Posts Tagged ‘Vaccine’

The Mad Hatter + Fish: Mercury Levels & Your Health


by Brenton Bauer, MD 2011 | bauer@myhousecallmd.com

You are probably wondering why the title of this article references a character from Lewis Carrol’s famous childhood story, Alice and Wonderland, when we are supposed to be discussing the effects of mercury on human health. Well, interestingly enough, it has everything to do with mercury. To take you back on a quick journey through history, 19th century hat makers (aka “hatters”) used to utilize a mercury-based solution in the process of curing animal pelts for their hats. Furthermore, they typically worked in very poorly ventilated workshops and, during the curing process, they would inhale large quantities of vaporized mercury. Over time, these hatters began developing neurological symptoms, which Carrol used as the framework for the idiosyncrasies seen in the character of the Mad Hatter. As Lewis Carrol has shown us, mercury and its impact on human health is not a novel idea. There is, however, a lot of hype regarding this heavy metal in contemporary news. Below, we strive to break down some of the key issues regarding mercury’s interaction with human health in today’s day and age.

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13

12 2010

Guide to a Healthy & Happy Holiday Season


by Joshua Goldman, MD, MBA | goldman@myhousecallmd.com

The holiday season is both an wonderful and hectic time of year.  Along with holiday cheer comes cross-country travel, quality family time, celebratory feasts…and unfortunately the seasonal flu, stress, sleepless nights in strange beds and post-feast weight gain.  The House Call, MD team has been diligently working around the clock to find proven ways to keep you safe and healthy this winter.  Follow our Holiday Survival Guide below to make it through the season just as happy and healthy as you started it.

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09

12 2010

What’s New With the Flu: 2010 Influenza Update

by Rebecca Shatsky, MD 2011

If you haven’t had your flu vaccine yet this year, there is no time like the present. Last year’s flu season left the whole world reeling with the introduction of our new friend H1N1: schools across America were closed, people stood in line for hours to get vaccinated and medical intensive care units in hospitals across the country were full of unsuspecting otherwise healthy patients who were unlucky enough to come down with this highly transmissible infection.  One little shot could prevent all this chaos and leave you resting comfortably at night.  Seems like a no-brainer to us.

Although the 2009 H1N1 “swine flu” caused quite the stir last year, the world somehow emerged relatively unscathed at the end of the natural flu season. In August 2010, the World Health Organization officially declared the H1N1 pandemic to be over.  But now, as the temperature drops and we inch towards cold and flu season, the panic of 2009 is starting to reemerge, as is the question (that has really yet to be addressed by the media), “Whatever happened to swine flu?”  So before this year’s flu virus starts spreading like wildfire, we at House Call, MD would like to take the opportunity to explain the natural course of the seasonal flu, what was different about last year’s pandemic and what to expect this upcoming flu season.

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27

10 2010

Travel Medicine: Staying Healthy in Kokomo

by Georgina Lee, PharmD 2011 | lee@myhousecallmd.com

With summer just around the corner, your dreams of traveling are very close to becoming a reality.  You open up your inbox and find ten unread messages highlighted in bold.  One of them may be from Aunt Sally but the rest have subjects like “$99 roundtrip airfare to Jamaica!”  Suddenly, a spark ignites and you start clicking on ads from Expedia, Jetblue, and Virgin and the next thing you know, you and five other friends are going to Timbuktu next week.

Before you start debating whether to pack your blue swim trunks versus the red ones, there are a few important questions you and your travel mates should ask:

•    Will I be going out of the country? If so, how many countries will I be visiting?

•    When will I be leaving and how long will I be staying at each destination?

•    What are my accommodations and what kind of activities will I be doing?

•    How am I traveling at my destination? (Hike, backpack, train, etc.)

•    What is my personal medical history including current medications, allergies, and other considerations or limitations?

