We all worry about the health of our children, but often give little thought to our own… It’s important to make sure we keep an eye on our health too. Here is a list of tests that parents should be having to ensure problems are spotted early enough to treat optimally. These are guidelines only and if you experience any worrying symptoms you should seek advice from your doctor.
Moms and dads
Blood pressure can fall into several categories: lower than 120/80 is optimal; 120/80 to 140/90 is pre-hypertensive; and above 140/90 is classified as high blood pressure. High blood pressure (or hypertension) can lead to an increased risk of heart disease or a stroke. Most people don’t experience symptoms of high blood pressure, so it is recommended you have your blood pressure tested every three to five years. Risk factors include a family history of heart problems, diabetes, and lifestyle factors such as drinking excessive amounts of coffee or alcohol, and not exercising.
Low blood pressure (or hypotension) is not usually a problem unless it is so low that not enough blood is getting to your organs. Symptoms would include dizziness and feeling faint.
Dr Shezadi Kamroodien, a Johannesburg GP, suggests starting with blood pressure tests in your 20s, particularly if you are in the high-risk category. The tests are inexpensive and can be done at most pharmacies and clinics. If you have high blood pressure you should see a doctor. (The test can also determine if your blood pressure is too low.)
As we age, our bones lose density, causing them to become fragile and fracture. Osteoporosis is a disease found in both men and women, and is characterised by loss of bone mass and increased fragility. The first sign is usually a fracture after minimal trauma, which often happens between 50 and 70 years of age, although it can happen at 30 or younger. It is advisable to go for testing if you are at risk. Kamroodien says “those who are very petite, are vitamin D deficient, and have a family history of osteoporosis” are at risk. Other risk factors include age, menopause before the age of 45, excessive use of alcohol or smoking.
Testing bone mass can be costly. According to Kamroodien, bone-density scans are generally only done if the doctor suspects osteoporosis. Tests can include a dual-energy X-ray absorptiometry, where an X-ray is passed through part of the skeleton, or computerised tomography, which measures spinal-bone mass. Other tests include X-rays, single-photon absorptiometry and ultrasound, although these do not always provide sufficient information.
Cholesterol is produced by our bodies and is used for things such as making vitamin D and building cell walls. It is also found in certain foods, such as eggs, dairy products and meats. While the body does use some cholesterol, the excess can gather on artery walls, which may lead to heart problems. High cholesterol is often only diagnosed after the damage has been done, so levels should be checked every five years. If you are found to have high cholesterol, or if there are high-risk factors, then more frequent testing will be recommended. Risk factors include age, a family history of high cholesterol, smoking and high blood pressure.
Kamroodien recommends that everyone older than 20 years have a fasting lipogram done, which tests total cholesterol, and good and bad cholesterol. Alternatively, a cholesterol test can be done by giving a small sample of blood for testing, either in a laboratory or onsite, although these are only suggested as diagnostic tools. A cholesterol reading of below 5 mmol/l (millimoles per litre) is preferable, while a reading above 7 mmol/l would require a visit to the doctor.
glucose and diabetes
High glucose and blood-sugar levels can be dangerous, so those at risk should be tested every one to two years. If blood glucose levels are normal, then testing can be done every three years. You should get tested if you are overweight and have other risk factors, including high blood pressure, high cholesterol or you have suffered from gestational diabetes. Kamroodien also highlights the “strong genetic component” of diabetes, saying that those with a family history of diabetes should be tested from their 20s. Those who don’t exercise are also at risk.
There are three tests that can be performed. The fasting plasma glucose test requires you to fast for eight hours, after which your blood will be tested to determine how much glucose is in the plasma. The oral glucose tolerance test can determine how well you handle a normal amount of glucose. You will be given a beverage containing glucose to drink and then your blood will be tested at two-hour intervals. Both tests can detect pre-diabetes and diabetes. In a random plasma glucose test, blood is taken randomly throughout the day – someone without diabetes will have fairly constant glucose levels. This test can detect diabetes.
In South Africa’s climate, it is essential for everyone to conduct regular skin checks, and to take note of new and changing moles. People at particular risk would include those who are fair-skinned, have a personal or family history of skin cancer, have suffered severe sunburn or have more than 50 moles. Kamroodien says that “a mole that gets bigger, changes colour or becomes painful” should be checked by a doctor.
