#primary prevention

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Breast cancer screening is essential, simple, and life-saving. Talk about it, encourage your loved ones, book that appointment.

Doctor’s orders [x]

A few additional notes on breast cancer prevention/screening:

Mammography remains the gold standard for screening

age: 50–74 years old

frequency: biennial screening (annual screening for high-risk individual)

Important: Breast self-exams are not considered a formal screening method. Instead, they’re about becoming familiar with your own breasts so you can notice any unusual changes early.

You could also check:

Breast cancer screening is performed using mammogram, clinical breast exam (CBE), and MRI (magnetic resonance imaging) tests. Learn about th

Breast cancer prevention strategies include avoiding known risks, having a healthy lifestyle, and medications or surgery for those at high r

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[teachingrounds]

How to treat osteoporosis:

Calcium 1200 mg/day--from both diet and supplements, either calcium carbonate with meals (or calcium citrate if the patient is also on a PPI)

Vitamin D 800 mg/day--typically Vitamin D3 400-800mg daily

Exercise--at least 30 minutes per day, 3 days per week

Smoking cessation

In (women) with a bone mineral density T score of -2.5 or less (osteoporosis), a fragility fracture, or high-risk postmenopausal women with osteopenia (T score -1.0 to -2.5) and a 10-year fracture risk of at least 20% (using FRAX), consider pharmacological therapy with a bisphosphonate.

Image: David Gregory & Debbie Marshall, "SEM bone, rotten trabeculae (osteoporosis) [computer-coloured]," Wellcome Images, CC BY 4.0.

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Manor Field Blog 12 – Aspirin

Manor Field Blog 12 – Aspirin Perhaps bark-chewing was a thing the ancients used to enjoy.

I had originally intended to write about dementia this morning although given I have had a specific request about aspirin and also that dementia is such a broad topic, I will start here.

Most people will know that aspirin is an ancient remedy. Way back when, our ancestors would chew willow-bark which contains a form of aspirin as they knew it eased pain.

As to how they knew this, I don’t know.…

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Manor Field Blog #3 – what is de-prescribing? ‘Take this pill and see me in six months,’ kind of thing, rather than, ‘No more Burger King,’ which for some is harder to palate. Most of the time, when I ask a man or woman in their 90’s whether they feel they are taking too many tablets, the answer is yes!

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The trouble with keeping people well.

The trouble with keeping people well.

We have a health and social care system that is built upon failure, or, at least, things going wrong.

Let me explain.

Imagine I invented a medicine that kept people well.

It is a pill you take, and it prevents disease.

Clearly, this is absurd, as there is no such thing as disease, only diseases (like when we think of a cure for cancer or dementia – these are multitudes of different conditions,…

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[teachingrounds]

Are you FIT tested?

The current threshold for a positive fecal immunochemical test (FIT) is 20 micrograms of hemoglobin per gram of stool. That catches three quarters of tumors (sensitivity of 74.3% at 20 μg/g). However, the older the patient the lower the sensitivity (68.9% in individuals 70-75 years old); the test is also less sensitive in women (average sensitivity of 70.6%). There should probably be age- and sex-related cutoffs for FIT testing. Original article: Selby K, Jensen CD, Lee JK, Doubeni CA, Schottinger JE, Zhao WK, et al. "Influence of Varying Quantitative Fecal Immunochemical Test Positivity Thresholds on Colorectal Cancer Detection: A Community-Based Cohort Study." Annals of Internal Medicine;169:439–447. doi: 10.7326/M18-0244 Short version: "Tailored thresholds for FIT may increase colorectal cancer detection," ACP Internist (19 September 2018), https://acpinternist.org/weekly/archives/2018/09/18/4.htm