When most people think of travel medicine, they think “vaccines” and “bothersome.”  In a 2003 U.S. airport survey, only 36% of travelers sought travel health advice.  73% of them went to high-risk malaria regions and, of those, only 46% brought along anti-malarial medications.  Most were traveling to regions where Hepatitis A was prevalent but only 14% of travelers were immunized.  Overall, vaccination rates were as low as 11% and 13% with respect to Tetanus Diphtheria (Td) and Hepatitis B.

For those who are asking “Well, how dangerous could it really be?”  Here are some statistics that might raise your eyebrows:

According to a network of specialized travel medicine clinics called GeoSentinel, the number of travelers with likely exposure ranged from less than 100 to over 1000 people in places like Mexico, South America, India, and parts of Southeast Asia.

Likely Country of Exposure in Patients Seen After Travel

(September 2009; n=43,216 Travelers with Known Country of Likely Exposure)

GeoSentinel and the CDC also collected data on large samples of sick travelers, specifically those who traveled to many countries, after they returned home.  Based on 17,353 travelers seen at 31 clinical sites on six continents, the following region-specific disease occurrences were found:

•    Febrile illness is most likely from Africa and Southeast Asia

•    Malaria is among the top three diagnoses from every region

•    Over the past decade Dengue Fever has become the most common febrile illness from every region outside sub-Saharan Africa

•    In sub-Saharan Africa, rickettsial disease (which causes a number of illnesses including Typhus and Spotted Fever) is second only to malaria as a cause of fever

•    Respiratory disease is most likely in Southeast Asia

•    Acute diarrhea is disproportionately seen in travelers from South Central Asia

In addition, 226 out of every 1,000 sick travelers had a systemic febrile illness, 222 had acute diarrhea, 170 had a dermatologic disorder, 113 had chronic diarrhea, and 77 had a respiratory disorder.  This doesn’t even include road travel-related deaths, falls, drowning, heat stroke, homicide, or altitude-related injuries.

Starting to sound scary?  The good news is that you and your friends can still go camel back riding in Peru or climb the Great Wall of China without fear, as long as you take the necessary precautions before traveling.  An ounce of prevention before you leave can make or break your trip.

Routine Vaccines

Tetanus-Diptheria (Td) and Pertussis

Everyone should get Td because you can get contract these illnesses almost anywhere, from countries like Russia and Eastern Europe to your own backyard!  It’s important to keep in mind that a routine booster is required every 10 years.

Influenza

This is also known as your flu shot, which is now available through both intranasal and injection routes of administration.  If you have a severe allergy to eggs or have other medical conditions, do not get the flu shot without consulting your doctor first.

MMR (Measles, Mumps, Rubella)

Did you know that most travelers should have 2 doses of MMR?

Update other routine vaccines

A pneumococcal vaccine is indicated for people who are 65 and older and individuals with certain medical conditions.  The Zoster vaccine (which protects you against chickenpox and shingles…note that they are caused by the same virus) is also indicated for people who are 60 and older so be sure to double check your immunization records before you hop on a plane.

Food/Water Borne Diseases

Catching a stomach bug while traveling is about as miserable as it gets.  Follow these simple tips to help prevent yourself from falling victim to the plethora of infections out there waiting to wreak havoc on your stomach.

“Cook it, peel it, boil it, or forget it!”

  • Make sure all your food has been thoroughly cooked and comes out steaming hot.

  • Avoid raw fruits and vegetables unless they can be washed in clean water and peeled by the traveler (think of the red apple from the movie Snow White).  If you can’t peel it yourself, you’ll have to trust that whoever brought it to you did a stellar job of washing it.  Are you willing to roll the dice?

