Figured it’s been a while since I saw a thread along these lines so could act as a PSA…
I tend to only go to the doc to get a new prescription or if there’s clearly something wrong. For those who go for regular checkups, what are you asking for as you age?
We aren’t detecting cancers etc by simply having our BP checked. What does the diligent doctor / patient arrange or request?
I’m 52 and get an annual physical. It consists of whatever my insurance covers. Seems like mostly a ton of bloodwork and a tri-annual colonoscopy since they found a few polyps in my first one.
Figured it’s been a while since I saw a thread along these lines so could act as a** PSA… **
I tend to only go to the doc to get a new prescription or if there’s clearly something wrong. For those who go for regular checkups, what are you asking for as you age?
We aren’t detecting cancers etc by simply having our BP checked. What does the diligent doctor / patient arrange or request?
If you’re of the male persuasion, I’d include the bolded
Figured it’s been a while since I saw a thread along these lines so could act as a** PSA… **
I tend to only go to the doc to get a new prescription or if there’s clearly something wrong. For those who go for regular checkups, what are you asking for as you age?
We aren’t detecting cancers etc by simply having our BP checked. What does the diligent doctor / patient arrange or request?
If you’re of the male persuasion, I’d include the bolded
Agreed.
Regular skin checks.
Comprehensive bloodwork
Calcium score (anything heart-related)
Even bloodwork to screen for pancreatic cancer. There’s so much I don’t agree with in the healthcare/insurance industry and this is one. Pancreatic cancer markers only shows up if you order a specific blood test. But insurance often denies this test bc the person is showing no signs of issue. But by the time you have symptoms or issues it’s too late. I understand the nature of pancreatic cancer and its prognosis. However I still believe screenings for diseases and pathology should happen before signs/symptoms. Patient last night just went through this exact thing with her mother in law and she’s been diagnosed as stage 4.
Bone density.
Out of pocket:
Musculoskeletal screen
VO2 max
(These have been linked to matter greatly for longevity and independence into later decades of life).
But by the time you have symptoms or issues it’s too late.
Yeah, I was just reading a thing on Patrick Swayze.
Paraphrasing.
“Huh, my eyes are yellow-ish, better get that checked out.”
“Well, honey, I’m a dead man walking.”
personally-36 yo female -
standard labs plus
free t4
tsh
hemoglobin/hematocrit
ferritin
cholesterol
skin cancer screening
bone density every 5 yrs
flu vaccine
.
Pancreatic cancer markers only shows up if you order a specific blood test./quote]
I don’t know anything about that test, but the issue with a lot of the blood tests to detect cancer is that the sensitivity and specificity are poor, and/or you end up causing more morbidity and death with unnecessary follow ups (e.g. prostate and breast biopsies) and treatments than good you do by catching cancers early.
Pancreatic cancer markers only shows up if you order a specific blood test./quote]
I don’t know anything about that test, but the issue with a lot of the blood tests to detect cancer is that the sensitivity and specificity are poor, and/or you end up causing more morbidity and death with unnecessary follow ups (e.g. prostate and breast biopsies) and treatments than good you do by catching cancers early.
I agree that S/S varies between tests. However, like most good diff dx you put findings together. Clinical tests, subjective, bloodwork, imaging. Independently they don’t tell much, but together they tell much more of the story.
Tumor markers in specific blood tests can lead to probing further and potentially catch something earlier than would normally be before more severe or complicated symptoms.
Something’s that thing has a poor prognosis regardless. But sometimes it can lead to significantly improved outcomes if detected earlier.
I’m not following what you mean regarding “causing more morbidity and death with unnecessary follow ups.â€
I’d say if you are over 40 fecal immunochemical testing. Easy to do and catches most colon cancers. If you are willing to go through with a colonoscope a bit better.
Since normal is what 95 percent of the population has as a measurement if you run 20 blood tests there is a good chance one gets one abnormal. Then one has to chase that down with possible harm but little benefit. So ordering a wack load of low yield tests isn’t a good idea
What I find distressing is how many new grads in general practice have an aversion to examining patients. They order tests. My own father’s cancer diagnosis was delayed for several months because several doctors didn’t exam his belly. The wait time for an ultrasound in many places in Canada can be many weeks. Over my career I have found several melanomas listening to people’s chests because I lift up their shirt. If a pt has rectal bleeding don’t just sent for a colonoscopy do a rectal exam. Sometimes you feel a rectal carcinoma and you fast track that pt. One of my friends stopped doing pelvic exams on women when he does pap tests for medical legal reasons. But I have found several ovarian cancers that way. The list goes on and on.
An annual dermatology exam is a given.
My insurance pays for an annual physical and they run the typical labs. This year I also signed up for more of a concierge program, mostly for all the body composition testing and V2 max testing that they do, but you also have access to a physician and he ran labs, which were much more extensive than what my annual insurance covered labs was.
