From Our Blog
Breast Cancer Awareness Month
Let us forget for a moment the recent media hype of radical surgery to prevent breast cancer and focus on simple things like how to detect it and how to decrease your risk. Most women who have been diagnosed with breast cancer do not carry a specific gene that increases their risk, so I will focus on the remaining majority. How often and with what method of screening for breast cancer is still very individualized and is dependent on many factors. It is a decision to be made between a patient and her physician.
Why screen for breast cancer?
It is the most common cancer, next to skin cancer, and the second most deadly cancer for women.
Over 40,000 women will die from breast cancer this year. The earlier we catch it, the more likely we are to cure it.
The majority of breast cancer cases in the United States will be found as an abnormal screening study; fewer are found by the patient or a physician on physical exam (a lump).
Who should be screened and how?
If you are between the ages of 50 and 70 you should absolutely have a screening mammogram every year. If you are 40-50 or over 70 you should discuss with your doctor if you should be having annual mammograms, as the consensus is not as unified within the medical field.
Self- breast exams and breast exams performed by your doctor are not a bad idea and most physicians still think periodically they should be performed.
Mammograms are still the main screening tool used. Ultrasound, MRI and genetic testing are other screening tools that are recommended based on various other risk factors. Knowing your family history of cancer and sharing that with your physician will be extremely helpful as she makes your individual recommendations.
Who has a higher risk?
The older you are, the greater the risk. This increases significantly over age 70.
Women are at a much higher risk than men.
Caucasian women in the United States have the highest rate of breast cancer.
Obese women; more specifically, women who gain significant weight after menopause.
Long term use of estrogen/progesterone replacement therapy (HRT) but NOT the use of birth control pills.
Starting menstrual cycle early and a late menopause can increase your risk especially of specific hormone sensitive tumors.
Women who have not had children and women who had their first child later in life.
If you have had breast cancer in one breast, you are at an increased risk to get cancer in the other breast.
If you have a mother or sister with breast cancer.
If you have specific genetic mutations, like BRCA1 or 2 (only 5-6%).
Increased alcohol consumption or smoking.
Working the night shift.
What can you do to minimize your risk?
Eat a lot of fresh fruits and vegetables every day.
There are currently studies in progress to determine if vitamins or supplements can reduce the risk (specifically vitamin D and omega 3 fatty acids).
Do not smoke.
Limited alcohol intake (1 drink per day or less).
Discuss when and how you should be screened with your doctor every year.
Flu activity in the United States can begin as early as the month of October according to the Centers for Disease Control and Prevention (CDC). Now is the perfect time to get your flu shot and a great time to learn more about what vaccine choices you have and debunking any myths related to the flu vaccine.
Flu Vaccine Fast Facts:
What Types of Vaccines are Available?
Most of the flu vaccine offered for the 2013-2014 season will be trivalent (three component). Some seasonal flu vaccines will be formulated to protect against four flu viruses (quadrivalent flu vaccines) and will available but limited this year. All nasal spray vaccines are quadrivalent,
- The nasal-spray flu vaccine — a vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for "live attenuated influenza vaccine" or FluMist®). LAIV is approved for use in healthy* people 2-49 years of age who are not pregnant.
* "Healthy" indicates persons who do not have an underlying medical condition that predisposes them to influenza complications.
- The traditional "flu shot" Fluzone®— an inactivated vaccine (containing killed virus) that is given with a needle, usually in the arm. The flu shot is approved for use in people 6 months of age and older, including healthy people, people with chronic medical conditions, and pregnant women.
- Fluzone® High Dose-an inactivated vaccine with 4 x the amount of antigen then the regular dose flu shot. It is approved for use in people 65 years of age and older. As with all flu vaccines, Fluzone High-Dose is not recommended for people who have had a severe reaction to the flu vaccine in the past. It is up to the individual physician to recommend using this on our patients over 65.