  • Drink only beverages made with boiled water (coffee, tea) or bottled water (double check the sealing)

  • Avoid tap water and anything mixed with water or ice

Traveler’s Diarrhea

This is probably the most common travel-related health problem for our jet setters.   It usually occurs within the first 14 days of travel, especially if it is caused by bacteria (such as E. coli).  It’s defined as having three or more loose stools in an 8-hour period or four or more loose stools in a 24-hour period plus other symptoms like stomach cramps, nausea, etc.  Sexy, we know.  Typically, traveler’s diarrhea is self-limiting (i.e. goes away on its own) and will last 3-5 days.  So how do you prevent it?  Standard food and water precautions should suffice.  For the hypochondriacs in the room, antibiotics such as TMP/SMX (Bactrim), or ciprofloxacin and levofloxacin can be used.  However, because many diarrheas go away without medication, using an over-the-counter medicine like Loperamide (Imodium) which slows down your overactive bowels should suffice for mild to moderate diarrhea.

Typhoid

People usually contract typhoid fever from food and water contaminated with the bacteria, Salmonella typhi.  Typhoid vaccines are 60-70% effective against this critter and can be administered as a pill or an injection.  The pill form provides 5 years of immunity and needs to be completed 7-10 days before departure.  Alternatively, The injection is a single dose that lasts for 2 years and needs to be given 14 days prior to departure.  Note: the pill form needs to be taken every other day (three doses total) and the pill causes mild gastric discomfort (i.e. an upset stomach for a few days).

Hepatitis A

Hepatitis A isn’t nearly as famous as Hepatitis B but is a virus you will definitely want to avoid during your next trip.  Hep A is transmitted via contaminated food and water and person-to-person.  Morbidity increases with age and reports show 2% mortality in those greater than 40 years of age.  Countries like South America, Mexico, China, India, Africa, and even Greenland have an elevated prevalence of Hep A.  Vaccines are very effective and well tolerated and should be administered 2-4 weeks prior to departure.

Poliomyelitis

This is an acute viral infection that typically involves the gastrointestinal tract.  At the end of 2007, areas of polio risk included Sub-Saharan Africa, Southeast Asia, and the Middle East.  Food, water hygiene and vaccinations remain the best defenses against this infection.

Diseases you can catch via Person-to-Person contact (watch out snugglers!)

Hepatitis B and C

Hepatitis B is transmitted via blood, saliva and sexual contact.  Hepatitis C is transmitted via blood.  There is an excellent vaccine for Hepatitis B but there is currently NO vaccine to prevent Hepatitis C.  You Hep B vaccine options include two interchangeable Hep B vaccines and a combination Hep A and B vaccine.  Since the Hep B vaccine consists of three shots given at 0,1, and 6 month intervals, plan ahead so that you’re fully vaccinated by the time you leave for your trip.

Meningitis

This is an acute bacterial infection that is spread by respiratory droplets (i.e. saliva and those tiny drops of water that fly everywhere when you sneeze), close personal contact, and nasal secretions.  Saudi Arabia, where Meningitis is common, requires a vaccine for those who travel to Mecca during the Hajj pilgrimage.  Additionally, the “Meningitis Belt” includes Sub-Saharan Africa and Asia wher risk is especially high during the dry season (Dec-June).  There are two vaccines available, both of which take 7-10 days to take effect.

Tuberculosis

TB is a bacterial respiratory disease spread by airborne respiratory droplets.  Risks to travelers include areas highly endemic with TB such as Sub-Saharan Africa, Russia, and Asia.  The vaccine is given at birth in many developing countries but not used in the U.S. due to variable efficacy.  However, it’s important to get screened either via the PPD skin test or chest x-ray from your provider.

Vector-Borne Illnesses (i.e. disease you get from critters)

Although vampire movies are all the rage right now, mosquitoes are unmatched in their ability to suck blood and transmit diseases (only they’re not as good looking).  Enter the insect repellent arms race!  The most common types of insect repellants are:

•    DEET

•    Picaridin

•    Oil of Lemon Eucalyptus

•    Soybean oil

•    Citronella

(Bold = CDC Recommended)

