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Lung cancer is the second most common cancer in the United States, just behind prostate cancer in men and breast cancer in women. Lung cancer also happens to be the most lethal cancer, accounting for approximately 25% of all cancer deaths. Each year, more men die of lung cancer than from colorectal, prostate, and pancreatic cancers combined, and more women die annually of lung cancer than from breast, cervical, and uterine cancers combined.
The main risk factor for lung cancer is cigarette smoking, associated with 85% of cases. Among smokers, the risk of lung cancer increases with number of cigarettes smoked and duration of smoking history. There is good news though: the risk of lung cancer will decrease with smoking cessation and may even approach that of the nonsmoking population after 10 to 15 years of tobacco abstinence. Meanwhile, associated risks of developing lung cancer from e-cigarettes are currently under investigation.
Each year in the U.S., up to 26,0000 lung cancer deaths occur in never smokers, with an even higher proportion in some geographic areas. This brings us to environmental risk factors of lung cancer, such as exposure to radon, a chemically inert gas from uranium decay, encountered by underground miners and less commonly, residentially, through indoor exposure in the home basement. Asbestos exposure can lead to a type of lung cancer called mesothelioma and can cause other types of lung cancer when combined with smoking.
Arsenic, chromium, nickel, air pollution, and second-hand smoke represent other occupational or environmental exposures associated with lung cancer risk. Patients with treated for breast cancer, Hodgkin and non-Hodgkin lymphomas with high doses of radiation to the chest have increased risk of lung cancer, especially if they smoke cigarettes. Family history is another predictor of increased risk. Other diseases associated with increased lung cancer risk include chronic obstructive pulmonary disease and restrictive lung diseases, including fibrotic disorders like pneumoconiosis.
Finally, there have been dietary associations with lung cancer. An increased risk has been found with diets deficient in vitamins A and C, but supplementation with beta-carotene has been associated with an increased risk (in heavy smokers, the highest-risk populations, in 2 of 3 clinical trials).
On the basis of findings from the NLST trial, screening for lung cancer with low-dose computed tomography (LDCT) scan is recommended for certain patients by the U.S. Preventive Services Task Force (USPSTF). See Table 1.
Table 1. USPSTF Recommendation Summary for Lung Cancer Screening
| Population | Recommendation |
| Adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years | The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. |
Adults aged 50 to 80 years have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years should screen for lung cancer with LDCT every year. A pack-year is a way of calculating how much a person has smoked in their lifetime. One pack-year is the equivalent of smoking an average of 20 cigarettes (1 pack) per day for a year. These recommendations are available at www.uspreventiveservicestaskforce.org.
If you would like to learn more and connect with a board-certified physician, click to book now on My Virtual Physician. My Virtual Physician offers comprehensive medical services where you can discuss the best screening plan for you with a virtual doctor.
References
https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening
Siegel RL, Miller KD, Jemal A: Cancer statistics, 2019. CA Cancer J Clin 69: 7-34, 2019. PMID: 30620402.
Jemal A, Thun MJ, Ries LA, et al: Annual Report to the Nation on the Status of Cancer, 1975-2005, featuring trends in lung cancer, tobacco use, and tobacco control. J Natl Cancer Inst 100:1672-1694, 2008. PMID: 19033571.
Omenn GS, Goodman GE, Thornquist MD, et al: Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med 334:1150-1155, 1996. PMID: 8602180.
Menkes MS, Comstock GW, Vuilleumier JP, et al: Serum beta-carotene, vitamins A and E, selenium, and the risk of lung cancer. N Engl J Med 315: 1250-1254, 1986. PMID: 3773937.
Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group: The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med 330:1029-1035, 1994. PMID: 8127329
More than 100 million Americans are living with abnormal blood sugar. Is it possible that you could be one of them? A simple A1c screening blood test shows when levels are too high. Elevated blood sugar means higher risk for diabetes.
A glycated hemoglobin, or hemoglobin A1C, test (HbA1c) is one screening test that checks blood sugar levels. Results show how much sugar is in the bloodstream over time. Testing is accurate since values are not affected by acute illness or stress. A1c screening is recommended for certain populations, including overweight adults and those with other risk factors.
Those thinking about blood sugar testing or wondering about risk factors should talk to their doctor. Here are some common questions about diabetic screening and A1c testing.
The A1c test can detect diabetes because it measures how much sugar, called glucose, is found in red blood cells. The red blood cells give a “glycemic history” of the past 120 days.
Everyone has sugar in their blood. But diabetics have higher levels. Blood sugar that is too high leads to cell and tissue damage.
When someone is diagnosed with diabetes, their doctor will also use the A1c test to monitor how the disease is being controlled.
A1c readings are measured in percentage. Here is what A1c results mean.
Higher blood sugar levels cause greater A1c values, and they equal greater risk for diabetes.
Early detection is key in diabetes because early treatment can prevent serious complications. When a problem with blood sugar is found, doctors and patients can take steps to prevent permanent damage to the heart, kidneys, eyes, nerves, blood vessels, and other vital organs.
Here are the current recommendations for A1c screening.
The CDC suggests A1c screening to know a baseline for:
They further recommend that any woman who has ever had gestational diabetes should have an A1c check every three years even if results are normal.
The USPTF also says that adults over age 45 should be checked for diabetes using the A1c test. Furthermore, it recommends repeat testing every three years.
