Transcription
When you look at what we do, and you look, as you mentioned earlier, uh, I'm glad you suggested this topic because of what I do. I'm one of a half a percent of doctors that's actually been trained in preventive medicine.
Right.
I ran the program at Johns Hopkins, and yet one of the best places in the world, if not the best. And yet I've never really spent significant time on the channel talking about the standard preventive recommendations. Those recommendations are put out by the US Preventive Services Task Force. When it was originally developed, I was running the program at at Hopkins, and we had our trainees, our residents, actually do the background science reviews for those recommendations.
Um, we've done, we've covered some of these in detail. For example, that uh recommendation regarding use of preventive low-dose aspirin, we've covered that in a couple of videos. Um, in our videos on uh undiagnosed diabetes and pre-diabetes, we've mentioned these things, but we've never really come out and talked about them in general, looking at the standardized list, um, as you and I discussed. So, let's focus on that.
What's killing people 40 and above and disabling them? Uh, pre-diabetes, undiagnosed pre-diabetes, insulin resistance, and arterial plaque that, you know, results in cardiovascular disease,
heart attack, stroke,
um, for the most part, but also dementia is a big deal. And uh, you start looking at that, underlying causes, metabolic disease. And uh, that's a really, really good place to look. Um, again, when I was at Hopkins, you always follow the numbers.
Okay.
When I was there, we didn't know this. That was one of the big things that threw me personally when I started having problems in this area 30 years ago. We didn't know what portion of people have metabolic disease. We didn't even define it that way. We just looked at, um, full diabetes, right? So we were only seeing the tip of the iceberg. Uh, now we know from, um, NHANES data. And if I could take us a minute and describe NHANES data, it's an acronym standing for the National Health and Nutrition Examination Survey. It's actually part of the US Census. So they take statistical uh portions of the US Census and they do a full, uh, full levels of uh laboratory exam ex uh examinations, uh, health, um, uh, health history programs to understand a little bit more about the health of Americans. In the recent ones, they began to discover that over half of American adults, not starting at age 60, starting at age 18, have metabolic disease. And you and I, we live this every day. We know the statistic. Over 90% of this has never been diagnosed.
Right?
So, uh, this is what's killing us, and that's what we need to be looking at. When you look at what the, uh, standards committees have created in terms of, um, preventive services, they do start off with that. Uh, they start off at looking at, uh, cardiovascular disease. They look at, uh, blood pressure. They look at, um, A1C, fasting glucose. Uh, tell us some other things that we're that they're telling us to look for.
Uh, the waist circumference, BMI, um, yeah, the blood sugar testing, lipid measurements. So for that kind of age group, um, you know, early, early prevention and screening.
Okay. So let me, let me start us off by reading just reading some of the basic recommendations by age group in the US. And these come from, as I mentioned before, the US Preventive Services Task Force, which is very much coordinated with the CDC.
And the American College of Surgeons.
Okay. In their 40s. Blood pressure, everyone, two to two years or more often if elevated. Cholesterol/lipids, get a baseline panel, repeat based on risk. Diabetes, screen if overweight or obese. And so that's in your 40s. In the 50s, what they do for this is blood pressure, lipids, diabetes, continue as above. Um, how would you screen for cardiovascular disease? Would you do it this way?
Oh, no. I think that's too late.
So, what would you do?
I think the screenings need to start, you know, the screenings you mentioned, they should start once they're 18. Once a patient's 18, you know, we should screen at their blood pressure once a year. Um, we should at least get, uh, fasting glucose. Um, hemoglobin A1C is an option as well, depending on, you know, the specific patient and and limit any limitations they may have regarding insurance or what have you. But, uh, and then, you know, a standard lipid panel.
So blood pressure, to me, is a great way to string. Uh, there's a whole lot of people. I'm not alone. Uh, for me, it was the first of the chronic diseases that showed up.
Right?
And you see that with a lot of people. And
that's one consideration. And let me just clarify what what that means in terms of chronic diseases. There's a thing called the theory of common, uh, common cause for chronic diseases. And it gets back to the fact that once we hit our 40s, it's not like some people get high blood pressure, other people get something else.