DEET is considered the most effective insect repellant by the CDC.  Two important variables with repellents are Protection and Retention Time, both of which are concentration dependent (10-35% formulations provide adequate protection for 3-6 hours while 50-100% formulations increase protection time by 1 additional hour).  At the same time, more is not always better.  Using too much DEET in high concentrations can lead to DEET toxicity in the form of skin irritation, allergies and, in rare cases, encephalopathy (brain swelling) and seizures.  Another important tip is to avoid products that contain both DEET and sunscreen because the DEET can decrease the effectiveness of the sunscreen.  Therefore, you should apply sunscreen FIRST followed by DEET 1-2 hours later.  Yes, we realize this is a huge pain…but not nearly as bad as malaria.  Travelers can also use Permethrin spray (another insecticide) that can be applied to clothes and lasts for 2 weeks or 2 washings (whichever comes first depending on your personal hygiene).

Malaria

There are currently 500 million cases worldwide and 1 million deaths reported annually as a result of malaria.  Clinically, there is a 10-14 day incubation period followed by fever, malaise (i.e. you feel like poop), headaches, chills, diarrhea and sweats.  The risk of malaria after 1 month of travel with no preventive medications are as follows:

•    Oceania                                           1:5

•    Africa                                               1:50

•    S. Asia                                              1:250

•    SE Asia                                            1:2,500

•    Mexico and Central America      1:10,000

There are a ton of options for malaria-preventing medications depending on the species of mosquito in the region you visit.   The drugs are categorized as Chloroquine-sensitive P. vivax malaria, Chloroquine-resistant P. falciparum malaria (CRPF), and Mefloquine-resistant P. falciparum malaria (MRPF).  There are many choices within each category and your physician will choose the best option for you based on your current medical history (pregnant, psychiatric disorders, drug interactions, etc.) and your travel itinerary.

Dengue Fever & Chikungunya

This virus is the result of a marriage between an African virus and an Asian mosquito.  It can be self-limiting and is associated with fever and joint/muscle pain that lasts for 2-3 weeks.  It is also associated with a 30% mortality rate (not a good thing).  Unfortunately, there is NO vaccine and NO treatment available so the best way to prevent this disease is by using DEET and/or Permethrin.  Countries with a notable risk of Dengue Fever include Mexico, South America, Sub-Saharan Africa, India, and Southeast Asia.

Yellow Fever

Prevalent in countries including Brazil, Peru, Colombia, and the entire Sub-Saharan region of Africa, this viral disease is transmitted via mosquitoes (surprise, surprise).  The incubation period is usually 3-6 days and symptoms range from subclinical (i.e. you don’t ever notice it) to severe (i.e. multiple organ system failure).  There are roughly 200,000 cases per year, 30,000 of which are fatal, leading to a mortality rate of 15% annually.  Each dose of the Yellow Fever vaccine lasts for 10 years and needs to be administered 10 days before entering the country of risk.

Japanese Encephalitis

This virus is extremely rare.  You are at risk if you spend extensive amounts of time in a rural outdoor setting in the evening (we told you it was rare).  Incubation is typically 4-14 days and is associated with fever, chills, headache, nausea, vomiting, and neurological symptoms.  Of note, 30% of encephalitis cases are fatal but encephalitis is rare in most parts of the world (except for countries in Southeast Asia such as Indonesia).  A 2-dose vaccine is available that needs to be administered 28 days apart, so plan accordingly if traveling to a destination that has a high risk of Japanese Encephalitis both seasonal or year round.

Okay, I’ve consulted my provider and received the necessary vaccines for my trip, does that mean I’m done?

The answer is almost, but not quite!  Avoiding/preventing infection is a big part of staying healthy while traveling but not the only health aspect to be mindful of.  It’s important to pack a few basics for your trip including:

  • Water – Your body has an uncanny ability to lose water while traveling.  The air (completely lacking moisture) on airplanes dries you out before you even set foot on foreign soil.  Once you arrive at your destination, you’ll notice that many parts of the word are extremely hot.  You can sweat multiple liters of fluid each day, all of which need to be replaced.  Make sure to drink plenty of water (as well as electrolytes) to stay hydrated during your adventure.  While traveling, bottled or purified water is always your safest bet.

