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WELL VISIT

 

 Routinely screens for and prevents problems based upon preventive guidelines.

U.S. Preventive Task Force Guidelines

depending upon your age and risk factors

BASIC CATEGORIES

GENERAL

Healthy Diet

Physical Activity

Optimal Weight

PSYCHIATRY

Unhealthy Drug

..opioid, cannabis, stimulant, sedative hypnotic

..tobacco

..alcohol

Depression (Lifeline 800.273.8255, text 998)

 

CARDIOVASCULAR

Hypertension (annually: age 40+, African, hypertension, overweight/obese; otherwise age 18-39 every 3-5 yrs)

Overweight/Obesity

Lipid (age 35+ male, risk factors)

Abdominal Aortic Aneurysm (age 65-75 if ever smoker)

Statin for cardiovascular disease 10 year risk 10+%)

 

INFECTION

Sexually Transmitted Infection Prevention (safe sex: limit partner, verify status, use condom)

HIV (exposure, age 15-65 x 1+, pregnant, Man Sex with Man HIV+ partner, IV drug use, or transactional/commercial sex, inconsistent condom use when not in a mutually monogamous relationship, every 3-6 mo)

..Pre-Exposure Prophylaxis (PrEP): Man Sex with Man, HIV+ partner, inconsistent condom use, syphilis/gonorrhea/chlamydia within 6 mo)

    PrEP reduces relative risk by 54% (73% if compliance is >=70%) so it is still important to limit partners, verify status, and use condom

      On-Demand PrEP 2-1-1 (an option if not using IV drugs), take 2 pills 2-24 hours before sex then 1 pill 24 hours later then again 1 pill after 24 hours later

Hepatitis B (exposure, born Asia/Africa, IV Drug Abuse, Men having Sex with Men, pregnant)

Syphilis (exposure, Man Sex with Man, prostitute, HIV+ living partner)

Hepatitis C (age 18-79 x 1+, exposure, born 1945-65, transfuse/transplant, IV Drug Abuse, liver disease)

Chlamydia + Gonorrhea (exposure, female sexually active age <=24 or age 25+ with new/multiple partner(s), symptoms)

Latent Tuberculosis (former resident in country at risk, homeless, prison)

Immunizations (may obtain at pharmacy)

..Pediatric

..Adult

  COVID

  flu (annual) (LIVE VERSION CONTRAINDICATED: PREGNANT, IMMUNOCOMPROMISED, or CLOSE CONTACT TO IMMUNOCOMPROMISED), inactive version recommended for pregnant, immunocompromised, or close contact with immunocompromised)

  TDaP tetanus Diphtheria Pertussis (every 10 years, each pregnancy week 27-36)

  MMR Measles Mumps Rubella (born after 1957, advanced education) (CONTRAINDICATED: PREGNANT or IMMUNOCOMPROMISED)

  VAR x 2 Varicella (no history of vaccination or disease) (CONTRAINDICATED: PREGNANT or IMMUNOCOMPROMISED)  USA vaccination began 1995

  HepB x 3 Hepatitis B (age<=60) USA vaccination began 1982;  new increased age

  HPV Human Papilloma Virus (age 11-26) USA vaccination began 2006;  +/- age 27-45

  PCV15 or PCV20 pneumococcal (age >=age65 and no history of any pneumococcal vaccination) USA vaccination began for adults in 1977 and pediatrics 2000;  new type

  RZV x 2 Recombinant Zoster Vaccine shingles (age 50+, immunocompromised) new

  RSV Respiratory Syncytial Virus (pregnant gestation week 32-26 and Sep-Jan) +/- age 60+ new

..Additional Immunizations for Specific Populations

  Pregnant: (1 TDaP each pregnancy week 27-36, RSV gestation week 32-36 Sep-Jan)  (CONTRAINDICATED: LIVE VERSION FLU, MMR, Var, HPV)

  Immunocompromised: RZV, pneumococcal (CONTRAINDICATED: LIVE VERSION FLU, MMR, Var)

  Chronic Liver Disease: hepA

  Healthcare Personnel: shingles RZV

  Men who have Sex with Men : shingles RZV, HPV <=age26, monkeypox if exposure https://myturn.ca.gov/

 

CANCER

Breast Cancer

..mammogram: (women age 50-74 biennial will soon change to 40-74 biennial) option age 40+ every 1-2 years (annual preferred)

  all mammograms ordered are 2D mammogram with 3D tomosynthesis

  if silicone implants, in addition to mammogram with additional views also post-operatively MRI or ultrasound at 5-6 years then every 2-3 years (implant rupture risk during mammography is 1%)

..BRCA gene (also for Ovarian Cancer)

     known family BRCA mutation

     Ashkenazi Jewish woman:  breast or ovarian cancer in 1st degree relative or two 2nd degree relatives

     1st degree relative(s) with breast cancer:  2 relatives or 1 relative with bilateral breast cancer

     1st or 2nd degree relatives::  3 relatives with breast cancer or comorbid breast and ovarian cancers or 2 relatives with ovarian cancer

     male family member with breast cancer

..endocrine Rx new including for:

      age 65+:  with 1 first-degree relative with breast cancer

      age 45+:  with more than 1 first-degree relative with breast cancer or 1 first-degree relative who developed breast cancer before age 50

      age 40+:  with a first-degree relative with bilateral breast cancer

      presence of atypical ductal or lobular hyperplasia or lobular carcinoma in situ on a prior biopsy

..breast exam: +/- self monthly, doctor annually (both preferred)

    inform doctor if pain, lump, skin changes, nipple discharge

Cervical Cancer (women age 21-65 every 3 years; every 5 yrs age 30-65 if Pap and HPV normal)

  please reschedule if menstruating and ideally abstain from sex 48 hours prior to pap

Colon Cancer (age 45-75), new decreased age +/- age 76-85

..Options

   high-sensitivity guaiac fecal occult blood test (HSgFOBT) or FIT fecal immunochemical test annually

   stool DNA-FIT (ColoGuard) every 3 years

      (help: 844.870.8870, complete UPS drop off or pick up within 24 hours)

   virtual colonoscopy (computed tomography colonography) every 5 years

   flexible sigmoidoscopy every 5 years

   flexible sigmoidoscopy every 10 years + annual FIT

   colonoscopy screening every 10 years (preferred) highest detection, risk of perforation is 1%

Lung Cancer (age 50-80 + 20 pack yrs + smoker <=15 yrs) new decreased age

Prostate Cancer men exam/lab +/- annual age 35+

  inform doctor if urinating >= 2 times per night, trouble emptying bladder, blood in urine/semen, weight loss, erectile dysfunction

ABUSE

Intimate Partner Violence (childbearing age female)

ENDOCRINOLOGY

Diabetes (age 35-70 overweight/obese, Family History, ethnicity: African, Native, Asian, Hispanic, Pacific Islanders)

Osteoporosis (age 65+ female)

DERMATOLOGY

Skin Cancer (if fair skinned) shade 10AM-4PM, cover, SPF 30+

  inform doctor if any suspicious lesions including using ABCDE pneumonic:

  Asymmetry, Border irregular, Color black or varying, Diameter >5mm, Evolving/Enlargement/Elevation

PREGNANCY PLANNING

folic acid 400-800ug daily

MORE INFORMATION

Guideline Clearinghouse

Prevention and Wellness

Annual Wellness Visits are recommended.  In the US, wellness visits and preventive health screenings have not returned to pre-pandemic levels. ~ JAMA  We have always remained open for In Person visits

and since the start of the pandemic we added Telehealth (portal, telephone, video) visits.

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