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Medicine and Health

Stethoscope, hypertension, Kidney Failure

The Checkup, Too Much Or Too Little?

By Dr. W. Gifford Jones

August 25, 2002

What constitutes a good checkup examination? Good sense dictates that young children don't need a Pap smear for cervical cancer, a PSA test for prostate malignancy or X-ray studies to measure bone density. So what's included in a checkup depends on the patient's age and it can save a life or prevent serious diseases.

Today many hi-tech diagnostic tests are available, but the stethoscope is all that's needed to spot a big killer. Since 60 million North Americans have hypertension a blood pressure check must be part of every annual examination. High blood pressure is the second leading cause of kidney failure.

Routine blood tests help to pinpoint problems such as anemia. But today the one test everyone requests is for blood cholesterol. What's debatable about this test is when it should be checked. Some argue it's needed as early as age 20, others say 35 is a more reasonable age. And then it should be done every five years.

The test that isn't debatable is the fasting blood sugar (FBS) to detect diabetes which has reached epidemic proportions. Every 45 seconds a new diabetic is diagnosed in North America and 90 percent of cases are due to obesity. Diabetes sets the stage for heart disease, kidney failure, blindness and gangrene of the legs. FBS is a "must" test since too many people have undetected diabetes.

At the age of 40 it's important to have an electrocardiogram (EKG) even if you don't have heart problems. Later in life if you experience chest pain it's helpful to compare any EKG changes with the earlier one.

In a perfect world, at 35 to 40 years of age everyone would have a colonoscopy. This procedure examines the entire large bowel to determine if polyps (fleshy growths) are present. It takes many years before some become malignant so early removal saves lives. If colonoscopy isn't available in your community arrange for a sigmoidoscopy which examines the lower large bowel. After age 50 a colonoscopy should be done every five years.

Breast examination should be a part of every yearly checkup. But there's no agreement about the right time. Some authorities say age 40, others age 50. But after age 50 most concur it should be done every two years. Unfortunately mammography sometimes detects masses that turn out to be benign which causes sleepless nights. And it sometimes misses cancers that are present. It's a test that leaves much to be desired.

Pap smears should be started as soon as a woman is sexually active. Some authorities claim that if the smear is normal three years in a row it can be done less frequently. But since Pap smears are not 100 percent accurate many gynecologists prefer an annual smear.

What is more controversial is when men should be advised to have a PSA test to detect prostate cancer. The American Cancer Society recommends prostate screening at age 50. Others argue that most prostate cancers grow slowly and not all are fatal. Agreeing to radical surgery or radiation treatment may result in impotence and spending the rest of your life in diapers. Only an open discussion with your doctor can solve this dilemma. But a PSA at age 70 becomes questionable. Even if it shows early prostate cancer most men survive 15 years without any treatment.

Today many adults have failed to keep immunizations up-to-date. A cut from a rusty nail may result in dying from tetanus. Or death may occur from cirrhosis or liver cancer unless protected from the hepatitis B virus. Each year thousands die from failing to obtain influenza and pneumoccal vaccine. And when did you last have a polio shot? The annual check-up is the best time to see what immunizations should be brought up-to-date.

Check with your doctor about supplements. All women of child-bearing age should take a multivitamin containing 400 micrograms of folic acid. It's vital that this is started before pregnancy occurs to prevent spinal cord defects in newborns. Unless you drink milk everyone needs vitamin D to help absorb calcium. And elderly people are often lacking in B12. There's also evidence that folic acid, B6 and B12 are needed to keep homocystiene levels normal and help to decrease the risk of coronary artery disease. And vitamins C and E , both antioxidants, help to rid the body of the waste products of metabolism called free radicals. There's reasonable evidence that antioxidants decrease the risk of cataracts and other aging problems.


W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones
Canada Free Press, CFP Editor Judi McLeod