General

Low-dose computed tomography (also called a low-dose CT scan) is a screening test for lung cancer.

 

Who is eligible for screening? As per recommendations by the U.S. Preventive Services Task Force (USPSTF), a yearly lung cancer screening is recommended for people who

  • Have a 20 pack-year or more smoking history, and
  • Are current smokers or have quit smoking within the past 15 years, and
  • Are between 50 and 80 years old
  • Do not have any current symptoms of lung cancer

pack-year is smoking is a calculation of # of packs smoked per day multiplied by number of years. 

What are the benefits of screening?

  • Early Diagnosis of lung cancer

What are some of the risks of screening?

Due to certain risks associated with lung cancer screening with a low dose CT scan, the screening test is only recommended for people who are at high risk of developing lung cancer that is based on their age, smoking history, and normal anticipated life expectancy. 

  • A False-positive result: The test can say that a person has lung cancer when no cancer is actually present. This could lead to more follow-up tests, procedures, and surgeries that are not needed and these interventions may have more risks.
  • Overdiagnosis: A lung cancer screening test can find cases of cancer that may never have caused a problem for the patient. This can lead to treatments/therapies that are not necessary. 
  • Radiation exposure from repeated LDCT tests can cause cancer in otherwise healthy individuals.

When Should Screening for Lung Cancer Stop?

The USPSTF recommends stopping yearly screening for lung cancer when the person: 

  • Turns 81 years old, or
  • Has not smoked in 15 or more years, or
  • Develops a health problem that prevents treatment for lung cancer if it was discovered. 

Speak to your doctor if you are interested lung cancer screening. Remember, the best way to decrease your risk of lung cancer is to not smoke and to avoid secondhand smoke. Lung cancer screening is not a substitute for quitting smoking.

Who Should Be Screened for Lung Cancer? | CDC

 

Regular exercise and physical activity has numerous benefits. Everyone benefits from exercise.

–        Exercise can reduce the risk of cardiovascular disease (such as heart attack, stroke, peripheral vascular disease) by strengthening the heart, lowering cholesterol, improving circulation, and lowering blood pressure.

–        It can help control weight and prevent obesity

–        Exercise helps your body control insulin and blood glucose levels which can decrease the risk of diabetes Type 2 as well as obesity and metabolic syndrome

–        Exercise can improve mental health by releasing chemicals that can increase relaxation, help with anxiety, depression and improves cognitive function.

–        Exercise releases chemicals that improve the structure and function of the brain

–        Exercise strengthens bones and muscles which can slow the loss of bone density that occurs with aging, helping to prevent osteoporosis, and improve arthritis

–        Exercise can reduce the risk of some cancers especially ones associated with obesity such as colon cancer, breast cancer, and uterine cancer.

–        Exercise can improve your sleep by helping you sleep longer and increasing the duration of sleep

–        Exercise can improve sexual health in both men and women

–        Balance and muscle-strengthening activities as well as moderate-intensity aerobic activity can help reduce the risk of falls in the elderly

–        Evidence shows that physical activity can reduce your risk of dying early from the leading causes of death, like heart disease and some cancers.

 

Exercise has a lot of benefits however prior to initiating an exercise program, please consult with your doctor. This is especially important if you have not exercised in a long time, have chronic health conditions, or have any concerns about your health.

 

Constipation is a symptom rather than a disease, generally defined as when bowel movements occur less than or equal to three times a week and when the bowel movements are difficult to pass.

It is the one of the most common digestive complaints in the United States. Constipation is typically a chronic condition. New and rapid-onset constipation in older persons may suggest an obstruction in the gastrointestinal tract.

A person suffering with constipation may also experience abdominal pain, painful defecation, rectal bleeding, episodes of diarrhea, or lower back pain.

Some people may develop such severe constipation that they require medically manual removal of the stool from the lower gastrointestinal tract.

