Health and Disease, Uncategorized

10 TESTS TO AVOID AT THE DOCTOR’S OFFICE

Health and Wellness Associates
EHS Telehealth

 

10 TESTS TO AVOID AT THE DOCTOR’S OFFICE

 

10teststoavoid

 

10 TESTS TO AVOID AT THE DOCTOR’S OFFICE

 

 

Bulletin, doctors are warning that some of the medical tests routinely taken by Americans do more harm than good, waste billions of health care dollars annually and could endanger your health or even your life.

Some of the tests that are overused by prestigious panels of doctors include annual Pap smears, regular PSA tests, regular EKG’s, and even routine yearly physicals.  Doctors are saying that the overuse of such tests can lead to dangerous side effects, pain, radiation exposure, unnecessary surgery, even death.

 

The American Board of Internal Medicine Foundation asked more than 50 medical societies—of family

doctors, oncologists, cardiologists, and other specialists—to identify tests and treatments that are often unnecessary.  AARP is a consumer partner with this campaign, called Choosing Wisely.

 

Another Choosing Wisely partner is John Santa, M.D., medical director at Consumer Reports, and he says that these screening tests often yield false-positive results that lead to a spiral of unneeded invasive procedures, medications and even surgeries.  If you have symptoms or certain risk factors, these tests can be valuable—even life-saving—but they’re performed on far too many people.

 

Nuclear stress tests, and other imaging tests, after heart procedures:

 

Many people who have had a heart bypass, stent or other heart procedures want to be reassured that their hearts are functioning properly, which is understandable because they feel as if they’ve had a brush with death.  A common way to reassure their patients is for doctors to perform tests like a nuclear stress test or other tests, to make sure their hearts are beating strongly.  But according to William Zoghni, M.D., performing these tests every year or even every two years in patients without symptoms rarely results in any change in treatment.  “More testing is not necessarily better,” he says. In fact, it can lead to unnecessary invasive procedures and excessive radiation exposures without helping the patient improve.

 

Instead, patients and doctors should focus on what does make a difference in keeping the heart healthy: managing weight, quitting smoking, controlling blood pressure and increasing exercise.

 

Yearly electrocardiogram or exercise stress test

 

A survey of nearly 1,200 people ages 40 to 60 who have never had heart diseases or any symptoms found that 39% had an EKG over the previous five years, and 12% said they had an exercise stress test.  The problem with this is that someone at low risk for heart disease could be 10 times more likely to get a false-positive result than to find a real problem, says John Santa of Consumer Reports, which conducted the 2015 survey.

This could lead to unnecessary heart catheterization and stents.  Instead, have your blood pressure and cholesterol checked.  If you’re at risk for diabetes, have your blood glucose level checked, as well.

 

PSA to screen for prostate cancer

 

Cancer is always scary, but the PSA test often finds slow-growing cancers that won’t kill men.  “The evidence is extremely convincing that in a man with usual risk and no symptoms, the PSA test causes more harm than benefit,” says Reid Blackwelder, M.D., president of the American Academy of Family Physicians (AAFP).

 

He also says that as a result of the test, men often have ultrasounds, repeat lab tests and even biopsies for a problem that isn’t there—an estimated 75% of tests that show high PSA levels turn out to be false alarms.  When men do have treatments like surgery or radiation, 20-40% end up with impotence, incontinence or both.

 

Not all doctors agree with AAFP’s recommendation against routine PSA screening, but many agree that the test is overused.  Even the American Urological Association, which supports the use of PSA testing, says that it should be considered mainly for men age 55 to 69.  The American Society of Clinical Oncology recommends against PSA testing for prostate cancer screening in men with no symptoms when they are expected to live less than 10 years.  A recent study published in the journal Cancer found that Medicare spent almost $450 million a year on PSA screenings, one-third of which was for men over the age of 75.

