Screening Tests: What Tests When?

Dr. Pooh & Tigger

Because a routine physical examination is not covered by the B.C. Medical Services Plan in a patient with no symptoms and no known disease, most adults are not aware of all the screening tests they should consider.

Screening tests are recommended for the early detection and treatment of particular medical conditions in individuals of average risk and with no symptoms.

For example, the stool occult blood test (FOBT or FIT) is recommended as a screen for colon cancer for adults over 50 years every 2 to 3 years. If it is positive (indicating a source of bleeding in the gastrointestinal tract), the next test is usually a colonoscopy (in which a flexible scope is inserted into the anus and used to see and remove polyps and other growths in the large intestine).

However, if an older adult has obvious blood in his stools, his physician will likely arrange a colonoscopy without the need for a positive stool occult blood test. If another individual with no symptoms has a family history of colon cancer, the first surveillance colonoscopy should begin at an age 10 years before the age at which the relative was diagnosed. For example, if a woman’s father was diagnosed with colon cancer at age 52 and her sister was diagnosed at age 48, she should have her first colonoscopy at age 38.

These are the screening tests for other conditions.

High Blood Pressure For adults 18 and older, blood pressure should be measured at every appropriate medical visit (e.g. annually). Once hypertension or high blood pressure is identified, the patient and doctor will discuss the appropriate frequency of rechecking blood pressure.

Cervical Cancer The pap smear is a sample of cervical cells taken during a pelvic examination, but please note that a pap smear is not necessarily done with every pelvic exam, which may have been necessary for pelvic pain or a possible infection. A woman should always clarify with her physician what tests were done during each examination.

Women should start pap smears at age 25 and continue at a frequency of every 3 years (or more frequently depending on the recommendations of the BC Cancer Agency which interprets the pap smears and sends reports to the physician). Women 70 years and older may stop screening after 3 successive normal paps in the previous 10 years.

Diabetes The fasting glucose blood test was formerly recommended as the screening test for adults over age 40. The confirmatory test was the 2-hour 75 gm glucose tolerance test.

The newest recommendation is the Hb a1c blood test only in high risk and very high risk patients based on the FINDRISC or CANRISK calculators. Those found to be high risk for diabetes should be screened every 3 to 5 years; those at very high risk every year.

Breast Cancer Monthly self-examinations and annual clinical examinations by physicians are no longer recommended. Screening mammograms are now the only remaining screening test and the Canadian guidelines recommend them every 2 years in women from age 50 to 70.

Prostate Cancer The standard screening test is the annual DRE (digital rectal examination). Don’t be fooled by the name; it’s not high tech imaging. It’s high touch with your doctor’s gloved finger checking the size and shape of the prostate. My patient, Tom calls it the fickle finger of fate.

This is not the right time to ask your doctor for a second opinion.

Doctor (as he snaps off his glove): You have a huge prostate and you need surgery.

Patient: Can I have a second opinion?

Doctor: You already did. I used two fingers and they both feel the same.

The PSA (prostate specific antigen) is a blood test to detect levels of a protein produced by the prostate. It may be elevated by benign enlargement of the prostate or by prostate cancer. It is not recommended as a routine screening test for men at any age. Men should discuss the value of this test with their physicians as it has to be interpreted in conjunction with the rectal examination.

The PSA is not recommended as a screening test because an abnormal test may result in investigations and treatment that may cause more harm than a slow growing prostate cancer that may not otherwise affect the patient.

Dr. Davidicus Wong is Physician Lead of the Burnaby Division of Family Practice. A poster of these screening tests can be found at divisionsbc.ca/burnaby.  For more information on screening tests, see the Canadian Task Force on Preventive Health Care http://canadiantaskforce.ca

 

Posted in Burnaby Division of Family Practice, Empowering Healthcare, Self-care | Tagged , , , , , , , , , , , , , , , , , | Leave a comment

Being Present

7 Mantras (Davidicus Wong)

7 Mantras (Davidicus Wong)

One of my favourite TV shows from the 90s was Quantum Leap. Scott Bakula played Dr. Sam Beckett. In each episode, he would find himself somewhere back in time in someone else’s body and he would have to solve some problem in that person’s life. It was like a cross between reincarnation and speed dating.

My favourite episode was when he found himself back in his own body as a 12-year-old boy. He was back on the family farm at Thanksgiving time just before his brother was to go to Vietnam where he would die and before his father’s heart attack.

Knowing the future, he did everything he could to try to change it but no one would listen to a 12-year-old boy. When he was feeling really helpless about his situation, his friend told him, “I would give anything to go back in time and enjoy one more Thanksgiving dinner with my family.” Sam was able to step back and enjoy the precious time with his family.

