SUN HEALTH MEDICAL CLINIC
, Inc.
Regardless of the weather, let's navigate together.
PREVENTION
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
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PSYCHIATRY
Unhealthy Drug
..opioid, cannabis, stimulant, sedative hypnotic
..tobacco
..alcohol
Depression (Lifeline 800.273.8255, text 998)
Anxiety
CARDIOVASCULAR
Hypertension (annually: age 40+, African, hypertension, overweight/obese; otherwise age 18-39 every 3-5 yrs)
Lipid (age 35+ male, risk factors)
Abdominal Aortic Aneurysm (age 65-75 if ever smoker)
Statin (40-75 with dyslipidemia/diabetes/hypertension/smoking and cardiovascular disease 10 year risk 10+%) optional if risk 7.5-9.9%
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INFECTION
Sexually Transmitted Infection (STI) Prevention (safe sex: limit partner, verify status, use condom)
HIV (exposure, age 15-65 x 1+, pregnant, Male Sex with Male (MSM) 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 54-99% (cabotegravir injections reduced risk by 66%) so still 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)
Post Exposure Prophylaxis (Gonorrhea, Chlamydia, Syphilis) for MSM and TG women with unprotected sex and STI in previous year: doxycycline 200mg within 72 hours
Latent Tuberculosis (former resident in country at risk, homeless, prison)
Immunizations (may obtain at pharmacy)
..Adult
COVID: new version since 30 Aug 2024 (Novavax, Moderna, Pfizer)
flu (annual, new version since 22 Aug 2024) (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 50+ 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
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CANCER
Breast Cancer
..mammogram: (women age 40-74 biennial, new USPTF 2024) +/- age 40+ annual
(a doctor’s prescription/referral is not required for screening mammogram)
(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
1 relative with bilateral breast cancer
1st or 2nd degree * relatives
3 relatives with breast cancer
comorbid breast and ovarian cancers
2 relatives with ovarian cancer
male family member with breast cancer
personal history of breast/ovarian cancer
* 1st Degree = parent, sibling, child; 2nd Degree = grandparent, aunt, uncle, half sibling, grandchild, niece, nephew
..endocrine Rx 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 Breast Exam (SBE) monthly, +/- Clinical Breast Exam (CBE) by doctor annually
inform doctor if pain, lump, skin changes, nipple discharge (40% of breast cancer is detected on SBE)
..MRI Breast: silicone implants (post-op at 5-6 years then every 2-3 years), high risk (lifetime risk >20%)
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: 92% detection
(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: 95% detection, 1% risk bowel perforation
Lung Cancer (smoker within 15 years + age 50-80 + 20 pack yrs: annual low dose lung CT)
Prostate Cancer (men exam/lab +/- age 55 or -/+ age 35)
inform doctor if urinating >= 2 times per night, trouble emptying bladder, blood in urine/semen, weight loss, erectile dysfunction (rectal exam is not routinely done, option given to patient if symptoms or may choose referral to Urology)
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ABUSE
Intimate Partner Violence (childbearing age female)
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ENDOCRINOLOGY
Diabetes (age 35-70 overweight/obese, Family History, ethnicity: African, Native, Asian, Hispanic, Pacific Islanders)
Osteoporosis (age 65+ female)
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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
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PREGNANCY PLANNING
folic acid 400-800ug daily
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MORE INFORMATION
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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, however since the start of the pandemic we added Telehealth (portal, telephone, video) visits. Annual Wellness visits are recommended.