When To Get a Flu Shot?

This is part of the big conspiracy to confuse patients. When am I supposed to get a flu shot? In previous years I would go to my primary care physician and get a flu shot. I saw her a couple of weeks ago and was told it was too early. I should wait until the hospital has its clinic in October or go to an other flu shot clinic I find. Hmmmm...

So I did some research. The latest wisdom is to get a flu shot between Halloween and Thanksgiving. But there is other evidence that it may be different for over 65 or the medically frail. Am I medically frail?

I don't know. I do know I am confused.

My doctor confused me

I went for blood work last week for two doctors. As usual I got the results the next day, or so I thought. This morning I got more blood work results back. And I don't understand them.

These are more thyroid blood tests. Originally I got my TSH level back. Then this morning I got T4, thyroglobulin AB and thyroglobulin. I didn't get my T3 levels. I don't always get all these thyroid tests done so I don't understand them as well as my TSH levels.

And why all of a sudden do I get all these blood tests? To be fair, the hospital switched to a new computer system last year with a patient portal where I get my test results directly instead of getting them from my doctor's office or the records office. So maybe they did these tests and I just wasn't aware.

So it means I definitely need to call my doctor about them.... But I'll give her until the end of the week to contact me first.

I think its a vast medical conspiracy to confuse the patients. I have been blogging about this for years. If you can't cure them, confuse them.

Too much advice = too much confusion

With every ailment, comes a list of advice. Do this, don't do that; eat this, don't eat that; these exercises, not those.That's fine with one ailment. But with my list of ailments, it quickly gets very confusing.

I subscribe to multiple Google Alerts - one for each ailment. Each one sends me a new list each day of articles or blog posts or some other piece of information found on line on each topic. The daily melange can include anything from somebody ran a race to fund raise for someone with one of the ailments to a medical research advancement. So there can be everything.

Including advice. Today's advice included diet secrets for arthritis, prescription review for fibromyalgia, a male oncologist who got breast cancer, and some woman and her family get lots of support after her thyroid cancer diagnosis. First of all its too much information for me to digest this early in the day, never mind later in the day.

Second of all, if I tried to select a specific topic (food/lifestyle, for example), it gets very confusing. Eat this, not that; drink this, not that; do cardio, skip cardio and do yoga, but my doctor says no yoga. Aaarrrgggghhh!

I give slightly more weight to advice from medical professionals, especially from my doctors. If one doctor gives me advice that conflicts with another doctor, I will ask what I should do.

So how do I handle all this? I do what feels right for me. That's the only way to deal with the piles of advice.

Those pesky breast cancer screening recommendations

Can I ask who is confused over the 'revised' breast cancer screening guidelines? Or should I just ask who isn't confused? Yes, no, yes, maybe, no one, everyone? How old? Not that young, should be older. Well maybe not. Not for everyone. Wait, oh just test everyone. No only for some people, talk to your doctor. That's a lot of different answers.

And in both my cancers I was clearly not a candidate for hitting the so called criteria for any testing. So I just ignore all the comments about too young or too old. Those really should be less likely or more likely instead of age related if you ask me. But they didn't ask me.

Anyway, so the USPTF (US Preventative Task Force) released a clarification on their breast cancer screenings earlier this week. They also claim they were misunderstood. And they want to clear up confusion. Well maybe the confusion was because what they said back in 2009 concerned everyone.

"The U.S. Preventive Services Task Force (USPSTF) released its final recommendations for breast cancer screening Monday in an attempt to clear up some of the confusion.

The group recommends that women at average risk for breast cancer should have a mammogram every other year beginning at age 50 up to the age of 74. Women in their 40s are advised to make an individual decision in partnership with their doctors, since the likelihood of benefiting from screening is lower for women in that age group.

Though this is an update from the group’s 2009 recommendations, the guidelines remain largely unchanged and a draft was released earlier this year.

The report, published in the Annals of Internal Medicine, also concluded that there’s not enough evidence to determine if newer 3D mammography is a good option for routine screening, or if women with dense breasts need extra testing.

The group’s 2009 report drew controversy for questioning the usefulness of mammograms for women in their 40s. But the task force says their words were widely misunderstood."

Blah, blah, blah. So in their clarification here they state that a mammogram every other year is all that is needed starting at age 50 if you have average risk. Let me ask all my friends in their 40's with breast cancer what they think if they had waited until 50 for a mammogram.

Okay, so medically maybe there is some logic in their plan. Or maybe not. If you look at breast cancer occurrence rates (from Cancer.gov):

Age 30 . . . . . . 0.44 percent (or 1 in 227)
Age 40 . . . . . . 1.47 percent (or 1 in 68)
Age 50 . . . . . . 2.38 percent (or 1 in 42)
Age 60 . . . . . . 3.56 percent (or 1 in 28)
Age 70 . . . . . . 3.82 percent (or 1 in 26)

It sees clear that most breast cancers occur after the age 40. So I don't understand this wait until 50 business at all. Now I am even more confused.

I am unsure

So I have had the same doctor for pain management, Dr G, for a good six years now because of my back pain and later fibromyalgia. We have had a good relationship and he has helped control my pain. I have always liked him and thought he was doing right by me.

I have a friend, L, who has been also going to him for pain management for her issues, which have included curvature issues with her spine. We have compared notes and treatments in the past and both like him.

I had lunch with L this week for the first time after some extensive back surgery last spring. She told me she will never see Dr. G again. He continued to treat her pain, never referred her to a surgeon or anyone else, or sent her for more scans. As a result, her back surgery was much more extensive than if she had had the surgery five years ago. She is very mad at him.

L got a new primary care last year who referred her to a surgeon for her back pain who told her she should have had surgery years ago. But Dr G is an anesthesiologist so he didn't ever refer her to a surgeon.

Now I do not know what to think. Dr G has always told me there is now surgical cure for my pain and I have believed him. I have also done some research on my own on potential back surgery and found that back surgery is very iffy in most cases so I have continued to agree with him. I know every patient is different but this makes me unsure about the whole situation.

I find this very disappointing and disheartening in that we assume a doctor has our best interests at heart but L clearly had a different experience. Dr G believes in medicine to treat pain as that is what he does as an anesthesiologist. A surgeon always believes that surgery is best because that is what they do. Patients get stuck in the middle. And we want to believe that what our doctors tell us is in our best interest.

I think I need to shift my focus from believing Dr G is always correct to doing some double checking. And I have a plan. I see Dr G this coming Friday as a follow up. But then I see my new primary care in a couple more weeks and I will talk to her about my pain issues, particularly my back. I do not want unnecessary surgery but I do want to do whatever I can to feel better.

We must trust our doctors but sometimes we need to do a little double checking. I don't like that part.

Soy and breast cancer, again

I hate tofu (as you may know) and have been avoiding soy and soy products since my breast cancer diagnosis. There has been a lot of controversy on the subject of soy and breast cancer because of estrogen issues. Now I think I have found some better information.

Some new research was done at the University of Illinois - Champaign/Urbana that was released earlier this week.

"Researchers at the University of Illinois found that the compounds in minimally processed soy flour stimulate genes that suppress cancer, while purified soy isoflavones stimulate oncogenes that promote tumor growth."

Hence the confusion. Soy is good if not processed and helps prevent cancer but if it is processed it can increase cancer risk.

So if you really want you can eat tofu (without me) and soy flour but skip anything with processed soy.