially if it jeopardizes your health conditions (e.g. persons with diabetes, hypertension, arthritis)
• read often on your health condition
• use email, fax, postal mail if unable to reach your doctor by phone
• get copies of your medical records and reports from all doctors you see
• contact your doctors for your test results, specialists reports if you fail to get contacted within 1 week
• tell your doctor what other doctors have told you as these reports often arrive after your visit, if at all

Best health!

Asymptomatic Symptomanic Static on Routine Pelvic Exams

Guidelines for pelvic exams in women has been "updated" again.  Avoiding pelvic exams in asymptomatic, non pregnant adult women is the newest "recommended" guideline.  Could this mean that a woman who meets these criteria should refrain from routine exams until she becomes symptomatic and/ or pregnant?  If this were the case, how many women would be left out of possibly being diagnosed with a disease that was indeed asymptomatic until diagnosed on a routine pelvic exam?

In asymptomatic non pregnant females, my diagnoses have included cervical cancer in an 80 year old, ovarian cancer in a 20 year old, massive uterine fibroid tumor in a 40 year old.  The routine pelvic exam was able to detect these malignant and pre-malignant conditions before they became life threatening.  Early detection allowed these ladies to escape the perilous pitfalls of cancer.  In these cases simple surgery was the cure.  They remained asymptomatic and cancer free by continuing with their routine pelvic exam and checkup.

Without symptoms may appear to indicate a disease free state, but often times it reveals disease.  It is up to patients and their health care providers to include routine exams in their health care plan.  Routine can be yearly, every other year or two, or less frequently depending on the patients medical history.  Routine evaluation and assessment is based on each individual.

Routine pelvic exam guidelines are just that, suggested recommendations that should be considered.  For this doctor and many others, especially women, routine pelvic exams will still be part of a well woman visit as deemed necessary.  The schedule is as follows:

• 18 - 20 first pelvic exam, sooner if sexually active and/or symptomatic
• 20 - 60 pelvic exam every year to every other year unless symptomatic
• 60 - life pelvic exam every 2-3 years unless symptomatic

Routine pelvic exams and pelvic/ transvaginal sonograms together offer earlier detection and diagnosis of more gynecological diseases that can be treated effectively before they affect a woman's quality of life.  In addition, they help avoid "all in your head" misdiagnosis, and can be lifesaving.  As for the concern of "false positives" and unnecessary tests...forget about the asymptomatic symptomatic static.  Most abnormal exams and tests can be repeated and followed on a closer routine schedule that may prevent riskier intervention.  Talk with your doctor about what is best for you.  Best health!

Your Choice: Medication or Food?

As health care costs rise everyone is looking for ways to save and cut costs. Recent studies and polls reveal that many are foregoing their medicine for other necessities of life like food and shelter.  Patient compliance has dropped to a new low.  Patients are taking their medication as needed when their budget allows.  This means less to none on a daily basis. Many are finding this indeed saves money, and possibly affects their health outcome minimally.

As food is the sustenance of life, many are making healthier choices.  This helps their medical maladies as well.  For hypertension and diabetes proper food choices can often alleviate the need for “stronger” treatment with medication. As more patients learn about dietary management and adhere to it, they find that they can indeed save money.

Talk to your healthcare provider if you are noncompliant with your medication because of the cost, or side effects that may cause other conditions requiring more medication, more money.  Be sure to get formal diet and nutrition counseling.  This will help make the right choices when you shop for food.  Contrary to popular myth, healthy food is actually affordable.  Shop smart to save your money and your health!     

Home Health Testing

Getting access to your doctor or health service may be a greater challenge than your health problems these days.  More patients are turning to home health care, treatment and diagnosis.  Preliminary self diagnosis aids are as close as the Internet and the corner drugstore.  DIY medical test kits are accurate and may aid your doctor in the final diagnosis.  Studies show that home testing may save your health, time, and money by making a correct diagnosis and starting treatment sooner.  Home health tests help many find answers to your healthcare concerns quickly and conveniently in the privacy of your home.

Home health testing is a mega billion dollar business which is an indication of their popularity and use. Many reliable test products crowd retail and drug store shelves across the world.  These tests enable you to screen, monitor, and/or diagnose yourself. 

As good as it may sound, DIY home testing is not a replacement for professional health care especially if the symptoms worsen or persist.  Once you have positive tests consult with your doctor or other health provider.  Get the tests repeated along with the others your doctor gets.  If a health care provider ignores your request, get another, or check at independent facilities that do testing for you.

