Gettysburg Medical News
The Clinical View
27 December 2006
by Phillip Hoffsten

Why Do We Bother to Check?

            Recently a 56 year-old gentleman came to the clinic for a “checkup".  He said that he just got tired of his wife harping at him about his health.  He made it very clear that if he had something that could not be treated or cured he didn't want to know about it.  He made the very valid point that there was no reason to worry about something he could do nothing about.  In addition, he didn't want to take any expensive medications with marginal benefit and bothersome side effects.  I agreed with him completely and so we began.

             The leading cause of death and disability in our country is heart disease which claims 600,000 of the two and a half million deaths that occur in the United States each year.  Considering that this gentleman was 56 years old and normal life expectancy is 77 years, screening for heart problems was in fertile place to begin.  He did not acknowledge any history of chest pain.  His blood pressure was slightly high at 150/90 mm Hg. His cholesterol was checked and found to be over 300 mg percent.  A normal cholesterol is less than 200 mg percent with a bad cholesterol of only 70 mg percent.  His bad cholesterol was 140 mg percent.  His blood sugars were normal and he was not a smoker.  This patient profile indicated that his risk of having a heart attack in the next 8 years was over 40%.  In other words for every 10 men like him, 4 of them would have a heart attack in the next 10 years.  Two of those individuals would die from their heart attack.  He thus had one chance in 5 of dying of a heart attack in the next 10 years.  I pointed out to him that this is the same odds as a game called Russian roulette.  This got his attention.

             I then pointed out that if he brought his blood pressure back to normal and if he had his bad cholesterol under 70 mg percent, his risk of heart attack in the same period of time would only be one chance in 20 and risk of death only one chance in 50.  I added  that the side effects of the medications to achieve this were few to none.  This seemed a good investment to him and two medications were started.

             The next most common cause of death in our country is cancer.  The leading cause or cancer death in men is cancer of the lung, followed by cancer of the colon and cancer of the prostate.  I pointed out that there is little reason to screen for cancer of the lung because it carries over a 90% mortality within two years of discovery.  Thus, the sooner you find it the longer the person has a death sentence hanging over their head.  But cancer of the colon can be totally prevented by removing precancerous polyps before they turn into cancer.  Performing a colonoscopy at age 50 and periodically thereafter can totally prevent the development of cancer of the colon and is well worth doing.  Cancer of the prostate is definitely favorably treated if found early.  Performing a PSA blood test is useful.  To finish the examination, I examined his skin. The rest of his physical exam  was normal.  In spite of his reluctance, he did get a colonoscopy done.  Fortunately it was normal and would not need to be repeated for at least 5 years.

            The next leading cause of death and disability in our society is stroke.  The factors that cause strokes are hypertension, high blood cholesterol, smoking cigarettes, and diabetes.  We have dealt with these considerations in the section on heart attack and I indicated to him there were no additional steps necessary.  Indeed, rare events such as Senator Tim Johnson’s arteriovenous malformation that bled into his head can occur.  But there is no practical way to screen for this type of problem which is simply an act of fate.

            Chronic lung disease and diabetes are the next two most important diseases in our society.  Fortunately this gentleman was not diabetic and not having been a smoker his lungs were in good repair.

            Safe driving habits and the use of seatbelts are life-saving.  Some of the most tragic individuals that I help care for are those who had moving vehicle accidents which resulted in paralysis of their arms or legs or both for the rest of their life.  Avoiding driving while intoxicated, or too tired and the use of seatbelts can prevent incalculable grief.  For one to think about, one of the most dangerous situations in South Dakota in 2004 was a man over age 50 on a ladder.  Probably should let the kids do that ladder stuff.

            Annual influenza shots and a pneumonia shot on schedule is probably worth doing.  The new shot to prevent shingles will prevent something you never want to get and is probably worth the price.  After discussion, the gentleman elected to have these injections.

            An annual eye exam to check for glaucoma, macular degeneration, and cataracts  is well worth the effort.

            Depending upon symptoms and problems that might arise, other tests might be utilized.  But he had no other symptoms or significant health risks, so I ended his exam.  He was a member of the 33% of Americans who are not overweight.  America’s obesity problem is overwhelming at this time but that is the topic of another whole column.

            For women an annual mammogram can save a lot of grief.  Checking bone mineral density and treating osteoporosis is critical in women to prevent fractured hips and broken backs.

            To summarize, health care professionals check in order to detect disease processes that can be reversed or prevented.  This checking can prevent a host of problems a person wants.