1. What does Blood pressure measure? How do I interpret the systolic and diastolic numbers? What is normal or high?

As the heart pumps blood it does so through vessels known as arteries. Blood pressure (BP) is the pressure blood exerts on the walls of the arteries. Blood pressure measurement is made up of two pressures: the systolic (top number) and the diastolic pressure. (Bottom number) and is written as two numbers: e.g. 130/80. The systolic pressure is the highest pressure in the artery when the heart is beating and the diastolic pressure is the lowest pressure when the heart is resting. They are measured in millimeters of mercury (mmHg)’

Optimal or normal blood pressure for an adult is 120/80 or lower. Prehypertension is blood pressure between 120/80 and 139/89. This refers to early stages of high blood pressure. Hypertension is high blood pressure and is pressures consistently greater than 140/90. Hypotension refers to low systolic blood pressure (less than 90 on the top) and often occurs with serious conditions like heart attacks, bleeding, shock, dehydration etc. High blood pressure is further classified into stage 1 and 2 depending on how high the numbers are. Stage 1: 140/90-159/99 and stage 2: greater or equal to 160/100
Anyone who has been diagnosed with prehypertension or hypertension should make sure they have regular visits with their primary care physician for blood pressure checks and for treatment with anti hypertensive medications if indicated. Many people do not have any symptoms but may have very high pressures.

2.Who should receive the flu and pneumonia vaccine?

Influenza or the flu is caused by a virus which infects the respiratory system (from the nose to the lungs). Each year about 20,000 Americans die from serious complications like pneumonia. Anyone who has decreased or low immunity, or has certain chronic diseases which puts them at high risk of getting severe complications should receive the flu vaccine.

The Center for Disease Control and Prevention (CDC) has recommended that all children 6months to 5 years should receive vaccination against the flu. Other groups at high risk include :individuals with chronic diseases like Asthma, emphysema, chronic bronchitis, sickle cell disease, pregnant women or women who will be pregnant during flu season.

Others who are at risk include residents of nursing homes, long term care, assisted living health facilities, health care workers who are in contact with patients are at high risk of serious complications from the flu- e.g. nurses, doctors, day care workers and all adults above 65 years of age.

Other individuals at risk are those with long term health problems like: diabetes, stroke, kidney and heart disease. Individuals with weakened with weakened immune systems: e.g. HIV/AIDS and cancers are also at high risk.

3. What is an advanced directive?

An advanced directive is directions an individual gives to his or her health care provider about what care they would like when they are in a coma or in a serious health situation in which recovery is unlikely. It may spell out the treatments you would like to have and the ones you do not want. Each state has different laws about advance directives. However, most times when admitted to hospital the staff will enquire about one’s wishes.

Two types of advance directives are living will and durable power of attorney for health care
.
A living will is a legal document which specifies your wishes regarding the use of extraordinary life support or other life-sustaining medical treatments when your condition may be without hope of recovery or death is inevitable. It enables loved ones to know your wishes in the event that you are unable to speak for yourself. It does not involve selecting or appointing someone to make those decisions for you. You make the decisions while you are alive and in your right mind.

Durable power of attorney for health care is a legal document stating who you have appointed to make medical treatment or care decisions on your behalf. It becomes active when you are unable to make medical decisions for your self because of physical or mental incapacitation.

4 What is the difference between a bacterial and viral infection? How do you get them?

A bacterium is a micro organism which is capable of causing disease when in sufficient quantities to overwhelm the body’s defenses. There are many hundreds of bacteria but not all are harmful. Most infections caused by bacteria can be treated with antibiotics. However, misuse of antibiotics has lead to development of resistance by certain bacteria and these may require very potent intravenous antibiotics to cure infections.

Viruses are another type of micro organisms. For example, common cold can be caused by many different kinds of viruses. Others are hepatitis, HIV and influenza viruses. Certain viruses have specific medicines used to treat them; however the common cold for example does not have a cure and is mostly treated symptomatically. For example, analgesics for fever and headache, expectorants, lozenges and cough suppressants for thinning mucus and cough relief. Most doctors try hard to dissuade and educate patients not to take antibiotics when they have a cold. The antibiotics do not cure colds, but rather lead to development of drug resistance.

One gets an infection when there is breach in the body’s barriers- skin, mucous membranes of mouth, vagina and anus coupled with introduction of disease causing microorganisms in sufficient enough quantities to overcome the body’s immune defensive mechanisms. One can have colonization by bacterial but not in sufficient quantities to lead to a full blown infection. Infection can be transferred from one person to other because of close contact with body fluids from coughing, sneezing in case of respiratory diseases, and oral or fecal route through contaminated hands introduced into the mouth as in diarrheal diseases.