The one test that he did have run, which turned out to be very fortuitous, was the LP(a) number, which led to getting a cardiac calcium scan. There is a very lengthy discussion of LP(a) and calcium scores over in the other forum. I think most doctors do not test for LP(a) so that would be something I would push for.
I’d say if you are over 40 fecal immunochemical testing. Easy to do and catches most colon cancers. If you are willing to go through with a colonoscope a bit better.
Since normal is what 95 percent of the population has as a measurement if you run 20 blood tests there is a good chance one gets one abnormal. Then one has to chase that down with possible harm but little benefit. So ordering a wack load of low yield tests isn’t a good idea
I have a completely different view on preventative care. I also might have a completely different view on for profit healthcare especially life-saving care. Those two views combined give me a different approach to how we should structure our healthcare. Far more proactive testing and screening would be possible if costs were not astronomical. Instead we are utilize a reactive healthcare model and as Trail said in another thread “by the time the last nail rolls around it’s typically too late.â€
In a risk/reward scenario I’m sure the individuals that achieve early detection would value the energy and effort to go through subsequent testing. I know I would. Especially since my family has experienced it first hand multiple times.
If the new GRAIL Galleri tests or similar tests end up being approved I’d gladly take 50% more positive findings if the alternative is zero because preventative testing isn’t done.
Responded before I saw your edit.
I agree with you. Granted I have no experience to the degree that you experience it on the medical side. I’m outpatient rehab but I’ve still caught a handful of systemic issues and two cancers in my years. And simply because I asked basic questions and connected the dots. One I had to send to another provider because their referring provider completely disagreed and wouldn’t schedule them for a follow up.
Another patient (post op laminectomy) I had to send to the ER because he was showing signs of infection and shock. His wife called me to get in ASAP bc of his pain and they told me his surgeon wouldn’t see him because he was probably just exaggerating and “those things were normal.†It was a week post op and I guess the intense stomach pains, sweating, chills, etc didn’t warrant any more scrutiny. I called an ambulance and ultimate diagnosis was sepsis.
I don’t blame all of the medical community. But the growing trend is that a lot of providers can’t be bothered for a multitude of reasons. And I don’t mean on just the medical side.
I’m not following what you mean regarding “causing more morbidity and death with unnecessary follow ups.â€
For example, you’ve got on older man, blood test shows PSA elevated. Instead of just letting it be, an aggressive approach might be to do a biopsy fearing it could be cancer. Biopsy damages the pudendal nerve and now the guy is impotent, or he gets an infection that goes septic and dies.
Turns out it was just a typical benign enlarged prostate causing the PSA elevation.
Another issue is let’s say it turns out to be cancer that was caught early by the blood test…but turns out survival is no better for people where it’s caught early with the blood test than it is with people where it’s caught later when they become symptomatic. I think this was the problem with one of the blood tests they tried for colorectal cancer.
I’m not following what you mean regarding “causing more morbidity and death with unnecessary follow ups.â€
For example, you’ve got on older man, blood test shows PSA elevated. Instead of just letting it be, an aggressive approach might be to do a biopsy fearing it could be cancer. Biopsy damages the pudendal nerve and now the guy is impotent, or he gets an infection that goes septic and dies.
Turns out it was just a typical benign enlarged prostate causing the PSA elevation.
Another issue is let’s say it turns out to be cancer that was caught early by the blood test…but turns out survival is no better for people where it’s caught early with the blood test than it is with people where it’s caught later when they become symptomatic. I think this was the problem with one of the blood tests they tried for colorectal cancer.
In the book Being Mortal (by Atul Gawande, MD) he details a situation similar to this. A patient has an elevated PSA. Advice is to get a biopsy. After the biopsy, the guy develops a fistula (inadvertent connection between colon and bladder) so now the poop in his colon has direct access to his bladder. He suffers terribly from this.
There’s debate as to who needs a PSA and at what age we should stop checking it. Well, maybe it’s not a debate, but it’s not my area of specialization so I don’t really keep up with the recommendations. For me personally, at age 53, my doc never checked one on me until I asked him to since I was having recurrent proststaitis. I don’t have a family history and also had never had urinary symptoms so he said he chooses who to test, based on this.
And that’s reasonable. In medicine, there’s a term referred to as number needed to treat (NNT) and another term called number needed to harm (NNH). It’s where researchers determine how many patients would need to be screened, or treated, before an actual benefit was realized (or harm caused). A quick search for a real life example of this is treating sinusitis with antibiotics. In this situation, the NNT is 15, meaning of those who took antibiotics, 1 out of 15 improved faster. The NNH, for this same scenario, is 8. This means out of every 8 patients who took antibiotics (for their sinusitis), 1 was harmed (side effects).
When my dad was in his 80s they wanted to put him under general for his prostate- everything I read was they it was 100 times more likely for the surgery to kill him than the cancer. The doctor was later brought down on Medicare fraud charges. It was crazy what they wanted to do. And way fun to fight with my sibling over how I didn’t want the best medical care for my dad. He never had any problems with it before dying.
