Help me take a snapshot of my health

March 7, 2022 8:56 PM

I've been watching my friend's bodies deteriorate lately and noted that there are only x-rays (for example) taken after the fact when something goes wrong. I'm looking for ideas of what to record at a thorough checkpoint instead: skin cancer screening, colonoscopy, comprehensive x-rays of the entire skeleton and brain scans for a start. What else do you think I need for a real baseline?

I will obviously need to consult with experts about the details, but right now I'm trying to figure out which experts to consult.

Budget is not a consideration.

posted by Tell Me No Lies to Health & Fitness (16 answers total)

Best answer: Whatever kind of thorough bloodwork makes sense, whatever they call the eye scan things.
DNA testing for hereditary things?
As complete a family medical history as you can get your hands on - man, do I wish I had mine!
posted by stormyteal at 9:24 PM on March 7, 2022

Hmmm.. in recent years, much work and thought has gone into exploring the potential harms of over screening. Exposing your body to radiation to look for symptomless growths for example, is not a net neutral for physical risk. Finding tiny beginnings of things can lead to potentially unnecessary treatments, which can carry their own risks. Much 'information' found in, for example, lab work, provides no real information, just numbers that are not actionable according to existing evidence.

I would suggest that your energy would be well spent taking actions associated with decreased disease, such as eating more vegetables, exercising, and spending time socially connecting with others.
posted by latkes at 9:29 PM on March 7, 2022 [27 favorites]

Best answer: ...right now I'm trying to figure out which experts to consult.

Executive Health & Preventive Medicine programs and plans may interest you. At the Cleveland Clinic: The standard Executive Health Program along with the Women’s Executive Health Exam and the Premier Health Exam are geared to discover potential health programs, target, reduce and eliminate medical risk factors and promote wellness. Exam options (for instance: "Bone densitometry to determine your risk of bone fractures"). Get familiar with the terminology and tests provided by reading the Executive Health Program Reference Guide. The Mayo Clinic's Executive Health Plan. The Johns Hopkins Executive & Preventive Health Program.

Note: Preventive Services Offered in Executive Physicals at Top-Ranked Hospitals (JAMA, 2019) - "We used US Preventive Services Task Force (USPSTF) guidelines to grade the appropriateness of services [...] Some important recommended services, such as risk-based lung cancer screening, were missing from all packages."

[The U.S. Preventive Services Task Force is "an independent, volunteer panel of national experts in disease prevention and evidence-based medicine. The Task Force works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services." Recommendation topics; Search & Filter all recommendations; A and B grade recommendations are services that the Task Force most highly recommends implementing for preventive care [...] These preventive services have a high or moderate net benefit for patients. The USPSTF explicitly does not consider cost as a factor in its recommendations.]
posted by Iris Gambol at 10:21 PM on March 7, 2022 [11 favorites]

Do you already have a regular doctor or primary care provider? A great way to establish a general baseline and ongoing comparison information is to have annual physicals with that person. They will do a bunch of checks that don't require specific imaging or procedures (like how's your breathing, how do your ears look, etc.) and make records. You'll also be building a relationship with that person so they'll have the past data and an eye peeled for changes. If you're in the USA and you have health insurance, this annual visit may have no cost, depending on your insurance plan.

They can also organize and prioritize preventive health screenings for you, like the ones listed in this page from the US Preventive Services Task Force (the team who reviews data and comes up with recommendations for Americans like "Get this one test every X years"). This is about getting any baseline tests done and then getting screenings done regularly. For example, you don't want just one colonoscopy. You want one every 10 years if you're average risk, starting around age 45-50. This is also about getting any vaccinations, like a shingles vaccine or tetanus booster.

You should also look into getting regular dentist cleanings and checkups. Their periodic x-rays and examinations check for oral cancer and problems with your teeth and gums, which can also have impact on your general health from bacteria being introduced into your bloodstream from your mouth.

(on preview: Nice! USPSTF jinx! :)
posted by cadge at 10:33 PM on March 7, 2022 [2 favorites]

Adding on to what I said above: A key point is not just taking a single baseline snapshot. It's about establishing regular practices, like annual visits to your primary care provider, regular visits to the dentist, and followthrough on periodic preventive screenings like mammograms and colonoscopies. Those build on the baseline, showing trends and actively taking preventive steps along the way.
posted by cadge at 10:37 PM on March 7, 2022 [1 favorite]

So-called "executive physicals" are money makers for an institution, as they are usually cash pay. The best thing I can say about them is that they (inefficiently) help fund indigent/charity care services.

Over-screening is its own beast. Google "incidentaloma."

The USPSTF guidelines is what you want. Evidence based; risk-benefit analysis. The Choosing Wisely guidelines and the NHS NICE guidelines are similar.

