Heart Attacks, Strokes, Blood Vessel Disease:

A low fat diet, regular exercise, stress management, avoiding tobacco, keeping the cholesterol low, controlling or preventing diabetes are all crucial. Enteric coated "baby aspirin" (65-81mg) is very helpful if it’s safe for you to take. Medicines such as "beta blockers" can profoundly reduce heart attack risk. Maintaining adequate intake of vitamins - particularly B12, folate and B6 - prevent the accumulation of "homocysteine" in the blood which raises heart attack risk. Avoiding anger and time pressure is very important. Family history, cigarette smoking, cholesterol problems, reduced breathing capacity, and stress management are all important. In the USA, most heart attacks occur between 4am and noon, particularly on Mondays. The blood lipids (including cholesterol), blood homocysteine levels, and fibrinogen (a clotting factor) can all be checked and help to assess risk and the need to do something before or after disease occurs.

Diabetes:

While family history is important, most diabetes can be prevented by staying slim, exercising at least 30 minutes daily (walking is fine), and keeping stress down. Warning signs include excess thirst, fatigue and slow wound healing. Virtually all obese patients have some form of diabetes.

Dental Hygiene:

Dental problems are the main cause of premature death in adults throughout the world. Regular brushing, flossing, and cleaning at a dentist’s office can make all the difference.

Lung Cancer:

Still the #1 cancer in both men and women. Routine chest X-rays are no longer recommended because they don’t seem to make a difference in survival. Over 80% are due to cigarettes.

Breast Cancer:

Relatively rare while young, the risk progressively increases with age - affecting 1 in 9 women by the 80's. Family history is a major risk, as is previous breast cancer. A low fat diet and low alcohol consumption reduce the risk. Hormones are controversial - they may slightly increase the risk of getting breast cancer, but not dying from it. Routine annual breast exams and mammograms reduce the risk of dying from breast cancer by 50-70%. While controversial, the current recommendations are a baseline at 35, every other year 40-49, annually at age 50. One out of every 100 cases of breast cancer is in men.

Colon Cancer:

Affects one in 16, rarely has symptoms until the cancer is far advanced. Family history is a risk factor, possibly skin tags are as well. Diets high in "cured" or "smoked" meats, barbecued meats, fat, and low in fiber increase the risk. Colon cancer basically comes from intestinal growths (called polyps), which can usually be removed without surgery - preventing colon cancer. Once a polyp is found, the entire colon must be examined, and follow-up exams are necessary. Stool tests for "occult (hidden) blood" can help find cancers early - but the test must be done properly. Colostomies (permanent bags after rectal cancer surgery) are almost totally preventable by getting a relatively painless exam ("flexible sigmoidoscopy") routinely after age 49, or sooner if the family history is concerning. Current guidelines are 2 years in a row, then every 3 years thereafter. The blood test "CEA" is for monitoring cancer, not screening for it.

Cervical Cancer:

Routine pap smears detect cancers and pre-cancerous conditions, allowing for early treatment. Important for women of all ages - but particularly important for young women. Most cases of cervical cancer are actually a venereal disease - caused by the virus that causes warts.

Prostate & Testicular Cancer:

Routine monthly testicle self-examination in men ages 15-30 allows for early detection - changing a deadly cancer into one that is over 95% curable. Virtually all men over 80 have a mild form of prostate cancer. Cancer that develops earlier is potentially more dangerous. Rectal exams, ultrasounds and biopsies can find the cancers and begin the treatment process. The screening blood test PSA is helpful, but it is not definitive.

Skin Cancer:

Most skin cancers (basal cell and squamous cell) are not dangerous if they are taken care of before they get very big and are obviously causing damage. Malignant melanomas are usually fatal, and the numbers are increasing at a frightening rate - primarily because of sun exposure and possibly from ozone layer damage. Moles that change in size, color, or shape need medical attention. Fair skin is an additional risk factor. Sun screens applied every 15-30 minutes and avoiding sun exposure from 10am to 4pm can prevent skin cancers. Precancerous lesions (actinic keratoses) can be removed by a topical chemotherapy cream.

Cancer from Tobacco and Alcohol:

Cigarette smoking, chewing and other forms of tobacco use profoundly increase the risk of cancers, especially of the mouth and throat. Tobacco combined with alcohol dramatically increases the cancer risk all over the body.

AIDS:

Prevented mainly by avoiding sexual activity with unsafe persons - the question is who is unsafe. Aids is spread primarily by sharing needles and blood getting through breaks in the skin or mucous membranes. Heterosexual sexual activity is the main source of new cases - it is no longer just a disease of drug addicts, homosexuals, and transfusion recipients. Latex condoms can reduce but not eliminate the risk. The blood test can be normal for 6-12 months after a person has been infected with the virus. Additional precautions include preparing for "elective" operations by storing your own blood for transfusions, and preventing blood from entering your body via cuts, needles, medical instruments, and breathing aerosolized blood and body tissues.

Infectious Diseases:

Proper hygiene (especially frequent hand washing), clean water, and good sanitation remain critically important - and are the main reason length of life has increased so much over the last 200 years. Immunizations are now available to prevent measles, rubella, whooping cough, diptheria, tetanus, hemophilus, influenza, polio, pneumococcal pneumonia, hepatitis B, and diseases not commonly found in the USA. Smallpox has effectively been eliminated. Misuse of antibiotics can cause severe infections by germs that are resistant to treatment.

Auto Accidents::

Wearing seat belts, having air bags for adults, avoiding driving while impaired from any chemical (including alcohol and medicines that cause drowsiness) and getting proper rest are all important for reducing injury and death from this all too common problem.

Seasickness:

Dramamine (dimenhydrinate) and meclizine work well, but cause drowsiness, blurred vision, constipation, and possibly urine problems. Pills made of the food/spice "ginger" work just as well.

A Merry Heart is Good Medicine:

Being happy, having a cheerful positive outlook, and having a good sense of humor (avoiding hurtful and sarcastic jokes and remarks) can make all the difference. A positive outlook, hope, a great attitude (including an "attitude of gratitude"), love, avoiding harmful emotions (fear, anger and depression), friends, regular exercise, a good diet, probably some vitamin supplement, a comfortable sense of spirituality and your place in the universe, play, and meaningful work make life worthwhile and reduces (but does not eliminate) the risk of medical problems.

2/5/97