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• please read the following and select from the menu provided
• This information is not fully comprehensive and is a guide only.
• It does not replace the need to be seen and examined for ongoing medical care.
• It is provided to assist the streamlining of the myriad of testing to be undertaken.

Medicine is constantly changing and to assist you from an education point of view we have provided a brief summary of certain testing and monitoring for health maintenance.

Your feedback on this initiative is welcome.

IF PLANNING TO BECOME PREGNANT

TAKE FOLIC ACID 1 MGS MINIMUM 3 MONTHS PRIOR TO PREGNANCY

ENSURE IMMUNE TO GERMAN MEASLES (RUBELLA), 5^TH DISEASE, CHICKENPOX PRIOR TO PREGNANCY- KNOWING YOUR BLOOD GROUP ALSO HELPS Tick here if needed 

CONSIDER FEMALES 9- 28 RANGE GARDASIL VACCINE TO PREVENT HPV INFECTION (THE CAUSE OF CERVICAL CANCER) –GIVEN 3 DOSES- 0 TIME, 2 MONTHS AND THEN 6 MONTHS

If you have had HPV then this vaccine is of no value. Tick here if needed  (not covered)

IF TRAVELLING TO CARIBBEAN OR MEXICO ADVISE HEPATITIS A VACCINE- BOOSTER AT 6MONTHS CONSIDER ECOLI (TRAVELLERS DIARRHEA VACCINE) 3 WEEKS PRIOR- 2 DOSES – 1 WEEK APART-ORAL VACCINE- STORE IN FRIDGE Tick here is travel visit req’d 

If you have varicose veins and are problematic will refer to Vein Clinic- please book 

(If small size not covered by OHIP )

If a Massage Therapy referral note is required for insurance purposes this is provided- for medical reasons and the note costs $15.00  needed

If an orthotic device is prescribed then a $15.00 fee is levied for this service  needed

50 and over mammogram to aged 75- advise enrol in OBSP- Mammogram request 

Ontario breast screening program- through local hospitals only

BREAST SELF EXAM IMPORTANT DETECTION

IF POSITIVE FAMILY HISTORY MAMMOGRAM SOONER

IF ANY LUMP FOUND REFERRAL NEEDED FOR BIOPSY- referral needed on urgent basis

US (ultrasound) ALSO NEEDED PLUS\MINUS MRI FOR SUSPICIOUS LUMP

To be discussed in office.

MAMMOGRAMS ARE NOT ACCURATE IN YOUNGER WOMEN BECAUSE

OF THE STRUCTURE OF THE BREAST TISSUE

PAP SMEAR EVERY 2 TO 3 YEARS TO AGED 75

HAVE PHYSICAL ANNUALLY- book annual physical 

BONE DENSITY TESTS AT 50 FOR BASELINE AND FOLLOW UP AS NECESSARY

IF ON TREATMENT EVERY 1 TO 2 YEARS

ADVISED TO BE ON CALCIUM 500 MGS TWICE A DAY AND VITAMIN D 800IU ONCE DAILY

FOR PREVENTION ANYWAY

IF ON TREATMENT CALCIUM AND VITAMIN D ALSO REQUIRED

TREATMENTS DIDROCAL (COMES WITH CALCIUM), ACTONEL AND FOSAMAX

SOONER AND REPEAT IF ON PREDNISONE OR RISK FACTORS FOR OSTEOPOROSIS

BLOOD WORK ANNUALLY- see below

UPDATE TETANUS (advise Td ) EVERY 10 YREARS- book Td 

Or If risk of bronchitis consider ADACEL (teranus diphteria pertussis advised) –book  (chargeable)

PNEUMOVAX every 5yrs– VACCINE FOR PNEUMONIA IS ADVISED IF A SMOKER, DIABETIC, HAVE CHRONIC DISEASE, OVER 65 OR VULNERABLE TO BRONCHITIS\PNEUMONIA- book 

ANNUAL FLU SHOT- attend flu clinic

ENSURE NO SIDE EFFECTS OF MEDS- COUGH (ACE INHIBITORS- eg ALTACE), ANKLE SWELLING( CALCIUM CHANNEL BLOCKERS-eg NORVASC), SHORTNESS OF BREATH (BETA BLOCKERS- eg ATENOLOL).

