Tag Archives: Prevention

Dr. C "Comments", Men's Health, Prevention, Technology, TELEMEDICINE, Videos, Women's Health

PREVENTION: “FORWARD CLINICS” ARE ALL-INCLUSIVE, FLAT-FEE PRIMARY CARE

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Forward care is evidence-based, focused on prevention and improvement. Set goals and collaborate for better health.

  1. Connect Your Biometrics Sensors
    • Receive your Sensor Kit
    • Record measurements in the app
    • Review insights together with your doctor
  2. Complete Your Labs at Home
    • Schedule your at-home blood draw with a lab specialist
    • Receive comprehensive results
  3. Create a Personalized Plan During Your Baseline Visit
    • Discuss your health goals and concerns
    • Review your biometrics and lab results
    • Develop a personalized, preventive plan
  4. Answer Questions In-App for Insights on Your Mental Health
    • Answer a short series of questions in-app
    • Receive a measure for anxiety and depression
    • Partner with your doctor on your results
  5. Customize Your Plan Based on Your Genetics
    • Receive your Genetics Kit
    • Review the results with your doctor
    • Update your plan to address your risks
  6. See Your Doctor In Person for a Custom Follow Up Visit
    • Request an in-person visit in the app
    • Review your progress with your doctor
    • Complete a physical exam and diagnostics
  7. Assess Your Skin Cancer Risk
    • Complete a physical exam of your skin
    • Capture high-definition images of any moles or blemishes
    • Discuss your skin health and cancer risks with your doctor
  8. Receive a Message From Your Doctor to Update Your Plan
    • Your doctor will check-in regularly 
    • Update your doctor on progress and goals 
    • Ask questions, anytime from anywhere
  9. Develop Nutrition Goals Based on Recurring Labs
    • Review your latest labs with your doctor
    • Develop a nutrition plan for targeted results
    • Measure progress with future labs

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COMMENTARY

Forward Healthcare differs from a conventional primary care clinic in several, generally good ways.

Most importantly, they stress PREVENTATIVE care. Blood tests that monitor diabetes, metabolic syndrome, and anemia are done regularly, since they have a laboratory on premises. They have their own EMR (electronic medical record) platform, and their own telemedicine platform, which are downloaded on the initial visit.

They give out a “sensor kit” consisting of temperature monitor, Pulse-oximetry, and a BP monitor, which wirelessly sends information to medical records.

Telemedicine is available through their own Downloaded platform. Although I get the impression that Telehealth isn’t as central as I would have expected in a technology oriented operation, it is increasingly important.

The monthly membership fee of $149 pays for the above and unlimited Doctor Availability 24/7 without copay.

Concierge Medicine has the monthly/yearly fee and unlimited access, but has a copay. Both will utilize your insurance, and neither treats patients in the hospital or provides referral care.

Government Health care is coming, and with it longer waiting times, shorter Doctor interaction times, and probably less time for Preventative Health Care.

Systems like Forward Health and Concierge Medicine will be the upper tier of a 2-tier system.

Proactive attention to Health in my opinion is essential in the future if we are to have a healthy nation, and not “bankrupt the system”. Telehealth is growing in importance, and offers help in making medical expertise more convenient, widely available and for less cost.

I am happy to see progressive Systems like Forward Health offer a preventative option to the present, broken, reverse-incentivized, fee-for-service System.

—Dr. C.

Dr. C "Comments", Opinion, Prevention, Women's Health

WOMEN’S HEALTH: RISK FACTORS AND PREVENTION OF OSTEOPOROSIS

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I have heard the same story over and over. You get older, you trip over your dog or on the edge of a rug, you fall and break your hip, and in treatment or convalescence, you get a pneumonia and die, or at least you get weaker, setting you up for the next fall. Your course is downhill.

The culprit is often OSTEOPOROSIS. Osteoporosis is a disease characterized by loss of bone mass, as opposed to Osteomalacia, discussed in a recent podcast on this site, which is softening of bone The word itself is a MEMONIC for the RISK FACTORS; Then comes WHAT TO DO.

The RISK FACTORS and Prevention Strategies can be remembered in the following mnemonic:

Osteoporosis prevention begins when you are a child, with healthy diet rich in Calcium, and lots of exercise. Your bone mass peaks in the early 20s. While you are young, in your reproductive years, your reproductive hormones, Estrogen and Testosterone protect you.

