Plan for the future. Basically medical testing can be done for one of two reasons: either something is wrong- heart attack or cancer for example- or you want to find a problem in its earliest stages so you can prevent its unfolding into a true crisis.
We are all going to die so start with that premise and some things become clearer. First you might quit living in denial about your future. Many people laughingly note youth’s sense of immortality. True enough; less noted is that most people act and often feel this way well into middle age when it is certain that death’s stealthy advance insurgents are already on the ground and making headway.
Absolute denial makes sense if fatalism is your only option. But this is not the case. What you know, when you know it and how your incorporate what you know into what you do, that actually all makes sense, can radically change the date and time of death’s arrival.
Maybe more important such knowledge can add quality, vigor and joy to the years you have. OK, we all kind of know that.
So what to do? I recommend you begin your quest with an exceptionally comprehensive set of tests. Properly done these can detect your risk for behavior modifiable diseases or aging phenomenon. Look, your blood pressure and total cholesterol numbers are easy to obtain and tell you absolutely nothing about the future. However checking for genetic diseases like Celiac disease, Alzheimer’s, Hemochromatosis, elevated Lp(a), various forms of thyroiditis, low testosterone, premature loss of bone density and so on can change your life for the better by merely knowing and then acting on knowledge of the problem long before the problem demands your attention by declaring itself as a disaster. Donate blood; you don’t die a miserable death from iron overload. Avoid gluten containing foods and you rid yourself of excess risk of a wide range of auto-immune and malnutrition related problems later in life. Lots to do if you only know you need to do it.
Is there a rational rule for choosing which tests to order? In my opinion there is: test for everything that occurs in the general population at the rate of about 1 in 1000. For example: colon cancer occurs in people in their 40’s at about the rate of 1 in 250. Conventional guidelines don’t even look for colon cancer until 50. Well one of my best friends from college died of colon cancer in his 40’s. His 80+ year old mother developed the disease at about the same time; too late to warn him of a family history.
Another more common risk is heart disease. Knowing your cholesterol number does very little to tell you whether or not you are actually at risk. Example, my own mother had extremely elevated cholesterol and in her early 70’s as the statins finally came into being they urged her to take the drug. Well she is well into her 90’s now, never took the drug even though it had been prescribed and, believe me when I tell you ‘My Mom Can Whip Your Mom.’ Well that’s being a little silly but she has not a whit of vascular disease and is tough as nails. On the other hand I’ve seen patients with nearly fatal heart attacks in their 30’s with very low cholesterol numbers. Is there anyway to find out if you are on track to having vascular disease? Well in fact there is. Coronary calcium screening is one way and there are others. But the point is to get objective direct measurement of the absence or degree of presence of atherosclerosis. Knowing these values will only tell you weather or not you have the underlying disease well on its way or absent at a statistically meaningful level. By the way passing a conventional stress test is nearly useless; you can pass one of these with an 80% blockage in the 3 main arteries to the heart. Dr. Ken Cooper was ahead of his time 50 years ago when he began using and advising this test; now we know you need some additional level of anatomical imaging like an echo or nuclear study. Still to quantify presence coronary calcium scoring is about the best way to go.
A related and meaningful risk is exercise induced hypertension: blood pressure normal at rest and dangerously high during peak exercise. Some of these are the guys out for a hard run who drop dead; their exercise is what killed them. Chronotropic competence is another important risk factor; how your heart rate responds to rest, change, sleep, and exercise is a powerful measure of the health of your heart completely missed by blood tests, EKGs and stress tests in the hands of most doctors. Check this one.
I am not going to list all of the diseases to screen for that occur at the 1 in 1000 range and for which there is effective behavioral interventional therapies; the list is too long. But it is not hard to find out for yourself; read CDC reports, look at available online statistics. Such testing is what we did at Tempus.
When clustered together such testing will usually yield important unsuspected, correctable problems in about 1 out of 10 people; well worth doing if you are one of my friends and family which is how to look at it. If you sit down and worry about the national debt or the justice of your getting such care when there are those in the third world not even getting enough to eat you will be surprised to learn, think it through, if you don’t take advantage of such an approach no one anywhere will get the chance eventually. Put another way what the rich have now the poor will have eventually and if the rich don’t get it no one ever will. Sounds harsh but that is how early adopter technology becomes affordable on a broader scale. Heck, if such an approach saves your life you may change the world for the better in some unseen and wonderful new ways. Do it.
Smile, Have Fun and God Speed,
Dr. Mike