 

PET scan to diagnose Alzheimer’s disease

 

Until recently, the only way to accurately diagnose Alzheimer’s was during an autopsy.  In the last few years, doctors have begun using PET scans with a radioactive dye to look for beta-amyloid protein that  is found in the brains of people with the disease.  Although this test has promising use for research, there are serious questions about whether it should be used on those who complain of fuzzy memory.  PET scans in older people consistently find the protein in 30 to 40% of people whose memories are just

fine.

 

Although beta-amyloid plaques are present in all of those who have Alzheimer’s, it’s not known if or when everyone with the plaques will develop the disease, says Peter Herscovitch, M.D., president-elect of the Society of Nuclear Medicine and Molecular Imaging.

 

What’s more, even if a PET scan could accurately diagnose the disease, it’s untreatable.  If you’re concerned about your memory, the better course would be a complete medical evaluation by a doctor who specializes in diagnosing and treating dementia.  Many other medical conditions, like stokes, thyroid deficiencies and vitamin deficiencies can cause the same symptoms, and these are treatable.

 

X-ray, CT scan or MRI for lower back pain

 

Unfortunately, back pain is incredibly common—80% of people will suffer from back pain at some point in their lives.  It can be both excruciating and debilitating.  Of course, people want to know what’s wrong with them.  Here’s the catch:  The best imaging machines in the world often can’t tell them what’s wrong.  Many older people with no back pain can have terrible-looking scans.

 

Most back pain goes away in about a month and imaging tests tend to lead to expensive procedures that often don’t help recovery.  One study found that people who got an MRI during the first month of their back pain were 8 times more likely to have surgery than those who didn’t have an MRI—but they didn’t get relief any faster.  If you don’t feel better in a month, talk to your doctor about other options like physical therapy, yoga or massage.  But if you’re experiencing numbness or weakness in your legs, you have a history of cancer or you have had a recent infection, see your doctor as soon as you can.

 

Yearly Pap tests

 

The yearly Pap smear is a common part of women’s health checklists, but it doesn’t need to be.

Women at average risk only need them every three years, since cervical cancer generally takes 10 to 20 years to develop.  If women have also had negative tests for the human papillomavirus (HPV), which is now known to cause the cancer, they only need a Pap test along with the HPV test every five years.  And women older than 65 who have had several normal Pap tests in a row can stop having them altogether.  Do note, however, that a yearly visit to an ob-gyn stays on the to-do list.

 

Bone density scan for women before age 65 and men before age 70

 

For the estimated 10 million people—mainly women—in the U.S. who have osteoporosis, bone-strengthening medications can lower the chances of breaking a bone.  A bone density test for anyone over the age of 70 is unnecessary.   You can no longer prevent osteoporosis at this age.

 

But many experts argue that for those age 50 to 65 who have osteopenia—mild bone loss—testing and subsequent drug prescriptions may be a waste of time and money also.

Not only is the risk of fracture often low, medications like Fosamax (alendronate) and Boniva (ibandronate) have been linked to throat or chest pain, difficulty swallowing, heartburn, muscle pain, bone loss in the jaw and thigh-bone fractures.  And there’s scant evidence that people with osteopenia get much benefit from the drugs.

 

To help keep your bones strong, try walking and weight-bearing exercises, says Blackwelder.  Get enough calcium and vitamin D in your diet.  If you smoke, quit.

 

Follow-up ultrasounds for small ovarian cysts

 

Many women receive repeated ultrasounds to verify that ovarian cysts have not become cancerous, but current research says that these tests are not necessary.  For one thing, premenopausal women have harmless ovarian cysts regularly.  For another, about 20% of postmenopausal women also develop harmless cysts.

 

“The likelihood of these small simple cysts ever becoming cancer is exceedingly low,” says Deborah Levine, M.D., chair of the American College of Radiology Commission on Ultrasound and a professor of radiology at Harvard Medical School.