Women should develop a Preventative strategy during menopause. Being THIN, like i am, is generally a marker of good health, much better than being Fat.

But especially as you get older and Lose muscle mass, Osteoporosis can become a problem, maybe because your bones don’t get the stress required to keep them strong.

BONE DENSITY DECLINES WITH AGE. I get a DEXASCAN as often as my insurance allows, about every 2 years, and am due this summer.

More and more treatments for Osteoporosis are emerging, if your bone loss becomes severe enough.

KEEP IN CONTACT WITH YOUR DOCTOR.

–Dr. C

Dr. C "Comments", Prevention, Resources, TELEMEDICINE

INFOGRAPHICS: “DIGITAL HEALTH TECHNOLOGIES IMPROVING PATIENT CARE”

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COMMENTARY

The technology of telemedicine will predictably and steadily get better.
Medical assistants, mostly human at present, are commonplace, notably in specialty offices, and machines using improving voice-to-text transcription are getting better.

Wearable devices are proliferating and hopefully coming down in cost, and platform technology is improving though still glitchy.

Patients generally accept Telemedicine. They like the saving of travel time and infection exposure.

Doctors may drag their feet because the increased effort and legal exposure is not compensated by increase in payment. On the contrary, pre-Covid compensation was LESS for a televisit. Continuing Parity would help.

The politicians at the state level should eventually make licenses valid across state borders.

The big wild card is the Legal Profession. Unless they develop restraint( and litigious patients reform), there could be a feeding Frenzy, which would delay implementation of a very good idea.

Eventually telemedicine deserves to be 50% or more of medical practice.

—Dr. C.

Dr. C "Comments", Prevention, Videos

HEALTH: THE HISTORY OF FACEMASKS AND DISEASE THROUGH THE CENTURIES

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Originating during the Black Death of the Middle Ages, face coverings to protect against the transmission of disease are not just medical requirements; they’re now a fashion statement. Mark Phillips talks with medical historian Mark Honigsbaum (“The Pandemic Century”) about the purpose and style of facemasks.

COMMENTARY

Medicine has always operated in the context of theory, which is easier to generate than fact. The medieval physician with the “bird mask” thought he was protecting himself from “miasma”, which was theorized to be the means by which PLAGUE was spread. In fact, the masks’ main function was to hide his identity from his Patient, whom he could not help. The painting makes him appear to be the Grim Reaper himself.

The story of Guaiac, another illustration medieval medicine, is entwined with Syphillis, the stigmatizing STD of post Columbian Europe. Each country blamed Syphillis on its’ rival- the English called it the French disease, for instance-until they were able to blame it on the “new world”. Since it came from the Americas, so must its’ HERBAL REMEDY, according to theory.

GUAIAIC, the resin from the small tree from the Caribbean, became a popular cure. It might have even lessened suffering from Siphillis, since it was used instead of the highly toxic MERCURY.

Guaiac eventually found a use in Criminology, as a test for blood at the crime scene. When Guaiac is mixed with a suspicious spot and peroxide, it changes color rapidly to a bright blue. Medicine later used Guaiac as a test for hidden (occult) Blood In the stool; a positive, brilliant blue test throws suspicion on intestinal cancer as the culprit.

We come full circle to present day mask usage in the Covid epidemic. Some countries outlaw masks because masks interfere with criminal investigation. This interdict had to be relaxed during The Pandemic. How convenient for the rioters and looters in Minnesota!

—Dr. C.

Opinion, Resources

DR. C’S MEDICINE CABINET: “OVERVIEW OF METABOLISM”

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“Life is nothing but an electron looking for a place to rest”.

Albert Szent-Gyorgy

Overview of Metabolism – Seeing an Essence of Nanosystems in the Hum of a Vibrant City; the Skyscraper as Catalyst, and Thought as Electron

What did it take to bring the world to its’ knees? SARS-CoV2? We will never know, because we instituted DISTANCING to control the virus because the projected number of deaths were unacceptable.

The distancing and isolation did hold the number of deaths, still large, below projection. However, it DEVASTATED our Economy.

OUR WORLD is a  massive, cooperative, interdependent system, with hubs, factories, supply chains and a myriad of products. It is a COMPLEX SYSTEM.

I would like to use the world as an analogy, and compare it to another Complex System, the HUMAN BODY.

