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Saima M. Ahmad_ MD

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					Preventive care
Saima M. Ahmad, MD
  Physicians Clinic of Spokane
  Clinical Faculty, University of
 Washington School of Medicine.
       Islam and Prevention
Islamic principles of cleanliness, food
consumption, regulations for sexual behavior,
and Salaat as a form of meditation and exercise.
Dec 19th 2008 Friday Sermon by Hazoor.
Jamaat commitment to delivery of healthcare
worldwide.
Dilemma?
               Prevention
Quality Health care: Treatment of current illness
and appropriate preventive care to lessen future
health decline.
Preventive care recommendations are based on
diseases causing most suffering to patients and
are targeted to conditions where preventive
testing helps patient outcomes the most.
    Access to Preventive care
Barriers for Muslim women – cultural and
gender appropriate care. (1,2)
Medicare – Yearly “Wellness” exam, after you
have had Part B for longer than 12 months.
Most commercial plans allow “Well exam or
physical” benefit without co- pay.
National Breast and cervical cancer early
detection program:
http://www.cdc.gov/cancer/nbccedp
                Access
American cancer society, 1-800- ACS-2345
YWCA Encore plus program, 1-800- 95EPLUS
October is National Breast Cancer awareness
month.
www.GovBenefits.org – to find out Medicaid
qualification
www.benefitscheckup.org - to identify
government and private Rx and other health
resources.
                 Access
Screen for life – CDC program for colorectal
cancer screening
Osteoporosis screening with heel test and it’s
limitations. (3)
Local Nursing school and Blood Bank may be
able to do free blood tests.
Planned Parenthood – Birth control, Women’s
health, HIV testing, Prenatal care.
   Early detection of Cancers
Cervical Cancer - most easily preventable, 8th
most common.
Breast Cancer - Highest incidence
Colon Cancer – Second most common cancer in
Asian women
Lung Cancer – Leading cause of death from
cancer.
   Early detection of Cancers
Skin Cancers – Melanoma, BCC, SCC
Oral cancer
Prostate Cancer – commonest cancer in males
Testicular Cancer
Non Cancerous Chronic Diseases
 Diabetes
 Hypertension – High Blood Pressure
 Hyperlipidemia – High Cholesterol
 Atherosclerotic Disease:
     Heart disease and Stroke
     Abdominal Aortic Aneurysm
 Osteoporosis
 Vaccinations
 Depression
         Injury Prevention
Falls and Fractures
Motor vehicle accidents
Domestic Violence
   Life style related problems
Obesity
Physical inactivity
STD’s
HIV
Alcohol
Tobacco
Vision and hearing related problems
Early detection of
     Cancers
Colon Cancer
             Colon Cancer
Age- 50-75 routinely, 76-85 if needed, stop at
85.
Family history -10 years younger than family
member with diagnosis.
Personal history of IBD, ovarian and breast
cancer.
Diet – High fat, low fiber diet increases risk.
DASH diet lowers risk.
Aspirin Use – may be preventive.
Diabetes – increases risk by 20- 40%
            Colon Cancer
Types of screening tests and procedures:
   Flexible Sigmoidoscopy $150 – $300
   Barium Enema - $250 - $50
   Colonoscopy $800- $2000
   Stool test for occult blood - $20
   Virtual Colonoscopy $500- $1000
   DNA Stool test (4) – Approx $300
Local symptoms of Colon cancer
Rectal bleeding
Alternating bowel habits
Change in the caliber of stools
Cervical Cancer
  Cervical cancer risk factors
HPV, Chlamydia infection
Smoking
Oral contraceptive pill use > 5 years.
High fat diet, over weight
Multiple pregnancies – 3 or more
Age less than 17 at first pregnancy
DES exposure, born 1940 – 1971 in US, anti
lactation and miscarriage prevention med.
            Cervical Cancer
Pap - Start at age 21 or within 3 years, then at
least every 3 years till age 65. (5)
Not indicated in women with Total
Hysterectomy for BENIGN reasons.
HPV screening test.
Gardisil - also protects against HPV related
warts. 3 doses at 0, 2, 6 month intervals
Cervarix - 3 doses at 0, 1, 6 month intervals.
Both are for girls 9 through 26 years of age.
Breast Cancer
      Breast cancer risk factors
http://www.cancer.gov/bcrisktool
Early menarche, late menopause
Nulliparity (no children), lack of nursing
Chest radiation
Family history, Rare genetic conditions – BRCA
Dense breast tissue, previous biopsies
Hormone use – contraceptives and post
menopausal, including bio identical.