Our present moments so quickly become the memories that we treasure or miss. The trick in life is to hold onto that awareness, to be fully present and fully alive to the ever changing beauty and wonder right in front of us, to see this precious present with that perspective from the future. From your soul’s perspective, we really can make time stand still and live eternity in a moment.

I loved Thanksgiving, Easter, Christmas and birthday dinners lovingly made by my mom. I loved helping her out in the kitchen, setting the table and cleaning up. I loved sitting around the table talking and eating with my parents, my brother and my sister.

Long before my mom’s unexpected passing, I had a deeper understanding that these moments - the everyday time we spend with our loved ones – are fleeting and precious so I had better pay attention and enjoy them.

I’m glad I did. Though I wasn’t consciously prepared for losing my mom, I am happy that I had lived as if each moment might be the last I might spend with the people that I cared about. Those moments remain touch points to eternity. I can remember and relive them as if they continued to exist.

This perspective continues to inform how I live each day, and I am not saddened with another Thanksgiving without my mom because I always feel her close to me and I feel how my life continues to be enriched by the past.

Posted in Coping with Loss, Letting Go, Relationships | Tagged , | Leave a comment

Thankfulness . . . the healthiest attitude

Central Park, Burnaby

Central Park, Burnaby

The way you look at your life at this moment can determine your future health and happiness.

How you habitually think has great bearing on your performance at school or work, your physical health, your emotions and your relationships.

If you see yourself as a powerless victim of life, you lose your confidence and sense of control. This leads to anxiety.

If your focus is on what is wrong in your life, you’ll no longer see what is good. This is the perspective of depression.

An attitude more conducive to your wellbeing is gratitude.

Contrary to popular opinion, thankfulness is not a function of what you have or a luxury when life is good. Lasting and authentic happiness doesn’t come when everything is perfect because it never is or when it seems to be, it doesn’t stay that way. In an imperfect world, we can still be happy.

We say that pessimists see the cup as half empty and optimists see it half full. With the perspective of wanting, we see what we don’t have and we get what we expect – more of less and more wanting. Happiness is not in the cards with the half empty attitude.

Pessimists may think that optimists are deluded. The cup is really not half full, and in a sense they may be right. Water is not static just as neither our selves nor anything in life is unchanging.

People come in and out of our lives, love comes in many forms and the gifts we are given are gifts in trust; we hold them for a moment and pass them on. Everything is fleeting, flowing and in flux.

Gratitude allows us to appreciate what we have been given in the past – the good that we have experienced, the way we were loved and the lessons we have learned. It allows us to see and appreciate ourselves, others and our world just as they are at this moment. It can allow us to see and create a positive future, the realization of potential.

When my children were young, I would make up a new story each bedtime. In the tale of the “Daily Fairy”, a child is befriended by a beautiful fairy who has nothing but love to give in her short life which lasts just one day. Rather than grieving her impending loss, the child learns to appreciate the gift of her fairy’s one sparkling day.

We and everyone around us are like the daily fairy – flowers in bloom today.

Take stock of what you have this day. There are seeds and flowers. Be grateful for the flowers you see today and recognize that in your hands are the seeds for the future.

When you turn your problems into goals – reframing the negative into positive, you begin to create a more positive future. You are no longer a victim of chance. You empower yourself. You see golden opportunities and you seize them. You plant seeds for future happiness.

Today, appreciate the flowers that now bloom in your life and give thanks for flowers past. Recognize the seeds in your life, and ask, “What can I do today to create happiness tomorrow?”

Posted in Coping with Loss, Emotions, Happiness, Letting Go | Tagged , , , , | Leave a comment

Let’s talk about your emotional health

DSC00585

Your emotional wellbeing is an essential part of your health, but many patients only see their doctors when something is wrong with their bodies.

In the daily reality of my family practice, I assist patients coping with overwhelming emotions, troublesome thoughts and anxiety. Many initially present a physical problem, such as abdominal pain or insomnia as the reason for the visit.

Physical problems themselves are a cause of distress and can have a significant impact on our lives. Yet emotional distress can result in even greater negative effects.

Our emotional states can narrow our thoughts and influence our behaviour, affecting our enjoyment of life, our performance at work or in school, and how we relate to others. This can create vicious cycles of distressing emotional states, negative or anxious thinking, and worsening of our circumstances that in turn leads to increasingly negative feelings.

Our feelings shape our thoughts. When anxious, we may see a more threatening, overwhelming and unpredictable world. We underestimate our ability to cope. We overestimate what we must deal with.

When we become depressed, we may see our selves, others and our circumstances in a negative light. We have more difficulty seeing our own good qualities and abilities, the good in our relationships and the positive aspects of our circumstances.

Many people suffering from emotional symptoms hesitate to get help because they think they should be able to manage on their own. Although normal emotional reactions are part of life – it’s human to feel sad if we lose a loved one and anxious when we’re threatened, we need help when our emotions are of an intensity and duration such that they negatively impact the important areas of our lives, including our relationships and our performance at school or work.