The ADA also recommends the A1c test, or other diabetic screening, for all adults at age 45 and over. Additionally, it advises overweight individuals with one or more risk factors to be screened, regardless of age. If results are normal, repeat screening is recommended every three years or less.
How to Get an A1C Test
If you meet some of these guidelines, you might be wondering how you can get a screening test.
A primary care doctor or other licensed provider can order this common blood test. Results take as little as a few business days.
Those who do not have a doctor to order the test, can still get this valuable screening. An online doctor or virtual physician can help. Telemedicine providers work with laboratory partners to treat patients without unnecessary trips to an office.
An online physician sends referrals and lab orders just like a brick-and-mortar doctors office. After going to a lab for blood work, virtual doctors offices schedule follow up video visits to go over the results, answer questions, and discuss treatment plans.
If you would like to talk with one of our board-certified physicians, book and appointment today. My Virtual Physician offers health screening, lab tests, and counseling to meet all of your healthcare needs.
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In the United States, colorectal cancer (CRC) is the third leading cause of cancer, after breast and lung cancer.
CRC almost always develops from precancerous polyps (abnormal growths in the colon or rectum). Screening tests can find precancerous polyps so they can be removed before they turn into cancer. Screening tests can also find CRC early, when treatment works best.
A screening test is used to look for a disease when a person has no symptoms. (When symptoms are present, diagnostic tests are used to find out the cause.)
Regular screening begins at age 45. The U.S. Preventative Services Task Force (USPSF) recommends adults age 45 to 75 be screened. For adults age 76 to 85, the Task Force recommends asking their doctor for screening recommendations.
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Several screening tests can be used to find polyps and/or CRC (see Table 1 below). There is no single “best test” for any person. Each test has advantages and disadvantages. Talk to a virtual doctor about which test may be best for you and how often to be tested. Testing modality depends on personal preference, individual medical conditions, the likelihood of testing, and the resources available for testing and follow-up.
Table 1. Screening Tests for CRC
| Test Name | Description | Testing Frequency |
| Stool TestsGuaiac-based fecal occult blood test (FOBT) | Uses the chemical guaiac to detect blood in stool. Test provided by health care provider. At home, use a stick or brush to obtain a small amount of stool. Return the test kit to doctor or lab, where stool samples checked for presence of blood. | Once a year. |
| Fecal immunochemical test (FIT) | Uses antibodies to detect blood in stool. | Once a year. |
| FIT-DNA test (or stool DNA test) | Combines the FIT test with a test that detects altered DNA in the stool. This test requires an entire bowel movement be collected and sent to a lab, where it is checked for cancer cells. | Once every 3 years. |
| Flexible Sigmoidoscopy | During this test, the doctor inserts a short, thin, flexible, lighted tube into the rectum through the sigmoid colon (lower 1/3 of colon). The doctor checks for polyps or cancer there. | Every 5 years, or every 10 years with a FIT every year. |
| Colonoscopy | Similar test to flexible sigmoidoscopy, except the doctor uses a longer, thin, flexible, lighted tube to check for abnormalities inside the rectum and entire colon. During the procedure, the doctor can find and remove most polyps and some cancers. Colonoscopy is also used as a follow-up test if anything unusual is found during one of the other screening tests. | Every 10 years (for people who do not have an increased risk of colon cancer). |
| CT Colonoscopy (Virtual Colonoscopy) | Computed tomography (CT) colonography, also called virtual colonoscopy, uses X-rays and computers to produce images of the entire colon. These are displayed on a computer screen for the doctor to analyze. | Every 5 years. |
The screening testing frequencies above are general guidelines and may be different for you if you have certain risk factors for CRC, such as a family history of CRC or detection of high-risk lesion. Testing is generally more frequent for patients who are high risk. Your doctor will help you decide the optimal screening interval.
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Sexually transmitted diseases (STDs), also called sexually transmitted infections (STIs), are very common, with around 25 million new diagnoses made yearly in the United States. Young people, ages 15-24 years of age, appear to be the most prevalent group to acquire and spread STDs, accounting for about half of newly diagnosed cases in 2018 per the Centers for Disease Control (CDC). Notably, 1 in 5 people in the United Stated have had an STD.
Oral, vaginal and anal sexual encounters are the methods of transmission and these infections vary greatly in their symptoms, severity, curability and prognosis. Treatment has improved over the years and some lifelong conditions now do not preclude a good quality of life. However, some of these diseases can be quite quiet in terms of initial symptoms, and screening tests, or tests to check if a disease is present even when symptoms are not, are a critical way to help reduce transmission and consequences of these infections.
Bacterial Vaginosis, not categorized itself as a sexually transmitted disease, is a condition named for alterations in the normal balance of bacteria in the vagina, which can lead to an increased risk for susceptibility to STDs, as well as preterm labor. A fishy odor may be noted after vaginal intercourse, and pain, itching and burning in this area or during urination, as well as thin, grey-white vaginal discharge, are among associated complaints. Although many cases of bacterial vaginosis clear on their own, antibiotic treatment may be needed at times. Currently, there is no recommendation for routine screening for BV.
