Good Health Blog

In my recent reading in the Medical press I came across a study in the Medical Journal of Australia (MJA) about your opinion about Preventative health care and who you think should be providing it.

Participants saw preventive care as legitimate in general practice when it was associated with concrete action or a test, but rated their general practitioners (GP) as poor at delivering prevention. Trust, rapport and continuity of care were viewed as enablers for participants to engage in prevention with their GP. Barriers to participants seeking preventive care through their GPs included lack of knowledge about what preventive care was relevant to them, consultations focused exclusively on acute-care concerns, time pressures and the cost of consultations.

The study concluded that a disconnect exists between your (the patient) perceptions of prevention in general practice and government expectations of this sector at a time when general practice is being asked to increase its focus and effectiveness in this field.

Preventative health makes good sense. It saves the Government money and improves the wellbeing of the community. There are barriers in the way General practice works. The slower, caring, comprehensive GP is the most likely to privately bill and is often booked out. The often similarly caring GP who bulk bills is overloaded with acute cases and long consultations are less likely to be undertaken.

And so eDoc evolved. The idea was to put the power back in your hands. Know what you should be doing, ask your GP to arrange the tests, educate yourself. The real responsibility is in your hands.

Consider doing a health check on your children. A good preventative health plan starts while the mother is pregnant!

To give you an example lets find out about a  10 year old boy whose grandparent had diabetes. The edoc recommendations include:

Dental Check-up
Most children and adults should see their dentist for a regular cleaning and check up every six to 12 months. People at a greater risk for oral diseases should have dental check ups more than twice a year. Tobacco and alcohol use, diabetes, pregnancy, periodontal and gum disease, poor oral hygiene and certain medical conditions are some of the many factors that your dentist takes into consideration when deciding how often you need your dental cleaning and check up.

Diabetes  Screening
Young people who are at risk for developing diabetes should be tested every two years. Risks include being overweight, inactive and a family history of diabetes.
Most people do not have any symptoms when they develop type 2 diabetes. However, when the levels of glucose in the blood are particularly high (this is common in type 1 diabetes), symptoms can include weight loss, tiredness and lack of energy, excessive thirst, blurred vision, increased infections and frequent urination.
Occasionally, the onset of diabetes can be abrupt. This is particularly the case with type 1 diabetes. The symptoms include: Loss of appetite, weight loss, vomiting, excessive passing of urine, atered consciousness and coma.
Seek immediate medical advice if these symptoms occur.

Eye examination
A routine eye examination should be done every two years to detect early changes that you may not notice now but might lead later to vision loss.
Your best defense is to have regular checkups, because eye diseases do not always have symptoms. See an eye care professional right away if you have a sudden change in vision or everything looks dim or if you see flashes of light. Other symptoms that need quick attention are pain, double vision, fluid coming from the eye and inflammation.

Weight screening
Know your childs weight and height and check it annualy to ensure theyremain in a healthy range over the years.   A healthy weight reflects a a healthy diet and exercise level.

To keep teeth healthy:

• Clean your teeth at least twice a day after meals.
• Low fluoride toothpaste is best for children under six years of age. Introduce low fluoride toothpaste from approximately 18 months of age.
• Enjoy a wide variety of nutritious foods.
• If you eat sugary foods and snacks, limit their intake – especially between meals.
• Drink plenty of tap water – especially if fluoridated.
• Milk and flavoured milks are preferable to other sugary drinks. If you do drink acidic and sugary drinks such as soft drinks, sports drinks, cordials and fruit juices, limit how often and how much of these you drink.
• If you live in a non-fluoridated area, seek advice about the use of fluoride toothpaste for children. A dental professional may advise more frequent use of a fluoride toothpaste, commencement of toothpaste at a younger age or earlier commencement of use of standard toothpaste.

Regular dental check-ups (as recommended by your dentist or other oral health professional) help to keep teeth and gums healthy. The Child Health Record recommends children’s teeth should be checked at least twice before they are three and a half years of age. This might be done by a maternal and child health nurse, dental professional or paediatrician.