Family members and friends sometimes don’t know what to do when someone they care about is suffering emotionally. Some mistake depression for a minor case of the blues that we all suffer when things don’t go our way, but people with depression can’t just snap out of it.

They need more information on how to recognize serious emotional problems and how to get help.

The Doctors of BC (British Columbia Medical Association) has just launched a new website, OpenMindBC.ca as part of its Council on Health Promotion Youth Mental Health Project. It contains valuable links to resources for youth and young adult patients and families, teachers and health care providers.

You’ll find information about common emotional problems, including anxiety, depression, substance abuse and psychosis. On the site, you can find online tools for self-assessment, practical self-help information, tips for managing stress and information to access professional help.

Even if you’re neither a youth nor a young adult, check out this invaluable website anyway. You’ll find helpful suggestions that anyone can use to manage stress and maintain emotional health.

And if you need some help with your emotional health, talk to your family doctor. It’s part of what we do to care for you as a whole person.

Dr. Davidicus Wong is a family physician. 

Posted in Caregiving, Emotions | Tagged , , , , , , , , | 1 Comment

Self-Care is Healthcare

icebergImagine an iceberg. All that we see is the fraction above the surface, but 90% of its bulk lies in the depths of the ocean.

In healthcare, most of our attention is drawn to acute hospital care with less given to the bulk of care within the community: in ambulatory clinics, primary care practices, residential and home care.

But really, who provides over 90% of your healthcare? Hint: It’s not doctors, nurses and other healthcare professionals. Where do actions have the greatest impact on your present and future health?

Your personal medical and family histories are important in identifying particular areas of your health that demand special attention. Yet by far the greatest predictor of your health tomorrow are the habits you practice today.

Some bad habits and their negative effects on our health are obvious. Smoking shortens life and its quality through accelerated atherosclerosis (narrowing and progressive damage to our blood vessels) thereby increasing our risks for premature dementia, strokes, heart attacks and kidney disease. It increases the risk for cancers including the lung, oral cavity, throat and bladder. It progressively damages the lungs, leading to emphysema or chronic lung disease.

Excessive alcohol (more than two or three drinks on any day) contributes to high blood pressure, progressive liver damage (leading to cirrhosis and liver failure), ulcers and impairment in the quality of work, social and family life.

Mood and mind altering street drugs, including marijuana, lead to dependence and addiction. They are a form of chemical coping – similar to the use of short-acting prescription tranquilizers and sedatives. They are ultimately disempowering; they take away one’s sense of control over one’s own life, body and emotions. Drug and alcohol dependence impairs mood, judgment, driving safety, work, school and relationships.

The quality of your daily lifestyle is a powerful predictor of your future health. You really are what you eat. What you consume provides the energy and building blocks for the cells and organs of your body. You wouldn’t build a car with defective parts and fill the tank with contaminated fuel.

For most of us, our bodies thrive on a variety of fruits and vegetables, which provide the vitamins and anti-oxidants we need for healthy cellular function. We need adequate protein to rebuild and repair muscles and other tissues. We also need adequate but not excessive calories and fats (such as fish oils) in our diet. In general, we should avoid excessive animal fat and processed food.

If you haven’t put too much thought into what you eat, take the healthy eating challenge. See how much better you feel with a month of more mindful eating. Over the long term, healthy eating reduces obesity, high blood pressure, kidney disease, diabetes, heart disease and strokes.

Three other key areas of self-care are (1) physical activity, (2) emotional management and (3) healthy relationships. These will be the focus of upcoming columns that will include practical tips to achieve your goals in healthier daily living.

Dr. Davidicus Wong will be speaking on self-care at the Bob Prittie (Metrotown) Branch of the Burnaby Public Library on October 20th. Register by phone at (604)436-5400 or online at www.bpl.bc.ca/events. You can read more about achieving your positive potential in health at davidicuswong.wordpress.com.

Posted in Balance, Burnaby Division of Family Practice, Empowering Healthcare, Exercise, Healthy Living | Tagged , , , , , , , | Leave a comment

Are you an introvert or an extrovert?

Central Park, Burnaby by Davidicus Wong

Central Park, Burnaby by Davidicus Wong

September is a month of anticipation, relief and anxiety. It depends on who you are (student, parent or teacher) and where you fall in the spectrum of introversion and extroversion.

An introverted child may find new teachers, group activities and speaking out in class incredibly uncomfortable and daunting. In fact, some parents choose to homeschool because of this.

Our place along the continuum of introversion and extroversion seems to be a hardwired aspect of personality and physiology. Although many are somewhere between the extremes of introversion and extroversion, at least a third of the people you know are introverted.

