Women’s Health—Self-Screening

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These DIY health assessments can sound the alarm for a number of women’s health conditions.

  1. Self-breast exams have been recommended by many health experts over the years, but there are currently no cancer-screening guidelines that include performing routine self-breast exams. Evidence has shown that mammograms are the preferred screening method; women should consult their physicians to find out the screening mammogram recommendations that are best for them. However, women should be familiar with how their breasts normally look and feel and should report any changes to a health care provider right away.

  2. Women can use the “Home Access HIV-1 Test System” to assess for the presence of the human immunodeficiency virus that can cause AIDS. By providing a blood sample, women can return this home kit for the answer. The results are confidential, as is the provided counseling. Many effective treatments are available.

  3. Atrial fibrillation, an irregular and often asymptomatic change in heart rhythm, can cause a significant increase in the risk of strokes. Pulse checks are best performed by placing the index and middle fingers on the underside of the opposite wrist, just below the base of the thumb. By checking your pulse, you can determine the pulse count per minute (normal is between 60 and 100 beats per minute) and also discover any irregularities, such as the fast and irregular rhythm of atrial fibrillation that varies from 100 to 175 beats per minute. If abnormalities are noted, please consult your doctor.

  4. High blood pressure, or hypertension, is another common women’s health condition; up to 58% of adult American women have high blood pressure. Hypertension is a major risk factor for heart disease, strokes and some types of kidney problems. Normal blood pressure is 120/80. Some guidelines define hypertension as blood pressures of 140/90 or more, while others are more strict at 130/80 or more. Obtaining a home blood pressure cuff is a good idea, especially if you have a known history of hypertension. Make sure that the monitor you buy will fit your upper arm and that it’s easy to use and read. Check your blood pressure about once a month. It’s also a good idea to bring your blood pressure monitor with you to doctors’ visits so that you can check its accuracy.

  5. To do a skin cancer check, every month perform a total body self-exam to look for new moles or changes in old ones. Basal cell and squamous cell cancers develop in different skin layers, and squamous cell cancers are more likely to spread to other areas. Melanomas, the most serious kind of skin cancer, are often black in color or composed of a variety of colors and also are irregular in shape. Look for moles that change in size, shape, thickness and color. Get naked and look everywhere, including your scalp and the soles of your feet. Have a partner help you check areas that are hard to see, especially your back. And don’t forget your ears, sun-exposed areas that are very prone to developing skin cancers.

  6. Depression, found in more than 17 million Americans, is twice as likely to be diagnosed in women than in men. The symptoms of depression can include weight loss or gain, irritability, fatigue, and feelings of hopelessness. You can use this depression screen (https://psychcentral.com/quizzes/depression-quiz/) to see if you are at risk. If you suspect depression, please contact your doctor for help.



Men’s Health—Self-Screening

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Rather than waiting for your doctor to discover medical problems, you can take the initiative to perform self-exams to look for early signs of disease.  By finding these problems earlier, your outcomes could be better.  But these examinations should supplement regular care rendered by your doctor, not replace it.

Here’s a list of common men’s health problems that can be monitored at home:

  • Belly fat check. Belly fat produces hormones that increase men’s risk of heart disease and diabetes. Simply measure the distance around your waist at the level of the belly button; if you measure more that 37 inches, you’re at risk. Repeat this test about once a month.

  • Heart rate check. Measure your pulse at rest at least once a month. Use this link for instructions:

https://www.mayoclinic.org/healthy-lifestyle/fitness/expert-answers/heart-rate/faq-20057979

Your pulse is normally between 60 and 100 beats per minute.  Any reading outside that range could be a sign of a problem.  An irregular pulse with variable times between each heart beat could indicate atrial fibrillation, a serious heart condition.

  • Blood pressure check. About 28 percent of men have high blood pressure, but up to 35% of men who have it don’t know. Undiagnosed and uncontrolled high blood pressure can lead to heart attacks, strokes and kidney failure. Easy-to-use blood pressure cuffs are available at pharmacies everywhere. Measure your blood pressure while seated and resting, taking about 10 separate readings and averaging them. If your upper number is consistently above 120 or the lower number consistently above 80, contact your doctor. Repeat this exam every few weeks.

