What do my cholesterol results mean?

You've probably had your cholesterol levels checked, or could very easily - it just takes a blood test. But what do these numbers mean, and what are they supposed to be?

Types of cholesterol measured:
Well, naturally you'd think that a lab test for cholesterol would simply tell you how much cholesterol you have. And it does, but wait: There are several cholesterol measurements. These are:

Total cholesterol.
HDL cholesterol.
LDL cholesterol.

Total cholesterol:
HDL cholesterol is the "good" cholesterol carried on high-density lipoproteins. Having more of it means you're more likely to have a lower risk of coronary heart disease (CHD).

LDL cholesterol is the "bad" cholesterol carried on low-density lipoproteins. You're better off with lower levels of LDL cholesterol, because it's associated with a higher risk of heart disease.
Note that total cholesterol doesn't equal HDL cholesterol plus LDL cholesterol. This is because there are still more types of cholesterol, which we won't talk about here.

Your cholesterol numbers:
Cholesterol is measured as milligrams of cholesterol per decilitre of blood, which is abbreviated like this: mg/dL.

Often, your total cholesterol is the only type tested. Or you may have both your total cholesterol and your HDL cholesterol tested at the same time.

If your total cholesterol is:

200 mg/dL or less: Desirable cholesterol level
Between 200 and 239 mg/dL: Borderline high cholesterol level
240 mg/dL or more: Too high

If your HDL cholesterol is:

Less than 40 mg/dL: Too low
More than 40 mg/dL: Beneficial especially if it's above 60 mg/dL

People should have a lipid profile test (total cholesterol, HDL cholesterol and triglycerides) after an overnight fast. These tests allow the LDL cholesterol to be calculated.

Elevated triglycerides are common and a risk factor for CHD. Triglycerides may be elevated even if the total and HDL cholesterol are normal. So there is no way to know if a person has high triglycerides unless it is measured.

If you are 20 years old or older, have no heart disease and your LDL cholesterol is:

Less than 100 mg/dL: Desirable
100 - 129 mg/dL: Near optimal/above optimal
130 - 159 mg/dL: Borderline high
160 - 189 mg/dL: High
190 mg/dL and above: Very high

If you already have CHD or diabetes, then your LDL cholesterol should be 100 mg/dL or less.

Your cholesterol ratio:
Sometimes you'll be given your cholesterol results as a ratio of total cholesterol to HDL cholesterol. (This is the same thing as saying total cholesterol divided by HDL cholesterol.) According to the American Heart Association (AHA), the ratio should be below 5:1 with the optimal amount being 3.5:1 (3.5 to 1).

It's also possible to divide LDL cholesterol by HDL cholesterol to obtain a ratio. (This is the same thing as saying the ratio of LDL cholesterol to HDL cholesterol.) In this case, the ratio should be below 3.5.

However, the AHA recommends using absolute numbers for cholesterol (as discussed above) rather than ratios. The reason is that the absolute numbers give doctors a better idea of what type of treatment is needed by the patient, than do ratios.

Triglycerides:
Your triglycerides are another fatty substance in the blood that affects your risk for heart disease. Most fat in food, as well as in your body, is present in the form of triglycerides. High levels of triglycerides are a matter of concern and are linked to the risk of heart disease, just as with cholesterol.

If your triglycerides are tested, here is how you can interpret the numbers, according to the Third Report of the Expert Panel on the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults:

Less than 150 mg/dL: Normal
150 - 199 mg/dL: Borderline
200 - 499 mg/Dl: High
More than 500 mg/Dl: Very high

Calculating LDL cholesterol:
If your triglycerides are less than 400 mg/dL, your doctor can calculate your level of LDL cholesterol from your tested levels of total cholesterol and HDL cholesterol and triglycerides. The equation your doctor might use is:

LDL cholesterol = total cholesterol -- (HDL cholesterol + [triglycerides/5])

Remember, only your doctor should determine the best way to evaluate and interpret your cholesterol levels. Speak to your doctor if you have any questions about your cholesterol levels or the best way, given your unique needs, to reduce your risk for heart disease.


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What is Cholesterol and how it affects me?

You've heard about cholesterol and know that you have to "watch it" to stay healthy. But what is cholesterol, and what exactly are you watching?

Cholesterol is a fatty substance that your body needs to function. In fact, it is essential for life. You need cholesterol to form cell membranes, many hormones and bile acids (which digest fat), to name just a few. Without cholesterol, you couldn't live. But, as is so often the case, too much cholesterol can hurt you.

When there's too much cholesterol in your blood, it can build up on the inside walls of your arteries. Over time, the cholesterol build-up, called plaque, can narrow the space for blood to flow through. This can happen in the arteries everywhere in the body but is most dangerous in the arteries that feed the heart and other vital organs.

When plaque build-up narrows the coronary arteries, which supply oxygen-rich blood to the heart, chest pain, shortness of breath and other symptoms of coronary heart disease occur. If a coronary artery is blocked completely, a heart attack results. Decreased blood flow to your brain can cause a stroke.

The higher your cholesterol levels, the greater your risk of heart disease and stroke. Given that heart disease is a top killer of men and women, this isn't a risk that you should ignore. However, eating in a heart-healthy way, being physically active and losing weight are things everyone can do to lower their cholesterol levels and their risks.

What's being measured when your cholesterol is checked? Why should some cholesterol referred to as "good," putting people at lower risk for heart disease, and another "bad"?

Types of cholesterol:
Your doctor may order tests to check your blood levels of cholesterol. Since cholesterol can't dissolve in the blood (it's not water-soluble), it doesn't circulate by itself. Instead, cholesterol travels through the bloodstream linked to "carriers" called lipoproteins.