- Fluzone® Intradermal-is the first influenza vaccine licensed in the United States that uses a new microinjection system for intradermal delivery of vaccine. It is indicated for active immunization of persons 18 through 64 years of age. The microinjection system uses an ultra-thin needle of 0.06 inches (1.5 mm) in length, or less than one tenth the length of the standard needles used for the traditional intramuscular route of administration.
The type of vaccine that you receive this year should be decided between you and your physician.
What should I do to prepare for this flu season?
CDC recommends a yearly flu vaccine for everyone 6 months of age and older as the first and most important step in protecting against this serious disease. While there are many different flu viruses, the flu vaccine is designed to protect against the three or four main flu strains that research indicates will cause the most illness during the flu season. Getting the flu vaccine as soon as it becomes available each year is always a good idea, and the protection you get from vaccination will last throughout the flu season.
In addition, you can take everyday preventive steps like staying away from sick people and washing your hands to reduce the spread of germs. If you are symptomatic with flu, stay home from work or school to prevent spreading influenza to others.
Who should Not Receive the Flu Vaccine?
- **Anyone who is highly allergic to chicken eggs
- Anyone who has had a severe reaction to the flu vaccine in the past
- Children under 6 months old
- The CDC recommends that everyone who is at least 6 months old should get a flu shot this season, especially those who are at high risk of developing serious complications if they get the flu. High risk categories include:
- pregnant women
- children younger than 5, adults older than 65
- healthcare personnel
Flu Vaccine Myths:
- “I can get the flu from the flu vaccine.”
False. You cannot get the flu from a flu shot, and the chance of a flu shot causing serious harm is extremely rare. However, like any type of medicine, the flu vaccine may have side effects, such as localized soreness or a low-grade fever. Occasionally, an allergic reaction may occur.
- “If I start feeling like I’m about to get the flu, I can stay at home from work or school so that I don’t pass it on to anyone else.”
False and True. People are able to pass on the flu to those around them even before they realize they are sick or start feeling poorly. Most healthy adults can infect others beginning one day before symptoms develop and up to five to seven days after becoming sick. The best prevention to making sure you’re not the culprit for some other poor soul coming down with the flu is to make sure you have already been vaccinated. However, when you are symptomatic with the flu, especially with a fever, you are the most contagious and you should avoid being around others.
- “I got a flu vaccine last year so I don’t need to get one this year.”
False. Even if the viruses in the current flu season are the same strains as those from the previous flu season, it is still important to get a flu vaccine for this year. This is because a person’s immune protection from vaccination declines over time and so a flu shot from a year ago is just not as effective in protecting your body as one that is freshly administered this year.
- “It is better for me to get the flu and obtain immune protection that way than to get the flu vaccine.”
False. Although people often do survive from getting the flu due to antiviral medication, the flu is a serious disease and it is simply not a pleasant experience getting it in the first place. Flu symptoms can include: fever, cough, sore throat, runny or stuffy nose, headaches, fatigue, muscle or body aches, and in some cases (particularly with children), vomiting and diarrhea.
Flu vaccines are typically available at your regular doctor’s office, clinics, pharmacies, health departments, and college health centers. Whether you are someone who already gets a flu shot every year or someone who avoids getting it, the flu shot is important for not only your health, but for the health of those around you.
We hope this article has encouraged you to get your flu shot this year and for many years to come. If you are a current member of Personalcare Physicians, call us to schedule your flu shot today!
Cholesterol is necessary for life. Without it your cell membranes would not function properly. In addition, critically important substances like steroid hormones (cortisol), sex hormones (testosterone), bile acids that allow for the absorption of fat, and Vitamin D require cholesterol as part of their biosynthesis.
The cholesterol in your blood comes from two sources. It is either absorbed in your small intestine from your diet or synthesized in your liver. Of these two mechanisms your liver is the source of the majority of the cholesterol we measure in blood. There is an intricate regulation of the rate at which cholesterol is made in the liver in balance with the amount absorbed through the diet and the level of cholesterol in the blood.