Right?
It's like everybody starts with one of these, high blood pressure, pre-diabetes, uh, plaque, heart disease, but then we all start getting the same thing. It becomes a cluster of diseases that we get. So, pe, some smart people began to ask 30, 40 years ago, are these all being caused by the same thing? And the answer is yes. It's a, it's metabolic disease starts causing these. How does metabolic disease cause high blood pressure? Well, it raises our insulin. We become resistant to insulin. So our blood sugar starts going up a little bit. Because our blood sugar is going up, we cut out more insulin. Well, insulin has several effects on the body. One of the things it can do is cause our kidneys to retain salt. So, our blood pressure begins to go up. So, if your blood pressure is beginning to go up, you need to be thinking insulin resistance. Uh, guess what? If you're starting to get this middle-aged spread,
start thinking about insulin resistance because insulin, if it becomes elevated on a regular basis, slows down our ability to burn fat. And that gets to Gary Taubes' book, "Why We Get Fat and What to Do About It." It's, you got, you start getting increases of insulin. Your insulin stops your fat burning ability. So, you're actually not getting fatter because you're eating more, which most people think happens to adults. You're eating more because you can't burn the, the, uh, energy that you're that you're eating. So if you start looking at this in a different way, you start thinking about screening in a different way. Back to blood pressure. Yes, it's a very common first presentation of chronic disease.
With others, often either usually people with
no symptoms.
Correct. Elevated blood pressure or even, you know, higher than that. Uh, yeah, they usually have no symptoms. They call it the silent killer for a reason, so it needs to be screened regularly.
And one other comment is that it's got special risk for stroke.
Correct.
Which, um, is a big, big deal in terms, it's the number one cause of, uh, permanent disability. Now, when I was your age, maybe not your age, but when I was like, what, in my 30s, 20s, we didn't have good home blood pressure screening
devices. Now you've got them, and they're 20-some bucks.
Right?
There's no reason to not get a home blood pressure screening device. And once you have it at home, you can do it monthly, you can do it weekly, you can do a lot of these on a regular basis. So for me, number one, at least by age 40, get a good, uh, there, there's a ton of brands. Omron is the one that that most people think of coming out, but there's several other brands that the competition has gotten very, very, uh, good for the purchaser. These things are inexpensive, and they're high quality. Get one. Use it. Use it at least weekly, especially by the time you're age 40. And you know what? If you're 18, and your your mom and dad should have one in the home, and you should do it once a week, too.
Yep. Agree. Now, uh, diabetes. Even the American Heart Association and the American Diabetes Association, in their white papers, their research papers, has said, look, um, A1C and fasting glucose miss over half of metabolic disease. So, if this is what's killing us, undiagnosed metabolic disease, why are we recommending the tests that miss over half of it?
Right?
That's my question, too.
So, it may sound like a, uh, a goofy thing to do a full-blown oral glucose tolerance test with insulin response because those are difficult. They take a couple of hours. But, you know what? I've, the lab nearest to me is about 15, 20 minutes away.
Mhm.
And when we're doing some research on these things, I just get up. I've, I've done in a period of three months, there are times when I've done this, uh, eight or nine times. Um, and then I'll go three or four months and won't do any of it because we don't need it for the channel. But the bottom line is, it's not that difficult. Get in your car, drive over, get it done. Take your your iPad or your phone, and just sit and do your
Yeah.
Do your work in the
Yep.
In the in the waiting room of the lab and don't get up and walk between, uh, between lab draws.
And it's interesting when we get those results, a lot of times we'll tell the patient, well, if we had just gone based off your hemoglobin A1C, you would be fine. You know, you're, you're not pre-diabetic, you know, you're under a 5.4, you're doing a great job, see you later. But oftentimes, oral glucose tolerance tests and insulin response really tells the full story. So, um, I agree. I think that's a, that's a great tool to get a better, better idea of how you are doing as far as insulin resistance and and if you have pre-diabetes, diabetes. Still in today's world, the vast majority of metabolic disease or diabetes is discovered, and 90% of it is still undiscovered. The, the ones that are discovered are discovered with a fasting glucose,
that they happen to get for some other reason, screening for surgery or something like that.
