Brown & Toland's HealthLink | Fall 2004 by davidpsu

HealthLink Fall 2004

WELCOME

Brown & Toland Medical Group’s New Health Newsletter elcome to HealthLink, the health newsletter designed especially for Brown & Toland Medical Group patients and the residents of San Francisco. As a physician group of more than 1,500 doctors providing care for close to 200,000 patients, we are proud to provide you with this useful source of important news and information. Part of any good health health Of course that’s the primary objective regimen is having at of any doctor, to keep his or her patients healthy. Part of any good health regimen is your disposal a good source of information having at your disposal a good source of information on a variety of health care topon a variety of health ics. We’ve designed this newsletter, which care topics. we will print quarterly, to provide health articles for all members of your family, from the very young to the not-so-young. We believe that preventive medicine is the best medicine. Additionally, our Web site, www.brownandtoland.com, also features a health library with thousands of articles on hundreds of topics. Please visit our Web site often, as we are constantly adding more Visit Us on the Web articles and interesting information. Our new Web site offers Brown & Toland was founded as the California Pacific Medical patients, physicians and Group in 1992 and, with the addition of physicians from the visitors a wealth of information. University of California–San Francisco, took its current name in 1997. Cholesterol and You Now one of the nation’s leading medical groups, Brown & Toland Why it’s vital to know your has earned numerous awards for quality, including the prestigious blood lipid levels. Blue Ribbon Award from the Pacific Business Group on Health for Diagnosing Diabetes three consecutive years. How to tell if you’re at risk At Brown & Toland, we take quality seriously. Please read the for this serious condition. information in this newsletter and let us know if you find it useful. Managing Send your comments to Richard Angeloni, HealthLink’s editor, at Hypertension There are many ways to rangeloni@btmg.com. Dear Neighbor

bring high blood pressure levels down, and they don’t all involve drugs. 9 Just for Men Men need some specific screening tests to stay healthy. 10 Just for Seniors Here’s information on the new drug discount cards, and more.

Sincerely, Lin Ho, M.D.

Gloria Austin

President and Chairman of the Board

Chief Executive Officer

Brown & Toland’s HealthLink editor: Richard Angeloni, Corporate Director, Communications and Public Relations, Brown & Toland Medical Group, 415.972.4307. Brown & Toland’s HealthLink is published quarterly and printed in the United States. Copyright 2004 by Health Ink & Vitality Communications, 780 Township Line Road, Yardley, PA 19067, 267.685.2800. Articles in this newsletter are written by professional journalists or physicians who strive to present reliable, up-to-date health information. Our articles are reviewed by medical professionals for accuracy and appropriateness. No magazine, however, can replace the care and advice of medical professionals, and readers are cautioned to seek such help for personal problems. Some images in this publication were provided by © 2004 PhotoDisc, Inc. (404)

Brown & Toland’s HealthLink, Fall 2004

www.brownandtoland.com

HEALTHY CHOICES

How to Choose A Medical Group Choosing a physician and a medical group is an important decision for you and your family. Here are some helpful hints se the telephone book or Internet to search for medical groups in your area. List a few questions to help you select the medical group that fits your needs, such as: Does the medical group accept my insurance? What hospitals does the medical group use? Where are these hospitals located? Are they close to my work? My home? My children’s school? Do my family’s physicians participate in the medical group? Can the medical group’s doctors automatically refer a patient to a specialist, or does the HMO/ insurance company have

to review the referral (sometimes called a “consult”) in advance? Can women see any gynecologist they choose? Next, try to narrow your choices down to three physicians by asking yourself the following questions: Do you have special needs? If you do, look for a Primary Care Physician (PCP) who has expertise in those conditions. Do you want a doctor who speaks a language other than English? Do you prefer a male or female doctor? Is the doctor’s office conveniently located? Do you have an age preference?

Your PCP is responsible for preventive care, managing routine illness and minor injury, prescribing medication, and coordinating all the care you get from specialists, hospitals or caseworkers. You should do both formal and informal research so that you are familiar with your PCP’s background. ■

For more information about choosing a physician, and for a list of the physicians available, please call Brown & Toland’s Customer Service at 800.225.5637 and request a Physician Directory. Or visit Brown & Toland Medical Group on the Web at www.brownandtoland.com.