The trouble arises when either through a genetic propensity, poor lifestyle choices with a high fat diet, or a sedentary lifestyle accompanied by weight gain, that the blood levels of cholesterol increase. Above a certain point, it appears the cholesterol circulating in your blood as it interacts with certain substances becomes oxidized and makes its way under the inner lining (intima) of arteries in the body. Diets high in trans-fats, smoking, poorly controlled diabetes and metabolic syndrome increases the likelihood of oxidation. Through a series of subintimal interactions involving inflammation an atheroma or plaque forms, narrowing the artery over time.
We now know that not all cholesterol is created equal. For example we now know that the LDL “Bad” cholesterol is made up of seven sub fractions, some of which are more atherogenic and likely to become oxidized and slip under the intimal lining of the artery. For example, an LDL with predominantly small, dense particles (Pattern B) may be much more risky that the same LDL level with predominantly larger more buoyant particles (Pattern A). Furthermore, some recent evidence suggests the number of particles (LDL-P) may be even more important than the density profile of LDL. In a similar way the HDL is composed of 5 subunits, some of which may be more protective that others. Finally, it now looks like it may be the number of each type of particle that matters most, making measuring LDL-P(particles) and HDL-P(particles) important in determining risk factors.
As you can see, our understanding of heart disease and cholesterol is constantly advancing. So when evaluating your cholesterol, it is important to consider the latest information we have about cholesterol and dig deeper than just the “good” (HDL) and the “bad” (LDL) levels. A complete understanding of cholesterol as a risk factor should include important genetic markers, an HDL and LDL phenotype with each of their respective sub-fractions, and LDL particle count (LDL-P) and markers of inflammation to evaluate oxidation risk. Only a comprehensive evaluation of cholesterol in your blood can assure that you are acting on the complete picture, allowing for a personalized and more precise action plan.
Meet David R. Bloom M.D., who has been a concierge physician for several years now. Dr. Bloom explains what he enjoys the most about being a concierge doctor, a story about one of his patient’s experience as well as his take on “the lost art of medicine.”
Quality Time with Patients
Dr. Bloom has spent the last six years of his career practicing medicine the way he had envisioned when he chose to go to medical school; by spending quality time with each patient and building a strong doctor-to-patient relationship. By joining Personalcare Physicians, which provides the premier concierge medicine experience in Orange County, he is able to practice medicine again as an art which would not be possible in a traditional practice due to the changing healthcare landscape.
Without the environment that Personalcare Physicians provides, Dr. Bloom has many patient success stories that would not have taken place in a traditional style practice. In one instance that stands out, a patient had initially expressed concern with her bad experience at her local hospital and opted to drive about 50 miles to see her own concierge doctor. Dr. Bloom was able to see the patient with a lung condition on two consecutive days. He was able to provide a variety of tests on site the same day that she had called and expressed concerns. She was able to go home after some treatment was given. Dr. Bloom followed up with the patient the next day and decided it would be best for her to come in again although her symptoms had not worsened. Test results during the follow up visit showed that her lung condition had declined and he decided to coordinate care with her lung and heart specialist to make sure everything was being done to help her recover as quickly as possible. Dr. Bloom describes this as the perfect type of care for her situation which put her on the road to optimal recovery. This may have been overlooked in a traditional style practice where one quick visit to the doctor is “good for now” and additional attention could have taken much longer; possibly long enough for serious damage to be done on the patient’s health.
The Lost Art of Medicine
What surprises patients most is that Dr. Bloom believes that practicing medicine is still truly an art. After all these years, science has played a very important role in advancing capabilities of modern medicine. But as Dr. Bloom describes it “there is so much more to it than just the science” and that the art comes into play when a doctor has a deep understanding of patient. This means that he has to juggle many factors including evidence based medicine results and the unique characteristics of a patient such as ethnicity and lifestyle. By embracing all these different factors Dr. Bloom is able to truly individualize treatment in the best way possible.
