Just go to the doctor and get that taken care of!

I’m under 50 years old and healthy, do I need to see my doctor every year? 

Surprisingly the answer to this question for both men and women is no, however when poled both physicians and patients overwhelmingly believe that the answer is yes. The premise is that at annual exams of asymptomatic healthy people tests are ordered every year that may need to be ordered less frequently driving up overall healthcare delivery costs. These tests such as blood count, kidney and liver function tests, and cholesterol levels are often checked yearly and the truth is that they probably need to be checked every 3-5 years in a person who is asymptomatic and has normal baseline labs done at some point in the past 5 years. 

Recently, I was speaking casually to a group of 40-45 year old men and women who were praising their doctors’ thorough annual exams where he or she reviewed extensive labs, including annual EKGs and chest X-rays, conducted a thorough exam and conveyed a very deep understanding of the patients overall health. There is no evidence to suggest that these labs and tests do anything in the long term to improve patients overall health. I suspect that it is the conveyance of a deep understanding and connection to our patients that makes the annual physical exam seem so important to all involved.

Should you stop going to your doctor every year? Despite the evidence that suggests that annual exams do not improve patient health, I believe that they are important as the majority of people are not asymptomatic by the time they are 25 years old. On a daily basis, I answer a variety of health, diet, and exercise related questions as well as dispel false pretenses that patients have. There is a plethora of medical information out there and people are generally overwhelmed by the data and want to know what they should be doing and how the medical information relates to them.  This data can create a tremendous amount of anxiety for patients that leads to its own problems. 

An annual exam gives me the chance to see my patients, form a connection to them, and answer questions that they have. We review family history and social history. We talk about current health issues in the media and how it should effect them. We talk about what screening is appropriate and what’s not and have a chance to look at blood pressure and weight.  Most importantly I think that patients leave with a sense of well being that gives them one less thing to worry about. Knowing they are healthy and that that they have been heard and their concerns addressed conveys a sense of well being that may not be able to be calculated on a cost basis. 

Food for Thought-Are Organic Foods Safer and Healthier?

The Annals of Internal Medicine published a study in September 2012  that asked the question are organic foods safer and more nutritious than conventionally grown foods. An interesting question given that the organic food business has grown from $3.7 billion dollars annually in 1997 to $27 billion dollars in 2010. The analysis yielded no significant difference from the perspective of health risks and benefits after comparing the outcomes of 240 seperate studies that met strict inclusion criteria. There was no significant difference in vitamin content, heavy metal presence, or prevalence of bacterial contamination of the various meats and vegetables.  Not surprisingly, organic foods had 30% lower contamination with pesticide residue and lower likelihood of contamination with antibiotic resistant bacteria. However, there was no difference in  the overall contamination with pathologic bacteria in conventional vs organic foods. Finally the study mentioned that there are no long term studies looking at the health benefits in populations who consume organic foods vs conventionally grown foods. 

My Thoughts: 

If your family is like mine we try and buy locally grown organic foods when possible.  This study and its outcomes will not change my buying practices but it will make me less concerned about giving by child a glass of milk that is not certified as organic or a conventionally grown banana. I think that ultimately the most important component of diet is the foods you choose as opposed to the technique used to grow the particular foods. Sensible portions of a low fat, low cholesterol diet, that have very limited exposure to processed foods probably makes the most sense. Regarding choosing organic vs conventionally grown foods the article suggests that making the decision to choose organic foods  may be more of an environmental and ethical decision than a decision based on nutrition and health. Until a study comes out that looks at the long term benefits of eating an organic diet, I think we should not blindly accept that eating an organic diet will make us healthier. If you are interested in learning more about these topics, two websites that I've been following recently are ThePlantEater and LivingMaxwell. 

What's a Concussion?

What’s a concussion and what should I do if I think my child has one? 

A concussion is the result of a head injury that causes a disturbance of brain function. 

Typically a concussion will result in confusion, “feeling foggy”, difficulty concentrating, poor balance and visual problems. There are other symptoms as well but these are the most typical symptoms. Concussion symptoms usually resolve within 3 days, occasionally last for a week, and rarely last longer than a week. Concussions are difficult to prevent but it is possible to limit the long term impact by recognizing and treating a concussion appropriately. 

What should I do? 

“When in doubt take them out!”

If you think your child has a concussion they should be removed from the activity and not allowed to return until they are seen by a doctor or medical professional. If your child has a concussion, their activity should be limited to resting until their symptoms fully resolve. That means no sports, no vigorous activity, no video games, and no loud music. 

What will your doctor do?

The vast majority of time your doctor will not order an MRI or CT scan as there is rarely any useful information revealed by these tests. If your child seems to be getting worse the doctor may order one of these tests, but this is rare.  Your doctor will do a series of tests of memory, concentration, and balance, which are performed in the office.  Once your child can pass these tests their concussion will be determined to be resolved. 

When can my child return to there sport? 

After your child fully recovers from their concussion your doctor will talk to you about “Graded Return to Play.” Essentially every 24 hours for 5 days, your doctor will advise you to gradually increase your child’s activity. If your child passes all these tests, your doctor will advise you that your child can return to full activity. 

Common Questions

1. Do I need to wake my child from sleep if I think they have a concussion? No, nothing will improve or change by waking your child and they will seem groggy when you wake them
2. What should I worry about? If you think your child is getting worse, they are more drowsy, weak, or having symptoms that don’t make sense to you, take your child to the Emergency Room or your doctor. These symptoms can rarely be assessed well by a doctor on the phone
3. What is the biggest mistake I can make? Letting your child return to play before your doctor says it’s okay. 
4. Is it okay to give my child Tylenol or Advil?-Yes, but before they return to play your doctor will want to make sure they are no longer taking these medications for their symptoms