I’m not following what you mean regarding “causing more morbidity and death with unnecessary follow ups.â€
For example, you’ve got on older man, blood test shows PSA elevated. Instead of just letting it be, an aggressive approach might be to do a biopsy fearing it could be cancer. Biopsy damages the pudendal nerve and now the guy is impotent, or he gets an infection that goes septic and dies.
Turns out it was just a typical benign enlarged prostate causing the PSA elevation.
Another issue is let’s say it turns out to be cancer that was caught early by the blood test…but turns out survival is no better for people where it’s caught early with the blood test than it is with people where it’s caught later when they become symptomatic. I think this was the problem with one of the blood tests they tried for colorectal cancer.
Oh yes as a patient gets older I can understand age and comorbidities as risk factors and a calculated decision must be made.
But we’re still talking about risk vs reward first. When there are treatment options available whether for quality of life, extending life, or curing the disease, I think it’s quite valuable to take some risks of potential complications when the risk of doing nothing is undiagnosed and untreated cancers (in many situations).
For instance, elevated PSA is indicative of cancerous lesions in 25-30% of cases. That’s a big gamble to say “well it’s elevated PSA which can mean >1 in 4 risk risk of cancer but there are potential complications from further testing so we’re not going to pursue those at this time.
I’m sure there are those who would forego treatment if the prognosis is inevitable. However I also know there are those who would try treatment to prolong life and QOL.
My brother in law was already stage 4 when diagnosed at 32 and passed within 8 months. He fought as long as he could and even with low odds he and my sister wanted to fight and try.
My father was in his late 60s when bloodwork showed elevated PSA. Subsequent biopsies showed cancerous lesions and he underwent radical prostetectomy. Thankfully he is ok now.
My opinion is that when the alternative is physical agony, severely decreased QOL, and or death then increased chance of early detection can make a large difference and should be up to the patients. But ethically I think we should have those options available from the healthcare community regardless of other complications strictly due to the nature and outcomes of many cancers. Even with uncertain accuracies. Few things worse than death IMO.
Again, this does not apply to all scenarios. I realize that is illogical. But I’m not sure how to square that circle yet.
Wow! Prior comments about prostate screening has compelled me to post. I’m sure we all agree that every medical procedure has risks. I didn’t search but I bet I could find someone who went to their dentist with a toothache and died from the “corrective” procedure to address it or left them sucking out of a straw for the rest of the life’s. If I did find something like that, I wouldn’t make a post scaring people from getting their annual cleaning and check.
PSA testing and prostate biopsy’s have saved or extended thousands (millions?) of men’s lives. I’m an n+1 example. My brother is, a training partner is, a co-worker is. That’s all-firsthand knowledge of PSA testing, biopsies, and surgeries and radiation. No one to my knowledge was maimed by any of the tests or procedure and I think I can post for all of us that we are living are best lives, cancer free.
My advice to any male reading this: start getting an annual PSA and digital exam. If your doctor is concerned about a troubling finding then follow up with a good urologist ASAP. Prostate biopsies are not fun. Either are root canals and a slew of other medical procedures that may save or extend the quality of your life!
PSA testing and prostate biopsy’s have saved or extended thousands (millions?) of men’s lives. I’m an n+1 example. My brother is, a training partner is, a co-worker is. That’s all-firsthand knowledge of PSA testing, biopsies, and surgeries and radiation. No one to my knowledge was maimed by any of the tests or procedure and I think I can post for all of us that we are living are best lives, cancer free.
That’s why data isn’t the plural of anecdotes. No individual’s experience is wide enough to tell us much of anything. You need large studies to come up with screening guidelines, and hopefully whatever doctor a person ends up seeing follows those guidelines.
I’m in no way advocating that the test is not useful and lifesaving. Just that in today’s medical system you, very unfortunately, need to do your own research when presented with options. There are too many doctors that may not have your best interest in mind. (Yes, there are more good doctors that bad- but that doesn’t protect you from the bad).
It sucks. But google Medicare fraud and it’s really sad what people will do to the elderly to get rich.
PSA testing and prostate biopsy’s have saved or extended thousands (millions?) of men’s lives. I’m an n+1 example. My brother is, a training partner is, a co-worker is. That’s all-firsthand knowledge of PSA testing, biopsies, and surgeries and radiation. No one to my knowledge was maimed by any of the tests or procedure and I think I can post for all of us that we are living are best lives, cancer free.
That’s why data isn’t the plural of anecdotes. No individual’s experience is wide enough to tell us much of anything. You need large studies to come up with screening guidelines, and hopefully whatever doctor a person ends up seeing follows those guidelines.
I agree we need to follow the data. But the American Cancer Society analyzed the data and they concluded that individuals with PSA levels in the “borderline†range had a 1 in 4 chance of having cancer.â€
That’s powerful data and powerful numbers in this example. 1 in 4 chance of having cancer. No thanks, too risky to not check IMO.