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Monthly Archives: August 2010

To PSA or not to PSA – the prostate question

Gavin LeSueur - August 31, 2010

I have had a number of questions regarding prostate screening and in particular the PSA test. All of the organizations emphasize the considerable controversy surrounding screening due to the lack of conclusive evidence that screening can reduce mortality (death) from prostate cancer. All of the groups also address the clear potential that screening may increase treatment-related morbidity (side effects). The groups agree that there is insufficient evidence to recommend routine screening for prostate cancer in any age group, and that the decision to undergo screening should be an individualized, informed decision on the part of the patient in consultation with his physician.

There is overall agreement that clinicians should inform men of the potential benefits, known risks (including overdetection and overtreatment), as well as the limits/gaps in current evidence. These factors, in conjunction with the patient’s personal preferences and age/life expectancy, should be taken into consideration in the collaborative decision-making process.
If the decision to screen is made, there is overall agreement that while the PSA test is more sensitive than the DRE (digital rectal examination), the DRE is useful and should be performed as well.

Confused? What this means is that we do not have a good test for prostate cancer and the tests we have may lead to complications. If you are a male over 45, have a family history of prostate cancer or have changing urinary symptoms it is recommended that you discuss the issues with your Doctor.

Trimming the fat…

Gavin LeSueur - August 29, 2010

Cholesterol is a type of fat that is part of all animal cells. It is essential for many of the body’s metabolic processes, including hormone and bile production, and to help the body use vitamin D. However, there’s no need to eat foods high in cholesterol. The body is very good at making its own cholesterol – you don’t need to help it along. In fact, too much cholesterol in your diet can lead to heart disease.
Screening for cholesterol is recommended after age 35 for males and 45 for females. The optimal interval for screening is uncertain. On the basis of other guidelines and expert opinion, reasonable options include every 5 years, shorter intervals for people who have lipid levels close to those warranting therapy, and longer intervals for those not at increased risk who have had repeatedly normal lipid levels.
Risk management is all about education. You learn to drive before hitting the highway. Learn what you need to know to maximise your health potential.

The Exercise Prescription

Gavin LeSueur - August 22, 2010

For many years I have been writing out the minimum recommended daily activities that my patients should be doing each day and week. In other words how much puffed and loaded exercise.
Observational studies show that sedentary lifestyles (little or no leisure time, household, or occupational physical activity) are associated with increased risks for many chronic diseases and conditions, including cardiovascular disease, hypertension, diabetes, obesity, and osteoporosis, and that increased levels of physical activity can reduce these risks.
Despite the well-established benefits of exercise, only about 20 percent of adults achieve the recommended level of moderate physical activity: 30 minutes of moderate physical activity on most days of the week. Only 15 percent of adults achieved a vigorous level of physical activity for 20-minutes on three days of the week.
I decided to put the recommendations into my electronic script writer. I now just print out a script and ask my patient to take what it says as recommended. I occasionally get a call from a Pharmacist saying ‘how do I give Mrs …. a tablet that will make her do 30 minutes puffed exercise four days a week?”
I just smile. At least one out of five is doing what is recommended. On the recommendations list is your age/sex exercise prescription.

The Eye’s have it!

Gavin LeSueur - August 8, 2010

Are You at Risk For Glaucoma?
Glaucoma is an vision problem caused by damage to the optic nerve, usually caused by increased pressure of the fluid contained in the eye. Everyone is at risk for glaucoma. However, certain groups are at higher risk than others.
People at high risk for glaucoma should get a complete eye exam, including eye dilation, at least every two years. High risk groups include having a family history of glaucoma, being over the age of 60, use of steroids, previous injuries to the eye and specific racial groups (eg african-Americans have a six fold increase over causcasians).
Other possible risk factors include:
* high myopia (nearsightedness)
* diabetes
* hypertension
There is no specific screening recommendation for the general population although the special interest groups recommend a review from the age of 40 years.
It is important to discuss screening with your Doctor if you have increased risk factors.

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