Patients who experience constipation and have abdominal pain, inability to pass gas, fever, vomiting, or bleeding from the rectum should seek immediate medical care.

Initial management of constipation involves dietary changes and exercise. Dietary changes include increasing intake of fiber and fluids while decreasing the use of constipating agents (eg, milk products, coffee, tea, and alcohol). Constipation should not be ignored and persons suffering from constipation should contact their medical provider.

Squatty potty is a stool that raises your knees above your hips to put you into a squat-like position when you are having a bowel movement.

The lower bowel is “kinked” when a person sits on a toilet. That forces you to work harder to push out the 💩. Squatting relaxes the puborectalis muscle more and straightens out the colon, giving the 💩 a straight route out. As a result, bowel movements are produced with less straining.

Pulse Oximeter

A popular device that can be purchased over-the-counter is a pulse oximeter. It’s a device that can be placed on your finger (or toe) that measures the oxygen saturation level of your blood. Certain smart watches available on the market can also measure oxygen concentration of blood.

It is non-invasive, not painful, rapid, easy to use, and the measurements can be performed in the comfort of your own home.

These devices have become popular during the time of COVID-19 pandemic when knowing oxygen concentration of blood is crucial. A typical pulse oximeter also provides a reading of the heart rate.

Pulse oximeters measure changes in light absorption in blood. Amount of oxygen in the blood is measured with small beams of light passing through the blood in the digit being measured.

 

Healthcare professionals often use pulse oximeters to monitor blood oxygen levels of people who suffer with lung diseases (such as COPD, asthma, lung cancer, pneumonia), heart diseases (such as heart failure, coronary artery disease, or congenital heart disease), sleep apnea, and anemia. This is done at the hospital, the office, during sleep studies, during medical procedures that require anaesthesia, or at home.

 

How to take a reading at home

  1. Remove nail polish from the digit you are using for measurement.
  2. Make sure your hand is warm, relaxed, and below heart level.
  3. Place the device on your finger, earlobe, or toe.
  4. Keep the pulse oximeter on the digit as long as necessary to obtain a measurement. Fingertip readings may be delayed by 30 seconds and toe readings by 90 seconds.
  5. Remove the device once the test is over.

 

Pulse oximetry readings

An oxygen saturation level of 95 percent or greater is considered typical for most healthy people.

A level of 92 percent or lower can indicate potential hypoxemia, which is a seriously low level of oxygen in the blood and considered a medical emergency.

Various factors can affect readings, including a person’s skin tone, poor arterial blood flow in the measured extremity, low blood pressure, low temperature of the measured extremity, hypothermia, nail polish, artificial fingernails, motion, and exposure to excessive light.

 

pain relievers

Whether a headache, toe pain, or a muscle ache after a prolonged tennis game, many of us has found our way into our local pharmacy with intentions to purchase over-the-counter pain medications.

Most people expect over-the-counter pain medications to be safe. However, there are several important side effects everyone should be aware of.

Two common examples are pain and fever reducing medications. These two medications can be found alone or purchased bundled with other medications in one pill for multi-symptom relief.

 

Acetaminophen (Tylenol)

–        Used for pain and fever

–        Although this medication is found over the counter, it has a black box warning issued by the FDA of “hepatotoxicity”, which means this medication can be toxic to the liver. This means there is a risk of acute liver failure which can lead to liver transplantation or death especially in doses of greater than 4000mg per day

–        This medication should be avoided by patients with history of prior allergic reactions to this group of medications and patients suffering from severe active liver disease

–        Caution must be taken if patient chronically uses alcohol, is dehydrated, malnourished, or has kidney disease

–        Adverse reactions to acetaminophen include anaphylaxis (severe allergic reaction), hypersensitivity reactions, rash, liver toxicity, acute kidney injury, chronic kidney disease if taken for a long time, anemia, and low platelets

 

Ibuprofen (Motrin, Advil), Naproxen (Aleve)

–        These medications belong to a class of medications called NSAIDS (Non-Steroidal Anti-Inflammatories)

–        They are used for treatment of pain, fever, and some inflammatory conditions such as arthritis

–        These medications also have a black box warning issued by the FDA.

o   Use of NSAIDs increases risk of serious and potentially fatal cardiovascular thrombotic events (such as heart attack and stroke)

o   NSAIDs also increase risk of serious and potentially fatal gastrointestinal adverse events that include bleeding, ulcers, and perforation of the stomach or the intestines.

