Doctor Johnson is a practicing General Practitioner in the U.K. and has many years of experience in Health Screening matters. He reviews all health screening results and writes an accompanying letter addressing any health concerns that are highlighted by the health screening report itself. He writes this blog in order to clarify any common themes that occur from time to time. If you have any questions please contact us at any time. Paul Harris is a registered Nurse in the U.K. with a strong interest in Health Screening and the benefits that health screening offers.
It is difficult to be certain what is causing your son's pain without seeing him - but the history, duration of symptoms, and negative ECG, do suggest costochondritis to me also.
Alternative diagnoses might include chest wall muscle strain, pleurisy (essentially chest wall inflammation associated with a lung infection), myocarditis or endocarditis (inflammation of the heart).
Any heart related problem would generally show signs on an ECG, and if it was endocarditis or myocarditis, the patient would generally be more unwell than you have described him as being.
Blood tests that can show recent heart muscle damage include CK-MB (peaking at 48hrs), lactate dehdrogenase and troponin. Creatinine kinase levels rise if there is any muscle inflammation (including heart). CRP levels are useful pointers to inflammation from some cause - but are non specific.
If your son continues to improve I do not think testing is essential. However, if you wish to be certain there has been no acute heart or other muscle injury or inflammation, I would suggest, in order of preference:
Troponin levels - these peak at 48hrs and return to normal 5-14 days after the injury.
CK (with CK-MB fraction) - peak at 24hrs and drop to normal after a few days....CK is a general test of muscle damage, CK-MB is specifically heart muscle. But troponin testing is probably more reliable.
CRP - decline to normal a week or so after the problem subsides.
I hope this helps - but if he is improving steadily, the likelihood is that the doctors he has seen were right and that the illness was not a serious one.
The Aspergillus fumigatus antibody level is on the high side. A level such as this increases the likelihood that you have, or have had, aspergillosis - a collective name for a number of conditions caused by infection with Aspergillus fungi , the most common of which affecting man being Aspergillus fumigatus. The most commonly encountered conditions are allergic bronchopulmonary aspergillosis, pulmonary aspergilloma, and invasive aspergillosis.
Diagnosis should be made by a chest physician and a chest X ray would normally be required in addition to any blood testing.
I advise you to discuss the result with your usual doctor as further investigation is probably warranted.
There is a small rise in alanine transferase (ALT), one of the liver enzymes. In the context of otherwise normal liver function results within a health check, this is highly unlikely to be of concern. Transient low level rises in liver enzymes such as ALT are not uncommon, and are often seen with mild infections or as a result of taking medication. There is a condition known as 'fatty liver' in which persistently raised levels of one or more liver enzymes are a feature - this is not a disease process as such, but is associated with obesity and an increased risk of developing diabetes.
Repeat testing and a general health assessment in a few months time would be reasonable to check that the level is not beginning to rise. If the level remained elevated it would be sensible to have a discussion with your usual doctor.
Mercury poisoning - identified at intervals throughout modern history - remains topical today. The term 'mad as a hatter' has its origins in the association noted between milliners and madness, who in the course of manufacture of felt hats in the 18th and 19th centuries, were exposed to mercury containing compounds - often with disastrous consequences. The literature is full of examples of small and large scale industrial incidents that have resulted in mercury poisoning over the centuries. And more recently, various camps have suggested that mercury amalgam used in fillings has the potential to cause poisoning - although this hypothesis has minority support. Similarly, there is a continuing suspicion amongst some that vaccination with mercury based vaccines (those containing thiomersal) is associated with the development of autism, but again there is little evidence supporting a causal link. Mercury poisoning is no longer common but it does still occur- the key to successful diagnosis within a health screening is to be mindful of the likelihood of an individual's encountering mercury compounds when suspicious symptoms develop.
