Immunizations

Immunizations have had far greater positive impact upon health in the developed nations than all of the other health services provided by physicians. Only a few years ago, smallpox, cholera, paralytic polio, diphtheria, whooping cough, and tetanus killed large numbers of people. These diseases are now effectively controlled by immunization in the United States and in most other developed nations. Smallpox has been eradicated from the entire world, and there is no longer any need for smallpox immunization. An incredible success story!

Frequent immunization is not needed now because these diseases occur less often and because we know that the immunizations provide protection for a long time. Thus, tetanus boosters are not required more often than every ten years for adults who have had the basic series of tetanus injections. As these conditions become rare, the problems of
side effects from the inoculations are in some instances as great as the risk of illness.

Do not allow yourself to be reinoculated just because you have lost records of previous immunizations. If you haven’t had a tetanus shot for ten years or so, ask for a booster shot while visiting the doctor for another reason. You can save future trips to the doctor by being protected for the next ten years. In general, do not seek out the optional immunizations. Flu shots, for example, are only partially effective and often cause a degree of illness themselves; they are recommended only for the elderly and for those with severe lung diseases.

Recommended Immunization Schedule

2 Months DPT (diphtheria, pertussis, tetanus), and Oral Polio

4 Months DPT and Oral Polio

6 Months DPT and Oral Polio

15 Months Measles

18 Months DPT and Oral Polio

5 Years DPT and Oral Polio

12 Years Rubella (Only for females with a rubella hemagglutination test that is

negative or less than 1:16)

Every 10 Years T(d) (adult tetanus, diphtheria)

We recommend that the optional immunizations (including mumps, hepatitis, pneumovac, and flu) be taken only upon the recommendation of your doctor, and than only after careful discussion. In general, do not initiate requests for those inoculations. They have a definite role for some people, but not for all.

Finally, here is a summary of what you need to remember about preventive medicine:

You don’t need frequent checkups if you feel well, except for a few specific tests. Blood pressure, Pap smears, breast examination, tuberculosis screening, glaucoma testing, and dental checks are the most important; most people will not even need all of these. Most of these procedures can be obtained through public health departments at city or county expense. Take your doctor’s advice concerning the need for a urinalysis, urine culture, tests of the stool for blood, rectal examination, or sigmoidoscopy.
Elaborate physical examinations or multiphasic screening may detect trivial abnormalities and thus worry you unnecessarily.
Complete physical examination should include counseling on health habits.
You should have a plan for obtaining medical care before the need arises.
You should be immunized according to recommended schedules, but you need “boosters” only occasionally in adult life.

If you follow these general principles and if you moderate your habits as discussed in my older posts, you are well on the way toward taking care of yourself.

Early Treatment

An effective health maintenance strategy includes seeking medical care promptly whenever an important new problem or finding appears. If you have a lump in your breast, unexplained weight loss, a fever for more than a week, or if you have begun to cough up blood, you should seek medical attention without delay. These may not represent true emergencies, but they do indicate that professional attention should be sought within a few days. Most times, nothing will be seriously wrong; on other occasions, however, an early cancer, tuberculosis, or other treatable disease will be found. In many cases, you can take care of yourself with home treatment. However, you must respond appropriately when professional care is needed.

To ensure timely treatment you need to have a plan. Think things through ahead of time. Do you have a doctor? If you need emergency care, where will you go? To an emergency hospital? To the emergency room of a general hospital? To the on-call physician of a local medical group? If you are not sure what to do after reading this matter, who can you call for further advice? Have you written down the phone numbers you need?
Only rarely will you need emergency services. But the time that you need them is not the time to begin wondering what to do. For all these Questions answer is plan ahead.

Multiphasic Screening

The term “multiphaisc” simply means that many laboratory tests are performed in an attempt to find abnormalities that are not readily apparent. Some multiphasic screening programs involve fifty or more tests, including blood studies, urinalysis, X rays, electrocardiograms, and other procedures. With automation, these tests can be performed quickly and economically.

Experience with these screening systems over the years has shown that many laboratory abnormalities are detected but surprisingly few major problems that need attention are found. No laboratory test is perfectly accurate, and each test has a certain number of “false positives” associated with it. There is danger that the doctor may feel obligated to follow up the “false positive” test with additional tests, thereby unnecessarily increasing both the patient’s cost and worries.

Because of these problems, we do not routinely recommend multiphasic screening except as part of a total health care program, such as the Kaiser-Permanente
Health Plans. In such programs, multiphasic screening has allowed more effective use of nurse practitioners and has encouraged more efficient health care delivery systems. Some physicians also feel that multiphasic screening is an effective way to reassure the “worried well.” That is, a negative multiphasic screening examination may help people who are overly concerned about their health to accept the fact that medical treatment is not likely to help them with their problems. Thus, like the complete physical examination, multiphasic screening may be of value not so much for the detection of disease as for providing a good opportunity for reassurance and counsel.

Screening for disease detection is justified only for those individual tests that can detect important and treatable problems. For many people, the blood pressure measurement is by far the most important test.