Our bodies are essentially a large pile of chemicals (mostly proteins) in a sack, our skin. These chemicals are constantly interacting with each other. If they grow to larger, more complex chemicals in a process we call anabolism, we take in more chemicals and energy by eating, and get bigger. If our chemicals get less numerous and complex in a process we call catabolism, we lose weight and get smaller.

Some of the proteins in our bodies are ENZYMES, and bring other proteins CLOSER TOGETHER, so that they can LINK TOGETHER  become more complex and PRODUCE things. Enzymes are a sine qua non of life. Without enzymes, life would slow so much as to be impossible. 

Let’s go back to our Society, Before Covid. 

Vast numbers of people are cooperating in close proximity, working together with machines, often supplied by other people far away, making things. This process takes place most efficiently in CITIES, where people are in closest proximity, doing things together.

Enter Covid. This interdependent process stops. What things that are produced are made to fight Covid. It is just like one of our cells infected by Covid: we have been HIJACKED  by the virus!

Lets’ GO BACK TO OUR CELLS. Our METABOLISM is like our teeming, cooperative CITIES, with SUPPLY CHAINS, factories and products. Our PROTEINS NEED PROXIMITY to function.

Some Proteins are at a critical HUB, and comprise a RATE-LIMITING step in the production line.

Many Vitamins and nutrients are COENZYMES, and act to ACCELERATE critical supply lines.

If the Hubs are OUT OF BALANCE and OVERACTIVE, many MEDICATIONS act to BLOCK THE ACTION of an enzyme to bring the system closer to balance.

Thus coordination, cooperation and careful monitoring to PREVENT A PROBLEM is superior to letting it break down and correcting the imbalance.

I hope that this Overview will be helpful. I will go through my MEDICINE CABINET to discuss a few of the 20,000 or so Medications approved by the FDA. I will also VIEW THE TEST RESULTS from my LABORATORY TESTS. NORMAL results show a SYSTEM IN BALANCE. Abnormal results show inefficiencies in the metabolism (supply chains, hubs), which need correction to restore balance.   

— Dr. C

Dr. C "Comments", Men's Health, Prevention, Women's Health

HEALTH: ARE FACE SHIELDS THE BETTER PROTECTOR?

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From a New York Times article (May 24, 2020):

Dr. Perencevich believes that face shields should be the preferred personal protective equipment of everyone for the same reason health care workers use them. They protect the entire face, including the eyes, and prevent people from touching their faces or inadvertently exposing themselves to the coronavirus.

The debate over whether Americans should wear face masks to control coronavirus transmission has been settled. Governments and businesses now require or at least recommend them in many public settings. But as parts of the country reopen, some doctors want you to consider another layer of personal protective equipment in your daily life: clear plastic face shields.

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COMMENTARY

When I take my walk, which currently is my only outing, I wear a face SHIELD for my personal protection against contracting Covid 19 from others.

I gave up on the face MASK because it is uncomfortable, especially when I am breathing heavily while walking rapidly up hills.

There isn’t much research supporting the self-protective use of face shields, but the video accompanying this article was enough for me; notice the aerosol-free area behind the face shield.

While walking, I breathe In deeply through my nose, and exhale through my mouth, using “pursed lips”, which aids in oxygen extraction by holding the alveolae open.

Exhaling through the mouth also clears the air behind the mask for subsequent nasal inhalation.

With nasal inspiration, any SARS CoV-2 aerosol particles would be deposited in the nasal passages, Which are that much farther away from your vulnerable lung.

It isn’t perfect. For one thing, it wouldn’t protect you much if someone coughed at you from the side or behind. I often hold my breath reflexes when I hear someone cough, or when I pass closely (even 6ft.) to someone.

The face shield holds promise for protecting you from viral infection, including the “flu”.

—Dr. C.

Men's Health, Opinion, Prevention, Women's Health

OPINION: FACE MASKS AND SHIELDS TO PREVENT COVID

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My main exercise for the day is a 45 minute fast walk around my community.

Hat – check. Sunglasses – check, FACE SHIELD – check.

Yes, face shield. The shield has the advantage of allowing me to talk, plus being more comfortable to wear. I clean it with a woolen cloth on one side and cotton on the other, hoping for a condenser electrostatic effect (I’m open to suggestion from engineers).

If I cough, any large particles of mucus would impact the shield, leaving only tiny aerosol particles to escape around the edges into the environment to endanger others.