So what would you feel like if you were being posioned by mercury? Mercury can interfere with the body's process for eliminating adrenaline like substances - so symptoms will include sweating, salivation, raised heart rate and blood pressure. Tingling, itching or burning skin may be experienced. Sometimes the skin will appear more pink, and may even be shed from some parts. Psychiatric symptoms may develop - emotional, irrational behaviour - and poor sleep. In the longer run, the kidneys may fail, or teeth and hair may fall out.
Remember - many other illnesses can present with some or all of the symptoms listed. The key is the history - as with any medical puzzle - what has the individual been exposed to recently, or what is the chance of his or her encountering significant amounts of mercury?
One scenario that may not be appreciated by many is that one food source considered to be a particularly healthy option presents a real hazard. Fish such as tuna or salmon, commonly consumed in the UK of course, may contain significant levels of mercury. This is an even bigger potential concern in nations where whale or dolphin meat are consumed. A recent study in Japan revealed that samples of whale meat contained levels of mercury 20 times the accepted standard.
So - if there is strong likelihood of mercury poisoning, blood testing should be undertaken. It is important to remember that recent consumption with fish may lead to an independent elevation in the level - it is best to avoid eating fish for 5 days before taking the test therefore. Treatment is successful if undertaken quickly - but a delay in treatment may lead to serious and possibly irreversible complications.
One of the delights of writing a health screening blog is that you can find an excuse to put down in writing, and thus hopefully think through clearly, things that have been concerning you. Something that has concerned me since I started working within the Blue Horizon group 4 or 5 years ago, given the frequency with which we encounter out of range results, is just how many people in my own NHS general practice might be living with undiagnosed conditions. I encounter 30 or more people every day as a GP, many of whom present with non specific complaints such as tiredness or aching muscles or general feelings of ill health. The great majority have no detectable signs of illness nor any abnormalities in a basic battery of blood tests. Thankfully, most get better anyway. Time is a great healer, after all.
But should I be looking further afield? The more interesting requests I see with our Health Screening Blue clients, the more I wonder whether I should change my practice, particularly as we have a relatively high 'positive' rate at Blue Horizon. Around 50% of all our clients' tests show at least one out of range value, many of which will be significant. Should I consider testing for more conditions amongst my NHS patients from the outset, when they first turn up feeling tired?
Take Addison's disease for example. This is a disease of the adrenal glands, tiny organs which produce any number of essential hormones. Adrenal gland insufficiency (Addison's disease) can lead to tiredness, and low cortisol levels. So, a blood health check of cortisol levels - this is a relatively cheap test which will give a good indication of the state of adrenal gland health - would seem a logical step to take in a patient presenting with profound fatigue. If the level is normal, Addison's disease is highly unlikely.
But I do not test every tired patient of mine's cortisol levels - and why not? The answer is in the prevalence of this condition. Prevalence is a measure of how common the condition is in the population. Various estimates have been made but Addison's disease is present in about 10 in 100,000 people, and an incidence (rate of occurrence) of 5 in 1,000,000 people per year (BMJ 2009). That is 6000 or so people in the UK. It is thought to be on the rise, and it is often diagnosed late because it is rarely encountered.
Even with a prevalence of 10 in 100,000, there may be only 1 person with this condition in my general practice population of 10,000. But with an incidence of 5 in 1,000,000, only 1 new case per 20 general practices like mine will be diagnosed per year. Put another way, I might have to work for 20 years in a practice like mine to encounter a new case of Addison's disease. That is why screening for Addison's disease is not at the forefront of a general practitioner's mind when he or she sees their twentieth tired patient that week.
But - there is always a but - clients of Health Screening Blue have often been seen by a number of clinicians, and have had a number of tests before they come to us. They have also done their homework, and perhaps spoken to friends or family who are medical professionals. Something in their range of symptoms is telling them we need to look further afield...could my set of symptoms fit with a diagnosis of Addison's disease for example? There has therefore been a degree of selection already, so testing for rarities may now be reasonable.
