Vision screening, Amsler grid, tonometry, Audiometry, Vascular ultrasound, ovarian cancer, CA125, pelvic ultrasound, cognitive screening, mental status exam, CMP, Lipid profile, homocysteine, C-reactive protein, hormonal profile, ferritin, vitamin levels

Health Screening: Part 3

Health Screening: Part 3

© 2009 Wellness Clubs of

Vision Screening

Two conditions in which early detection is valuable are glaucoma and age-related macular degeneration. Both conditions can lead to blindness if untreated. Early detection can halt the progression of these conditions, sparing vision. Annual vision screening that includes tonometry (a measurement of the pressure inside the eye) is therefore highly recommended.

A simple screening test for macular degeneration uses a figure called an Amsler grid (Figure 1). One eye is covered and the open eye looks directly at the dot in the center of the grid. The lines should appear solid and the squares should be of a uniform size. If any of the lines appear wavy or dotted consultation with an eye doctor should be sought immediately.
Amsler Grid

An annual vision screen is especially important to individuals with diabetes because the condition can cause new blood vessels to form in the eye or bleeding to occur. These can be treated with laser surgery to preserve vision if found in time.


Audiometry, a test of hearing, should be performed regularly if occupational or recreational noise exposure occurs. While it is not usually possible to restore hearing once it has been lost, recognition that a loss is occurring may convince the person to use protective devices when noise exposure is likely to take place.

Vascular Ultrasound

When people hear the term ultrasound they commonly think of looking at a baby in the womb during pregnancy. Ultrasound has many other applications, however. It is often used to screen for blood vessel abnormalities.

Ultrasound can be used to check for plaque build-up in the carotid arteries of the neck. If significant narrowing is present measures, including surgery in advanced cases, can be taken to stop the progression of the disease and decrease the likelihood that a stroke will occur.

Abdominal ultrasound is capable of looking at the aorta to determine whether a weakness, called an aneurysm is present. Abdominal aortic aneurysms are commonly asymptomatic until they suddenly rupture without warning. Two out of three people with ruptured aortic aneurysms die before reaching a hospital. Only 50 % of those who do reach a hospital survive. Detection and repair before rupture occurs is therefore of great benefit. Risk of having an abdominal aortic aneurysm begins to rise at the age of 55 in men and 70 in women.

Ultrasound can also be used to detect narrowing of the arteries that supply blood to the legs and feet. This condition, referred to as peripheral arterial disease (PAD), does not carry the risk of fatality associated with an abdominal aneurysm, but it limit activity and place an individual at risk for amputation. Early detection of diminished blood flow may motivate the person to take steps to stop the progression of the disease and hopefully bring about improvement over time. Smoking cessation, nutritional supplementation, and an intensive walking regimen can significantly alter the course of PAD. The earlier these measures are undertaken the better the result will be.

Ovarian Cancer Screening

Whether women should undergo screening for early detection of ovarian cancer is currently being debated. Screening using pelvic ultrasound alone is not recommended. It is estimated that if 100,000 women were to be screened for ovarian cancer using pelvic ultrasound 40 cases of ovarian cancer would be detected, but 5,398 women would be wrongly suspected of having the disease. This would result in 160 women having complications from unnecessary surgeries.

On an encouraging note, a British study published in April 2009 demonstrated that when CA125, a blood test, is combined with pelvic ultrasound 90 % of ovarian cancers may be detected with 99% accuracy. This would dramatically decrease the number of unnecessary surgeries. The study was not able to determine whether detection was able to change the outcome of the disease, however. Research seeking to determine whether there is an advantage to early detection and treatment of ovarian cancer is ongoing.

At present, it appears best to reserve routine screening for women who are at high risk of ovarian cancer based upon a family history of breast or ovarian cancer. Women should be aware of the early signs of ovarian cancer and seek evaluation should they occur. These include persistent bloating, pelvic or abdominal pain, trouble eating or feeling full quickly, frequent urination, or a sensation that the bladder must be emptied immediately.

Cognitive Screening

Mental decline is a concern as people age. Almost everyone over the age of forty reports some decline in memory compared with that of their twenties or early thirties. It is important to distinguish between mild memory loss and serious mental decline. One of the tests physicians use to determine whether dementia (defined as loss of mental capacity to the point that ones ability to function in social or occupational settings may be impaired) is present is called the mini mental status examination. The test assesses short and long-term memory, awareness, mathematical skill and ability to reason. A cognitive screen may be run quickly at home to determine whether or not a significant problem is likely to exist.

Long-term memory is assessed by asking a question such as "Who is the President of the United States?” Short-term memory is evaluated by giving the person a list of three items to memorize. He or she is asked to recall them fifteen minutes later. Awareness is judged by an individual’s ability to correctly identify himself, where the conversation is taking place, the day of the week and the date of the month.

Mathematical skill is determined by asking the person to begin by subtracting 7 from 100 and continue subtracting 7 from each successive result. A correct series would be 93, 86, 79, etc. Reasoning ability is evaluated by reciting a common proverb (such as "A bird in hand is worth two in the bush” or "A stitch in time saves nine”) and asking for an interpretation.

If any of the responses are incorrect a more comprehensive evaluation is needed. It is important to do so promptly, as many causes of dementia can be treated if caught in time. It should be noted that over-the-counter and prescription drugs are leading causes of dementia in the elderly. Discontinuing the drug or drugs that are causing the mental impairment can often restore normal mental function.

Blood Tests

Many blood tests are used for screening purposes. They are run so frequently that many people consider them the sum total of a "physical”. Addressing this in August 2006 I stated that blood tests can be valuable when viewed in the context of a thorough evaluation, but can be worse than useless when they are examined independently. It is important to keep this in mind when deciding whether to have screening blood tests run.