Two of the most predominant, but easily treatable STDs, include chlamydia and gonorrhea. Both can spread through oral, vaginal or anal sex. Though either condition may be asymptomatic, some suspicious findings include abnormal vaginal or penile discharge, burning while urinating and pain or swelling of the testicles. Chlamydia and gonorrhea can also reoccur if infectious sex continues, despite prior treatment. Also, having these infections increases a woman’s risk to develop pelvic inflammatory disease (PID), which is damage to the internal reproductive organs, making future fertility a challenge. If infected during pregnancy, risk for miscarriage, preterm labor, low birth weight or an infection in the fluid surrounding the fetus, called chorioamnionitis, increases. Newborns of untreated mothers may also suffer postnatal complications such as eye infections and pneumonia. Pregnant women < 25 years of age, or older pregnant women at increased risk of exposure to gonorrhea or chlamydia, are typically screened at their first prenatal visit. Similarly, it is recommended to screen all sexually active women < 25 years of age, yearly, for gonorrhea and chlamydia, and older women who have multiple sexual partners. All sexually active gay or bisexual men, should also be screened at least yearly, but more often depending on frequency of new sexual encounters/multiple partners. Testing for these diseases can be as simple as a urine sample ordered by a virtual physician, however it is prudent to discuss symptoms and history to determine the best course of screening.
According to the CDC, every 1 out of 6 people in the United States has herpes simplex virus (HSV) infection, oftentimes without knowing it. HSV can be divided into HSV 1, more commonly known as oral herpes, and HSV 2, known as genital herpes. Although designated as such, either can occur orally or genitally. Many people are infected with HSV 1 in their childhood, through non sexual mediated contact with infected saliva. Oral herpes results in cold sores or fever blisters, around the lip and mouth area. Genital herpes, likewise, can demonstrate sores throughout the genital region of infected individuals. Lack of active sores however does not negate infectious activity and the disease can still spread through unprotected oral, vaginal and anal routes. There is no curative treatment for HSV and the virus can go into a dormant phase where no symptoms occur for years, though patients are at risk for recurrent outbreaks, where an antiviral medication may be prescribed. Devastating effects can occur if left untreated during pregnancy, including life-threatening infection to the newborn. If there is history of infection or active infection at the time of labor, a Cesarean section may be indicated. The United States Preventive Services Task Force does not recommend routine screening for HSV in asymptomatic sexually active adolescents or adults, including pregnant women.
Syphilis is a bacterial infection spread through sexual contact, and is divided into distinct phases, first beginning as painless mouth/oral, genital or anal sore(s) several days to several months after initial exposure. This sore or sores will resolve after a few weeks, even without medication. Then a body rash develops, sometimes with swollen lymph nodes, general fatigue and a fever, later. There can be a long period of “latency”, or no symptoms, followed by the last stage classified by neurological, ocular and cardiac symptoms. This is a curable condition, but can cause life-long consequences if untreated, including dementia and blindness, and can lead to death. Screening is indicated for sexually active individuals on a yearly basis, but more often such as every 3-6 months for high risk features, such as multiple partners. This can be performed through a blood test, which may be ordered through a virtual physician’s visit.
Although there are other methods of transmission, typically hepatitis B may be acquired through the sexually transmitted routes mentioned above. Hepatitis C is less commonly sexually transmitted, but spreads through exposure of infected blood, such as in activities like sharing needles in illicit IV drug abuse. Both conditions, though incited by different viruses, have the same impact on the liver and symptoms can overlap, with fever, fatigue, yellowing of the eyes and skin, abdominal pain and changes in urine color. With the exception of individuals living in extremely low prevalence areas, it is recommended that hepatitis C screening be given to a person at least once after the age of 18 years. Additionally, although hepatitis B is a vaccine preventable illness, the USPSTF recommends screening by blood test, those individuals at high risk such as those who inject drugs or share needles, men who have sex with men and immunocompromised patients, such as those with HIV, as well as those living in areas with a 2% or higher prevalence of the hepatitis B surface antigen, regardless of vaccination status. This is especially important given that hepatitis B is a chronic illness that will need lifelong treatment and both viruses present a higher susceptibility to liver cancer.
HIV, or human immunodeficiency virus, eventually progresses to acquired immunodeficiency syndrome (AIDS). Fortunately, through screening and early detection, appropriate prophylactic and supportive agents can be provided to help maintain CD4 counts and stable immune status in order to prevent, or at least slow, this advancement. It is generally recommended that adolescents beginning at 13 years, through adulthood, into the 60s, be screened via blood test, at least once as part of routine health maintenance. For those in higher risk categories, such as individuals with multiple sexual partners, men who have sex with men and those who share needles, screening may be advised yearly or with more frequent intervals depending on individual circumstances. Once again, this is a blood test that may be ordered through a virtual doctor visit.
While prevention of any illness is optimal through regular visits with a physician, screening tests have proven to be useful in early detection of otherwise asymptomatic diseases, allowing for quicker treatment. In particular, sexually transmitted diseases are relatively easy to screen for through blood or urine samples. If you have questions or concerns regarding your need to be screened for these conditions, it is quite simple to schedule a virtual visit with one of our physicians at My Virtual Physician, and we can help determine which testing is right for you. In addition, depending on the results, oftentimes follow up guidance or medication can also be provided! Schedule a visit today!
Half of adults over the age of 50 are at risk for broken bones. Maintaining healthy bones is important for a long healthy life.
Osteoporosis (OP) is a condition of weakened bones. Thin bones are at risk for fractures. OP screening can be an important part of staying healthy. Early disease detection and treatment may prevent complications later. Broken bones are painful and costly. Luckily, screening tests like the Dual-Energy Xray Absorptiometry (DEXA) scan alert doctors of problems early.