In answer to the question posed by the title - it all depends. Individually, a doctor in an average practice with an average population will not see many rare conditions, like Addison's disease, in his or her lifetime. But magnify the population to a national scale, and recognise that many Health Screening Blue clients have already undergone basic health assessments and health checks, and for them time has not proved to be the great healer. Then looking for the canaries in the garden, and not just the sparrows, would not seem so crazy.
References - BMJ 2009
Health Screening for Hepatitis C - in terms of media coverage, this illness is the little brother of Hepatitis B. But its impact is significant, and growing. A recent Department of Health report has estimated that 215,000 people in UK are affected by this virus, with half of those infected not knowing they have the illness. Deaths attributable to Hepatitis C have increased four times since 1996. So Hepatitis C is a real problem - both for the individual with it of course - and for the public too as the illness is highly contagious (and is usually spread by sharing of needles used for iv drug use, less commonly through sexual activity).
Hepatitis C can be a brief and mild illness, and it may leave no consequences. More often, after a mild illness, the individual becomes a 'carrier' of the virus, and is prone to chronic liver disease later in life.
What is probably less known however is that there is effective treatment for Hepatitis C now freely available. Only 3% of those who know they have the virus are treated each year. But outcomes are improving all the time - cure is achievable in up to 80% of all cases.
For the best chance of complete clearance of the virus (cure), it is essential that those that have the virus are first identified of course through a routine health check...and the sooner it is known about, the better as early intervention is associated with better cure rates.
So if you feel you may be at risk of Hepatitis C don't remain silent - doing nothing is not really an option any more. Speak to your own doctor if you have any concerns by all means, or consider ordering theHepatitis C antibody test as part of your health assessment today.
Last week the medical press was briefly filled with the revelation that gout is a hidden epidemic in our country - (for example Daily Mail 16 Jan 2014 - "Why Boozy Britain is the Gout Capital of Europe") - with all sorts of potentially scary consequences. At Blue Horizon we were not overly surprised to receive this latest body of evidence - we have noticed over the past few years a number of marginally elevated uric acid readings on many of our clients' health screening blood tests. Uric acid excess is what causes gout. But often these individuals will have had no symptoms at all. And gout is not only an affliction of the port swigging game munching gentry.
What is the problem with uric acid (urate) then? Uric acid is a normal 'end product' of purine breakdown (or more generally speaking from various proteins) in our bodies. Whenever we eat protein (meat, offal, beer etc), we digest it in our gut and absorb the various component parts - purines are some of them. Purines are carried in the blood stream to our organs, where they are formed into new proteins specific for our needs. When these proteins have done their job, they too are broken down and one of the waste products formed is uric acid.
Normally, a little is made and our bodies can cope with that. If too much is made - either because we cannot handle it well or because we have assaulted our systems with too much protein - the uric acid level will rise, eventually reaching a point where it effectively comes out of solution and deposits in our joints - causing often exquisite tenderness, swelling and heat. Classically it is the big toe which is affected - but any joint can become 'gouty'.
It has been estimated that up to 1 in 40 (that is 1.5 million) of us has gout, and the numbers are on the increase. The UK now has the highest reported prevalence of gout. Some of us have a genetic predisposition for the condition, and it is more common in men (by a factor of 4). Some medication can trigger gout. The risk is greater for the obese, and those who are diabetic, have high blood pressure or drink too much alcohol. It is thus another disease of the more affluent developed world.
It is a painful condition, and may be confused for 'wear and tear' arthritis - but treatment is available, for both the acute attack and to prevent relapse. Obviously, the attacks can be made less likely for some if preventive measures are taken - losing weight, controlling diabetes, cutting back on the alcohol etc. Dietary modifications, including swapping steak for soya and eating more cherries may pay dividends too.
So - are you one of the possibly hundreds of thousands who just put up with attacks of acutely painful joints, or do you think you might be at risk? A Health Check for uric acid in the blood is relatively cheap, and is included as standard within the Health screening Blue, Plus V or PLUS X. Act today!