An Ounce of Prevention

An ounce of prevention, it is said, is worth more than a pound of cure. Medicine in recent years has been oriented to “cure” rather than prevention, even though many of the greatest medical successes, such as eradication of smallpox and control of paralytic polio, have been achieved through preventive measures. We have been “crisis-oriented”: our approach has been to wait for a consequence to appear and then try to treat it. Now, interest is appropriately focusing upon preventive medicine. The most important part of preventive medicine, moderating health habits, was discussed in my previous posts. The idea of preventive medicine also includes the following four strategies, and it is important to understand both their strengths and their limitations;

The checkup or periodic health examination
Multiphasic screening
Early treatment
Immunizations and other public health measures

The Myth of the Annual Checkup

The “annual checkup” is still recommended by some schools, camps, employers, and the army. Curiously enough doctors seldom go to each other for routine checkups, nor do they send their families. The complete “executive physical,” made popular a few years ago by large corporations that wished to insure the health of their most critical employees, is slowly being discontinued. Even these elaborate checkups, involving several days in the hospital, do not detect early and treatable diseases with any regularity, and they raise false confidence to some degree. That is, they encourage the false belief that if you are regularly checked you do not need to concern yourself as much about personal health maintenance.

There are a few areas in which periodic screening is necessary, and it is important to keep them in mind:

High blood pressure is a significant medical condition that gives little warning of its presence. During adult life it is advisable to your blood pressure checked at least every year or so. This measurement can easily be done by a nurse, physician’s assistant, or nurse’s aide; a full examination is not required. If high blood pressure is found, a doctor should confirm it, and you should carefully attend to the measures needed to keep it under control.
If you are a women over twenty-five, you should have a “Pap smear” taken every year or so. Some authorities now recommend beginning Pap smear testing at the age of beginning sexual activity, decreasing frequency to every three to five years after the first three are negative and again increasing the frequency to every one or two years after age forty. This test detects cancer of the womb (cervix), and in early stages this cancer is almost always curable.
Women over age twenty-five should practice breast self-examination monthly. Any suspicious changes should be checked out with a physician; the great majority of breast cancers are first detected as suspicious lumps by the patient. Women with large breasts cannot practice self-examination with as much reliability as other women and may wish to discuss other screening procedures with their doctor. In general, we do not like to recommend mammography as a screening procedure for women below the age of fifty, but there are exceptions, such as women who have already had a breast tumor or women with a strong history of breast cancer in their family.
A test for glaucoma (a treatable disease that can cause blindness) should be done every few years after age forty if there is a family history of glaucoma. Most cases of this disease are discovered during eye examinations, so it is generally advisable that such examinations include a routine check for glaucoma.
Tuberculosis skin tests (PPD or Tine Test) or periodic chest X rays are indicated if there has been any possibility of exposure to this disease. If the skin test was negative and becomes positive, check with your doctor.
Dental checks can save teeth, and regular dental examinations are recommended. The primary purpose of an annual dental examination is to find and fill cavities; the benefits of other aspects of the examination ritual are less well established.
Screening tests of Urine, tests for blood in the stool after age thirty, and regular sigmoidoscopy after age fifty are of more dubious value. Some doctors feel that these are worthwhile, and others do not.

The importance of these few examinations is underscored by their availability as a public service, free of charge, at many city and country clinics. These are the crucial elements of periodic checks; others are optional and controversial.

Self-Destruction Syndromes

Cigarette smoking, inactivity, alcohol abuse, obesity, drug use, and accidents all represent a form of suicide or self-destruction. These factors combine to be the most important determinants of your present and future health. You can live longer and feel better by employing enjoyable disciplines in your life-style. Get back in control. Remember that the effects of each bad health habit are cumulative. The probability of early death or disability increases the longer you continue to smoke, the longer you are obese, the longer you lack exercise, and the percentage of time that you ignore your seatbelt. Stopping bad habit at any time is beneficial. And for most of these problems, moderation, rather than total elimination, is the crucial health element.

Avoid making excuses: “Everyone is overweight in my family.” “I just wish I had the time to exercise.” “It’s easy to give up smoking, I’ve done it fifty times.” “I never drink before lunchtime.” “I can handle it.” I don’t smoke cigarettes all the way.” “Diets just don’t work for me.” It is embarrassing to hear such statements offered by apparently intelligent people. First you need insight; then change is possible.

How can you conquer a habit? This is accomplished only by hard work. We have given most of the principles above. Avoid self-deception. Set goals and write them down. Chart your progress. Work with others who have the same problems. Plan to work at it the rest of your life. Tell others what you are doing. Discover the pleasant dividends of your change of habit and remind yourself of them: a better sex life, better physical reserve during the day, admiring looks from others, more energy, more money, a clear mind, less illness.

Decide to make permanent changes in your life. Crash diets, periods of time “on the wagon,” and spurts of physical activity are all poor practice. When you exercise beyond your conditioning, you stress muscles, ligaments, and the heart. When your weight bounces from high to low to high like a yo-yo it is just as harmful to your heart and arteries as if you had kept the initial high weight. The spree drinker adds additional social and medical problems to those of the steady alcoholic. These issues are for a lifetime, and there are no short-term solutions.

You are the patient. It is your life and your responsibility. Define for yourself those health goals which are important to you and your family. Define a solid and workable program to approach these goals, and plan to maintain that program for the rest of your life. You will live longer, feel better, and have more energy to share with your family and friends.

The Errant Vehicle

Fastening an automobile seat belt doesn’t seem like medical treatment, but it is very powerful preventive medicine. Trauma now accounts for 74 percent of all deaths between the ages of fifteen and twenty-five, and accidents are the fourth most important cause of death at all ages.

Seat belts interlock devices, speed limits, and drunken driving programs are often considered to be annoying interferences with our personal freedoms. Yet, attention to safety measures is the easiest of all of the personal health habits. Because accidents kill often in youth, the total health impact in terms of years of life lost is even greater than statistics suggest. Young people forget the importance of good health habits because they do not feel threatened by cancer, heart disease, and strokes. But poor driving habits, such as not using seat belts, showing off, and drinking before driving, can kill just as surely as cigarettes, and even more quickly. Young Americans who die on the highway usually perish at the hand of another young American.