Sunday
   September 24, 2017

An Apple A Day
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"An Apple A Day"


Orcas Family
Health Center

A Washington State and IRS 501 (c) (3) charitable non -profit corporation


"Apple A Day Articles"

ADULT “CHECK-UPS”

AN APPLE A DAY...FOR WOMEN

COMMUNICATION BASICS

FDA LICENSES NEWVACCINE FOR PREVENTION OF CERVICAL CANCER

GETTING THERE FROM HERE

LEMONS AND LYMES

NO MERCY FROM MRSA

ONE FLU OVER THE CUCKOO'S NEST

PROSTATE CANCER SCREENING

TO ERR IS HUMAN

ADULT “CHECK-UPS”

Last year we introduced the concept of screening tests and the criteria established by the United States Preventive Services Task Force (USPSTF) to justify their recommendations for a medical evaluation. Refer to the table below which summarized the USPSTF merit for each test (included in parentheses) as we outline this month the recommendations for adults of both sexes. Remember, we are talking about screening tests. These rules do not apply to the evaluation of any patient with symptoms.

To begin with we should look at what is not recommended as a valid screening test. Last week this paper contained bright pink fliers advertising “LifeLine Screening,” for $129 to “measure your risk for stroke, etc.” Unfortunately, many folks buy the hype and several patients have noticed these fliers and have brought them in asking whether or not to have the tests done. Some of the testing includes an ultrasound of the carotid arteries to rule out stroke (I), the abdomen to rule out aneurysm (I), and heel for osteoporosis (a non-standardized test that provides no information on bone architecture). Needless to say, we have a far better use for that $129. Additionally, patients often ask about other tests that are not advised such as a “routine” chest x-ray (I) or electrocardiogram (D).

A regular check up is recommended every five years for adults up to age 50 and annually thereafter. Such an evaluation should include a review of an individual’s past medical problems including surgeries, current medications and allergies, immunizations, habits such as alcohol and smoking, any significant family history, a review of symptoms, and lastly a directed physical exam with medical tests and counseling.

Blood Pressure (A): By far the most important test we do for the most common disease we treat. All adults should have frequent blood pressure determinations. The current normal is less than 130/85 with high blood pressure defined as greater than 140/90.

Cholesterol Screen (A): Recommended every five years over age 35 with no risk factors for heart disease. With significant risk factors there is a (B) recommendation for screening between the ages of 20-35. We reviewed the specifics of cholesterol values in a previous Apple.

Colon Cancer (A): Recommended for all adults greater than age 50. The specific testing could be with fecal occult blood, sigmoidoscopy, colonoscopy.

Immunizations (A): A tetanus shot should be given every 10 years. Adults over age 65 should receive an annual influenza vaccine along with pneumococcal vaccine at that age or younger if high risk.

Aspirin Therapy (A): Daily aspirin is recommended for all adults at risk for heart disease. Some of us expand this to include a discussion of daily aspirin with all adults over age 50.

Counseling: Among countless issues, patients should be advised against smoking (A), evaluated for alcohol misuse (B), and encouraged to exercise regularly and use seat belts.

A = Strongly Recommended
B = Recommended
C = Neutral
D = Recommended Against
I = Insufficient Evidence


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