Archive for prevention
We here a lot about what we should be doing every day in terms of supplements and vitamins. A question I often get in the clinic is whether a daily aspirin should be taken and if so, how much. As with almost everything in life, it depends!
Aspirin has been around for a long time and is a marvelous pain reliever. One of its other major actions is that of a blood thinner. This can benefit you in preventing clots such as those that accumulate in the arteries that supply blood to the heart muscle. People with cholesterol blockages in those arteries are at greater risk for clot formation occurring on and within these cholesterol blockages. These are the types of clots and blockages that can rupture and cause a heart attack.
So it would stand to reason that we should all take a daily aspirin to prevent heart attacks. Not so fast! Aspirin can have serious side effects and not everyone needs that much protection from a heart attack.
It is currently recommended to take a daily aspirin if you have had a heart attack or stroke, if you have had a stent placed in an artery, if you have angina or if you have had coronary bypass surgery. You could also benefit from aspirin therapy if you are at high risk for a heart attack. It is also recommended in men over 50 and women over 60 with diabetes.
It is NOT recommended for you to take aspirin if you have a clotting disorder that causes you to bleed easily, if you have an allergy to aspirin and/or get asthma symptoms when you take aspirin, and if you have stomach ulcers. It is also important not to take aspirin if you are already on a blood thinner, as this would increase your risk of bleeding.
The dose of aspirin is as confusing as whether or not to take aspirin. Because of the increased risk of bleeding, especially from stomach ulcers; a low dose aspirin is often the first recommendation. A baby aspirin, or 81 mg, is low enough to usually not cause stomach problems but high enough to help with anti-coagulation (blood thinning). By the way, I don’t think babies are given aspirin any more. Full dose aspirin is 325 mg, and is usually recommended in the high risk groups.
The next question usually revolves around whether enteric coated aspirin is better than regular. Enteric coating prevents breakdown and absorption in stomach, theoretically preventing ulcers. This does not always work and there is some question as to how available and effective enteric coated aspirin is for protection. The aspirin given at the time of chest pain and potential heart attack is always #4 81 mg aspirins chewed. This has been shown to help survival and limit damage to heart muscle when taken early in a heart attack. Taking an aspirin when you think you may be having a stroke is generally not recommended as you may worsen a hemorrhagic stroke.
There has been some recent research suggesting aspirin reduces cancer. This is still debatable and studies have been inconclusive and contradictory; as has the reporting of these study results.
It does seem that high dose aspirin (too high for you to do without recommendation by your provider) may prevent or reduce colon cancer risk in high risk individuals with a specific gene mutation. There have been some early reports of reduction of breast cancer in women taking aspirin therapy, but the data is still inconclusive and no specific doses or length of therapy has been determined.
So the question remains, should you take a daily aspirin? I recommend discussing this with your medical provider at the next visit, as it is not my role to give medical advise through this blog. If however, you are not at high risk for heart attack or disease, do not have a bleeding disorder or stomach problems; a low dose 81 mg every other day will most likely not harm you and may give you some benefit for prevention of cancer and cardiovascular events. Ask your provider at your next visit what is right for you. He or she will know best how to answer this question knowing your personal and family history, your health habits and risk factors.
Women have traditionally been second-class medical citizens. More of them still die from heart attacks each year than men. More of them die with their first heart attack and though they live longer, Their end of life quality has been poorer. What do you do to prevent the preventable diseases?
What are preventable diseases? How about those that immunizations could prevent, or avoiding tobacco could prevent. How about colon cancer. No one should die of colon cancer, we can find it before it becomes cancer and remove it with a scope. Take a look at the following list and tell me which ones you do. It is anonymous! I don’t know who answered and who did not just how many. Please, check off the ones that apply. They all should!
When you are done, LEAVE US A COMMENT! Tell us what you think.
Ovarian cancer is the 9th most common cancer women can have and is the 5th leading cause of cancer deaths in women.
It is difficult to diagnose early, which can make it one of the more dismal gynecologic cancers a woman can have. Research is ongoing on methods of early diagnosis and detection, as well as trying it identify risk factors to aid in prevention.