For many bacterial or viral infections prevention is through good common sense practices: e.g. hand washing, not coughing into someone’s face, avoid sharing personal objects, towels, etc. and getting immunized if a vaccine is available e.g. flu vaccine before the flu season starts.

Exercise, adequate rest and sleep, decreased stress and healthy eating all help in building up your immune system so that one can fight infection when it arises.

5. What re the differences between Conventional Medicine, Homeopathic, Integrative and Alternative Medicine?
Conventional or allopathic medicine is medicine practiced by holders of MD (medical doctor) or DO (doctor of Osteopathy) and their allied professions like physical therapists, registered nurses, lab technicians etc. Other terms for conventional medicine include allopathic, Western, mainstream, orthodox, regular medicine; and biomedicine

The terms complementary and alternative medicines have been used interchangeable but there is a strict definition for each. Complementary medicine is practiced in Addition to conventional medicine while Alternative medicine is used in place of conventional medicine. Both terms form CAM (Complimentary and Alternative medicine) which are a group of health and medical care systems and products which are not considered part of conventional medicine.

Integrative medicine combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness. It is also called integrated medicine. (definition by the National Institute of Health’s National center for complementary and alternative medicine)

Integrative Medicine (IM), according to the Consortium of Academic Health Centers for Integrative Medicine, is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, and makes use of all appropriate therapeutic approaches that are informed by evidence. It is important to differentiate IM from complementary and alternative medicine (CAM), which is associated with IM therapies for which much of the evidence is still unsettled
Some of the CAM systems are:

Aromatherapy: Scents of essential oils from flowers, plants, herbs and trees are inhaled to promote health and well being. It can be used complimentary with conventional medicine following surgery to lessen the effects of pain.

Ayurveda: Healing system with roots from India. Believes body, mind and spirit are all involved in disease prevention and healing. It uses several remedies including, yoga, herbs, meditation and massage and dietary changes.

Homeopathy: Healing which has its roots from Europe. Believes in ”like cures like”, as the body is stimulated with small amounts of diluted compound which in large amounts would produce symptoms or complications. The patient interview identifies the person’s personality and body type which in term determines type of treatment given.

Naturopathy: Healing which also has its roots from Europe. It uses a whole lot of CAM methods to help the body heal its self. Methods include: dietary and lifestyle changes, joint manipulations, plant based remedies, exercise, stress reduction, education, and massage to bring about healing.

There is a branch of the National Institute of Health called the National center for complementary and alternative medicine which does research, training, education and clinical trials in CAM to keep health professionals and the public informed about non allopathic medicine. Visit their website at http://nccam.nih.gov/health/decisions/index.htm; www.familydoctor.org

6. What is the difference between an MRI and CAT and PET scan?

MRI (Magnetic Resonance Imaging)

A special non invasive imaging technique used to image internal structures of the body, particularly the soft tissues. An MRI image is often superior to a normal X-ray image. It produces high resolution images in several planes and axis without any known biohazard effects because it lacks ionizing radiation. It uses the influence of a large magnet to polarize hydrogen atom in the tissues and then monitors the summation of the spinning energies within living cells. It uses non iodinated contrast media Images are very clear and are particularly good for soft tissue, brain and spinal cord, disc infection or degeneration, nerves, joints and abdomen. These scans may be used for detecting some cancers or for following their progress. It is more expensive than a CAT scan and patient has to lie very still because motion can cause artifacts. It’s contraindicated if patient has metal clips, pacemaker or ferromagnetic implants. Claustrophobia may be a problem for some patients; however, we now have open MRI’s, which can be used for some parts of the body.

A CAT scan is also a non invasive, painless radiological procedure which uses a computer to combine multiple x-ray images into a two dimensional cross sectional image on a screen. It can reveal details of many soft tissue and bony structures not seen by normal x-ray such as in the diagnosis of fractures, tumors and dislocations, infarction and fluid accumulation. It uses ionizing radiation and can be used along with special dye to help differentiate between abnormal tissue and details of the blood network in an organ.
A PET scan (Positron Emission Tomography) is a scanning device which uses low-dose radioactive sugar to measure cell activity. It reveals abnormal cell activity, but does not display precise anatomy to pinpoint the site of the problem area. This is a limited-use diagnostic tool.

PET/CT Imaging combines the two images from a PET and a CT, to display the problem area along with a precise display of anatomy to pinpoint the location of abnormality. PET/CT scanning is used for the diagnosis and treatment of cancer, diagnosis of Alzheimer’s, Parkinson’s disease, refractor seizures, and cardiac viability. Cancer survivors can also have annual PET/CT for checking recurrence.

