Mammograms and Breast Cancer prevention

The nice thing about blogging is that I can have an opinion and express it as such. This may be in direct contrast to the official 'recommendations' of the medical establishment.
A case in point are the new mammogram recommendations. Last year someone who was writing an article for 'Good Housekeeping' called me and asked how the new recommendations would change my practice. I told her honestly, they wouldn't.
My response must have been either uninteresting or not politically correct as it wasnt published!

Now that Breast Health awareness month is back (October) I get asked this question again quite a bit.
As far as I'm concerned the new recommendations dont make sense and I believe if my patients see the facts they will agree.
Some of the most egregious recommendations include: discouraging women from doing their own self breast exam and not starting mammograms until the age of 50. Do these jokers know how many of my patients would have been dead by now if I followed these recommendations?

While glancing through a recent edition of Family Practice News I noticed a reference to a study done in Michigan, with more than 5000 women, which agrees with me. The study was reported at the symposium of the American Society of Clinical Oncology. It found that many breast cancer patients would have more advanced disease and face harsher treatment if the recently updated screening guidelines of the US Preventive Services Task Force were widely adopted.
In women under 50, 48.3% of breast cancers were detected by mammography, 46% by palpation.
The speaker concluded that " you are better off if you can have your cancer detected by mammography .....you will have more options and likely need less aggressive treatment......we would support the societies that continue to recommend annual screening mammography starting at age 40"

Do not misunderstand me, mammograms are not perfect and there is some radiation exposure but if you have breast cancer they definitely beat the alternative! I think if you are under 50 you can work it where you can get more thermograms and less mammograms but you still need to get that baseline mammogram to know where you stand. They dont hurt anymore and can be life saving.
Breast cancer treatment has come a long way but we still have a long way to go to eradicate the disease.

Prevention is ALWAYS better than cure.

Stay Well

Dr Tuakli

DOCTORS ABUSING PAIN MEDICATION PRESCRIPTIONS !!

As a follow up to my last Blog, I had a patient last week who was seen in one of the area hospital ERs complaining of Flu-like symptoms. The doctor she saw confirmed that she did in fact have THE FLU and gave her Ibruprofen 600mg and Percocet to take every 4 to 6 hours! My incredulous medical student asked the patient several times if she was sure she hadnt complained of pain and the patient insisted that she hadnt. Quite frankly whether she had or not it is totally inappropriate for a patient to be given narcotics for THE FLU!
Unfortunately this patient was very compliant and took her narcotic medication as prescribed. She passed out at work the next day and was rushed back to the hospital. In the process of falling she scraped her leg and had some other minor injuries, she could have cracked her skull open.......... because of the flu.
Unbelievably, when the patient came to my office she was still taking the medicine because they told her in the ER that she had passed out because she had not eaten but they forgot to tell her to stop taking the medicine. Such compliance!

I plan to complain to the hospital in writing, its time we did something about this dissemination of drugs in our community. As a popular commercial on the radio says "not a sermon, just a thought".

Prescription Pain Medications

I recently had a minor procedure done and it was a very illuminating experience for two reasons:

Firstly, being a patient is a very humbling experience, I must confess I was deeply moved by the kindness of the people that took care of me. It is so different when you are the one with the clothes on giving instructions!
In those few hours I learned so much that I would venture to suggest that every doctor and medical student be required to be a patient for a day. Even though I knew all about the procedure, the staff carefully explained to me what I should expect. They were very sensitive about maintaining my privacy and making sure I was comfortable. Being on the receiving end made me realize how priviledged we are as health care providers to be able to help other people. It is amazing how a little kindness can be so affirming.
My promise to myself from now on is to be more compassionate and empathetic with my patients, I believe nothing else in Medicine is as important.

The second thing that I have pondered a lot since my procedure is how we as physicians have to a large extent caused the epidemic of prescription drug abuse. A subject that is featuring prominently in the news media these days because of Michael Jackson's death.
Prior to my procedure the resident (Intern) physician asked me which pain medication I 'preferred' Oxycodone or Tylenol #3. I was very taken aback because number 1, I don't have a preferred pain medication (and I don't believe most people do) and number two I knew that this procedure usually doesn't cause any pain. She reluctantly gave me a prescription for Motrin which I didn't even fill. I had no pain, none and can't imagine why I was expected to have any. If I didn't know better I could have gone home with a prescription for Oxycodone which has pretty good street value.

I have noticed for sometime now that many surgeons just routinely give patients pain medications in case of need, they constantly say "we want to get ahead of the pain".
What pain?! What we need to do is get ahead of the Pain Medication addiction and only give people pills when they need it. Even women who have just had a baby are given scripts "just in case". It really hit home hard with me a veteran physican being offered unnecessary pain medication by a young doctor who is already programmed to dispense it.

One can only imagine how much pain medication Micheal Jackson was given after all his surgeries, and I have no doubt that is probably where his addiction started.

We physicians must first do no harm but if we doctors wont change at least the patients can.
Here are my suggestions:
Decline a script if you don't need it and don't obediently take any for your family members either without questioning.
If an over the counter pill will take care of your pain don't even fill the prescription.
Get only small amounts of pain medication if needed and flush away any remaining pills when you no longer have pain.

This is my personal opinion and I feel very strongly about it.I really think that with all the technology and other advances we have made we should be able to eliminate the scourge of drug addiction.

Help spread the word.
Be well and stay active!