Healthcare today is no longer just about “reacting” to a problem; it’s also about taking preventive action to avoid disease in the first place. Preventative care is a major priority at West Valley Internal Medicine. As part of our preventative care program, we ask all our patients to undergo an annual physical as well as routine tests.
At each annual review, we also discuss the important preventative actions patients should take on their own accord outside our office.
In general, the National Commission on Preventive Policies recommends the following preventive medications, screening and counseling that help with health and are very cost effective :
Possible Daily Aspirin Use
We’d like to talk to you about this topic. This counseling does not mean everyone should take aspirin to prevent heart attack and stroke, but rather that individuals at moderate to high risk should weigh with their doctors the risks of bleeding and ulcers against the benefits of reducing cardiovascular disease. Heart attacks, strokes, and peripheral arterial disease accounts for over 900,000 deaths in the United States each year. According to UpToDate, net benefits of aspirin have been proven in secondary prevention for those who’ve already suffered a heart attack, occlusive stroke, TIA, angina, or coronary bypass surgery. Acute ischemic syndromes such as acute MI, unstable angina, and acute occlusive stroke also benefit.
Aspirin use for primary prevention of a first cardiovascular disease event is the most controversial, with recent trends favoring only using aspirin for those found to be at moderate to high risk. The National Commission estimates that “Physicians advising all high-risk adults to consider taking aspirin would save 80,000 lives annually and result in a net medical cost savings of $70 per person advised.”
Colorectal Cancer Screening
Colonoscopy remains the gold standard for early detection and prevention of colon cancer, although other options include fecal occult blood testing and sigmoidoscopy. Colon cancer is the 3rd highest incident cancer in the U.S. with 160,000 new cases in 2008, and 55,000 deaths. 19,000 deaths could be prevented each year if people over age 50 were periodically screened as recommended. It is estimated that only 1/3 of adults are up to date with screening. The risks of colon perforation are quite small but should be discussed with the doctor.
The U.S. Preventive Services Task Force Recommends: “Screen routinely for lipid disorders among all men aged 35+ and all women aged 45+. Also screen men aged 20-35 and women aged 20-45 if they have other risk factors for coronary heart disease. Treat with lipid-lowering drugs to prevent the incidence of cardiovascular disease.”
The facts cited by the report are convincing:
- 21% of adults age 35+ have high cholesterol. Of these, most will develop high cholesterol before age 55.
- One out of 4 adults who do not control their high cholesterol will have a cholesterol-attributable heart attack. One out of 3 will die of cholesterol-attributable coronary heart disease.
- Long-term use of therapies is necessary to achieve maximum benefits of screening
Blood pressure should be measured routinely in all adults over 18 and that anti-hypertension medications should be taken to prevent the incidence of cardiovascular disease when needed. 30% of American adults have hypertension, resulting in at least $100 billion in medical costs. Due to various factors only 1/3rd of hypertension cases are controlled. Many suitable generic medicines exist in this category. A low salt diet, weight loss, and exercise are also very effective means to lower blood pressure.
The Advisory Committee on Immunization Practices recommends annual flu shots for those adults over 50 years of age, women who will be pregnant during the flu season, persons with certain chronic medical conditions, children 6 months to 18 years old, and several other important adult and pediatric groups you can review at the CDC. Influenza contributes to 35,000 deaths in the U.S. each year, many hospitalizations, absenteeism and presenteeism at work. The flu shot has been proven to protect against getting the flu to varying degrees based upon patient characteristics and each year’s serological match.
The Advisory Committee recommends vaccinations against hepatitis B, diphtheria, tetanus, pertussis (whooping cough), Haemophilus influenzae type b (Hib), polio, measles, mumps, rubella, varicella (chicken pox), pneumonia, and influenza for average risk children. This series is cost- saving and highly effective, and has made childhood deaths and suffering from the above diseases rare. Immunizing children also protects the health of the community, including those who are too young to be vaccinated or cannot be vaccinated for medical reasons, as circulating epidemics cannot easily take hold in an immune population.
Recommended especially for elderly persons using a Snellen acuity test (the one that hangs on the wall). Very cost effective, and vision correction can reduce hip fractures from falls, improve quality of life, reduce accidents, help with proper use of medication bottles, and increase activities such as exercise. Up to 25% of older people wear inappropriate visual correction.
Cervical Cancer Screening
While the starting age and interval between Pap smears is currently in debate again, screening for cervical cancer in women is certainly effective. It is largely responsible for the 50% decline in cervical cancer mortality over the past 30 years. Further long-term benefits remain to be studied for the HPV vaccination series, but this also looks quite promising for women. The American College of Obstetrics and Gynecology released new guidelines just last month, but these are still quite new and your doctor may advise more frequent screenings.
We can help you determine which preventive screening would be best for you. Make an appointment today.