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Health Menu (Adults)
Everything is ala cart, please pick and choose to your individual
tastes!
General Screening Complete Physical Exam (CPE)- This yearly filling entree is the foundation and starting point for anyone with the appetite to stay healthy. It is here that we review all relevant medical history, family history, habits and concerns that you may have and do a comprehensive exam of your entire body (except certain features are reserved based on age- for instance rectal exams will be deferred until age 50 unless a specific reason to be done). This is the place to find problems before they truly are problems and prevent them! It is best served fasting (nothing to eat after midnight) This is the Chefs top choice, it can begin at any age.
Labs- General
labs such as cholesterol panels, blood counts ( to screen for
anemias or leukemias), general screens for liver , kidney and
electrolytes and
glucose is commonly recommended.
Thyroid tests would be a good side dish as well.
Thyroid disease can be very sneaky as it has many nonspecific
symptoms such as fatigue. Vitamin
D levels are a relatively new addition to the menu- proper vitamin D
levels have been associated with better mood, improved bones and
some say lower cancer rates among many other benefits.
The choice of labs is usually reserved for dessert at the end
so more can be added if needed.
A urine sample is usually tested before the exam to make it less
uncomfortable. Colon Cancer Screening
Colonoscopy is the choice of the Chef even though it is not
served at this establishment.
The data shows that it will
more effectively find colon polyps farther up than the
sigmoidoscopy. Because
of this it can be done every 10 yrs instead of every 5yrs.
It is more expensive and is usually done at an outpatient
facility of the hospital and performed by either a
Gastroenterologist or a Colorectal or General Surgeon.
It is also performed using sedation so there is the
additional but very minor risk of anesthesia.
This delicacy is served at age 50 or if there are specific
reasons such as blood in the stool such as on exam or seen, or
change in bowel habits.
The whole aim is to find a polyp (pre-cancerous growth) or small
cancer while it is easy to take care of.
If you wait for symptoms such as bleeding or altered bowel
habits the cow may have already left the barn.
Heart Disease Screening
Cardiac Stress Test are done in several different ways to make your
heart work harder (or to simulate it) and see how your heart does
under more work.
Although the Chef will always bring it up if there is an indication
(or a diagnosis that goes along with one being done) he is certainly
open to it as screening, just be aware it may not be a covered
benefit. Berkley Heart Lab- They have what we call The Full Berkley and The Half Berkley. The Full Berkley lab includes a lipid profile like usual but then it also includes the subparticles of the cholesterol / lipid elements. For instance, it tests for the HDL 2B subparticle which helps remove cholesterol from the inside of the artery endothelium , so this is something we want more of. Or they check for LDL small dense subparticles which are the ones that cause the most damage. With the Full Berkley we also check Omega 3 levels to see if you are getting enough fish oil or equivalent. Then the one component in The Full Berkley which we took out of The Half Berkley is the genetics test looking at genetically what is your risk of heart disease, how well would you expect to respond to certain medications., and if you are prone for atrial fibrillation. These tests are commonly covered by health insurance but not always and can be expensive.
Womens
Special Menu2004
Pap and pelvic is included with the CPE for women over age 21
or have been sexually active for at least 3yrs whichever comes first.
The pap is recommended every 3 yrs.
Colposcopy is when vinegar is applied to the cervix and then
use a scope (which does not touch you) that magnifies it and finds
fast growing cells such as pre-cancerous cells.
Paps have a 40% false negative rate which means it misses a
lot. The colposcope
does not. You will find
this is an exclusive offer at Dr. Schindler’s to do the colposcopic
exam with each routine pap at no extra charge.
Highly recommended by the Chef.
He has found well over 20 pre-cancerous areas with normal
paps since this fine establishment opened.
Breast Cancer Screening
Lots of special dishes in this group.
It seems that many of the different medical societies
have different recommendations as to how often
it should be done.
Mammograms- This
traditional dish has been the most controversial regarding its
cooking time. There are
recommendations as far as yearly after age 40, to every other year
from 40-50 then yearly after 50, to some starting at age 50 yearly
and even some starting age 50 and only every other year.
The Chef recommends yearly after age 40 with the following
rationale. The highest
incidence of breast cancer does come after age 50, however there is
still a significant amount in the 40’s and the ones in the 40’s tend
to be more fast growing tumors so that a mammogram yearly would be
more likely to find it at a smaller stage so there is more of a
chance of intervention.
Breast ultrasounds-
This fresh dish is the rave of the young and women with dense
breast. It is less
uncomfortable and it sometimes compliments the Mammogram.
Mostly to discern between solid and cystic lumps.
Thermoscan- This
is an exotic alternative choice.
Not in the mainstream as of yet.
It is more comfortable then the other choices and there is no
exposure to any radiation- just measures heat.
Some of the statistics that they present are impressive,
however again not mainstream yet.
There is suggestion that it can find cancers even earlier than
mammograms.
It is usually not covered by insurance.
