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Be a proactive patient by considering these five tests your doctor may not mention.

We’ve all had routine blood work, and we’re used to having our vitals taken at the doctor’s office. If you have a few decades behind you, you’ve probably had an EKG, mammogram or colonoscopy. But there are other, fairly routine tests that doctors don’t necessarily suggest, but which, depending on your health profile, could save or prolong your life. These five are chief among them.

1. Heart Disease: Multi-slice computed tomography

Heart disease is the No. 1 killer of Americans, claiming some 800,000 lives in 2017 and accounting for one out of every three deaths. More than 90 million Americans are living with the disease today. Lifestyle changes are slowly making a dent in those grim statistics, but we’ve got a long way to go. That’s why testing is so important for people who are at higher risk.

Dr. Bijoy Khandheria, a cardiologist at Aurora St. Luke’s in Milwaukee and the former chair of the Mayo Clinic’s Division of Cardiovascular Diseases, says those risk factors include obesity, a family history of heart disease, high blood pressure (hypertension), diabetes, smoking, a sedentary lifestyle and an abnormal cholesterol profile, meaning “bad” (LDL) cholesterol of 130 or higher and “good” (HDL) cholesterol of 39 or lower. Notably, one’s risk profile increases with age; simply being a male over 50 is considered a risk factor.

Illustration by Lindsey Balbierz

“Beyond the stress test, EKG and echocardiogram, the best predictor of disease of the blood vessels is the cardiac, or multi-slice computed tomography (CT) scan, also called a noninvasive angiogram,” Khandheria says. This 3-D computerized image measures the amount of calcified plaque in the blood and is extremely accurate in predicting blockages in blood vessels. Calcified plaque is a key warning sign of coronary artery disease since it shows up long before a heart attack strikes. The goal is to catch the problem early and begin treating it in hopes of preventing a heart attack or stroke.

The test involves spending 15 to 30 minutes in a scanner, depending on the age and speed of the machine. Newer models, such as the one at St. Luke’s, are faster and expose the patient to far less radiation.

Most at-risk people are good candidates for this procedure, with the notable exception of those with advanced chronic kidney disease (CKD). Because a dye is inserted into the bloodstream, patients with CKD may not be able to excrete the dye, which carries a low but real potential of toxicity. Also, hypertensive and diabetic patients need to be carefully evaluated by their cardiologist to asses them for risk of toxicity. The scan may or may not be covered by insurance, and it may or require pre-authorization or a preliminary stress test.

2. Glaucoma: Periodic exams by an ophthalmologist

Illustration by Lindsey Balbierz

Here’s an eye-opening statistic: Of the 3 million or so Americans with glaucoma – the second leading cause of blindness – half are walking around undiagnosed. That’s because the most prevalent form of the disease, called primary open-angle glaucoma, shows no symptoms in its early stages. This progressive eye disease can damage the optic nerve, which transmits information from the eye to the brain to form an image.

Glaucoma occurs from a slow, painless buildup of fluid in the eye caused by a compromised drainage pathway, according to Dr. Sarwat Salim, a Milwaukee ophthalmologist. That fluid increases “intraocular pressure,” or IOP, which over enough time leads to optic nerve damage and vision loss. “The first hint that something is wrong is the gradual loss of peripheral [side] vision, but typically people don’t know they have it until the vision loss is severe,” Salim says. Risk factors for glaucoma include advanced age, a family history of glaucoma, hypertension, diabetes, long-term steroid use or being of African or Latino descent.

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While glaucoma can’t be prevented or cured, it can usually be controlled with prescription eye drops. (If not, a laser or surgical procedure is required.) This is why the American Academy of Ophthalmology recommends a complete eye exam by an ophthalmologist every two years starting at age 40, or earlier if you’re at risk. This exam includes a visual acuity test, tonometry (to measure IOP), gonioscopy (to assess the drainage pathway), an inspection of the optic nerve and a visual field test to gauge loss of peripheral vision.

Illustration by Lindsey Balbierz

3. Diabetes: A1C blood glucose

This pervasive disease interferes with the body’s ability to produce or use the essential hormone insulin. Insulin is released to help transport energy (in the form of sugar or glucose), which comes from our food to the cells and disrupts the normal metabolism of carbohydrates, elevating the levels of glucose in the blood and urine.

It’s estimated that 30.2 million, or 12.2 percent, of American adults have diabetes, and the percentage jumps to more than 25 percent among those 65 and older. Diabetes is the seventh leading cause of death in the U.S. As with heart disease, the risk factors include being overweight or obese, smoking, a family history of the disease, a sedentary lifestyle, high blood pressure and high cholesterol. Left untreated, diabetes can lead to diseases of the heart, kidneys and eyes. While there’s no cure, it can be treated and managed with diet and medication. Early diagnosis is key to living a normal, healthy life.

