Your Checkup Checklist

These tests may spot signs of trouble before
something serious happens.

February 2016

By Sandra Gordon

Feeling fit and healthy is good but that doesn’t mean everything is OK internally. That’s why doctors recommend screening tests, which look for signs of disease before you experience symptoms. “They’re helpful in terms of prevention,” says Joseph T. Barry, MD, a board-certified primary care physician in Camillus, New York. They can help detect a condition in its early, most treatable stages to improve and even save your life.

Still, they’re not perfect. Screening tests can backfire by indicating the presence of a condition that’s not there (false positive), which can lead to unnecessary testing, anxiety and treatment. They might also miss a condition (false negative), which can delay treatment.

Screening tests can also be costly. According to choosingwisely.org, an initiative of the ABIM (American Board of Internal Medicine) Foundation and the Society of General Internal Medicine, $300 million is spent annually in the US on unnecessary tests that are ordered in annual physicals. Similarly, a 2014 survey of the Robert Wood Johnson Foundation found that three-quarters of physicians surveyed say unnecessary testing is a very or somewhat serious problem.

For these reasons, doctors don’t always agree on which screening tests are necessary. Which tests do you need and which ones can you live without? Here’s a rundown of some standard medical tests most doctors agree everyone should get.

Blood Pressure

This basic yet important test measures the force of your blood against your arteries when your heart beats (systolic) and when it rests (diastolic). Get your blood pressure tested at least once every two years, starting at age 20, or more often if your blood pressure is higher than it should be.

What’s normal: 120/80. Chronic high blood pressure (140/90 or more) can increase your risk of stroke and other conditions. Blood pressure can vary throughout the day and be temporarily elevated in the doctor’s office, known as white coat hypertension. In prehypertension, which increases your risk of developing outright high blood pressure, the systolic reading is between 120 and 139 or the diastolic reading is between 80 and 89.

Questions Surround Mammography and
PSA Testing

Two of the best-known medical tests, mammograms for women and PSA testing for men, are among the most controversial.

The American Cancer Society recommends that women without symptoms such as a breast lump go for mammograms every year between the ages of 45 and 54, with the option to start testing at 40 and to start skipping years at 55. Additional testing is recommended for women with risk factors such as a family history of breast cancer or having a mutation of the BRCA1 or BRCA2 genes. Testing for levels of PSA, a substance released into the blood when the prostate is dysfunctional (and not necessarily cancerous), is recommended to begin at age 50 for men at average risk, 45 for those at high risk (being African American or having a father, brother or son diagnosed with prostate cancer before age 65) and 40 for those at the highest risk (having two close relatives with early prostate cancer). These ACS recommendations run counter to those of the US Preventive Services, which recommends against PSA testing for screening purposes and for mammography on a less-rigorous schedule.

Experts do not agree about the value of either screening test. That’s because followups after abnormal results for what turn out to be false-positives can be expensive and possibly harmful. And even if cancer is found, there is no way to immediately determine how dangerous the tumor is in terms of being likely to spread. In fact, the title of a report by researchers from Oregon Health and Science University released just last month in BMJ states, “Cancer screening has never been shown to ‘save lives.’”

The best way to determine the scheduling of mammograhy or PSA testing—or of any screening tests, for that matter—is to consult with your healthcare practitioner, taking your personal risk factors into account.

If your blood pressure is high in the doctor’s office, ask your doctor about wearing a 24-hour blood pressure monitor. It gives at least 40 readings over 24 hours to provide a better indication of your blood pressure status. “A 24-hour blood pressure monitor is especially helpful to see if your blood pressure dips at night,” Barry says. If your blood pressure doesn’t drop when you’re sleeping, that’s a sign that you truly have hypertension and may require treatment.

Alternatively, take your blood pressure with a home monitor or at places where public blood pressure monitors are available. “I tell my patients to bring me a bunch of readings,” Barry
says. “Numbers from the real world are more helpful than taking your blood pressure in the doctor’s office.”