DEXA scans or other OP screening tests are advised for some at-risk groups. To find out if you should be concerned about bone testing today, read on.
OP is more common in adults than you may believe. One health department called it a major public health threat.
OP screening may prevent:
People with OP may not know anything is wrong until they suffer an injury. With advanced bone disease, normal activities can cause bones to break. Studies have shown that many patients do not get the right treatment for low bone density (LBD) despite the great prevalence, complications, and costs of fractures related to bone disease.
Therefore screening tests for bone loss are important to your health. Doctors or specialists can diagnose problems with weak bones before they become serious.
OP affects one-in-three women above 50 years old. It is also a serious condition for men.
It is best to talk to a doctor about when to get a screening test. They can explain the test and treatment options. Physicians will also answer questions about what to expect.
Currently, we have a few recommendations for OP screening.
The NOF advises a DEXA scan of the hip and spine for:
Also, they also encourage testing in those with:
The ISCD has similar guidelines. They recommend DEXA scan of the hip and spine for the same groups above, but also in:
AACE recommends a DEXA scan for
The AACE says that the lumbar spine and proximal femur are the best sites for testing.
The USPSTF recommends screening for OP in women 65 years or older. Also in younger women with certain risk factors. At this time the USPSTF does not have a recommendation for men.
ACOG currently urges screening for women 65 or older and those under age 65 with risk factors for fracture. They also say physicians should screen patients using the FRAX tool to define their risk of a major fracture.
The FRAX® tool evaluates fracture risk in patients. Based on the score, a 9.3% or higher risk should be referred for a DEXA scan.
The DEXA scan is a quick and reliable test for measuring bone mineral density (BMD). It aids in the diagnosis of OP.
The scan usually takes around 15 minutes. And it doesn't hurt. First, the patient lies down on an open table.
Next, a scanner passes over the body. It sends two X-ray beams. And the machine tells how the rays pass through the bones. This shows how thick or thin they are. The results give the doctor a good idea of how healthy the bones are.
Like other medical tests, a DEXA scan is ordered by a healthcare professional. Typically, doctors or specialists can write a prescription or send a referral. Virtual doctors and online physicians can also arrange this test for their patients.
OP screening may be a part of your yearly check-up. Or it can be used to check on certain risk factors.
Thanks to telemedicine, it is now fairly easy to get this important test. An online doctor can tell you about OP screening and answer your questions. Online appointments are convent. Patients meet doctors from wherever they are, on a mobile device or smartphone.
My Virtual Physician offers screening consultations at little or no out-of-pocket cost. They can order blood tests, imaging or scans, X-rays, and more. And in some cases, same-day appointments are available.
Many screening tests are covered by health insurance or medical benefits. Check with your insurance to see if any out-of-pocket payment is required. Medicare pays for bone density testing every two years for adults over 65 with some risk factors.
My Virtual Physician offers full preventive care services for men and women. To talk with one of the top physicians, click to book an appointment now. The MVP caring experts help patients with screening plans that are tailored to their healthcare needs.
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Sources:
Breast cancer is now the most common cancer in the world. In fact, 12% of all new cancer cases in 2021 will be breast cancer. As a result, chances are you know someone who has faced this terrible disease. And it is likely you have wondered about breast cancer screening.
Currently, there are several recommendations about breast cancer screening. There are benefits to screening and early detection, but there are also potential problems. Your doctor should help you decide which tests you need based on your history and risk. For high-risk men and women with a family history of cancer, BRCA genetic testing is invaluable.
Breast cancer screening is a great way to take charge of your health. Here's what you need to know about breast cancer screening.
According to the National Cancer Institute, screening means looking for the disease before there are any signs. Hence, the best time to get checked is before you have symptoms.
Screening is looking for abnormalities. It may find cancer at an early stage. Because of advanced detection, doctors can more easily treat the disease. Patients also have better odds at survival. Each type of cancer has unique guidelines for screening.
Overall, current guidelines and recommendations say that most women should have a mammogram to detect tissue changes beginning at age 40.
Men are also affected by breast cancer. However, most guidelines do not include them in the recommendations. A doctor can give male patients personalized guidelines for screening.
Here are the most current routine recommendations for women starting at age 40.
| Organization | Women Age 40-49 | Women Age 50-74 |
| US Preventive Services Task Force (USPSTF) | Individualized to the patient | Digital mammogram every 2 years |
| American College of Obstetricians and Gynecologists (ACOG) | Offer annual mammogram | Mammogram every 1-2 years until age 55, then every 2 years |
| National Cancer Institute (NCI) | Mammogram every 1-2 years | Mammogram every 1-2 years |
| American Cancer Society | Offer annual mammogram until age 45, then mammogram every year | Mammogram every year age 50-55, then every two years after age 55 |
| American College of Radiology (ACR) | Annual | Annual |
Some men and women worry about breast cancer because they have a family history of cancer.
Women with a personal or family history of some cancers could have changes in their genes. These mutations are known as BReast CAncer gene 1 (BRCA1) or BReast CAncer gene 2 (BRCA2) changes. They may mean a higher cancer risk.
High-risk patients should see a doctor or specialist. They will need a risk assessment, genetic counseling, and in some cases, lab testing. Mutations in the BRCA1/2 genes may lead to:
Genetic testing for BRCA1/2 requires a special blood test that your doctor can order. The doctor can explain the details. They can also answer questions you might have.