Exactly.
Now, whenever I raise this, I'll often get some academic making a comment of, you don't have to do all that. Just get a HOMA-IR. So basically, it's a, it's a ratio between fasting insulin and fasting glucose.
And the academics love to say and to show off and say, that's all you have to do, that's going to tell the story. The bottom line is, you and I get that all day, every day with these. That's a small part of an insulin response test, OGTT with insulin response, and quite often both come out totally normal, and the, um, the HOMA-IR is normal. It's not until you actually hit the body with glucose that you actually drink that drink. That's when the numbers go haywire.
Right. And so it's really, really clear that HOMA-IR is not the way to do that either. Oh, the other thing that I wanted to say about this is, as you know, on a practical basis, labs often don't get the the OGTT and IR exactly correct. But to me, that with a combination of a couple of other things, really tells the story about metabolic disease. Uh, one of them is, uh, also recommended in the standard recommendations, that is some lipid studies.
Now, they're looking at cholesterol because quite often when metabolic disease occurs, people start getting an increase in their LDL bad cholesterol. That's why how, how and why it got its name. But you and I look at something else on baseline cholesterol tests. What do we look at?
We look at the triglyceride to HDL ratio.
Right. And, um, I remember I had a patient come to see me once who said, "You know what? I lost 50 pounds on a low-fat diet. I was seeing a well-known, uh, influencer, Caldwell Esselstyn." And this is not a, a criticism of Esselstyn because he's, his work has saved thousands of people. But he lost 50 pounds. He said, "Esselstyn kept telling me, 'No, no, you're getting a little bit of oil in the nuts. Don't eat any anything that has any oil in it.'" He got, he lost his 50 pounds, and he had a heart attack. And he saw our, he saw one of our videos on triglyceride over HDL. His ratio was seven.
Wow.
So, low, I mean, low-fat can work, but it's not for everybody. And right,
you just need to be careful, and you do need to know triglyceride over HDL. There's another, there's another lipid test that we look at. It's called fractionation.
How does that help?
That's looking at, you know, uh, kind of what we focus on is the, the large particles of HDL and LDL. And, uh, depending on, you know, how large your LDL particles are determines the pattern of the LDL. So, this also can give some great insight on how you're doing overall regarding metabolic disease, too.
Yeah, it gets back to that comment that we've already made about insulin impacting the way you burn fat.
Correct.
And if you've got too much of an impact from insulin and you can't burn your fat, your triglycerides do go up.
In addition, it's going to change the pattern of the the LDL and even the HDL particles. And we can tell that by, uh, by looking at those with a special test. It's very easy for the lab to get. It's nothing but a simple lab draw.
Exactly.
To, to me, getting those two plus one other thing is the best way for assessing metabolic health. The other thing is not on any of these recommendations. It should be, but it's not. And that is a CGM.
Yep. Agreed. And that's the best way to really experiment and see the diet that you're following at home and how your glucose levels are responding to that. It's a great way for patients to learn about how their bodies respond to foods and fasting, exercise, 'cause we're all different. Um, none of us are the same. And then make those lifestyle changes to their diet depending on their, um, glucose readings an hour and two hours after eating. Now, that is a whole bunch about blood pressure, uh, cholesterol and lipids, diabetes, pre-diabetes screening. But there's one other thing in terms of this kind of vascular disease, uh, screening that we haven't talked about, and that's actually taking pictures. It's imaging.
Yep.
So, what do, what do you recommend there?
We usually will look at a CINT. Uh, the CINT kind of is the carotid intima-media thickness test. So, it's, I like to reference it as a, a, uh, supercharged carotid ultrasound because it's looking for not just blood flow, but if you have plaque, and if so, what kinds of plaque do you have? And we worry the most about the soft plaque. Um, so definitely getting a CINT to kind of, uh, go with all the other, you know, pair that with the lab testing and the CGM when you wear your continuous glucose monitoring sensor. So all three of those things together really kind of helps us look at your overall risk.
