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April 2001 Issue
Routine Medical Checkups: Which Tests, at What Age?
by Michael Fick
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So, you subscribe to several magazines and health newsletters and cruise the bookstore or library health sections regularly. You work out, play, or load hay bales every day. You eat nothing but fruits, veggies, whole grains, cold-water fish, and olive oil. You sleep 8.25 hours every night. The strongest chemical you use is aspirin. You are 30, and your great-grandparents still play tennis every afternoon. You drive at the speed limit, have been monogamous since marrying a virgin as a virgin, have washboard abs, and live in Seattle (no sun). You run to your doctor every time you get a hangnail, and have never had a cold.

You still should be getting health checkups. At the very minimum, you should know your blood pressure, blood lipids (the cholesterol alphabet soup), and blood sugar levels. They are not just cocktail party chat fodder; they are basic health-related numbers anyone who enjoys life (and thus wants as much of it as possible) should know.

They are our only means of knowing whether we have certain potentially devastating silent diseases (i.e., symptom-free) which kill or cripple hundreds of thousands of us every year. People suffer needlessly because they don’t bother with the simple, painless, quick, and cheap tests to determine those numbers or with the simple lifestyle changes which often prevent or reverse the illnesses. We take our car to the shop and tell the guy to change the air in the tires and let us know if anything else needs doing, but we won’t do the same for our bodies. Where are our priorities?

Don’t we all have otherwise intelligent friends who won’t go to a doctor except tied down in an ambulance? Not ready for that, you say? Having too much fun, you say? Then get thyself to a doctor for a checkup; nothing less makes any sense. Only s/he can determine those important numbers, and a good provider can check you out in an hour with no more discomfort than tickling your feet and poking a gloved finger or cold gadget where the sun don’t shine. Then we fill a cup and a syringe with fluids and we’re done. Frankly, I’d rather be the pokee than the poker, and I’d rather provide the fluids than handle them.

Which tests we need, and when, is a very complicated, controversial issue, with at least these risks at stake:

  1. False positives can wrongly scare us, cost unnecessary treatment and expense, and clog the medical system.

  2. False negatives can convince us symptoms can be ignored.

  3. New, unproven tests can increase the risks due to #1 or #2.

  4. Reliable, accurate tests often reveal problems we aren’t sure how to treat.

#1 may frighten us, but further and better tests should reveal the truth. #2 has the greatest potential risk, so symptoms cleared by negative tests should not be ignored. Try other tests. Cutting edge tests may lead to deeper diagnosis, but often just stir up a big commotion with no resolution because their interpretation is controversial. And there are diseases whose resolutions are highly controversial despite clear diagnoses.

A classic example of all four of those risks is the simple, cheap PSA test for prostate cancer. It gives many false positives for several known reasons. It can miss early cancers. It’s new enough that its interpretation is still imperfect. And even when a positive PSA test is confirmed by other tests, valid treatments for prostate cancer range from several forms of prompt surgery to “take an aspirin and call me in 10 years”.

Why waste blood, sweat, and tears making kids, spineless middle-aged doctor-fearing macho idiot guys, and cantankerous old geezers get regular checkups? Simple: early problem detection prolongs, even improves, millions of lives every year. You drag the kids, embarrass the middle-aged chickens, and tell the geezers they’re going for ice cream if that’s what it takes to get them in for a checkup.

That’s the simple part. The tricky part is deciding what to check, how, and how often. The bad news: there’s no clear, correct answer. The good news: any competent checkup beats none. The necessity, types, and implications of many exams, including colon, prostate, and breast, are being studied and debated in the field and the literature, so your exam provider should be keeping up with research.

The best a single, brief article can do is present one good source’s recommendations, add a few details, and provide some solid additional references. Let’s start with prolific author Dr. Isadore Rosenfeld’s recommendations (presuming you’re in very good health) from Parade Magazine (the Sunday paper supplement, Feb 11), because he’s respected, his books are easy to find, and he writes for us laymen.

What needs checking? Simple: most things between your hair and your toenails, plus your hair and toenails, plus your relatives. Any doctor who says s/he can do that in 30 minutes … can’t. Healthy teenagers need at least blood, urine, family history, eye, ear, skin, genitals, heart, and lungs checked at least once to provide a baseline for future checkups. I would also recommend starting cholesterol and blood sugar screening in the teens for the tens of millions of fat kids living on Twinkies and Big Macs because their lax parents aren’t doing their job, or maybe a heart exam for serious athletes. Many teenagers should also be concerned about AIDS, hepatitis, and tuberculosis. If you stay symptom-free, you should continue these checkups every few years (that’s deliberately vague), plus gynecological exams annually, into the mid-30s, so your doctor can learn your body and detect small or silent changes.

Then add cancer, heart, liver and kidney function, cholesterol, thyroid, blood sugar and blood pressure tests to the list. Most of that is simply another number extracted from the same blood and urine they’re going to take anyway. Increase checkup frequency to every three years. Inform your doctor of any symptoms, no matter how vague or chronic, because they may prompt additional tests which may save lives, health, and money.

In your early 40s, get those checkups every couple of years. It’s time for men to add a digital rectal exam. Get a thorough eye health exam from an optometrist. Many eye problems can be quite curable if caught early, or unnecessarily devastating if not.

Then you hit 50. There should be a sign at the initial brink of every roller coaster that reads, “The Big Five-Oh. Steep Hill Ahead”, because many of our systems start declining here. Our vision, muscle mass and strength, joints, skin, cardiovascular system, digestion, and reflexes start down a steep hill in many quantified ways. Mother Nature never intended us to live this long, and her design isn’t up to the challenge. We need help from our doctors to foil her plan.

At 50 it’s time to start getting checkups for many more things. Even cancer can be delayed or cured if regular checkups catch it in time. Add a colonoscopy every five years (they put you under for this, so it’s a yawner, and any HMO with half a brain pays for it), plus these tests every year: PSA exams for prostate cancer and EKG for men, occult blood tests, high blood pressure, arteriosclerosis, cancer, lung problems, arthritis, and attitude (an attitude change can indicate treatable medical problems).

Afraid test results will worry you? Don’t be. Negative results will lift a huge load off your shoulders, and confirmed positive results will motivate you to stop eating Big Macs. Both of those are good things.

You say you can’t afford all these tests? Economics says we cannot afford NOT to have them. Tests are much cheaper than treatment, and if your HMO or personal accountant can’t do that math, it’s time for a new HMO or accountant. Assuming you enjoy life, wished you did, and/or want more of it, only adequate food should come before medical tests in your budget. Half the people who say they can’t afford routine medical checkups have plenty of money for cigarettes, late model cars, 36” TVs, and restaurants. They’d better enjoy them while they can, because they’re playing Russian roulette without spinning the cylinder between trigger pulls.

For a great deal more information, click on these resources below and start reading. I suspect there's more variation between individual people's needs than between sources. Develop your own test program tailored to your personal circumstances, ask your doctor about it, and heed his/her advice. S/he should be willing and able to explain why s/he recommends or discourages each test. A little ache here, a family history there, and the canned lists become just a starting point anyway. Advance knowledge and understanding will help you get a better checkup.



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