Saturday, September 25, 2010

199. Health screening for adults

Sep 23, 2010 Perth, Australia

Health screening at SGH

"We practise evidence-based medicine," the nurse at the reception said to me when I asked her about health screening for people with no signs and symptoms of illnesses like heart disease or cancer. What is evidence-based medicine? Must a person be dying of heart attack first to be eligible for health screening in the Singapore General Hospital?

Recently I met Edwin, a good friend of a pastor whom I knew from my National Service some 30 years ago and who had died some 5 years ago. The pastor's son had become a doctor and was at the government polyclinic. Edwin told him that he came for a health screening as his sister-in-law was pestering him to do it. "Sorry, uncle," the doctor said. "I can't permit you to do it." Edwin who brought in his dog for health certification before export to Malaysia said: "I am glad that Pastor ... imparted values of integrity to his son." Edwin said: "What are the chances of meeting the pastor's son at a polyclinic? I don't even want a health check. It was my sister-in-law pestering me to do it. Now Pastor ... must be satisfied and happy from Heaven." I don't know what to say. This Pastor ... had many divine inspirations prolonging his life by a few years despite having heart diseases, kidney failure and diabetes.

It was not surprising therefore that the nurse at the reception rejected me. No choice but to go to the private hospital. A staff in violet uniform told me that I needed an appointment to consult the doctor for health screening. I was a walk-in prospective patient. "OK," I said. "I will make after I return from my holiday in Perth." I doubt I would bother as I have no health problems. I still would like a health screening for cancer as two older vets had been diagnosed with cancer and I was not a spring chicken at the age of 60.

I could not give a date for appointment and said I would call. This meant I would procrastinate. After all, evidence-based medicine is the excuse. I have no evidence of poor health. A bit tired nowadays. Due to stress of hectic pace of city living in Singapore.

As I was about to leave, a fair lady in black dress with some floral strip on one side of the neck came to the receptionist and said: "You can see the doctor today as somebody did not turn up." No show is common in Singapore as many don't have the courtesy to cancel their appointments.

"So now the walk-in cannot walk out?" I tried my hand at humour with the service staff. Nobody laughed but there were some smiles. "I wish to consult an old doctor," I said. "Don't you want to give young ones an opportunity to gain experience?" the receptionist said. "Well, at my age, I may not live long to be a guinea pig. I know every doctor learns from experience in handling cases but I can't afford to let young ones do it at my age. I need experienced doctors to tell me whether I am all OK."

"Don't worry," the lady in the black number assured me. "The doctor is the head of the department." It was my lucky day as I don't have any referrals for this health screening. People usually ask friends for referral but here I was, a walk-in who had starved for the past 12 hours and was trying my luck.

My health screening took about one day from 10 am to 4 pm. The following was accomplished.

1. Blood collection. Blood test must be done again if the previous one was more than 6 months if one wants to go for general anesthesia.
2. Urine collection. Clear light yellow urine as far as I could see.
3. Lung function test. Bit a plastic mouth piece and breathe out as much as I could.
4. Fat, water etc analysis of the body. I stood on a machine and pressed two thumbs on the handle. Can't figure out how it worked.
5. X-ray. Although I had X-ray 9 months ago, the nurse advised one as it was part of the package. "You will not get a refund if you don't do it," she knew many Singaporeans are the calculating type. "It is the radioactivity that I am worried about," I said. "The radiation dosage is very low," she said. OK. I went for it.

6. Eye pressure test. Some machine to check for glaucoma.

7. The doctor's consultation and tests include
7.1 History of past treatments as he keyed into the computer the report
7.2 Physical examination for hernias and palpation for abdominal growths
7.3 Eye-sight. Bright light shone onto my eyes. He said I have no cataracts. A few days earlier, an experienced optometrist said I have little bits of cataract. In any case, I trusted this doctor. It was good news.
7.4 Hearing test. 3 types of sounds I had to say "yes" when I heard it. "The last type is one which many people thinks they may have or have not heard it," the good doctor laughed when I told him that I could hear something but was not sure.
7.5 Explanation of the Treadmill test. (see para 8 below).

8. The Treadmill test. I had to sign a consent form in case I suffer a heart attack during the test. "Don't worry," the doctor took back the signed form. "My nurse is very experienced in detecting any heart attack and will stop the test." I was given the ECG leads and proceeded to walk slowly. The speed increased. "Stop," I said as I became breathless after the 7th minute. "I need the maximal rate to be 85%," the kind slim senior nurse said. "Do you have chest pains or cramped muscles?" I had neither. I was just breathless and did not want to over-exert myself. The machine must have had reached 85% as the nurse stopped the movement. It was past 9 minutes of threading. She printed out the graphs and did not seem too happy with the reading. The doctor would explain to me.

Bad news. "See the ECG," the doctor showed me. "ECG reading is normal before exercise." I could see the regular repetition of the PQRST complexses throughout the strip of paper.

"After exercise, the blood takes a long time to flow back to the heart, even after 5minutes. The ST curve did not rise up as normally as it should be. Indicating a blockage in the heart's coronary arteries."

Yet I had occasional chest pain like over-exertion but it was once in a few months. So I opted for a CT scan of the heart.

9. CT scan
Blood pressure taken at least 3 times and said to be normal although I could see that it was 138 at the upper value. I cannot remember the lower value. Maybe I should be 138 for my age of 60. I thought it should be less than 120. Must do some research.

BPS. This was below 50 beats per minute. "Exellent reading, so we don't need to give you sedatives as the CT machine dislikes people with high pulse rate," a nurse told me. I thought it was abnormal as bps should be 70. Need to do some research.

An experienced nurse tapped my right hand and inserted a long 23G catheter for the injection of radioactive dye when I went into the CT scan for X-raying.

"MRI would be better," another nurse told me. "There will be no radioactivity but it costs a few hundred dollars more."

10. Abdominal ultrasound scan for abnormalities of the liver, spleen, kidneys usually. This was done before CT scan. An experienced nurse put gel. I had to be scanned from above the abdomen, turned to the right and left side. "Can the ultra-scan detect bones in the stomach?" I asked the cheerful nurse. I knew of one vet who had advised ultrasound scan for foreign body the the dog's stomach to confirm what X-rays had shown some opaque foreign bodies. So I was interested in asking this nurse whether it could be useful. "No," she said. "Too much gas, movement in the stomach." I remembered she said about some fat affecting the results. "I have not done it." I need to do some research here. In foreign bodies in the dog's stomach, X-rays with or without contrast media are traditionally done. I am not convinced that ultra-sounds can pick up foreign bodies in a dog's stomach.

Will stop now. I recorded the above for reference. It is 8 am in Perth on a Sunday. Some Royal Show. Some flower show. The Queen's birthday on Monday. So a long week end. Bright sunshine, blue skies. Clear spring air at Willeton near Murdoch University. I have this sadness as my plane touched down at Perth Airport on Sep 24, 2010. There was a car accident on Sept 3, 2010 affecting a girl whom I had carried as an infant and whom I saw growing up.

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