- The American Cancer Society predicts that in 2010, 21,880 women will receive a new diagnosis of ovarian cancer and there will be 13, 850 deaths from ovarian cancer.
- These statistics are close to past years stats on diagnosis and death, although the rate of ovarian cancer has been declining slightly.
- 93% of women diagnosed in early stages of ovarian cancer live 5 yrs or more, however, only 19% of women with ovarian cancer are diagnosed in the early stages.
- Lifetime risk of developing ovarian cancer is 1 in 71, lifetime risk of dying from ovarian cancer is 1 in 95
- 50% of women diagnosed with ovarian cancer are over 60, risk is higher in white women over African American women.
- 3 in 4 women diagnosed with ovarian cancer survive at least 1 year, 46 % survive 5 years; women younger than 65 fair better than older women.
SYMPTOMS OF OVARIAN CANCER: many of the symptoms listed below can be present for completely normal or benign reasons, their presence does not ensure an ovarian cancer. Experts suggest however, that if many of these symptoms are new, unexplained, present daily or almost daily, last more than a few weeks; that evaluation is needed.
- Bloating, upset stomach, early satiety or difficulty eating a full meal, and constipation
- pelvic and/or abdominal pain, as well as back pain, pelvic or abdominal pain during intercourse
- Changes in menstrual pattern and especially post menopausal bleeding
- urinary frequency or a change in the pattern of urination, urgency to urinate
- unusual or unexplained fatigue
WHAT ARE RISKS OF OVARIAN CANCER?
- AGE: as mentioned above, incidence increases with age
- OBESITY: studies suggest a BMI of over 30 increases risk and death from ovarian cancer, although this has not been proven. Likewise, studies have suggested a diet low in fat and high in vegetables has shown a lower rate of ovarian cancer
- CERTAIN DRUGS: the use of fertility drugs for over 1 year especially if pregnancy was not achieved is associated with a higher incidence of low malignant potential tumors. These are tumors of the epithelial cell type which tend to grow slowly. Use of androgens (Donazol) has suggested a higher risk in a small study, however a larger study did not confirm this. Use of HRT, especially estrogen alone for more that 5-10 years has been associated with a higher rate of ovarian cancer.
- FAMILY HISTORY: 10% of ovarian cancers are from the genetic mutation on BRCA1 and BRCA2, many causes of epithelial ovarian cancers, which are the most common, are caused by inherited gene mutations and therefor identifiable through genetic testing. This is recommended for a family history of breast, colon and ovarian cancer even if on father’s side of the family.
- PRIOR BREAST CANCER: many of the same risk factors for breast cancer also exist for ovarian cancer, primarily the gene mutations mentioned above ; and possibly use of HRT. The presence of a prior cancer suggests a problem with DNA replication.
Other factors that have been looked at are use of talcum powder, use of analgesics, smoking and alcohol consumption. The use of talcum powder applied to the genital region, as well as sanitary napkins containing talcum powder; has been suggested as one possible cause of ovarian cancer. It is speculated that talcum powder used more than 20 years ago contained trace amounts of asbestos, which is a known carcinogen. The FDA has required all talcum powder to be asbestos free, and there is no association with use of corn starch containing personal hygiene powders with increased risk of ovarian cancer. Studies have failed to demonstrate and increased risk of ovarian cancer with use of aspirin, acetaminophen products, alcohol or smoking.
How can a woman reduce her risk of getting ovarian cancer? There is not a lot of data to give concrete answers but studies doe suggest that the following strategies can be considered:
- Use of oral contraceptives for 5 years or more seems to reduce risk by 50% over non users of birth control pills. Likewise, risks goes down with each pregnancy as well as breast feeding. This is most likely associated with lack of ovulation, or continued activity within the ovary month to month.
- Gynecologic surgery such as bilateral tubal ligation and hysterectomy is also associated with lower risk, exact reasons are unknown. These tests should only be done for valid, medical reasons.
- Genetic counseling is very important if there is a family history of cancer including the BRCA gene mutation. this is a complicated issue, but can identify women at risk and allow them to take recommended surgical action.
It is most important to see your medical provider for any new signs and symptoms of ovarian cancer, even if there is not a family history of cancer. Long term survival is best when this particular cancer is diagnosed and treated in the early stages. Regular exams and good dialogue with a medical provider you trust is key, tell your provider everything you are feeling even if it seems trivial!