  • Elderly patients and patients that have history of peptic ulcer disease or gastrointestinal bleeding are at a greater risk for serious gastrointestinal events.

–        Serious reactions reported with use of NSAIDs include

o   Gastrointestinal bleeding, ulceration, and perforation

o   Heart attack, stroke, blood clots

o   Hypertension

o   Heart failure

o   Kidney failure (many different types)

o   Liver toxicity

o   Anaphylaxis, allergic reactions including Stevens Johnson Syndrome

o   Bronchospasm

o   Rashes including sensitivity to light

o   Low platelets, Anemia, and low white blood cell count

o   High potassium

o   Abdominal pain, nausea, constipation

o   Ringing in the ears

Please consult with your doctor prior to taking any medications over the counter.

 

Buyer Beware!

The team of Concierge Medicine of Jupiter

 

pain relievers

ANTIBIOTICS are medications that are used to help us fight BACTERIAL infections.

When antibiotics are used to fight BACTERIAL infections, they help us recover, shorten duration of bacterial illness, and can save lives. It is appropriate to treat bacterial illnesses with appropriate antibiotic therapy. The type of antibiotic that is used to treat a bacterial infection depends on the type of bacteria, the location of the infection in the body, and most importantly, it depends on the patient’s specific needs.

Antibiotics are not meant to treat VIRAL infections. Not only are the antibiotics not effective if used in the wrong context, but they can cause harm. Different antibiotics have different side effects. Some people can develop allergic reactions to antibiotics that can be life threatening. Other antibiotics can alter the rhythm of the heart and can cause a life-threatening arrhythmia. There are antibiotics that can cause liver failure, kidney failure, and/or failure of other organ systems.

When antibiotics are used inappropriately, we suffer a great cost both personally and as a society. Overuse or misuse of antibiotics leads to antibiotic-resistance. What that means is that bacteria “learn” how to evade the antibiotic mechanisms of action and the medication is no longer effective when you really need it most. Consequences of this include longer duration of illnesses, more severe illnesses, more doctor visits, use of stronger antibiotics with more side effects, and higher chance of dying from a bacterial illness.

MULTIVITAMIN SUPPLEMENTATION

According to the Food and Drug Administration, Congress defined the term “dietary supplement” in the Dietary Supplement Health and Education Act (DSHEA) of 1994.

A dietary supplement is a product taken by mouth that contains a “dietary ingredient” intended to SUPPLEMENT the diet. The ingredients of these products may include: vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars, and metabolites. DSHEA places dietary supplements in a special category under the general umbrella of “foods,” not drugs.

Under DSHEA, the company that produces the dietary supplement is responsible for determining the supplement’s safety and that any representations or claims made about them are substantiated by adequate evidence to show that they are not false or misleading. This means that dietary supplements do not need approval from FDA before they are marketed.

Unlike drug products that must be proven safe and effective for their intended use before marketing, there are no provisions in the law for FDA to “approve” dietary supplements for safety or effectiveness before they reach the consumer. Once the product is marketed, FDA has the responsibility for showing that a dietary supplement is “unsafe,” before it can take action to restrict the product’s use or removal from the marketplace.

FDA disclaimer

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WHO MAY BENEFIT FROM SEVERAL NUTRIENTS IN MULTIVITAMINS?