  • Sunscreen – As we all know our skin protects against heat, sunlight and infection, however, we need to protect our skin from skin cancer, aging, wrinkles, pigment discoloration, sunburn and heat rash.  The SPF on a sunscreen measures a product’s ability to screen or block UVB rays and is calculated based on the smallest dose of UV radiation (measured in hours) which causes erythema (i.e. inflammation in your skin affectionately known as sunburn).  The FDA does not like labeling sunscreen above SPF 30+ because there is not much protective benefit beyond that level.  The factors to take into consideration when choosing a sunscreen include the amount you need, broad or full spectrum, water resistance and formulation.  There are two types of sunscreen – chemical absorbers and physical blockers.  Chemical sunscreens have active ingredients that absorb, filter and reduce UV radiation penetration (examples include PABA, cinnamates, salicylates and octocrylene) and their strength is measured in SPF.  Physical blockers such as titanium oxide or zinc oxide reflect or scatter the sun’s UVR and are not measured by SPF.

  • Insect Repellant – Another option besides DEET or Permethrin is Picaridin, which is equally as effective as 20% DEET and is non-greasy and odorless.  For those who prefer more natural products, 30% Oil of Lemon Eucalyptus (PMD) is equivalent to 20% DEET but requires more frequent application.

  • Mosquito Net (if applicable)

  • Anti-Diarrheal Medications – Other than rehydration, over-the-counter agents such Loperamide (Imodium) work fast to absolve diarrhea symptoms by minimizing loose stools and stomach cramps (it works like brakes on runaway bowels).  Bismuth Subsalicylate (Pepto-Bismol) can also be used as an antidiarrheal, antimicrobial and a mucosal protective agent, however, it can interact with certain antibiotics including Ciprofloxacin (such as for Traveler’s Diarrhea), and should be avoided in pregnant women.

  • Pain Medications – Non-steroidal Anti-Inflammatory Drugs (NSAIDs) like Ibuprofen or Naproxen can not only help decrease generalized pain but it can also decrease erythema or sunburns.  Other agents that can be used for sunburns include aloe vera and vitamin E creams and gels.

  • Allergy Medications – Pack some Diphenhydramine (Benadryl) or a non-drowsy alternative like Loratidine (Claritin) or Cetirizine (Zyrtec) in case you develop allergy symptoms such as watery/itchy eyes, runny nose, rash, or hives due to exotic foods or flowers.

  • First Aid Kit – Most pharmacies sell pre-made kits you can easily purchase that include antibiotic creams (Polysporin and Neomycin), band-aids, gauze and alcohol wipes.

  • Water Disinfectants & Hand Sanitizers

There are many resources available to travelers (for example, the CDC website, www.cdc.gov), which can be very useful and informative for important travel information.  It’s always better to be safe rather than sorry before hitting the road.  The last thing anyone wants is to end up in a hospital instead of showing off his or her cool tan lines.  An ounce of prevention goes along way when traveling.  As always, remember to seek professional medical advice before starting any new treatment.  Happy travels!

References

1.    Shoreland’s Medical Reference Guide

2.    Shoreland’s Travel and Routine Immunizations (“Blue Book”)

3.    Shoreland’s Travax/EnCompass

4.    TravelCare©

5.    Tropimed© by Astral, Switzerland

6.    CDC Health Information for International Travel (“Yellow Book”) – 2009

7.    World Health Organization (WHO). International Travel and Health – most current edition

8.    Rose S. and Keystone J.S. International Travel Health Guide. December 2005

9.    Dawood, R. (2002). Traveler’s Health: How to Stay Healthy Abroad (4th ed.).

10.    DuPont, H.L., & Steffen, R. (Eds.). (2000). Textbook of Travel Medicine and Health (2nd ed.).

11.    Jong, E. & McMullen, R. (2003). The Travel and Tropical Medicine Handbook (3rd ed.).

12.    Keystone, J.S., Kozarsky, P.E., Freedman, D.O., Nothdurft, H.D. (Eds.). (2008). Travel Medicine

13.    Leggat, P.A., & Goldsmid, J.M. (Eds.). (2002). Primer of Travel Medicine (3rd ed.). Brisbane: ACTM Publications. actm@tropmed.org