If you’re introverted, you may prefer reading a book at home to going out to a party. You need to reflect before you speak, and you may find social interactions with multiple people emotionally draining. You need time alone to recharge your batteries.

Extroverts on the other hand thrive on social interaction and in fact are energized by people. They may need to express themselves in order to figure out what they’re thinking.

In her bestseller, “Quiet: the Power of Introverts in a World That Can’t Stop Talking”, Susan Cain outlines the neuroscience, psychology and sociology that explains the differences and relative strengths and gifts of introverts and extroverts.

She describes how our western society is biased towards an Extrovert Ideal. We favour charismatic leaders, people who speak out and control meetings, and the gregarious and outgoing.

Our classrooms and workplaces often favour extroverts who feel more comfortable working in groups and shouting out the answers to the teacher’s questions.

Beautifully written and researched, Cain’s book is a must read for teachers, employers, parents and partners of introverts. It will change the way you see and value introverts, and if you’re an introvert, it will change how you see yourself.

In workplaces with an open office design without privacy, more introverted employees will be more uncomfortable and less productive. If an organization relies on group brainstorming meetings, they may not hear the creative insights of the more introverted who do some of their best work alone.

In the classroom, group activities do not bring the best out of more introverted students. The brightest are not always the first to press the buzzer.

Susan Cain’s book offers practical advice for introverts on self-acceptance and appreciation, understanding extroverts with whom they live and work, when to act more extroverted, and the importance of finding restorative niches to recharge themselves.

The marriage of an introvert and extrovert can be both challenging and rewarding. Extroverts may say things they don’t mean and thrive on conflict; introverts can be more sensitive to their words. Each partner needs to understand how the other needs solitude or social engagement. Cain offers insights to improve mutual understanding and honouring one another’s natures.

Our society is enriched by a variety of cultures, temperaments and personalities. Introverts have great ideas, feelings and insights to share, and with better understanding, we can nurture their strengths at school, at work and at home.

Dr. Davidicus Wong is a family physician. 

Posted in Relationships | Tagged , , , , | Leave a comment

The measure of your day

The Pool at Central Park, Burnaby

The Pool at Central Park, Burnaby

Is today just another day?

And tonight after it has passed, will it be forgotten?

Is it a day in the way? That’s a countdown day that you just want to get through because it stands between you and what you anticipate – a special day in the future, a holiday or the weekend.

In the trance of everyday life, we can get caught up with nonstop activity, endless goals and distractions. We lose sight of what matters most, and we can forget a simple truth.

Every moment is precious and every day a gift.

When they were young, I taught my children to frame each day.

Before they rolled out of bed, I asked them to say a prayer of thanks, considering all the good in their lives, especially the people they loved. By beginning the day with their cups half full, they would be more inclined to see the positive throughout each day, and when their cups were full, they would be more likely to share and give.

Again at the end of each day, at suppertime and at bedtime, they would recall the gifts of the day: what they enjoyed, what they received and what they gave.

This summer, my kids are asleep when I leave the house and they’re awake when I go to bed. I no longer keep track of their prayers, and I wonder if they like most grownups and teens have become too busy to frame their days and measure their moments day by day.

Most physicians experience a nearly constant pressure of time. While looking after our patients, there are always competing demands on our time. And outside of clinical time, we may be on call, attending endless committee meetings or managing a perpetual pile of forms and reports.

I must confess that every one of my days – like an overstuffed suitcase – is packed with activity. I sometimes judge the day by how much I have accomplished: A good day is a productive day.

But none of us should wait until the next holiday, retirement, or the end of life, to wake up and live each day.

We should begin – and continue – with the end in mind.

To not waste a day does not mean to pack it full of activity.

We waste this day by not being fully awake.

What gives your life meaning? Are you awake to the experience of being alive – tasting, touching, breathing, feeling?

What are your greatest goals? What are you doing with your time?

What are you doing this day to take one small step in the direction of your dreams?

Today are you talking to the people who matter most? Are you fully present in the presence of others?

The measure of each day is like the measure of our lives, and the unit of measure is love.

How have you shared love this day? Be gracious when receiving it. Be generous in expressing it.

How were you helped in big and small ways, and how are you helping others?

Don’t let this day slip by as another blur of time, another square on the calendar or another countdown day.

Make it count.

Preferences
§
1
2
3
4
5
6
7
8
9
0
-
=
Backspace
Tab
q
w
e
r
t
y
u
i
o
p
[
]
Return
capslock
a
s
d
f
g
h
j
k
l
;
\
shift
`
z
x
c
v
b
n
m
,
.
/
shift
English
alt
alt
Preferences
Posted in Grace, Happiness, Parenting, Positive Change, Positive Potential, Purpose, Relationships, Wisdom, Your Calling, Your Goals | Tagged , | Leave a comment