In January 2009 I was Stage 5 chronic kidney disease, in July 2009 I had a kidney transplant. Looking back there were so many telltale signs that I had over the last six months, which I was ignoring as I was busy building my startup. A regular health check has the potential to catch a problem like this. I now nag each of my friends and family in having an annual health check.
Its the best time you can spend.
This was not the first time I made a mistake like this. When I was a kid, I had trouble seeing my teacher's blackboard. I just kept moving closer to the blackboard. I saw a doctor when I had trouble understanding what the teacher was writing from the first row.
Problems like this creep up on you over years, and they are so gradual you don't realize them.
You wont run your site without a Google Analytics/Pingdom. Dont do it with your life. If you haven't had a health check, get it done today.
So, yes. Please find a good primary care physician you trust and visit on an annual basis. Make sure you update that phsyician with what's going on in your life. That includes any family history, pain, issues etc. When in doubt, see another physician. But please don't go out and get a full MRI of your body just because (which, you are not saying, but does happen). There are enough VOMITs[0] in the course of normal defensive medicine. Don't go looking for problems because -- although they'll definitely help you look -- you might not be better off for it.
When the procedure was finished, I was told they would analyze the result, but I had a cancerous tumor and they sent me for a CT scan which confirmed stage iv colon cancer with liver metastasis. I'm now 8 months into chemo and after having my sigmoid colon removed, seem to have "stable disease" in my liver. I was otherwise asymptomatic.
Another chap at my company wasn't so lucky. He got hit by a car and lost consciousness. They did an MRI to check out his brain - and found tumors. A CT scan showed the same don't diagnosis as me, but his was far more advanced, with mean mastastasasis to the liver, lungs and brain. He passed away about 5 months later and was otherwise asymptomatic.
In both our cases, A blood test given after the diagnosis (CEA) showed highly elevated numbers - perhaps two orders of magnitude from nominal.
So my question would be: given that this blood test was a marker for our disease, why can't it be given more regularly as part of a routine checkup? I realize there are other reasons for a false positive, but couldn't it be an indication that further testing should be done? Yes a CT scan can cost $1500, but my chemo costs $12,000 per month.
A central problem is that you get loads of false positives when you are screening symptom-free individuals, and these false positives can cause real harm: beyond anxiety, they often bring on potentially painful, expensive and side-effect causing treatments. Just see the recent recommendations over the PSA test: http://en.wikipedia.org/wiki/Prostate_cancer_screening.
Definitely go to the doctor if you notice any symptoms or worrisome changes. For other types of screenings, be aware that the recommendations often change and that there is a real cost/benefit analysis (even in terms of your own body, not just financial cost) to be done.
Say that a random scan uncovers that you have a minor brain aneurysm. The aneurysm's size and location implies it has a chance of rupture of around 0.2% per year. The operation to resolve the aneurysm, however, may have a 5% risk of death.
Weighing up the decision to have an operation is incredibly difficult, since most would be rather distracted by the idea of a ticking timebomb going off in their head at any time, yet the risk of the operation is more immediately significant. If undetected, the aneurysm may never rupture, or it may grow to a size where it causes other symptoms and can then be operated on.
(Or, of course, as in the case of a young friend of mine in his then early 20s, pretty much anyone can keel over at any time due to an undetected aneurysm anyway.. it's totally pot luck.)
There's nothing wrong with getting an MRI every year if you aren't actually looking at it on its own, but rather diffing it in a time-series, and extracting chartable statistics from it, to see if anything in your body is getting progressively [adjective]er each year.
This approach won't actually tell you if you've got six months to live, but it's not supposed to. It's to show you that your liver has been getting 10% more scarred over with each visit, so—with evidence!—you'd better lay off the booze already. Or to find something like arteriosclerosis before it presents clinically.
[1] https://health.ucsd.edu/specialties/ehw/services/Pages/gold....
Most tests do have some degree of false positives, but there a number of defensive diagnostic tests which are nearly error free and clinically significant
To name some: * BUN + Serum creatinine - Kidney health * LFT - Liver health * Sugar levels - Early detection of diabetes
I am not recommending a MRI, but everyone should get an annual health check, for some values of comprehensive.
Also, avoid being caught in modern media's constant drive toward polarizing sensationalism; your own life is actually fair simpler and more enjoyable than the internet and TV would have you believe (if you live in the first world)
So sure - get health checks done. Then be prepared to spend weeks or months double checking what your doctor is telling you, and possibly getting 2nd opinions and more tests.
Personal story: Head health test. High A1C. Diagnosed Diabetic, despite being a very fit triathlete who hasn't drank soda in 6 years and eats < 20g of sugar a day. Literally had near 2 weeks of full blown panic attack. Tried to change my diet to crazy low glycemic index food and eat 8 times a day to try and get my A1C down without medicine.