7. What are the factors that determine if someone has a thyroid problem?

The thyroid is an H shaped gland in front of the neck located below the Adam’s apple. The role of the gland is to make hormones (chemical substances) to control your body’s metabolic functions, e.g. digestion, heart rate, burning calories, keeping cells functioning etc.

The most common type of thyroid dysfunction is hypothyroidism. This is when the gland is sluggish and is not producing enough hormones to maintain optimal body metabolism. About 95% of this is related to abnormality within the gland itself and the other 5% is caused by drugs, surgery and radioactive iodine. A condition called Hashimoto’s disease is the most common cause of hypothyroidism. It is caused by inflammation of the thyroid gland or thyroiditis. This occurs when the gland is attacked either by antibodies made by the body’s own immune system or by an infection or certain medications. Thus thyroiditis is not one disorder. The inflammation causes damage to the thyroid cells. If the damage progresses slowly, the thyroid hormone level falls and the symptoms will be those of hypothyroidism (sluggish function). These include: weight gain, fatigue, depression, dry skin, constipation, enlarged thyroid gland, (goiter) and irregular periods for women and hair loss.

The thyroiditis may also cause thyroid hormones to leak out and increase the levels in the blood causing symptoms like hyperthyroidism (over functioning of the gland). This is called thyrotoxicosis and the symptoms include fatigue, anxiety, tremors, palpitations, difficulty sleeping, irritability, weight loss, muscle weakness, goiter and heat intolerance. The most common causes of hyperthyroidism are Graves Disease, toxic multinodular goiter and thyroiditis. Sometimes excessive treatment with thyroid replacement medications for hypothyroidism can tip the balance and cause subclinical hyperthyroidism.
If you think you have any of these symptoms see your primary care provider who will run some blood tests to determine if you have thyroid problems. Most thyroid diseases are found in women.
Treatment of hypothyroid requires thyroid replacement therapy with thyroid hormones. Treatment for hyperthyroid requires either medications to suppress production of thyroid hormones, surgery to remove the gland or, radioiodine ingestion.

8 What are the most common issues you treat on a regular basis?

The top five issues that I treat at my clinic are hypertension, diabetes, high cholesterol, upper respiratory illnesses, arthritis involving knees and low back causing pain. The next five will be depression, gastro esophageal reflux disease (acid reflux,) chronic bronchitis or emphysema, hypothyroid and physical examinations or preventive maintenance exams.

9. What are good preventative health measures?
Eat Fruits, vegetables, a high fiber diet, nuts, grains, legumes and fish, with small amounts of fat trimmed red meat, poultry and pork. Limit frying and do more grilling, broiling and baking. Increase intake of good fats like monounsaturated and polyunsaturated fats. Good fats are found in fish, olive oil, canola oil, almonds and avocados.

Avoid foods that contain hydrogenated fats and Trans fats, saturated fats and cholesterol. Most saturated fat is from animals but some vegetable oils like coconut oil and palm oil are high in saturated fats. Both lead to high cholesterol levels. Choose low fat dairy products, e.g. skim, 1% or 2% milk, 1% or 2% cottage cheese. Decrease intake of refined sugars which can cause a rise in triglyceride levels and lower your good cholesterol (HDL)

Get into the habit of reading food labels to find out types and content of fats and sugars. Stop smoking or chewing tobacco, and avoid second hand smoke. If you must drink, limit alcohol to 2 drinks a day for men and 1 drink for women.

Exercise regularly. The cheapest and safest way is brisk walking. Be active for at least 30 minutes most days of the week. The 30 minutes may be spread out into three 10 minutes sessions. Aim for a healthy BMI (Body mass index: which is calculated from your weight and height (body weight in kilograms divided by height in meters squared) see chart below

Female

Male

Underweight

< 19

<20

Acceptable

19 - 25

20 - 25

Overweight

25 - 30

25 - 30

Obese

30 - 40

30 - 40

Morbidly Obese

> 40

> 40

The formula is:BMI = W / H 2. Where W is the weight in kilograms and H is the height in meters.

Drink lots of water and fluids (8 glasses a day). It helps to prevent dehydration, keeps your skin supple and flushes your kidneys. Exercise your mind by reading or doing cross work puzzles. Lower your stress level by making time for yourself, relaxation, getting enough sleep, talking about your problems, having friends, getting a hobby, setting and maintaining boundaries.

Take care of your body, soul and spirit. Have regular health screenings for your age group.Use sun screens if you must be in the sun, and avoid sun tanning to prevent skin cancer.