  • Testicular cancer check. This cancer is uncommon and is one of the most curable forms of cancer, but the earlier it’s found the better the prognosis. Most cases occur in men ages 20 to 35. Use this link for directions on how to perform this exam:

 https://www.mayoclinic.org/healthy-lifestyle/fitness/expert-answers/heart-rate/faq-20057979

Repeat this exam about once a month.

  • Oral cancer check. Oral cancer, which is twice as common in men than in women, may show up as a sore or lump that doesn’t heal on the lips or in the mouth. To check, open wide and look and feel for any abnormalities, running your finger around and under your tongue. White or red patches in the mouth can be early warning signs of cancer. Consult your doctor or dentist about any worrisome findings. Repeat this check monthly.

  • Skin cancer check. Do a monthly total body self-exam to look for new moles or changes in old ones. Compared with women, men are twice as likely to have basal cell cancers and three times as likely to have squamous cell cancers. These cancers develop in different skin layers, and squamous cell cancers are more likely to spread to other areas. Look for moles that change in size, shape, thickness and color. Get naked and look everywhere, including your scalp and the soles of your feet. Have a partner help you check areas that are hard to see, especially your back. And don’t forget your ears, sun-exposed areas that are very prone to developing skin cancers.

  • Breast cancer check. About 2,000 cases of breast cancer are diagnosed in men annually in the United States, and since men do not have screening mammograms, these cancers often develop undetected. After a shower, look for changes in breast size and shape and feel each breast for lumps. Also, squeeze both nipples to look for discharge. Do this check about once a month

WHAT IMMUNIZATIONS DO ADULTS NEED?

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According to the Center for Disease Control,

  • Seasonal influenza (flu) – Everyone 6 months and older should get a flu vaccine every year as the best way to reduce the risk of flu and its potentially serious complications.

  • Pertussis, also known as whooping cough – The Tdap (tetanus, diphtheria, and pertussis) vaccine is recommended for women during each pregnancy and once for all adults who have not previously received it.

  • Tetanus and diphtheria – The Td vaccine is recommended every 10 years.

  • Shingles – The herpes zoster vaccine is recommended for adults 50 years and older.

  • Pneumococcal disease – Two pneumococcal vaccines are recommended for adults 65 years and older. One or both vaccines may be recommended for adults younger than 65 who have specific health conditions, such as diabetes, or who smoke cigarettes.

The Truth About Turkey and Tryptophan

Source: Time

No Thanksgiving is complete without a turkey at the table—and a nap right after it’s eaten. The meat has a bad reputation for making eaters sleepy, but is there really science to back that up?

Here’s the lowdown: turkey contains the amino acid L-tryptophan, which produces sleep-promoting serotonin and melatonin. But turkey has about the same amount of tryptophan as other meats. It may even have a built-in secret weapon against sleepiness: an abundance of protein, which can regulate insulin levels and actually combat fatigue. So don’t blame the turkey for your tiredness; the heavy load of carbs that made up the rest of the meal are likely the culprits. Here’s what turkey really does to your body.

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Gastroesophageal Reflux Disease

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The passage of gastric contents into the esophagus (gastroesophageal reflux) is a normal physiological process.  Most episodes are brief and do not cause any symptoms, esophageal injury, or other complications.  Gastroesophageal reflux becomes a disease (GERD) when it either causes symptoms, which include a burning sensation the throat (heartburn), chest pain, difficulty swallowing, a sensation of a lump in the throat, and/or regurgitation of food or sour liquid, or it causes detectable damage to the esophagus as seen during medical testing.

For patients whose GERD symptoms are mild and occur less than once a week, over-the-counter antacids may be effective and may be taken as needed.  Patients with mild and intermittent symptoms occurring more that twice weekly should seek medical attention. 

The first step in treating GERD is to make diet and lifestyle modifications.  The only two changes proven to help are weight loss and elevating the head of the bed.  Dietary triggers that may play a role in GERD include caffeine, alcohol, spicy foods, food with high fat content, carbonated beverages and peppermint.  Selectively eliminating one of these at a time may provide patients with specific dietary guidance.

When symptoms persist in spite of lifestyle modifications, famotidine, an over-the-counter acid blocker, can be effective.  If symptoms persist for more than 2 weeks in spite of daily famotidine use, a proton pump inhibitor (PPI) such as omeprazole is indicated.  PPI’s must be taken regularly to be effective.  PPI’s are stronger than famotidine and these drugs usually control GERD symptoms.  Famotidine and PPI’s both work by significantly reducing the amount of acid released by the stomach.  Commonly reported PPI side effects include diarrhea, headache, and vitamin B12 and magnesium deficiency, as well as associations with increased risk of fractures.  These side effects may increase if PPI’s are taken for more than 8 weeks.  The use of alcohol with PPI’s may also increase some side effects.

