Wellness assessments are important tools in achieving optimal health, and they can be compared to the multiple rest stops taken on a road trip; they allow us to assess, re-fuel correctly, and catch any troubles before we get stranded by them; they should form part of our journey to good health. They are opportunities to check that everything is still working properly and they allow us to flag any issues before they become critical to the successful completion of the trip. And, as is normal on these trips: the fuel light may come on, or perhaps the car needs oil, but the car is still healthy and able to continue, the warning lights are simply indicators of a maintenance requirement. Health tests are thus aimed at preventing problems. Wellness assessments include both health screenings and medical tests; the latter is performed when the problem presents with specific symptoms that need further investigation and diagnosis. In both instances, the physician relies on one or a combination of blood urine and stool tests. These samples give the examiner some insight into what is in the body that may be leading to a set of symptoms.
We highlight some of the important tests your practitioner may request. The frequency of tests depends on a number of factors: sex, age family history, the current state of health and/or co-morbidities or risk factors.
Tests for Men and Women
FULL BLOOD COUNT (FBC) or COMPLETE BLOOD COUNT (CBC)
The full blood count is the measure of the concentration of white blood cells, red blood cells, and platelets in the blood and helps detect a wide range of disorders, including anaemia, infection and leukaemia. Red blood cells carry oxygen and low levels are seen in anaemia. White blood cells fight infection and could be high if there is an infection or leukaemia. Platelets help with blood clotting. Abnormally high or low levels can be seen in anaemia, bleeding disorders, iron deficiency, leukaemia etc.
KIDNEY FUNCTION TESTS
Urea measures the amount of urea that is in your blood. Healthy kidneys remove urea and other waste products from your blood. A urea test can reveal whether your urea levels are higher than normal, suggesting that your kidneys may not be working properly.
Creatinine is a chemical waste product that is produced by muscle metabolism and by eating meat. Healthy kidneys remove creatinine and other waste products from your blood. If your kidneys are not functioning properly, an increased level of creatinine may accumulate in your blood.
LIVER FUNCTION TESTS
Your doctor may conduct liver function tests if you have liver disease, you drink alcohol excessively, you are taking medication that can harm the liver or you have symptoms of liver or bile system disease (nausea and vomiting, abdominal pain or yellow skin).
The liver filters and processes blood as it circulates through the body. It metabolises nutrients, detoxifies harmful substances, makes blood clotting proteins, and performs many other vital functions.
The cells in the liver contain enzymes that carry out these chemical reactions. When liver cells are damaged or destroyed, the enzymes in the cells leak out into the blood, where they can be measured by blood tests. The two main enzymes that are elevated in liver disease are aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Alkaline phosphatase (ALP) and gamma glutamyl transferase (GGT) may also be increased if there is liver disease. ALP and GGT may indicate that there is an obstruction in the liver, although there may be other reasons for these enzymes being increased as well.
Albumin is the main protein made by the liver. It performs many important functions including transport of hormones, vitamins, and other substances throughout the body. A low albumin level indicates that the liver is not functioning properly. Albumin may also be decreased when you have an infection or inflammation.
Bilirubin is a waste product resulting from the breakdown of red blood cells. It is processed by the liver before being excreted through the stool. If your liver is damaged, it cannot properly process bilirubin. This will lead to an abnormally high level of bilirubin in the blood. It may show up in a urine sample as well.
BLOOD SUGAR METABOLISM
SHORT-TERM: FASTING BLOOD SUGAR
This measures blood sugar (glucose) after you have not eaten for at least 8 hours. It is often the first test done to check for diabetes. Glucose comes from carbohydrate foods and is the main source of energy used by the body. Insulin is a hormone produced in the pancreas that helps your body’s cells use glucose. Normally, your blood glucose levels increase slightly after you eat. This increase causes your pancreas to release insulin so that your blood glucose levels do not get too high. In diabetes, the blood glucose levels are higher than normal.
LONGER-TERM: HAEMOGLOBIN A1c (HbA1c)
The haemoglobin A1c (HbA1c) test or glycated haemoglobin test is a blood test used to diagnose diabetes and to determine how well your diabetes is being controlled. Haemoglobin is a substance within red blood cells that carries oxygen throughout your body. When your diabetes is not controlled, sugar builds up in your blood and combines with your haemoglobin, which becomes “glycated”. Haemoglobin A1c is a measure of the average concentration of your blood sugar over the preceding six to twelve-week period and is used in conjunction with blood sugar monitoring to diagnose diabetes or metabolism problems as well as make adjustments in your diabetes medicines. If your blood sugar levels have been high over recent weeks, your HbA1c test result will be higher than normal.