10. When do I get a second opinion?

Although doctors are all trained in medicine they have their own opinions and ideas of practicing medicine. Some doctors are more conservative or take a traditional approach to diagnose and treat diseases while others are more aggressive and use newest therapies, tests and cutting edge technologies. Medicine is changing everyday with new discoveries and research findings. It may be necessary to get a second opinion to get new information option, perspective or confirm what one doctor has said. If you get similar opinions from two doctors, you may be more satisfied or content; but even if you are not, you can go ahead and get a third opinion. Most doctors will encourage you to get a second opinion and are not hurt when you seek one.

You may ask your doctor for a name of another specialist and most will be happy to give you one. You may ask someone who has had a similar medical condition where they were treated. You may call your local medical society, a university teaching hospital or the department of health of your state would have lists of doctors in that specialty who practice in your area. The department of health would have a website you could access to get information

Health insurance providers have a list of specialists who are part of their provider pool. You can call their referral department or check on the internet. The internet is a good source of information for any medical problem. Read, download and find out about your condition and treatment options available. Take this information with you when you go to see the new doctor. The new doctor should take a history and do a physical examination as well as exam your records from your first doctor. They may do more tests and discuss your options with you. You will then be able to make an informed decision. It may be a good idea to let your first doctor know what final decision you have made.

Dr. Entsuah is passionate about conducting medical missions overseas and is a graduate of Ghana medical school. Dr. Entsuah is in private practice in Groveland, FL.and a member of The Healing Continuum.com team.

The Facts about Colorectal Cancer
By Barbara Entsuah, MD

Colorectal cancer is the third leading cause of death due to cancer in the US. In 2005 according to the American cancer society, 145,000 people were affected. Family history may play a significant risk factor, with about 30% of diagnosed cases showing familiar groupings, meaning that those people may have a definable genetic component. About 3-5% of colon cancers are associated with inherited colon cancer syndromes. Those with ulcerative colitis also have a higher risk. Most colon cancers begin in the large intestines (colon). Rectal cancer begins in the rectum- which is closest to the anus. Most of these cancers begin as a polyp.

WHAT IS A POLY?

Most polyps start as a small harmless fleshy growth in the wall of the colon or large intestine. However, as a polyp gets larger, it can develop into a cancer that grows and spreads. Polyps are extremely common, and incidence increases with age. About 50% of individuals over the age of 60 years will have at least one polyp. With time a polyp can grow larger and develop into cancer that grows and spread outside the walls and inside the lumen of the colon. It will then spread to nearby lymph nodes and outside to other organs. There are four main different types of colon polyp groups: hyperplastic, Inflammatory, hamartomatous and adenomatous. The most common polyps are adenomatous polyps (account for 75% of all polyps) and they have the potential to develop into cancer. A large polyp has the tendency to be cancerous and when they are about one inch in size, their risk of becoming cancerous is about 20%. It is for this reason that doctors remove polyps during a sigmoidoscopy or colonoscopy. It is then tested for cancer. One is more likely to get polyps if one eats a lot of fatty foods, smokes, drink alcohol, don’t exercise or is overweight. Eating more calcium and folate may lower one’s risk of getting polyps. Some foods rich in folate are peas, leafy greens, spinach, kidney beans.

Recent studies in the journal of American Medical Association have shown that flat colon growths also have potential to be cancerous and cancer have been found in flat or depressed growths. This calls for a careful thorough screening process.

WARNING SIGNS OF COLORECTAL CANCER

These include blood in the stool or toilet bowl after a bowel movement, change in the shape of the stool, pain in the lower abdomen, and change in bowel movements. There can also be other non specific symptoms like weight loss, fatigue, feeling of fullness, anorexia and anemia. However many polyps do not cause any symptoms

RISKS ASSOCIATED WITH THE DEVELOPMENT OF COLORECTAL CANCER

Many studies have examined the relationship between diet and development of colorectal cancer. For total vegetables majority of studies reported that risk was reduced by at least 20% for those in the highest compared with individuals in the lowest intake category. For total fruits the results are not as consistent as with vegetables, and the studies also showed inverse association with risk of distal (lower part) colon cancer compared to proximal part( upper part) of the colon . Fruits and vegetables are rich in many nutrients and bioactive compounds such as folate, fiber, vitamins, and carotenoids that may have cancer preventive properties. Nutrients can also detoxify or deactivate carcinogens (cancer causing substances). Diets rich in fruits and vegetables are important even for other health outcomes like cardiovascular disease and other cancers.