In terms of imaging screening, there's a couple of other things that, uh, people do. One is a calcium score, and the other is the new CTA with AI.
Great.
Let's talk about the calcium score for a second. What's the difference between a calcium score and a CINT? At least in terms of of what we do.
So, the coronary calcium score is like a CT. So, it's a little bit more invasive, you know, versus a CINT is using ultrasound technique. But the, the coronary calcium score is only showing us calcified plaque in the coronary arteries. So, it does give you kind of an idea on if you, you know, have calcified plaque because maybe obviously at one point it was a soft plaque and it's it's healed and stabilized and calcified. Um, but there's limitations with that. It's not telling us where you're at for your soft plaque or mixed plaque, just looking at calcification of plaque.
Yeah. So, there's a couple of clear advantages. Number one, you can get a good C, a good calcium score, uh, anywhere, right?
It's easy to standardize, high quality. You can rely that you probably have one in your town,
where almost anywhere you live in the US, anywhere they have an X-ray department. It's easy to standardize, easy to get good quality. Uh, number two, uh, because you've got one somewhere close, not only can you get good quality, you can get good quality close. And number three, it's inexpensive, right?
Couple hundred bucks usually, and you usually don't need a, a doctor's
recommendation or order.
Now, the downside, though, is it only shows us calcium, which is a stable plaque. It does not show us soft plaque, and soft plaque is what confers the risk. So, we use a little bit of calcium score because sometimes people just, you know, they want to get at least some sort of information. They want to know, do I have any evidence of plaque?
Right.
Um, and yes, I'll go get a good CINT, but it's going to be another month till I get there. I'd like to know something before. Once you get a good CINT that actually tells you about soft plaque,
it's harder to find a good quality one. It's like you said, it's a lot of people think it's just an ultrasound of the arteries of the neck. So, they'll go get one at a local,
u, local radiology place, and but it still doesn't tell us what we need to know. It's got some additional, uh, analytics there. Now, for years, up until actually last year, I basically did this work without CT angiogram because CT angiogram existed for a few years, but it just wasn't quite ready for prime time. The, the evidence at this point would show, nope, it's now ready for prime time using some AI analytics. Now, Jesus and I will be covering some information soon indicating that not everybody's AI is the same.
So, there are challenges there, too. And we actually saw that with my own CTA with AI.
Interest.
Uh, at first, they lost the, the data for the AI analysis. Then they sent it to the wrong place. Then they said, "Well, it was done on old machinery, so we can't really analyze it." And then they said, "Well, okay, maybe we can, and here's what it is." So, uh, there's, it's still not like you've got a CTA with AI at the at the corner like you do with calcium score, right?
If you can get a good one, it is the, the state-of-the-art now. And we're sending a lot of folks to get that.
We are. And the recording is, I mean, it's so
detailed, and it's colored, and you can really see, um, each coronary vessel, and they label all the different types of plaque, uh, you know, they look at the narrowing of the vessel, the stenosis. So, it has a lot of great data on that report, so you really kind of know where you stand, um, with your.
Well, I'm glad you brought that up because it's sort of like CINT MT. You get all these reports that show specific areas and what's going on, the anatomy of the plaque, and everybody gets focused on it.
Right.
And I try to redirect them and say, don't focus on any of that. Just go to this one number. What's your percentage of soft plaque?
If it's 2% or less, you're in great shape.
Correct.
Um, and if it's 2% and you want to get better, you know, here's the things to do. Lifestyle first.
Absolutely.
Anything else on cardiovascular screening before we go to some of the other things like cancer, men's health, women's health, some of the areas where you're the expert?