In postmenopausal women, only cysts larger than 1 centimeter in diameter need a follow-up ultrasound.  For premenopausal women, who typically have benign cysts every monthly when they ovulate, cysts smaller than 3 centimeters aren’t even worth mentioning in the radiologist’s report, Levine says.

 

Colonoscopy after age 70

 

Most people should have screening for colon cancer at age 50 and then every 5 to 10 years after that, if the first test is normal.  By age 70—if you’ve always had normal colonoscopies—you can stop taking this test altogether.  That should be good news, because a colonoscopy can cause serious complications in older people.

 

“Just the preparation for colonoscopy can be exceptionally harsh,” says James Goodwin, M.D., director of the Sealy Center on Aging at University of Texas Medical Branch, who studies overuse of colonoscopies.  Some patients become incontinent or experience weeks of pain, diarrhea and constipation.

 

In worst cases, the procedure can perforate the colon.  Despite such risks, recent studies have found that substantial numbers of people over 75, even over 85, are still getting screening colonoscopies.

 

To protect your colon, eat plenty of fruits, vegetables and whole grains for fiber.  Cut down on fatty foods, red meat and processed meats.  Lose weight if you’re overweight and exercise.

 

Sound familiar?  It should, because that’s the best advice for protecting the rest of your body—and mind—as well.

 

Yearly physical

 

There’s little evidence that having an annual checkup can keep you healthy.  Many tests that doctors regularly perform—to diagnose anemia, liver disease or urinary tract infections, for example—don’t make sense unless there’s a reason to suspect a problem.  “A healthy 52-year-old does not need to see the doctor once a year,” says Jeremy Sussman, M.D., an internist for the VA system and assistant professor at the University of Michigan who was on the Societof General Internal Medicine task force for making the ChoosingWisely recommendation.

 

“We certainly don’t think people should never see doctors—quite the opposite.  We question the value of seeing someone for the sake of seeing someone.”  Your specific needs should determine how often you go to the doctor’s office, he adds.  If you have an illness that needs treatment, you should see your physician.  And do talk to your doctor about how often you need to have your blood pressure and cholesterol tested.  “Our real point is, don’t do these things for the sake of a calendar,” he says. “Do them for the sake of your health.”

 

Health and Wellness Associates

Archived

312-972-WELL

Healthwellnessassociates@gmail.com

https://www.facebook.com/HealthAndWellnessAssociates/

 

 

 

 

Health and Disease, Lifestyle, Uncategorized

Prostate Cancer Test Saves Lives, Risks Remain

PSA

 

Prostate Cancer Test Saves Lives, Risks Remain

 

Men who get a controversial blood test that looks for signs of prostate cancer appear to have a reduced risk of death from the malignancy, according to a new analysis by an international group of researchers.

The analysis re-examined data from two earlier studies that had led experts to recommend against routine use of the test, which measures levels of prostate-specific antigen (PSA).

 

“The trials taken together indicate there is an important benefit,” said Ruth Etzioni, who is the senior author of the analysis from the Fred Hutchinson Cancer Research Center in Seattle, Washington.

 

A flaw of the earlier trials is that some men who were assigned to a no-screening group actually did get the PSA test on their own, making it difficult to identify differences between the screening group and the no-screening group.

 

The unclear results – and the risk that the blood tests could lead to unnecessary biopsies and treatments – led the government-backed U.S. Preventive Services Task Force (USPSTF) to recommend against PSA screening.

 

The new analysis attempts to clear up the confusion by reexamining the data in computer models, to account for the men who got PSA tests when they weren’t supposed to. Etzioni’s team compared men in the two trials based on the intensity of screening they received.

 

In one of the trials, PSA testing was tied to a 25 percent to 31 percent reduced risk of death from prostate cancer, the researchers report in the Annals of Internal Medicine.

 

 

In the other trial, PSA testing was tied to a 27 percent to 32 percent reduced risk of death from prostate cancer, they found.