It is Saturday today, and I pass a man and a woman pushing a baby buggy, and give them wide berth. I don’t consider 6-feet far enough distancing. 12-18 feet would be better, since, at 88-years of age, I am at least 2-3 times more susceptible.

A 12-year old zooms by me on a scooter. His age predicts less viral effluent, and the exposure time is less. I then go by a large collection of 20-year olds, Wide berth again, and, holding my breath, continuing to walk fast.

As I walk, I breathe air in through my nose, and out through my mouth. I feel the warmth (and purity) of the exhaled air, which may push aside and dilute any contaminants coming from the outside.

Another group of young adults! Well, maybe the risk is not as bad as the numbers would indicate. Odds are there would be only one spreader in the group, and the healthy ones would act as particle filters for me.

So far, not a single young person had a mask on. They are probably just thoughtless young people, and not necessarily “objectors” believing that mask-wearing is a sign of submission. As Peggy Noonan said in her column in today’s WSJ:

“…IT’S A SIGN OF RESPECT, RESPONSIBILTY AND ECONOMIC ENCOURAGEMENT”.

Going forward, we must all do our part to reduce the likelihood of another Covid surge. WEARING A MASK PROTECTS OTHERS.

I finally spied 2 masks! They were fitted on 2 ceramic lions flanking a front door. It is true that felines can catch Covid. But ceramic ones?

I thought I was walking fast, but was overtaken from the rear by a long-legged young lady. She passed within 4 feet of me, and of course had no mask on. I only hope she didn’t have Covid, and that my shield worked.

On the subject of the effectiveness of wearing a shield, while walking I tune into the odors along the way. I use the odors as surrogate aerosols, especially a recently fertilized curbside flower bed, I compare walking by the flowers, with and without my face shield, and find that the shield reduces but does not eliminate the odor. For more distant odors, like a barbecue, it does not make a difference.

Perhaps the shield, like the prow of a ship, pushes aside STREAMS of particle-laden air. Like coughing or talking nearby. But if the particles (yes, odors are nanometer particles) are well mixed with the air, there is no effect. Air must be breathed, after all.

There are a couple of other things I practice on my walk. I exercise my EYES by looking into the DISTANCE as much as possible. I try to walk as erect as I can. Gravity, my friend in grounding many big Covid-containing mucus particles, tries to bend me over.

The BOTTOM LINE, until more information is available), is: SPREADERS WEAR MASKS, SUSCEPTIBLES  WEAR SHIELDS. Of course, hand-washing, social-distancing, coughing into your elbow, and staying at home, especially if sick, are all still important admonitions.,

-Dr. C.

For further reading

Men's Health, Opinion, Prevention, Women's Health

OPINION: THE BENEFITS OF HIGHLY NUTRITIOUS DIETS

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Vitamins and minerals, as we all know, are of critical importance to our health. Gone are the days when scurvy(vitamin C) was the scourge of the high seas, and rickets (vitamin D) was common in the children of smoke-filled industrial cities with insufficient sunlight.

We are in a state of such overabundance that many medical authorities feel that vitamin supplementation merely makes our toilets healthier.

Covid 19, with a deficit of prevention and treatment options, has forced a new appreciation of the role of our immune systems in fending off Covid, and future viral plagues that are certain to follow. Optimum Health has never been more important.

A May 4, 2020, British Medical Journal (BMJ) article highlights the role of vitamins C and D, and minerals, especially Zinc, in functioning of our immune systems. Here are several highlights from the article:

  • Foods that are naturally abundant in vitamin C such as broccoli (60 mg/100 g), blackcurrants (130 mg/100 g), fortified breakfast cereals (up to 134 mg/100 g) and oranges (37–52 mg/100 g)45  should be made accessible to older individuals who are most in need of their nutritional benefits.
  • In the UK 5.5% of men and 4% of women 65 years and over (around 1 in 20) presently have zinc intakes lower than the lower reference nutrient intake (the level below which deficiency could occur).46 The consumption of foods naturally abundant in zinc such as canned crab (5.7 mg/100 g), canned shrimps (3.7 mg/100 g), canned adzuki beans (≈2.3 mg/100 g) and boiled eggs (1.3 mg/100 g) should be encouraged as a supplementation strategy to reinforce immunity.
  • Tolerable upper intake levels (ULs) are intake levels which should not be surpassed as toxicity problems could appear.47 For vitamin D a UL of 50 µg/day is advised and for zinc a UL of 25 mg/day is recommended. 47 There is insufficient evidence to establish UL for vitamin C, but available human data suggest that supplemental daily doses of up to about 1 g, in addition to normal dietary intake, are not associated with adverse gastrointestinal effects.47 Not having an adverse effect, however, is not necessarily indicative of a benefit either, and ongoing trials are warranted.
  • Among those with established respiratory conditions or pneumonia, specific nutrients such as vitamin C, D or zinc could be considered as potential adjuvants to conventional treatment pathways.