BP CONTROL – IF DIFFICULT TO ACHIEVE BUY A HOME MONITOR

IF DIABETIC AIM TO HAVE BP BELOW NORMAL RANGE- 120\60 RANGE

AN ACE INHIBITOR (ALTACE FOR EXAMPLE) IS USED FOR KIDNEY PROTECTION FOR DIABETES AND BP CONTROL) Have ekg  Have echocardiogram  See Cardiologist if concern 

DIABETES- test regular-attend diabetic clinic, weight control

SCREEN FOR SAME IF IN HIGH RISK AND ON A REGULAR BASIS

WEIGHT – IF BMI IS HIGH THEN A HIGH RISK FOR INSULIN RESISTANCE-

MEANING YOUR OWN INSULIN WILL NOT WORK WELL IN CLEARING SUGAR

PREDIABETIC STATE CAN BE TREATED WITH WEIGHT REDUCTION

DIABETIC CONTROL - book diabetic clinic  see endocrinologist (poor control) 

IF TYPE 2 - REMEMBER CHOLESTEROL HAS TO BE LDL AT 2,4 OR BELOW

BP TO BE CONTROLLED BELOW NORMAL, TREATMENT TO PROTECT KIDNEYS (with "ace Inhibitor or ARB is required)-

Have Microalbuminuria checked for (and A\C Ratio) for diabetics .

This is a special test for checking for early kidney disease problem, by measuring

protein(albumin) in the urine. Please check 

EYE EXAM REGULAR, FOOT CARE-METHFORMIN CAN CAUSE PROBLEMS WITH KIDNEY FUNCTION- CARE WHEN HAVING TESTS

An Eye exam is covered 18 to 65 if a medical condition is present requiring an optometrist assessment. An opthalmologist (MD) is covered always, but addresses complex problems.

A special form is required if you are going to an Optometrist for a medical reason.

Eye Form required  Medical Reason _____________

Remember if on cholesterol meds have choesterol testing , liver and muscle enzymes( if on a Statin) checked every 3 months- book  forms will be provided for repeat x 1

YOUNGER IF POSITIVE FAMILY HISTORY- please book  - more below

Provide stool sample for Occult (hidden) blood called an "FOB" fecal occult blood annually please book 

If you have palpitations or high blood pressure or overweight (BMI over 30) ask for an ECHOCARDIOGRAM – please book 

• common condition is "mitral valve prolapse"
• Important to know because of need to have antibiotics 1 hour prior to dental procedures , cystoscopy (check of bladder) or colonoscopy(check of colon)
• Echocardiogram can detect LVH (left Ventricular Hyptertrophy- sign of strain on heart related to hypertension effect)

IF YOU HAVE A FAMILY HISTORY OF CERTAIN ILLNESSES GET SCREENED

HEMOCHROMATOSIS – EXCESSIVE IRON-CHECKED AUTOMATICALLY

B12 DEFICIENCY-PERNICIOUS ANEMIA- CHECKED AUTOMATICALLY

UNDERACTIVE THYROID-CHECKED AUTOMATICALLY

Cancer ovary- CA125 is not a very useful screen in detection

Ovarian cancer is difficult to detect- if concerned with bloating , vague abdominal pain, history

Of fertility treatments then ask for a Pelvic Ultrasound 

? OTHER CONDITIONs- please ask

for example family history of aneurysm- in the brain __________________________

IF YOU ARE A SMOKER HAVE A CHEST X RAY EVERY YEAR- please book 

IF A SECOND HAND SMOKER A CHEST X RAY EVERY 2-3 YEARS- please book 

PLEASE HAVE AN EKG (CARDIOGRAM) DONE EVERY 3-5 YEARS over 50 book 

IF YOUR BMI IS OVER 30 YOU MAY BE AT RISK FOR SLEEP APNEA

-NOISY BREATHING, SNORING AND stopping and restarting of Breathing you may need a SLEEP STUDY-please book 

If you need to know your BMI provide Height ____ and Weight ____ BMI Result ____

Gradual and a diet that suits your lifestyle is essential

Medication Xenical- blocks fat absorption is an aid – not a cure!