There are three different types of lipoproteins. The two that are most important to remember in terms of your possible risk of heart disease are high-density lipoproteins (HDL) and low-density lipoproteins (LDL).

Cholesterol that is carried on low-density lipoproteins is called LDL cholesterol, the "bad" cholesterol. Higher levels of LDL cholesterol are associated with an increased risk for heart disease.

Cholesterol molecules that are linked to high-density lipoproteins are called HDL cholesterol, the "good" cholesterol. If you have higher levels of HDL cholesterol, you're at lower risk for heart disease.
Can't remember which cholesterol is "bad" and which is "good?"
Try this as a way to remind yourself: LDL cholesterol ("bad") is "low-down." HDL cholesterol ("good") comes "highly recommended."

"Good" and "bad" cholesterol:
Why should one type of cholesterol be labelled "good," putting people at lower risk for heart disease, and another labelled "bad?" Because LDL is the main carrier of cholesterol to body tissues, and HDL carries cholesterol away from body tissues.

When you have a lot of LDL cholesterol, there is a greater danger that too much may be deposited in artery walls, which may then become damaged. The arteries may develop a cholesterol and fatty build-up called a plaque on the inside, referred to as atherosclerosis, or "hardening of the arteries."

Cholesterol build-up can prevent adequate amounts of blood from flowing to the heart and may lead to complete blockage of an artery. It is the most common cause of CHD, and happens so slowly that you are not even aware of it. The higher your LDL cholesterol, the greater your chance of this build-up.

When you have higher levels of HDL in your blood, it means that more high-density lipoproteins carry cholesterol away from arterial walls and to the liver. The liver then eliminates the cholesterol from the body by excreting it in the bile. Clearly, the more this happens, the less likely is cholesterol to accumulate in arterial walls and worsen the progression of atherosclerosis.

Woman with lines of trans–rectus abdominis muscle (TRAM) reconstruction incisions.
A lines of reconstructed breast incisions
B circle of re–positioned "belly button" incisionC line of abdominal surgery incision
















Woman in process of trans–rectus abdominis muscle (TRAM) reconstruction.
A lines of reconstructed breast incisions
B right trans rectus abdominis muscle
C left TRAM muscle is swung over to re–create the new breast
D incision circle of re–positioned "belly button" incisionE line of abdominal surgery














Woman after mastectomy, showing trans–rectus abdominis muscle (TRAM) and surrounding tissues, in preparation for reconstruction.
A mastectomy site
B right trans rectus abdominis muscle
C left trans rectus abdominal muscleD segment of abdominal tissues: skin and fat, to be transferred along with muscle to create the new breast
















Side view of breast area with filled tissue expander in place lobules.
A tissue expander–filled (silicone gel/saline)
B port
C catheter
D syringe
E ribs
F pectoralis major muscleG Other muscles of the chest wall.

Woman with radical mastectomy.
A pink highlighted area indicates tissue removed at mastectomy
B axillary lymph nodes: levels I
C axillary lymph nodes: levels II
D axillary lymph nodes: levels III
E supraclavicular lymph nodesF internal mammary lymph nodes

Woman with modified radical mastectomy.
A pink highlighted area indicates tissue removed at mastectomy
B axillary lymph nodes: levels I
C axillary lymph nodes: levels IID axillary lymph nodes: levels III

Woman with total (simple) mastectomy.
A pink highlighted area indicates tissue removed at mastectomy
B axillary lymph nodes: levels I
C axillary lymph nodes: levels IID axillary lymph nodes: levels III

Woman with lumpectomy.
A dark area indicates tumourB light pink highlighted area indicates tissue removed at lumpectomy

Breast Cancer- Treatment
(Part-I)

Breast cancer can be cured completely if detected early. When cancer is suspected, generally it includes confirmation of the suspicion by proper diagnosis, evaluation of stages of the disease and proper selection of therapy. The outcome is favourable in the following cases
v Younger the age
v Having disease of Stage I and II
v Cancer limited to the breast
v Favourable pathological features and cell type
v With positive ER-PR status.
For patients other than the above, various treatment modalities are available, but they are more of palliative nature.
Different types of treatment are available for patients with breast Cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials.
A treatment clinical trial is a research study meant to help improve current treatment or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Such trials are freely available in western countries and are comparatively rare in India.
Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team. Usually four types of standard treatments are available. Usually more than one type of treatment is used depending up on the stage and type of the disease.
I. Surgery
Most treatment options in breast cancer will involve some form of surgery. In the past, cancer was thought to spread sequentially from the primary tumour, to regional lymph nodes and finally to distant sites. However, more thinking that is recent recognizes the early metastatic potential of breast cancer and that cancerous cells may have already spread to distant sites by the time the patient presents. Therefore, early diagnosis and/or surgery are important mainly for control of local disease rather than for preventing spread of the disease.
The aim of the surgery is to remove the cancer from the breast as far as possible. Some of the lymph nodes under the arm are usually taken out and looked at under a microscope to see if they contain cancer cells. The following are the standard surgical interventions:
1. Breast conserving surgery: It is an operation to remove the cancer but not the breast itself, includes the following:
v Lumpectomy: A surgical procedure to remove a tumour (lump) and a small amount of normal tissue around it.
v Partial mastectomy: A surgical procedure to remove the part of the breast that contains cancer and some normal tissue around it. This procedure is also called a segmental mastectomy.
Patients who are treated with breast-conserving surgery may also have some of the lymph nodes under the arm removed for biopsy. This procedure is called lymph node dissection. It may be done at the same time as the breast-conserving surgery or after. Lymph node dissection is done through a separate incision. This lymph node dissection is very important to know whether the cancer is restricted to breast alone or spread to distant parts. Knowledge of this is essential to plan further treatment. After the surgery, usually the removed part is sent to study for the presence or absence of Oestrogen receptors (ER) and progesterone receptors (PR). Its presence or absence has a major say in the further plan of treatment.
2. Other types of surgery: They include the following:

v Total mastectomy: A surgical procedure to remove the whole breast that contains cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. This is done through a separate incision.
v Modified radical mastectomy: A surgical procedure to remove the whole breast that contains cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
v Radical mastectomy: A surgical procedure to remove the breast that contains cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy.