Susceptible people, particularly the old, should use every safe measure to stay well.

– Dr. C

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Prevention, TELEMEDICINE, Women's Health

TELEMEDICINE: Obstetrics & Gynecology Services

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The following list contains preventive services that may be done via telehealth (from ACOG.org):

General Health

  • Alcohol screening and counseling regarding alcohol use
  • Anxiety Screening and referral*
  • Counseling regarding aspirin to prevent CVD and CRC
  • Blood pressure screening (if patient has appropriate resources available such as a blood pressure cuff)
  • Contraceptive counseling, discussion of methods, and prescribing contraceptives that do not require an in-person visit such as intrauterine devices or implants*
  • Depression screening and referral
  • Fall Prevention counseling
  • Counseling regarding folic acid supplementation
  • Healthy diet and activity counseling
  • Interpersonal and domestic violence screening and discussion of available resources*
  • Obesity screening (if patient has appropriate resources available such as a scale)
  • Substance use assessment (drug use)
  • Tobacco screening and cessation counseling
  • Urinary incontinence screening*
     

Infectious disease

  • HIV risk assessment*
  • Sexually Transmitted Infection prevention counseling*

Cancer

  • Counseling and possible prescribing of medications to reduce breast cancer risk 
  • Risk assessment for BRCA testing
  • Skin cancer counseling

Pregnancy and postpartum

  • Breastfeeding services and supplies*
  • Postpartum contraceptive counseling, discussion of methods, and  prescribing contraceptives that do not require an in-person visit such as intrauterine devices or implants
  • Depression screening and referral
  • Counseling regarding folic acid supplementation
  • Interpersonal and domestic violence screening and discussion of available resources*
  • Preeclampsia prevention with low-dose aspirin
  • Preeclampsia screening (if patient has appropriate resources available)
  • Tobacco screening and cessation counseling

*WPSI recommendation. For more information about each recommendation, please see our WPSI Recommendation page.

Download Well-Woman Care Chart

ACOG.org website

Read this May 4, 2020 “Women’sHealth” article for information about what a Telemedicine Visit is like

Opinion, Prevention

OPINION: THE IMPORTANCE OF VITAMIN D3 SUPPLEMENTS

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EVERYBODY should have a SERUM VITAMIN D level!

The medical establishment has been slowly acknowledging that the importance of vitamin D is not limited to just calcium absorption and the bones, or to the athletes and elderly.The lower limits of normal has been slowly creeping up, as has the RDA.

But how much vitamin D you have in your body depends upon your diet, supplements, how much sunshine your skin gets, how much sunshine is screened out ( sunscreen, melanin), and other factors. Measuring the vitamin D serum level tells you directly.

My own Vitamin D level was at first in the low 20’s (ng./ml.), and I raised it to the low 50’s when I started taking 4,000 I.U. daily, the lower limit suggested by the NFL.

Serum Vitamin D levels cost almost $100. Why not just take 4-6,000 I.U.? For me, adding to  already nauseating handfuls of pills (to be enumerated later) was unappetizing. I needed a Serum D level to convince me.

But I didn’t need to be convinced of the importance (with hospitalized Covid Patients the VITAL importance) of this amazingly versatile Vitamin. Vitamin D tends to benefit the innate immune system, helping to ameliorate infections when they first hit. It then helps to turn off “the first responder” when the “big gun” adaptive immune system kicks in at 5-10 days. Failure of this shift ( with continuing interleukin production) may contribute to the “cytokines storm” of the seriously ill Covid-19 patient.

Many Doctors, inured to “health food industry” hype, give little attention to Vitamin D.  You might need to expressly ask for a vitamin D test on your next visit. I hope you do!

—Dr. C.

Further reading:

Vitamin D is crucial for immune health