Sunday August 29,

Managing our health in this chaotic time we call the 21st century is very much a job unto itself. It’s quite a chore and some people even make a career of it—enter life coach, gym coach and health guru. I guess it even validates this column! Holistic approaches to health care are ever more needed as we, now, due to the pressures of everyday life need to ‘package’ our trips to the doctor’s office. I am already seeing the need in clinic to address not only my patients’ breast concerns but also give guidance on basic weight management, diabetes and high blood pressure. ‘Plain English’ and easy to use advice are best remembered. One of the ways to help make medicine interesting is to be able to provide guidance in a simple and easy to understand manner. And that applies not just to medicine; our lawyers, bankers and politicians can use this approach as well. Hence, when asked recently by a patient—‘what checkups do I need to do?’, I thought about how I could make my advice easy to use and remember.

To this question I’d say there are five really important medical tests you should be thinking about every year (and sometimes more frequently). For women: think breast cancer, cervical cancer, diabetes, high blood pressure and heart disease. The really awful bit about most of these dreaded conditions is that they often don’t cause any pain or problems until it’s too late.

Breast cancer test
Whilst both breast and cervical cancer develop and grow silently, if caught early there is the possibility of ‘cure’ in many. The key bit is to be aware that as long as you are a woman, you’re at risk—get your mammograms and pap smears even if you have no symptoms. Talk to your doctor about these conditions and get the most current advice. Whilst it’s all too easy for this column and many others to simply advise women to get a mammogram etc., there are always significant barriers to women routinely getting them. Often, it’s not a financial problem but rather one of many other reasons. Many women may simply think “I’ll get to it next week” and just don’t get around to it. Some may have had a bad experience previously, for example, where the arms of the mammogram pressed too hard and made it uncomfortable. Others are advised that they don’t need it—‘just an ultrasound will do’.

Over 40?...you need it
If you’re over 40...you need it. An ultrasound alone will NOT do. Discuss with your doctor which centre he recommends, as there is considerable controversy in Trinidad about which centre is good and which is not. Do discuss the entire process with the technician who will operate the mammogram machine. She should talk you through it well before hand and inform you on the length of the tests, need to position yourself and other important details. There is significant ongoing research to develop other ways to diagnose breast cancer earlier, such as a mouth swab or a simple blood test like that used for sugar (diabetes) testing. The science is driven by the body’s immune system to detect and fight-off young cancer cells.

When doing so, our bodies release thousands more of fighting cells, which can be detected in the blood long before cancer cells have developed. (It’s called an autoantibody response). However, many other conditions can also raise false alarms, and thus this technology is still experimental.

Cervical cancer
Similarly, getting screened for cervical cancer requires a detailed discussion with your doctor; getting information on how the examination is done and what can be the possible outcomes of the pap smear. Many patients may not realise that such tests are not simply ‘good’ or bad’, but there is often an ‘in between’—but if we leave it, it will turn to something bad. You should be well informed on what is the meaning of all such results. Educating yourself like this gives better insight into making important health decisions, especially in a time where you will be extremely anxious and confused. Your medical team is there to help—use them.

High blood pressure (hypertension), diabetes can be silent stalkers
In Trinidad there is the worrying problem of a very high incidence of diabetes and high blood pressure. It still makes me pause when my patients tell me: “I’m diabetic and hypertensive (high blood pressure) but I only take my medications when I feel a little ‘off’.” It’s really important to regularly check for diabetes and hypertension. These two diseases are rampant in our Trinidadian population and account for an alarming death rate in both women and men. If diagnosed early and with good attention to diet, exercise and medication (when needed), many patients do very well. A simple blood test with a pin prick is all that’s needed to get an answer on your sugar levels (diabetes).

There are two types of diabetes—Type 1 and Type 2. Type 1 usually develops in childhood and will require treatment with insulin. There is no cure but with exercise, diet, education and treatment, many can live a long and healthy life. Type 2 diabetes usually starts later in life and is the type most adults in Trinidad and Tobago will have. There is no cure for this type either. The aim of treatment is to keep your sugar levels within the normal limits as often as possible. Diabetes that is not controlled will lead to many complications which range from heart attacks, leg amputations to blindness.

The treatments of Type 2 diabetes can be complex and should involve both your family doctor and a diabetes specialist (usually an endocrinologist) who will work with you and the community nurse to lower and maintain your blood sugar levels. Your family plays a great part here as motivation and sticking with the programme can be difficult and frustrating, especially in the beginning. Today, there are many drugs used to manage your sugar levels; some are tablets, others are injections. Some work to break down sugar, some work with the liver to soak it up and others work to release more insulin from your body. And then there’s the insulin. Many patients find having to inject themselves with insulin difficult and daunting.

The thought of handling a needle can often cause a level of anxiety. There are many options of delivering insulin in the development pipeline such as nasal (nose) insulin, an insulin pill or a patch. However, there are many complex issues withholding its release to the public but we may see an alternative to the injection by the end of this year or next. In the meantime, for those who find the needles painful, there are now much thinner (less painful) needles available and you should discuss with your doctor if this is suitable for you.

holesterol
I decided to put a cholesterol test up there with my top fve tests. Unchecked high cholesterol (the bad type) will lead to clogged arteries, heart pains (angina) and even heart attacks. If caught early, simple measures such as diet and exercise can help a great deal. There are many medications (called statins) which can also work together with the simple things to bring your cholesterol down and open up your blood vessels do its work properly. Nowadays your cholesterol test can be done in the office with immediate results. There are also manufacturers of home testing kits. In fact, for all the above conditions you can get the answer immediately in the same visit—surely you’ll agree that’s convenience!

HIV testing
My last recommended medical test is an HIV test. This is an extremely sensitive area and each person’s choice has to be individualised and driven by each person’s needs. Suffice it to say, HIV is no longer to be considered a sure death sentence but rather with modern medicine a necessary but major adjustment to one’s life that can be managed as a chronic disease. Medication may be life-long, but many HIV positive people are able to live full and enjoyable lives. There have been significant strides locally not only to bring much hope to those afflicted with HIV but to also raise awareness in a positive way and reduce the stigma that was tagged with those three letters.

So in answer to that question: ‘What test do I need?’, I’d say these five:
1. Screening for breast cancer
2. Screening for cervical cancer
3. Tests for diabetes
4. Tests for cholesterol
5. HIV tests

These are quick, painless and easy to get. Results are fast and may save your life. Dr Rajen Rampaul is Consultant Breast Surgeon and Surgical Oncologist at the NWRHA.