Brown & Toland Debuts New Web Site rown & Toland B Medical Group will debut a new Web site in September 2004. The Web site, www. brownandtoland.com, features a fresh, new look as well as a health library with thousands of articles on a variety of health topics. The site also includes a comprehensive physician directory that allows users to search for physicians by name, specialty or ZIP www.brownandtoland.com

code, as well as other important information for Brown & Toland patients and visitors to the site. The new look features easy-to-use navigational tabs designed to provide quick, easy access to information. The Web site also contains a portal to Brown & Toland’s Web site for physicians and physician offices. The information on the physician site is password protected.

On the site, patients and visitors may access electronic editions of HealthLink and “opt in” to tailor the health information they receive via the Web. Future modifications to the site will allow Brown & Toland patients to make appointments and reconcile their accounts with select physician offices. “Today’s consumer has come to expect to use the Web as a research tool and

www.brownandtoland.com

a tool for transacting business, be it making appointments or paying bills online,” says Nancy Griest, Brown & Toland’s Vice President, Medical Group Services–Information Technology. “In the future, we will make improvements to the Web site to make it even easier for our patients to use and to provide more information.” ■

Brown & Toland’s HealthLink, Fall 2004

HEALTHY DIET

Cholesterol What is it and what does it do?

soft, waxy substance found in your cells and blood, cholesterol is — to be technical — a steroid that is classified as a lipid (fat), says Richard Stein, M.D., chief of the division of cardiology at Brooklyn Hospital Center in Brooklyn, N.Y. “This classification reflects its integration throughout the body in cell membranes — the walls of the individual cells that make up our body,” he says. Although cholesterol is an essential part of life and contributes to our health and well-being, too much of it can lead to heart disease, a heart attack or a stroke. Changing eating and exercise habits to become heart-healthy can benefit not only you, but all members of your family. Discuss with your physician if you are at risk for heart disease and should have a cholesterol screening.

The good, the bad and the excess Because cholesterol can’t dissolve in the blood, lipoproteins carry it to and from cells. “These lipoproteins include low-density lipoprotein [LDL], high-

density lipoprotein [HDL], very low-density lipoprotein [VLDL] and triglycerides,” says Dr. Stein. Of these, LDL and HDL are the most important. “LDL cholesterol is a lipoprotein used to deliver

Recommended Low-Cholesterol Foods The National Heart, Lung, and Blood Institute (NHLBI) recommends the following foods to keep cholesterol at a healthy level: Foods low in saturated fat and low in total fat. Foods containing fat have both saturated and unsaturated fats. Saturated fat raises cholesterol levels, so choose foods such as whole grains, fruits and vegetables. All of these are naturally high in fiber and starch and low in total fat. Foods high in starch and fiber. Pasta, grains, bread, cereal, fruits and vegetables are low in cholesterol and saturated fat — but try to limit toppings such as butter and sauces. Foods low in cholesterol. Your liver produces all the cholesterol required by your body, so eating animal products only raises cholesterol levels. Even though some animal products are low in saturated fat, they are high in cholesterol (such as egg yolks or liver). The American Heart Association (AHA) also recommends eating no more than 6 ounces of lean meat, poultry or fish per day, and using low-fat and skim/fat-free dairy products. Protein from animal products can be replaced by protein from vegetables, such as beans.

Brown & Toland’s HealthLink, Fall 2004

cholesterol to cells, while HDL is used to carry cholesterol from the body back to the liver for excretion,” Dr. Stein adds. LDL can accumulate in the arteries, forming a hard deposit called plaque, which blocks the flow of blood. When LDL levels are high, your risk of heart disease increases. High levels of HDL — sometimes referred to as “good” cholesterol — decrease your risk of heart disease. “LDL is the form of cholesterol associated with coronary artery disease and heart attacks,” Dr. Stein says. “High levels of LDL cholesterol are associated with an increased risk of heart disease.” LDL cholesterol should be less than 160 mg/dl in normal individuals and 100 mg/dl in patients with coronary heart disease or increased risk — such as those with diabetes. “High HDL levels are associated with a reduced risk of coronary heart disease,” he says. “HDL cholesterol should be higher than 40 in

men and 50 in women. Triglycerides should be less than 175 mg/dl.” Your liver produces 80 percent of the cholesterol in your body, says Dr. Stein. Therefore, foods that contain cholesterol — such as animal products (meat, poultry, fish, egg yolks and whole milk dairy products) — should be eaten in moderation. Fruits, vegetables, grains, cereals, nuts and seeds do not contain cholesterol. Dr. Stein suggests a diet low in fat, “such that less than 30 percent of our daily calories come from fat, and most of the fats are not saturated fats,” he says. “Reducing cholesterol in the diet is important, but not as important as the fat reduction, since fats — especially saturated fats — stimulate the liver’s production of LDL cholesterol.”

