Lancaster Physician Winter 2021 - 18

L A N C A S T E R M E D I C A L S O C I E T Y.O R G

Healthy Communities

Flu shots: Recommended annually for
everyone >6 months of age, with high dose
flu shots recommended in patients >65.
PNEUMOVAX® 23 (pneumococcal
vaccine): Should be given once after turning age 65. Can also be given to high-risk
patients aged 19-64 with a booster dose five
years later. (High-risk patients include those
with cardiac disease, pulmonary disease
- including asthma, chronic liver disease,
diabetes mellitus, smoking, and alcoholism.)
Prevnar 13®: This pneumococcal vaccine
is no longer recommended routinely after age
65 but can be offered to high-risk patients.
Tdap (tetanus, diphtheria, and pertussis vaccine): Give once as an adult and
either Td or Tdap every 10 years after that.
Tdap should be given with each pregnancy
regardless of how many years.

Osteoporosis: Start screening with DEXA
scan for women aged 65, or younger with
increased risk, and males with increased risk.
No more than every two years.
Ovarian cancer: There is no routine
screening recommended, but patients with
a family history of ovarian cancer may benefit from further evaluation and/or genetic
counselling.
Malignant melanoma: Regular skin
checks should be performed during routine
visits in all patients but those at high-risk
should have full body checks on a regular
basis. High-risk includes white males
aged >50 and individuals with a history
of significant sunburns, multiple moles,
family history of malignant melanoma, or
atypical nevi.
Vitamin D: Blood test to determine
vitamin D levels may be recommended
for patients at high-risk for Vitamin D
deficiency. High-risk patients include those
with limited or no sun exposure, obesity,
osteoporosis, and malabsorption.

Sexually transmitted disease (STD): All
sexually active women aged <25 and women
>25 with risk factors should be screened for
chlamydia and GC (gonorrhea). Risk factors
include history of STDs, new or multiple
partners, sex partners with risk factors,
exchanging sex for drugs or money.
Hepatitis B: Screening for high-risk patients.
Depression: Starting at age 18, should
screen with a PHQ 2 and if positive a PHQ
9 (with follow up if positive).
Dementia: Screening done during routine
Medicare Wellness Visits, with follow-up
evaluation if positive.
Smoking, alcohol, and drug use: Screening should occur during regular office visits.
ROUTINE IMMUNIZATIONS
These are less involved than in childhood,
assuming childhood vaccinations are up
to date.

LANCASTER

18

PHYSICIAN

HPV (human papillomavirus vaccine):
Recommended up to age 26 with two to
three doses depending on what age the first
dose was given. Also indicated for individuals
aged 27-45 with shared decision making.
SHINGRIX (shingles vaccine): Recommended to prevent shingles and given
after age 50 with two doses given two to
six months apart.
Hepatitis A, hepatitis B and meningitis:
Vaccines may be indicated in certain circumstances. Anyone planning on traveling
to foreign countries should check with their
PCP or a travel clinic to see if there is a need
or requirement for vaccinations to travel to
those countries.
This covers the majority of recommendations for preventative measures, but
probably the most important yet most difficult measure for patients to take is lifestyle
modification. Start with simple changes in
your diet and do more walking; I expect
you'll be surprised of the benefits you'll see
in your health.
Just remember, your car is not important
if you are not healthy enough to drive it.



Lancaster Physician Winter 2021

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