 

Internet Information and Your Health

Health information once obtained from bought or borrowed hard copy books, magazines, and papers is now available on your computer in seconds. Many studies have shown that the Internet is rapidly becoming the main source of health information for patients and health care providers around the world.  This has made it a tool of preventive medicine individually and globally.  Many are able to "pre-diagnose" themselves and maintain wellness by the time they seek medical care.  This makes for a shorter differential diagnosis dilemma for your doctor; thereby, shortening the time for correct diagnosis and treatment.

Health literacy on line also includes abundant applications for your smart phone and computer, interactive social media, and websites from health providers and institutions.  One of the most interactive and informative is Twitter.  Lists such as these for doctors,  http://bit.ly/2XWKw29 and medical/health http://bit.ly/2GWkbvH  contain lots of information that links directly to sources. Most of these include websites as well as individual snippets of information called "tweets".  Searches for specific health information can also be done using the internal search box.

While the Internet may help diagnose, it far from replaces your doctor's advice. Use it as a health literacy tool to educate yourself.   Check out "What the Internet Does for You and Your Health" http://bit.ly/a3RAjw for more health literacy lessons. Best health!

Are You Too Old for Colon Cancer Screening?

Eighty" is the "new" fifty. Why? Many are in good health as natural and unnatural aging occurs.  This may be attributed to ongoing healthy lifestyle habits, good genes, as well as preventive screening.  In addition, early intervention and treatment of conditions found from preventive screening add additional healthy years.  Should preventive screening tests like colonoscopy be abandoned after 80 years of age?

Scientific studies report that one is more likely to die of something other than colon cancer after 80 years of life.  This may be interpreted to mean that at age 80, your last screening colonoscopy if positive for colon cancer, will really be a diagnosis you can live with until you die. In fact, the colonoscopy itself gets riskier with more complications as one gets older especially after 65.  Chronic conditions can potentially increase complications as well. Life expectancy is expected to decrease anyway in spite of the risk that cancer increases with age.

Though current guidelines are without an age limits, there is much controversy over whether colonoscopy after 80 is beneficial.  The risk of complications from colonoscopy as well as the prep and sedation get much higher after 65.  There is up to 75% higher risk of gastrointestinal bleeding and perforation of the gut after 80.  Add more risk if chronic conditions like stroke or heart attack are part of the past medical history.

Much medical success and good health depend on you.  Individual assessment based on your medical history, physical exam and tests is key to obtaining the best outcome for you, regardless of "one size fits all" guidelines.  These guidelines are just that, a guide to help you and your doctor decide if you are too old for colon cancer screening via colonoscopy. 

Here's to making 100 the "new" fifty!

Best health!

Health Maintenance: How You Gain When You Maintain

Screening tests save lives. Talk to your doctor and do your own research on tests you need and how often. What the guidelines suggest and what you need may be different.

Common screening tests for women include:

1. mammogram/ MRI for breast cancer
2. PAP smear & HPV test for cervical cancer
3. stool check for blood (fecal occult blood test, colonoscopy)
4. EKG, ECHO (stress test if indicated)
5. bone density scan to check for osteoporosis
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*


Common screening tests for men include same as above except mammogram and PAP smear.


Be sure your doctor goes over the test results with you and explains EVERYTHING! Leave with your questions answered! Be sure to follow up with your doctor to prevent any delays.

Get a copy of your test results. That way you will know if you were told everything and that the information is accurate. Research your results and diagnosis. Things you don't understand, ask again. Getting a second and sometimes third (because you were told different things by each doctor!) evaluation and assessment is sometimes necessary to get what is right for you.

Patients must be their own advocate and take charge of their health. Health maintenance and prevention are so important to one's quality of life. Make it an important part of yours - maintain and gain your best health!

*What Your Blood Tests Mean http://mypatienthandbook.blogspot.com/2012/03/what-your-blood-tests-really-mean.html

Basic Diagnostic Tests http://mypatienthandbook.blogspot.com/2012/04/basic-health-tests.html

How to Make Your Doctor Visit Easier

Visits to your doctor or any healthcare provider can be frustrating and time consuming for all involved.  These are some things you can do to make it an easier and more productive.

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 or even last year.