If PPI’s fail to control symptoms within 8 weeks or if alarm symptoms are present, esophagogastroduodenoscopy (EGD) is indicated.  Alarm symptoms include difficulty swallowing, painful swallowing, intestinal tract bleeding, anemia, weight loss and chest pain.

For an EGD, the patient takes nothing by mouth for at least eight hours before the test is performed.  An intravenous line is inserted and the patient is given sedation but continues to breathe on their own.  A gastroenterologist then inserts a flexible tube that includes a camera through the mouth and down through the esophagus and into the stomach.  The doctor can see evidence of inflammation of the esophagus and stomach, unusual growths, ulcers, and active bleeding,  and samples can be taken to confirm a diagnosis.  After a brief recovery, patients return home for rest and are usually back to normal within a few hours.

Findings related to GERD at the time of EGD can include erosive esophagitis (acid irritation and inflammation that can injure the esophagus over time) and Barrett’s esophagitis (a condition in which the flat pink lining of the esophagus becomes damaged by acid reflux).  Unchecked, Barrett’s esophagus can  transform into cancer.  Both conditions are usually treated with high-dose PPI’s.  Patients with these conditions should have regular monitoring by a gastroenterologist.

Management of GERD in special circumstances:

  • In pregnant patients, GERD is more likely both because the muscles that push food down the esophagus move more slowly, and, as the uterus grows, it pushes on the stomach and may force stomach acid up into the esophagus.  For patients who are pregnant or  breastfeeding, treatment begins with lifestyle modifications.   When symptoms persist, medical therapy includes  antacids and, if needed, sucralfate (a prescription drug that acts to protect the lining of the esophagus and stomach), rather than PPI’s.

  • For patients with asthma, GERD has been identified as a potential trigger for asthma attacks and is often present in cases of severe asthma that are difficult to treat.  The likely cause is that asthma patients may be unknowingly inhaling small amounts of stomach acid, which then triggers spasm and obstruction of air passages in the lungs.  Gastroesophageal reflux in asthma patients should be evaluated and treated.   Respiratory symptoms, including those associated with asthma (eg, cough, wheezing, difficulty breathing and chest tightness), are increased in patients with gastroesophageal reflux.  

Mild and self-limited GERD symptoms can be managed at home.  For persistent, worsening and/or severe symptoms, patients should contact their physician.

For more information, see these links:

https://www.medicalnewstoday.com/articles/14085#what-is-GERD

https://www.webmd.com/heartburn-gerd/guide/heartburn-during-pregnancy#2

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Corticosteroids and Covid-19

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Cortisol, commonly called the "stress hormone," is a naturally-occurring steroid hormone that is released in response to stress. It is involved in a wide range of processes in the body, such as metabolism, inflammation, blood pressure regulation and bone formation, according to Johns Hopkins Medicine.  Corticosteroids are synthetic forms of cortisol that work by decreasing inflammation and suppressing the immune system, according to Cleveland Clinic.  Left untreated, excess inflammation can damage healthy tissue, as well as cause redness, swelling and pain.

Corticosteroids are important in the treatment of many inflammatory, allergic, immunologic, and malignant disorders

In the October 6, 2020 issue of the Journal of the American Medical Association, 3 recent studies were presented that all agreed that corticosteroids are beneficial in the treatment of patients with severe Covid-19 infection.  Patients requiring the use of ventilators and/or oxygen appeared to derive the most benefit.

An accompanying editorial reviewed the benefits of corticosteroids not only in Covid-19 patients but also in patients with non-Covid-19 adult respiratory distress syndrome (ARDS), a common cause of respiratory failure in hospitalized adults.  Because of the many Covid-19 trials initiated this year, much has been learned about the use of corticosteroids in these critically-ill patients that can generate more research and also hope for many seriously-ill patients.

Corticosteroids are inexpensive and useful in many conditions.  These readily available drugs can immediately be utilized for those Covid-19 patients who need them.  President Trump received the corticosteroid dexamethasone as part of his Covid-19 treatment regimen.

For more information:

https://jamanetwork.com/journals/jama/fullarticle/2770275?resultClick=1