We hope this video has provided insight about Dr. Bloom and how a concierge doctor at Personalcare Physicians views and approaches the art of medicine.
If you are interested in becoming a patient of Dr. Bloom’s or would like to learn more about the unique concierge medicine environment that Personalcare Physicians provides, shoot us an email or give us a call at 949.229.7727.
It is important that you understand that your spine is the foundation of your health. The common problems associated with bad posture are back, neck and shoulder pain. Recently, studies have shown that poor posture has even more adverse effects on your health then you would expect.
Increase Risk of Death and Disease
A recent Australian study found that after 25 years of age, every single hour of television (slouching and bad posture on the couch) reduced the viewer’s life expectancy by 21.8 minutes. How much TV watching and slouching do you do? In addition, when English researchers cross-referenced sitting time with health outcomes from a different study, they found that the people who sat the most increased the risk of developing diabetes by two fold and had almost a 150% increase in their risk for cardiovascular disease; yes, even if they exercised!
Can Cause Issues in the Workplace
Slouching and bad posture can affect how people see you, not just your attitude. “You don’t want to walk into somebody’s office slouching and bent over. Because people really do perceive you as not as vital” says Janice Novak, author of Posture, Get it Straight and director of improveyourposture.com
Brings Down Your Confidence and Raises Stress
In a recent study from Harvard, results showed that when people took on more robust postures (open shoulders and straight backs) they had a 20% increase in testosterone levels and a 25% decrease on cortisol levels. But people who slouched (bad posture) showed a decrease in testosterone at 10% and cortisol levels increase by 15%. That translates to low self-confidence and high stress.
A recent study from San Francisco State University had students either walking down a hall in a slouched position or had them skipping down the same hall. Although this example may seem a little extreme, it is no surprise that the slouchers expressed increased feelings of depression and lower energy levels than the skippers.
So What Can We Do?
Check out this awesome video which gives tips on what we can do to improve bad posture and shows why office posture matters.
Unfortunately, the office is where many people are held captive during the day and feel tied down to their chair. Here are a few tips on what you can do throughout your day at the office to help prevent bad posture:
Keep monitor at arm’s length distance and eye level to keep you from hunching over
Support your back by adjusting your chair and comfortably rest your feet, slightly elevated if possible
Avoid crossing your legs as it can restrict circulation
Consider investing in a standing desk or better yet, a treadmill desk
Interrupt your sitting at least once every 30 minutes, even by simply walking to the restroom
Get up and do simple lunges, calf raises or shoulder shrugs to help relieve tension
We hope this article helps to encourage you to pay a little bit more attention to your posture and rethink how important good posture can be.
If you are interested in learning more about correcting your bad posture, contact one of our fitness professionals today. We are able to provide posture analysis during physical assessments as well as through our personal training sessions, and can provide stretches or exercises to address any type of postural issues.
But often missed are these questions, related to prevention:
What preventive testing is recommended?
It is all too common for a doctor to focus on the primary problem(s) or acute condition, and this would leave out the often more important issue of prevention. Some of these are age or gender related, such as when you are due for a colonoscopy or mammogram. Other screenings are more patient specific, such as having a cardiac test (stress echocardiogram, treadmill stress test, Carotid Intima-Media Thickness ultrasound, calcium heart score, etc.) due to the presence of hypertension and high cholesterol. Perhaps performing a spirometry breathing test, chest x-ray, or CT scan in a smoker or former smoker with certain risk factors is an appropriate preventative action.
Are there any preventive medications or supplements needed?
There are many possible recommendations: for example, common aspirin has many beneficial properties. But too many physicians may not mention when it might be beneficial to begin a daily low dose (81mg) tablet. Some doctors only recommend such preventative medicines starting at age 50 which may be too early or too late for certain individuals.
The ideal solution is to have a discussion at least yearly, during your annual complete physical.
By having your doctor weigh aspirin’s possible effects (or any other preventative medication) in relation to your specific risk factors, the optimal recommendation can be made.