Are you at risk? There are several risk factors contributing to heart disease, according to Dr. Stein. These include smoking, high blood pressure, an inactive lifestyle and a history of heart disease in parents or siblings (below age 55 in male relatives or 65 in female relatives). Cholesterol levels are also an important consideration — increased total cholesterol, increased LDL cholesterol and reduced HDL cholesterol increase the risk of heart disease. Is high (or low) cholesterol hereditary? “Some forms of high LDL cholesterol are entirely inherited, but most are a combination of heredity and lifestyle,” says Dr. Stein. “HDL levels are, by and large, inherited, although they are reduced in smokers and inactive people.” www.brownandtoland.com

MEDICATION

to control cholesterol

Diabetes

Both you and your doctor should discuss whether you need to take medication to control your cholesterol levels. The AHA lists several factors that may affect the decision to take cholesterol medication:

Five million Americans with diabetes are undiagnosed

Age: Men age 45 or older, and women who have premature menopause without estrogen replacement therapy or are age 55 and older Family history: Anyone whose father, brother or son has a history of coronary artery disease before age 55, or whose mother, sister or daughter had coronary artery disease before age 65 Smoking: Anyone who smokes, or lives or works every day around people who smoke High blood pressure: Anyone with a blood pressure reading of 149/90 mm Hg or above on two or more occasions Diabetes: Anyone with a fasting blood-sugar level of greater than 126 mg/dl

You are what you eat There are several methods used to reduce high cholesterol levels, including following a healthy diet, getting plenty of exercise and taking medication, or a combination of the three. “Diet and exercise are key elements of treating high cholesterol because they will normalize cholesterol values and will act independently to reduce the risk of heart disease,” says Dr. Stein. Foods to avoid, Dr. Stein advises, include whole milk and cream, foods cooked in fats (oils), fatty red meats and baked goods with fats — especially “tropical fats” such as palm and coconut oils — which are highly saturated. Exercise Exercise is another important component in lowering cholesterol. Physical activity, for some people, increases www.brownandtoland.com

No established heart disease: Anyone without heart disease but with high cholesterol levels (LDL greater than 160 mg/dl in a normal individual or greater than 130 mg/dl in someone with two or more risk factors)

HDL (good) cholesterol levels and reduces the risk of heart disease. In addition, exercise helps control other factors that can affect cholesterol levels and contribute to heart disease — weight, diabetes and high blood pressure. Jogging, swimming and brisk walking all help condition your heart and lungs, and moderate daily exercise — walking, housework, gardening and dancing — are also beneficial. NHLBI suggests increasing your level of physical activity by adding the following activities to your daily routine: Taking a walk at lunch or after dinner Using the stairs instead of the elevator Getting off the bus a few

RISK FACTORS

stops early and walking Parking farther away when shopping Riding a bicycle Working in the yard or garden Check it out There are a variety of factors to take into consideration when deciding how often to have your cholesterol checked. Everyone age 20 or older should have his or her full cholesterol panel measured every five years, according to the latest guidelines. Discuss your particular situation with your physician. Dr. Stein says that once a year is usual, but if your cholesterol levels are borderline, then every six months is probably a good idea. ■

iabetes is more widespread than most people D realize. Eighteen million Americans have the disease, but only 13 million have been diagnosed. By the time the remaining 5 million are diagnosed, they will have had diabetes for an average of five to seven years, says Davida F. Kruger, M.S.N., R.N., an officer of the American Diabetes Association (ADA). “The condition is often missed in routine exams because it can develop slowly and shows no initial sympYou’re at risk of diatoms.” betes if you answer Most health care pro“yes” to two or more viders test blood sugar of these questions: or glucose as part of an annual exam, but don’t Are you more than hesitate to ask for this 20 percent overweight? test if you’re concerned. Are you over age 40? A fasting blood-sugar Does an immediate level of greater than family member have 115 mg/dl indicates you diabetes? may need additional Are you of American tests for diabetes. Indian, African American “Once people know or Hispanic lineage? they have diabetes, they Do you have high blood can control their glucose pressure, high cholesto improve their longterol or high triglyceride term health,” Ms. Kruger levels? says. “Research has Did you ever have high shown that eye disease blood sugar during can occur within five pregnancy (gestational years of the disease’s diabetes)? onset, and kidney disease starts to develop after 15 years if diabetes isn’t well controlled. But a person’s risk of having diabetic complications is reduced by 65 percent if the condition is well-controlled.” The ADA recommends that people with diabetes use the following strategies to control their glucose and their symptoms: Diet: Eat more fresh fruits, vegetables, lean meats and fish, and eat fewer high-fat foods. Exercise: Physical activity is one of the best treatments for type 2 diabetes; it decreases blood glucose and promotes weight loss. Medication: Take medication if your doctor prescribes it. ■ Brown & Toland’s HealthLink, Fall 2004

