SUN HEALTH MEDICAL CLINIC
, Inc.
Regardless of the weather, let's navigate together.
Here to help with your health and happiness, for (almost) any medical condition under the sun.
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EXCLUDES CONTROLLED SUBSTANCES (opioid, stimulant, sedative hypnotic, benzodiazepine, testosterone) exception for terminal illness, cancer, fracture
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EXCLUDES GENDER CHANGE
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EXCLUDES OBSTETRICS (referral)
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EXCLUDES <AGE 11
PRIMARY HEALTHCARE
SICK VISIT
SICK VISIT
Routine or Urgent Symptoms, Issues, & Problems
(Emergencies -> call 911 or go to Emergency at the hospital.)
EXAMPLES
NONSPECIFIC
Pain (including back, abdomen, head, foot, chest, knee, wrist, arm, leg, neck, finger)
Fatigue, Dizziness, Fainting
Pink Eye, Ear Plugged, Runny Nose, Sore Throat, Cough, Fever, Chills, Shortness of Breath, Snoring, Abnormal Lump
DIGESTIVE
Acid Reflux, Constipation, Diarrhea, Gallstone, Nausea/Vomiting, Hemorrhoid
MUSCULAR
Weakness
INTEGUMENTARY
Acne, Rash, Wound
LYMPHATIC
Allergies, Infection
ENDOCRINE
Diabetes, Thyroid, Hirsutism
NERVOUS
Depression (treatment) [Lifeline 800.273.8255 text 998], Anxiety, Grief, Numbness, Weakness
SKELATAL
Fracture, Arthritis, Sprain
MALE REPRODUCTIVE
Erectile Dysfunction
FEMALE REPRODUCTIVE
Vaginal Discharge, Abnormal Menstruation
RESPIRATORY
Asthma, Chronic Obstructive Pulmonary Disorder
URINARY
Urine Infection
CIRCULATORY
Heart Failure, Abnormal Heart Rhythm
EMERGENCIES: call 911
FOLLOW UP: if problem not resolving, if new symptom arises, and for routine wellness
Medicine follows an step-by-step algorithm so if conservative treatment fails, escalated testing and/or treatment may be indicated.
APPOINTMENT PREPARATION
BRING
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government photograph identification
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health insurance card
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Rx list (if any)
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test reports (if any)
WEAR (recommended but not required)
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corrective visual lenses (if any)
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hearing aid (if any)
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short sleeve shirt (blood pressure measurement, blood draw)
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2 piece outfit (examination, electrocardiogram)
FOLLOW UP
EMERGENCIES: call 911 or go to closest Emergency (our associated hospital is Scripps Mercy)
SICK: If problem does not resolve or new problem arises then follow up. Medicine follows a step-by-step algorithm and escalated testing and/or treatment may be indicated.
WELLNESS: Wellness visits are for routine care and are recommended annually. Diabetics every 3-6 months.
WELL VISIT
WELL VISIT
Routinely screens for and prevents problems based upon preventive guidelines.
United States Preventive Task Force (USPTF) guidelines
depending upon your age and risk factors
Since the Affordable Care Act in 2010, most health plans fully cover the cost of this portion of the visit.
BASIC CATEGORIES
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)
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 still limit partners, verify status, and use condom
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)
..Adult
COVID: new version since 30 Aug 2024 (Moderna, Pfizer, Novavax)
flu (annual, new version since 22 Aug 2024) (LIVE VERSION CONTRAINDICATED: PREGNANT, IMMUNOCOMPROMISED, or CLOSE CONTACT WITH IMMUNOCOMPROMISED), inactive version recommended for pregnant/immunocompromised)
TDaP (every 10 years, pregnancy gest week 27-36)
MMR (CONTRAINDICATED: PREGNANT OR IMMUNOCOMPROMISED)
VAR x 2 if no history of vaccination or disease (CONTRAINDICATED: PREGNANT OR IMMUNOCOMPROMISED)
HepB x 3 (if exposure, born Asia/Africa, IV Drug Abuse, Men having Sex with Men, pregnant)
PCV15 or PCV20 (if age >=age65 and no history of any pneumococcal vaccination, new CDC recommendation)
RZV x 2 Recombinant Zoster Vaccine shingles (age 50+, immunocompromised) new
..Additional Immunizations for Specific Populations
Pregnant: 1 TDaP each pregnancy week 27-36 (CONTRAINDICATED: LIVE FLU, MMR, VAR, HPV)
Immunocompromised: shingles RZV, pneumococcal (CONTRAINDICATED: LIVE FLU, MMR, VAR)
Chronic Liver Disease: hepA
Healthcare Personnel: shingles RZV
Men who have Sex with Men : HPV <=age26, monkeypox if exposure https://myturn.ca.gov/
CANCER
Breast Cancer
..mammogram: (women age 40-74 biennial, new USPTF 2024) +/- age 40+ annual
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 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 breast/ovarian cancer
* 1st Degree = parent, sibling, child; 2nd Degree = grandparent, aunt, uncle, half sibling, grandchild, niece, nephew
..endocrine Rx ncluding 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
..MRI Breast: silicone implants (post-op at 5-6 years then every 2-3 years), high risk (lifetime risk >20%)
Cervical Cancer (women every 3 yrs age 21-65; 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), newly lowered 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
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 past 15 years + age 50-80 + 20 pack yrs: low dose lung CT annual)
Prostate Cancer (men +/-exam/lab age 55+) -/+ annual age 35+
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