In general, their review found that screening more often than every 3 years adds little benefit but greatly increases harms such as additional procedures, and evaluation and treatment of abnormal findings that would only be temporary and wouldn’t need treatment.

Here are there new recommendations. Remember that these are general recommendations for healthy women who have a cervix, regardless of their sexual history, and do not take into account individual health conditions or risks.

1. Women ages 21-65 should get pap tests every 3 years. Another option for women ages 30-65 is to do both paps and human papillomavirus (HPV) testing every 5 years.
2. Screening for cervical cancer with HPV testing before age 30 is not recommended.
3. Screening for cervical cancer is NOT recommended in the following women:

• Under 21 years of age
• Over 65 years, as long as they have had adequate prior screening and are not otherwise at high risk for cervical cancer. Risks factors include infection with HPV or HIV, a weakened immune system, exposure before birth to a chemical called diethylstilbestrol (DES), or prior treatment for cervical cancer or a high grade precancerous condition of the cervix.
• Who have had their uterus removed (hysterectomy) including removal of the cervix, and who do not have a history of a high-grade precancerous condition of the cervix.

Consider My Health Checklist 2012 (iPhone/iPod/iPad app) for more information and a complete list of adult preventive recommendations. These new cervical cancer screening recommendations will be included in the next clinical update.

This is a question that appears to make sense but doesn’t. The terms “primary care” and “specialist” have distinct elements but are not mutually exclusive.

Merriam-Webster defines specialist as “one who specializes in a particular occupation, practice, or branch of learning.”

The American Academy of Family Practice defines primary care as “that care provided by physicians specifically trained for and skilled in comprehensive first contact and continuing care for persons with any undiagnosed sign, symptom, or health concern (the “undifferentiated” patient) not limited by problem origin (biological, behavioral, or social), organ system, or diagnosis.”

Now, I would not limit primary case to physicians; nurse practitioners are fully capable of independently providing primary care as well, as are many physician assistants in conjunction with physicians.

So, primary care providers are indeed specialists, being specially trained and skilled in an area distinct from other providers. Therefore, it doesn’t make sense to speak of “primary care providers or specialists.”

So what should these non-primary care physicians be called? While I have heard some refer to them as “partialists” as opposed to “generalists, “I do find that a bit negative in connotation. I think reasonable terms include “other specialists,” or “secondary care providers.”

We then might more appropriately ask “Should I see a primary care provider or another specialist?” This is not only more accurate, but will also help to frame primary care as equal in importance and value to other specialties, rather than “less special.”

Why is ACIP making this recommendation? It is because adults under age 60 with diabetes are twice as likely to get Hepatitis B than those of the same age without diabetes.

Hepatitis B is a virus that infects the liver and is spread through blood and other bodily fluids. It sometimes doesn’t cause much of a problem, but other times can be very serious, essentially destroying the liver. It may even lead to death.

People with diabetes use lancets to poke their fingers and test their blood sugar, and these lancets are at times used in an unsterile form, and may spread the virus.

It is OK for adults over age 60 with diabetes to get the vaccine if they so choose, but the risk of getting Hepatitis B is not increased in this group so it is not routinely recommended.

Children have had a routine recommendation for hepatitis B vaccine since 1991.

A researcher from Cornell (link to study details) performed a lunchtime experiment with 78 university staff. Groups of 3-4 staff were given a meal of pasta, apple sauce and pudding that was self-served from a counter. For some of the groups the food was then left on the counter, and for some it was then moved to the table where they were sitting.
All of the participants were told to help themselves and given 45 minutes at the table. Serving sizes, intake and food waste were measured. Participants estimated how many calories they consumed and how full they felt after eating. Here is what was found:

• Men ate 29% fewer total calories when serving bowls were moved from the table to the counter. Think about that. 29% fewer calories!
• The difference in calories eaten between groups for women was not statistically significant.
• The differences found were due to differences in how much pasta was eaten, not apple sauce or pudding.
• All of the participants in both groups thought they ate about the same number of calories.
• All of the participants thought they were equally full after eating.

I personally use this information mentally. I don’t want to subject my family to a change of serving bowl location, so I pretend that the serving bowls are not on the table. Once I fill my plate and eat, I consider the serving bowls, and therefore second helpings, off limits. Believe it or not, it actually works! The craving I have for a second helping actually goes away. At least most of the time.

This is an important question, and here is why. Prostate cancer is the most common cancer in men. By the time you are 60, you have about 60% chance of having prostate cancer, and it goes up from there. Yet even without treatment, your overall chance of dying from prostate cancer is less than 1 out of 25. Because of this big difference between the chance of getting prostate cancer and the chance of dying from it, and the fact that treatments for prostate cancer can be harmful, it is not clear that otherwise healthy men should be checking to see if they have it. There is some evidence, however, that we can prevent prostate cancer. An excellent review of the evidence in this area was recently published (Fleshner and Zlotta, Cancer 2007, Vol 110, Iss 9, p. 1889-1899), and I will summarize it here, adding some comments where helpful.

Taking preventive medicines = uncertain benefit

A testosterone-blocker called finasteride has been shown to reduce the risk of prostate cancer, but in the men who get cancer while taking it, their cancer is a more dangerous type. Anti-inflammatories like aspirin and ibuprofen have unknown benefit, yet often have side effects.

Taking Vitamin E = might reduce risk

Vitamin E seemed to reduce the risk in one study, but this has not been confirmed in other studies. Still, it is probably not harmful and may be helpful to take a daily multivitamin with E in it.