Adjuvant therapy:

Even if the doctor removes all of the cancer that can be seen at the time of surgery, the patient may be given further treatment, which depends up on the age, type of cancer, stage of cancer and ER-PR status. This will be in the form of radiation therapy, chemotherapy or hormone therapy. This is essential where we are trying to kill any cancer cells that may be left. This increases the chances of a complete cure.

Brest re-construction surgery:

If a patient is going to have a mastectomy, breast reconstruction (surgery to rebuild a breast’s shape after a mastectomy) may be considered. Breast reconstruction may be done at the time of the mastectomy or at a future time. The reconstructed breast may be made with the patient’s own (nonbreast) tissue or by using implants filled with saline or silicone gel.

II. Radiation therapy:

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

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- Dr.N.Someswara

Breast self Examination:

Fig.1: Stand in front of mirror. Disrobe up to Vaist level. Keep your arms on your waist and study your brerast in the mirror.

Observe for changes in your breast size, shape, nipple size, shape, changes in the skin and other new features. If you note any changes, report immediately to your Doctor for further evaluations.










Fig 2: Lift your hands and and observe for changes in your breast.

Fig 3: Lie down flat. Keep a pillow below your shoulder blade. Examine your right breast with left hand and left breast with right hand in small circles as shown in the figure. Feel for any new growths by examining the whole breast including the corresponding armpit.



Fig 4: While taking shower, examine your breast using pulp of fingers as shown in small circles. Squeeze nipple tip and observe the liquid. It should be watery and colourless. If you notice any changes, immediately report it to your doctor.

Note: Counduct Breast Self Examination (BSE) on the 4th day of your Menstrual Cycle every month. Women, who have attained menopause should conduct this on 1st of every month.

Get your self examined by a Surgical Oncologist once a year with out fail.

Basics of Breast Cancer.

WHAT IS BREAST CANCER?

Breast cancer has become a major health problem in the last 50 years, affecting as many as one in eight women have during their lifetime. It has become a major health concern and is putting heavy financial burden on both developing and developed countries. In the family it affects, it causes immeasurable anxiety, suffering and loss. Hence, it is high time to implement an effective counter measure directed towards prevention, early diagnosis and an effective treatment.



Fig1: Structure of the breast:
TOP:
A = Milk duct B = Milk glan C = Enlarged portion of the duct
D = Openings on Nipple E = Fat
F = Muscle G = Rib

BOTTOM:
A = Duct cell B = Basement membrane C = Lumen

Risk Factors:
No single factor has been identified, as the cause of Breast Cancer while several predisposing factors could be the probable cause. They are grouped as genetic andfamilial factors, hormonal factors, dietary factors, benign breast diseases and environmental factors. Approximately half of all women who develop breast cancer have no identifiable risk factors.

- Sex: Though breast cancer is also seen in man, it is common in woman.
- Age: It is less common in the younger age. As age advances, chances of getting breast cancer also increases.
- Genetic and family factors: A family history of breast cancer has been recognised as a risk factor for the disease. After gender and age, a positive family history is the strongest known predictive risk for breast cancer. It is known that in some of the “cancer families” there are specific mutations in single cancer susceptible genes. BRCA1 and BRCA2 are the two important genes whose presence increases the chances of getting breast cancer. The presence of Oncogenes like HER-2 also increases the risk.

- Hormonal factors: Breast cancer is clearly related to hormone levels. An early menarche and late Menopause increases the chances, as does a late first pregnancy. The total duration of the menstrual life is an important risk factor for Breast cancer risk-the less the better.
- Diet: An increase in dietary fat intake is associated with increased incidence of the disease.
- Smoking & Alcohol: Multiple studies have shown an indication between alcohol consumption, smoking and risk of breast cancer.
- Benign breast lesion: They are classified as prolifierative, non-proliferative and atypical hyperplasia. Atypical hyperplasia is associated with an increase in risk of Cancer development.
- Environmental factors: As with many other cancers, exposure to certain environmental factors, such as Ionising radiation, electromagnetic fields and organo- chlorine pesticides increases the risk of Breast cancer.

Malignant tumours:

Malignant tumours can arise from any of the breast structures. Ductal carcinomas are the most common (78%), which arises from the milk ducts followed by lobular carcinoma (9%), which arises from the lobules, the milk secreting units of Breasts. These two cancers are aggressive and are known as Invasive Carcinomas. Other varieties are comparatively rare.

Investigations:

In 75% of cancers, the presenting symptom is a breast lump, most frequently in the upper outer quadrant of the Breast. However, the presence of a breast lump does not always indicate cancer. The majority of breast lumps (>90%) are benign. The commonest benign lumps are Cysts, fibro adenomas or areas of fibroadenosis.
The other common presenting symptoms are Breast pain and tenderness, change in Breast shape or size, dimpling, flaking or thickening of the skin of the breast, nipple inversion, rash or discharge and swelling of the upper arm or in arm pit.
The three important methods to detect breast cancer early are Breast self-examination, Mammography and examination by qualified Oncologist.
All women aged more than 20 years, should perform monthly Breast self-examination on the 4th day of every menstrual cycle and are very useful in detecting the lump early. During examination, special attention should be paid to the above-mentioned presenting features. Women, who are under menopausal period, may perform the same, say on every 1st day of the month.
Mammography is special kind of X-ray examination of the breast. It can detect cases long before they become apparent by physical examination. Combined with clinical examination, it can be at least 90% accurate in its diagnosis. The following recommendation may be followed for Mammography.
- 40-49 years: Once in two years.
- >50 years: Once a year
- With a positive family history: Once a year after 35 years.