All of our 23 page health screening reports come with our Doctors' comments. This helps keep the results in context and is what sets us apart from other screening companies that rely totally on a computer print out. We'll always advise you to share the results with your usual Doctor of course, but you won't be going into a GP appointment unduly worried. We have anonymised a recent comment that one of our Doctors made so you can see for yourself! - see below...
CRP is an 'acute phase protein' - present in the blood to a significant degree (that is greater than 5mg/l) only when there is active inflammation, of some type, somewhere in the body. Finding a normal level of CRP therefore is very reassuring if you are suspecting significant disease which involves inflammation - choose from a very long list including bacterial and fungal infection, many cancers, autoimmune diseases, and general inflammatory diseases such as Crohn's disease of the bowel. Whilst not being a specific enough test to enable accurate diagnosis of a particular condition, a high CRP will back up a clinical suspicion in many instances.
CRP rises rapidly in the blood during any inflammatory event, to easily detectable levels. The quantity also declines quickly once the cause is corrected, so CRP levels can be, and often are, used as a marker of progress towards cure or maintenance of the disease, especially of chronic conditions such as Polymyalgia Rheumatica (PMR) and Rheumatoid Arthritis (RA).
More recently, smaller background rises in CRP have been looked at in the context of increased risk of cardiovascular (heart and blood vessel) disease. As many laboratories do not routinely record levels below 5mg/l, a more accurate test is available - known as the High Sensitivity CRP (HiS CRP) test. The American Heart Association recently concluded that having a level below 1mg/l is regarded as low risk, between 1 and 3 average risk, and greater than 3mg/l high risk - of heart disease. But because CRP is elevated in potentially many scenarios, this finding should not be taken in isolation, and should be followed up over time and alongside other indicators of risk of heart disease - such as cholesterol levels, diabetes, smoking and so on.
Are there any cautions? Well yes. As with all forms of testing there are downsides. Some viral illnesses will not trigger a significant rise in CRP, neither will some cancers or autoimmune conditions. Having a low CRP level does not guarantee good health, particularly of course if symptoms or signs are pointing towards something being not right.
But as a general marker of overall health, few tests come close to the relatively humble CRP.
There are a number of reasons for requesting tests as part of a health assessment for specific or general antibodies, or antigens, in the blood. It is a subject that creates confusion, but the principles are fairly straightforward.
The level of antibodies in a blood sample is measured and expressed as eithera titre (or concentration) OR expressed as whole units on a normal or molecular scale.. The antibody levels rise in the blood when you have been exposed to an antigen (that is a potential invading organism - or sometimes something that the body thinks is foreign). These antibodies attack and remove foreign substances, or cause harm if the object of the antibody assault is your own tissues.
The antibody titre result can answer one of a number of questions - depending upon the clinical scenario:
INTERPRETATION OF RESULTS
What constitutes a normal range depends upon the antibody being tested.
· If the test is being carried out to look for antibodies against your own body, the normal value would be expected to be very low
· If the test is being done to see if an immunisation programme has been successful, the antibody count would be expected to be higher - demonstrating that protection is in place against invasion by that organism
· Looking for evidence of infection from particular organisms, negative antibody tests can help rule out certain infections whereas a rising titre would suggest infection – either current or past
DIFFERENT CLASSES OF ANTIBODIES
Within any group of antibodies that confer protection (or potential destruction of one’s own tissues) there are different types – knowing which type of antibody present can help differentiate between current or past infection, and active or quiet disease.
When requesting tests for certain viruses, it is essential that the laboratory knows what question is needed to be answered. Broadly speaking, is the problem one of possible infection at some point, a question of immunity or not, or whether there is an autoimmune disease or not?