In a February 2003 study published in the Archives of Internal Medicine, women who consumed a high fat, low fiber diet had an increased risk of developing colon cancer compared with those who had a lower fat, high fiber diet. However there was also a reduced risk for those who had a high fiber and healthy protein diet. Western diet consisting of high intake of red meat, sugar desserts, high fat and refined grains have a 3- fold increase in cancer recurrences and death in patients who had colon cancer and had undergone previous treatment.

Other factors associated with increased risk for colon cancer include increased Body Mass Index (BMI), smoking, and second hand smoking.

Factors associated with reduced risk but still needing more studies include high dose Aspirin, and Celebrex- both of which are anti-inflammatory medications. As with any medications, risks and benefits ratios have to be taken into consideration before any of these are used.

A vigorous exercise program has been found to decrease the risk of colon cancer and polyps in men.The good news is that the disease can be prevented if polyps are removed in time before they become cancerous. This is when screening procedures come into play

SCREENING FOR COLON CANCER

Getting a colonoscopy or other colon screening procedure, allows your doctor to spot polyps and take them out of the colon or rectum before they become cancerous. Also, if screening shows cancer, early treatment increases the odds of survival. The U.S. preventive services Task Force (USPSTF) is a credible organization which provides current evidence based preventive care guidance and recommendations. It recommends initiating screening at 50 years for men and women at average risk for colorectal cancer. In those with higher risk e.g. those with a first-degree relative who was diagnosed with colorectal cancer before 60 years of age initiating at an earlier age is suggested. Earlier screening is also suggested for those at very high risk like those with familiar polyposis, ulcerative colitis, or hereditary nonpolyposis colorectal cancer. Those with genetic syndromes may also need genetic counseling or testing.

The appropriate age to discontinue screening is not known because most screening studies involved patients less than 80years of age. However, no matter the age, when there are symptoms suggestive of a bowel problem e.g. bleedinG, an exam has to be performed.

SCREENING OPTIONS FOR COLORECTAL CANCER ARE:

Fecal occult blood test: Checks for blood in stool samples. Its done annually. Usually 3 different specimens taken on 3 consecutive stool samples are forwarded to the lab.

Flexible sigmoidoscopy: Doctors use a thin, flexible, lighted tube to examine the rectum and lower part of the colon; done every five years.

Flexible sigmoidoscopy and Fecal occult blood test combined (See above)

Double-contrast barium enema: Patient gets an enema containing barium dye, followed by X-rays of the colon and rectum; done every five years.

Colonoscopy: Doctors use a thin, flexible, lighted tube to examine the rectum and entire colon; done every 10 years, unless a polyp is found. Then in this case depending on type and number of polyps removed subsequent colonoscopy may be between one and five years. This procedure usually requires sedation. Each screening procedure has its benefits and potential harms which you can discuss with your primary care physician.

Though colon cancer screening is up, many people still aren’t getting tested. Talk to your doctor about getting screening if you are 50 years or older, have any symptoms, or someone in your family has had polyps or colon cancer.

Colorectal cancer is the third leading cause of death due to cancer in the US. In 2005 according to the American cancer society, 145,000 people were affected. Family history may play a significant risk factor, with about 30% of diagnosed cases showing familiar groupings, meaning that those people may have a definable genetic component. About 3-5% of colon cancers are associated with inherited colon cancer syndromes. Those with ulcerative colitis also have a higher risk. Most colon cancers begin in the large intestines (colon). Rectal cancer begins in the rectum- which is closest to the anus. Most of these cancers begin as a polyp.

WHAT IS A POLYP?

Most polyps start as a small harmless fleshy growth in the wall of the colon or large intestine. However, as a polyp gets larger, it can develop into a cancer that grows and spreads. Polyps are extremely common, and incidence increases with age. About 50% of individuals over the age of 60 years will have at least one polyp. With time a polyp can grow larger and develop into cancer that grows and spread outside the walls and inside the lumen of the colon. It will then spread to nearby lymph nodes and outside to other organs. There are four main different types of colon polyp groups: hyperplastic, Inflammatory, hamartomatous and adenomatous. The most common polyps are adenomatous polyps (account for 75% of all polyps) and they have the potential to develop into cancer. A large polyp has the tendency to be cancerous and when they are about one inch in size, their risk of becoming cancerous is about 20%. It is for this reason that doctors remove polyps during a sigmoidoscopy or colonoscopy. It is then tested for cancer. One is more likely to get polyps if one eats a lot of fatty foods, smokes, drink alcohol, don’t exercise or is overweight. Eating more calcium and folate may lower one’s risk of getting polyps. Some foods rich in folate are peas, leafy greens, spinach, kidney beans.

Recent studies in the journal of American Medical Association have shown that flat colon growths also have potential to be cancerous and cancer have been found in flat or depressed growths. This calls for a careful thorough screening process.