It is a good to make appointments when you are well and stable.  Keep 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." This gives you a complete assessment of all your medical problems. 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 poor handwriting. It is surprising to see how many doctors are often unable to read their own writing.

Schedule your appointment for first available times in the morning or afternoon.*  This will likely ensure that you will be seen on time with a shorter wait time and longer visit.  It will help you and your doctor focus on your total health care versus acute, intermittent health concerns that can easily take up your whole time. Unless an emergency arises, the wait should be less than 15 minutes.  If there is an emergency you should be notified and given the option of waiting or rescheduling, or going elsewhere for treatment. 

The easiest thing you can do is be on time.  Best health!

*How to Make Your Doctor Appointment http://bit.ly/akMrpX

by J.L, Richardson, M.D., family medicine expert and author of Patient Handbook to Medical Care: Your Personal Health Guide, honorable mention of Writer's Digest International Self-Published Book Award** and Indie Excellence Award finalist.

(**Written by a reliable source, this book is the perfect quick reference for all of those squeamish people who hate going to the doctor. I am one of those people. I hate wondering why a certain test was performed, exactly what a common diagnosis may mean, what the proper specialist for my malady might be called, and negotiating the maze of health insurance forms and other paperwork that seems to accompany my ailment; thereby adding insult to injury. To avoid the mystery, misery, and tedium of the wellness process, I often remain sick in order to forego or delay much needed medical appointments. The author writes for people like me; she writes in a calming, professional tone and explains, in as simple and non-threatening a manner as possible, what I can expect along every step of the healing process. By learning to keep a medical diary, knowing what to expect of my medical staff as well as how to decode their complicated language, and then by understanding the basics of the complex American healthcare system, I can take charge of my own healthcare. This little book provides me with all the tools necessary to do just that. ~Writer's Digest)

Your Medical Information

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 personal interview and questions.

Writing or typing this information is a sure way to keep all of your PMH http://bit.ly/f8FZ55 . Make a copy for your doctor. While talking you both can refer to this vital source of health information.

Best health!

Why Screening Tests Are Important

Screening tests save lives. Talk to your doctor and do your own research on tests you need and how often. What the guidelines suggest and what you need nay be different.

Common screening tests for women 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; colonoscopy, baseline at 50
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 osteoporosis
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


Common screening tests for men include same as above except mammogram and PAP smear.


Be sure your doctor goes over the test results with you and explains EVERYTHING! Leave with your questions answered! Be sure to follow up with your doctor to prevent any delays.

Get a copy of your test results. That way you will know if you were told everything and that the information is accurate. Research your results and diagnosis. Things you don't understand, ask again. Getting a second (and sometimes tiebreaker third because you were told different things by each doctor!) opinion is a reasonable research tool, also.

Patients must be their own advocate and take charge of their health. Health maintenance and prevention are so important to one's quality of life. Make it an important part of yours!

Basic Health Tests

These basic health tests can help your doctor with your diagnosis and treatment. Know what they are so you know that you are getting it when it is needed. These can be baseline, routine screening tests as well.

EKG

This test, also known as an electrocardiogram, gives information about your heart. It is usually done by the primary care doctor as part of a routine physical, especially if heart disease runs in your family. Typically, this test is done on anyone complaining of chest pain or discomfort. Small patches with adhesive on the back are placed on the chest, arms, and legs while the patient lies on her or his back. The electrode patches are attached to the wire cables running from the EKG machine. The heart’s electrical activity is recorded on paper. By looking at this “heart tracing” graph, the doctor can tell if there are any abnormalities like irregular heartbeats (called arrythmias), damage to heart muscle
from a heart attack, poor blood flow to the heart that causes chest pain (called angina), and heart enlargement. The doctor has been trained to know what changes or abnormalities need further testing, treatment, or hospitalization.

X-Ray

This test uses small amounts of radiation through an X-ray machine to make pictures. Itcan be done on almost any part of the body to check out a patient’s symptom, and/or the
doctor’s findings during the physical exam. Many primary care doctors have X-ray equipment in the office. If not, the patient may be referred to a special office (diagnostic center) that performs Xrays or to a local hospital radiology department.

X-rays are most commonly done on the chest, abdomen, back, joints, and extremities (arms and legs) and are done either with the patient lying down or standing up, depending on the part of the body being checked. After you have been positioned, the X-ray film cassette is placed in the machine next to the body part being X-rayed. The radiation from the machine will pass through the body part being X-rayed onto the film. The radiology technician (the person who operates the X-ray machine) will then move to a closedspace in the same room and press the buttons to take the X-ray.

