Complete checkup

[takeitasread]

Hi

OK, so it's a new year and I want to get a complete physical checkup (at Mrs Takeit's request). Sadly I'm just on the wrong side of 50 and don't have a GP. Can anyone suggest - through personal experience - of a good doctor who can do a complete checkup? I'm in Melbourne, work in the CBD and live in the inner eastern suburbs.

Any assistance would be most appreciated.

Thanks

[Addictr3]

Complete check ups are pretty standard why not just go to a local medical centre GP?

[sonj]

As an aside, I would love to know what a 'complete checkup' entails. My last few years included a token BP reading, brief attacks with a stethoscope and if lucky a few whacks to the knee with a hammer, and some lifestyle/general 'is there anthing you're worried about' questions. And this was worth a double appointment? Am a complete noob when navigating medical services, as an insofar fortunate lifetime avoider of scablifters

[triangle]

As an aside, I would love to know what a 'complete checkup' entails. My last few years included a token BP reading, brief attacks with a stethoscope and if lucky a few whacks to the knee with a hammer, and some lifestyle/general 'is there anthing you're worried about' questions. And this was worth a double appointment? Am a complete noob when navigating medical services, as an insofar fortunate lifetime avoider of scablifters

Depends on your doctor but a really thorough check up should involve measuring your blood pressure, stethoscope listen for heart murmurs and lung function plus blood tests for liver function, renal function, cholesterol and blood glucose (fasting for these two). Depending on your age, weight and lifestyle factors like drinking, smoking and exercise (and your doctor's thoroughness) you may also get an ECG. The blood tests, blood pressure reading, age and yes/no smoking are often then used to conduct a coronary risk assessment which just involves plugging some values into an online calculator that calculates your risk of heart attack. Depending on the outcomes of that calculation and/or individual results, there may be more tests.

[sogood]

The definition of complete check up can vary tremendously depending your geographic location and wealth. US President and in some countries, this annual check up can extend to CT scans and other imaging and invasive procedures eg. Endoscopy. We in Australia aren't as extravagant and typically stop at those expensive procedures unless specifically indicated. Clinical examination (with some invasive steps), blood/urine/faecal screens and an ECG is pretty standard through a local GP. A mammogram would also be added for females in the appropriate age group.

[Ken Ho]

In addition to stuff already mentioned, screening for bowel cancer is a VERY good idea. It's a silent killer and you are in the zone.
PSA is something to consider, but is not a "gold standard" test. That said, I do pick up prostate cancer by doing it, so it's not a bad idea, just needs to be done thoughtfully.
BP, cholesterol, and waist measurement are important. I assume you don't smoke as you are interested in your health.
Skin cancer check is also a very good idea too, as is glaucoma screening. Like bowel cancer, glaucoma sneaks up on you and early detection makes all the difference.
Iron studies and vitamin D levels also, as issues with both are common. Too much one, not enough of the other.

[malnar]

I recently went to a bulk billing clinc for the first time and because I'm over 45 he asked me to make an appt for blood tests and also make another appt with him for a full check up.

The blood testing was a full blood examination including a prostate test.

At the second appt he was working through a template (?Fed Gov't) & he did BP, height & weight, lifestyle questionnaire, stephoscope, pulpaption and an ECG. I thought he was going to do a prostate check but apparently the blood test covered that off.

All bulk billed. Very impressed.

[PawPaw]

Has anyone got insight into % false negatives (picking up rhythm abnormalities) with stress ecg's and 24 hr holter monitoring?
Would several tests over 1-2 months improve this % significantly?
I also understand these tests do not unmask predilection to myocardial infarct, presumably because coronary artery blockages do not correlate strongly with abnormal rhythms.
I'm very curious about this stuff and if anyone can recommend reading sources, would appreciate it. I've socialized with several cardiologists in the past and their views on intense effort over the age of 45 varies tremendously.

[Ken Ho]