WARNING SIGNS OF COLORECTAL CANCER

These include blood in the stool or toilet bowl after a bowel movement, change in the shape of the stool, pain in the lower abdomen, and change in bowel movements. There can also be other non specific symptoms like weight loss, fatigue, feeling of fullness, anorexia and anemia. However many polyps do not cause any symptoms

RISKS ASSOCIATED WITH THE DEVELOPMENT OF COLORECTAL CANCER

Many studies have examined the relationship between diet and development of colorectal cancer. For total vegetables majority of studies reported that risk was reduced by at least 20% for those in the highest compared with individuals in the lowest intake category. For total fruits the results are not as consistent as with vegetables, and the studies also showed inverse association with risk of distal (lower part) colon cancer compared to proximal part( upper part) of the colon . Fruits and vegetables are rich in many nutrients and bioactive compounds such as folate, fiber, vitamins, and carotenoids that may have cancer preventive properties. Nutrients can also detoxify or deactivate carcinogens (cancer causing substances). Diets rich in fruits and vegetables are important even for other health outcomes like cardiovascular disease and other cancers.

In a February 2003 study published in the Archives of Internal Medicine, women who consumed a high fat, low fiber diet had an increased risk of developing colon cancer compared with those who had a lower fat, high fiber diet. However there was also a reduced risk for those who had a high fiber and healthy protein diet. Western diet consisting of high intake of red meat, sugar desserts, high fat and refined grains have a 3- fold increase in cancer recurrences and death in patients who had colon cancer and had undergone previous treatment.

Other factors associated with increased risk for colon cancer include increased Body Mass Index (BMI), smoking, and second hand smoking.

Factors associated with reduced risk but still needing more studies include high dose Aspirin, and Celebrex- both of which are anti-inflammatory medications. As with any medications, risks and benefits ratios have to be taken into consideration before any of these are used.

A vigorous exercise program has been found to decrease the risk of colon cancer and polyps in men.The good news is that the disease can be prevented if polyps are removed in time before they become cancerous. This is when screening procedures come into play

SCREENING FOR COLON CANCER

Getting a colonoscopy or other colon screening procedure, allows your doctor to spot polyps and take them out of the colon or rectum before they become cancerous. Also, if screening shows cancer, early treatment increases the odds of survival. The U.S. preventive services Task Force (USPSTF) is a credible organization which provides current evidence based preventive care guidance and recommendations. It recommends initiating screening at 50 years for men and women at average risk for colorectal cancer. In those with higher risk e.g. those with a first-degree relative who was diagnosed with colorectal cancer before 60 years of age initiating at an earlier age is suggested. Earlier screening is also suggested for those at very high risk like those with familiar polyposis, ulcerative colitis, or hereditary nonpolyposis colorectal cancer. Those with genetic syndromes may also need genetic counseling or testing.

The appropriate age to discontinue screening is not known because most screening studies involved patients less than 80years of age. However, no matter the age, when there are symptoms suggestive of a bowel problem e.g. bleedinG, an exam has to be performed.

SCREENING OPTIONS FOR COLORECTAL CANCER ARE:

1. Fecal occult blood test: Checks for blood in stool samples. Its done annually. Usually 3 different specimens taken on 3 consecutive stool samples are forwarded to the lab.
2. Flexible sigmoidoscopy: Doctors use a thin, flexible, lighted tube to examine the rectum and lower part of the colon; done every five years.
3. Flexible sigmoidoscopy and Fecal occult blood test combined (See above)
4. Double-contrast barium enema: Patient gets an enema containing barium dye, followed by X-rays of the colon and rectum; done every five years.
5. Colonoscopy: Doctors use a thin, flexible, lighted tube to examine the rectum and entire colon; done every 10 years, unless a polyp is found. Then in this case depending on type and number of polyps removed subsequent colonoscopy may be between one and five years. This procedure usually requires sedation. Each screening procedure has its benefits and potential harms which you can discuss with your primary care physician.
6. Though colon cancer screening is up, many people still aren’t getting tested. Talk to your doctor about getting screening if you are 50 years or older, have any symptoms, or someone in your family has had polyps or colon cancer.

Primary care physicians (PCP’s) take care of your primary health and medical conditions. They can either be a family practice physician, internal medicine physician, and Advanced Registered Nurse Practitioner or a Physician’s Assistant. They assure continuity of care for your health and medical conditions by knowing your medical history. Your PCP receives reports from the other specialists that you may see for more complicated conditions. The PCP is able to look at the results and the treatments that were prescribed by the specialist and assure that you as a whole are being cared for. PCP’s have a holistic approach to your care. They are also the main coordinators of your care. They keep track of the medications that you are on and make sure that you are not taking any duplicate medications or medications that conflict with each other that could cause you harm.