During this test it is important that a protective lead shield apron be placed over the reproductive parts of the body.  Usually the technician will need to take more than one view, and so you will be asked to move a certain body part or turn a certain way. Different X-ray views give the radiologist (the doctor who reviews and interprets X-rays) a more complete view of the body part. Using the information from this test and the information from your history and physical, your doctor will be able to determine the proper diagnosis (what the problem is), treatment, and/or more tests, if needed.

There is some concern that the radiation from X-rays may be harmful. Studies have shown that small amounts of radiation are not linked with an increased risk of health problems. Over the years the amount of radiation used for X-rays has been decreased.



Ultrasound

This test is also referred to as a sonogram or sound wave test. The ultrasound uses sound
waves to make images of body parts. This changes electrical energy to sound waves that go throughthe skin into your body. When the waves contact the body’s organs, they reflect to the transducer, producing echoes. The echoes are then converted into still or moving images by a computer that makes a picture of your organs. The technician is able to see this on the monitoring screen and to make an X-ray or Polaroid-type picture. The ultrasound uses no radiation.  In this test the technician applies gel to the area to be tested. A transducer held by the technician is moved back and forth against that part of the body. This sends out the sound waves that go back into the computer.

The sonogram is commonly used to look at your internal organs in the abdomen (such as the gallbladder, kidneys, liver, spleen, and pancreas), prostate, uterus, and ovaries. It is also used to look at blood vessels (arteries and veins), the thyroid gland, breasts, and the skull. In a pregnant patient, actual moving images of the fetus can be seen. As there is no radiation exposure, the sonogram is very valuable in following fetal development in pregnancy. It is also able to detect and diagnose other conditions related to pregnancy. Sonograms are also useful in checking the heart. These are called echocardiograms or Doppler echos.



Computerized Axial Tomography
(CAT Scan, CT Scan)

The CT scan is another way to make images of body parts. The CT scanner uses X-ray beams that rotate around the body. These beams then go through a detector, and a computer analyzes and processes the data into an X-ray film. The CT machine has a table that is pulled in and out of the machine, which is a large hollow tube (like a doughnut) that can surround the body. During the test the patient lies down on the table. The scanner (inside the hollow tube) then rotates around the patient.  The CT scan is able to image many parts of the body. It detects more than a regular X-ray and produces two-dimensional views. This test is commonly used to pick up tumors, infections, enlarged organs, and many other abnormalities.


 

Magnetic Resonance Imaging (MRI)

The MRI scan is another diagnostic test that does not use X-rays. Instead, it uses magnetized energy. The images produced are extremely detailed pictures of the body part scanned. It is very much like looking at the pictures in an anatomy book or almost like looking at a person internally. The MRI machine is designed muchlike a CT scan machine, except a magnet is in the hollow tube instead of X-ray beams. The test is also done while the patient lies down on a table that moves in and out of the machine. The MRI scan takes about thirty minutes to an hour. The MRI is not recommended for persons with metal or electronic implants (such as pacemakers, joint pins, prosthetics, artificial heart valves, metal fragments, shrapnel, IUDs, etc.), as those might interfere with the machine. Be sure

your doctor and technician are made aware if you have any such implants. For the claustrophobic person, the closed space of the MRI machine may create some anxiety.  Again, alert your doctor and technician. A mild sedative may be necessary prior to the test to help relax you, or you may be sent to a facility that has an open MRI. MRI scans are useful for scanning almost any body part for almost anything. Tumors, cysts, aneurysms,
herniated back discs, and orthopedic conditions are among the many abnormalities that can be detected with this test.


Mammogram

The mammogram is a plain X-ray picture of the breast. It requires a special machine that
compresses each breast against X-ray film to take the picture. The X-ray passes through the breast tissue and shows how the breast looks inside.  This test is excellent for detecting tumors and cysts. It may also show if the area is benign (no cancer) or malignant (cancer). The mammogram is able to pick up cancers that are too small to be felt or seen. It is a valuable cancer screening test.