Uh, not necessarily. I mean, I know when we're talking about cardiovascular disease, you know, whether you have high blood pressure, diabetes, um, we want to make sure we're getting, you know, your eyes checked every year and also your dental cleanings. I think those two things are very important, um, when we're looking at, you know, your prevention and and making sure that your eyes are good. Diabetes can lead to blindness with diabetic retinopathy. So, um, you know, anyone that's been diagnosed with diabetes, type 1, type two, really encourage, you know, you to get, make sure that you're on board and getting your regular, um, eye screenings with your, um, eye health provider. Um, and then if you do have retinopathy, there's probably going to be more indication to have the eyes checked more regularly than just the once a year. But again, that's all individualized and and specific to the patient and their provider. And then dental exams and cleanings are really important, especially if you're diabetic and have gum disease because, you know, um, you know, periodontal disease can worsen blood sugar levels, uh, increases cardiovascular risk. So, um, you know, we want to make sure that you're seeing the dentist regularly, uh, getting those cleanings done, and making sure there's no gum disease present, um, to really kind of improve your overall oral, metabolic, and cardiovascular health.
Yeah, I first learned about that connection when I was doing, um, I learned it from Brad Bale and Amy Donnen. And, um, they have a, they do a whole lot of the Lord's work in terms of helping people in this space. They talk about, uh, gum disease causing cardiovascular disease. And yeah, they worked with my friend David Pearson at, um, Vanderbilt, a great lab scientist, and indicated and actually showed that. But to me, I think that's a little bit of, um, I don't entirely agree with it because here's the thing. It's not so much A causing B. In other words, the tooth problem causing the vascular problem.
Right?
It's C causing both A and B. And what's C? Metabolic disease. The number one cause of, uh, bad gum, of bad oral health, gum disease, bleeding gums when you go to the dentist. And that's something if you don't know this, you should. If you're, most people's, most adults' gums bleed when they go to the dentist. The dentist just touches their their gums in some places and they get bleeding. Most dentists are are so used to this, they don't even mention it to their patients anymore.
Right?
But if you're watching this and your gums bleed when you go to the dentist, be afraid. Be very afraid. Get this screening that we're talking about. Go get an OGTT. Get an insulin response. Get a CGM. Start measuring this. Come to us, you know, call 859-721-1414. Come see one of us and get a little bit better understanding of, uh, what's going on with your health because you got a major red flag for vascular disease. Not because you got a, you know, pain when you go to the dentist, uh, couple of times a year, but because that's a red flag for vascular disease.
Absolutely. So, here's what happened. As I mentioned before, I ran this at John, I ran this program at Johns Hopkins, the, uh, preventive medicine program. I taught doctors there. But even I, as an individual, was surprised with my when my own, I found out I had my own plaque, cardiovascular disease plaque. I was doing all the stuff that we taught back at school, and evidently, it didn't all work. And it was because the academics were missing something. You know, to our defense, at that point in time, and most of them still don't know this, we had no idea how common metabolic undiagnosed metabolic disease was.
Right?
So that's one of the things I had to learn my own, on my own, the hard way. Uh, I started putting this kind of information out on YouTube.
Uh, there's been an overwhelming response. A lot of people started calling us up, wanted to be seen, and there's just not enough of me to go around. If you look at at docs that do this, number one, less than half of 1% of doctors actually train in prevention. Number two, um, you know, if you're going to be seen by somebody, they need to be licensed in the state where you're talking to them. Where, so if you're in California, they need to be licensed in California.
Absolutely.
Uh, as of a few years ago, there was only 18 doctors licensed in all 50 states, and I was one of them. So, it's just hard. There's not enough of me to go around. So what we did was, um, we developed a program where we have you, we have Gina coming on, has come on board. We've, you guys have been trained very well. You work with us every day, every week on how we, uh, take care of patients. And now we've gotten a bunch of, uh, health coaches who work with us. And so we have
I'm sorry.
And they're amazing. All of them.
