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Journalism of Courage
Today let me talk about a 50-year-old patient of mine, who has a healthy constitution but gets himself tested every one to three months without fail. Neither does he have any family history of a chronic disease, nor do his routine tests show wild variations to merit concern or medication. Lest laboratories refuse to repeat tests, he goes to different labs for sample collection. If any reading is slightly out of range or is marked bold, he compares with the last report and seeks an emergency appointment. Worse, he self-monitors his health with specialised tests like CRP and cortisol without the advice of the doctor. What is driving his anxiety about health?
My patient has even ignored my assurance, uploaded his test results on Chat GPT and ended up being worried that he was developing a major illness that floated up on his screen. Currently, we are counselling him for mental stress but many of you should know about the tests you should do, what you don’t need and how not to waste money.
Ideally, every adult should do a full body checkup once a year. People with chronic conditions or a family history of certain illnesses may need more frequent checkups, possibly every six to 12 months. Unless there is a worrisome condition that develops in between and which requires specific tests, these are enough.
Repeating tests at small intervals can yield false positives and build unnecessary tension. This leads to ten more tests that the patient wants, leading to medical mismanagement. Your doctor is the best person to interpret your basic package of tests and suggest specific tests should they suspect a condition.
CRP: Most patients ask me if they should get a CRP test, a blood test that measures the amount of C-reactive protein (CRP), a protein produced by the liver in response to inflammation. CRP is not an everyday test because it indicates overall inflammation, which is not a diagnostic tool for a specific condition. Doctors order it to help diagnose and monitor acute illnesses like Covid, autoimmune disorders, arthritis, pneumonia and infections, not to track daily health fluctuations. Besides, CRP is affected by age, obesity, smoking, diabetes, and even intense exercise.
HsCRP: This is the high sensitivity CRP test that many people go for, having gotten tested for it during Covid. This is specific for cardio-vascular risk management and is not for everybody. It is recommended for those above 45 with high cardiovascular risks like obesity, diabetes, blood pressure, cholesterol, family history, smoking. In fact, frequent repetitions will show different readings as they fluctuate with exercise, stress or even mild infection.
Homocysteine: This is an amino acid linked to blood vessel damage, high levels of which indicate Vitamin B12, B6 or B9 deficiency. Although this test is being mentioned in terms of preventive heart health, it is recommended only when you develop an unexplained heart disease or stroke without a history of risk factors, when you have a strong family history of premature heart attacks, or when you have clotting disorders and unexplained B12 deficiency. Also lowering homocysteine has not reduced heart disease risk in patients, a risk which needs to be mitigated by other lifestyle parameters. Repetition is not required unless the vitamin B 12 levels need to be corrected
Serum cortisol: Being a stress hormone, cortisol levels fluctuate wildly through the day. So a reading cannot give you the exact health status of your body. It is very specific to assess adrenal gland dysfunction.
While being conscious about tests is good, overdoing it stresses you out altogether. Instead, maintain your healthy body by focussing on diet, exercise and sleep.
(Dr Tickoo is Director, Internal Medicine, Max Healthcare)
