Monday, April 30, 2012

Be Wary of Being Test Weary


Be wary of becoming test weary.  
 Here are seven tests and procedures doctors often recommend.  Are they safe, appropriate, and reasonable?
Electrocardiograms and heart stress tests for people who have no symptoms or history of cardiac disease.
Pro: Cardiac screening tests are reasonable for people with diabetes, hypertension, and family       history of heart disease.
Con: People with low risk of heart disease may have indeterminate or false positive results that lead to expensive and invasive testing.

DEXA (bone density test) scans.  
PRO: Steroids can weaken the bones. People who take long-term prescription steroids for certain diseases, such as severe asthma, adrenal insufficiency, and multiple sclerosis, can reduce fracture risk by having a bone density test to screen for and treat osteoporosis. 
Con: People who take physician prescribed steroids may develop hypertension, stomach ulcers, glaucoma, and diabetes. In these cases, DEXA testing can lead to unnecessary and expensive imaging tests and questionable treatment. The American Academy of Family Physicians recommends DEXA screening predominantly for women over sixty five and men under seventy.

Antibiotics for patients with mild sinus infection.
Pro: Antibiotics are appropriate for bacterial sinus infection.
Con: Viruses cause more than ninety percent of adult sinus infections. Antibiotics don’t kill viruses. Antibiotics can cause diarrhea and drug resistance, which increases risk of life-threatening bacterial infection.

 Over the Counter Anti-inflammatory medicines (i.e., Motrin, Advil, Aleve) for joint and back pain.
  Con:Pro: These medicines are cheap, easily available, and need no prescription.
Adverse effects of anti-inflammatory medicines include decreased kidney function, elevated blood pressure, fluid retention, and stomach bleeding.


 MRI and CT imaging for uncomplicated headache.
PRO: These imaging tests are highly sensitive for diagnosing stroke and tumors.
CON: Cumulative radiation from CT scans increase cancer risk. However, MRI imaging does not involve radiation. Though MRIs show exquisite detail, false positive findings could lead to unnecessary invasive procedures and surgery.
 Allergy testing:
PRO: Allergy testing by IgG (immunoglobin) antibody can diagnose food allergies so that people can eliminate certain foods and feel better.
Con: Presence of IgG antibody suggests a normal immune system.  However, IgE antibody, used in skin patch testing, is more specific for food allergy. Inappropriate dietary restrictions can weaken the bones and immune system.
X-rays, CT Scans, and MRI imaging for low back pain.
1.       Pro: These imaging tests are useful in diagnosing tumors and cancers for people with long-term low back pain.
Con: Chronic low back pain is rarely due to tumor and cancer. Most back pain resolves in six to eight weeks with no treatment.  However, people with long term back pain and weight loss, leg weakness, loss of control of bowel/ bladder, and fever should have further testing.
Source: AARP Bulletin, May, 2012


 Get Off Your Duff and Get Involved
A recent report in Archives of General Psychiatry (vol. 67, p. 304) suggests that having a purpose in life reduces risk of Alzheimer’s disease and mild cognitive impairment (MCI).  Over nine hundred participants greater than age eighty were evaluated by questionnaire in the Rush Memory and Aging Project for a seven year period.  Initially, none had clinical evidence of Alzheimer’s.  At the end of the study, 155 participants were diagnosed with Alzheimer’s.  Participants who had a strong sense of life purpose were 2.4 times more likely to not have Alzheimer’s.  Those participants had a reduced risk of MCI and slower rate of mental decline.  The study concluded that having a goal-directed purpose can lead to improved mental and physical health as well as longevity.