Bone Density

A DEXA scan, a specialized X-ray of the hip and spine to determine bone strength, is recommended for women 65 and older and men 70 and older. But consider getting this test earlier if you have ever had a bone break after a minor injury, smoked or used steroid medication, or if you’re in menopause but not taking estrogen replacement therapy.

“I recommend DEXA for women who are several years into menopause,” says Patricia Sulak, MD, author of Should I Fire My Doctor? (Next Century). “A lot of women will develop osteoporosis by age 65. If you have a DEXA scan earlier, you might pick it up when it’s just osteopenia (low bone mass).”

What’s normal: Bone mineral density is measured by a T-score. A T-score between +1 and -1 is considered healthy. Once you have your T-score, plug it into FRAX (shef.ac.uk/FRAX/tool), an online calculation tool that can help you estimate whether you’re at high risk for fracture.

Cholesterol

This simple blood test, performed after you’ve fasted for nine to twelve hours, measures blood levels of cholesterol, a waxy substance produced by your liver and found in food. There are three types: LDL (“bad”) cholesterol, HDL (“good”) cholesterol and triglycerides, another form of blood fat ]that can increase your risk of heart disease. Total cholesterol is LDL + HDL + 20% of your triglycerides.

What’s normal: Optimal total cholesterol is less than 200; LDL should be less than 100 and HDL should be over 40, the higher the better.

High cholesterol can increase your risk of heart attack and stroke. If you don’t have cardiovascular disease, the American Heart Association recommends getting your cholesterol tested every five years, starting at age 20. If you have CVD or your risk is high, get your cholesterol checked more often. Ask your doctor about a testing schedule that’s best for you, based on your personal and family medical history.

Colonoscopy

Screening colonoscopy is recommended for most people starting at age 50. During the test, you’ll be sedated while your doctor uses a thin, flexible scope to examine your colon and rectum for polyps or other growths that may turn into cancer over time. Consider it one-stop shopping: Your doctor can screen for colorectal cancer and simultaneously remove polyps before they become a problem.

What’s normal: No polyps. If you have polyps removed, your doctor may suggest repeating the test every three to five years. Otherwise, get a repeat colonoscopy at least every 10 years. A study in the New England Journal of Medicine found that removing non-cancerous polyps during colonoscopies resulted in 53% fewer deaths.

Electrocardiogram (EKG)

For this painless test, electrodes are taped to your chest to measure your heart’s electrical signals in 20 seconds. An EKG checks for evidence of strain or heart damage. It’s a routine part of an annual physical. “Everyone gets one at any age,” says Barry, about the patients in his practice.

What’s normal: A wave pattern on the read-out that electrical activity is steady, rather than slow, fast or irregular. If your EKG is abnormal, ask your doctor about being referred to a cardiologist for additional tests, such as an exercise stress test. It can show if your arteries are supplying your heart with enough blood while you’re walking on a treadmill.

Fasting Blood Glucose

This test measures the amount of glucose (sugar) in your blood. You’ll need to give a blood sample after you haven’t eaten for at least eight hours.

What’s normal: 70 to 100. A level of 100 to 125 means you have prediabetes and 126 or above indicates diabetes. If you don’t have diabetes, be on the lookout for it with a fasting blood glucose test every three years, starting at age 45. If you’re overweight, start getting your blood sugar checked at age 40.

If your test results are abnormal, expect to take the A1C (also known as glycated hemoglobin, glycosylated hemoglobin, hemoglobin A1C and HbA1c), another blood test that reflects your average blood sugar over the past two to three months. If you’re blood sugar is close to 100, act as if you have prediabetes and ask your doctor what you can do to improve it.

Blood pressure, cholesterol and blood sugar are three key indicators of heart health. “Ask your doctor what your number are and write them down,” Sulak says. Knowing your numbers can motivate you to take lifestyle steps to get them in the optimal range and get your health on track.

Urine Test

In this routine test, your urine will be tested in the lab for blood, glucose, protein and signs of infection.

What’s normal: There shouldn’t be any blood, sugar or protein in your urine. “A positive result could indicate kidney damage, diabetes or even cancer,” says Mark Carney, ND, LAc, co-founder of Thriveology in Denver, Colorado.