WOMEN’S HEALTH

Women and the Risk for

Heart Disease f an older man comIdoctor plains of chest pain, his will probably think heart attack. But if an older woman has chest pain, her doctor may think first of indigestion. And even if a

woman is diagnosed with heart disease, the recommended treatment may be less aggressive than for a man with the same stage of disease. Why is there such a differ-

ence in treating and diagnosing heart disease in men and women? “I think there’s a belief held by many men and women, physicians and laymen alike, that heart attacks

are solely a man’s problem. But coronary artery disease is the leading cause of death of both men and women in the United States,” says Marianne J. Legato, M.D., founder of the Partnership for Women’s Health at Columbia University. Her female patients tell her they worry more about cancer, yet 250,000 women die of heart attacks each year, compared with 40,000 who die of breast cancer. Why women are at risk Although both men and women are susceptible to heart disease, the reasons they develop it are different. Women typically have smaller hearts and narrower arteries than men do, so it takes less plaque to block a coronary artery and impair the flow of blood and oxygen to a woman’s heart. The female hormone estrogen is believed to

STAYING HEALTHY

Managing Borderline Hypertension Without Drugs ven if your blood presE sure is normal or highnormal, you’re still at increased risk for hypertension (high blood pressure), the condition in which your heart works too hard and the resulting forceful blood flow harms arteries. But it’s possible to keep your blood pressure from

rising, or even push it back to the optimal range (120/80) if you change your health habits, especially if you’re overweight and slim down. “The moment you start a lower-calorie diet and lose weight, blood pressure begins to fall. It’s almost like instant gratification,”

Brown & Toland’s HealthLink, Fall 2004

says Michael Weber, M.D., past president of the American Society of Hypertension and dean for research at Downstate Medical College of the State University of New York in Brooklyn. High blood pressure is 140/90 mm Hg or greater. Systolic blood pressure between 120 and 139 mm Hg or a diastolic blood pressure between 80 and 89 mm Hg is considered prehypertension. Both hypertension and prehypertension can increase your risk for stroke, coronary heart disease and congestive heart failure, especially if it’s uncontrolled. Dr. Weber offers these

lifestyle suggestions for keeping blood pressure in check: Exercise your options Work out regularly and build more physical activity into your day even if you’re not overweight. For example, pace while talking on the phone, walk instead of driving, or play with your children instead of watching from the sidelines. “There’s evidence that exercise alone slightly lowers blood pressure,” says Dr. Weber. “It can also make weight loss easier, even if you don’t reduce calories. People who exercise burn calories more efficiently than those who don’t.”

provide partial protection against heart disease. After menopause, however, as the body gradually stops producing estrogen, the risk of developing the disease steadily climbs. The symptoms of heart disease in women are different from those in men, which can make it more difficult to diagnose. Women’s symptoms include angina (or chest pain), chronic breathlessness, chronic fatigue, dizziness, edema, rapid heartbeat and nausea. Men’s symptoms include sudden pressure, fullness, squeezing or pain in the center of the chest that lasts for more than a few minutes or goes away and then comes back; pain that radiates from the center of the chest to the shoulders, neck or arms; chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath; and sudden onset

Test your salt sensitivity Some people with borderline hypertension, especially African Americans, are salt-sensitive. “When they consume salt, they see a rise in their blood pressure. When they reduce their salt intake, their blood pressure falls,” says Dr. Weber.

www.brownandtoland.com

of rapid heartbeats. If a woman has a heart attack, she is twice as likely as a man to die within a year, according to the American Heart Association (AHA). If she doesn’t die, she is twice as likely to have a second heart attack. Besides heart size and the estrogen factor, each woman’s risk for heart disease may be increased by other factors, including: Family history. You’re at greater risk if your father had a heart attack before age 56 or if your mother had one before age 60. Hyperlipidemia (high blood fat) runs in the family. Obesity. Your risk increases if you are 20 percent to 30 percent overweight. Where you carry your weight. Fat concentrated around your midsection puts you at greater risk. You’re at less risk if fat is

