Preventive Medicine or Too Much of a Good Thing

When do we draw the line for preventive medicine? The latest ASCO guidelines for high risk, post menopausal women to prevent breast cancer recommend proactively taking Evista, Aromasin, or Tamoxifen to reduce risk. I had already heard about Tamoxifen but not Evista or Aromasin.

When I first read this the first thing that jumped into my tiny chemo-fogged/fibro-fogged brain is this a big ploy by the pharmaceutical companies to generate millions of new patients? That would be a huge conspiracy theory that I immediately pushed away.

The next thing that leaped into my tiny chemo-fogged/fibro-fogged brain is that its getting to be that we need to stop enjoying ourselves and live preventatively with no fun? The guidelines end with:

"If you have a higher-than-average risk of breast cancer, it makes sense to do everything you can to keep your risk as low as it can be. There are lifestyle choices you can make, including:

• maintaining a healthy weight
• exercising regularly at the highest intensity possible
• limiting or avoiding alcohol
• limiting processed foods and foods high in sugar
• eating healthy, nutrient-dense food
• not smoking"

I felt this is getting to the point of  ridiculousness. I mean 'healthy, nutrient-dense food' - can you please define that? I am sure it does not include chocolate or ice cream. If I went to the grocery store and asked for 'healthy, nutrient-dense food', I think they would look at me like I was crazy.

And exercising regularly at the highest intensity possible? This is getting to be too much in my book. Just tell me to live healthy and I can handle that.

I am not dissing ASCO here. They are a wonderful organization but I think that this is overkill.

Yes preventive medicine is a good thing but this is too much. I'm sorry.

Antibiotic resistance

When was the last time you were prescribed antibiotics? And took them? The entire course of them? And what ailment did you have? I think the last time I was prescribed antibiotics was a few years ago after some surgery. I very rarely take them.

I hear more and more complaints from friends and family that they were sick for a couple of weeks, went to their doctor finally, and were told they would have to wait it out with over the counter medications, fluids and rest. They were not given antibiotics as they had expected and were frustrated.

This is a good thing. One of the biggest medical problems we have these days is resistance to antibiotics and the emergence of 'super germs' which cannot be treated with antibiotics. Too often prescriptions for antibiotics have been given without signs of infection and often prescriptions are not being taken for their entire course - the patient feels better but is not completely recovered and still has the germs in their body which now have the potential to become antibiotic resistant.

On Monday, I was a moron (to use the term loosely) and managed to cut the palm of my hand with pruners. Yes it bled a lot. Yes it was deep. Yes I panicked. No it wasn't very big. But as it was on my lymphedema arm, I called my doctor's office which sent me to the minor ER (who knew there is a minor ER but there is) in case it needed stitches. It needed a pressure bandage, no stitches, no steri strips. I felt somewhat like an idiot that I even went to get medical attention in the first place but was concerned about my lymphedema arm which is not supposed to have any punctures or pressures, never mind incisions from pruners, to prevent lymphedema which can become a permanent problem.

They also gave me a prescription for antibiotics and told me that at the least sign of infection to fill the prescription and take the entire course of them. I toyed with the idea of taking them to prevent infection but rejected that thought on the grounds that I really don't want to take any more medications at this point. I hadn't expected to get antibiotics at all.

I do think that patients go to the doctor and expect to get antibiotics for almost anything these days. Doctors are heeding the call of reducing prescriptions to prevent the emergence of more super drugs but patients do not always understand.

As patients we need to understand the bigger picture. Antibiotics are good but should not be taken unless they will help. And if you take them you need to take the entire dose.