2 weeks later got into a 2nd doctor for another opinion. Turned out my test was just bunk. A1C is fantastic. Apparently it happens all the time (a bad test). My first doctor did not tell me this at ALL.. just told me I was a diabetic and to stop drinking so much Soda.
My takeaway? If not showing signs, don't bother with routine tests. Too many medical quacks.
67, been following a congenital heart murmur for years. Cholesterol at 130. Noticed my running and biking dropping performance dropping off, so think time for a heart valve replacement. Routine pre-op catheterization shows coronary artery blockage. Have bypass and valve replacement, doing great. But 130 was too much cholesterol for me apparently. On statins and down to 95! I am now 68, no prostate, artificial heart valve, bypassed coronary artery, but feel great and am still active.
Glad the heart surgery took place after I started medicare though. Say want you want about government ineptitude administering anything, but medicare works.
It's a good question what are the best tests to do periodically. I doubt that "none" is the right answer.
And yes, you should stop drinking soda, diabetic or not. Nothing bad will come from not drinking it, but plenty of bad things can come from drinking it. Telling you this doesn't make either your doctor or me a "quack".
Or you might want to postpone your visit to the doctor until you have an actual reason to go there:
http://www.nytimes.com/2015/01/09/opinion/skip-your-annual-p...
http://kaiserhealthnews.org/news/ritual-not-science-keeps-th...
I would consider tests comprehensive if tests all major internal organs (kidney, liver, heart, spleen + common cancers depending on gender/age), you can come up with one after talking to a physician. Because I am based in India, I can only recommend India specific one, https://www.apollohospitals.com/preventive-health-care-check... are generally good.
If some or all of these are "no", it's not a comprehensive exam.
Start by NOT asking random people on the internet.
Ask your doctor about what tests to do and he'll tell you based on your age / history, and you can trust him better than a random stranger or some web post.
http://healthblog.dallasnews.com/2015/04/mark-cuban-is-wrong...
It's 2015, and there's still no general agreement on which tests to run to tell if you are healthy or not. We don't even have firm evidence whether your annual physical with a doctor is a net positive or negative.
Meanwhile, people are dying decades prematurely due to uncaught illnesses that we know how to fix.
We have a check engine light for our car engine. Why on earth don't we have one for our bodies yet?
If your car starts easily and runs well, has no changes in fuel economy, and you have been keeping up with basic maintenance, it's probably fine.
Same with people. Sure there are some people who just drop dead out of the blue. But most people have symptoms. Unexplained weight gain or loss. Fatigue. Difficulty sleeping. Changes in bodily functions. For most people, if you have no symptoms and feel healthy, you most likely are. If you have family history of certain problems, of course be more vigilant about that.
We can't possibly continually test everybody for everything that might possibly be wrong with them, at least not until we have Star-Trek style medical devices. Unjustified testing in the absence of symptoms will simply further drive up the cost of medical care for those who really need it. One could argue that it already has.
Sometimes, thanks to technology, we don't know who has access to our data and whether this is going to be used against us: for example, will we have an impossibly high insurance premium attached to us for life - with the data in our hands, we lose the right to use insurance to even out that risk.
Sometimes, in medicine, there are ethical considerations, that the eventual treatment for a screened condition presents its own risk that people may not wish to decide and the healthcare system might not be well-equipped to manage.
Nonetheless, I still personally prefer to have the data than not. I want to decide my own healthcare needs based on my own knowledge and understanding of my own risks. This is "data driven".
> I fail to see how screening of healthy, relatively young, people would be "data driven".
So just by looking at yourself, you don't know if you are healthy, only that you look healthy. The tests are to ensure that you are, and to give you time and flexibility of treatment if you are not.
Thanks for sharing! Having known and worked with you for years I could not agree more. I ran the startup life for 6 years and it'll eat you alive if you let it.
Regards, Lane
I wanted to add my thoughts about false positives and executive health checkups, which fall under the larger umbrella of screening. I conduct executive checkups fairly regularly, but i’m not promoting anything here. I just want to share a personal philosophy that you, as a patient, could adopt to reduce risk.
Firstly, it should be stated that the utility and performance of any diagnostic test that has a binary outcome (eg. diseased/healthy) depends on 1) its intrinsic test characteristics 2) the prevalence of the disease in the population being tested[1], 3) the available diagnostic/treatment options for positive people, and 4) the threshold chosen to call something ‘positive’ since you are virtually always measuring a continuous variable.