If you’re salt-sensitive, it may help to go on a reduced-sodium diet, such as the DASH diet, developed by the federal government’s National High Blood Pressure Education Program. Rich in fruits and vegetables, this Mediterranean-style diet also includes low-fat dairy products. It has been

on your hips and thighs. Cholesterol. Risk increases with a high overall cholesterol count in which good cholesterol (HDL) is low and bad cholesterol (LDL) is high. Diabetes. Women with diabetes have double the risk for heart attack. High blood pressure. This condition is a major risk factor for a heart attack and the most important risk factor for stroke, according to the AHA. Smoking. A tobacco habit or exposure to second-hand smoke raises the risk for stroke and heart disease and can cause early onset of menopause, adding to risk. Sedentary lifestyle. Women who don’t exercise increase their risk by a factor of three. Stress. Constant stress may increase your risk. ■

found to prevent high blood pressure and lower it as effectively as many prescription drugs, says Dr. Weber. For a copy of the diet and tips on how to stay on it, visit the Web site for the National Heart, Lung, and Blood Institute at www.nhlbi.nih.gov. Get more potassium The recommended daily potassium intake is 3,500 mg, but Americans average 2,723 mg, according to a large, long-term government study. “Americans definitely don’t get enough potassium, which is associated with reduced blood pressure,”

www.brownandtoland.com

TAKING CARE OF YOURSELF Heart disease doesn’t happen overnight. Years of neglect can create silent damage, setting you up for a heart attack. That’s why it’s important to practice prevention, no matter what your age. The American Heart Association recommends that screening for heart disease risk factors begin at age 20. Screening includes measuring blood pressure, body mass index, waist circumference and pulse every two years. Here are ways to protect your heart’s health: Stay active. Exercise at least 30 minutes, preferably every day. Eat a heart-healthy diet. Limit your daily fat intake to 30 percent of your total calories and your cholesterol to 300 mg. Have your blood fats checked every five years. If your levels are high, you will need to follow a special diet to lower them or take lipid-lowering medication. Have your blood pressure checked every two years. If your pressure is high, and your healthy diet and exercise don’t lower it, you will need medication to bring your blood pressure into normal range and keep it there. Have your blood sugar checked every five years, especially if you have diabetes in your family. Don’t smoke. Becoming a nonsmoker will reduce your risk for many diseases, including heart disease. Maintain a healthy weight. If you’re overweight, combining a more healthful diet with exercise will help you shed excess pounds. Control stress. Make time for stress-reducing activities, such as relaxation exercises. Know the danger signs. Don’t ignore the following signals of heart distress: intense pressure or crushing pain in the chest; lightheadedness, breathing difficulty or shortness of breath; a feeling of severe indigestion that doesn’t go away after taking an antacid; and a feeling of impending doom.

says Dr. Weber. To increase your intake and reduce your hypertension risk, try consuming more of potassium-rich foods, such as cantaloupe, bananas and orange juice. Raise your glass (in moderation) If you drink, do so in moderation, meaning no more than two drinks daily if you’re a man, one if you’re a woman. One drink equals 12 ounces of beer, 4 or 5 ounces of wine or one 1.5-ounce shot of 80-proof liquor, all of which supply about 0.5 ounce of alcohol. In studies, moderate amounts of alcohol have

been shown to be hearthealthy, but people who have a family history of alcoholism or addiction shouldn’t drink at all. Don’t smoke Smoking only increases blood pressure when you’re actually smoking. “That causes some smokers to say, ‘Well, I only smoke for five or six minutes, so it doesn’t matter,’” says Dr. Weber. But it does. “If you smoke 20 to 30 times a day, the amount of time your blood pressure is elevated because of smoking quickly adds up to several hours,” he adds. For women who take

birth-control pills, smoking is especially dangerous if their blood pressure is already slightly elevated. To play it safe, “get your blood pressure checked every time you go to the doctor,” Dr. Weber says.

“The moment you start a lower-calorie diet and lose weight, blood pressure begins to fall.” — Michael Weber, M.D., past president, American Society of Hypertension

“Check it at home on a regular basis and keep a log of the readings to share with your physician.” ■

Brown & Toland’s HealthLink, Fall 2004

STAYING HEALTHY

Medical Tests You Shouldn’t Do Without o stay healthy for the long haul, it’s important to undergo certain medical screening tests regularly. “Screening tests are especially meaningful as you get older because the risk for many illnesses and diseases increases with age,” says endocrinologist Yank D. Coble, M.D., former president of the American Medical Association. Because screening tests check for health problems before they cause symptoms, “they can help detect a potentially serious medical condition in its earliest, most treatable stages and increase the chances of survival,” says Dr. Coble.

