An Annual Physical is one of my favorite visits. It’s an appointment specifically designated to review your health – both where you are now and where you are heading. It’s the body’s status update. It’s also where I feel I get to know a person a little better, more about your life in general, not just your blood pressure or back pain. Besides having a conversation about your health, a blood test is usually performed. Often, when we get to drawing blood at a physical exam, a patient will say, “Test me for everything.” Obviously, everything is not possible – so a discussion of what “everything” entails is needed.
Often, patients use “everything” as a signal for testing for sexually transmitted diseases (STDs). It is important to know that HIV can not be tested for without your request – so do not assume it is being tested – ASK FOR IT!
Other STD tests usually include HIV, syphilis, gonorrhea, chlamydia and Hepatitis B & C. Herpes can be tested for in the blood as well, but the test only shows whether a person has been exposed to the Herpes virus, it does not give information on contagiousness or disease activity.
HPV is tested for in women during a PAP smear. It is a test done on cervical cells – it is not a blood or urine test. There is no test for men for HPV, unless there is a lesion – usually a wart – that can be biopsied.
So what are the usual blood tests done at a physical?
It depends on your age and gender. The blood tests I order fairly universally:
- blood count (CBC)
- sugar (glucose)
- liver function (AST, ALT)
- kidney function (BUN, Cr)
- lipid panel (cholesterol)
- thyroid function (TSH, Free T4)
Often tested, but not “mandatory”
- iron levels
- vitamin B12
- vitamin D
Other tests determined by age, gender or a medical condition
- high sensitivity C-reactive protein (cardiovascular risk)
- hemoglobin A1c (for further assessment of diabetes)
- urine protein (for people with diabetes or hypertension)
- prostate specific antigen (PSA) – this is ordered after a discussion about risk and benefits
- other tests can be considered depending on individual risk – advanced lipid testing, imaging studies, stress tests – these depend on your specific medical needs and are not “one size fits all”
Do I have cancer?
One of the most common questions asked when we draw blood is can you tell if I have cancer? Blood tests for cancer or genetic information are not routinely done, with the exception of the PSA in men for prostate cancer. While there are tests that exist for following some cancers, they have not improved diagnosis – especially the CA-125 test that is touted in many email chain letters for finding ovarian cancer – it is not a diagnostic test but rather a test for following someone with ovarian cancer. Using tests improperly leads to confusion, anxiety, more testing and misdiagnosis!
More cancers can be detected or screened for with specific tests other than blood tests. Colon cancer, breast cancer, cervical cancer and lung cancer all have screening tests (procedures) that improve detection. There are many guidelines as to when these tests should be done – the bottom line is that each person should discuss their individual risks with their doctor to determine what tests should be done, as well as when and how often!
This leads to the biggest issue of testing – interpreting the information in a meaningful way for you. The FDA recently forced a home genetic testing company, 23 and Me, to stop marketing their kits due to quality and interpretation issues. As more tests are developed, our need to synthesize this information to make good decisions is becoming more apparent.
So, “everything” means different things to different people – so be specific if there is something you wish to have tested. You can’t assume it is part of everything. An Annual Physical gives you a snapshot of where you are, and serves as a guide for how to get to where you want to be. Have a conversation with your doctor about your health fears – an annual physical is the time to chart your path to health!
The path to wellness begins with a proper diagnosis