A common question I get from patients is whether organic food is better for them. My first response is that there currently are no clear-cut definitions of what the term “organic” means. Having grown many fruits and vegetables of my own, I know that it is virtually impossible to grow anything without some type of fertilizer or means of pest control. Most organic foods are said to be grown without antibiotics, synthetic pesticides or fertilizers. Though organic foods cost more, they have been gaining in popularity. People choose to eat organic foods for many reasons including reducing the amount of chemicals entering their bodies, protecting the environment, and the idea that the foods contain more nutrients than their chemical-coated counterparts.
A recent review published in the Annals of Internal Medicine, titled “Are Organic Foods Safer or Healthier than Conventional Alternatives?”, found no significant difference nutrition-wise between conventional and organic foods. Though there were some major flaws in many of the studies cited, including heterogeneity of the study methods, there were some interesting findings. The foods in the studies, which included fruits, vegetables, poultry and eggs, had the same amount of vitamins and minerals. However, there was a greater pesticide residue (30% higher) and bacteria resistant to antibiotics found on the conventionally grown foods.
My general rule of thumb is to buy organic when the fruit or vegetable has a thin skin such as tomatoes or plums. If you cannot buy organic, be sure to peel the fruit or vegetable before eating or cooking. One study cited found that children who were switched to an organic diet for 5 days had lower amounts of detectable pesticides in their urine. With all fresh produce, it is always important to thoroughly wash them. Interestingly, the study found E.coli bacterial contamination was the same between the two types of produce. The bottom line is this: If you can afford to buy organic, there really is no downside to taking the extra precautions, especially if you are pregnant or have children in the household.
Flu shots are now available for the 2012-2013 flu season. I have had many patients ask if now is a good time to get the flu vaccine because they know we are still a few months away from flu season. Though there have been studies showing that the peak antibody production is about 2 weeks after the vaccine is given, this does not mean you have no protection later on. If you have an intact immune system, you will still have immunity to the flu virus strains found in the vaccine when the flu season peaks in December to March. Also, you may forget to get your flu shot as the holiday season approaches and your chores pile up. The best way to protect yourself and your family is to get the flu vaccine early. This is especially important if you have a household with children or elderly parents.
The relationship that women have with their Women’s Health provider is an extremely important and intimate relationship built on trust- similar to a hair stylist! The ideal time to establish a relationship with your Medical and Women’s Health Provider is when you are healthy.
What can I expect from my Well Woman Annual Visit?
– Cervical Cancer Screening
In March 2012 the United States Preventative Services Task Force (USPSTF), made changes to recommendations for cervical cancer screening:
Pap Tests are not recommended for women under the age of 21, regardless of sexual history
These recommendations are based on the fact that cervical cancer is rare in young women, abnormal cells usually return to normal over time and follow-up treatment is unnecessary and possibly harmful.
Women ages 21-65 should be screened at least every 3 years
Women ages 30- 65 may elect to have a Pap test AND HPV Testing to extend the screening interval to every 5 years.
These guidelines do not apply to women with an increased risk of cervical cancer
A statement from American Congress of Obstetricians & Gynecologists (ACOG) reads, “The well-woman visit has always been more than just a “Pap smear,” and the decreased need for cervical screening actually constitutes a minor change to an important aspect of a woman’s health care”. Common practice is to continue to offer annual cervical cancer screening to women in spite of the guidelines. It is important for women to understand the guidelines in order to have a conversation with their women’s health provider and make informed decisions about their care.
– Human Papilloma Virus (HPV) Vaccine
The HPV Vaccine should be offered to women up to age 26, who have not already received it.
Many women may have HPV, but very few of these women will ever get cervical cancer. In most cases the body fights off the virus, and the infection goes away without any treatment. In some women however, the infection lasts and can cause cervical cancer. Even though HPV is an important risk factor for cervical cancer, research suggests other factors, such as smoking, infection with other sexually transmitted infections and diet, may play a part in the development of cancer. The HPV vaccine protects against several of the most common types of HPV.
– Sexually Transmitted Infection (STI) Screening
Annual screening for Chlamydia is recommended for all sexually active women ages 25 and younger.
Women older than 25 with new or more than one partner since their last visit should also be screened.
– HIV Test must be offered.
In 2010 voluntary HIV testing became part of New York’s State Public Health Law. The law requires health care professionals to offer all patients between the ages of 13 to 64 a voluntary HIV test.
Screening for other STIs, such as Gonorrhea, Syphilis or Genital Herpes, should be discussed with your provider
– Clinical Breast Exam (CBE)
Common clinical practice is to follow American Cancer Society (ACS) guidelines which recommend CBEs at least every 2 years and screening Mammograms starting at age 40. Any findings during screening exams should be referred for additional testing. Anyone with a 1st degree relative (mother or sister) history of breast or ovarian cancer should consult with a Breast Specialist for screening recommendations.