With every screening test, borderline results are common. “You may need to repeat the test or do a more refined one,” says Dr. Coble. “Overall, screening tests can be helpful, but they can also be misleading. Doctors have to be careful to interpret them in light of the patient’s age, sex, and medical and family history.”

“Screening tests are especially meaningful as you get older because the risk of many illnesses and diseases increases with age.” — Yank D. Coble, M.D., former president, American Medical Association

As you get older, make sure you get the following medical tests. Your doctor may recommend more frequent screenings, depending on your personal and family medical history, and your physical health.

The Pap test What it is: The conventional screening test for cancer or precancerous cells of the cervix. A doctor uses a cervical brush to collect cell samples from in and around the cervix during a pelvic exam. The cells are collected on a glass slide, then inspected at the lab for cellular abnormalities. The American College of Obstetricians and Gynecologists recommends that women who are, or have been, sexually active or who have reached age 18 get a Pap test and pelvic exam annually. “After three or more consecutive annual exams with normal findings, the Pap test may be performed less frequently as long as you’re in a monogamous relationship,” says Dr. Coble.

and shape or size differences between the breasts. The doctor also feels for lumps by palpating each breast, including the underarm and collarbone area. Beginning at age 20, women should get a breast exam yearly. They should also do monthly breast selfexams at home.

Clinical breast exam What it is: A breast exam during which a doctor looks for skin changes, such as dimpling, scaling or puckering; nipple discharge;

Lipoprotein profile What it is: A blood test done after a 9- to 12-hour fast to measure your blood fat, including your total blood cholesterol, LDL (bad)

Brown & Toland’s HealthLink, Fall 2004

Mammogram What it is: A safe, low-dose breast X-ray. It’s the most effective tool for detecting breast cancer early. Beginning at age 40, women should start getting a mammogram at least every two years and more frequently after they turn 50. “When to start varies per your doctor’s recommendation and your personal and family breast-cancer history,” says Dr. Coble.

cholesterol, HDL (good) cholesterol and triglycerides. It helps your doctor assess your risk for heart disease. Everyone should get a cholesterol test at least once every five years beginning at age 20, according to the National Heart, Lung, and Blood Institute. “If you have a strong family history of heart disease or have risk factors, such as high blood pressure or diabetes, or if you smoke, your doctor may suggest having your cholesterol tested more often,” says Dr. Coble.

Double-contrast barium enema, colon and rectum X-rays taken after an enema with a barium solution Colonoscopy, an exam of the rectum and entire colon with a flexible, lighted instrument These tests are recommended for those age 50 or older. But Dr. Coble says you should talk to your doctor about getting screened earlier if you have a personal or family history of colorectal cancer or intestinal polyps.

Colorectal cancer test What it is: A test for colon and rectal cancer. You typically have these four test options, which may be combined: Fecal occult blood test (FOBT), which detects hidden blood in the stool Flexible sigmoidoscopy, an exam of the rectum and lower colon using a flexible, lighted instrument

Skin-cancer screening test What it is: A head-to-toe skin exam by a doctor, dermatologist or a nurse for suspicious freckles, moles and lesions. Skin cancer is the most common of all cancers, so be sure to show any abnormalities to your doctor. Adults should get their skin examined every three years between ages 20 and 40, and yearly after that. www.brownandtoland.com

Eye exam What it is: A series of eye evaluations. Regular, comprehensive eye exams are your best defense against eye diseases, such as cataracts, glaucoma and macular degeneration, the incidence of which increases with age. Those under age 40 with normal eyes, no particular vision problems and no family risk factors should get their eyes examined every three to five years. Those ages 40 to 64 without eye diseases or risk factors should get examined every two to four years. Those 65 and older need an exam every one to two years.