Most people who have true vitamin deficiencies have underlying medical problems that either prevent absorption of a nutrient from the diet or its metabolism. For example, patients who have undergone a gastric bypass surgery, have been afflicted with malabsorption disorders, or suffer from chronic alcoholism are unable to obtain the right nutrients in their diet. It is best for most people to obtain vitamins and minerals from eating a well-rounded healthy diet.

However, some people benefit from certain vitamin supplementation. Pregnant women and women who might be pregnant are recommended folic acid supplementation, especially in the first trimester, to prevent neural tube defects in their babies. Pregnant women may also be recommended iron supplementation by their health care provider.

Patients that have vitamin D deficiency and/or suffer from osteoporosis or osteopenia are recommended Calcium and Vitamin D supplementation to help increase bone mineral density and decrease fractures in post-menopausal women.

People over age 50 tend not to absorb Vitamin B12 as well as vegans and they should obtain recommended intakes of vitamin B12 mainly from fortified foods or dietary supplements.

Individuals with poor nutrient intakes from diet alone, who consume low-calorie diets, or who avoid certain foods (such as strict vegetarians and vegans) might also benefit from taking multivitamins.

 

TOO MUCH OR TOO LITTLE? HOW DO YOU CHOOSE A MULTIVITAMIN?

When you are supplementing your diet with pill-form of multivitamins, how do you know if you are taking too much or too little?

Your doctor is the best person to ask about a supplement you are planning to take. In addition, the back of the vitamin bottle contains percentage of daily allowance of recommended supplement intake.

Supplement Facts

Special Considerations for Certain Population Groups

Most basic multivitamins usually contain both vitamins and minerals, mostly at levels that do not exceed the daily recommended values for these nutrients. However, people who take multivitamins and other supplements and who eat fortified foods and beverages might consume some nutrients at levels that exceeding the upper level of recommended intake, which increases the possibility of adverse effects.

Smokers and, possibly, former smokers should avoid multivitamins that contain a large amount of beta-carotene or vitamin A due to an increased risk of lung cancer, as it has been suggested in several studies.

Taking excess vitamin A (as preformed retinol but not beta-carotene) during pregnancy can increase the risk of birth defects in infants. In general population, over-consumption of vitamin A can cause staining of skin a yellow-orange color, loss of hair, developing dry and scaly skin, mouth sores, anorexia, vomiting, nausea, abdominal pain, and headaches.

Over-consumption of Vitamin D can cause high blood calcium levels, kidney stones from high blood and urine calcium levels, anemia, and kidney failure.

Information about different dietary supplements can be obtained online by reviewing dietary supplement fact sheets at National Institute of Health website:

https://ods.od.nih.gov/factsheets/list-all/

According to World Health Organization and Center for Disease Control, cancer is preventable and treatable. The leading causes of cancer are tobacco, infections, alcohol, obesity, and air pollutants.

Tobacco

–        Smoking damages DNA and causes cancer

–        Tobacco is associated with the following cancers:

o   Bladder

o   Blood (acute myeloid leukemia)

o   Cervix

o   Colon and rectum

o   Esophagus

o   Kidney and renal pelvis

o   Liver

o   Lungs, bronchi, and trachea

o   Mouth and throat

o   Pancreas

o   Stomach

o   Voice box (larynx)

–        Prevention: Smoking cessation/avoidance

Infections

–        Certain infections are associated with cancers

–        Human Papilloma Virus is associated with cancer of the cervix, vulva, vagina, penis, anus, and oropharynx.