It is advisable to get the breast examined by qualified oncologist periodically as follows:
- 20-39 years: Once in every 3 years.
- >40 years: Once a year.
- With a positive family history: every year from 20th year onwards.

Diagnosis:

The diagnosis is always confirmed by either Fine needle aspiration Cytology (FNAC) or Open Biopsy. A needle is inserted in the lump and its cells are aspirated which are studied under the microscope. If the diagnosis is still in doubt, then an open biopsy or excision biopsy is done where the tumour is removed surgically and sent to the laboratory for a detailed study.

Staging:

The pre-treatment evaluation of a breast cancer patient should determine the clinical stage of the disease. There are four stages depending up on the location and spread of cancer.

Stage I: Breast alone
Stage II: Breast as for stage I and axillary nodes involved, but mobile
Stage III: Skin invaded, fixed or ulcerated, or tumour fixed to underlying muscle or pectoral fascia
Stage IV: Fixed axillary lymphadenopathy, supraclavicular involvement and/or distant metastases

A classification known as TNM (T=tumour, N=Node, M=Metastasis) classification is more useful and is used extensively where the size of the tumour, involvement of node and presence or absence of metastasis is taken in to account.

What Can Make Your Risk for Breast Cancer Go Down?
Eating a healthy diet
Losing extra weight
Regular exercise
Reducing alcohol use
Quitting smoking
Minimizing/eliminating extra estrogens
Preventive measures for high risk (surgery, medication)


What Can Make Your Risk for Breast Cancer Go Up?
Personal or family history
of breast cancer
Smoking
Excessive weight
Prolonged estrogens exposure
Abnormal breast cell growth
First full-term pregnancy after age 30
Never having a full-term pregnancy
Heavy alcohol use
Early start of menstruation
Late menopause
Factors affecting Breast Cancer


- Dr.N.Someswara

What is Cancer?

Fig: Normal Human Cell. Note the position of Nucleus

Fig.2: This is Human Karyotype. The 22 pair of choronmosomes vary in their shape and sizes. They are given numbers from pair 1 to pair 22. Sex chromosomes are named as X and Y.

Fig.3: This is an imaginative figure of normal human cell. Note the positionof Nucleus, the chromosomes, the double helix of DNA and their base pairs.

Cancer is an age-old disease affecting mankind. It was recognised by ancient Egyptians as early as 1600 BC. Even ancient Indian Doctors like Sushrutha and Charaka identified this disease and named it as arbuda. It is increasing in an alarming pace from last 50 years because of rapid Industrialization, Urbanization and Modernization.

Our body is made up of billions of cells. Cells unite to form tissues. Tissues form organs. Organs form Organ systems, which finally form what we call whole body and life.

All the cells have same plan of construction but vary in certain aspects depending upon the organ where they are present and the function they are doing. A red blood cell is saucer shaped cell-carrying Oxygen and supplying to each and every cell of the body. A muscle cell is spindle shaped helping in locomotion. A nerve cell has an elongated structure helping in conduction of electrical impulses and participating in communication.

The billions of cells of the body that are the result of a single cell called zygote, which is the product of fusion of sperm with Ovum. Zygote multiplies repeatedly to form the whole body. Each and every cell has a nucleus (exception: Red blood cells). In the nucleus, there are 23 pairs of chromosomes. Each chromosome has several genes and each gene is made up D.N.A, which is made up of several base pairs, which are nothing but various Chemical molecules!

Genes are the blue prints of our life. All the details concerned with the various functions of the body including re-productions are present in the form of specific codes in these genes. The genes you pass along with your spouse decide whether your child will have blue eyes, curly hair or fair colour. Also some diseases are transmitted to offspring through genes.

A cell is predetermined as to how many times it has to re-produce in its lifetime. Cancer develops when cells in a part of the body begin to grow out of control. This is an abnormal feature resulting in the formation of abnormal cells. Although there are many kinds of cancer, they all start because of out-of-control growth of abnormal cells.

Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person's life, normal cells divide more rapidly until the person becomes an adult. After that, cells in most parts of the body divide only to replace worn-out or dying cells and to repair injuries.
Because cancer cells continue to grow and divide, they are different from normal cells. Instead of dying, they outlive normal cells and continue to form new abnormal cells. Cancer cells develop because of damage to DNA. Most of the time when DNA becomes damaged the body is able to repair it. In cancer cells, the damaged DNA is not repaired. People can inherit damaged DNA, which accounts for inherited cancers. Many times though, a person’s DNA becomes damaged by exposure to something in the environment, like smoking.

Cancer usually forms as a tumour. Some cancers, like leukaemia popularly known as Blood Cancer, do not form tumours. Instead, these cancer cells involve the blood and blood-forming organs and circulate through other tissues where they grow.

Often, cancer cells travel to other parts of the body, where they begin to grow and replace normal tissue. This process is called metastasis. Regardless of where a cancer may spread, however, it is always named for the place it began. For instance, breast cancer that spreads to the liver is still called breast cancer, not liver cancer.

Not all tumours are cancerous. Benign (noncancerous) tumours do not spread to other parts of the body (metastasize) and, with very rare exceptions, are not life threatening.

Different types of cancer can behave very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments. That is why people with cancer need treatment that is aimed at their particular kind of cancer.