This test measures the amount of lipids (cholesterol and other fats) in the blood and it is done to assess your risk of developing cardiovascular disease (heart and blood vessel disease). Excessive lipids in the blood cause a build-up of plaques in the arteries that can lead to narrowed or blocked arteries throughout the body (atherosclerosis), causing reduced blood flow. Atherosclerosis can result in heart disease, kidney disease and stroke.
Typically, you will be required to fast for 10-12 hours (no food or drink, except water) before the test, to eliminate the contribution of any fat you recently ate.
Triglycerides (TG) are a type of fat in the blood. When you eat, your body converts any calories it doesn’t need into triglycerides, which are stored in fat cells. High triglyceride levels are associated with several factors, including being overweight, eating too many sweets or drinking too much alcohol, smoking, a sedentary lifestyle, diabetes, thyroid or liver disease and genetic conditions. High levels of triglycerides are related to a higher risk of heart and blood vessel disease.
Total Cholesterol (TC): Cholesterol is a type of fat found in your blood. It is produced by your body and also comes from the foods you eat (animal products). Cholesterol is needed by your body to maintain the health of your cells. Total cholesterol level is the sum of all the types of cholesterol in your blood including low-density lipoproteins (LDL), high-density lipoproteins (HDL), and very low-density lipoproteins (VLDL). The higher your total cholesterol, the greater your risk for heart disease. However, what is more important are the ratios of HDL: LDL.
As cholesterol and triglycerides are insoluble in blood, they need to be transported in the body. The role of lipoprotein particles is to transport triglycerides and cholesterol in the blood between all the tissues of the body.
High-Density Lipoprotein (HDL) or “Good” cholesterol is a lipoprotein (a combination of fat and protein) found in the blood. It is called “good” cholesterol because it removes excess cholesterol from the blood and takes it to the liver for disposal. A high HDL level is related to a lower risk of heart and blood vessel disease, i.e. the higher your HDL level, the better. Low-Density Lipoprotein (LDL) or “Bad” cholesterol is a lipoprotein (a combination of fat and protein) found in the blood. It is called “bad” cholesterol because it picks up cholesterol from the blood and takes it to the cells. A high LDL level is related to a higher risk of heart and blood vessel disease. However, science is showing that both are vital and the ratios of HDL to LDL are more important than considering one “good” and the other “bad”. One practitioner describes it this way:
Think of HDL & LDL as garbage bags, refuse collectors and refuse trucks. If you have too much garbage and no bags= problems. If you have enough bags for the garbage but the truck breaks down or there aren’t enough collectors to make the rounds = problem. You need enough bags, enough workers and enough functioning vehicles to ensure refuse is disposed of properly.
HEPATITIS B (Hep B)
Hepatitis B is a disease caused by the hepatitis B virus (HBV). Infection with this virus can cause scarring of the liver, liver failure, liver cancer, and even death. Hepatitis B is spread by infected blood and other bodily fluids such as semen, vaginal secretions and open sores.
The human immunodeficiency virus (HIV) is spread by sex, contact with infected blood and from mother to child during pregnancy, childbirth or breastfeeding. HIV interferes with your body’s ability to fight the organisms that cause disease by weakening your immune system to the point that you have AIDS (acquired immune deficiency syndrome).
Both men and women who are sexually active should be periodically screened for sexually transmitted diseases. Frequency and type of testing varies. It is dependent on several factors including sex, age, and lifestyle choices. Interestingly, Chlamydia is typically asymptomatic in females and is the leading cause of infertility. Therefore, it’s imperative to screen for this in younger, sexually active women.
Colon cancer is the third most diagnosed cause of cancer death for both sexes. Both women and men should have colon cancer screening starting at the age of 50 with some research indicating that earlier testing may be a consideration for individuals with chronic conditions and poor lifestyle habits. Early screening is also recommended if there is a family history of colon and, or other cancer. There are many methods to screen, from the less invasive stool tests, which must be done every 1-3 years, to the more invasive colonoscopy, which is good for 10 years if negative and there is no family history of colon cancer. Talk to your doctor to determine the best method for you.