According to the National Cancer Institute, many women with ovarian and breast cancers are not receiving these genetic tests, even though they have become inexpensive and easily accessible.
Now with telemedicine, it is easier than ever to get this valuable testing done. An online provider such as a virtual gynecologist or virtual physician can tell you if you need it and when or how to get it.
My Virtual Physician offers consultations about this important BRCA gene testing. For little or no out-of-pocket cost, they can arrange for you to have your blood drawn. They make it easy. They work with many local LabCorp or Quest outpatient testing centers who can provide this service for you.
Like much in healthcare, tests may not be “one risk fits all.” That is why you should talk to your doctor about what is best for you. He or she will consider factors such as lifestyle, family history, and other health concerns. Then they can help you decide what to do.
Your doctor can recommend one of these methods below. If you do not have a doctor, a virtual doctor online can be a great place to start.
The most common test for breast cancer is called mammography. It is ordered by a doctor. Mammograms look for early changes in the tissue that could be dangerous.
A mammogram is a special type of X-ray that shows the breast tissue. Sometimes, doctors can see lumps on the images that they cannot feel.
Women who have a high risk of cancer or have dense breast tissue may require magnetic resonance imaging.
The MRI test is more sensitive and can detect finer irregularities. MRI images also give a clearer picture of the breast tissue. Unfortunately, this screening method is much more expensive and therefore is not used for routine exams.
Breast cancer testing is an active area in clinical research. Other methods include:
Physicians can explain the options to patients. And they can help them make informed choices about each type of screening.
Doctors can help guide a patient to the best choice. Physicians also tell their patients about risks that they need to consider.
Your doctor should tell you when to get screened for breast cancer. Talking to a board-certified physician about the right time for you to have a cancer screening may prevent problems.
Specialists caution patients that there are risks involved with all medical tests, including cancer screening. Some of them include:
This is why you should talk to your doctor when you are thinking about breast cancer screening.
My Virtual Physician offers a full line of virtual physician services. To talk with one of our board-certified physicians, click to book now. Our caring experts can talk with you about a screening plan that is best for you.
If you have suggestions for other topics you want to read about, let us know! Don’t forget to follow us on social media.
Sources:
Breast Cancer Overtakes Lung As Most Common Cancer - WHO. Reuters. Feb 2, 2021. https://www.reuters.com/article/health-cancer-int/breast-cancer-overtakes-lung-as-most-common-cancer-who-idUSKBN2A219B
Cancer Screening Overview (PDQ®)–Patient Version. National Institute of Health. National Cancer Institute. Aug 19, 2020. https://www.cancer.gov/about-cancer/screening/patient-screening-overview-pdq
Breast Cancer Screening. U.S. Preventative Task Force. Jan 11, 2016.https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening
Breast Cancer Risk Assessment and Screening in Average-Risk Women. American College of Obstetricians and Gynecologists. Practice Bulletin. Number 179. July 2017. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/07/breast-cancer-risk-assessment-and-screening-in-average-risk-women
American Cancer Society Guidelines for the Early Detection of Cancer: Breast Cancer. American Cancer Society. Jul 30, 2020. https://www.cancer.org/healthy/find-cancer-early/american-cancer-society-guidelines-for-the-early-detection-of-cancer.html
New ACR and SBI Breast Cancer Screening Guidelines. American College of Radiology. Apr 4, 2018. https://www.acr.org/Media-Center/ACR-News-Releases/2018/New-ACR-and-SBI-Breast-Cancer-Screening-Guidelines-Call-for-Significant-Changes-to-Screening-Process
BRCA Overview. Basser Center for BRCA, Penn Medicine. Accessed Jul 24, 2021. https://www.basser.org/brca
Chen, S., Parmigiani, G. (2007). Meta-Analysis of BRCA1 and BRCA2 Penetrance. Journal of Clinical Oncology, 25(11), 1329-1333. https://doi.org/10.1200/JCO.2006.09.1066
Fewer Women with Ovarian, Breast Cancer Undergo Genetic Testing than Expected. National Cancer Institute. Apr 9, 2019. https://www.cancer.gov/news-events/cancer-currents-blog/2019/ovarian-breast-cancer-testing-inherited-genetic-mutations
BRCA1 and BRCA2 Testing. BreastCancer.org. Sep 21, 2020.https://www.breastcancer.org/symptoms/diagnosis/brca
Pediconi, F., & Galati, F. (2020). Breast cancer screening programs: does one risk fit all?. Quantitative imaging in medicine and surgery, 10(4), 886–890. https://doi.org/10.21037/qims.2020.03.14
There really are few things worse than feeling gastrointestinal distress. Nausea,
vomiting and diarrhea can easily stop the most active and symptom-refractory
person cold in their tracks. While there are numerous possible reasons behind
these unpleasant feelings, we will take a look two different etiologies that
frequently get confused: viral gastroenteritis (stomach virus) and food poisoning. Let's check out
the differences.
Viral gastroenteritis (VGE), commonly dubbed the "stomach flu", is named aptly,
as it is caused by a viral infection. Typical symptoms can include fever, vomiting,
diarrhea and abdominal cramps, and they occur about 1-2 days post-exposure to
the responsible virus.