 

Etzioni said the new results don’t mean all men should be screened for prostate cancer.

 

In the U.S., about one in seven men will be diagnosed with prostate cancer, according to the American Cancer Society, but most men with the slow-growing cancer won’t die from it.

 

As a result, it’s often reasonable to monitor prostate cancers instead of treating them, since the side effects of treatment – which can include incontinence and impotence – may be more harmful than helpful.

In a proposed update to its recommendation, the USPSTF suggests that men ages 55 to 69 should be able to decide if they want PSA testing based on a discussion with their doctors about the possible benefits and risks, such as biopsies and unneeded treatment.

 

“This finding confirms or reinforces what everybody has been moving to over the last 5 to 8 years,” said Dr. Otis Brawley, chief medical officer of the American Cancer Society. “There is some benefit to prostate cancer screening and there are some harms associated with it.”

 

Brawley, who wasn’t involved in the new analysis, told Reuters Health that the benefits of screening are becoming more apparent as doctors move away from aggressively treating all prostate cancers and instead decide to monitor the many that will likely never advance and cause death.

In an editorial published with the new analysis, Dr. Andrew Vickers of Memorial Sloan Kettering Cancer Center in New York City identified ways to help ensure the benefits of prostate cancer screening outweigh the harms.

 

For example, he advises shared decision-making between doctors and patients, carefully selecting which men to biopsy and not screening elderly men, who are unlikely to benefit.

 

“The controversy about PSA-based screening should no longer be whether it can do good but whether we can change our behavior so that it does more good than harm,” wrote Vickers.

Health and Wellness Associates

Archived

Dr P Carrothers

312-972-WELL

 

HealthWellnessAssociates@gmail.com

https://www.facebook.com/angelique.rose.50

Rx to Wellness

10 Medical Tests to Avoid

aarp

AARP: 10 TESTS TO AVOID AT THE

DOCTOR’S OFFICE

According to the March 2014 AARP

Bulletin, doctors are warning that some of the medical tests routinely

taken by Americans do more harm than good, waste billions of health care

dollars annually and could endanger your health or even your life.  Some

of the tests that are overused by prestigious panels of doctors include annual

Pap smears, regular PSA tests, regular EKG’s, and even routine yearly

physicals.  Doctors are saying that the overuse of such tests can lead to

dangerous side effects, pain, radiation exposure, unnecessary surgery, even

death.

The American Board of Internal

Medicine Foundation asked more than 50 medical societies—of family

doctors, oncologists, cardiologists, and other specialists—to identify tests

and treatments that are often unnecessary.  AARP is a consumer partner

with this campaign, called Choosing Wisely.

Another

Choosing

Wisely partner is John Santa, M.D., medical director at

Consumer

Reports, and he says that these screening tests often yield false-positive

results that lead to a spiral of unneeded invasive procedures, medications and

even surgeries.  If you have symptoms or certain risk factors, these tests

can be valuable—even life-saving—but they’re performed on far too many people.

Nuclear

stress tests, and other imaging tests, after heart procedures:

Many people who have had a heart bypass, stent or other

heart procedures want to be reassured that their hearts are functioning

properly, which is understandable because they feel as if they’ve had a brush

with death.  A common way to reassure their patients is for doctors to

perform tests like a nuclear stress test or other tests, to make sure their

hearts are beating strongly.  But according to William Zoghni, M.D.,

performing these tests every year or even every two years in patients without

symptoms rarely results in any change in treatment.  “More testing is not

necessarily better,” he says.

In fact, it can lead to unnecessary invasive procedures

and excessive radiation exposures without helping the patient improve.

Instead, patients and doctors should focus on what does make a difference in

keeping the heart healthy: managing weight, quitting smoking, controlling blood

pressure and increasing exercise.