14.    Steffen R., DuPont H.L., & Wilder-Smith, A. (Eds.). (2003). Manual of Travel Medicine and Health (2nd ed.).

27

05 2010

Managing your Doctor: Make the most of your visit

by Joshua Goldman, MD/MBA 2010

Managing your life is a lot like managing a company.  You sit in the corner office as CEO and manage your team of employees who may include (but are by no means limited to) your accountant, personal trainer, lawyer, hair stylist, and, most relevantly, your physician.  We often forget this relationship due to the dynamics of our interactions with these “employees” but at the end of the day, they really do work for you.  That being said, you have an obligation to “manage” these individuals, informing them of your needs and expectations, so that they can do the best work possible on your behalf and subsequently allowing you to enjoy the fruits of their labor.  The question then becomes, “How do you manage your doctor?”

Step 1: Hire the Right One

The first and most critical step is to find the right doctor for you.  You want a physician that is personable and who you feel comfortable trusting with your health.  You also want to make sure that your physician can provide you with the face time you deserve and need.  Many doctors now have to rely on a larger volume of patients to compensate for the decreasing reimbursements they receive from insurers (i.e. they crank through 40+ patients per day and look a lot like this guy flying from exam room to exam room).  So make sure that your doctor is willing to spend enough time with you each visit to address all of your medical needs.  Another key is to make sure you’re seeing the right type of doctor.  Primary care doctors come in many forms (internists, family physicians, geriatricians, etc.) so make sure that the doctor you hire is the right one for you.  How do you know what’s right for you?  Ask them about the types of patients in their practice.  If 90% of their patients are 65+ and you’re 24 years old, you may want to find another doctor with more experience with a younger population.  If you’re a female and don’t feel comfortable with a male physician, you should probably find a female (females, by the way, have now surpassed men and become the majority in medical schools in America).  The takeaway: Find someone that you can relate to and that you feel comfortable with.

Step 2: Schedule Your Meeting

Just as in business, there are good times and bad times to schedule appointments with your physician to maximize the attention you receive and prevent yourself from waiting for hours in a crowded waiting room (like the one we are all too familiar with seen here).  Imagine the energy and enthusiasm you would bring to a board meeting at 4:30pm on a Friday afternoon.  It would be a sad showing to say the least.  A Monday morning seems like a more logical choice.  So let’s begin with when NOT to schedule an appointment:

  • Right Before Lunch: Doctors often have lunch meetings that they have to attend.  If the doctor is running behind (which they almost always are) you may be bumped to the first appointment of the afternoon meaning an extra hour in the waiting room.  Those magazines can only keep you entertained for so long.

  • At the End of the Day:  We would bet a small fortune that the doctor will be behind by the time the 4:00pm appointments start to arrive.  The few minutes behind that he has been with each patient will have snowballed into at least 30 minutes by now translating into more waiting for you.  In addition, it’s hard to keep everything straight in your head by the end of the day.  With 30+ patients already floating around in your doctor’s mind, you will certainly not be getting the attention you need at this time in the day.

With all this in mind, the first or second appointment in the morning seems to be the best time to see your doctor.  They will be on time (we hope) and with a clear mind that can be entirely focused on your needs.

Scheduling your appointment is the next step.  Behind every famous Senator has a wonderful assistant who holds the key to face time with that elected official.  The same goes for doctors.  Schedulers are the gatekeepers of the doctor’s office.  Find out who your doctor’s scheduler is and shower that individual with love and kindness.  If you do, they can make miracles happen.  If you are rude to the, they can make your life miserable.  Once you’re on their good side they can squeeze you in at the last minute, give you a call if someone cancels and help you secure that perfect time first thing in the morning.  You may have a longer wait time if you try to get an appointment the same day but the scheduler is the only one that can get you on the books.  They’re like wizards.