People talk about false positives often, but you should know that there is some room for judgement here. The typical threshold for PSA has historically been 4.0 ng/mL. Above this is considered a positive screen, and you are recommended further testing to confirm prostate cancer, which can be invasive and lead to complications (bleeding, nerve damage, etc). This kind of two-stage testing is a common theme. The issue is that PSA values in people with cancer and people without cancer are normally distributed and have some overlap. A value of 4.0 is in the overlap zone, and the vast majority of people with 4.0 will not have cancer. However, lets say hypothetically that guidelines changed and we now use 20. At this level, most people who test positive probably have something bad, and the risk:benefit ratio is in favor of confirmatory testing and probably in favor of treatment too. I won’t bother going into it, but there’s a fair amount of liability, psychology and economics at play when choosing thresholds. Biochemical tests like PSA do have some variance, but are mostly reliable. It’s more complicated with imaging and amorphous things like mammograms that have some operator variability in judgement (and hence more liability).
This was a long-winded way to say that information is not necessarily bad, but it’s what you and your doctor choose to do with it. There’s room for discussing probabilities, and the various available pathways. Trust is huge. Your doctor will act in your best interests when he feels safe from lawsuits, otherwise he'll be focused on not missing anything regardless of likelihood or cost. The financial misalignment of our system doesn’t help in building trust either. Most first-stage screening tests have very minimal risk involved. Things like checking your blood pressure, cholesterol, glucose, doing a treadmill stress test, reviewing your meds, vaccinations, etc which are part of these annual checkup programs are, on balance, usually good ideas.
http://recode.net/2015/05/02/beloved-silicon-valley-entrepre...
Ryan Davis from Giantbomb also died suddenly while on his honeymoon.
http://www.giantbomb.com/ryan-davis/3040-93335/forums/ryan-d...
I spent 4+ years not getting any REM sleep and my metabolism STILL suffers as a result - even 14 years after starting on CPAP and using it EVERY night since then.
It's too long to go into here - but I did a writeup years ago about my "journey", along with my wife's issues with PCOS (Polycystic Ovarian Syndrome).
http://weblog.mrbill.net/archives/2014/01/13/falling-in-love...
Do you snore (badly)? Do you find yourself tossing and turning a LOT at night? Do you wake up gasping or with a general sense of dread/fear? Are you super-tired during the day? Have you ever fallen asleep while typing, while at a stoplight in your car, etc? Talk to a doctor about having a sleep study done. It might save your life.
http://entrepreneurzine.com/dave-goldberg-surveymonkey-at-st...
After I hit reply here, I'm going to finish the entire document before I come back here. I have too many loved ones to leave stranded in this world after me just because I was too lazy and distracted to do what's needed.
A few years ago a nurse told me my blood pressure was a bit high but I didnt think it was that high to worry about so I never followed up on it. Then a few months ago I went for a dental check up where they checked my blood pressure and after a particularly chaotic morning the nurse told me my blood pressure was 220 over 150, which is crazy high blood pressure The dentist ended the appointment and told me very strongly to go straight to the doctor. When I got there my pressure had gone down to 150 / 90, but the doctor started me on a low dose of blood pressure medicine. It costs $5.00 per month, and who knows what health disaster was awaiting me had I not discovered this.
Even if you are relatively normal weight, in your 20s, and healthy, you could still have issues and not realize it until you have a check up.
It seems that doctors in South Africs have a fairly high threshold for prescribing medications for blood pressure to younger people. The contrast with your case in the U.S., where the doctor started you on BP meds immediately is quite striking.
Knowing something (blood pressure is high) is cool.. but turning that into (I must pop pill X) doesn't always seem like the best strategy.
I am active, eat healthy, and have tried to go off of my high blood pressure meds more than once, but each time, my blood pressure creeps back up. Modern medicine is a wonderful thing. Don't be scared of medicine when it's the right option.
http://thisweekinstartups.com/dave-goldberg-of-surveymonkey-...
I think it's a difficult task in that you can't include everyone...but I think it'd be fine if the admins did it by personal consensus...I imagine who they think would be noteworthy would be in line with what most users think.
I'm sure every single one of us cares that people died yesterday. Don't want to get into a big debate, jus sayin. #deepbreaths
I saw someone say on Twitter "Dave defined the word 'mensch'" - very true.
Let aeroplanes circle moaning overhead Scribbling on the sky the message He Is Dead, Put crepe bows round the white necks of the public doves, Let the traffic policemen wear black cotton gloves.
He was my North, my South, my East and West, My working week and my Sunday rest, My noon, my midnight, my talk, my song; I thought that love would last for ever: I was wrong.
The stars are not wanted now: put out every one; Pack up the moon and dismantle the sun; Pour away the ocean and sweep up the wood. For nothing now can ever come to any good."
W. H. Auden
http://www.unz.com/isteve/dave-goldberg-died-same-day-as-car...
My condolences to his family.
