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Breast Cancer Screening Recommendations Revisited

Are you confused about breast cancer screening recommendations? If you are, you are not alone.

Multiple organizations have come out with conflicting studies, data, and recommendations. Those advocating for reduced screening argue that screening does not improve the death rate from breast cancer; that women who have biopsies that are found to be benign suffer significant psychological harm; and that cancers are found that would never cause death.

Significant flaws have been found in these arguments by physicians who have committed their careers to understanding and treating breast cancer. There are multiple problems with the scientific methodology, assumptions, endpoints and analyses used in these critiques of mammogram screening recommendations. One problem is that medical science currently does not have the ability to distinguish between lethal cancers and those that will not cause death. Based on rigorous scientific data, we do know that the best way to improve survival from breast cancer is to detect it before it becomes clinically obvious and to treat it early.

None of the major oncology organizations support the guidelines calling for reduced screening. A letter to the New England Journal of Medicine ....

High blood pressure in the doctor’s office

“I don’t get it! Everytime I come to your office my blood pressure is high. It’s never like that anywhere else!”

“White Coat Hypertension” is very common and affects many people, even those who feel at ease with their physician. But whether your blood pressure is low or high at the doctor’s office, if you’ve been told you might have hypertension, you are likely to find yourself at home, or in a grocery or drug store with your arm in a cuff trying to figure out if your blood pressure is reasonable. A key to successful self-measurement is knowing the proper technique.

The big studies of blood pressure in the population upon which we base all our definitions of normal and high values were careful to take their measurements in a standardized way. The patient should avoid coffee, tea, nicotine, and other stimulants for at least 30 minutes prior to the test. She should sit quietly for a full 10 minutes reading or softly conversing before measurement. Even reaching across the table to pull the BP cuff near is to be avoided. (Get the machinery next to you when you first sit down.) Use an upper arm cuff. Forearm and finger devices are not reliable. Feet should be flat on the floor, clothing comfortable, and a bare arm may be needed for some machines. Two or three measurements a few minutes apart may be averaged.

A few caveats to mention: if one arm is higher than the other, you have to go by the higher side. Humans have a natural ‘diurnal’ variation, with most of us having a little higher blood pressure in the morning compared with later in the day. Blood pressure rises with physical and mental exertion and takes some time to come down, so don’t expect a resting value if you’ve not been at rest for 10 minutes or more.

Blood pressure is dynamic and always changing. The majority of values should be in a good range; your physician can help you determine if your numbers are in the range you need for optimal health.

Tips for getting the most out of your inhalers

“Darn! My inhaler is out and I am going to have to call today, a Sunday, to get a refill…”

Spring is here! And that means asthma season is back, and with the nicer weather, pollen counts are high. Flowers are wonderful and the trees beautiful, but if you are like me, some of those plants have your number. The beautiful smells come with itchy eyes, sneezes, and for some, a serious amount of wheezing.

Patients are reaching for their inhalers more often, and sometimes getting into serious respiratory trouble, especially if their medication is running short. Inhalers are expensive, too, and so using them optimally is both financially and healthfully important.

Fortunately, a couple of tricks can really help maximize an asthma spray’s value.

The medication comes out fast and hard when you squeeze the canister, and it can be difficult to time your breath to inhale the dose well, plus with the energy of the release being so high, a lot of misted drug can zoom right out of your mouth. The trick is to use a ‘spacer’, and the simplest is a rolled up piece of paper, to about a one inch diameter. Tuck the sprayer in the far end, wrap your lips around the outside of the other end, and take your leisure squeezing and breathing! The tube holds the mist in place for a few seconds, letting you better coordinate your inhalation and improve substantially the amount of drug you get to where it is needed.

The second tip is to use a steroid inhaler daily if you need your rescue inhaler more than a few times a week. The rescue inhaler will become less effective the more you use it if you don’t directly treat the inflammation of the allergic response in your bronchial tubes with a low dose of cortisone type medication. The dose of the latter is small and will not cause harm to the rest of your system if used according to directions, but it will keep your rescue medication most beneficial!

Two years in the life of the Swedish blog

For those of you who don't know, today is the official two year anniversary of the Swedish blog - this means Swedish has been blogging several times a week for two full years!

What have we been blogging about this year?

Who's been blogging?

We've had people from across Swedish blogging (more than 100 the last time we checked), including:

  • Surgeons

  • Nurses

  • Family Medicine and Primary Care Physicians

  • Dietitians

  • Educators

  • (And many others!)

Why are we blogging?

We started the blog as a way to connect with you (our community), whether you're a current patient, a past patient, a future patient…or just someone who stumbled across our site looking for health information. We believe our role is to be a resource of information, both online and off. Blogging gives us an easy way to keep you up to date, informed, and engaged on a number of health topics

Can stress cause a rash?

“Did my stress cause this rash?!”

A patient recently asked this question half-jokingly, but as we talked further about his life circumstances, he came to the answer of his own question. Issues between him and a loved one came tumbling out, his persistent unhappiness with the present state of affairs made it clear that yes, very much so, his stress is playing a role in his rash.

How can this be possible? And if it is true, that our mental states can give rise to very straightforwardly visible physical maladies, how are we to respond?

The interplay of our minds and bodies runs deep. The more time I spend in the practice of medicine, the more amazed I am at the powerful effects that run back and forth between the two poles of our being, the physical and the mental aspects of our selves. Physical events, such as broken bones, strokes, and degenerative disease strike ...

Picky Eaters - Tips for Establishing Healthy Eating Habits

Picky eaters. We all know at least one, have a child that’s proud to be one, or heck, might have a history of being one (gulp). Every child is unique, hence the approach to picky eating needs to be highly individualized, but here I will outline some general tips on how to establish healthy habits for picky eaters!

The Basic Rules...

Healthy holiday eating and drinking tips

Happy (healthy) holidays! Here's a roundup of great tips, recipes, and videos to help you make decisions about what to eat or what to make & bring to holiday gatherings:

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