Other drugs have serious side effects and complication risks.

Abdominal Girth is the latest best indicator of Heart Disease risk-

Ask to be measured if weight an issue at your next physical – Abd Girth= ___

Other conditions of concern

If you have fatigue and just feeling unwell (plus minus fever)then consider

Foreign travel (malaria etc.,) Aching muscles (Polymyalgia Rheumatica- PMR- a not uncommon condition) or Statin side effect, Lupus or Rheumatoid Arthritis (fatigue), Headache ( Temporal Arteritis –sedimentation bloodwork required- rare condition,but treatable) please book 

If headaches and unwell in Summer consider West Nile Virus and rule out Lyme disease with or without a rash- if not treated early severe arthritis can develop with Lyme.

Remember a bat found in your bedroom could have a concern for Rabies- even of no bite observed- a bite when sleeping can leave no sign.

Contact Public Health –2% of bats carry rabies

If having ulcer or abdominal pains testing for H Pylori to be done ( a bacterial responsible for ulcer and increased risk of stomach cancer) H Pylori blood test reqd 

Tested by bloodtest or biopsy- proof of cure only by breath sample or biopsy.

Concern re Hepatitis C (possible C and HIV) - please screen 

ABCDs of moles- warning of moles

Asymmetry , Border irregular, Colour Changing, Diameter greater than end of eraser

Arthritis is an aggressive disease in some case and referral to the TAP can be helpful

Fibromyalgia – always associated with poor sleep

Refer to Fibromylalgia Clinic needed 

If repeated acid regurgitation (GERD) then consider a change in esophageal lining-

Referral to GI specialist required- this condition is called "Barrets Esophagus" and is premalignant.

Rule out infective causes, celiac disease, polyps or cancer

Alternating diarrhea and constipation –consider cancer - discuss in office

A one step test is just that 1 screen and read 2 or 3 days later

A 2 step is a test on one arm , repeated 10 days to 2 weeks later to detect what is called

A booster effect. This is for people who will be tested over time , usually at their place of employment The second test is used to see if the immune system is sensitive to the protein in the test, which if not identified could cause a false positive interpretation in later years.

If you happen to have a positive tb skin test it does not mean you have tb- but have been exposed to it and it is dormant or you have had a vaccine for it (BCG)

In the case of a 2 step a return visit is req’d 2 or 3 days later after each test.

LABWORK – ROUTINE IS GIVEN PLUS B12, FERRITIN (IRON), THYROID.

FAST 10-12 HOURS FOR TEST – WATER ONLY TO DRINK

GO TO LAB IN BRADFORD, AURORA OR NEWMARKET, OR MDS OR CML IN YOUR AREA

THESE TWO LABS SEND RESULTS ELECTRONICALLY TO US

Hours of lab Address

Bradford please ask  

Select what you need- quick final checklist

a urine container 

occult blood test (40 and over) 

lab form  (routine includes Thyroid, liver, kidney function, B12, Ferritin (iron) as well as sugar, white cells etc)

EKG (added to lab form) 

Other tests for lab please list ____________________________________________________

Mammogram (50 and over or younger in risk category) 

Bone Mineral Density (50 and over or younger if at risk) 

Chest X ray 

Echocardiogram 

Referrals needed

Sleep Clinic 

Colonoscopy screening 

Select location Dr Tripathi  Dr Stotland  Rudd Clinic (Toronto-available sooner) 

Cardiac Assessment- advised if over 50 and positive FH of heart disease, smoker, high cholesterol or overweight. 

Please indicate cardiologist requested _______________________

If you have a lot of moles or suspicious skin lesions one then referral to a dermatologist is advised-

Please indicate if this is needed  and Dr requested if known _______________

Eye specialist requested  and Dr requested if known ______________________

Other specialist required – please name _________________ and reason __________________

Please see us 2 weeks after bloodwork is done-book physical for this time if possible

US, mammograms etc., take longer to come in and even book.

If you do not select a physician we will select for you.

Information not enough enough too much

Ease of understanding

What additional topics do you need addressed?

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