Due to your medical condition you may see several different specialists, one for your heart, one for you kidneys and one for you skin. They may not all be aware of what the other specialist prescribed for you but your PCP will get a report from each specialist and it is their job to coordinate your care and ensure the proper treatment is received. If you don’t have a PCP, you may be unaware of what the medications you are taking may hurt you.

The PCP is your advocate and they help maneuver you through the very complicated health system. The PCP will be the doctor to help interpret the results of tests that other physicians may have ordered for you. Your PCP is able to give you solid advice on what your treatment plan should be for your given condition. There have been many times in my practice that a patient will come back to me and say, “Please tell me what the doctor meant when he told me about my test results. He seemed very rushed and I did not feel it was appropriate to ask him a question, or all he did was write in my chart. He did not explain anything to me. Can you tell me? What is wrong?” The PCP interprets the results for you and encourages you to ask questions. They have an established relationship with you and they may be able to interpret your fears and questions that you have that you may not know how to put into words. They help you make decisions about your health and your treatment plan when you are faced with a tough choice, like a cancer treatment plan or how to care for your heart disease. PCP’s also have access to resources within the community that can be helpful to the patient, like self help groups, support groups and social services. The internet and other sources provide a lot of medical information and it can be very confusing for patients. Your PCP can help you weed through the maze of health care information and can let you know what is valid and what is worth doing to improve your health

PCP’s help patients get appropriate screens based on their age or health concerns and also make sure they have the appropriate immunizations. They give you your annual physical exam. They can advise you when it is time to get your first mammogram, or colonoscopy or PSA to screen for prostate cancer. They also have record of when your last tetanus shot was and when you are due for another one, or if you need the flu shot or pneumonia vaccine. If traveling over seas. The PCP can advise you on the immunizations you may need as well as how to care for your health when you are in a foreign county.

There are several ways to obtain a PCP. Sometimes you don’t always have a choice on what PCP you go to. Depending on your insurance, you may be given a book from the insurance company and you will choose which physician you go to for Primary care. You can also locate one in your area by going through the State Medical Association or through the American Medical Association or www.americanmedicalassociation.org This will give you information on the physician, like if they are Board Certified, the length of time they have been in practice etc… Another source is the Department of Health in you state, www.departmentofhealth.org. They will have the information on physicians in your area. Your friends may be the best source for identifying a PCP. Word of mouth and knowing what their experience has been with that PCP may be he best way to find a doctor you will be comfortable talking too and discussing you health information.

However you choose, make sure you choose a physician you are comfortable with and you are able to talk with. You need to feel that they listen to your concerns, that you feel comfortable in their presence and they are able to connect with you. This will allow you to be open an honest with your doctor about your emotional, spiritual and health needs. I recently saw a patient who went to see a specialist. The specialist had to relay some bad news to this patient, this patient had cancer. This patient then came and saw me and talked about her experience with this doctor and how this doctor did not connect with her during her visit. And how receiving this news was very painful. Receiving it from a doctor who did not express care and concern made it even more unbearable. As her PCP, I was able to explain her diagnosis and spend the time with her that she needed as well as give her the emotional and spiritual support that she deserved. That is what makes the PCP important and your relationship with them special.

It is important to remember that even a PCP has to see patients in a timely manner and they probably have a waiting room of patients to see during the day. As a patient you need to prioritize your “list.” It is important to discuss with the doctor the things that are most acute or immediately pressing for you. If you have multiple concerns, let the doctor know that you have several issues to discuss. If there is not enough time, the doctor should suggest that you schedule another appointment to discuss your other concerns.

Everyone needs a Primary Care physician. Someone to be their health care advocate. Someone that they feel comfortable talking about the intimate details of how their body is functioning and responding as they go through life. Someone who feels like an old friend.

Dr. Entsuah is passionate about conducting medical missions overseas and is a graduate of Ghana medical school. Dr. Entsuah is in private practice in Groveland, FL.and a member of The Healing Continuum.com team.

A Q&A session with Kirti Kalidas, MD, ND

What are some of the ailments that conventional medicine ignores that you deal with daily?
For the adult population, I see chronic fatigue syndrome, Fibromyalgia, chronic Lyme, inflammatory gastrointestinal syndromes, like ulcerative colitis, irritable bowel syndrome, chrones disease. For children, I see a lot of children with autism, ADHD,ADD, etc.