–        Chronic infections with Hepatitis B and Hepatitis C can cause liver cancer

–        Prevention: Human papillomavirus (HPV) vaccine, Hepatitis B vaccination, treatment of active hepatitis B and hepatitis C infections

Alcohol

  • Drinking alcohol increases the risk of obtaining mouth and throat cancer, voice box (larynx) cancer, esophageal cancer, colon and rectal cancer, liver cancer, and breast cancer in women.
  • The human body breaks down consumed alcohol down into a chemical called acetaldehyde.Acetaldehyde damages your DNA and prevents your body from repairing the DNA damage. Damaged DNA can cause a cell to grow without control and cause cancer.
  • Prevention: avoidance of alcohol

Obesity

–        Obesity is associated with the following cancers:

o   Adenocarcinoma of the esophagus

o   Breast (in post-menopausal women)

o   Colon and rectum

o   Uterus

o   Gallbladder

o   Upper stomach

o   Kidneys

o   Liver

o   Ovaries

o   Pancreas

o   Thyroid

o   Meningioma (a type of brain cancer)

o   Multiple myeloma

–        Prevention: Healthy well-balanced diet and physical activity

Air Pollutants

–        Air pollution is associated with lung cancer, urinary tract/bladder cancer

–        Prevention: Reducing exposure to outdoor air pollution and indoor air pollution, including radon (a radioactive gas produced from the natural decay of uranium. Exposure to radon can occur in homes and buildings).

Sun Exposure

–        Causes cancers that include:

o   Melanoma

o   Squamous cell carcinoma of skin

o   Basal cell carcinoma of skin

–        Prevention: Includes wearing sunscreen (on skin and lips), wearing protective clothing and hats, avoiding peak sun rays at midday, and avoiding indoor tanning beds

 

Foods

–        Foods that are associated with cancer include processed foods, processed meats, red meat and charred food, sugar, fried foods, and alcohol

–        Red Meats and processed foods increase the risk of colorectal cancer (American Institute of Cancer Research)

–        Sugar and fast foods increase risk of obesity which increases risk of cancers

–        Prevention: Eating a balanced diet rich in healthy nutrients

Covid 19 Vaccine

So….a little birdie told us that some of you have been FULLY VACCINATED against the COVID-19 virus. What does that mean for you?

After a long year of COVID19 pandemic, the CDC guidelines are changing again. People who have been FULLY VACCINATED are wondering what activities are considered safe.

What is FULLY VACCINATED?

People are considered fully vaccinated for COVID-19 ≥2 weeks after they have received the second dose in a 2-dose series (Pfizer-BioNTech or Moderna), or ≥2 weeks after they have received a single-dose vaccine (Johnson and Johnson (J&J)/Janssen).

As per CDC guidelines dated April 2nd, 2021, FULLY VACCINATED people can: 

  • Resume domestic travel and do not need to get tested before or after travel or self-quarantine after travel.
  • FULLY VACCINATED people do not need to get tested before leaving the United States (unless required by the destination) or self-quarantine after arriving back in the United States.
  • Visit with other FULLY VACCINATED people indoors without wearing masks or physical distancing.
  • Visit with unvaccinated people from a single household who are at low risk for severe COVID-19 disease indoors without wearing masks or physical distancing.
  • Refrain from quarantine and testing following a known exposure IF they are asymptomatic.

As per current CDC recommendations, FULLY VACCINATED people should continue to:

  • Take precautions in public such as wearing a well-fitted mask and practice physical distancing.
  • Wear masks, practice physical distancing, and adhere to other prevention measures when visiting with unvaccinated people who are at increased risk for severe COVID -19 disease or who have an unvaccinated household member who is at increased risk for severe COVID-19 disease.
  • Wear masks, maintain physical distance, and practice other prevention measures when visiting with unvaccinated people from multiple households.
  • Avoid medium- and large-sized in-person gatherings
  • Get tested if experiencing symptoms of COVID-19.
  • Follow guidelines issued by individual employers.
  • Follow CDC and health department travel requirements and recommendations.

Other considerations….

  • Sometimes you don’t know who is FULLY VACCINATED or who is at a high risk for severe COVID-19 infection.
  • CDC guidelines and Health Department recommendations will likely change as more information becomes available.
  • keep in mind: guidelines change quickly as we learn about this virus. Stay informed and stay safe!

From your friends at Concierge Medicine of Jupiter