Most of the time, though, a "baseline" is shorthand for some mythical Eden when your body was at its peak. Hate to break it to you, but a single "baseline" doesn't exist; your body has been constantly changing since egg met sperm. Each of your organs is toodling along doing its thing; each of them will mature and deteriorate at its own rate. There is strong evidence that diet and exercise in midlife are the best predictors of quality of later life. You'll have far better ROI using the time/money you'd spend on "baseline tests" on diet/exercise instead. Also: sunscreen, dental care, mental health.

I'm a neurologist; if you bring me an MRI from 15 years ago, I'll shrug (but hey, I can bill you/your insurance more for reviewing this ancient scan!) and assuming it's something that might show up on an MRI (most things I deal with are not) I'll probably order a new scan but not to compare them, the technique is just different.
posted by basalganglia at 11:38 PM on March 7, 2022 [18 favorites]

Response by poster: I'm a neurologist; if you bring me an MRI from 15 years ago, I'll shrug

And if I bring you one from six months ago because I’ve developed cognitive problems in the interim?

Honest question. Is there some marginal use there?
posted by Tell Me No Lies at 11:50 PM on March 7, 2022

Response by poster: For everyone, this question is very definitely not about preventative care. It is about taking a snapshot.
posted by Tell Me No Lies at 12:02 AM on March 8, 2022

Best answer: And if I bring you one from six months ago because I’ve developed cognitive problems in the interim?

If you had cognitive problems when you had the MRI, sure. If they are new since getting the MRI, nope.
posted by basalganglia at 12:26 AM on March 8, 2022 [5 favorites]

Best answer: Aside from the time course thing, an MRI is made up of different sequences that are chosen to highlight particular clinical scenarios. An MRI for stroke is going to be different from one for MS is different from one for cognitive concerns is different from one for hemifacial spasm is different from one for... That's why there's no such thing as a "baseline" MRI.

Sometimes people bring me recent scans that were done for some other indication than why they are seeing me. I always review them (again, for billing). In more than a decade of doing this I can't think of a single instance where a presymptomatic brain scan was clinically useful.
posted by basalganglia at 12:34 AM on March 8, 2022 [11 favorites]

Best answer: Every time I had an ultrasound they've wanted the old photos to compare, even when they were a decade old at that point, to see how things have changed and grown. My doctor recommends an abdominal ultrasound every few years, and it might be worth it to get a baseline of the thyroid as well (plus uterus and breasts for women). No physical downsides to more ultrasounds, though they can result in "better safe than sorry" biopsies.
posted by I claim sanctuary at 1:59 AM on March 8, 2022

Best answer: As basalganglia alludes, every part of the body and every possible problem with every part of the body has an imaging modality that is best for its evaluation. For example, you might think "MRI is the most detailed, what I want is a full body MRI," but MRI of the lungs is for the moment essentially useless (it is in very early research stages). MRI of the heart can be useful in certain circumstances, but only if it is performed in a specific, highly-specialized way that allows interpretation of cardiac images (the heart moves a lot, you see). IV contrast can help to visualize the blood vessels... unless you want to see calcifications of the coronary arteries, in which case IV contrast will reduce the utility of the scan. I could go on and on.

In terms of "snapshot" data that I would find useful (I am a doctor, IANYD), I am willing to admit there are a few pieces of data that aren't part of the USPSTF guidelines that I am sometimes glad to find in the medical record when trying to understand someone's history. A 12 lead EKG, a baseline creatinine (part of the basic metabolic panel, or BMP), and a baseline complete blood count. If a patient came to me and said they had your goal and wanted more testing than I was offering, I would explain to them that obtaining these tests without a real indication exposes them to the risk of finding something that would need to be worked up (and might not benefit, and may even harm them), but these are low cost, relatively noninvasive tests that I'd be willing to order. But that's about it.
posted by telegraph at 4:53 AM on March 8, 2022 [5 favorites]

I would seriously weigh the pros and cons of this. I know it seems at first glance - how could this be bad? More info is better, right?

But as mentioned above, there are lots of benign lumps and bumps and cysts etc in the body. They could be there your whole life, never causing any problems, never noticeable. But if they show up on a scan, then they may need to be investigated.

IANAD. Here's my personal recent experience with this:

In the last 2.5 years, I've had so much bloodwork, multiple MRIs, multiple CAT scans, SO MANY CHEST XRAYS and other xrays, an upper GI endoscopy. This is because of a number of related health problems I've been having.

But like, when they did a lower back MRI, they found nothing useful to explain my back pain, but they did find some sort of mass in my upper abdomen. They were like, "it's probably not cancer, but we have to do more screening to be sure." So then one week after my first MRI, I had to do another one, this time with contrast, of the abdomen. They decided this time it was "most likely benign". I'm sure it's nothing, but it was stressful at the time, MRIs are no fun to do, and now it's like sort of in the back of my mind that it's there. It would have been a very invasive place to do a biopsy so they didn't do that.

