By Garth A. Rattray
A severely hypertensive, middle-aged female patient, who had missed many appointments and completely run out of blood-pressure tablets for quite some time, saw my look of surprise and dismay and rightfully announced, "I'm living dangerously."
Living dangerously usually means involvement in criminality, careless or dangerous physical activities. However, in reality, more people die from non-communicable/chronic (often treatable/controllable) diseases than from anything else.
We cannot change risk factors like our age, gender and genes. However, we can lower health risks with lifestyle modification, medication (where necessary), vaccines, investigations and physical check-ups. Even healthy individuals should schedule regular check-ups, blood and other investigations - depending on age, family history and any existing or past medical conditions.
The important tests to remember include breast cancer screening for women (routine breast self-examination in adulthood and mammograms beginning at 40 years of age) and prostate cancer screening for men (digital rectal examination and blood test), beginning at 40.
Women should get Pap smears (to prevent or detect cervical cancer) and men should check their testicles for tumours. Bowel cancer screening should begin at 50 for men and women. All screening should commence earlier than usual if there is a strong or early family history of certain diseases.
Blood pressure screening may be started as early as eight years old and must be done in every adult, but it should also certainly be checked in teenagers - even occasionally. The literature states that, in people with no risk factors, screening tests for diabetes should begin at 45 (but most doctors check it in people 35 years old) and much earlier for those with a strong family history or suspicious signs and/or symptoms.
Screening for high cholesterol may be started as early as 20. Eye examinations should be started at 40 or earlier if there is a family history of glaucoma or some other chronic disease. Renal, liver and thyroid screening tests are usually performed on 60-year-olds and above, unless otherwise indicated.
In sexually active individuals, screening for HIV (and perhaps other sexually transmitted infections) should be annual. There is a plethora of special screening examinations for patients with other conditions.
A major reason for illness and premature demise for patients with non-communicable/chronic diseases is non-adherence (previously referred to as 'non-compliance'). Patients who ignore screening, check-ups and those who need prescribed medications but do not take them are living dangerously.
Medications for chronic (ongoing) conditions are usually required for life. They are not to be taken for a certain period of time; they are not antibiotics. Some patients tell me that they don't want to become 'addicted to medications'. However, an addiction is a physiologic or psychological dependence on a potentially harmful drug or substance. Medicines for blood pressure, diabetes and high cholesterol, for example, do not fall in that category.
Many fear the potential side effects and hate 'drugs in their bodies', yet they take unproven alternative chemicals that can also have side effects. True, some prescribed medications MAY have side effects, but the conditions that they treat WILL cause extremely serious and/or deadly 'side effects' (major problems) if left uncontrolled.
I liken necessary medications to a bridge over an extremely busy highway. All of us would use the bridge (even though we know that there is a small possibility that the bridge could collapse while we are on it), and not risk our lives by crossing the extremely busy highway (because we know that the risk of death is extremely high via that route).
Death is inevitable, but there is no need to invite suffering and an early demise. Regular screening, lifestyle modifications and medications, where appropriate, can save us a lot of unnecessary expenses, pain and suffering.
Garth A. Rattray is a medical doctor with a family practice. Email feedback to email@example.com and firstname.lastname@example.org.