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Doc Talk: Who needs a mammo?

Kristen CoburnBy Kristen Coburn, FNP

First, let’s acknowledge that men can get breast cancer. The risk for males is significantly lower than the risk for females, but that doesn’t matter if you’re the man who receives this diagnosis. For the sake of simplicity, the rest of this article will refer to a female audience.

Who needs a mammogram? It seems like a simple question, but the answer isn’t the same for all.

Before we wade into the controversy, it’s important to know that a screening mammogram is different than a diagnostic mammo.

In Idaho, you can request a screening exam without a doctor’s order. If you don’t have any risk factors (age, family history, symptoms) your medical provider may recommend that you don’t need this screening. Screenings take less time, use a lower dose of radiation and provide general images of your breasts. Diagnostic mammos are prescribed by a medical provider, use a higher dose of radiation, and usually focus on specific areas of your breast(s).  Your provider may order a diagnostic mammo based on your risk factors and other indicators, or you may be asked to get a diagnostic follow-up if the results from your screening mammogram indicate the need.  Under current insurance mandates through the Affordable Care Act, screening mammos are covered by insurance, at no cost to the patient, for women 40 and over. Diagnostic mammos may or may not be covered 100% by insurance. It’s always a good idea to check with your insurer before you get a mammo or any type of medical care.

Resources on the internet offer a confusing mix of opinions on preventive mammogram screenings based on factors such as you’re under 55, over 40, overweight, underweight, a wine-drinker, vegetarian, under 25 with a family history, or menopausal. Of course, internet resources vary widely in the degree of science and research that went into the answer.

Most of us have heard the recommendation that every woman should have an initial screening at the age of 40, and every year or two after that. Over time, different medical research organizations have come forward with other studies and recommendations, not to mention all of the online experts sharing research from unsubstantiated sources. We’re frightened to hear about false-positives, false-negatives, overtreatment, under-treatment, and radiation exposure, and yes, all of these problems can occur. As with nearly every choice in life, we need to weigh potential benefits against possible harms. 

What’s a woman to do?

At Teton Valley Health Care, we agree with the position of the National Cancer Institute: Talk to your provider. Together, come up with an informed plan that fits your preventive care needs based on proven outcomes. Ask questions and share information that concerns you. Choose what’s best for you: your body, your history, and your well-being.

Through donations from Teton Valley Hospital Foundation, our community hospital offers free screening mammograms for anyone who cannot afford them. The request form is one-page, requires no financial documents, and is simple to fill-out. Funding is also available to pay toward biopsies, ultrasounds, follow-up clinic visits, surgery, and travel costs related to breast cancer prevention and diagnosis. Call (208) 354-6331 for more information about this program.

For good health, prevention is the best route to take. Make sure you’ve had your vaccinations, and take advantage of screening opportunities that are recommended for you and your family. When in doubt, talk it out with an appropriate medical provider.

Kristen Coburn is a Family Nurse Practitioner serving clients at the Teton Valley Hospital Aesthetics Clinic, and Driggs and Victor Health Clinics.

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Doc Talk: The downside of toughing it out

By Dr. Mo Brown
Orthopedic surgeon

Mo Brown head shot

Dr. Maurice (Mo) Brown

I love taking care of the tough people who live in beautiful Teton Valley. If you live here, you are “tough”. This is not a sit-and-play-checkers-as-the-sun-goes-down kind of place. Our valley is full of tough people. They ski on torn ACLs, they board with broken tailbones, they sled with ripped rotator cuffs, they drive tractors with broken wrists and they go on with their work and recreation for years with these injuries. Really, I have to marvel at the pain these people must endure and the inventions they create to keep on moving.

If you think I’m writing about you, then please read on.

I admire your high pain threshold and your unwillingness to give up any time for rehabilitation because you’re having too much fun or have too much work to do. Just know this: It’s better for you and your orthopedic surgeon to have something to work with when you decide to get “it” fixed, whatever “it” may be.

Just know this: It’s better for you and your orthopedic surgeon to have something to work with when you decide to get “it” fixed, whatever “it” may be.

Orthopedists see X-rays and MRIs that tell the whole story in a few simple images and sometimes, it isn’t pretty.

A good example of long-term damage being the end product of ignoring an injury is a meniscus tear in a knee joint. It’s very common for me to see patients with a “torn and ignored” meniscus. The meniscus is designed to be a protector of the knee joint. But when torn, it becomes a defector and can destroy the joint’s surface cartilage. I see too many patients that have put off treatment because some days it feels fine and they can live with the popping and occasional pain. It’s a bummer to see the joint surface severely damaged when we finally get around to fixing the problem. If I can offer treatment soon after the injury, there is much less damage to the joint surface resulting in a quicker, better recovery and much better long term outlook.

In modern sports medicine we are generally more aggressive when it comes to early rehab. ACL patients start rehab right away — a big change from casting (eek!) and a year in rehab in the early days of ACL reconstruction. However, recent data regarding ankle sprains has led to a step back in how those injuries are managed. Instead of pushing immediate movement, it’s clear that a period of casting or boot immobilization produces better outcomes.

Again, I see lots of patients who ignore a bad ankle sprain and keep on truckin’. They sprain their ankle over and over and ultimately require surgery to reattach or reconstruct the ligaments.

Now, I’m not throwing stones here. I’m just as guilty of delaying treatment. But take my advice: if you get hurt, have it checked out. If you wait too long, what could have been a little R & R with physical therapy or maybe a minor surgical repair can morph into a more complex procedure such as joint replacement.

If you get hurt, have it checked out.

Orthopedics_Mo Brown

Mo Brown and patient

It’s important to know what the consequences can be if you put off medical help for injuries. You may be mentally able to handle physical pain, but your body is sending that pain signal for a reason.

For all of you die-hards out there, let me put it this way: The toughest thing you can do in these situations is to stop your activities, see your doctor and get “it” fixed before it becomes a bigger problem.

Dr. Mo Brown is an orthopedic surgeon at Driggs Health Clinic.

This article originally appeared in the Teton Valley News.

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