Yearly electrocardiogram

or exercise stress test

A survey of nearly 1,200 people ages 40 to 60 who have

never had heart diseases or any symptoms found that 39% had an EKG over the

previous five years, and 12% said they had an exercise stress test.  The

problem with this is that someone at low risk for heart disease could be 10 times

more likely to get a false-positive result than to find a real problem, says

John Santa of Consumer Reports, which conducted the 2010 survey.  This

could lead to unnecessary heart catheterization and stents.  Instead, have

your blood pressure and cholesterol checked.  If you’re at risk for

diabetes, have your blood glucose level checked, as well.

PSA to

screen for prostate cancer

Cancer is always scary, but the PSA test often finds

slow-growing cancers that won’t kill men.  “The evidence is extremely

convincing that in a man with usual risk and no symptoms, the PSA test causes

more harm than benefit,” says Reid Blackwelder, M.D., president of the American Academy of Family Physicians (AAFP).

He also says that as a result of the test, men often have ultrasounds, repeat

lab tests and even biopsies for a problem that isn’t there—an estimated 75% of

tests that show high PSA levels turn out to be false alarms.  When men do

have treatments like surgery or radiation, 20-40% end up with impotence,

incontinence or

both.

Not all doctors agree with AAFP’s recommendation against

routine PSA screening, but many agree that the test is overused.  Even the

American

Urological Association, which supports the use of PSA testing, says

that it should be considered mainly for men age 55 to 69.  TheAmerican Society of Clinical Oncology recommends against PSA testing

for prostate cancer screening in men with no symptoms when they are expected to

live less than 10 years.  A recent study published in the journal Cancer

found that Medicare spent almost $450 million a year on PSA screenings,

one-third of which was for men over the age of 75.

PET scan to

diagnose Alzheimer’s disease

Until recently, the only way to accurately diagnose

Alzheimer’s was during an autopsy.  In the last few years, doctors have

begun using PET scans with a radioactive dye to look for beta-amyloid protein that

is found in the brains of people with the disease.  Although this test has

promising use for research, there are serious questions about whether it should

be used on those who complain of fuzzy memory.  PET scans in older people

consistently find the protein in 30 to 40% of people whose memories are just

fine.

Although beta-amyloid plaques are present in all of

those who have Alzheimer’s, it’s not known if or when everyone with the plaques

will develop the disease, says Peter Herscovitch, M.D., president-elect of the Society of Nuclear Medicine and Molecular Imaging.

What’s more, even if a PET scan could accurately diagnose the disease,

it’s untreatable.  If you’re concerned about your memory, the better

course would be a complete medical evaluation by a doctor who specializes in

diagnosing and treating dementia.  Many other medical conditions, like

stokes, thyroid deficiencies and vitamin deficiencies can cause the same

symptoms, and these are treatable.

X-ray, CT scan or

MRI for

lower back pain

Unfortunately, back pain is incredibly common—80% of

people will suffer from back pain at some point in their lives.  It can be

both excruciating and debilitating.  Of course, people want to know what’s

wrong with them.  Here’s the catch:  The best imaging machines in the

world often can’t tell them what’s wrong.  Many older people with no back

pain can have terrible-looking scans.

Most back pain goes away in about a month and imaging

tests tend to lead to expensive procedures that often don’t help

recovery.  One study found that people who got an MRI during the first

month of their back pain were 8 times more likely to have surgery than those

who didn’t have an MRI—but they didn’t get relief any faster.  If you

don’t feel better in a month, talk to your doctor about other options like

physical therapy, yoga or massage.  But if you’re experiencing numbness or

weakness in your legs, you have a history of cancer or you have had a recent

infection, see your doctor as soon as you can.

Yearly Pap tests

The yearly Pap smear is

a common part of women’s health checklists, but it doesn’t need to be.