Step 3: Lead the Meeting

The most important part of this step is to BE ON TIME.  How would it look if you showed up 15 minutes late to a board meeting you were running?  Think of your appointment the same way.  Your physician, unfortunately, may not be on time but if you’re late and the doctor is on schedule, you run the risk of losing your appointment and having to start the process all over again.  Also, you will undeniably have to do paperwork when you get there.  We’re not entirely sure where all this paperwork comes from or what it is used for (we doctors don’t see the majority of those forms) but you will, without a doubt, have to fill out some new form and sign a document or two before the doctor sees you.  It’s as predictable as the weather in Seattle, so plan for it.  Also, bring a book or a magazine to keep you entertained for the few minutes until your appointment but make sure you’re there on time.

In addition, be prepared.  Bring your personal medical records with you including any imaging and lab studies you’ve had performed (we’ll cover what to include in your record in a minute).  Many physicians will request to see these studied before they make any treatment decisions so save yourself an extra visit by having these tests performed in a timely manner and bringing the results with you.  You only need to bring your full medical record to your first visit with a new doctor but always bring your most recent labs and imaging for the doctor’s reference.

Now it’s time to run the meeting.  The key to any successful meeting is a clear agenda.  As soon as the doctor walks in, set this agenda with him, outlining all of the issues you’d like to address as well as the questions you would like answered before you leave (remember that, on average, the doctor only has 15 minutes to spend with you each visit).  It’s amazing how many times patients, when asked why they have come to the doctor, reply, “I don’t know. I thought you would know.” Our advice: Know why.  You’ve called the meeting for a reason and we can’t help you unless we understand what you need so be sure to let us know why you have made the appointment as well as all of your specific questions and concerns. Many people also forget the questions they wanted to ask (we call it “White Coat Anxiety”) so the best strategy is to write them down and bring them with you to your appointment.

The next key step is to recap and plan your treatment.  Physicians are required to complete the note they write in your chart with an “Assessment & Plan.”  Your job is to make sure you understand both of these inside and out.  It sounds simple but you’d be amazed how many people don’t leave with this understanding.  The number of patients who don’t know why they’re taking a certain medicine is astounding.  Before you begin any treatment plan, you should ask these questions:

  1. What is my diagnosis and how did you confirm it?

  2. What treatment am I being given and why?

  3. How does that treatment work?

  4. Are there any alternative treatments?  If so, why is this treatment the best choice?

With this knowledge, you’ll be able to make better decisions about your treatment and will understand why the treatment is necessary.  Your health care is a team effort and there’s no “I” in “team.”  You are the CEO of the company called “You” and are as accountable for your care (the doctor is your hired consultant, remember?).  While we’re talking about accountability, let’s discuss your medical records.

Step 4: Manage your Records

Until the government and private industry resolve the battle over the ultimate solution to electronic medical records in America, you are responsible for keeping your thorough medical record.  It is scary how many patients can’t remember the name of their medications.  The most common response to “What medications are you taking?” is “A little white pill for my blood pressure.”  Not a good answer (and a scary one at that) given the ridiculous number of blood pressure medications on the market and the catastrophic effects of medication interactions.  Have we convinced you to keep your personal medical record yet?  If not, we’re happy to fill you in on all the gory details of medical mishaps from poor record-keeping.

What should you keep track of?

The medical profession is highly regimented.  We are trained to follow a very specific (and thorough) format when recording a medical history.  Below, is an outline of all the medical information your physician will need to know to provide you with the best care possible.

History of the Present Illness: This is the full story of your current medical problem.  Write it all down so you don’t forget any important details when you finally get face time with your doctor.

Past Medical History:

  • Hospitalizations: Have you ever been admitted to the hospital?  If so, keep copies of your “Discharge Summary” from each admission.  These are not routinely given to patients so be sure to specifically ask for a copy or track one down via medical records.