Cancer is curable if it is detected early. Today, millions of people are living with cancer or have had cancer. The risk of developing most types of cancer can be reduced by changes in a person's lifestyle, for example, by quitting smoking and eating a better diet. The sooner a cancer is found and treatment begins, the better are the chances for living a productive life for many years.

- Dr.N.Someswara

RECOMMENDED HEALTH SCREENINGS

Health is Wealth. Health is a rare commodity. You can not buy it. No money can buy you good health. Hence you have to maintain your health.

One way of maintaining your health is to undergo periodical medical check ups. You have to undergo a set of medical tests and examination so that you can identify the beginning of disease and eradicate it completely before it gets its foot-hold in your body. After evaluaating your medical records and your physical examination, your Doctor will suitably advise you to modify your life style so that you can avoid diseases and promote your wellbeing.

The following article gives you a birds eye view of various tests and medical examinations that you may have to undergo periodically at different age times. This is only a general guideline. Your Doctor is the best person to select appropriate tests required for you and your family. In the following article, I have not mentioned general tests like Hb%, routine blood counts, routine Urine tests and routine stool tests and others. These are manadatory tests for any general medical examination. Hence I have not included. I have emphasized more on special tests. Now Go ahead! Read!! Get benefit from the same. You may write to me for any clarification.

Recommended Screening Procedures
-Ages 18-29

Its never too early to start taking care of your body. In addition to not smoking, eating right, maintaining a healthy weight, and exercising, following the screening recommendations on this chart can help you enjoy a healthy future.

1. Dental exam-Twice a year -To check for cavities and to have a cleaning, which may prevent gum disease

2. Eye exam-At least once between ages 20 and 39.

3. Skin exam-Every 3 years.

4. Skin self-examination-Monthly

• To look for changes, growths, or sores that don't heal. They should be reported to your Doctor.
• Here are the ABCD warning signs for marks on the skin :
• A is for Asymmetry, one half is unlike the other.
• B is for Border irregular, wavy, uneven border.
• C is for Color varied, different shades or colors
• D is for Diameter larger than a pencil eraser
• Protect your skin. Unprotected sun exposure over time can lead to skin cancer, including melanoma, a potentially deadly form of skin cancer. Melanoma is the most common form of cancer in women aged 25 to 29; so don't forget to reduce your exposure to the sun and to protect your skin with appropriate sun protection (SPF - 15 or greater) products when outside. Examine your skin on a monthly basis for any changes in appearance, including your legs, arms, abdomen, back, and face.

5. Clinical breast exam-Every 3 years.

6. Breast self examination: Perform regular breast self-exams. Most breast lumps are found by women who check themselves during monthly breast self-exams. Ask your healthcare provider how to perform this important examination. Look and feel for changes in size, shape, contour, or skin texture. Call your healthcare provider if you notice any lumps or changes

7. Pap smear-Every year until 3 normal tests, then at a Doctor's discretion
Get a Pap test. You should start having Pap tests when you become sexually active or at age 18. Pap test screening, early identification and treatment can actually prevent the development of cervical cancer almost 100% of the time in younger women.

8. Pelvic exam-Every year.
Get advice about birth control and preconception care. The best time to prepare your body for a healthy pregnancy is long before you make a decision to become pregnant. This is called preconception care. Ask your doctor about a plan of action that is right for you. If you do not intend to become pregnant, ask your Doctor for advice on what form of birth control is best suited for you.

9. Sexually transmitted disease (STD) test(HIV, chlamydia, etc)-Whenever engaged in potentially risky behavior. Practice safe sex. Risky sexual behavior can include sex with new or multiple partners, inconsistent use of condoms, or unprotected sex with a partner who is not monogamous. Eighty-six percent of sexually transmitted diseases (STDs) eg, chlamydia, gonorrhea, genital warts, and HIV (the virus that causes AIDS) occur in people 15 to 29 years of age. HIV infection is among the top 10 causes of death in 15- to 24-year-olds. Always use a condom and get tested for STDs annually.

10. Cholesterol (total and HDL)-Every 5 years.

11. Blood pressure-At least every 2 years.

12. Immunizations: Tetanus boosters once in every 5 years. Get your immunizations. Protect yourself now by asking your healthcare provider about follow-up immunizations. Get vaccinated against hepatitis B, and make sure that you are up-to-date on your immunizations.

13. Osteoporosis prevention: Get enough calcium. Believe it or not, osteoporosis prevention begins now. So it's important to eat calcium-rich foods to build and preserve the strength and density of your bones. You need milligrams 1000 milligrams (mg) of calcium every day. You can achieve these levels by eating dairy products including non-fat, low-fat, and fortified. If you can't get enough calcium in to your diet, ask your Doctor to recommend a dietary supplement.

14. Chest-X-ray: PA View: There should be one base line chest x-ray of the chest. This functions as reference x-ray for your future chest problems. Just take one x-ray, at the age of 18 years! That is enough.

15. U/S pelvis & abdomen: A base line Ultra sound evaluation will give a lot of information about your internal structures like Liver, kidney, Uterus, Ovary and other organs. This should serve as a reference while your Doctoabdominal your abominal problems.

Recommended Screening Procedures -Ages 30-39

1. Dental exam-Twice a year: To check for cavities and to have a cleaning, which may prevent gum disease.

2. Eye exam-At least once between ages 20 and 39.

3. Skin exam-Every 3 years.

4. Skin self-exam-Monthly. To look for changes, growths, or sores that don't heal. They should be reported to your healthcare provider. Here are the ABCD warning signs for marks on the skin:

A is for Asymmetry-one half is unlike the other

B is for Border irregular-wavy, uneven border

C is for Color varied-different shades or colors

D is for Diameter-larger than a pencil eraser.

