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Medical Information & Advice Page

Inclusion of a particular external link (marked ) on this page does not imply endorsement of a particular organization, diagnostic modality, or treatment regimen by General Internal Medicine Group, P.C. and is included for informational purposes only.

Preventive Care Checklist (all links in this table are external)

A Healthy Lifestyle	Periodic Health Examinations
weight control, Body Mass Index (BMI) < 25 or as instructed healthy diet, low in calories, sodium, and saturated/trans fat; fish intake ≥2 days/wk, or fish oil (see below); reference: NIH DASH diet physical activity, ≥30 minutes, ≥5 days/wk no tobacco use (cigarettes, cigars, smokeless) alcohol intake in moderation: ≤24 oz beer or ≤8-10 oz wine or ≤1½ oz liquor daily; no binging avoid substance abuse, illegal or prescription women: monthly breast self exam men age <40: monthly testicular self-exam	a prevention-focused health history & physical examination at least every 3-5 years prior to age 40, every 1-3 years afterwards a review of current lifestyle habits, and to address new or revised recommendations women: breast & pelvic exam men: prostate examination, when indicated
Personal Safety	In-office tests (when indicated)
responsible/protected sexual behavior seat belt & helmet use when driving/riding sun protection use when outdoors secure weapons/firearms when not in use avoid violent behavior & seek aid if needed be aware of any workplace safety issues	electrocardiogram (EKG/ECG–heart tracing) urinalysis (protein, blood, infection) complete blood count (anemia, bleeding, immune functioning) cholesterol panel including total cholesterol, HDL (good), LDL (bad), triglycerides (fat) comprehensive chemistry panel including blood sugar (glucose for diabetes screening), kidney & liver function, electrolytes if exposed or new/multiple sexual partners, consider these tests: hepatitis B, hepatitis C, HIV, chlamydia/gonorrhea, syphilis additional tests for those at risk: thyroid, tuberculosis
For Our Older Patients	Immunizations
Do you need help with the phone, shopping, transportation, preparing meals, housework, laundry, or managing your money? Does your home have rugs in the hallway, lack of grab bars in the bathroom, lack handrails on the stairs, or have poor lighting?	influenza, annually if at risk tetanus-diphtheria-pertussis , every 10 years tetanus-diphtheria, every 10 years age ≥65 pneumococcal, if at risk, and age ≥65 shingles, age ≥60 HPV (cervical cancer), women age ≤ 26 hepatitis B, meningitis, if at risk
Miscellaneous	Screening Tests
Know your medication names & dosages. Are you getting enough sleep? Are you under too much stress? We recommend an advance directive (living will), so that your health wishes are in writing in the event you are ill and unable to make medical decisions.	colon cancer: colonoscopy every 10 years starting at age 50, earlier if at risk cervical cancer: Pap smear ± HPV DNA test, at least every 3 years or as indicated breast cancer: mammogram annually starting at age 40, earlier if at risk osteoporosis: bone density (DXA) test, at least every 5 years if at risk prostate cancer: PSA blood test annually starting at age 50, earlier if at risk aortic aneurysm (AAA): sonogram, if at risk
Recommended Vitamins & Supplements	Preventive visits to other practitioners
aspirin 81 mg daily, if at risk fish oil instead of fish, 1000 mg ≥ 2 days/wk premenopausal women: calcium with vitamin D 1000 mg daily folic acid ≥400 mg daily (childbearing age) postmenopausal women: calcium with vitamin D 1500 mg daily in recent studies, vitamin D 800 IU daily may prevent cancer, & guidelines are being revised If desired, a daily multivitamin has approx. calcium 220 mg, vitamin D 400 IU, and folic acid 400 mg. Men & postmenopausal women should pick a daily multivitamin without iron.	Dentist, every 6 months Eye exam for glaucoma, cataracts, retinal diseases, age 40 Dietician, for diabetes and kidney disease

Medicare Preventive Health Information - note that Medicare covers only selected services

US Preventive Services Task Force (USPSTF) guidelines from the Agency for Healthcare Research and Quality

Guide to Clinical Preventive Services

Patient Instructions

24 hour urine collection (revised 7/6/2003)
Diskus (Serevent, Advair) use instructions
- instructions with movie from from the University of Michigan College of Pharmacy
- instructions from GlaxoSmithKline web site
- products dispensed with a Diskus include Serevent (salmeterol) and Advair (fluticasone/salmeterol)
Exercise Stress Testing when scheduled at GIMG (revised 7/6/2003)
Metered-dose inhaler (MDI) use instructions and movie from the University of Michigan College of Pharmacy
Flexhaler use instructions from the Pulmicort (budesonide) manufacturer web site

Vaccination

Vaccine Information Sheets from the Centers for Disease Control
The following lare links to the forms our office gives for the following vaccines:
- Hepatitis A & B
- HPV (human papilloma virus)
- Influenza
- Japanese Encephalitis
- MMR (measles, mumps, rubella)
- Meningococcal
- Pneumovax (pneumoccocal polysaccharide 27)
- Polio
- Rabies
- Shingles
- Tetanus-diptheria-pertussis (Tdap)
- Tetanus-diptheria (Td)

Lyme vaccine (Lymerix) was discontinued by the manufacturer in 2002 due to low demand and is no longer available.