How often should I be seen for preventive care?
Often patients assume that a yearly checkup is enough and other times, they may just wait for a reminder call or postcard. Depending upon your age and medical history, the answer may vary. A teenager may not need a medical checkup and blood tests every year, however a yearly wellness visit is typically best. Then he/she may review important health issues such as eating disorders, mental health, drug and alcohol use, etc. A person over age 40 with high cholesterol may need maintenance visits every 3-6 months to repeat his/her blood lipid tests. Likewise, a patient on a daily prescription medication may need a liver or kidney blood test every 6 months, even when he or she is feeling fine.
I hope this article has encouraged you to ask these three simple questions related to preventive measures which can be brought up at the end of the next visit with your doctor. If you found this article helpful, feel free to share it with friends and family using the social icons below.
Authored By: Amanda Allen | Contact Us Today To Learn About Our Healthfit 4 Life Program
Research has shown that sitting for more than 6 hours increases your risk of premature death by 37%; not to mention that inactivity also increases your risk of obesity, cancer, and diabetes. Engaging in physical activity is one of the most effective ways to boost your overall health and lose weight, but let’s be honest, not everyone has time for structured workouts or gym activities.
That’s ok, because you can still reduce your risk of death and disease as long as you participate in enough physical activity throughout the day. And this is where the Fitbit Zip can help. The FitBit Zip is a small pedometer that tracks how many steps you take, total distance traveled, and calories burned throughout the day. With the FitBit Zip, you will know precisely whether you have moved enough, or if you need to take a few more laps around the office. It’s great for increasing your overall fitness and losing weight, since you will know exactly how many calories you’ve burned each day. Check out this short video review to learn more about the FitBit Zip, and see if it could be just the motivation you need to get moving.
For more health, fitness, and nutrition information from Amanda, follow her on Google.
You were on time to see your doctor and yet again, they are running behind. As you sign in, you are greeted with a stale hello and a request for your copayment. You look around and observe a waiting room full of people reading outdated magazines. Each time the door opens patients look up in hopes that their name is called. Face it, you will be parked in the waiting room longer than you’d like only to spend about five minutes with your doctor who may not even know who you are.
With increased attention to healthcare, advancement in medicine, and expansion in education there were high hopes for improved patient care in the U.S. but with the Patient Protection and Affordable Care Act (PPACA) activating in 2014, some doctors are concerned that the future might not be so bright for quality medical care. The PPACA or Obama Care mandates that everyone has insurance. This doesn't sound like a bad mandate but it does come with repercussions. Currently, many uninsured patients as well as Medicaid and Medicare patients are not accepted at your doctor's office so they go to the emergency room for any ailment. But what happens when everyone is insured? According to the Council on Graduate Medical Education, there is already a shortage of doctors and even though the number of doctors will expand through 2020, the demand for physicians will grow at a significantly faster rate than the supply of physicians.
Consider the following questions for your current healthcare environment:
- Can you get an appointment right away or do you have to wait several days or even weeks to see your doctor?
- How long do you actually spend with your doctor at your appointment?
- Do you trust your doctor and feel he/she has your very best interest in mind?
The moment you need your doctor the most, when you need advice, when you are seeking direction for your health or when you need urgent treatment, you shouldn’t have to wonder if you and your family are getting quality health care.
You deserve the best quality of healthcare, which means face to face time with doctors who do not deal with bureaucratic practices and a medical system that puts your health first. You shouldn't have to wait an hour or more in a waiting room because quite frankly, you have better things to do with your time like enjoy your family and your life. Your health care is a serious matter and should be treated as such. That’s why concierge medicine is the best choice now more than ever before and why our concierge doctors at Personalcare Physicians chose a healthcare solution that allows them to see less patients while focusing more on each. Despite the challenges with PPACA, the quality care and availability of your doctor will remain consistent or improve with Personalcare Physicians. So take a deep breath and relax. We have the best health care option, the best care is personal.