  • Surgeries: Have you ever had surgery?  If so, keep copies of your “Operative Reports” so the doctor knows exactly what was done and when.

  • Medical Conditions: The doctor will want to know about all of your medical problems.  This includes any history of cancer, heart disease, hypertension, diabetes, STD’s, etc.  If you’ve had something, keep track of it.

  • Medications: Do you take any prescription medications?  It is very important to keep detailed records about the medications you take, how often you take them and what dosage you take.  Also, keep track of any side effects you’ve had with medications in the past.  Many classes of drugs are related and tracking your side effects may be helpful in finding the right medication for you in the future.

  • Allergies: Do you have any allergies to food, medications or things in the environment?  Allergic reactions are horrifying and are often more severe each time you are exposed to the allergen.  Definitely worth keeping track of!

  • Trauma: Have you even been in a major accident?  A history of trauma of any sort is very important for a physician to know.

  • Vaccinations: The government currently gives you a small card to keep track of your vaccinations…not the easiest thing to keep track of.  Add your vaccination history to your medical record so you can be sure to stay up to date with any boosters you may need.

Family History: Many of the diseases that plague our society have a genetic component passed down from one generation to the next.  Keep a detailed history of any major medical problems that have affected your parents, aunts & uncles, siblings, and children.

Imaging: X-Rays, CT Scans, Ultrasounds and MRI’s are extremely expensive.  These test are repeated too often because physicians cannot track down copies of the most recent imaging studies performed (the cost of which comes back to you as a patient).  If they can’t find it, they’ll just do it again.  Request a copy of every imaging study you have performed as well as the report from the radiologist who examined the study.  This is a huge time and cost saver for you.

Lab Results: Same idea as the imaging studies.  Keep a copy of all lab studies you’ve had including blood work and biopsies.  For biopsies, you will want to keep a copy of the “Pathology Report” which contains a description of what the specialist saw when they examined the biopsied tissue.  Nobody wants to have two biopsies done if they don’t have to (they are not as much fun as they sound)!

How do you keep track of your personal medical record?

There are a number of ways you can manage your personal medical record depending on your personal preference and predilection for technology.  There are thousands of additional options, but these should get you started.

  1. Google Health: Google Health, a free record keeping system, allows you to manually input your medical record or import it from a number of medical provider networks’ electronic record systems.  They also have partnerships with a number of record-keeping companies that will track down and upload your personal records for a fee.  Google Health is an efficient paperless way to track your records. At the same time, many people fear the repercussions of inputting their health record into an online database.  We feel you.  If you are more of a Microsoft fan, Microsoft has created a similar program called HealthVault with similar functionality.

  2. Word Document:  If you’re worried about the hackers of the world finding out about your vaccine history, a password-protected Word Document may be the solution for you.  This method requires the same amount of manual data entry as Google but requires you to format the record yourself.  Luckily, you have our nifty outline above to follow…your doctor will be seriously impressed.  Be sure to back up the file on a CD or external hard drive in case your computer crashes.  You don’t want to have to start all over again if you spill coffee on your hard drive.

  3. A Good Old Fashioned Folder: If technology isn’t your thing or you don’t want to have to retype everything into a document, keep copies of all of your doctor’s notes, operative reports, imaging, lab reports, etc. in a big folder.  Oh yeah, and put the folder somewhere safe (ideally fireproof) that you will remember.  We know how hard it is to keep track of paperwork…don’t lose this stuff!

Now that you’ve compiled your extensive medical record, take a copy with you each time you see a new physician.  This document will save you a ton of time in the office with them (which you can use for your personal questions) and ensure that you receive the best care possible.

Armed with these strategies, you’ll be able to make the most out of each meeting you have with your doctor.  Remember, the most crucial step is finding the right doctor for you; someone you can trust, who spends time listening to your concerns and who leaves you feeling well cared for.  Your health is a team effort and you are the team captain.  Assume the helm and lead “You” to a happier, healthier life, beginning with more meaningful visits with your doctor.

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04 2010

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