What Your Blood Tests Really Mean

When the doctor orders blood tests (also called lab tests, blood profile/ panel), she or he is checking for certain things. The most common tests are CBC (complete blood count), basic complete blood panel, and UA (urinalysis). The CBC checks the body’s WBCs (white blood cells) and RBCs (red blood cells). In the lab the cells are examined for size, shape, and number. The WBCs may tell if you may have some type of infection or leukemia(cancer of the white cells). The RBCs carry oxygen to the rest of the body. This is done by hemoglobin, which is carried inside the RBCs.  Some inherited diseases, such as sickle cell
anemia and thallassemia, can be identified by abnormal RBC shape and size. Also included in the CBC is a platelet count. Platelets are cells that help your blood to clot, for instance to stop the bleeding after a flesh wound.

The basic complete blood panel measures many different things. Included in these tests are:

• Na = sodium

• Cl = chloride

• K = potassium

• Mg = magnesium

• Glc = glucose (sugar)

• Ca = calcium (bone mineral)

• PO4 = phosphate (bone mineral)

• BUN = blood urea nitrogen (kidney)

• Cr = creatinine (kidney)

• SGOT = serum glutamic oxaloacetic transaminase (liver)

• SGPT = serum glutamic pyruvic transaminase (liver)

• GGT = gamma glutamyl transferase (liver)

• Alk phos = alkaline phosphatase (liver, bone primarily—also gallbadder)

• Fe = iron

• TIBC = total iron binding capacity

• transferrin = iron

• uric acid = checks gout

• chol = cholesterol (fat)

• LDL = low density lipoprotein (“bad” cholesterol)

• HDL = high density lipoprotein (“good” cholesterol)

• TG = triglycerides (fat)

Blood panels may differ from lab to lab. The above tests make up the basic chemistry panel. This should be part of a routine checkup. Some panels may include more tests than those listed above. The urinalysis (UA) may or may not be included, but it is important. Urine tests are able to check for infection, sugar, blood, protein, and many other things. Additional tests that may be ordered by the doctor for preventive screening will depend on your symptoms, diagnosis, family history, and age. Some of these tests are:

• PSA = prostate specific antigen (prostate cancer test)

• TSH = thyroid stimulating hormone (thyroid function)

• T4 = thyroid hormone (thyroid hormone level)

• B12 = vitamin B12

• folate = B vitamin

The Pap smear test and stool for occult blood (blood in stool that cannot be seen with the

naked eye) should also be performed. The Pap smear is a test for females that checks for cancer of the cervix. The stool test, also called Hemoccult test, checks for blood in the stool, which may indicate bleeding from the bowels secondary to cancer, ulcers, or other serious conditions.


Other tests than those listed may be checked depending on your history and physical exam. Be sure you are scheduled for a return visit to follow up on all tests. Some doctors’ offices will also let you know by phone or mail, especially if there is an abnormal test that must be checked before your next appointment.

Your symptoms, the doctor’s physical findings, and blood test results are what the doctor looks at when deciding the next tests that need to be done. This and any additional tests may be used for screening, diagnosis of conditions, and for ongoing management of disease once it is present.

Ovarian Cancer: Early Detection

September is teal time for Ovarian Cancer Awareness Month.  Ovarian cancer kills many women quickly and silently.  It is one of the cancers that is hard to detect.  The treatment is pure hell and the vague symptoms become unbearably painful.  Ladies, there is something we can do! The pelvic and transvaginal sonogram (also called ultrasound) is a simple test that every woman should have just because you are a woman. Like the mammogram, this medical test is inexpensive and non-invasive (unless vaginal insertion is considered so) as far as no IVs or contrast dye.  Consuming mass amounts of water until you have to urinate (but must hold) is the least discomfort you should experience.

Talk to your doctor about pelvic sonogram screening.  Most gynecologists have them in their office which is excellent standard of care and convenient for the patient.  It can be done and read the same day by your gynecologist, possibly by the time you sit down to talk after the exam.  The pelvic and/or transvaginal sonogram becomes part of your medical record for easy reference as needed thus providing consistency and, if necessary, for future comparison.  These tests are also becoming more readily available for direct consumer purchase without prescription at diagnostic centers and through health fairs.

The CA-125 blood test may be useful; however, it is nonspecific and may be seen with other conditions like endometriosis, pregnancy, fibroid tumors, diverticulitis, and liver cirrhosis.  It has been proven to be a reliable tumor marker once ovarian cancer is diagnosed. CA-125 tests, like the pelvic songram , is not recommended for women at average risk of ovarian cancer.  High risk patients like those with a family history of the disease, mutations in BRCA1 or BRCA2 genes, or suggestive symptoms are encouraged to get tested.