– Preconception and/ or Contraception Consultation
Women need to consume 400- 800 micrograms of Folic Acid daily regardless of plans for conception. Folic Acid is a B vitamin that prevents Anemia, prevents birth defects and may also play a role in heart health. Sources of Folic Acid include: Fortified cereal, Leafy Vegetables, Citrus Fruit, Beans, Whole Grains, most Multivitamins, Multivitamins for Women, and Prenatal Vitamins.
Not ready to start a family? There are many options for contraception. Method selection is based on individual medical history and personal preferences. Start by conducting research and use credible sources as opposed to Google and scary stories from friends! After learning about the options, schedule an appointment with your women’s health provider for additional information and a prescription if indicated. An excellent resource can be found at www.arhp.org/methodmatch
“If I have my Women’s Health Exam every year, why do I need a Routine Physical?”
Your provider will obtain a detailed personal and family medical history in addition to conducting a thorough physical exam. Recommended screening tests, vaccines and/or referrals will be based on information gained from your history and physical exam.
“What screening tests may be done during the Physical Exam?”
– Blood Pressure Screening
Your blood pressure should be checked at least every 2 years if normal (Less than 120/80), or annually if greater than 120-139/80-90.
- Body Mass Index (BMI) is a calculation of heart disease risk based on Height & Weight
- Cholesterol Screening
If you smoke, are obese, have high blood pressure, diabetes, personal history of heart disease or family history of premature heart disease.
- Diabetes Screening is recommended if you have a history of high blood pressure
- Hepatitis C Screening may be recommended if you were born between 1945- 1965
- Bone Mineral Density/ Osteoporosis screening should be done at least once at age 65 or older
- Colorectal cancer screening is recommended starting at age 50. Earlier for African-Americans and those with a family history
“What recommendations may be made to keep me healthy?”
Vaccines
- You should receive a Tdap (Tetanus, Diptheria & Pertussis) one time booster and a Tetanus shot (Tetanus & Diptheria- Td) every 10 years thereafter.
- Influenza (Flu Shot) is recommended Annually
- HPV Vaccine is recommended for all women up to age 26
- Pneumococcal Vaccine is recommended if you have a chronic condition such as Asthma, Diabetes, a condition associated with immunosuppression or are a smoker
- Varicella Vaccine may be recommended if you have never had chickenpox
- Travel Vaccines are location specific and will be determined during a travel consultation
Your provider may also have a conversation about things you can do to remain healthy such as quit smoking, limit alcohol to no more than 1 drink per day, exercise 30 minutes per day and make healthy food choices. By establishing a relationship with your provider you can become partners in maintaining your overall health and wellbeing.
Your skin is the largest organ of the body. Aside from providing protection from the elements your skin provides protection from billions of bacteria in the outside world ready to invade the sterile environment within. Whenever you have a cut, scrape, insect bite, or puncture wound, a layer of defense is breached. Bacteria, especially the notorious MRSA (methicillin resistant Staphylococcus aureus) take advantage of this vulnerability and cause nasty wound infections that lead to infections called cellulitis or abscesses (boils). You can prevent these by making sure all wounds are properly cleaned. At the first notice of an injury, wash the area immediately with clean water being sure to remove any debris or dirt on the area. When you have access to an antiseptic such as iodine, hydrogen peroxide or alcohol, apply the liquid generously to the area immediately. Next, apply a layer of bacitracin, neosporin, or other antibacterial ointment. Finally dress the wound with a adhesive bandage or gauze and tape. By covering the area, you will prevent the area from being in contact with bacteria in the environment. It will also remind you to keep the area clean and dry and prevent you from touching the area. Potentially pathogenic bacteria such as Staph often colonize the areas just inside our nostrils and you can easily spread them to open wounds by merely touching your nostrils and then the area.
Keeping wounds dry is also important as very dangerous bacteria such as Pseudomonas love warm moist environments. This bacteria is also known to cause infections after bathing in hot tubs, especially in people who have recently shaved their skin, called hot tub folliculitis.
Tetanus is another bacteria which is a potentially deadly infection that can arise from simple wounds. It is generally found on rusty surfaces or soil-contaminated areas. However, any deep cut or puncture wound should be assumed to be a tetanus risk. Luckily there is a vaccine that everyone should get called TDAP. All adults should be vaccinated every 10 years against tetanus. If you don’t remember your last tetanus vaccine, there is no harm in getting another. In fact, it is best for piece of mind as one can never know when you may have an accident.
Traveling to foreign countries is often exciting. Taking the right precautions can reduce the chance of unexpected problems. As soon as you know you will be traveling to an underdeveloped country, you should see your doctor. This is extremely important because many vaccines take a few weeks to become effective. Some countries also require a record of Yellow Fever vaccine before you can even enter or leave. It’s also better to see your doctor because it gives him/her time to space out the necessary travel vaccines. Who wants to have 5 injections in one day?
Traveling abroad is also a good time to make sure you have all your medical records including vaccinations, even the ones from childhood. Be sure to bring these to your doctor as you may be due for a booster. Your doctor may also provide you with prescriptions for motion sickness, and antibiotics for traveller’s diarrhea and malaria if indicated. Do some preparation beforehand by going to the CDC travel website. You can select the countries you will be visiting and see specific health travel advisories and required vaccines.