Low-fat diet = probably reduces risk

Avoiding pesticides = might reduce risk

Exposure to pesticides is associated with prostate cancer, but we are not yet sure if avoiding them reduces risk.

Selenium = might reduce risk

Also may increase the risk of skin cancer

Green Tea = conflicting research results

Soy = uncertain benefit

Lycopene = weak evidence of benefit. Not proven.

This is an antioxidant found in tomato products.

Lyme disease (named for Lyme, Connecticut where it was first described) is an infection carried by Deer Ticks that can cause a skin rash, as well as serious nerve, heart and brain problems. The infection is most common in late spring or summer and in most people the first sign is a flat or raised skin bump that slowly gets bigger, often with clearing of the rash in the middle, resembling a target. It is diagnosed by recognizing the rash, and/or blood tests. It is not spread from human to human.

According to State of Wisconsin public health officials, a warmer spring can increase tick activity and therefore Lyme disease. If you think you might have Lyme disease you should see your health care provider, but it is sometimes tricky to diagnose and difficult to treat. Therefore, it is important to reduce the chance of tick bites that cause Lyme disease in the first place.

Here is how to prevent Lyme disease (or other infections spread by ticks):

• Avoid areas where there are a lot of ticks if possible
• If you do get a tick on you, remove it as soon as possible by grabbing it with a tweezers as close to the skin as possible and slowly pulling it off (other techniques such as a smoldering match or kerosene might cause the tick to pass along the infection earlier by irritating it)
• Wear light-colored clothing so that ticks can be more easily seen and removed (the ticks don’t usually pass along the infection until they have been attached for a day or more)
• When in a tick-infested area, use tick repellent and examine yourself daily to look for and remove ticks
• There used to be a vaccine for Lyme, but it was discontinued due to some reports of joint reactions and a low demand

One of the most frequent questions I get in the Ask a Question section of Proven Health Ways is:  How do I stay healthy when traveling abroad?

Strategies to protect your health while traveling include vaccinations, avoiding times of political unrest or violence, protection from infection from insect bites, and food/water cautions. Some vaccines need at least 4-6 weeks to work well, so it is important to plan ahead.

One excellent resource for information about travelling anywhere in the world is the Centers for Disease Control (CDC) website. Go to www.cdc.gov, click on “Travelers’ Health” and then “Destinations” to see what is recommended for your planned destination.  Then call your primary care provider or travel clinic to see how you can get the vaccines you need.

As to the reader’s specific question: Yes, TWINRIX (a combined vaccine for Hepatitis A and Hepatitis B) would be a good idea before travelling to Jamaica, either in the usual schedule of 0, 1 and 6 months, or an an accelerated schedule of 0, 7 and 21 days (and a booster at 1 year).

Because she was a new patient to me, I asked for more information. I found out from her and her reliable caretakers that she had never actually been sexually active. You can imagine her relief when I told her that she did not need Pap tests because research indicates that only women who have had sexual intercourse are at significant risk for developing cancer of the cervix.

So who needs to have Pap tests done, and who doesn’t? The US Preventive Services Taskforce sums it up well:

Pap tests are strongly recommended for all women who have been sexually active and have a cervix (the part of the uterus that is tested with a Pap) .

· When should you start having Paps? Start at age 21, or three years after starting sexual activity, which ever comes first.

· How often should you have Paps? Every 3 years appears to be just as beneficial as having them every year.

· When can you stop? Since cervical cancer is less likely after middle age, stopping Pap tests at age 65 makes sense if recent tests have been done and were normal.

Check with your doctor or nurse practitioner to see if Pap tests are right for you. Visit Proven Health Ways for more information about Pap tests and other prevention activities.

Whoever submitted this question is wise to question the advertised claims. Remember that what happens in a research lab with plants or animals does not necessarily predict what will happen in people.

I just did a review of the literature and found absolutely no conclusive research that the Acai Berry leads to any positive health outcomes in people. If anyone knows of any studies (actual research, not just reports of someone experiencing benefits), please submit a reference, and I’d be happy to evaluate the study and comment on what if any evidence it provides.

Salted water to cover
2 large russet potatoes, peeled, cut into six or eight same-size pieces

2 tablespoons butter
1 teaspoon fennel seed, crushed (or fennel powder, I used a mixture)
Salt & pepper
1 large fennel bulb, outside layer trimmed if needed, cored, chopped roughly in fairly big pieces (save some of the frond for garnish)
1/2 cup half ‘n’ half (or fat free half ‘n’ half, the inspiring recipe called for at least 1 cup, how much is used may depend on the relative moisture in the cooked potatoes as much as taste preferences)
More salt & pepper to taste (if needed)

Bring the water to a boil. Add the potatoes as they’re prepped. (If you do the prep work in advance, peel the potatoes and so they don’t brown, cover with cold UNSALTED water. Replace the water before beginning to cook.) Cover and cook til tender, about 15 minutes. Drain. (Here, the inspiring recipe called for returning the potatoes to the hot pan and cooking for a few minutes more to dry a bit. I liked this step but not sure it made a pile of difference so you might want to try it yourself to see.)

While the potatoes cook (or 2-3 hours in advance if you like), melt the butter and fennel seed on MEDIUM in a skillet til shimmery, let bubble a minute. Add the fennel, sprinkle with salt and pepper, stir well to coat with fat and disperse the salt. Cook softly for 15-20 minutes, til soft but not brown. (If you’re prepping ahead, stop here.) Add the half ‘n’ half until just beginning to bubble.

Mash the potatoes with a masher or a hand mixer (NOT a food processor which creates gum). Stir in the fennel-cream mixture. Season to taste and serve.