Early detection of ovarian cancer saves lives as well as fertility especially for women of childbearing age.  For these reasons alone sonograms should become part of every woman's prevention schedule on a routine basis like the mammogram.  The patient's quality of life can be saved in a cost effective manner.  The nonspecific symptoms of pelvic pain, low back pain, abdominal pain (bloating, fullness, distension), changes in bowel or bladder habits are surely worth looking into, but can lead your doctor into a quandry with many other diagnostic tests before ovarian cancer is suspected. The time this takes can definitely delay diagnosis. 

Speak up before the silence of ovarian cancer quiets your life.  Though unpreventable there are things you can do to lower your risk.  This includes oral contraceptives, genetic counseling, and removal of ovaries (oophorectomy).  Seek care and advice from experts in these areas via your gynecologist. The National Ovarian Cancer Helpline is very good for locating local resources. http://www.ovarian.org/local_chapters.php

Without a bonafide early detection test for ovarian cancer, we still must do all we can to detect early and prevent the rampage of this deadly disease.  The pelvic and transvaginal ultrasound along with a thorough pelvic exam can reduce the sounds of suffering that ovarian cancer shouts out in silence.

Your Physical Exam: Above the Waist

After your doctor has taken a thorough medical history, a complete physical exam (CPE) is performed. The doctor started your physical exam from the time you were greeted just by looking at you. Are you able to get up and shake hands? Are you able to sit back down? Is there a cane or walker lying beside you? Are you speaking clearly? Are you tearful? This and many other observations can tell the doctor a lot. So the physical has begun before the doctor puts a healing hand on you.

The head, eyes, ears, nose, and throat (HEENT) are usually inspected first. The doctor looks at the scalp for any hair loss or other abnormalities. Your head is palpated (touched and felt) to check for any lumps, swelling, or sore spots. The eyes are next. You will be asked to follow the doctor’s finger with your eyes up, down, left, right. This tests your eye muscles. Pulling down the lower eyelid and pulling up on the upper eyelid allows for inspection of the white of the eye and the eyelids. The eye reflex is checked by shining a light on the colored part of the eye and is done with the lights dimmed (or light off and door cracked). The doctor uses the ophthalmoscope (an instrument) to look inside the eye. The blood vessels and nerve to the eye can be seen. Certain abnormal findings in the eye indicate diabetes, high blood pressure, and other maladies. For any findings that are abnormal with the eye, you will be sent (“referred” is the
up-to-date term) to an ophthalmologist (eye specialist). Routine eye exams by the ophthalmologist may also detect some diseases that are known to progress toward blindness or other complications. Looking at and reading from an eye chart tests the vision.

Can you hear a whisper? How about a watch ticking? Faint noises close to the ears allow a doctor to check to see how well you can hear. Formal hearing tests (like audiometry) are done by an otolaryngology doctor, also known as the ENT (short for ear, nose, and throat) doctor. Hearing tests may also be done by hearing aid centers. The doctor uses the otoscope (the same instrument used for the eyes with an attachment made for looking in the ears) to look in the ear canal and at the eardrum. Using the same tool, each nostril and the mouth are inspected. A stick called a tongue blade is used to hold the tongue down when the doctor asks you to say “aaaaahhhhh.” This is done so that the throat and the rest of the mouth can be checked. This procedure also tests the nerve for the gagging reflex (part of the nervous system exam). A gloved finger may be used to palpate (touch) the inside of the mouth. Any problems here will earn you a referral to the ENT doctor or dentist. Now may be a good time to ask any questions about the exam thus far. Please wait for the doctor to remove the gloved hand first.

The neck exam is next. At this time the thyroid gland is palpated. This is best done while the doctor stands behind the patient and places the right hand around the right side of the neck and the left hand on the left side of the neck. If any swelling or lumps are noted, further blood tests and a thyroid and/or neck scan may be ordered by the doctor. The lymph node glands can also be checked at this time. They are located in the front, back, and sides of the neck. They are also in the armpit and groin and are checked with those parts of the body. The lymph nodes should not normally be enlarged. More blood tests and Xrays may be ordered if they are enlarged.

Inspection, palpation, and percussion (lightly tapping) as well as listening to the chest give the doctor a chance to check the lungs. The doctor listens with a tool called a stethoscope, which makes the sounds louder. It is placed on the bare skin (beware of the doctor who tries to listen on top of your clothes) starting at the top of your upper back moving from the left to right, or right to left, from the top to the bottom of the chest
while you take deep breaths. The same will be done on the chest.

