WHAT IS GOING ON INSIDE?
Do you remember the little sounds in the night as a kid? What did they mean? Was something in the closet or under the bed? Too terrified to check it out for yourself, you spent the night paralyzed and sleepless. Here we are again, ages 50+, listening to the creaks of age and too terrified to check it out. Of the many awful things about COVID-19, the lack of access to routine check-ups, screenings, scans, and medical tests ranks towards the top.
Even those blessed with health hold competing thoughts when the body does not feel exactly right. The choice is: do I have COVID-19 or do I have some other life-threatening disease? The overwhelming probability says you are suffering from a cold, allergies or something else benign. A medical test confirming that fact would sure be nice. Once assured, we could switch to losing sleep over that weird click the just-out-of-warranty car is making.
The good news is that the vaccine cavalry is just over the horizon. The caseload should decrease this spring and some normalcy will return to medical care. That still means most of us will have missed our normal medical tests for more than a year. Even when our doctors can practice normally, the backlog may make appointments scarce. And let’s be true to ourselves; many of us were behind on annual testing in the first place.
OUT WITH THE OLD.
In a few weeks we will start our New Year’s Resolutions. Given our desire to put 2020 in the rearview and then rip the mirror from its post, resolving to do our part to make the new year a better one might carry more force this time around. Who knows, the feeling may persist all the way to February.
If getting healthy is on your list, it is time to set some baselines. To get started, here are some basic medical tests you can do from home.
Before you jump in, however, we should make one thing perfectly clear: home testing should not replace regular consultation with your doctor. Medical test results are only pieces in the jigsaw puzzle of your body; doctors are the puzzle masters. A health care provider’s training means that they have access to more precise tests, can better administer the tests, and have a deeper understanding of the test results. Most importantly, doctors can tell you what to do when a medical test turns troublesome.
If you cannot get to a doctor or are between visits, the information below should be helpful.
IT’S PRETTY BASIC.
What does it mean when that red engine light comes on? Your engine is overheating, likely because a mechanical failure makes the engine inefficient. Inefficiency means more effort.
Your body works the same way; your temperature reflects how hard the engine runs. Everyone is a little different, but anywhere between 97-99 degrees Fahrenheit qualifies as normal. Temperatures over 100.4 degrees tell us that the engine is running hot. That is okay, the body should work harder to overcome imbalances. If you reach 103 degrees, however, that red engine light is blinking.
Basic medical test number one covers about 90% of your health concerns; check your temperature. To do that, invest in a high-quality thermometer. Call the doctor when you reach 103.
THE IRREPLACEABLE TEST.
Heart disease leads America’s causes of death; if you check one thing out, it should be the ticker. Measuring your resting heart rate (RHR) gives a great baseline on your heart function, making RHR an essential medical test. RHR counts the number of beats per minute the heart takes to keep blood pumping in the absence of stressors. Doctors consider a RHR in the range of 60-100 as normal.
Many electronic watches will perform the calculation for you, just use the app. For the low-tech among us, checking your RHR is easy. Find a timer you can watch for 30 seconds. Place two fingers over the artery on either front side of your neck or the artery on the thumb side of your upturned wrist. After you locate the artery, count the beats over 30 seconds and double that number.
Remember, RHR is a “resting” rate. Rates after exercise, caffeine, or stressful situations will elevate, so check your rate a couple hours after a workout, a coffee or an argument. As those three things are not the only factors that might bump up your RHR, doctors recommend checking RHR several times a week and at different times of day. First thing in the morning before leaving bed is a good place to start.
Consistent readings at the high end of the scale suggest the need for improvement. Studies indicate that RHR rates between 81-90 double the risk of premature death and RHR rates between 91-100 triple that risk.
An abnormally low RHR could reflect an exceptionally healthy heart; many athletes will see their RHR around 40. If you are not a superstar and you rate below 60, you might be seeing something else. That holds particularly true if you experience fainting, dizziness or shortness of breath.