HIGH BLOOD PRESSURE
Screening for high blood pressure (hypertension) should begin at age 18. If normal and an individual is not at an increased risk for hypertension, rechecking every 3-5 years is reasonable. After age 40, blood pressure should be checked bi-annually, more often if abnormal.
Screening for depression is recommended annually in all adults. This can be accomplished with general questionnaires such as the Beck’s Depression Inventory. Results should prompt a more extensive interview with a trained mental health practitioner.
For many people, weight could be one of the greatest health risks. Surprisingly, weight issues which are becoming more prevalent can be ignored — even by health practitioners — only until a serious problem arises. Recent stats show that more than 3 out of 4 people are at an unhealthy weight, which significantly increases the risk of:
- Heart disease
Body composition is the more accurate test. While BMI (Body Mass Index) can be a general indicator of weight issues, the index should only be used for higher-mass individuals (obese or potentially obese). BMI purely looks at mass and does not take into account composition: the ratio of fat mass to muscle mass, in an individual meaning that a healthy athlete with a higher concentration of muscle mass could register a high, and thus obese, BMI.
These may be used to diagnose the presence or absence of a number of medical conditions.
- Faecal Occult Blood Test (FOBT): Faecal occult blood (FOB) refers to blood in the faeces that is not visible (occult). Common conditions that cause bleeding in the digestive system include peptic ulcer disease and cancer of the stomach, colon or rectum. Taking red meat, iron tablets and aspirin can also result in a positive test. Avoid these for at least 3 to 4 days before taking the test. Vitamin C tablets may also interfere with the chemical reaction.
- Microscopic examination of stools may reveal the presence of larvae or eggs of worms in the intestines. This can aid in the diagnosis of intestinal worms including Ascariasis, Hookworm, Strongyloidiasis and Whipworm.
TESTS FOR WOMEN
- Pap smear: A Pap smear is used to test for cervical cancer in women. It involves collecting cells from your cervix – the lower, narrow end of your uterus that is at the top of your vagina. Detecting these abnormal cells early with a Pap smear is the first step in halting your possible development of cervical cancer.
- HPV screening: The human papillomavirus (HPV) test detects the presence of human papillomavirus, the virus that causes cervical cancer. The cells collected during the Pap test can be used to test for HPV in the laboratory.
- Pelvic Exam: A lot of women equate a pelvic exam with a Pap smear. Although typically done at the same time, the pelvic exam is the physical exam of the external and internal female reproductive organs. This can aid in determining any abnormalities of the uterus or ovaries and sexual health challenges.
- Breast Exam: Regular, personal examinations are critical as by the time a cancerous lump is/can be felt in the breast, it has probably been there for quite some time, sometimes several years. Manual breast exams should be performed regularly as the patient should get a sense of what is “normal” for her anatomy and thus any irregularities can be picked up, however, mammograms are currently the preferred method to screen patients where there is a family history of cancer.
- Mammogram: Mammograms are the standard of care for breast cancer screening. There are differing opinions from reputable organizations about the best time to start and how often to be screened. There is general consensus that women between the ages of 50 and 75 need a mammogram at least every other year. Recommendations to start earlier may depend on personal family history.
- Osteoporosis: Osteoporosis is a condition where the bones weaken, increasing the risk for fractures resulting in chronic injuries and loss of function and productivity. Caucasian and Asian women are more prone to this condition. Screening is done via a Dexa Scan (a form of x-ray) and is recommended starting at age 65.
TESTS FOR MEN
PROSTATE CANCER SCREENING IN MEN
Two tests are commonly used to screen for prostate cancer:
- Digital rectal exam (DRE): A doctor inserts a gloved, lubricated finger into your rectum to estimate the size of your prostate and feel for lumps or other abnormalities.
- Prostate-specific antigen (PSA) test: This test measures the level of PSA in your blood. PSA is a substance made by your prostate. As a rule, the higher the PSA level in your blood, the more likely a prostate problem is present. PSA levels also can be affected by certain medical procedures, medications, enlarged prostate and prostate infection. Because many factors can affect PSA levels, your doctor is the best person to interpret your PSA test results.
Article updated on 1 March 2023