Rotavirus and norovirus are two of the most common viral bugs that cause VGE,
and both are highly contagious. In fact, prior to the development of the rotavirus
vaccine for children, rotavirus was the leading cause of gastroenteritis in children
globally, infecting nearly all young children before their fifth birthday. Because of
their smaller size and weight, significant diarrheal losses can greatly increase risk
for death by dehydration in children, which prompted initiation of the rotavirus
vaccine. Norovirus is flagged as the offending virus in about half of all VGE
cases and is also the culprit of about 90% of diarrheal epidemics around the
world.
These viruses transmit through fecal-oral fashion, or more simply, a person
becomes sick after swallowing infected stool. If trace amounts of fecal matter
remain on a person's hands, on commonly touched objects or even on food,
there is risk for spreading infection. As could be expected, hand washing is most
critical in prevention. Also, staying away from others during the peak of your
symptoms is important, but also take note that you can pass the virus on through
stool shedding that may last up to 14 days after symptoms have resolved. And it
is recommended to vaccinate young infants with the rotavirus vaccine series,
shown to have approximately 90% efficacy in prevention of severe rotavirus
infection.
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Due to similar symptoms, food poisoning often gets lumped in with the “stomach
bug”. Interestingly, food poisoning may also be caused by a virus, but is more
frequently the result of bacterial toxins or parasites. You’ve probably heard of the
advice, don’t eat raw cookie dough, because of the uncooked eggs. Other
sources for these bugs include raw or undercooked meat products,
unpasteurized dairy as well as seafood, unwashed produce and surprisingly,
flour. So essentially, these pathogens cross over different dietary staples, and
can cause similar feelings of gastrointestinal upset, body aches and fatigue, with
or without fever.
Sometimes, certain bacterial strains, such as Shiga toxin-producing E. coli
(STEC), can cause damage to blood vessels and lead to kidney injury and
failure. The diarrhea that accompanies food poisoning typically presents after a
few hours from the time of exposure and can often be bloody as compared to a
simple viral gastrointestinal illness.
Most cases of food poisoning resolve fairly quickly, within a day or two, as the
offending bug works its way out of the system. Properly storing, washing,
handling and cooking food products are the best means of prevention.
As noted above, one of the biggest concerns with VGE and food poisoning is the
risk for dehydration. Replacing fluid loss is important, focusing on water and
electrolyte replenishment. Water is usually best, however low sugar sports drinks
and pedialyte are also good options. While vomiting is still an active symptom,
taking small sips of fluids more frequently is most helpful to keep hydration in
balance. Alternatively, for those who can’t tolerate sips well, low sugar popsicles
or ice chips can work. Once symptoms have started to subside, increasing food
intake should be done slowly and intentionally. Going to your favorite fast food
drive through the day after GI symptoms is probably not in your stomach’s best
interest, as recovery is still underway, and greasy, processed food may counter
that process. Most physicians have navigated away from a traditional bland diet,
such as the often-referred to BRAT (bananas, rice, applesauce, toast) diet that
many pediatricians once advised, due to the lack of nutrition. Concentrate on
food choices that include healthy fats and plenty of protein and fiber, which can
be found in fruits and vegetables as well as whole grains.
Both viral gastroenteritis and food poisoning are often mild and self-limiting
illnesses (meaning they do not require medical intervention to resolve).
However, symptoms that should prompt a doctor’s attention would include
changes in stool color including blood in the stool, changes in breathing patterns
or difficulty breathing, pink or red urine, severe pain, worsening fatigue or
irritability in young children, or lingering symptoms such a fever, vomiting or
diarrhea that don’t abate within a few days.
As always, if you have any concerns, the online physicians at My Virtual
Physician, make it quick and convenient to help you! An online visit is easy to
arrange and we can help with guidance as well as testing, if necessary.
Schedule a visit today!
You know the stuffy feeling when sinus pressure in your face is so intense that you can’t think straight. It could be a sinus infection. But what if you're unable to feel anything? Can sinusitis cause facial numbness?
Sinusitis is associated with signs and symptoms, including a runny nose, facial pain or pressure, and a change in the sense of taste or smell. Facial numbness is another less common symptom. However, facial numbness could be a sign of other more serious conditions. So it is best to discuss facial numbness with a doctor.
How do you know what is causing facial numbness? And when should you schedule an online doctor appointment? Here is what you need to know when it comes to talking to a doctor about sinusitis.
Sinusitis is one of the most common health complaints leading to doctor visits. Sinusitis is an irritation or infection in the sinuses. Sinuses are hollow passageways behind the cheekbones and around the eyes. Healthy sinuses are filled with air. They produce mucus to keep nasal passages moist.
Sometimes sinus passageways become blocked. Bacteria, viruses, and allergic responses cause swelling or inflammation in the passages. These are frequent causes of sinusitis.
Individuals with sinusitis may have different symptoms. Sinus problems can be chronic, meaning they last over a longer time, or acute, meaning sudden onset with short duration.
Some commonly reported signs of acute sinusitis lasting less than four weeks are:
Signs that are frequently seen with chronic sinusitis that last 12 weeks or more include:
Sinusitis, whether recently starting or bothering you for a while, can be diagnosed by a history and examination with a doctor.
You should never ignore facial numbness. It is important to report new or worsening feelings of tingling or no sensation at all to your doctor for evaluation.
Altered sensation in the face could be complications such as:
A doctor can evaluate possible reasons for the symptoms and help develop a plan for diagnosis and treatment.
Yes! An online doctor consultation may be a great option. Feelings of facial tingling or numbness can be urgent. But sometimes it is difficult or costly to see a doctor right away. Booking a virtual physician appointment is a way to get fast and convenient care.