A wise old Dentist told me ‘You only have to floss the teeth you want to keep’

I reckon the number one health issue in Western countries today is elevated blood sugar levels.    Pre-diabetes is a condition in which blood glucose levels are higher than normal, although not high enough to be diabetes. Pre-diabetes has no signs or symptoms and people with pre-diabetes have a higher risk of developing type 2 diabetes and cardiovascular (heart and circulation) disease.

Without lifestyle changes , approximately one in three people with pre-diabetes will develop type 2 diabetes.

Type 2 diabetes is a condition in which blood glucose levels are higher than normal because the body is unable to produce sufficient insulin, or the insulin it produces is unable to work as effectively in the body (insulin resistance).

Insulin is a hormone that is needed to move glucose from the blood into the cells for energy.. A lack of insulin leads to raised blood glucose levels. Type 2 diabetes is a serious and chronic medical condition that over time can lead to long-term damage of nerves and blood vessels, kidneys, heart, eyes and feet.

Symptoms of pre-diabetes – NONE !

Pre-diabetes has no signs or symptoms. It is important to be aware of the risk factors and have your blood glucose levels checked by a blood test ordered by your doctor if you are at risk.

Risk factors for pre-diabetes

The risk factors for developing pre-diabetes are the same as for type 2 diabetes, and include:

• A family history of type 2 diabetes
• Being overweight or obese
• Low level of physical activity
• Smoking
• High blood pressure or abnormal blood fats (or both)
• Cardiovascular disease
• Indigenous Australian or Torres Strait Islander people
• People from some cultural backgrounds including Middle Eastern, South Asian, Pacific Islander and North African backgrounds
• Gestational diabetes during pregnancy
• Polycystic ovarian syndrome
• Some antipsychotic medications.

During my average consulting day about half of the patients have risk factors for pre-diabetes.  I try and do as many blood sugar finger prick tests as practicable but one of the best ways to determine if YOU have a problem is to ask.

‘Can I have a sugar test please Doc!’

One of my favorite research projects that I have followed over the years are the longitudinal studies of aging.  This is not because I am necessarily getting older any faster than anyone else  – but ageing  is an inevitability for all of us!

The Baltimore study is a prime example and really demonstrated the relevance of undertaking preventative health at any age.   When I started medical school the general concensus was that once you were an adult you stayed much the same until retirement when you were suddenly ‘old’ and things started going wrong.  Life does not work that way apparently.  You do not age any faster between 70 and 80 than you did between 30 and 40 or 20 and 30.  What you do determines your health. What is essential at 25 for good health remains essential at 75.  The following are the recommendations for staying Healthy at 50+

These are adapted from information provided by the Agency for Healthcare Research and Quality; based on research findings from the U.S. Department of Health & Human Services and the U.S. Preventive Services Task Force.

DAILY STEPS TO GOOD HEALTH

• Be tobacco free.
• Be physically active.
• Eat a healthy diet.
• If you drink alcohol, drink only in moderation.

SCREENING TESTS AND PREVENTIVE MEDICINE

Heart and Vascular Diseases

• Aspirin to prevent heart attack: Men at risk* — Ages 50 to 80.
• Aspirin to prevent stroke: Women at risk* — Ages 55 to 80.
• Abdominal Aortic Aneurysm Screening Test: Once for men who have smoked — Ages 65 to 75.
• Cholesterol Screening Test: All men and women — Ages 50 and older.
• Diabetes Screening Test: Men and women — Ages 50 and older with high blood pressure.

Cancer

• Breast Cancer Screening (Mammogram): All women — Ages 50 and older, every 1 to 2 years.
• Breast Cancer Preventive Medicines: Women at risk*— Ages 50 to 80.
• Cervical Cancer Screening (Pap Test): All women — Ages 50 to 65, at least every 3 years.
• Colorectal Cancer Screening Test: All men and women — Ages 50 and older.

Bone Disease

• Osteoporosis Screening (Bone Density Scan): Women at risk* — Ages 60 to 65, and all women — Ages 65 and older.

Sexual Health

• HIV and Sexually Transmitted Infection Screening Tests: Men and women at risk* — Ages 50 and older.