Skin cancers usually appear as tumours, with the most dangerous being melanomas. These can appear as a new mole, or as changes in an existing mole – doing an ABCD check helps to identify these changes. Check for asymmetry (the halves don’t match), border (the edges are irregular), colour (uneven colour) and diameter (there is a change in size). Other checks you can do include regular self-examinations as well as mole mapping, where moles are photographed regularly in order to pick up any changes. Mole mapping can be done by a doctor or dermatologist, or you can do it yourself.
Breast cancer occurs when cells in the breast divide and grow into tumours. Symptoms of breast cancer include a change in the shape, size or colour of the nipple or breast, discharge from the nipples, puckering of the skin, a lump or swelling, or pain in the breast or armpit.
Breast cancer occurs predominantly in post-menopausal women, however, younger women are also susceptible, so they should start checking their breasts regularly once they reach puberty. Tina Naidoo, Durban health programmes coordinator at CANSA, says women should begin self-examining “when they start to menstruate”. This familiarity with your breasts also increases the chance of detecting a lump.
Women should examine their breasts at the same time every month, “two weeks after menstruation when the breasts are not tender”, says Naidoo. Self-examination can be done by looking at both breasts and the armpit area, and by feeling both while standing up and lying down. Naidoo also recommends that women over 50 years schedule regular mammograms with their doctor, where a special X-ray is used to determine if there are any lumps in the breast. If there is a high risk, such as a family history of breast cancer, then women should begin having mammograms at 40 years of age.
Cancer of the cervix is mostly caused by various strains of a virus called the human papillomavirus (HPV). HPV is a sexually transmitted infection; most of the time the immune system will eradicate the virus itself. However, in some cases, the virus remains and over time has the potential to convert normal cervical cells into cancerous ones. Cervical cancer often only manifests symptoms in its later stages. These symptoms include abnormal vaginal bleeding, pain during intercourse or after a pelvic exam, or bleeding after menopause. Early symptoms, such as unusual or odorous discharge, are rare, so pap smears are done to detect pre-cancerous and abnormal cells in the cervix.
Cervical cancer cells change over time from normal to abnormal and the pap smear helps to detect these gradual changes. CANSA therefore recommends that all sexually active women get tested every two to three years. If there is evidence of abnormal cells, Naidoo suggests getting tested annually. Women should go for their first pap smear if they experience frequent viral infections or symptoms of cervical cancer. Otherwise, 30 years is the recommended age. A pap smear is a straightforward test, where a sample of cells is taken from the cervix. A small instrument is used to scrape cells off the wall of the cervix; these are then placed on a slide and sent for testing.
testicular cancer screening
Men are encouraged to begin testing for cancer of the testicles from as early as the onset of puberty – being familiar with the normal testicle will help to identify unusual lumps or swelling if they develop. Risk factors include being between the ages of 15 and 40, having had an undescended testicle at birth, having a family history of testicular cancer and being HIV-positive. Symptoms include a lump in the testicle, the enlargement of one testicle, or of the breast area or nipples, and a heaviness in the testicles, scrotum or groin.
Dr Ehab Helmy Abdel Goad, clinical head of the Ethekwini Department of Urology encourages mothers to check that their baby’s testes are in the scrotum. He also recommends self-examination from early on to detect “any changes, such as the testes becoming painful or increasing in size”. Self-examination can be done by looking at the scrotum and feeling each testicle for any unfamiliar lumps or nodules. Men should also ask their doctors to examine their testicles once a year.
prostate cancer check
Older men are at risk of developing prostate cancer, and this risk increases with age, or if there is a family history of prostate cancer. CANSA therefore recommends that men start with being tested once a year at about age 50 (45 if they are at higher risk). The prostate is a small gland underneath the bladder, and once this becomes enlarged, the urine stream begins to slow. Other symptoms, according to Goad, include burning or pain at the tip of the penis, and a dull ache in the prostate. These symptoms often only become apparent in the later stages of the disease, so screening tests are advisable.
There are two tests men can have to detect prostate cancer. The first is a PSA test in which blood is drawn and the amount of PSA (prostate specific antigen) in the blood determined. A high reading means that there may be prostate cancer. As there are other causes of high PSA, further tests are then likely to be performed.
A digital rectal exam (DRE) is used to check for abnormalities in the lower pelvic region. To perform this test, the doctor places a gloved, lubricated finger into the rectum and applies pressure to the prostate to examine it. If either test indicates a risk of cancer, then the doctor is likely to recommend further testing.