They are really good. Most of them are, uh, really good doctors in their own country. They're not licensed as doctors here. So they don't practice as docs here, but they practice as extremely well-qualified health coaches. And you and Gina and I do the actual medicine because we're, uh, uh, licensed providers here in the states. And as I mentioned, we've got every state of the union in the US covered. So, um, if you'd like to to come in and and get care from our team, just call 859-721-1414. 859-721-1414. And if you're not quite ready for that, here's a, here's another thing. You do need to know a little bit more about what your doctor is recommending because, like we said, very few doctors have been trained in this. So, um, we've written a book. Uh, it's got seven steps in our program. It's, it basically lays out our program for how to do this. You can only cover so much on a video, but this covers a lot more, and it's in writing, and it's free. You just click on the link below and, uh, get your free copy of it. Now, having said all that, it's like that's a real setup for do-it-yourselfers, right?
Mhm.
And I, and I know I've had, uh, some do-it-yourselfers come to some of our events, like the one in Dallas and the one in Florida.
Right?
And it makes me nervous because this is not a model airplane we're dealing with. You know, if you, if the wing falls off of a model airplane, okay, you glue it back on. If this is our body that we're talking about here, it's a lot more precious, a lot more valuable, and it's a heck of a lot more complicated. So, I mean, if it, if I can teach at the number one university in the world for this and still have to learn stuff,
Oh, yeah.
Be, be careful. Be very, very careful being a DIY. We're still going to continue to provide this information. Not so much to encourage people to to do it yourself, but to encourage people to understand.
Yes.
Because the information is just not out there. The information is poor. The state-of-the-art is to simply do what you and I are talking or reading off of these lists here and not really understand what you're doing or why you're doing it.
Exactly. Speaking of which, now you've, uh, I, for the past, gosh, couple of decades, I've been way deep in cardiovascular disease screening.
Um, as I mentioned in that early story, there's a heck of a lot more out there than just cardiovascular disease, like, uh, colon cancer.
Right?
This huge trend of colon cancer happening in younger and younger people. Um, and I know you've been doing a lot of work in that. You've done a lot of work in terms of men's health and women's health. So, can you take us to school a little bit on that?
Yeah. So, as far as colon cancer screening, you know, I'm from a family practice, uh, and before, you know, I parted with family practice, they had changed the age for colon and rectal cancer screening from 50 to 45. And like Dr. Brewer mentioned, it was because we were seeing younger and younger patients, uh, you know, get diagnosed with colon cancer. So, the screening age now is age 45, uh, for those of average risk. Now, you've got those patients that may have a family history of colon cancer or inflammatory bowel disease like Crohn's or ulcerative colitis. So, their risk is completely different than the average, uh, patient risk. So, it's really recommended that you have that first colon rectal cancer screening. You can do a, you know, via colonoscopy. There's also, you know, the FIT test or the DNA FIT test, like a Cologuard. Um, so the fecal, that's the, the FIT test is that fecal, uh, immunochemical test, so that they can do, you know, just to make sure there's no blood in the stool. And then the DNA FIT is like a Cologuard where you, they send you the kit, and, uh, you know, you collect your own specimen, send it back, everything's included. Um, but a lot of patients, you know, to get that colon rectal screening started, those are some alternative options to colonoscopy. And again, it's just for those patients that are at average risks. Um, and then, you know, usually that FIT test or the DNA FIT test can be done every three years, but obviously, if if one of those are positive, then a colonoscopy is recommended. So, um, you know, screens can be, um, you know, until the age of 75, and after the age of 75, it's really, uh, you know, dependent on that particular patient's history, uh, and, uh, the patient's history and, uh, it's an individualized decision between the patient and the provider. So, we have that. So, I'm a big proponent of colon cancer screening. I worked surgery for many years prior to becoming a nurse practitioner and saw all, all walks of life, all, all patient ages, uh, having major bowel resections and surgeries, um, related to colon cancer. So, please, please, I do encourage you to at least consider this screening. There's many, many other cancer screenings. We have your prostate cancer screening for men. Um, we have your obviously your, um, mammograms and Pap smears for our ladies, and then of course, you know, we also have lung cancer low-dose CT screens for those current former smokers starting at age 50. So, that is something to consider