TESTING FOR INFECTION
This is when things can get tricky. Through Healthscreening.co.uk, dozens of tests of viral or bacterial activity are available. Don’t worry if you not entirely sure what it is that you want to be tested – we can help. It is important that we know the question to be answered, and that you let us know any useful background information – unless of course you have already done your homework and know exactly what test or tests you wish to order. It is important also to realise that not all infections will show positive results immediately – and this will vary between organisms and the tests applied. If you are uncertain, ask us. As a rough guide, antibodies can take quite a long time to show their presence in the blood so if there is any urgency PCR testing may be desired – this type of testing detects the presence of virus in the blood within days of any infection
Commonly requested tests for active infection include:
· Hepatitis B status – specific testing of various classes of antibody, antigen or virus (viral load) can reveal whether there is infection, and if so, how long it has been present. Testing can differentiate also between those who are carriers or more likely to have complications.
· Hepatitis C status – again it is possible to detect active infection by measuring antibody response, antigen presence and viral load.
· HIV status – antibody and viral tests are available. The latest PCR tests are can be employed which give reliable results 1-2 weeks after testing. Antibodies may take 6 months to become detectable however.
· Herpes Simplex Type I and II - antibody testing, or the latest PCR testing is available
· Lyme disease (Borrelia) – antibody testing
· Epstein Barr virus infection – antibody testing
Many more infections can be screened for including a large number of tropical organisms.
TESTING FOR IMMUNITY
You may wish to know whether you have been exposed in the past to a disease causing organism – and if so, whether you are immune to its effects in the future. This might be necessary for occupational reasons, or to check if your unborn baby is at risk from a disease which you could catch while pregnant. There are literally hundreds of antibody tests for immunity available through Healthscreening.co.uk, although some of the more commonly tested ones include:
· Hepatitis B status – usually requested to check that a course of vaccination against the virus has been effective.
· Rubella (German measles)
· Varicella (Chicken pox)
As always, if you need any help to decide which is the most appropriate test for you please let us know.
TESTING FOR AUTOANTIBODIES
Autoantibody screening is often requested if an autoimmune disease is suspected, or just needs to be ruled out. Autoimmune diseases occur when the body makes antibodies to its own tissue – it literally attacks itself. Any organ or tissue can be affected – the thyroid gland, the liver and joint surfaces are examples of many areas that can be attacked. The tell tale signs are often found in the blood – and the choice of antibody testing will be determined by symptoms or signs.
Conditions that can be revealed by autoantibody testing include Hashimoto’s and Grave’s disease (thyroid), Rheumatoid arthritis, and Systemic lupus erythematosis (SLE) – and many more. Commonly requested groups of tests include:
· Autoantibody screen – thyroid peroxidase antibodies, antinuclear antibodies, mitochondrial antibodies, smooth muscle antibodies, gastric parietal cell antibodies, Reticulin antibodies, anti-liver kidney microsomal antibodies
· Connective Tissue Disorder Screen – antinuclear antibodies, anti-dsDNA, antibodies to extractable nuclear antigens, rheumatoid factor, anti CCP antibodies (plus ancillary tests such as CRP)
· Sjogren’s syndrome – anti RO (SSA), anti La (SS-B), salivary duct antibodies
Again – if there is any confusion do ask the Healthscreening.co.uk clinical team for guidance towards the most appropriate testing for your symptoms or concerns.
No testing is perfect – and testing for antibodies is not without its issues. False positive results are commonly encountered when testing for autoantibodies in particular – weakly positive readings of antinuclear antibody, for example, are not unusual in perfectly healthy individuals.
The sensitivity of the antinuclear antibody (ANA) test renders it a very useful screening test for systemic lupus erythematosis in particular. Since most people (more than 95% of individuals) with lupus will test positive, a negative ANA test can be helpful in ruling out that condition. However, just over 10% only of those with a positive ANA test have lupus, more have some other autoimmune condition, while up to 15% of completely healthy people have a positive ANA test. Thus a positive ANA test does not automatically translate into a diagnosis of lupus, nor indeed any other autoimmune disease.
It is timely to remember at this point that diagnoses are rarely made through blood testing alone – clinical presentation, along with relevant medical history, is all important. Blood testing provides the evidence necessary to substantiate a diagnosis, and generally only when the clinical picture fits.