Beyond the Basics

A variety of screening tests are available at your doctor’s discretion. Here are six nonstandard tests to ask your doctor about that can provide an even clearer picture of health and your risk for disease.

Carotid ultrasound: This test uses sound waves to show if the arteries on the side of your neck are blocked or narrowed. It’s appropriate if you’ve ever had a stroke or mini-stroke (a transient ischemic attack, or TIA). But some physicians recommend carotid ultrasound for anyone over 60 or anyone over 50 with risk factors for heart disease, such as being a smoker and/or having high cholesterol or hypertension.

C-reactive protein: This blood test measures a protein made by your liver that rises when there’s inflammation throughout your body. High C-reactive protein can put you at increased risk for heart disease.

Homocysteine: This blood tests check for methylation disorders. “Methylation is something that happens in every single cell in your body hundreds of thousands of times a second,” says Laurie Steelsmith, ND, LAc, naturopathic physician and author of Natural Choices for Women (Harmony). It’s a pivotal step for breaking down homocysteine, which is part of your body’s natural detoxification system. High homocysteine (above 15) can signal high inflammation throughout your body, which can put you at risk of cardiovascular disease, osteoporosis and other conditions.

Stress echocardiogram or a nuclear stress test: These advanced screening tests use sound waves or a small amount of radioactive material to show if blood flow to your heart is adequate. Ask your doctor about undergoing one of these tests if you have diabetes, peripheral artery disease or symptoms of heart disease, such as chest pain, shortness of breath or an irregular heartbeat.

Vitamin B12: This blood test measures the amount of vitamin B12 in your blood. Having adequate amounts of B12 can help keep your nervous system healthy. Low levels can signal that you may need a B12 supplement.

Vitamin D: Officially known as the 25-hydroxy blood test, it measures whether you’re deficient in vitamin D. A level greater than 30 is optimal. If yours is less than that, consider taking a vitamin D3 supplement. Low levels of vitamin D may contribute to osteoporosis and other health problems.

Medical Tests on the Cutting Edge

A number of companies are developing assessments designed for everything from detecting food sensitivities and allergies to pinpointing cardiovascular risk; these are only a few of them. Keep in mind that not all practitioners are familiar with these tests and that insurance plans may or may not cover them. You should always discuss possible medical testing with your own practitioner, taking your own unique needs and risk factors into account.

Array 10: This test is one of many on the market that look for food reactions, which have been linked to autoimmune disorders. The company says that this specific panel “tests 180 cooked, raw and modified foods,” thus searching for immune reactivity to foods in the ways they are most likely to be consumed; it recommends testing for patients with “unexplained symptoms whether gastrointestinal, neurological, dermatological or behavioral in nature.” Cyrex Laboratories, joincyrex.com

Boston Heart Cardiac Risk Assessment: Takes an in-depth look at heart risk factors, such as the specific types of high-density lipoprotein (HDL) in the blood, cholesterol balance and whether or not you can properly metabolize statins, a common class of cholesterol drugs; other tests look at apolipoprotein B (apoB) and high sensitivity C-reactive protein (hs-CRP). Boston Heart Diagnostics, bostonheartdiagnostics.com

Estrogen Gene Test: Looks for variants in the genes that help the body metabolize estrogen; cumulative exposure to this hormone over a woman’s lifetime has been linked to increased breast cancer risk. The company says this test “is particularly important in women who are considering oral contraceptives, hormone replacement therapy, bio-identical supplementation, in vitro fertilization or who have been diagnosed with estrogen receptor-positive breast cancer.” Estrogen Gene Test Company, estrogengenetest.com

Hydrogen Breath Testing: Analyzes gases in the breath that may indicate digestive issues; the company says it can test for small intestinal bacterial overgrowth (SIBO); malabsorption of the sugars lactose, fructose and sucrose; and infection with H. pylori, a bacterium associated with ulcers. Commonwealth Laboratories, hydrogenbreathtesting.com

 

 


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