there, especially if your quit date was less than 15 years ago and you're over the age of 50, and or currently smoking, which, you know, we also work with patients to help them, uh, develop a plan to quit smoking too, if that's something that you're struggling with. And, uh, so really, those are kind of just our basic, um, cancer screenings. Prostate cancer screening for men. It's a blood test, but, you know, the, the guidelines have kind of changed throughout the years, uh, regarding that. It's, it's not really routine, so to speak, anymore like it used to be, but really, um, you know, starting at around the age of 55 to 69, you should discuss this again, it's individualized, um, you know, and discussing with your, your healthcare provider what the best options are for prostate screening. Um, but the PSA, the prostate-specific antigen, it's a simple blood test that they can add on to an annual, um, wellness exam lab order to check, um, a PSA level. And then of course, if that's, if it's elevated, um, we don't want to kind of, you know, we want to kind of do a repeat analysis of that because we don't want to have unnecessary testing and biopsy done, um, for elevated PSA. It may be a specific reason why, you know, maybe a PSA was elevated that first time, but it should always be verified with a second, second draw on that. And, uh, for ladies, you know, uh, we talk about, um, you know, the breast cancer screening, you know, uh, usually recommended every two years. Again, this is for, you know, patients not including those patients that have risk of, um, you know, high risk for breast cancer, family history, those sorts of things. Again, those are all very personalized and individualized after discussions with, you know, a healthcare provider to determine the frequency and the age of when, um, mammography should start. And then of course, your cancer screening, uh, your cervical cancer screening for ladies, typically your Pap smears start at age, at age 21. Um, and as long as that you have normal results with that initial Pap smear, usually, and after that, every three years, those guidelines have changed a little bit too over the last couple of years. Um, and then once you're aged 30 to 65, you can do a Pap smear. You can continue with the Pap smear every three years, or you can do HPV testing every five, or you combine both and have a Pap smear with HPV screening, um, every five years. And then generally after the age of 65, as long as you've had normal, uh, you know, Pap smears and HPV testing, um, prior, there's really no need to continue, um, you know, Pap smear and HPV testing. And again, uh, that is individualized and needs to be discussed further with your healthcare provider, uh, that's specific to your, uh, individual, um, his patient history. And lastly, we do talk a lot about osteoporosis for our ladies and men. Um, we really kind of, some of the things that we, we, um, monitor is a DEXA scan, looking at body fat composition, visceral fat, but also bone density. And I think that's really important to, uh, make sure that there's not an osteopenia or osteoporosis, uh, diagnosis there that may be kind of hiding that, that, that ladies may not know about. So, you know, according to the task force, women all ages of 65 and older should have a DEXA scan, a bone density scan. Women, uh, younger than 65 that are post-menopausal should also be tested, um, have a DEXA scan, especially if they have, uh, risk factors like low body weight, they're a current smoker, they're on chronic steroid use for maybe an autoimmune disease, or if they have a family history of osteoporosis. Men, the evidence is kind of less, less strong, but those with significant risk factors, um, you know, especially that family history of osteoporosis, um, should definitely consider bone density, uh, a DEXA scan. And then, you know, like I said, osteoporosis is, is kind of a silent, uh, silent disease till a fracture occurs. And hip fractures in an older adult, um, can lead to serious disability or even death because of the hip fracture. So, detecting, um, low bone density early allows for treatment and to to reduce fracture risks. And I think that's it. That's kind of just.
That was a very good, that was a very good summary. You know, I think one of the things we may want to do,
Uh, I've, I've got some time constraints today, but
Yeah.
I think we may want to do this again and do some, uh, visuals and show exactly what the recommendations are. And I,
Let both of us dive a little bit deeper because there's so much behind each one of these things, and people just don't know what they are.
Right?
Mhm.
And when they do, when they do see the list, they're sort of like, a doc, your typical doctor, your internist, family practitioner, they're just following rote on the list rather than actually understanding the underlying drivers and being able to make an intelligent discuss, uh, decision.
Right?
No, I agree. I think I think it's important, and I hate to even just summarize some of those because they're all, you know, they all can be important, but again, it's very individualized and to a specific patient and their history and all the things. Hell.