Next up, the dreaded scale. Medical tests can be complex, but the simple scale gives more useful information than most. Or maybe we should say that the scale reminds us of the information we need. Most people understand were they are weight-wise. In its most recent set of statistics from 2017-2018, the Center for Disease Control reports that over 42% of American adults are obese. As a reminder, obesity leads to higher risk for heart disease, stroke, type-2 diabetes and several types of cancer. Simply put, keeping your weight in reasonable control is among the most important steps in protecting your health.
The most used “medical test” for weight control is Body Mass Index or “BMI”. In its simplest form BMI expresses a ratio of your weight to your height. There are plenty of sites that allow you to input your weight and height, producing your BMI ratio. Government agencies have long indicated that BMI ratios of 20.0-25.0 are normal; 25.1-30.0 are overweight; and above 30, is obese.
BMI is not infallible First, not all weight is the same; lean muscle is denser than fat. As a result, highly muscled people with low body fat might show up higher on the scale than they should. Second, the base calculation stays the same for men and women, young and old. In truth, different body types mean different things. Third, a high BMI does not mean you have heart disease or other conditions, just that you should be wary of heart disease and other conditions.
Recently, refinements to BMI began to appear. For a more nuanced approach, try this Smart BMI calculator.
HIGH TECH TESTING.
If you feel like BMI is not giving a true read or if you are really serious about getting healthy, try measuring body fat percentage. Body fat measurements are a more precise way of calculating the same risk factors as BMI. As a bonus, it is easier to find recommended levels for men and women.
To give precise body fat readings, machines exist that demonstrate how much volume of certain gases correlated to fat and lean muscle mass exist in your body. Displacement is the key so the measurement takes place either in an enclosed pod (BOD PODs) or in the water. These tests are available outside medical offices they so may be something you could take advantage of if you feel it safe.
More likely in the current world, you can do a home medical test by measuring the physical amount of fat existing in skin folds. The only equipment you need are inexpensive calipers. For more accurate readings, a partner should perform the measurements. Simply squeeze the skin at designated areas and measure the amount of excess skin in milligrams with the calipers.
There are three-point tests, four-point tests and seven-point tests that measure different body areas. As with BMI, enter the measurements in an on-line calculator to see your percentage of body fat. For women over 40, a healthy body fat percentage falls into a range between 23%-34%; for men that range is 11%-24%.
LET ME CHECK UNDER THE HOOD.
If your resting heart rate and BMI/body fat percentages fall within normal levels, you are off to a great start. The human body, however, is a delicate machine. Just like your car, the body might be in great shape with a mechanical issue on the inside. The two dangerous issues that you can most easily check are elevated cholesterol and high blood pressure.
Cholesterol is an essential substance; the body has to have it. Some of that substance is low density (LDL cholesterol) that builds up in your arteries–that is bad. On the other hand, some of the substance is high density (HDL cholesterol) that returns straight to your liver to improve its function-that is good. Closely related are triglycerides, which are fats and are also essential to body function. Again, too much triglycerides means a higher chance of heart problems or strokes.
The American Heart Association has a great video demonstrating the basics:
Blood pressure measures the amount of pressure your blood exerts on your arteries. Like any physical structure filled with a liquid, two much pressure from the liquid damages the structure. So, too much “blood pressure” damages the arteries. That blood pressure changes as the heart beats, increasing on the beat and decreasing as the heart rests in between the beats. The familiar medical test for blood pressure expresses both numbers: systolic (the higher number for when the heart beats) and diastolic (the lower number in between beats).
Why do we do medical tests for cholesterol and blood pressure? First, there are high correlations between poor results and dangerous health events. Second, the conditions exist in many otherwise healthy people. In other words, a good RHR and a low body-fat percentage are no guarantees against high cholesterol or high blood pressure.
THE CHOLESTEROL TEST.
You can find relatively inexpensive home cholesterol tests on-line or at the drugstore. Be forewarned, not all home cholesterol tests are created equal. First, check the advertisement or packaging to understand exactly what the test measures: total cholesterol; HDL and/or LDL; or triglycerides. A test that tells you your total cholesterol number might be a decent starting point, but there is much more to know.
Second, understand how the test kit works. The most basic kits rely on dropping drawn blood on a test strip, then using shaded colors to read the results. Sometimes, interpreting those results can be a bit tricky. Other kits come with an analyzer. You feed the blood or test strip to the analyzer, which does the work for you. Analyzers are a little pricey, but they also are a long-term investment. Finally, you can find kits that allow you to send the blood in for a laboratory analysis.
