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Congratulations! You just made a giant step forward in improving your health simply by reading this pamphlet. The physicians and staff at Dubuque Internal Medicine are concerned about your health and one of the most important aspects of maintaining and improving health is prevention.
The recommendations given in this pamphlet represent minimum standards for prevention for people who are without any significant risks and currently have no symptoms.
Your doctor may recommend additional tests/treatments when necessary depending on your individual circumstances. These guidelines are based on a report by the US Preventive Services Task Force (USPSTF). Other major organizations also set guidelines for preventive care that may differ slightly from the recommendations outlined here, but the USPSTF serves as a useful starting point for an excellent preventive medicine program.
Remember, no screening test is perfect and may miss the disease it was designed to detect. If you develop any symptoms, let us know about it even if your screening test was normal.
If not already completed by your physician, please place a mark in front of all measures that apply to you.
GENERAL PREVENTIVE MEASURES
BLOOD PRESSURE (all adults)
High blood pressure is generally defined as a blood pressure greater than 140/90. High Blood pressure is frequently called a "silent killer" because it usually does not cause any symptoms until it has caused serious damage to the heart, brain, eyes or kidneys. Checking your blood pressure is quick and easy. Every adult should have a blood pressure check at least every two years as long as the blood pressure is lower than 130/85. Higher blood pressures should be repeated more frequently. For more information, see the pamphlet on "High Blood Pressure."
CHOLESTEROL SCREENING (over age 35)
Elevated cholesterol is an important risk factor in the development and progression of heart disease. Because of the beneficial effects of estrogen, women tend to develop heart disease at an older age than men. For this reason, men should have cholesterol levels checked starting at age 35 and women, starting at age 45. If you have a family history of heart disease ( man in your family with heart attack prior to age 50 or a woman in your family with heart attack prior to age 60), then your cholesterol should be checked starting at an earlier age.
COLON CANCER (age 50 and over)
Colorectal cancer is the second most common cancer in the US and there is good evidence that screening for early cancer and polyps of colon saves lives. Screening for colorectal cancer should begin at age 50. There are three tests currently recommended for colon cancer screening:
Fecal occult blood test- this test should be done yearly
Flexible sigmoidoscopy- this test involves looking inside the last 2 feet of the colon for early signs of cancer or precancerous growths. If normal, this test should be repeated every 3-5 years.
Colonoscopy: this test involves using a flexible scopre to view the inside of the ENTIRE colon. This test is normally done in place of the flexible sigmoidoscopy and if normal, is repeated every 10 years.
For more information, ask for the pamphlet "Prevention and Early Diagnosis of Colorectal Cancer."
IMMUNIZATIONS (all adults)
Influenza: anyone more than 50 years old or anyone with a chronic medical problem regardless of age should get this vaccine yearly (best time to receive the vaccine is mid October- mid November). Anyone else who doesn't want to risk getting influenza can also receive this vaccine.
Pneumococcal vaccine: again, anyone over age 65 or with a chronic medical condition should consider this vaccine. This vaccine may be required only once in your lifetime.
Tetanus/diphtheria: although rare today, these two diseases can be fatal. This vaccine is highly effective at preventing these diseases. The vaccine is given as an initial series of three injections (usually in childhood) with booster doses given every 10 years or so.
Rubella: all women of childbearing age should be sure they are immune to this infection as rubella in a mother can cause serious injury to the developing fetus.
SUBSTANCE USE (all adults)
Tobacco More than 400,000 Americans die each year as a direct result of smoking. No other preventive measure in this pamphlet is more important than quitting smoking if you smoke or not starting if you don't smoke. There is help available for smokers wanting to quit so don't get discouraged. For more information, ask for the pamphlet "Kicking the Cigarette Habit."
Alcohol Heavy drinking is associated with a number of medical problems including high blood pressure, cirrhosis of the liver and cancer of the throat, esophagus and liver. In addition, more than 40% of traffic-related fatalities are related to alcohol use. If you want more information on alcohol use, ask your physician.