Overweight, high fat diet, lack of exercise,
        Breast cancer myths
Parabens in antiperspirants
Bras
Breast implants
Polychlorinated biphenyls – PCB’s in plastics
Night work – related to melatonin alteration
History of Abortion or miscarriage – No
association (6)
Smoking – may be higher in women > 40.
     Breast cancer screening
ACS – Mammogram yearly at age, Clinical breast
exam (CBE) every 3 years in 20- 40 year olds,
yearly when > 40.
USPTF – Mammogram start at age 50, then
every 2 years, stop at age 75. No need to do
CBE or Breast self exam (BSE)
ACOG – Mammogram every 1-2 years in 40-49
year olds, Yearly mammogram for women > 50,
BSE regularly. CBE yearly in women > 19
              Breast MRI
Breast MRI – 2 types one is to check integrity of
implants a different type of MRI is used as a
screening tool:
    High risk women with dense tissue.
    Personal or family history of BRCA
    Chest wall radiation under age 30.
    Certain genetic syndromes – Li-Fraumeni,
Cowden.
    Personal history of Breast cancer.
    Digital Mammogram (7)
Women under age 50.
Women with dense breast tissue
Peri menopausal (within 1 year of menopause).
Pre menopausal (Have not had menopause).
    Breast Cancer Symptoms
Breast lump
Lump in axilla – arm pit
Skin changes or ulcers
Nipple discharge or inversion
Most Breast cancers cause no symptoms till
fairly advanced.
Lung Cancer
     Lung cancer risk factors
Smoking
Asbestos insulation in older homes
Radon gas
Crystalline Silica from mining, sand blasting
Arsenic – in ethnic skin remedies by hakim’s (8)
Chromium – steel industry, leather dye.
Family history of lung cancer
COPD
  Lung cancer Screening tests
Chest X –ray – No benefit
Chest CT (9,10) – Can detect early stage cancer
Sputum cytology – helpful in combination with
CXR.
PET scan – high cost, no additional benefit.
USPTF – recommends no screening test be
done routinely.
Skin Cancer
    Skin Cancer risk factors
Family history
Sun burns and excessive sun exposure
Lighter skin – red hair
Tanning
History of Radiation therapy
Immune suppression from HIV, Leukemia or
medications.
          Types of Skin cancers
Basal Cell Carcinoma   Squamous Cell Carcinoma
Melanoma
Oral Cancer
     Oral cancer risk factors
Smoking cigarettes, cigars, pipes
Chewing tobacco
Chewing betel leaves (Paan) and Areca nut
(Supari)
Alcohol
Oral HPV infection
Radiation exposure
Poor oral hygiene
           Prostate Cancer
Risk factors – Family history, African ethnicity,
Testosterone use, smoking, Obesity, lack of
exercise, Prostatitis, no increased risk after
Vasectomy.
PSA blood test
DRE – Prostate exam by physician
 Non cancerous
Chronic conditions
Diabetes Mellitus
      Screening for Diabetes
CDC, ADA - All adults > 45 every 3 years
Yearly screening if high BP or cholesterol, high
birth weight > 9 lbs, polycystic ovarian
syndrome, overweight, family history.
USPSTF – routine screening if BP is > 135/80
or high Cholesterol
Individuals with borderline high test may need
Oral glucose tolerance test and/or A1c blood
test.
Interpretation of Blood Glucose
Fasting Blood Glucose (FBG) < 100 mg/dl –5.6
mmol/L - Normal
Pre diabetes or Impaired Fasting blood glucose
100- 125mg/dl or 5.6-6.9mmol/L
Impaired Glucose tolerance – 2 hour test, 75
gram sugar – 140- 199 or 7.8-11mmol/l
Diabetes - BG > 126 or Non Fasting BG > 200
  Abdominal Aortic Aneurysm
ACC/ AHA - Men over
60 with family history of
AAA
USPSTF - All men who
ever smoked at age 65
Women over 65 with
family history of AAA
    Heart Disease and Stroke
Risk factors - Family history, Smoking, Obesity,
Diabetes, High BP, Sedentary lifestyle, High
Cholesterol, Alcohol.
Start screening and risk assessment at age 35.
Framingham risk calculator
http://hp2010.nhlbihin.net/atpiii/calculator.asp
Low risk <10%
Intermediate risk 10- 20%
High Risk > 20%
   Heart Disease (continued)
Aspirin for men 45-79 in high risk group to
reduce heart attacks and in Women 55-79 to
reduce strokes.
USPTF advices against routine carotid screening
           Hyperlipidemia or
           High Cholesterol
 Current
 recommendations
All men 35 and older, and
 men 20- 35 with risk
 factors
All women 45 and older,
 and women 20-45 with
 risk factors
         High Cholesterol
Olive oil, canola oil
Fish twice a week
Flax seed, Walnuts, Soybean
Daily consumption of 1-3 grams of Omega 3
Fatty acids (11)
Reduce added sugar consumption to 5 tsp daily
or 80 calories for average adult woman (12)
                   Quiz
How much sugar is there in a 12 oz can of
Coca- cola?