Third, understand that cholesterol and triglycerides react to what is happening in your body. To get useful results, follow the instructions about the time and place of testing, fasting and limiting exertion before the test, as well as the procedures for the test.
Putting all that together, the good folks at VeryWell Health provide these recommendations on home cholesterol tests for all situations and pocketbooks. After you take the test, the Journal of the American College of Cardiology says to look for a total cholesterol score of 200 or less with LDL cholesterol under 100 and HDL cholesterol at 50 or above. Triglycerides should be less than 149. Once again, the Journal paints these recommendations with a broad brush, your doctor will have more accurate and detailed recommendations fit to your personal health history.
We are all familiar with the blood pressure cuff as a traditional medical test. You can still get “cuffed” at grocery stores and drug stores if you want to go that route, but there are lots of advantages to home kits. Beside the convenience aspect, home testing gives you the ability to measure your blood pressure over time. One slightly elevated result does not mean that much; repeated tests tell you if there is aa need to look into the matter further.
If you buy a home test kit, take it with you to your next doctor appointment. Doing a side-by-side test with the medical grade equipment and a professional medical test administration will let you know how accurate your instrument is. Home test kits include upper arm cuffs and wrist cuffs; the first are more accurate but uncomfortable. If you go with the wrist cuff, make sure you raise your arm to heart level before taking the measurement.
For the most accurate results, do not smoke, drink caffeine or exercise within thirty minutes of taking your pressure. Calm yourself for five minutes before doing the test. When ready, sit upright, feet flat on the ground with your back supported. The cuff should be on skin, not clothes. Support the arm on a flat surface and elevate the point of measurement to heart level. an upper arm cuff should start right above the bend in the elbow. Finally, do readings at the same time each day and record the results.
Generally speaking, doctors want your reading to be below “120 over 80“, with slightly more attention paid to the higher number.
THE BIG C.
Cancer causes the second most deaths in the United States each year. While early detection is a key factor in treatment, many cancer indicators are not easily found at home. For that reason, unusual and unexplained symptoms merit calls or visits to the doctor’s office, particularly as we age. There are three cancer types, however where self-exams are crucial to early detection and successful treatment.
Skin cancer more frequently occurs in men, but they are less likely to do self exams. Once a month, everyone should do a “head to toe” looking for changing moles, blemishes and freckles. Pay particular concern to moles that are asymmetrical; have multiple colors or uneven edges; are larger than a pencil eraser or are evolving (enlarging, hardening, rising or bleeding).
Breast cancer occurs far more commonly in women, but men are at risk also. Once monthly, check your breasts for lumps, swelling, irritated skin or dimpling. Most of these symptoms have other explanations or may be temporary; neither of those facts should prevent you from reporting your result to a doctor immediately.
Testicular cancer more often manifests itself earlier in life, but it is a killer and the check is simple (credit here to Hopkins Medicine).
Once a month while taking a warm shower, starting with one side and gently roll the scrotum with your fingers to feel the surface of the testicle.
- Check for any lumps, bumps or unusual features. Contrary to what many assume, cancerous tumors typically aren’t painful.
- Make note of any changes in size over time. While the most common symptom of testicular cancer is a painless mass, some men experience swelling of the testicles and scrotum.
- Be aware of any dull soreness or heaviness.
Again, report any unusual results as soon as you can.
Whew, that seems like a lot! It really is not if we break it down into simple steps:
- Regularly check your temperature;
- Regularly check your resting heart rate, looking to be below 80 beats per minute;
- Regularly check your BMI, aiming for a number below 25 or your body fat percentage, trying to score in the 23%-34% range for women and the 11%-24% range for men;
- Regularly check your cholesterol, keeping it below 200 total;
- Regularly check your blood pressure, it should be at 120 over 80 or below;
- Regularly (monthly) do skin, breast and (for men) testicular exams; and
- Report any troubling results to your doctor.
These at home medical tests can save your life, but they are no replacement for a doctor’s care. As soon as you can, resume your annual physicals.