DIET AND EXERCISE
The benefits of exercise include reduction of heart attack risk, reduced blood pressure, weight reduction, prevention of osteoporosis and improved control of diabetes. Thirty minutes per day of some exercise on most days of the week is a great start on your way to better health. Vigorous activity is NOT required in order to reap the benefits of a regular exercise program. Look for opportunities to incorporate activity into your everyday life (for example, use the stairs instead of the elevator).
A healthy diet should limit saturated fat intake, and promote the intake of fiber (found primarily in fruits, vegetables and whole grain products). If you are trying to lose weight, drastic calorie reduction diets are not normally recommended. For women, it is important to get at least 1000 mg of dietary calcium, more during adolescence, pregnancy, lactation, and after menopause. Women contemplating pregnancy are encouraged to take a multivitamin containing at least 400 mg of folic acid. For additional information on the use of dietary supplements, see the pamphlet "Nutrient Supplements."
INJURY PREVENTION (all adults)
Vehicle safety: the majority of traffic -related fatalities are related to alcohol use and failure to wear safety belts. If you drink, DON'T DRIVE. If you drive, wear your safety belt AT ALL TIMES. If you have young children, use the children's safety seats. Motorcyclist, bicyclists and ATV users should always wear a safety helmet.
Home safety includes installation and maintenance of smoke detectors, reduction of hot water heater temperature to less than 120°F, and if you must have guns, keep guns unloaded and stored in a locked cabinet separate from the ammunition.
OTHER ISSUES
Dental Hygiene which involves flossing and brushing with fluoride toothpaste daily and seeing your dental care provider regularly.
Eye care which should include measurement of visual acuity in the elderly and if you have diabetes, a yearly exam of the back of the eye is recommended.
Sunscreen use a sunscreen that blocks both UVA and UVB, especially if you have a history of precancerous skin lesions, a large number of moles or light skin, hair and eye color.
Diabetes This is a new recommendation that has not yet been reviewed by the USTFPS. Beginning at 45 y/o, you should have a fasting blood sugar test and if it is normal, repeat every three years.
FOR WOMEN ONLY
BREAST CANCER (age 40 and over)
For all women 50-69 y/o, there is good evidence of benefit (decreases risk of dying from breast cancer) for annual mammograms and a yearly breast exam done by a physician. Screening of women from 40-49 y/o is currently an area of intense debate. Obtaining a mammogram every 1-2 years for women in this age group would be reasonable. Screening mammograms in women more than 70 are also probably quite beneficial but scientific studies have not specifically looked at this age group.
CERVICAL CANCER (all adults)
The incidence of advanced cervical cancer has dropped dramatically in the last 40 years, attributable for the most part to regular screening with a pap smear. Once a woman has had sexual intercourse, she is at risk for developing cervical cancer and should begin having annual pap smear testing. If the first three annual pap smears are completely normal, the frequency of pap smears can be reduced to every 1-3 years.
HORMONE REPLACEMENT AFTER MENOPAUSE
Throughout the 1990's,
hormone (estrogen +/- progesterone) replacement therapy was recommended
for most women. However, a recent clinical trial (Women's Health Initiative)
has shown that long term use of hormones after menopause is associated
with significant risks. Women taking hormones after menopause have a greater
chance of heart attack, stroke, blood clot and breast cancer. The benefits
of taking hormones include decreasing the risk of hip fractures (by preventing
osteoporosis) and probably decreasing the risk of colon cancer. While
the absolute risk to an individual women for an adverse event like a heart
attack or stroke is low, the recommendations now are for most women NOT
to take
hormones after menopause.
The main current role of hormones after menopause is to treat symptoms of menopause like hot flashes and vaginal dryness. When hormones are used for this purpose, it is recommended that they be used for less than 5 years, if possible. For more information, see the pamphlet on Hormone Replacement Therapy.
FOR MEN ONLY
PROSTATE CANCER (age 50 and over)
Currently, a yearly rectal exam and a prostate specific antigen are recommended by the American Cancer Society for all men over 50y/o. However, the USPSTF believes this recommendation is premature and may do more harm than good. For further information on this topic, ask for the pamphlet "Prostate Specific Antigen."
Dubuque, IA 52001-6389
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