As promised here is the article on health screening.  Well, actually half of it anyway.  The other half is pretty well complete but I didn't want to send you too much at a time.  Plus, perhaps inspired by the film industry, I seem to be in a mood for sequels.

• PAINKILLING MEDICATIONS IN PREGNANCY
• NSAIDS, ACHES AND PAINS
• NSAIDS USE MAY LOWER BREAST CANCER RISK
• HEALTH SCREENING, WELLNESS AND DISEASE PREVENTION

The awareness of the ill effects of chronic use of even nonprescription medication continues to grow.  Researchers from Kaiser here in California screened pregnant women for their use of over the counter (OTC) painkillers.  We call most of them NSAIDS for NonSteroidal AnitInflammatory Drugs.  The NSAIDs include aspirin, ibuprofen, Motrin, Naprosyn etc, essentially all of the nonprescription pain killers except Tylenol (acetaminophen).

Over 2/3 of the women took no pain killing medication.  The investigators learned that the minority that did had a miscarriage rate 80% higher than that of the nondrug women.  This risk was specific to the NSAID users as none of the 172 women who took acetaminophen miscarried.  The greatest risk was close to the time of conception.

An ounce of prevention is worth a pound of cure

Old truisms like this one persist because they contain wise advice.  Unfortunately, while we all know them to be true, we often aren't so good about implementing the advice.  Many of my patients do a very good job of researching their health problems.  Many put lots of energy into sorting out what supplements might be good for them.  However, relatively few of them adequately attend to the basic health screenings they should receive.  Fewer still come in to go over their lifestyle habits to prevent disease or learn how to improve the way they feel on a day to day basis.  In the rush of life we tend to overlook things until they force us to take notice.

I recommend that patients come in every year or two, even if they feel well, so that we can discuss their health habits.  Part of this review is going over their diet looking for problem areas.  If they have been in before, I will try to learn if they have been acting on my previous recommendations or if the recommendations should change.  Every year there are literally millions of new research findings published in medical journals.  As we learn more, I work to incorporate the best parts of what we have learned into my recommendations to patients.  As medical researchers have finally begun to research alternative medicines and dietary supplements, we are learning so much so fast that it is simultaneously wonderful and overwhelming.  My family can tell you of the mounds of medical journals I plow through every week.  I even keep a stock of them in my car so I can read whenever I have an opportunity.

This article is focused on the health screening that I recommend.  Please go to Fundamental Health Principles on my website to read about what I believe we all need to do on our own to be healthy and happy.

Beginning Before Birth

Prenatal care is preventive medicine.  It is the most purely wellness-oriented aspect of conventional medical care.  Prenatal care is also unquestionably one of the most successful aspects of conventional medical care.  It saves lives, leads to healthier children and saves money.  I would like to see more parents educated about diet, supplement and lifestyle interventions that appear to have great potential for improving the wellbeing of their coming child no to mention the soon-to-be delightedly stressed parents.

Childhood

Continuing through the life cycle, well child exams are a justifiably popular means of screening children for health problems.   Many problems, can be identified early and then treated before they become significant.  In some cases, like hip dislocations or strabismus, delayed treatment can make the problem very difficult to treat succesfully.

 In addition, these visits provide a fantastic opportunity for health education.  New parents should receive support informationally and often emotionally in these visits.  Experienced parents can get help sorting how to deal with the new and different model now in their possession.  The physician learns about the new patient and his/her family while providing preventive health education.  In some cases it can be important to screen for anemia or environmental toxins (lead for example).

The nutritional needs of children are quite different from those of adults.  Also, dietary choices made in the formative years have life long repercussions.  US government data tell us that 30-70% of American children are deficient in some of the most common vitamins (E, C & A).  Despite this fact, very few pediatricians routinely inquire about their patients' dietary habits.

After completing the customary run of well child visits by age 2, I like to see healthy children every 2-3 years to go over their diet, conduct a physical examination and address any health related questions.  This becomes most important around the major growth spurts because overlooked chronic nutritional inadequacies often lead to disease or worse when the body lacks the nutrients needed to fuel its transformation.

Children increasingly participate in sports with a specialized dedication making them more susceptible to a variety of injuries.  For example, girls playing sports that involve explosive directional changes like soccer, volleyball, basketball and skiing have a major risk for serious knee injuries peaking in the mid teenaged years.  Children and adults for that matter who play contact sports (football, soccer, boxing, skiing, horse riding) are at risk for head injuries.  We now have exercise regimens proven to reduce the risk of knee injuries and computerized testing to follow subtle signs of brain injury guiding decisions about safe return to competition.

Teenagers - Yikes

As the officially designated source of societal debate, frustration, controversy and criticism teens have a heavy responsibility to challenge the assumptions of the rest of us.  Although I can understand the reasons for friction between parents and their teens, I enjoy working with them.  Maybe that has something to do with my lifelong role as an agitator.

In my experience it is very important for me to see my young patients again during this time of their life.  One reason is that they need to know that I am their doctor and, limited by threats to themselves and others, I can be a confidential source of information.  As their lives change, so do their risks and inevitably their responsibility for their own health.

I have mixed feeling about vaccinations but maybe the most important vaccination to consider is the hepatitis B vaccine.  It is usually administered to infants because of the "we've got them in our clutches" public health attitude.  Except when family members are hepatitis B carriers, children are not at risk for hepatitis B until they begin dating.

Just as with the rest of the lifecycle, prevention is better than treatment so this is a critical time for education about high-risk behaviors, diet and exercise.  The old fear about marijuana use leading to addiction to "harder" drugs may have some truth to it but we know for certain that cigarette smoking is clearly and strongly associated with subsequent drug and alcohol abuse.

Next time - On to Adulthood