Disease Information

Endocarditis prevention/antibiotics recommendations April 2007 from the American Heart Association
- most patients no longer need to have antibiotics prior to dental work
Gastroesophageal reflux GERD) (revised 6/30/2002)
Hemorrhoids/Fissures/Rectal Irritation (revised 10/15/1999)
High Blood Pressure new recommendations and the revised DASH Eating Plan from the National Heart, Lung, and Blood Institute
Hormone replacement therapy (HRT) from the Women's Health Initiative, National Heart, Lung, and Blood Institute
Influenza & flu shot info from the Centers for Disease Control (CDC)
Onychomycosis (nail fungus) (revised 10/14/1999)
Osteoporosis from the National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center
Pre-diabetes and insulin resistance from the National Institute of Diabetes and Digestive and Kidney Diseases
Severe Acute Respiratory Syndrome (SARS)
- Centers for Disease Control (CDC, US)
- World Health Organization (WHO)
Smoking Cessation from the American Cancer Society
- Complete Guide to Quitting Smoking
Trans (partially hydrogenated) fats are vegetable oils treated to improve their texture and shelf life and are used in a wide variety of foods including margarine, bread, crackers, and snack chips. Trans fats have been found to raise blood total and LDL (bad) cholesterol levels at least as much as saturated fat and elimination of trans fat intake is strongly recommended.
- Consumer Reports has articles containing the trans fat contents of various foods in their March 2003 and November 2003 (subscription required) issues
- Trans Fat information and new regulations from the Food & Drug Administration
- Organic food by definition does not contain trans fat, as it is an artificial process.
- Restaurants often use trans fats for fried food due to its stability. Although some chain restaurants have talked about reducing trans fat, few, if any, in the Greater Washington, DC area have eliminated trans fats to our knowledge.
Upper Respiratory Tract Infections (revised 12/13/1999)
Vertigo (benign positional) self-treatment instructions from the Neurology Clinic, Charité University, Berlin, Germany
- for right sided symptoms
- for left sided symptoms

Supplements

Supplements are currently regulated by the Dietary Supplement Health and Education Act of 1994. Supplements may be marketed in the United States without proof as to whether or not they are safe or effective. This is not the case in other countries where supplements may be quickly withdrawn from sale as soon as suspicious data becomes available - as you can see from our list below, supplements considered potentially dangerous are still available here! Quackwatch has a lengthy critique of this law.

Fish and fish oil supplements containing omega 3 fatty acids have been demonstrated to reduce the likelihood of heart attack in patients with coronary artery disease (narrowing of the arteries). A prescription version is available which is highly concentrated and purified, and does not have a fish odor. Recommended.
- Guidelines from the American Heart Association
- Ratings: Consumer Reports July 2003 issue (subscription required)
- Monterey Bay Aquarium: Seafood Watch Program: A Consumer's Guide to Sustainable Seafood
Folic acid, at least 400-600mcg daily, for women planning to have children. Recommended.
- Reference: National Women's Health Information Center

From Consumer Reports: Dangerous Supplements, Still At Large, May 2004

Beta-carotene, an antioxidant, has not been proven to prevent disease in trials done to date, and may have an adverse effect on mortality (shorten life span). Not recommended for cancer or heart disease prevention.
- Reference: The Lancet, Volume 361 Issue 9374 Page 2017 (free registration required)
- Reference: New England Journal of Medicine, May 2, 1996
Ephedra (Ma Huang, Sida cordifolia, Pinella) banned by the FDA as of February 28, 2004 is a stimulant supplement marketed for weight loss, increased energy, and improved athletic performance. It has been linked to multiple side effects including nervousness, increased heart rate and blood pressure, seizures, and death. Not recommended.
- FDA Plans to Prohibit Supplements Containing Ephedra, December 30, 2003
- Ephedrine alkaloids FDA Web page
Gugulipid, a plant-derived compound, was not found to be effective for cholesterol lowering
- Reference: Journal of the American Medical Association, Vol. 290 No. 6, August 13, 2003
Kava is a plant-derived antianxiety supplement which has been linked to potentially fatal liver damage, as well as causing yellow discoloration of the skin with long term use. Although still available in the United States, multiple other countries have banned kava supplements. Not recommended.
- Reference: Food and Drug Administration advisory, March 25, 2002
Red Yeast Rice (or extract) contains among other compounds naturally occurring lovastatin, a prescription cholesterol lowering medication. Known side effects of statin-class medications include abnormal liver tests and muscle weakness or injury which require periodic blood monitoring by a physician. Please tell your provider if you are taking this supplement as generic lovastatin is now very inexpensive and taking a prescription is likely safer and more affordable.
- FDA action against Internet sellers of red yeast rice, August 9, 2007
Vitamin E, another antioxidant, has not been proven to prevent disease in trials done to date, and may have an adverse effect on mortality (shorten life span) and heart failure. Not recommended for cancer or heart disease prevention.
- Reference: Annals of Internal Medicine, Volume 142 Issue 1, January 4, 2005
- Reference: Journal of the American Medical Association, Volume 293, Issue 11, March 16, 2005

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