What thyroid issues are best treated with integrative medicine?
Most doctors look at the TSH (a marker for the thyroid gland) levels but the tests don’t often go with the symptoms. You could have weight gain, lack of energy and your labs could be in the normal range but you could have hypothyroidism. So I treat the symptoms not just the lab results.

How would you treat thyroid issues?
I would give them zinc to start off with because it is primary to converting the thyroid from T4 to T3 which is an active thyroid.

Why is integrative medicine so expensive and not covered by insurance?
The patients I see are multiple complex issues. If I would document in a patient chart that they have chronic fatigue syndrome, the average physician would see a patient 10 minutes or so, where as I see the patient for up to an hour to really understand what is going on with the patient. Insurance companies will not reimburse me for the time I spend with the patients. So I choose not be included in insurance plans.

What is the web of dysfunction?
The web of dysfunction or the health web is about how you deal with toxins in your environment. Our ability to deal with the toxic load is dependent on how well your liver is functioning, how well you are hydrated, your hormonal status and how well nutrients can be absorbed. Since we are a society that eats on the run, overly stressed and bombarded with electromagnetic waves daily, there are pesticides that we are exposed to daily through the air or the foods we eat. This can lead to cellular fatigue which means the cell can no longer regulate themselves. The liver is then affected and can no longer handle the stress. Your body starts to react to chemical, perfumes and you begin to get headaches or walking through a department store, you start to feel sick. These are all ways that your body shows you that it can’t detox. On its own.. This starts to affect the hormones in your body.

What is integrative medicine or Naturopathic medicine?
These can be used interchangeably. The naturopathic, works with five modalities botanical medicine, life style, nutritional, homeopathy and manipulation. Only fifteen states lets a naturopath be primary care physicians. There are about three thousand naturopaths in the county. You are a rarity being an MD and a Naturopath. I spent two years in training after being a medical doctor to get the degree as the naturopath. Being an Integrative physician means using natural modalities with a typical MD approach. People come to me because of my naturopathy background and training. While being a medical doctor they know I will order the appropriate tests but will integrate the natural approach into all of their treatments.

What is your philosophy of the Golden hour?
The golden hour or the first hour that I spend with a patient, I keep very open and this is when I get a social history on the patient, during the first 10 minutes. This pretty much sets the pace for the rest of the exam. Then I will have them discuss there symptoms. We then dig deep down into their issues or symptoms. We also cover a lot about their life style choices. We look at their faith, their exercise routine, how much they drink, their caffeine intake, and their nutritional intake and what meds they are taking. A lot of time is spent on digestive health. We find out about their sleep patterns, are they fatigued? Does their energy fluctuate during the day? I focus a lot with women on their hormonal health. With men we talk about their libido.

I will also do a general evaluation on their skin, nails, look into their mouth and look at their teeth and their fillings a well as their tongue. While we are talking, I am also determining if they need further testing.

Do you have a menu of services or a list of tests that patients can pick from?
No, I rely on my assessment of the patients and then determine what is needed. I am looking at what tests can affect a patients functions and what can get to the root cause of the problem. Another test that is important is a spectra cell test which tells you what your vitamin status would be.

What are some basic supplements that people can use to optimize their health?
Take a daily vitamin that has adequate B vitamins then focus on taking a fatty acid supplements like fish oil. Zinc is also a crucial supplement. Many people have a zinc deficiency which can affect their liver and how they metabolize foods. Vitamin C is another crucial supplement as well as magnesium. Coenzyme Q10 is also an important supplement.

What is the next great treatment on the horizon?
The ability to diagnose more quickly and then be able to treat them according to their symptoms. Chronic Lyme continues to be an issue here in Florida. You find chronic Lyme more in the New York and often these patient s go untreated here in Florida.

How does ones attitude determine the outcomes?
Attitude is key. To fight anything, cancer, chronic fatigue you must have hope. I help the patient connect the dots so they understand how everything affects them in their environment.

I Detoxified a 40 year old lady. She was disabled for 8 years, was in a wheel chair with five back surgeries and she was about to go in for bladder surgery. She came to me and I determined she had mercury toxicity. She had dental fillings that had been replaced. The mercury had leaked out into the blood stream caused major elevation in mercury levels in the blood stream. Through a series of detox, after three months she was out of the wheel chair off oxygen was starting to do activities again. After 15 months, she was walking with a cane and going back to school to be a social worker.

Kirti M. Kalidas M.D., N.D. is a Board Certified Physician in Internal Medicine. Dr. Kalidas spent an additional two years broadening his medical knowledge at the NationalCollege of Naturopathic Medicine. He is now one of few physicians in the country to hold dual doctorate degrees, and is thus uniquely positioned to truly integrate both disciplines to optimize wellness.