Then the stethoscope will be placed over the heart on the left and right sides of the breastbone. These areas are where the heart valve sounds are heard best. You may also be
asked to do certain things like holding your breath or bearing down (as when having a bowel movement). This makes some murmurs easier to hear. Certain positions may also be better for hearing some heart sounds. Your doctor has been trained to listen for certain things. If any abnormal sounds are heard, more tests may be ordered. These may include an X-ray of the chest(CXR, for short) and heart tracing(electrocardiogram—EKG, for short). Usually these can be done in the office after completion of the exam. Depending on your complaints, symptoms, and the results of the CXR and EKG, you could require more tests that are not done in the primary care physician office.

The breast exam is also done at this time. The doctor will let you know exactly what is to be done. For female patients, it is recommended that a third person or chaperone be present when this exam is done. After the gown is lowered to the waist, the doctor looks at the breasts with the patient sitting up on the exam table. The breasts should look the same size (sometimes one can normally be a tad larger or smaller than the other) and shape with the nipple positioned centrally. The breast is also checked to make sure there is no abnormal swelling, lumps, skin discoloration, or skin changes. Next you will be asked to put your hands on your hips and then raise your arms above your head much like doing your own breast inspection in front of the mirror. The doctor will again look and examine for any abnormal places. While you lie down on the exam table, the doctor will palpate each breast up and down vertically from right to left or vice versa. Palpation in a circle from out to in is another technique used. Breast tissue under the arm is also checked. The nipples are then squeezed gently to check for any discharge. Deeper palpation of the axilla (armpit) is then performed to check the lymph node glands. These steps are then repeated on the opposite breast. Any abnormalities may warrant a
mammogram and/or sonogram and possibly a surgeon’s evaluation. Men should also receive a breast exam. This is a good time for the doctor to teach to do your own self breast exam (SBE).

Now it’s time to look, listen, tap, and feel the abdomen, the area many people refer to as the stomach. This is where the liver, spleen, kidneys, bowels, and female reproductive organs are located. With this lineup of important organs the doctor has a lot to check. This part of the exam is done in the supine (lying on your back) position. Looking at the abdomen for scars tells about anysurgery you may have had. Listening with the stethoscope for overactive or underactive bowel sounds and/or bruits (sounds made by abnormal blood flow through arteries when there is blockage) is next. By tapping and feeling, a doctor is able to check for enlargement of the vital organs listed and to make sure that there are no abnormal internal masses or swelling. At this time the groin is also checked for any enlarged lymph nodes. If there are any abnormalities, further tests will be ordered by the doctor.



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

Praying for Health - No Insurance Required

Pray for me. This often forgotten yet basic request is often deferred until times of severe health duress. How effective is prayer in helping heal your illnesses or that of someone else? Combining this with other forms of treatment has proven effective in managing illness, especially chronic disease.

Prayer is considered an alternative health treatment; however, faith healing is the only way to many. Man made medical treatments like drugs and surgery combined with modern technology have overshadowed prayer. Prayer, like many other alternative "natural" treatments, is usually left off the intern and resident training in medical school. Research has shown that many patients pray for their health regardless of religious background, and that is does indeed have healing health benefits.

Praying for oneself as well as being prayed for are effective in staying healthy as well as in healing. The beautiful thing is that you can do it anywhere, anytime without paying any money. No health insurance is required.

Best health!

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

This book provides 112 pages (large print) of health information that will tell you what your doctor should be asking you, telling you, and doing for you - as taught in medical school and used since Hippocrates. http://amzn.to/13m51UU

TOC FOR PATIENT HANDBBOOK TO MEDICAL CARE

"Patient Handbook to Medical Care: Your Personal Health Guide" is a source for helping patients. The book's introduction states that "The goal of this book is to inform and educate patients about medical care...It is very important for patients to learn as much as possible about wellness, disease prevention, and disease management for themselves."


TABLE OF CONTENTS

Chapter 1
Medical Records and Diary

Chapter2
The Doctor Visit

Chapter 3
Preventive Checkups and Health Maintenance

Chapter 4
Medical Tests

Chapter 5
Doctors and Specialists

Chapter 6
Health Insurance and Quality

My Health Notes (last pages)- blank pages to start medical diary