United States Preventive Care Can Be Better, Center for Disease Control Says

Ralph Coates, PhD of the Center for Disease Control (CDC) described in the June 15, 2012 issue of Morbidity and Mortality Weekly Report that by looking back at a U.S. study done between 2007-2010 called “Use of Selected Clinical Preventive Services among Adults,” health providers need to do a more comprehensive job of offering preventive services.

According to the report, only 47% of patients with documented heart and vascular disease were given a recommendation to use aspirin for prevention. They additionally found that only 44% had their blood pressure under control. When looking at cholesterol and lipid control only 33% of the men and 26% of the women were tested with a blood lipid test in the last five years.  Of those patients who did measure their lipid levels, only 32% of the men and women surveyed had their lipids under control. Among diabetics, 13% had poor sugar control with a HgbA1C > 9 (goal is 6-8).

The data indicate that at 37% of the visits, patients weren’t asked about their smoking or tobacco status.  When patients were asked, and answered that they were smoking, only 21% were given smoking cessation counseling and only 7.6 % were prescribed medications or a way to stop smoking.

Screening for cancer needs improvement as well. Twenty percent of women between the ages of 50-74 had not had a mammogram in over two years.  In the same age group, a third of the patients were not current on screening for colon and rectal cancer.

The data was collected prior to the passage of the controversial Affordable Care Act. When the data was analyzed and divided according to socioeconomic status, education level, and health insurance status; it was clear that the poorest and least educated had the fewest screenings. It is hoped that with passage of the new health care law, and new insight by health insurers that it is cheaper to prevent a disease than treat it, these numbers will improve.

There are several other factors that need to be looked at as well. Data is now being collected from electronic medical health records.

I ask my patients about tobacco status on every patient visit.  When I note that the patient is smoking in their electronic health record, there are three or four ways to document counseling has been offered. Only one of them triggers the audit data for the government to review. Our software instructors were unaware of that when they taught us to use the system.  How much of this study is the result of data collection error is unknown.  “Health care providers” – not just physicians, are now delivering health care.

Access to physicians and a shortage of primary care physicians exacerbate the problem. It takes time to extract this information, record it, and counsel the patient. Because PCPs are underpaid, they will continue to see patients in high volumes to cover their expenses, causing the use of comprehensive preventative questioning to remain low.

Heat Related Illness

It is summer time and the heat and humidity are higher than at any other time of the year.   We spend more time in the outdoors so we must learn to protect ourselves against the unique illnesses caused by this increased exposure.  Heat related illness occurs when your body cannot keep itself cool. As the air temperature rises, your body cools off by sweating.  Sweating occurs when liquid on your skin surface evaporates. On hot humid days, the evaporation of moisture is slowed down by the increased moisture in the air. When sweating cannot cool you down your body temperature rises and you may become ill.

Some people are at greater risk to develop heat related illness than others. This includes infants and young children, people 65 years of age or older, people with mental illness taking medications, the physically ill; especially those with heart disease, high blood pressure and lung disease.  Individuals who have suffered from heat exhaustion or heat stroke in the past have an increased risk of developing recurrent heat illnesses.

When your body overheats due to very hot weather and or exercise in the heat, you are susceptible to heat exhaustion. Patients experience heavy sweating, non-specific weakness and or confusion, dizziness, nausea, headache, rapid heartbeat and dark very concentrated urine.

If you experience these symptoms in the heat you need to get out of the heat quickly. Find an air conditioned building and rest in it. If you cannot find an air conditioned building then get into the shade and out of the sun. Start drinking cool liquids (avoid caffeine and alcohol which exacerbate fluid loss and heat related disease). Take a cool shower or bath or apply cool water to your skin. Remove any tight constricting clothing.  If you do not feel better within 30 minutes you must contact your physician or seek emergency help.

Untreated or inadequately treated heat exhaustion can progress to heatstroke. Heatstroke occurs when the internal body temperature rises to 104 degrees Fahrenheit or higher. Heatstroke is far more serious than heat exhaustion it can cause damage to your internal organs and brain and it can kill you.  Patients with heatstroke are running a fever of 104 degree F or higher. They complain of severe headaches with a dizzy or light headed feeling. Their skin is flushed or red in appearance and they are NOT sweating.  Many will be experiencing severe and painful muscle cramps accompanied by nausea and vomiting. Their heartbeats are rapid, their blood pressure low. They are often extremely agitated, anxious and disoriented with some experiencing tonic clinic epileptic type seizures.

Heatstroke is a medical emergency and you must call 911 immediately. While you are waiting for help to arrive remove their clothing after taking the patient to an air conditioned or shady place. Wet the skin with water and fan the skin if possible. If you have access to ice or ice packs place them on the patient’s neck, back, groin and armpits while waiting for help.