Or like when I had my upper GI endoscopy, they found like 30 stomach polyps. They did a bunch of biopsies, I guess none of them seemed concerning enough to remove, but of course, polyps can turn cancerous.

I used to think about doing what you're about to embark on, but now that I've had all these tests... nope. I've done all these tests and literally the only tests that gave any actionable information were the ones that found I was low on B12 and Vitamin D. But nothing to actually help diagnose or treat my actual symptoms.

So now, when they suggest another scan or test, I just dread it, because I know odds are it won't give them any useful information*, and the more they look at your body, the more likely they are to find these minor abnormalities that you could have gone your whole life without ever knowing about without causing any issues.

If nothing else, think long and hard if you're the kind of person who will be bothered by finding out about these things. I'm not even particularly prone to medical anxiety/hypochondria, and it's not like I think about these cysts and polyps etc that often, but I still would have been happier not knowing about them.

Again, IANAD, but I just wanted to put this out there as something to think about, especially since I used to be like you. I love knowing things! How could it be bad to know more about your body? But it's really something to think critically about. This isn't just like doctors saying this so they don't waste hospital resources. there are good reasons to avoid these kinds of scans (not counting situations when they are necessary for actual concrete health reasons).

*Okay, I recognize in the case where the scan is due to actual concrete symptoms, a scan that comes back as clear does at least give some useful info as far as ruling things out.
posted by litera scripta manet at 5:28 AM on March 8, 2022 [6 favorites]

I used to work for a large University, and every once in a while their Exercise Science/Kinesiology department would call for volunteers to get a physical evaluation. I volunteered and it was really interesting! It's been a while, but there was a blood test section, where - amongst other things - I learned that I have surprisingly low cholesterol. And there was an exercise section, in which I had nodes attached to me as I ran on a treadmill; and then later on I was dunked in a tank of water to get an accurate body fat reading. I also recall flexibility tests and a lung capacity test. All of these took place over a single day, done by students under a TA's watchful eye.

So, if you have a college/university nearby that has an exercise science/kinesiology department, perhaps they do something like this? From what I remember, they would all take turns being "the patient" but they were also interested in having patients from other demographics (so, not 20-something college students with an interest in exercise...they need to practice on the older and less fit amongst us :^))
posted by Gray Duck at 7:11 AM on March 8, 2022 [3 favorites]

(Caveat - not a clinician.) Can't speak to the body part, but in terms of brain, just wanted emphatically second everything basalganglia said. Also want to highlight this part of their comment: "assuming it's something that might show up on an MRI (most things I deal with are not)"

Some things can show up on an MRI, but a lot doesn't. Brains are messy and complicated and their function is not as deterministically understandable from their (detectable) structure. For example, if a bone breaks, it will hurt and stop stabilizing that part of your body and that loss of function would be visible as a dark space or crack in the bone on an xray . In contrast, if you were experiencing the onset of dementia it's unclear that an fMRI would show any difference in your brain. An MRI (or EEG) is likely most useful as one prong of a diagnostic battery to chase a symptom.
posted by BlueBlueElectricBlue at 8:48 AM on March 8, 2022

Best answer: > For everyone, this question is very definitely not about preventative care. It is about taking a snapshot.

Speaking just for myself: In my experience as a medical writer and health communication specialist, getting started on those preventive care tasks is the process of taking that snapshot (or a big part of it).

Starting colon cancer screening =
You're probably going to get a colonoscopy done, or some other procedure that's not quite as gold standard as colonoscopies but still good. That's a snapshot, plus they might chop out potentially sketchy bits while they're in there.

Kicking off getting annual exams =
You'll probably get your cholesterol levels checked (last I heard, recommended every 5 years) and other basic blood labs done. You might get a prostate exam and possibly prostate blood tests, or a Pap smear and instructions for lining up a mammogram. You may be encouraged to get an HIV test (recommended across the board). They will do a baseline check for stuff like your vision, hearing, breathing, balance, nerves, and lifestyle (exercise, substance use, seatbelt wearing, etc.).

Going to the dentist =
X-rays of your mouth, a baseline for your gum health, and a check for signs of oral cancer

Plus, doing this will put it all in context. It'd suck if you went out of your way to get some general "snapshot" imaging procedure, and then when you meet with a doctor, they say "This imaging report isn't helpful. We would have needed you to get a (insert name of a specific imaging procedure) to help inform what I understand from examining you."

ps. Totally understandable if you're shrugging this off because you're an American who doesn't want to create a medical record of all this and accidentally document pre-existing conditions that insurance companies might slam you about later, regardless of the current laws about pre-existing conditions.
posted by cadge at 2:39 PM on March 9, 2022 [1 favorite]