Bone mineral density test What it is: An X-ray that measures the calcium in your bones to diagnose osteoporosis, determine your risk of fracture and monitor your response to osteoporosis treatment. Women should be tested at age 65. Fasting blood glucose What it is: A blood test to diagnose type 2 diabetes; it gauges the amount of glucose in your blood. The American Diabetes Association suggests having this test every three years, beginning at age 45. ■

KEEPING CURRENT

Web Directory

These Web sites can help you keep up-todate on medical tests: American Academy of Dermatology www.aad.org American Academy of Family Physicians www.familydoctor.org American Optometric Association www.aoa.org American Cancer Society www.cancer.org American College of Obstetricians & Gynecologists www.acog.org American Diabetes Association www.diabetes.org American Heart Association www.americanheart.org

MEN’S HEALTH

Screening for

Men’s Health Problems lthough you might A not want to take the time to see your doctor if you're feeling fine, regular checkups and screenings can help you find out about any potential health problems you may have. Early detection is crucial in treating the following conditions affecting men. Testicular cancer Cancer of the testicle is the most common type of cancer in American men ages 29 to 35. The following are considered at-risk groups: males ages 15 to 35 (especially Caucasians), men with a family history of testicular cancer and those who had an undescended testicle at birth. Monthly self-examinations for lumps are crucial, as often there are no other symptoms in the early stages. If cancer is confirmed by a physician, the affected testicle usually is surgically removed. The remaining, healthy testicle, in most cases, can produce sufficient sperm and hormone levels for normal functioning.

American Lung Association www.lungusa.org American Medical Association www.ama-assn.org National Heart, Lung, and Blood Institute www.nhlbi.nih.gov/chd National Osteoporosis Foundation www.nof.org American Stroke Association www.strokeassociation.org Centers for Disease Control and Prevention www.cdc.gov

www.brownandtoland.com

Self-examination of testicles After a hot shower or bath, when the scrotum is relaxed, gently grasp a testicle and slowly roll it between your thumb and forefinger. Check for any lumps on the surface of the testicle. Also check for any change in size, shape

or consistency, or for increased sensitivity. Repeat for the other testicle. If you find a lump or any other change, consult your physician as soon as possible. Enlarged prostate The prostate gland surrounds the urethra, the tube that carries urine from your bladder out of the body. While the prostate becomes enlarged in nearly all men over age 50, in one of every 10 men this enlargement constricts the urethra, making urination difficult or, in extreme cases, blocking the flow of urine altogether. African American men are especially prone to this condition. Look for these symptoms of prostate enlargement: Frequent urination Difficulty in starting flow of urine Decreased force and thickness of urine stream Sleeplessness due to need to urinate at night Dribbling after the end of urination Report these symptoms to your physician, who will conduct appropriate testing. Prostate cancer Except for skin cancer, prostate cancer is the most common type of cancer among American men. The following are considered at-risk groups: all men over 50 (especially African

Americans), men with a family history of prostate cancer and those with a high-fat diet. All men should consult their doctor to assess their potential risk and discuss an appropriate screening strategy. Periodic screenings using a digital rectal exam or a prostate-specific antigen test may detect prostate cancer in its early stages. If prostate cancer is confirmed, surgical removal of the organ is not always necessary. Doctors will determine if the disease is limited to the prostate and recommend further treatment as needed. Colon and rectal problems Cancer of the colon or rectum is the third most common form of cancer among American men. Several tests are used to screen for colorectal cancer. They include a digital rectal exam, a fecal occult blood test (to look for blood in the stool), sigmoidoscopy (examination of the lower colon with a thin and flexible scope), barium enema with air contrast and colonoscopy (examination of the entire colon). The American Cancer Society recommends that men 50 and older have a yearly fecal occult blood test and a sigmoidoscopy every five years. ■

Brown & Toland’s HealthLink, Fall 2004

ACTIVE SENIORS

Medicare Special Edition Q&A: Your Medicare-Approved Drug Discount Card

n June, Medicare beneficiaries began using the Medicare-approved drug discount card with a Medicareendorsed card sponsor of their choice. The drug card is part of the government’s long-term plan to supply Medicare beneficiaries with coverage for medications. Many members have had questions regarding the drug card, so for your convenience we have prepared answers to some frequently asked questions: Q: Who is eligible? A: Members must have Medicare parts A and B. Members receiving outpatient prescription drug assistance from Medi-Cal are not eligible for the Medicare Drug Discount Card Program. Q: Do I have to sign up for a Medicare-approved drug discount card in order to get one? A: It depends: If you are a member of an exclusive plan sponsor like Health Net Seniority Plus, you will be automatically enrolled into their program. If you have low income and wish to apply for transitional assistance, you will need to complete the enrollment form. If you are not a member of an exclusive plan sponsor, you may need to apply for the card. Remember, you can only have one Medicare-approved drug discount card at a time. Q: I already have another prescription drug discount card. How will the new approved card work with my old card? A: Present both cards to your pharmacist to determine which one works best with each of your medications. You won’t be able to combine discounts, but your pharmacist will help you determine the lowest possible cost for your medication.