Heat illness is preventable. When the heat index is over 90 and you must go outside wear lightweight, light-colored, loose fitting clothing. Wear a hat or use an umbrella.  Apply sunscreen SPF 30 or greater 15-20 minutes BEFORE going outside. Drink plenty of water before you go out and 2-4 glasses of cool water each hour you are outside working in the heat. Avoid alcohol and caffeine including soda with caffeine.  Take frequent breaks every 20 minutes and drink water or sports drink even if you do not feel thirsty. Try to schedule your outside work for before 10 a.m. or after 6 p.m. to avoid peak sun exposure.

If you are being treated for chronic medical conditions ask your doctor how to prevent heat illness.  Patients taking antihistamines, some blood pressure medications (beta-blockers and vasoconstrictors), diet pills, anti depressants and antipsychotics impair your ability to control your internal body temperature. Water pills to prevent excessive fluid lead to dehydration. Anti-epilepsy and anti-seizure medicines impair your body’s ability to regulate internal temperatures as well.

Heat illness is preventable if you take the precautions outlined above.

I Lost 52 Pounds And Feel Fantastic!

Patients have noticed my recent 52 pound weight loss but, for the most part, have been reluctant to approach me to discuss it. I’m sure many have wondered if this was a planned weight loss or the result of a serious illness.

Let me bring clarity to any concerns. My weight loss was planned as part of a lifestyle improvement program and, as a result of my commitment, I now feel great!

Like many Americans, I had accumulated extra pounds due to poor food choices, large portions and poor health habits. Finally, I decided to get healthy BEFORE I became ill and my doctor insisted on it.  I established certain criteria in choosing a weight loss program. It had to be safe, effective and rapid. I did not want medications or injections to be involved. Any program I was to consider had to have a proven safety record with no patients becoming ill.  There needed to be a sane transition program and maintenance program to teach me how to prevent regaining the weight rapidly and how to move on and live a healthy future life.

After much research I found the Take Shape for Life Program (www.tsfl.com).  Clinical studies by Johns Hopkins, the National Institutes of Health (NIH) and other organizations have proven the effectiveness of this program.  It has been recommended by over 20,000 doctors.

Take Shape For Life provides a network of ongoing behavioral support, education and other tools while using the nutritionally-sound Medifast meal replacements.

TSFL participants eat six small meals per day – all of which are low in fat and sugar but rich in protein and nutrients.  The five daily small Medifast meal replacements are supplied by TSFL and are eaten every two to three hours along with one lean and green meal that you prepare yourself.  These small frequent meals keep you from becoming hungry and getting cravings. As part of the program you have access to a free health coach / guide / cheerleader who assists with recipes, lifestyle tips and helps order product. The low average monthly cost to participate in the TSFL program is about $315.

I started the program in mid January and reached my goal weight in just four months. I am now working on transitioning to the maintenance program. My lovely wife is also participating in the TSFL program and has over 40 pounds to date.

I suggest those of you who are struggling to lose weight discuss it with me.  The program is perfect for diabetics, hypertensives, individuals with heart disease and individuals with gluten sensitive enteropathy.

Please contact me with any questions you may have, to request information or, to begin your journey to achieving optimal health by enrolling in Take Shape For Life.

Aspirin Holiday Carries Its Risks

A recent publication in the British Medical Journal looked at the risk of stopping aspirin therapy and taking a drug holiday from it if you are taking aspirin as secondary prevention for heart disease. The study, conducted from 2000 – 2007, looked at almost 40,000 participants aged 50-84 who were taking low dose aspirin (75- 300 mg per day) for secondary prevention of cardiovascular outcomes. They followed the patients for 3.2 years.

Researchers determined that individuals who stopped aspirin for 1-6 months had significantly more myocardial infarctions (heart attacks) and cardiovascular deaths than individuals who continued the aspirin.  Most of the patients who stopped the medication just stopped it on their own for no particular reason.

The study has implications for patients who have known coronary artery disease, have had a heart attack or stent placed or have survived bypass surgery. It says that if you stop the aspirin you increase your risk of having a cardiac event.

As a physician I am always faced with phone calls from patients going for minor dental work and the dentist insists on stopping the aspirin. I have patients going for elective cosmetic procedures who are required to stop their aspirin.  The message must be “is the risk of excessive bleeding from the elective procedure greater than the risk of having a heart attack?”  This is a question you should ask your cardiologist, internist or family physician before stopping the aspirin. You and they will need to ask your dentist or surgeon the same question before you stop the aspirin.

There will be times when you will have no choice but to accept that increased risk to have work done which may be necessary.  By informing your physician of the problem, and discussing it with the surgeon or dentist, we can determine if stopping the aspirin is essential and if there are other measures we can take to prevent a cardiac event.