1. Total carbs?
2. Calories from carbohydrates?
3. Tea spoons of sugar?
12 oz can of Coca Cola
      12 oz can of Coca Cola
1. Total carbs? 39 grams
2. Calories from carbohydrates? 140 calories
3. Tea spoons of sugar? Approx 8 Teaspoons
                Osteoporosis
Routine screening for
women with family
history or risk factors –
age 60
All women – age 65
 Risk factors for Osteoporosis
Eating disorders,
Low dietary intake of calcium < 1200mg/day
Alcohol, Smoking,
Caucasian or Asian ethnicity
Rheumatoid Arthritis
Medications - Steroids, thyroid medication,
Seizure medications, Prilosec like medications,
stomach malabsorption diseases like Celiac,
Crohn’s
            Bone Health
Vitamin D 1000- 2000 IU daily
Calcium 1200 – 1500mg daily post menopausal
women, 1000 – 1200 mg younger women
Weight bearing exercises
Calcium in 8 oz glass of skim
           milk ?
         Milk Calcium
300 mg
Calcium in 8 oz Plain Yogurt
         Calcium in yogurt
450 mg
              Vitamin D
Skin in tropics makes 10,000 IU daily on
exposure to UVB
Dark skin blocks conversion
Optimal sun exposure is between 11- 4 PM, 25-
35 min daily with 50% skin exposed to sun, so
adjust adequately for clothing.
Use UVA blocking SPF 15+ sunblock for early
am and late afternoon sun
        Adult Vaccinations
Flu – Influenza with H1N1
Pneumonia – age 65, or with preexisting
conditions.
Tetanus, Pertussis – Whooping cough. Tdap
now with booster every 10 years.
Shingles vaccine – over 60, must check with
physician – live vaccine.
Hepatitis A – 2 doses and B vaccination 3 doses
Meningitis vaccination
Depression
              Depression
1. Have you felt depressed or hopeless over last
2 weeks?
2. Over the last 2 weeks have you felt lack of
interest or pleasure in doing things?
If you answer yes to any one take the full test
online and take your printed results to your
physician
www.depression-screening.org
     Cancer Prevention Diet
Avoid Pesticides, Herbicides, Hormones
Food coloring, Preservatives
Salt, Frying – releases Acrylamides
Cook at low temperature for longer periods –
this reduces harmful cancer causing oxidizing
agents.
Red meat increases cancer causing nitrogen
metabolites which damage DNA.
                    Diet
Vitamin B12, Folic acid, Niacin, Zinc, deficiency
increase DNA damage thereby increasing risk of
diseases including cancer.
Dyes like Blue 1, Blue 2, Red 3, Yellow 5,
Yellow 6.
Green tea, Soy bean, Broccoli, Flax, Honey,
Fiber 25-35 grams daily
                Exercise
Target heart rate, 226 – age = max HR, 60-
80% of MHR is Target HR.
Aerobic exercise 25- 30 min 5 days a week.
All exercises work – Just pick the one that works
for you!
                         References
1. Culturally sensitive prenatal care for southeast Asians. Journal of Obstetrics
and Gynecologic and neonatal nursing. Volume 21, issue 1, pages 48-54, Jan
1992
2.Middle eastern Asian Islamic women and breast self exam. Cancer nursing
Feb 2000, volume 23, issue 1, pg 64-70.
3. Accuracy of Quantitative Ultrasound for identifying patients with
Osteoporosis. Annals of Internal Medicine, vol 144, 11, pg 832-841(June
6,2006)
4. Ann Internal Medicine 2008; 149: 441-50.
5. http://www.cdc.gov/std/hpv/ScreeningTables.pdf
6. ACOG committee on gynecologic practice Opinion No 434, Obst
Gynecology. 2009; 113: 1417-1418
                      References
7. NEJM, Diagnostic performance of Digital vs. Film Mammography for
breast cancer screening, Oct 27,2005, Vol353,no.17, 1773-1783.
8. BMJ 1993; 306:506 doi:10.1136bmj.306.6876.506 Arsenic and mercury
intoxication due to indian ethnic remedies.
9. NEJM. 2006 Oct26;355(17)1763-71
10. Current Onc Rep 2003 Jul;5(4):309-12
11. Circulation, fish consumption 2002;106:2747-2757
12. Dietary Sugar intake, Circulation; 2009;120;1011-1020
Thank You



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