Protect your skin. Unprotected sun exposure over time can lead to skin cancer, including melanoma, a potentially deadly form of skin cancer. So reduce your exposure to the sun and protect your skin with appropriate sun protection (SPF >15) products when outside. Examine your skin on a monthly basis for any changes in appearance, including your legs, arms, abdomen, back, and face.

5. Clinical breast exam-Every 3 years.

6. Breast self-exam-Monthly. Most breast lumps are found by women who check themselves during monthly breast self-exams. Ask your healthcare provider how to perform this important examination. Look and feel for changes in size, shape, contour, or skin texture. Call your healthcare provider if you notice any lumps or changes.

7.Pap smear-Every year until 3 normal tests, then at a healthcare provider's discretion.

8. Pelvic exam-Every year: Get advice about birth control and preconception care. The best time to prepare your body for a healthy pregnancy is before you make a decision to become pregnant. This is called preconception care. Ask your Doctor, about a plan of action that is right for you. If you do not intend to become pregnant, ask your Doctor for advice on what form of birth control is best suited for you.

9. Sexually transmitted disease (STD) test(HIV, chlamydia etc): Whenever engaged in potentially risky behavior Practice safe sex. Risky sexual behavior can include sex with new or multiple partners, inconsistent use of condoms, or unprotected sex with a partner who may not be monogamous.

10. Cholesterol: Cholesterol (total and HDL)Click to learn more about understanding and controlling your levels. Every 5 years.

11. Blood pressure: At least every 2 years Check for high blood pressure, which can increase the risk of serious conditions like Stroke & Heart attack.

12. Immunizations: Get Tetanus boosters every 10 years.

13. Osteoporosis prevention: Get enough calcium. It's important to eat calcium-rich foods to build and preserve the strength and density of your bones. You need 1000 to 1500 milligrams (mg) of calcium every day. You can achieve these levels by eating dairy products including nonfat, low-fat, and fortified. If you can't get enough calcium into your diet, ask your Doctor to recommend a dietary supplement.

Recommended Screening Procedures -Ages 40-49

1. Dental exam-Twice a year. To check for cavities and to have a cleaning, which may prevent gum disease.

2.Eye exam-Every 2 years . To check vision and look for other conditions such as cataracts and glaucoma.

3. Skin exam-Every 3 years.

4. Skin self-exam-Monthly. To look for changes, growths, or sores that don't heal. They should be reported to your healthcare provider. Here are the ABCD warning signs for marks on the skin:

A is for Asymmetry-one half is unlike the other

B is for Border irregular-wavy, uneven border

C is for Color varied-different shades or colors

D is for Diameter-larger than a pencil eraser.

5. Mammogram-Every 1 to 2 years. To look for changes in the breast that can't be seen or felt. Start having regular mammograms. Why? Because breast cancer risk increases as you get older, starting at age 40. Women should have a mammogram and a clinical breast exam performed by a healthcare provider every 1 to 2 years. Early detection of breast cancer using mammograms may be lifesaving

6. Clinical breast exam-Every year.

7. Breast self-exam-Monthly. Most breast lumps are found by women who check themselves during monthly breast self-exams. Look and feel for changes in size, shape, contour, or skin texture. Call your Doctor, if you notice any lumps or changes.

8. Pelvic exam-Every year .

9. Pap smear- Every year until 3 normal tests, then at a Docotors discretion.

10. Sexually transmitted disease (STD) test(HIV, chlamydia, etc):
Whenever engaged in potentially risky behavior. Risky sexual behavior can include sex with new or multiple partners, inconsistent use of condoms, or unprotected sex with a partner who may not be monogamous.

11. Lipid profile: Once a year.

12. Blood pressure: At least once a year. High blood pressure affects your health. Check for high blood pressure, which can increase the risk of serious conditions like stroke and heart attack.

13. Diabetes screening: Once a year. Experts recommend that adults older than 40 be tested for adult onset diabetes, a condition in which blood sugar levels are too high. Millions have it and don't even know it because symptoms usually don't occur in the early stages. Obesity, or having excessive body fat, is a major risk factor for adult onset diabetes. Other risk factors include family history of adult onset diabetes, high cholesterol, high blood pressure, and a history of diabetes during pregnancy.

14: ECG in 12 leads: Once a year.

14. Immunizations: Get Tetanus booster opnce in every 5 years.

15. Osteoporosis prevention: Get enough calcium. It's important to eat calcium-rich foods to build and preserve the strength and density of your bones. You need 1000 to 1500 milligrams (mg) of calcium every day. You can achieve these levels by eating dairy products including nonfat, low-fat, and fortified. If you can't get enough calcium into your diet, ask your Doctor to recommend a dietary supplement.

16. Chest X-ray PA View: Just repeat another base line Chest X-ray at the begining of of your 40's.

17. U/S of Pelvis & abdomen: It is better to repeat once U/S of abdomen at the begining of your 40's.

Recommended Screening Procedures - over 50 years.

1. Dental exam-Twice a year. To check for cavities and to have a cleaning, which may prevent gum disease

2. Eye exam-Every 2 years . To check vision and look for other conditions such as cataracts and glaucoma.

3. Skin exam-Every year.

4. Skin self-exam-Monthly. To look for changes, growths, or sores that don't heal. They should be reported to your Doctor. Here are the ABCD warning signs for marks on the skin:

A is for Asymmetry-one half is unlike the other

B is for Border irregular-wavy, uneven border

C is for Color varied-different shades or colors

D is for Diameter-larger than a pencil eraser

5. Mammogram-Every year. Early detection and treatment of breast cancer may be lifesaving.

6. Clinical breast exam: Every year .To look for any changes and feel for any lumps.

7. Breast self-exam- Monthly. Most breast lumps are found by women who check themselves during monthly breast self-exams. Look and feel for changes in size, shape, contour, or skin texture. Call your healthcare provider if you notice any lumps or changes.