A recent article published by the Open Forum Infectious Diseases found virtual care for sinusitis was associated with better diagnosis and treatment than in-person primary care visits.
Virtual physicians may be able to diagnose and treat this condition without making a trip. Sinusitis symptoms can make driving difficult. An online doctor appointment can feel like a house call. You get personalized care in the privacy of your home without the inconvenience of traffic, waiting rooms, and commute time.
Signs and symptoms can be bothersome. Yet, left untreated, it can progress into worse problems. Book an appointment with a virtual physician online today.
My Virtual Physician offers board-certified physicians who are now accepting new patients in many states. Click "BOOK APPOINTMENT NOW" to book an appointment with convenient evening and weekend hours. Or let us know if you have questions about your symptoms. We are standing by to help.
References
Johnson, K., Dumkow, L., Burns, K., Yee, M., & Egwuatu, N. Comparison of Diagnosis and Prescribing Practices Between Virtual Visits and Office Visits for Adults Diagnosed With Sinusitis Within a Primary Care Network, Open Forum Infectious Diseases, 6 (9), 2019. https://doi.org/10.1093/ofid/ofz393
Wyler, B., Mallon, W. Sinusitis Update. Emergency Medicine Clinics of North America, 37, (1), 2019. https://doi.org/10.1016/j.emc.2018.09.007
Ziegler, A., Patadia, M. & Stankiewicz, J. Neurological Complications of Acute and Chronic Sinusitis. Curr Neurol Neurosci Rep 18, (5), 2018. https://doi.org/10.1007/s11910-018-0816-8
This past year tested many young businesses. Telemedicine is not new. But the My Virtual Physician (MVP) business model is. The virtual doctor practice offers the best in online doctor services as a direct-to-consumer multi-specialty provider licensed in multiple states. Regardless of 2020's challenges, the MVP virtual doctor team didn't slow down. They focused on their path to becoming the #1 online doctor and forged ahead.
Over the last 12 months, MVP worked hard to bring high-quality medical care into homes in 15 states. They now offer online pediatric, gynecologic, and primary healthcare services for patients of all ages. Plus, they provide same-day scheduling for online physician appointments, some in-network insurance benefits, and five-star customer service.
As the #1 online healthcare provider, MVP doctors get to know their patients. Quality care is emphasized, and they aim to provide the best patient satisfaction in telemedicine. Here’s what patients are saying about MVP's online doctors:
“I would give My Virtual Physician more stars if I could”
“Dr. Howard has the best personality and is very friendly.”
“The future of medical visits; what better way to social distance.”
“A+ would recommend to everyone.”
Since their launch, MVP has opened new offices and added service lines such as nutrition and diabetic care. The practice has partnered with more online doctors and added office staff. Just this Spring, MVP enhanced their patient portal for self-scheduling, and integrated a program to trend patient reviews.
This one year anniversary milestone is cause for celebration. It is exciting, and this is only the beginning. Despite any challenges that lie ahead for this medical practice, their progress shows that the future is very bright for My Virtual Physician.
Congratulations to Dr. Howard, Dr. Masghati, Dr. Ayyagari, and all of the My Virtual Physician Staff.
Advanced practice nurses work alongside physicians in many settings. As more facilities employ nurse practitioners to work with their doctors, you may wonder: is care improved by a collaborative approach?
The truth is that care is better when physicians and advanced practice registered nurses (APRNs) or nurse practitioners work together in a collaborative care model. When these professionals come together to treat the patient, the result is a synergistic effect that improves care outcomes and increases satisfaction.
To find out how, read on.
A care approach by a doctor and APRN team improves:
A recent article on collaborative care between physicians and nurses found that outcomes improves in many areas. To sum up, the results were better compliance, lower symptom severity, and fewer hospitalizations.
There are many reasons for these findings. Firstly, when doctors and nurses work together on a treatment plan, they complement each other. Each brings a different set of skills, knowledge, and background. Putting these two views together gives a better picture of the patient and how to treat them.
Physician and APRN teams provide a more comprehensive treatment plan that addresses more factors affecting health and illness than each one could alone.
Certainly, a team approach improves satisfaction in many ways. Patients, family members or caregivers, and the healthcare providers themselves report more contentment from this care model.
One reason for increased satisfaction is the focus on health promotion. Nurse practitioners provide education. They can counsel patients and families, and they even perform care coordination. Patients and families get great benefits from this added care management. It makes them feel they are getting better care.
Secondly, when APRNs work with physicians in outpatient settings, they help to increase efficiency and optimize patient care. For example, clinics or offices that use nurse practitioners are able to give patients more appointments. These care teams can make same-day visits, walk-ins, and extended hours possible. APRNs can provide routine health care services, while letting physicians to treat the more complex cases.
Healthcare continues to change. Read more about in our article here. More doctors and patients are focusing on preventative care, health, and wellness.
Meanwhile, factors such as a growing, aging population and increased access to care under the Affordable Care Act have helped create a greater demand for physicians. The workforce is not able to meet the need. Moreover, the physician shortage is expected to continue. Nurse practitioners are one of the answers to this crisis.
Working with doctors, nurse practitioners can diagnose and treat patients in many settings from hospitals to specialty clinics.
Nurses provide health promotion and education. Consequently, APRNs complement the care that physicians provide. They are an integral part of the healthcare team. The results of this doctor-nurse collaborative care model include improved health outcomes and increased satisfaction.