“There’s now a simple blood test that can predict diabetes and measure with uncanny accuracy how one is managing the disease,” says Khandheria, the St. Luke’s cardiologist. This one, called the hemoglobin A1C blood glucose test, is different from the familiar glucose test that’s part of a complete blood count (CBC). The A1C measures the average amount of glucose inside the red blood cells over the past three months as opposed to the amount that’s currently circulating in the bloodstream. This “gold standard” is considered a vastly superior indicator of diabetes. It doesn’t require 12 hours of fasting or a trip to a lab, as it can be performed at your doctor’s office or even your bedside and is generally covered by insurance.

4. Lung Cancer: Low-dose CT screening

Illustration by Lindsey Balbierz

Lung cancer accounts for 27 percent of all cancer deaths. In 2016, 158,080 Americans died from the disease – more than from prostate, breast and colorectal cancer combined. Sadly, it also has the lowest five-year survival rate: 18 percent, compared with prostate (99 percent), breast (90 percent) and colorectal (65 percent).

There are two ways to diagnose lung cancer, explains Dr. Peter Mazzone, director of the Lung Cancer Screening Program at the Cleveland Clinic in Ohio, and the choice depends on whether someone is showing symptoms. Early signs of the disease, including a cough that doesn’t go away, shortness of breath and unexplained weight loss, will prompt a physician to perform a CT scan and/or biopsy. Often by the time patients have symptoms, they’re at an advanced stage, and their chances for survival are slim.

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But there’s another tool that’s considered the standard of care for at-risk lung cancer patients, much as mammography and colonoscopy are routine to diagnose breast and colorectal cancer. The low-dose CT screening for lung cancer is specifically for people who are showing no symptoms but who have at least two risk factors. Because it can catch cancerous lesions at a very early – and very treatable – stage, this 10-second test can literally be a lifesaver.

Smokers, people who’ve smoked within the past 15 years, those who smoked more than “30 pack years” (i.e., a pack a day for 30 years or two a day for 15 years) who are 55 to 77 or 80 yet present no symptoms qualify for this test, which is covered by Medicare and most insurance carriers.

The scan takes less than one minute, but beforehand, the patient is required to have a “shared-decision-making” consultation with his doctor. There are some potential risks and downsides, such as the inherent risks from additional tests that might be indicated, but the life-saving and -extending potential generally far outweighs them.

5. Hepatitis C: Blood test

Illustration by Lindsey Balbierz

As the largest internal organ, the liver processes everything we take in orally and through our skin, and it plays a vital role in our metabolism. It breaks down fats, produces energy, detoxifies chemicals and aids in blood clotting. That’s why Dee Girard, executive director of the Upper Midwest Division of the American Liver Foundation, says, “Your liver is your life.”

Of the many kinds of liver disease, one is a deadly “silent killer” because it can show no symptoms for decades. Affecting up to 4 million Americans is hepatitis C, a virus that infects the liver and compromises its function. (Hepatitis A and B are less common and more easily diagnosed and thus treated.) About 75 to 85 percent of cases of hepatitis C become chronic, meaning if they’re not caught and successfully treated with medication, they can eventually lead to cirrhosis, liver cancer and liver failure.

Baby boomers (born between 1946 and 1964) are at highest risk – estimates run as high as one in 30. That’s because hepatitis C wasn’t discovered until 1989 and donated blood wasn’t screened for the virus until July 1992. At risk are people who received a blood transfusion or an organ transplant before then, or had tattoos or body piercings or shared needles – or straws – to take drugs. Even those who shared toothbrushes or razors may have caught it.

But it’s not just boomers who need to be tested. Anyone who’s shared needles or engaged in “non-sterile” activities could have contracted it. In light of the current opioid crisis, medical professionals fear the numbers may be on the rise.

The good news is that the test is simple and painless, and false reads are rare. In fact, the Centers for Disease Control and Prevention recommends all baby boomers get it, and many if not most insurance carriers require it. Should you test positive, your doctor will prescribe a six- to eight-week treatment protocol of oral medication, and with today’s new generation of hep-C drugs, the cure rate is better than 90 percent. For more information, call the American Liver Foundation’s 24-hour hotline: 800-GO-LIVER.


“Be a Proactive Patient” appears in the 2018 Health issue of Milwaukee Magazine.

Find it on newsstands beginning April 30th, or buy a copy at milwaukeemag.com/shop.

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