8. Pelvic exam- Every year.

9. Pap smear- Every year until 3 normal tests, then at a Doctor's discretion.

10. Sexually transmitted disease (STD) test(HIV, chlamydia, etc): Whenever engaged in potentially risky behavior. Risky sexual behavior can include sex with new or multiple partners, inconsistent use of condoms, or unprotected sex with a partner who may not be monogamous.

11.Lipid profile: Every year.

12. Blood pressure: Every year, One out of every 10 in their 50s have some degree or some type of heart disease. In Weman, when estrogen levels decrease, the risk of heart attack is similar to that for a man. Your Doctor can assess risk factors you may have, such as high blood pressure, high cholesterol, diabetes, and family history of heart diseases and develop an effective plan for good heart's health.

13. Diabetes screening: Once a year. Check for fasting and post prandial blood sugar levels.

14. Tread meal test (TMT): Once at the begining of 50th year which should serve as reference for future evaluations. Then depending up on your blood pressure, Diabetes, your weight, your physical activity, your stress level and family history, your Doctor will deside the frequency of this test.

15. Echocardiogram: Once at the begining of 50th year. This will serve as a baseline reference. It may repeated at the discretrion of your Doctor.

16. Immunizations: Get booster dose of Tetanus every 5 years. Pneumococcal vaccine once after age 65 and Influenza vaccine every year if 65 or older.

17. Fecal occult blood test- Every year. To test for blood in the stool, a possible sign of colon or rectal cancer.

18. Colorectal cancer tests (sigmoidoscopy, colonoscopy): This cancer is comparatively rare in Indians when compared to westerens. This may be done at the discretion of the Doctor once in every 5 to 10 years. Eating lots of fresh fruits, vegetables, and whole grains may reduce your risk of developing colon cancer.

19. Osteoporosis screening (bone mineral density test): As determined by your Docotr. It measures the density of your bones, can show if you have osteoporosis, and can predict your risk of spine and hip fractures. Your healthcare provider can discuss your risk factors with you and determine if you should have this test.

20. U/S of the pelvis & abdomen: This is done at the begining of the 50th year which will serve as a base line reference. Then this may be repeated every year at the discreation of your Doctor. This helps in early detection of BPH (Beningn Prostatic Hypertrophy)

21. Thyroid profile: Thyroid disease is common in women. An underactive thyroid (hypothyroidism) can cause fatigue, sensitivity to cold, weight gain, and other troubling symptoms. An overactive thyroid (hyperthyroidism) may cause rapid heartbeat, weight loss, and dizziness. A simple blood test done for thyroid-stimulating hormone (TSH) may detect a thyroid problem.

- Dr.N.Someswara

Let us Invest....

Let us Invest......

Health is a state of physical, mental, social, sexual and spiritual well-being. Contrary to the popular belief, health is not a state of absence of diseases or deformities. By making conscious and mindful decisions, let us try to gain the best health in all areas of our life. This is the most important investment we can make in our life.

The choices we make about the way we live or lifestyle we adopt are important to our health. Here are some choices we can make to help our self to stay healthy:

Abstain from using any form of tobacco.
Eat a healthy diet.
Exercise regularly.
Drink alcohol in moderation, if at all.
Never use illegal drugs.
Practice safe sex.
Use a helmet while riding our bikes and fasten seat belts when driving in a car.
We must always consult our doctor regularly for preventive health care. This may be a test, or advice from our doctor.

Preventive health services can include the following:

• Tests (also called screenings) to check our general health or the health of certain parts of our body
• Measurements of weight, cholesterol levels and blood pressure etc.
• Advice about diet, exercise, tobacco, alcohol and drug use, stress and accident prevention.
• Immunizations for both children and adults.
• Special tests at certain times in our life, such as during pregnancy and after the age of 50 years.

The most important aspect of well being is getting educated and being aware of our self, our health, fitness & well being. For this

v Let us learn and educate ourselves to become our own "second opinion" so that we can understand and practice with perfection all aspects of treatment that our health practitioners or consultants may prescribe to us.

v Let us reclaim personal responsibility for our own health and make it a priority. When we are sick, health becomes our #1 priority, because without it we have nothing. With total health and high energy we can accomplish our dreams and heart's desires.

v Let us take charge, make changes and do what it takes to enjoy the abundant rewards of total health & well-being.

This writing, I hope, will inspire us in educating our self and equip us to take care of the health of our family. I sincerely request you to invest in preventive health care in order to lead a total, complete & fruitful life.

-Dr.N.Someswara

SAFE USE OF MEDICINES

Safe Use of Medicines

Doctors, physician assistants, nurses, pharmacists, and YOU make up your health care team. To reduce the risks from using medicines and to get the most benefit, you need to be an active member of the team.

To make medicine use SAFER:·

Speak up·
Ask questions·
Find the facts·
Evaluate your choices dispense·
Read the label and follow directions.

SPEAK UP:

• The more information your health care team knows about you, the better the team can plan the care that’s right for you.
• The members of your team need to know your medical history, such as illnesses, medical conditions (like high blood pressure or diabetes), and operations you have had.
• They also need to know all the medicines and treatments you use, whether all the time or only some of the time.
• Before you add something new, talk it over with your team. Your team can help you with what mixes well, and what doesn’t.
• It helps to give a written list of all your medicines and treatments to all your doctors, pharmacists and other team members.
• Keep a copy of the list for yourself and give a copy to a loved one.
• Be sure to include:· Prescription medicines, including any samples your doctor may have given you·
• Over-the-counter (OTC) medicines, or medicines you can buy without a prescription (such as antacids, laxatives, or pain, fever, and cough/cold medicines)·
• Dietary supplements, including vitamins and herbs·
• Any other treatments· Any allergies, and any problems you may have had with a medicine·
• Anything that could have an effect on your use of medicine, such as pregnancy, breast feeding, trouble swallowing, trouble remembering, or cost.