Find Out More To learn more about drugs discounted through Health Net’s Medicare-approved card, contact one of the customer service representatives at the toll-free number on the back of your ID card. Or visit www.healthnet.com.

Q: How can I tell which of the Medicare-approved cards is best for me? A: To help you compare discounts offered by various Medicare-endorsed card programs, Medicare’s Web site, www.medicare.gov, has a section called “Prescription Drug and Other Assistance Programs.” If you don’t have Web access at home, your local library may offer it. Or call Medicare at 800.MEDICARE (800.633.4227). TTY users should call 877.486.2048. Q: How can I learn about drugs discounted through Health Net’s Medicare-approved card? A: Contact one of the customer service representatives at the toll-free number on the back of your ID card or visit www.healthnet.com.

Brown & Toland’s HealthLink, Fall 2004

Q: How will I know if the discount drug list or the prices change? A: Drug discounts are subject to change as often as weekly and may vary by geography, pharmacy and/or enrollees. For updated pricing information, please contact your Medicare-endorsed card sponsor. Q: Where is the Medicare-approved card accepted? A: Pharmacy networks consist of major chains, supermarkets, retailers and independent pharmacies. Contact your card sponsor for a complete list of providers. Q: What if I travel? A: If you need medication while you’re traveling, take your prescription to a national retail chain that contracts with your drug card provider. You may also want to use any mail order benefit your card sponsor may offer to fill your maintenance drugs. Q: How much will I save with a Medicare-approved card? A: Medicare expects you will be able to save 10 to 15 percent on your total prescription costs, and up to 25 percent on individual prescriptions. Savings will vary and covered medications must be included on the Medicare formulary (www.medicare.gov). Q: How much will the Medicare-approved card cost? A: The cost can be up to $30 per year. The Medicareendorsed card sponsor determines the price. Health Net Seniority Plus has opted not to charge for the Rx card. Q: Is financial help available if I enroll for the approved card? A: Yes: If you earned no more than $12,569 last year as a single person, or no more than $16,862 for a married couple, you may qualify for a credit of up to $600 toward your drug costs. You’ll have to apply for this credit by completing the “Enrollment Form for the MedicareApproved Drug Discount Card and Additional Assistance in Paying for your Prescription Drugs.” Also, if you qualify for the additional assistance, you may not have to pay the card’s annual enrollment fee, if applicable. You should apply for transitional assistance if you think you qualify. Q: What if I move outside of my card’s service area? A: If you move outside your Medicare-approved discount card’s service area and want to enroll in a new Medicare-approved card program, you must first disenroll from your current card and request a “special election period.” You then will be able to enroll in a new approved card program whose service area includes your new address. ■ www.brownandtoland.com

Travel Tip If something comes up while you’re traveling, take your prescription to a national retail chain that contracts with your drug card provider.

BENEFITS FOR SENIORS

Comprehensive Coverage Brown & Toland and Health Net Seniority Plus Offer Medicare Beneficiaries a Wide Range of Benefits

eople approaching their 65th birthday often have questions concerning continued health care coverage. Here are a few examples: “Can I keep my doctor?” “What kind of coverage is available beyond traditional Medicare?” Seniority Plus is a Medicare Advantage plan offered by Health Net, a Medicare Advantage organization and one of California’s largest health maintenance organizations (HMO). Seniority Plus provides its members with more affordable and more comprehensive coverage than Medicare. This includes hospitalization, emergency coverage and access to an extensive network of private practice physicians. Working together, Brown & Toland physicians and Health Net offer people entitled to Medicare a wide range of important benefits, including an unlimited generic www.brownandtoland.com

drug plan and $10 physician office visit co-payments, for a monthly premium of just $59. Brown & Toland is San Francisco’s pre-eminent physician network. Brown & Toland doctors practice quality health care at UCSF Medical Center, UCSF/Mount Zion Medical Center, California Pacific Medical Center, St. Mary’s Medical Center, Saint Francis Memorial Hospital and St. Luke’s Hospital. Please come to an informational meeting and learn why Health Net is one of California’s leading plans for people entitled to Medicare. You’ll also learn how you can receive affordable health care coverage when you choose a Brown & Toland doctor and Health Net Seniority Plus. For further information, please call 800.935.6565 or return the enclosed business reply card for more information. ■ Brown & Toland’s HealthLink, Fall 2004

PRSRT STD U.S. POSTAGE The Doctors Behind Every Good Health Plan

P.O. Box 640469 San Francisco, CA 94164-0469

PAID Effingham, IL Permit No. 148