Women at average risk only need them every three years, since cervical cancer

generally takes 10 to 20 years to develop.  If women have also had

negative tests for the human papillomavirus (HPV),

which is now known to cause the cancer, they only need a Pap test along with

the HPV test every five years.  And women older than 65 who have had

several normal Pap tests in a row can stop having them altogether.  Do

note, however, that a yearly visit to an ob-gyn stays on the to-do list.

Bone density scan for women before age 65 and men before

age 70

For the estimated 10 million people—mainly women—in the U.S.

who have osteoporosis,

bone-strengthening medications can lower the chances of breaking a bone.

But many experts argue that for those age 50 to 65 who have osteopenia—mild

bone loss—testing and aubsequent drug prescriptions may be a waste of time and

money.  Not only is the risk of fracture often low, medications like Fosamax (alendronate) and Boniva (ibandronate) have been linked to

throat or chest pain, difficulty swallowing, heartburn, muscle pain, bone loss

in the jaw and thigh-bone fractures.  And there’s scant evidence that

people with osteopenia get much benefit from the drugs.

To help keep your bones strong, try walking and

weight-bearing exercises, says Blackwelder.  Get enough calcium and

vitamin D in your diet.  If you smoke, quit.

Follow-up ultrasounds for small

ovarian

cysts

Many women receive repeated ultrasounds to verify that

ovarian cysts have not become cancerous, but current research says that these

tests are not necessary.  For one thing, premenopausal women have harmless

ovarian cysts regularly.  For another, about 20% of postmenopausal women

also develop harmless cysts.

“The likelihood of these small simple cysts ever

becoming cancer is exceedingly low,” says Deborah Levine, M.D., chair of the

American College of

Radiology Commission on Ultrasound and a professor of radiology at Harvard Medical School.

In postmenopausal women, only cysts larger than 1

centimeter in diameter need a follow-up ultrasound.  For premenopausal

women, who typically have benign cysts every monthly when they ovulate, cysts

smaller than 3 centimeters aren’t even worth mentioning in the radiologist’s

report, Levine says.

Colonoscopy after age 75

Most people should have screening for colon cancer at

age 50 and then every 5 to 10 years after that, if the first test is

normal.  By age 75—if you’ve always had normal colonoscopies—you can stop

taking this test altogether.  That should be good news, because a colonoscopy can

cause serious complications in older people.

“Just the preparation for colonoscopy can be

exceptionally harsh,” says James Goodwin, M.D., director of the Sealy Center on Aging at University of Texas Medical Branch,

who studies overuse of colonoscopies.  Some patients become incontinent or

experience weeks of pain, diarrhea and constipation.  In worst cases, the

procedure can perforate the colon.  Despite such risks, recent studies

have found that substantial numbers of people over 75, even over 85, are still

getting screening colonoscopies.

To protect your colon, eat plenty of fruits, vegetables

and whole grains for fiber.  Cut down on fatty foods, red meat and

processed meats.  Lose weight if you’re overweight and exercise.

Sound familiar?  It should, because that’s the best advice for protecting

the rest of your body—and mind—as well.

Yearly physical

There’s little evidence that having an annual checkup

can keep you healthy.  Many tests that doctors regularly perform—to

diagnose anemia, liver disease or urinary tract infections, for example—don’t

make sense unless there’s a reason to suspect a problem.  “A healthy

52-year-old does not need to see the doctor once a year,” says Jeremy Sussman,

M.D., an internist for the VA system and assistant professor at the University of Michigan

who was on the

Society

of General Internal Medicine task force for making the ChoosingWisely recommendation.

“We certainly don’t think people should never see

doctors—quite the opposite.  We question the value of seeing someone for

the sake of seeing someone.”  Your specific needs should determine how

often you go to the doctor’s office, he adds.  If you have an illness that

needs treatment, you should see your physician.  And do talk to your

doctor about how often you need to have your blood pressure and cholesterol

tested.  “Our real point is, don’t do these things for the sake of a calendar,” he says. “Do them for the sake of

your health.”

Health and Wellness Associates

312-972-WELL