We all want to prevent the more negative or harmful aspects of aging, but given our genetics, can we really? YES! The field of Preventive Medicine is structured around the actions of HEALTH PROMOTION and DISEASE PREVENTION.
The leading contributors of death in the US are all related to :
- Tobacco-contributes to >400,000 deaths annually
- diet and activity patterns-obesity in age 25-45 has associated risk of Hypertension 5.6 x higher than non-obese and in 20-75 yr old obese people, risk of diabetes is 2.9 times higher than non-obese people
- alcohol overuse and related accidents, risky sexual behavior, illicit drug use
- Microbial and toxic agents
- Motor Vehicles
Health promotion actions would be structured around mitigating or changing behavior in relation to the items listed above. In looking at this list, suggestions would include:
- Alcohol overuse avoidance. Small amounts of alcohol-7 or less per week in women-is considered safe. More than this raises blood pressure, causes weight gain, can cause liver disease, is linked to increase risk of breast cancer, interferes with quality of sleep
- Tobacco use- causes lung disease such as COPD which can also cause heart disease, lung cancer, blockages in blood vessels in legs, causes hypertension, injures and interferes with ability of skin to remain healthy and repair itself
- Exercise-improves cardiovascular health, keeps blood pressure low, helps glucose metabolism, helps with weight control, improves mood and sleep, helps breathing capacity, improves bone strength and helps to prevent osteoporosis, aids in digestion and elimination
- Healthy diet-helps with most of the above, additionally, a diet high in antioxidants can help to prevent cancers such as skin, colon, breast cancer. It aids the immune system to fight off the microbial agents mentioned above such as influenza, pneumonia, common colds.
- UV light exposure reduction-use sunscreens to prevent skin cancer. Different skin cancer cares different health risks, all of which can be serious.
- Safe sex-use condoms if with a new partner! Even menopausal and peri-menopausal women can get an STD such as HIV, syphilis, chlamydia, gonorrhea, hepatitis B and/or C, and herpes. These STD’s are serious and some are fatal.
- Seat belt use-motor vehicle accidents are a major cause of injury and death. Seat belt use has become almost ubiquitous with driving but some people continue to avoid use.
Disease prevention is related to actions and person and their medical provider plan and implement together in order to prevent or improve disease outcomes. Examples of this would be:
- Blood pressure monitoring
- Lipid testing
- Glucose testing
- Immunizations such as Td(tetanus & diphtheria), influenza, pneumococcal(pneumonia)
To summarize the above information-what can someone do in their lives to improve their health and prevent disease and illnesses such as hypertension, heart disease, lung disease, diabetes and osteoporosis; as well as help to prevent cancers such as skin, breast, lung and colon. My list includes:
- eat a diet low in salt, animal fat, trans-fats and polyunsaturated fats, processed carbohydrates that are white (pasta, bread, rice, potatoes), and avoid too much sugar. Remember-moderation is key !
- QUIT SMOKING-there is nothing of benefit to smoking!
- Keep alcohol consumption low
- take supplements such as fish oil or krill oil, calcium tablets (1200-1500)daily, Vit D3 1000-3000IU’s or more depending on your level (need to check with your medical provider), some people may need selenium, iron, vitamin E depending on your medical condition and where you live
- EXERCISE! This helps mood, bones, muscles, heart, endocrine system, sleep, concentration, metabolism, weight
- Find time to relax (my personal favorite)-this lowers cortisol levels which helps heart, lungs, mood, weight, digestion.
- Visit your medical provider regularly and ensure you are up to date on health maintenance screening tests such as colonoscopy, mammogram, bone density testing, monitoring of blood pressure, glucose and lipids.
Life is to be enjoyed and what better way to do this than being alive, able to move and breathe, think and love, relax and sleep!
Bruce and I discuss the new cervical cancer screening guidelines. In this discussion we will explain the organization – USPSTF – that issues guidelines and discuss the mission it receives from the Department of Health and Human Services. We review the new guidelines, interject our own non-academic opinions, and give you plenty of information to discuss with your health care provider.
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