Self Breast Exams-
This take home variety is simplest and least expensive yet
the United States Preventative Task Force recommends against it ,
since they find statistically that it does more harm (excessive
breast biopsies that were unnecessary) than it did in preventing
death from breast cancer.
On the other hand its your choice to decide since you are an
individual not a statistic and for some women it was life saving.
It can supplement any of the above dishes.
It is the finest when done monthly just after
your period.
Ovarian Cancer Screening-
An equally controversial test available to screen for Ovarian
Cancer. It has many
false positive tests as well.
It is not very specific.
Some insurances do not cover this test.
The Chef generally recommends this if the exam is suspicious.
Bone Density Studies-
This easy dish
is a favorite with those who are post menopausal, particularly ones
who are not on hormone replacement.
It screens for osteoporosis or the thinning of bones.
Besides Hormone replacement (which is controversial) there is
also medications which put more calcium in the bones.
They can be taken weekly, but sometimes have difficult
abdominal side effects.
Hormone replacement-
This is a very controversial subject but still on the menu.
Please discuss with the Chef about whether traditional
hormone replacement or natural alternatives might be right for you.
Mens Special Menu2004
Prostate
Cancer Screening
PSA
(prostate specific antigen) is a controversial test and
recently takenoff the menu. The us preventative task force has
strongly recommended against it feeling it does more harm ten good.
It is
controversial because there is a large number of false positive
tests meaning that many people who have a positive test really do
not have prostate cancer.
Many physicians feel that the rectal exam is a better test.
To further the controversy more, it seems that a lot of the
prostate cancers found with a PSA but have a normal rectal exam tend
to be very slow growing and there would be consideration to the
treatment possibly being worse then the problem. On
the other hand, the amount of advanced prostate cancer has
significantly gone down since screening with PSA, which that
suggests it is a useful test.
Some insurances do not cover this test.
The recommendation starts after age 50.
Rectal Exam – This is the complimentary finish(dessert)
to the physical exam for those after age 50.
It helps screen for prostate as well as colon cancer.
Although certainly not the most pleasant of desserts (for
patron nor chef) it has that way of
bringing in the rear of the exam.
Testicular Self exam – This take home leftover is simple yet
important. Particularly
for young to middle age men where there is the higher incidence of
testicular cancer. Just
simply check to see if there are two lumps and no extras.
Takes just seconds in the shower but can save your life.
In an effort to make the Mens special Menu somewhat equal to the
womens, in spite of the lack of many special screening for men the
Chef also offers labs and recommendations on male hormones.
Testosterone levels-
The chef recommends
testosterone levels for those men who may experience decreased sex
drive, ability to
obtain or maintain an erection, or even have noticed a decreased
strength as they age.
Although testosterone does go down with aging in some it goes down
too much needlessly.
There is supplements of testosterone to bring it within the normal
levels safely. This is
different then the athletes who may have abused steroids in the past
and have received injections.
The usual supplement is a topical gel to be rubbed in the
skin or a supplement which is placed in the gum line.
It is a smooth delivery of the testosterone and will be used
to achieve normal levels- not super high levels.
Other hormones such as DHEA and
Pregnenolone (a building block to testosterone) can also be
measured.
There are also samples of Viagra and
Levitra and Cialis
available usually to help the erection.
Please do not hesitate to discuss these with the Chef.
Immunizations for adults
Recommendation of getting an adult TDaP instead of the
adult Td that we give as adult tetanus shots.
Basically adding Pertussis which has been found more common
than we used to think and may be responsible for 20% of the
bronchitis around.
Whooping cough is still very rare in adults.
But the thought is that by immunizing the adults would cut
down on the population of Pertussis that is available to give kids
whooping cough. It
spreads quickest within a family.
This has some particular merit for those of you who had
chosen not to immunize your children with DTaP.
Thus at least limiting their exposure to Pertussis, as well
as decreasing some of your bronchitis exposure.
Zostavax
- Shingles vaccine. This vaccine is to prevent shingles
in people over age 60. It is estimated to prevent 50%- 64% of
the shingles in this population. This vaccine may have limited
insurance coverage so you may want to check first.
Influenza - It comes as both injection and Flu
Mist. At this point I carry Flu Mist only. The Flu Mist
is a spray for your nose. It does not contain Thimerasol or
Mercury. Which is the main reason I stock that. It is a
live vaccine meaning it is weak or attenuated influenza virus that
probably gives the best immunity . Interestingly enough , even
though it is a live vaccine so technically it is giving you the flu,
but because it is so weak it does not produce symptoms unless you
are more immunocompromised (such as HIV or Cancer drugs which you
should not get the Flu Mist). In contrast the usual Flu shot does
not give you the flu however is more likely to give you flu like
symptoms. The Flu Mist may also be more forgiving if they
guessed wrong on the upcoming strain.
David Schindler M.D.
Personal Care Physician P.L.L.C.
(248) 912-1919
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