ASK QUESTIONS:

• Your health care team can help you make the best choices, but you have to ask the right questions.
• When you meet with a team member, have your questions written down and take notes on the answers. You also may want to bring along a friend or relative to help you understand and remember.
• Use the Question Guide at the end of this pamphlet to help you get the answers you need from your health care team.
• Before you and your team decide on a prescription or OTC medicine, learn and understand as much about it as you can, including:·
• Brand and generic (chemical) names·
• Active ingredients—to make sure that you aren’t using more than one medicine with the same active ingredient·
• Inactive ingredients—if you have any problems with ingredients in medicines, such as colours, flavours, starches, sugars·
• Uses (“indications” and “contraindications”)—why you will be using it, and when the medicine should/should not be used·
• Warnings (“precautions”)—safety measures to make sure the medicine is used the right way, and to avoid harm·
• Possible interactions—substances that should not be used while using the medicine. Find out if other prescription and OTC medicines, food, dietary supplements, or other things (like alcohol and tobacco) could cause problems with the medicine·
• Side effects (“adverse reactions”)—unwanted effects that the medicine can cause, and what to do if you get them·
• Possible tolerance, dependence, or addiction—problems that some medicines can cause, and what you can do to avoid them·
• Overdose—what to do if you use too much· Directions—usual dose; what to do if you miss a dose; special directions on how to use the medicine, such as whether to take it with or without food·
• Storage instructions—how and where to keep the medicine· Expiration—date after which the medicine may not work, or may be harmful to use.
  Your pharmacy, the library, the bookstore, the medicine maker, and the Internet have medicine information made for consumers.
• If you have questions, ask your health care team.
• EVALUATE YOUR CHOICES—Weigh the Benefits and RisksAfter you have all the information, think carefully about your choices.
• Think about the helpful effects as well as the possible unwanted effects. Decide which are most important to you.

This is how you weigh the benefits and risks.

The expert advice from your health care team and the information you give the team can help guide you and your team in making the decision that is right for you.

READ THE LABEL AND FOLLOW DIRECTIONS:

• Read the label to know what active ingredient(s) is (are) in the medicine. The active ingredient in a prescription or OTC medicine might be in other medicines you use.
  Using too much of any active ingredient may increase your chance of unwanted side effects.
• Read the label each time you buy an OTC medicine or fill your prescription.
• When buying an OTC, read the "Drug Facts" label carefully to make sure it is the right medicine for you.
• Prescription and OTC medicines don't always mix well with each other.
• Dietary supplements (like vitamins and herbals) and some foods and drinks can cause problems with your medicines too.
• Ask the pharmacist if you have questions.
  Before you leave the pharmacy with your prescription, be sure you have the right medicine, know the right dose to use, and know how to use it.
• If you've bought the medicine before, make sure that this medicine has the same shape, colour, size, and packaging. Anything different? Ask your pharmacist.
• If your medicine tastes different when you use it, tell your health care team.
• Read and save all the information you get with your medicine.
• Read the label each time before you use the medicine.
• Be sure it’s right in 5 ways:1. The right medicine 2. For the right patient 3. In the right amount 4. At the right time 5. In the right way (for example, swallow instead of chew a pill) follow directions on the label and from your health care team.
• When you are ready to use the medicine, make the most of the benefits and lower the risks by following the directions.
• If you want to stop a medicine your doctor told you to use or to use it in a different way than directed, talk to a team member.
• Some medicines take longer to show that they are working. With some medicines, such as antibiotics, it is important to finish the whole prescription, even if you feel better sooner.
  When you stop using some medicines, you must reduce the dose little by little to prevent unwanted side effects.

REPORT BACK TO THE TEAM:
Pay attention to how you feel.
If you have an unwanted effect, tell your health care team right away. A change in the dose or a change in medicine may be needed.

QUESTION GUIDE:
Use this guide with your health care team to find out what you need to know about the medicines you use, and about the medicines you are thinking about using. Be sure to find the answers to these questions for any sample medicine your doctor gives you.·

What are the brand and generic (non-brand) names of the medicine?·

What is the active ingredient?·

Could I use a generic form?·

What is the medicine for, and what will it do for me?·

When should I start to feel better?·

When should I report back to the team?·

Will this medicine take the place of any other medicine I have been using?·

Should I avoid any drinks, foods, other substances, or activities while using this medicine?

Can this medicine be used safely with the other medicines and treatments I already use?

Does this include prescription and OTC medicines, vitamins, herbals, or other supplements, and other treatments?·

Should I avoid starting other medicines (prescription or OTC), dietary supplements (like herbals and vitamins) or other treatments while I am using this medicine?·

What are the possible side effects from this medicine? What do I do if I get a side effect?·

Is there any chance that I could become tolerant, dependent or addicted to this medicine?

What can I do to avoid this?·

How and when should I use the medicine, in what amount, and for how long?

Are there any special directions for using this medicine?·

Will I need any tests (blood tests, x-rays, other tests) to make sure the medicine is working, as it should? How will I get the results?·

What should I do if I miss a dose?

What should I do if I use too much by mistake?·

How and where should I keep this medicine? (Remember: Always put medicines out of the sight and reach of children and pets.)·

Where and how can I get more information about this medicine?

Remember: To reduce the risks of using medicines and to get the most benefit, you need to be an active member of your health care team.

-Dr.N.Someswara