Paw paw, this is what I can contribute, as a GP.
Exercise stress testing carries a high enough false positive rate, that it is not considered to be a good idea to use it to screen asymptomatic people. This is because a positive result will be followed by angiography, which is b expensive and invasive
Some insurance companies will require an ETT before insuring older clients who may be borrowing a lot of money, for example, because a negative result is quite re-assuring.
Now, about cardiologists. They mostly believe in studies. Studies are all about drugs, and to a lesser extent interventional procedures. There have been a ton of studies done that prove significant benefit from lowering blood pressure and cholesterol in particular for prevention and similar things as well as controlling heart rate for people with established IHD both befo and after myocardial infarction. So, that's what they focus on. Basically, even if you are a fat diabetic slob, if you take your pills, which people will actually do, you'll do OK. There is not the same weight of evidence supporting diet and exercise, and it's harder to get people to do it.
Now I would argue that taking your pills and fixing your numbers is not the same as being healthy, but "health". Is a fuzzy concept.
I would postulate that a cardiologist's views on vigorous exercise will be informed by their own lifestyle. A sedentary doctor will be unlikely to strongly advocate exercise, whereas one who can cruise a half-iron will be keener. I think that's where the inconsistency arises. Remember, medicine is a sedentary desk job.
Regardless, I can assure that there is no quicker way to piss people off than to suggest they need to lose weight and/or exercise, even if they are obviously suffering the ill effects of morbid obesity.
There have been studies proving that patients with severe heart failure live longer and do better if they do weight training.
In the over 45, the safety of high heart rate exercise will vary between individuals, depending on how well they have lived, and if they have crap arteries.

[PawPaw]

Thanks Ken. I value the opinion of anyone informed and daily at the coal face.
Some of the studies and hospital staff kitchen conversation I've heard recently is arrhythmia is a growing issue amongst middle aged westerners, and some are blaming intense exercise.

My feeling is yes it might be a growing issue due to
- demographics (boomer spike and increased comorbidity amongst frugals)
- higher rate of overweight and obesity
- higher rate of uptake of high intensity exercise and crash dieting amongst boomers and X'ers.

Personally, I see too many middle aged folk try and replicate the Biggest Loser experience, and take advice from a personal trainer who did an 8 week course, or some buff Cross Fit forum guru..... It would seem intense exercise such as on that show should be gradually progressed towards only after significant weight has been stripped.

I suppose my intuitive feeling is an aging body has an aging cardiovascular and neural system, and therefore, it is possible intense efforts are more likely to unmask or over stress those systems. I suppose there's a balance to be had, which might be more closely followed by listening intently to our intuition and internal feedback.but it seems everyone wants quantifiable responses from doctors more.

[Ken Ho]

Drinking lots of strong coffee has become trendy, as have "energy drinks". Personally, if I have more than one coffee a day, I get palpitations, and stupider in the head.
Age is no doubt a contributor, but caffeine from the many sources it comes form is probably a significant factor as well
Your comment "internal feedback" is pretty important. I tend to listen to my body, and while I do push long and hard at times, I'm always paying attention to myself. I don't measure my heart rate, and I am not really a fan of deliberately pushing heart rate during exercise.
There is no dispute that faster heart rates increase oxygen demand while reducing supply. The heart can only perfuse itself during diastole, so increased rates always lead to a reduction in perfusion.

[wombatK]

I suppose my intuitive feeling is an aging body has an aging cardiovascular and neural system, and therefore, it is possible intense efforts are more likely to unmask or over stress those systems. I suppose there's a balance to be had, which might be more closely followed by listening intently to our intuition and internal feedback.but it seems everyone wants quantifiable responses from doctors more.

You might find some insights from this DocMikeEvans presentation (warning: it's 23 Mbytes)

About 7 minutes in, he mentions a German Researcher Rainer Hambrecht who looked at the effectiveness of exercise compared with stenting as a treatment for 107 patients with coronary blockages in 2004 (see Percutaneous Coronary Angioplasty Compared With Exercise Training in Patients With Stable Coronary Artery Disease).

Half the patients got 20 minutes a day on an exercise bike, plus once a week 60 min aerobics class; 88% of these were event free one year later. The other half got stents, and only 70% of these were event free one year later. The low-tech exercise treatment worked on the whole body - the stent fixes just one part; if you read the study article, the exercisers got numerous other benefits.

It's not a big study, but the result ought to have people reaching for the low-tech answers before surgical big-guns are
brought to bear.

Hambrecht's study can probably also give you an indication of what is "safe" - 20 minutes per day, with a 180 minute weekly total is safe. There's probably quite a margin between this and the marathon-running territory where you might have to worry about
your ability to recover from the cardiac damage over-exertion can cause.

Cheers

[sogood]

Remember, medicine is a sedentary desk job...

Depends. There are also many specialties in medicine (used generically) that's tough both mentally and physically, a far cry from a sedentary desk job.

[sogood]

Half the patients got 20 minutes a day on an exercise bike, plus once a week 60 min aerobics class; 88% of these were event free one year later. The other half got stents, and only 70% of these were event free one year later. The low-tech exercise treatment worked on the whole body - the stent fixes just one part; if you read the study article, the exercisers got numerous other benefits.

Without digging into the specific selection criteria, I would want both if I have critical a stenosis that deserves a PTCA+stent!