To talk with one of our board-certified physicians, click below to schedule an appointment. My Virtual Physician treats health conditions, provides routine screening, counseling, and more. If you have any suggestions for additional topics you want to read about, let us know! Don’t forget to follow us on social media.
In 2018, about 10.5% of Americans were estimated to have diabetes. Furthermore, about one-fifth of those cases were undiagnosed. It is important that individuals know their risk, and talk to their doctor about screening when it comes to diabetes. So, why is early detection key in diabetes?
Early detection is key in diabetes because early treatment can prevent serious complications. When a problem with blood sugar is found, doctors and patients can take steps to prevent permanent damage to the heart, kidneys, eyes, nerves, blood vessels, and other vital organs.
With simple tests for early detection, patients can make changes to reverse diabetes and even go into remission. Read on to learn more.
Diabetic care often focuses on treatment of the condition. While treatment is important, early detection increases the potential for effective changes early in the disease process.
An article in the Current Opinion in Endocrinology, Diabetes and Obesity journal recognizes that there are many reasons why earlier detection of diabetes could be of benefit to the individual and the health system, because it creates the opportunity to treat the high blood sugar and the risk factors for heart disease that often show up with diabetes. Individuals who don't know that anything is wrong may suffer long-term effects such as cardiovascular disease and stroke.
Furthermore, undiagnosed diabetes often results in potentially preventable, costly complications. Hospital stays could be avoided if patients are aware of their illness and work to manage it.
Diabetes can be expensive. The estimated cost of living with diabetes is around $9,600 per year. This covers prescription medications, diabetic testing supplies, doctors appointments, and hospital care. Medical expenses rise drastically when emergency room visits are needed for unmanaged diabetic complications.
Diabetes is a disease in which your body is not able to efficiently turn the food you eat into energy. Sugar then builds up in the bloodstream. Therefore, two problems arise: the cells are not getting the energy they need, and sugar is accumulating in the blood. High blood sugar, known as hyperglycemia, causes damage to tissues and organs of the body. That is to say, this is why diabetes is a serious condition that can be dangerous.
Normally when you eat, your body breaks food down into sugar molecules, called glucose. After that, the particles get into the bloodstream and your blood glucose level rises, signaling the pancreas to release insulin. Insulin is a hormone that tells body cells to let the glucose inside.
In diabetes, either your pancreas does not make insulin correctly, or your body cells do not react to the insulin the way they should. As a result, glucose stays in the blood, which is why diabetics experience high blood sugar, also known as hyperglycemia. Over time, hyperglycemia can damage nerves and blood vessels.
A blood test can determine if a person has diabetes. Doctors commonly use two tests to check for diabetes.
A glycated hemoglobin test, known as a hemoglobin A1c (HbA1c) test, measures the glycated form of hemoglobin to determine the three month average of blood sugar. This blood test takes about a minute to perform, and results are generally available in two to three days. A normal HbA1c is below 5.7%. Prediabetes is 5.7 to 6.4%. A result of 6.5% or more is classified as diabetic.
Another way a provider can use a blood test to see if you have diabetes is a fasting blood glucose, or fasting blood sugar (FBS), test. This blood test measures the basal (base) sugar levels of the blood. Testing is usually performed in the morning after the patient has had nothing to eat or drink for eight hours or more. This test may take around ten minutes and results can be immediately available. A normal FBS is 70-100 mg/dl (3.9 - 5.6 mmol/L). The doctor may repeat the fasting blood sugar test or order additional tests to confirm an abnormal blood sugar reading.
Diabetes is a chronic condition which means it may not go away. It is possible, however, to reverse some of the effects of diabetes and go into a remission for those with Type II Diabetes. Remission in diabetes means that your blood sugar levels are within the normal range and you have not required medication to manage your blood sugar for six months or more.
Lifestyle changes like a healthy diet, daily exercise, and weight management can improve the way your body uses insulin and can improve the prognosis for someone diagnosed with diabetes.
Diabetes is a global health problem. Health officials expect that rates will only continue to increase. Risk factors such as family history of diabetes, obesity, and sedentary lifestyle increase likelihood that you may get diabetes and so it is important to be proactive in your health and talk to your doctor about your risk for diabetes. .
If you would like more information on diabetic screening, or want to talk about your risk with one of our board-certified physicians, click to schedule an appointment. My Virtual Physician treats conditions including hyperglycemia, diabetic screening, counseling and more. If you have any suggestions for additional topics you want to read about, let us know! Don’t forget to check out our podcasts for more and follow us on social media.
Colagiuri, Stephen; Davies, Daniel The value of early detection of type 2 diabetes, Current Opinion in Endocrinology, Diabetes and Obesity: April 2009 - Volume 16 - Issue 2 - p 95-99 https://doi: 10.1097/MED.0b013e328329302f
Harris, M. I., & Eastman, R. C. (2000). Early detection of undiagnosed diabetes mellitus: a US perspective. Diabetes/metabolism research and reviews, 16(4), 230–236. https://doi.org/10.1002/1520-7560(2000)9999:9999<::aid-dmrr122>3.0.co;2-w
Narayan, K. M., Chan, J., & Mohan, V. (2011). Early identification of type 2 diabetes: policy should be aligned with health systems strengthening. Diabetes care, 34(1), 244–246. https://doi.org/10.2337/dc10-1952