Mental Health

• Depression Screening: All men and women — Ages 50 and older.

Immunizations

• Flu Vaccine: All men and women — Ages 50 and older, annually.
• Other Vaccines: You can prevent some serious diseases, such as pneumonia, whooping cough, tetanus, and shingles, by being vaccinated. Talk with your doctor or nurse about which vaccines you need and when to get them.

The best time to undertake preventative programs is NOW.

In these unpredictable times, the blog updates on eDoc.net have been a bit tardy.  Our excuse is that this site is managed by a coal face team and, to put it mildly, life has been busy.  At the start of January, I flew in Mallacoota, a country town in Victoria, Australia, and provided volunteer medical work for a couple of weeks to help the community through the devastating fire season and aftermath.  Much of the time was spent in a face mask for protection from the ash and smoke.  Fast forward only a couple of months and again most days are again spent again in a face mask, this time treating patients amid the covid-19 pandemic.

It is now time to take stock of 2020 and remember that despite natural disasters – fire and pandemic – life goes on for many and those scientific research-backed preventative health recommendations are still there to ensure you maintain the best possible quantity and quality of life.  If you haven’t done an eDoc.net screen for while then now is a ripe opportunity. It’s free, it’s anonymous, and takes only a few minutes.  Preventative health measures extend and improve the lives of millions.  The first step in knowledge and this is at your fingertips – literally – now. 

It is now recommended that Doctors offer to prescribe risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, to women who are at increased risk for breast cancer and at low risk for adverse medication effects.

The United States Preventative Health Task Force recommends against the routine use of risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, in women who are not at increased risk for breast cancer.

This recommendation applies to asymptomatic women 35 years and older, including women with previous benign breast lesions on biopsy (such as atypical ductal or lobular hyperplasia and lobular carcinoma in situ). This recommendation does not apply to women who have a current or previous diagnosis of breast cancer or ductal carcinoma in situ.

How would you know?  If you have a family history of breast cancer then talk to your Doctor.

There are a number of risk factors that may make you suitable for these medications.

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 the production of hormones, bile and 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 may lead to heart disease.

Health authorities provide recommend cholesterol levels If there are other cardiovascular risk factors such as smoking and high blood pressure or pre-existing cardiovascular (heart) disease then the recommended levels are lower. In developed countries approximately half the adult population has elevated cholesterol levels. A one in two risk!

This makes high blood cholesterol a major health concern.

Lifestyle tips to cut cholesterol

Changing some of your lifestyle habits may also help to reduce your cholesterol and triglyceride levels. Suggestions include:
Cease alcohol consumption or reduce your alcohol intake to no more than one or two drinks a day. Avoid binge drinking. This will to help lower your triglyceride levels.
Don’t smoke. Smoking increases the ability of LDL cholesterol to get into artery cells and cause damage.
Exercise regularly (for example, at least 30 minutes of brisk walking daily). Exercise increases HDL levels while reducing LDL and triglyceride levels in the body.
Lose any excess body fat. Being overweight may contribute to raised blood triglyceride and LDL levels.
Control your blood sugar levels if you have diabetes. High blood sugars are linked to an increased risk of atherosclerosis (‘hardening of the arteries’).

Do you know your ideal weight for your height? What is the normal range? Good health is many things and the focus on weight is only one parameter. I tell my overweight patients that I would prefer them fat, fit and happy than unfit, smoking and thin. Life is a balance. Good health is a balance. An obsession with weight as a primary measure of health is misguided. Still, it is nice to know what is recommended. The reports give a link to weight/height details. Good health and preventative health go hand in hand.

The US Preventative services task force has released a new recommendation about screening for HIV infection.

“Screening for HIV is important so that everyone knows their HIV status, and those with HIV can begin treatment right away,” says Task Force member John Epling, M.D., M.S.Ed. “Today’s treatments help people live long, healthy lives and lower the risk of passing HIV to others.”

That’s it in a nutshell.  If you have ever had sex or used intravenous drugs then you should know your HIV status. There are ‘at risk’ groups but the recommendation is for everyone to know their HIV status.  This is because over half the new transmission cases are by people who did not know they were HIV positive.