A complete blood count (CBC) looks at the solid components of the blood. These include the red cells, white cells, and platelets. The report lists the number of red blood cells per microliter (mcL), the percentage of the blood volume made up of red blood cells (hematocrit), their oxygen-carrying capacity (hemoglobin), and the size of the red blood cells. It gives the number of white blood cells per mcL and the percentage of each type of white blood cell that is present. The size and number of platelets is also reported.

The CBC is most commonly used as a screening test in women of childbearing age who are most susceptible to anemia because of the blood lost during each monthly menstrual period. It is useful in screening for an excessively high percentage of red blood cells that can make it more difficult for the heart to pump blood through the vessels of the body. The condition, called polycythemia, is particularly common in smokers. The CBC can be useful in screening men and older women for anemia due to blood loss from an undiagnosed cancer or from B vitamin deficiencies. A screening CBC will occasionally detect an unsuspected leukemia due to a high white cell count.

A comprehensive metabolic panel or profile (CMP) is a group of chemical tests that measures blood sugar, body salts (electrolytes), and chemicals that are indicative of liver and kidney function. It may suggest that diabetes is present or that an individual is developing diabetes. Most cases of hepatitis C have been discovered through a CMP screen.

When evaluating the results of a multi-test panel such as the CMP it is important to understand that "normal” values are actually "average” values in most cases. "Normals” were determined by drawing blood from a number of individuals who had no known health issues. The results formed what is called a "bell-shaped distribution curve”. Values from the 3rd through the 97th percentile were called "normal”. Individuals whose results fall outside of the "normal” range may be perfectly healthy.
Bell Curve

If a single test is run the result of a healthy individual should fall within the "normal” range 96 % of the time. When multiple tests are run the odds of all results falling within the "normal” range are much less – in fact it is likely that one or two values will fall slightly outside of the reference range. Those values need to be viewed in context of the entire picture. In nearly all cases they simply represent a normal variation and do not mean that a disease process is present.

There is no reason, other than curiosity to screen for blood type. Should a blood transfusion ever be required a typing will be performed at that time. No institution would dare give an individual a unit of blood based simply upon the statement on a card that the person had a certain blood type.

A Lipid Profile that measures the fatty constituents of the blood is one of the most commonly run screening tests. Unfortunately, it says little about the state of a person’s health or their risk of having a heart attack or other cardiovascular problem. I have written extensively about this in the past and will simply state that it is oxidized LDL cholesterol that places an individual at risk for arterial plaque build-up. A lipid profile measures total cholesterol, HDL and LDL cholesterol, and triglycerides, but it does not determine the amount of oxidized LDL in the bloodstream. I do not recommend routine lipid profile screening as it serves only to provide a basis for prescribing a cholesterol-lowering drug. Since the majority of people who choose to lower their cholesterol will die sooner as a result of doing so I cannot recommend it.

Homocysteine is a chemical that has no useful purpose in the human body. Under normal circumstances it is simply an intermediate product that occurs briefly during the manufacture of needed compounds. When the body runs short of the materials required to complete the manufacturing process homocysteine begins to accumulate. Since the same raw materials are essential for repair of DNA, cell membranes, and other parts of the body, rising homocysteine levels are a direct indication that the body has lost its ability to repair itself. Homocysteine levels are elevated in nearly every degenerative disease known. In addition, homocysteine is a direct toxin to the lining of arteries, causing injury that predisposes to plaque development and causing a rise in blood pressure.

Homocysteine levels can be lowered using a combination of B vitamins, minerals, N-acetylcysteine, and dimethylglycine or trimethylglycine. Unfortunately, screening for an elevated level of homocysteine is rarely done, since there is no patented drug available to deal with the issue.

C-reactive protein is a non-specific indicator of inflammation in the body. Obesity, chronic infections, lack of sleep, adrenal fatigue, essential fatty acid deficiencies, vitamin D deficiency, copper deficiency, and diets high in protein or cooked food are known to trigger inflammation. Many medical conditions are caused or aggravated by inflammation. For example, hardening of the arteries is now known to be triggered by inflammation in arteries. Inflammation is recognized as a trigger for cancer development. Any condition ending in "itis” is due to inflammation. Identification of elevated C-reactive protein levels can allow individuals to address the causes of chronic inflammation and thereby reduce their risk of developing conditions that arise from it.

Hormonal profiles are of little benefit as screening tests. Some commonly tested hormones are estrogen, progesterone, testosterone, cortisol, DHEA-S, LH, FSH, T4, and TSH.This is because the normal range of these substances is very wide. What may be a perfectly normal level for one individual may be abnormal for another. Hormonal testing may be helpful, but should be reserved for evaluation of symptoms that suggest that a deficiency or imbalance is present.

Ferritin serves to identify both iron deficiency and iron overload. Its use as a screening test is justified, because iron overload (hemochromatosis) often goes undetected until the condition is far-advanced and serious complications have occurred. It need not be tested frequently unless a family history of iron overload is present.

Vitamin screening tests are of little value, particularly because so little is known about optimum levels. ”Normals” have been determined on individuals living in a vitamin-deficient nation and do not necessarily reflect levels that are required for good health. Vitamin D screening has recently become popular, but low levels are being treated with excessively high amounts of vitamin D in a range known to place people at risk for calcification of the soft tissues of the body, including the heart. I believe that it is better to provide comprehensive nutritional supplementation than to attempt to determine adequate blood levels of individual nutrients.

An area of health screening that is gaining in popularity is genetic testing. I will address this phenomenon next month.

© 2009 Wellness Clubs of

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