Medical Tests

Do I really need an annual checkup?

DEAR DOCTOR K: I'm 73 and in great health. Do I really need to have an annual physical?

DEAR READER: Let's start by defining "great health." I would define it as having no known chronic (ongoing) illnesses. However, most people your age

Should I be worried about blood test results that fall out of the normal range?

DEAR DOCTOR K: Last week I received the results of some recent blood work. A few of my values fell just outside the normal range. My doctor says it's fine, but I'm still worried. Do I need to be?

DEAR READER: A printout of lab results typically indicates normal ranges for each blood test next to your personal results. If your personal result is right in the middle of the normal range, you'll likely feel relief.

Could I have had a silent heart attack?

DEAR DOCTOR K: I recently had an ECG in preparation for a surgical procedure. The doctor said it showed I'd had a silent heart attack. How could I have had a heart attack and not known about it?

DEAR READER: I know it sounds strange. After all, on television, heart attacks are portrayed in rather dramatic fashion. Typically, you see a person clutching their chest with agonizing pain. This mental image is embedded in our culture. But my colleague, Dr. Deepak Bhatt, a cardiologist at Harvard-affiliated Brigham and Women's Hospital, cites a recent study that is the latest to show that heart attacks often can be "silent."

Do I still need to fast before a cholesterol test?

DEAR DOCTOR K: I heard that fasting will no longer be required before a cholesterol test. Will the results still be as accurate?

DEAR READER: To answer your question, I need to first describe what a "cholesterol test" is. There are three types of cholesterol that typically are measured: LDL ("bad") cholesterol, HDL ("good") cholesterol and total cholesterol (basically, the sum of LDL and HDL). There is a fourth type of fat measured at the same time: triglycerides. Most doctors order all four tests as part of what's called a "lipid (fat) panel."

Can you give me some advice for measuring my blood pressure at home?

DEAR DOCTOR K: My doctor told me to check my blood pressure at home, but he didn't give me many details. Could you provide some guidance?

DEAR READER: Keeping your blood pressure in check is vital to maintaining heart health and preventing stroke. But the way most of us monitor our pressure -- by trekking to the doctor's office for occasional blood pressure checks -- is far from ideal.

I have dense breasts. Does that increase my risk of breast cancer?

DEAR DOCTOR K: My doctor says I have dense breasts, and a friend says that means I have an increased risk of breast cancer. I'm hoping you'll tell me that's not so.

DEAR READER: I wish I could fully reassure you, but I can't. A woman who has dense breasts does have a slightly increased risk of breast cancer, although not clearly an increased risk of fatal breast cancer.

What will happen during laboratory sleep testing?

DEAR DOCTOR K: My doctor thinks I may have sleep apnea, and he wants me to go to a sleep lab to be tested. What will happen during the testing?

DEAR READER: Sleep apnea is a serious health condition in which breathing stops or becomes shallower. In the most common form, obstructive sleep apnea, the tongue or throat tissues temporarily and repeatedly block the flow of air in and out of your lungs. This can happen hundreds of times each night. Laboratory sleep tests are the most reliable way to diagnose this problem.

Should I get a c-reactive protein test to check for heart disease?

DEAR DOCTOR K: Both my parents had heart disease, so I'm worried I might get it. A friend said I should get a CRP test, but my doctor hasn't ordered one. Should I ask him about the test?

DEAR READER: The answer is controversial. For full transparency, I should say that this test was developed and studied by a colleague of mine at Harvard Medical School, and revenue from the test comes to my colleague and to the hospital where I practice.

What are the risks and benefits of mammograms?

DEAR READERS: In yesterday's column, I answered a question from a 47-year-old woman who had never had a mammogram and wondered if she should have one. She had heard that one group of experts -- the American Cancer Society (ACS) -- had recently changed its recommendations on this issue.