(If you’ve arrived here and want to know a little more about me, Margaret, and the background to this project this 3-minute introductory read is for you. You can also see my other Posts in the Wellness Project series here. These are my personal views. I'm just an interested, serious, lay person with no medical or scientific qualifications. I’m very open to learn and rethink things).
Thanks for being here. In this Post I’m going to start with some more objective ways in which I can understand my current physical wellness. On my last Post, Week 5 - A Pause for Reflection, I talked about taking time to think carefully about i) how I feel before moving on to tests; and ii) how the results of any tests might affect me. It might be a helpful read for context if you haven’t already read it.
This has turned out to be quite a dense Post and it’s only a Part 1! Please bear with me. The overall content of the Post is - my thinking about important ways to test my physical wellness.
Which tests?
I’ve pondered about which tests I might focus on and reflected on the fact that this could morph into a huge list of all the possible tests and measures that I could do to build up a picture of my wellbeing. However, that would definitely be too unwieldy. It feels to me that there is some information that it’s important for me to know, some that it’s good for me to know and some probably only appeals to my (not so inner) geek. Also, of course, there is always the potential for health challenges that might arise completely out of the blue which I could never have anticipated or tested for.
Important things for me to know.
I'm talking here about information that it’s important for me to have about my physical health and to understand. I think in the past I’ve forgotten about the second bit, understanding. I’ve had some blood tests and because everything on the printed results sheet says the results are in the acceptable/average range I haven’t stopped to think about what the results mean for me. Accepting the average or normal range doesn’t sit well with personalised wellness. Also, different countries use different measures (or %s) and names for the same test which is confusing but worth getting to grips with.
To identify these Important areas I’m going to follow some guidance from Dr Peter Attia in his 2023 book Outlive: The Science & Art of Longevity and also include the tests that I am encouraged to take by my French health care provider. Dr Attia is a big advocate in his book and via his podcast of people getting ahead of any potential physical health problems by being proactive which, hopefully, results in early detection. As he explains very clearly (although not particularly succinctly) in his book, the major causes of serious illness or death rarely arrive out of nowhere, unannounced. Heart disease and diabetes typically take years to develop into life threatening conditions, and the signs are on the wall long before a severe problem arises. Why wait for the problem if you can prevent the cause?
Dr Attia calls this approach Medicine 3.0. The essence is that I am not a passive observer of my health waiting for a problem to arise and then asking a doctor to steer my health journey via a medical intervention. In Dr Attia’s scenario I am the captain of my ship actively charting my own wellness course with good data and knowledge of the potential risks making use of all the resources and expertise available to me. It’s a bit of a cheesy Titanic analogy but I think it captures the difference between conventional health care approaches when we go to the doctor because we feel ill and an approach where we truly focus on and work actively to feel and be well. Gosh, that sounds very preachy but is it helpful to have that mindset? For me, yes.
Why are tests for cancer and cardiovascular disease important?
The tests I’ve mentioned below focus on two areas, cancer, and cardiovascular disease. To over simplify both the science and the statistics, these are important diseases because at a global population level cancer or cardiovascular disease rank as either the number 1 or number 2 cause of death in all genders and across all age groups. In France (based on 2021 data) cancer was the leading cause of death followed by cardiovascular disease.
This is why many countries, including France and the UK, offer free cancer screening programmes:-
· for defined populations/age groups;
· for specific types of cancer;
· for which there is a proven, deliverable at scale, method of screening; and
· where the positive outcomes as a result of screening justify the costs/risks.
Such screening programmes, their scope and funding, are in part politically driven and involve some of the issues I thought about in Week 1 – Definitions and Dilemmas.
Cardiovascular disease is in many age groups the leading cause of death, globally. It has a number of different but common causes including high blood pressure, smoking, metabolic poor health (such as diabetes) and high cholesterol. The causes and treatments for cardiovascular disease are much better understood than they are for cancer. In many cases highly effective treatments, whether medical interventions or lifestyle changes, are available as long as the underlying problem is identified early enough, hence the importance of testing blood pressure and, through blood tests, metabolic disease/health markers.
French Periodic Health Tests for my age & gender (60s, female)
The French healthcare system is essentially paid for at the point of delivery by collective insurance which each working person in France contributes to. You can also buy top-up insurance privately for any gap between the price of the care/treatment and the collectively insured element. However, these cancer screening tests (1-3 below) are “free”, so no separate payment is needed.
1. Bowel cancer screening – at home test with results sent to me directly.
2. Breast cancer screening – at a clinic with results given at the appointment by a doctor.
3. Cervical cancer screening – at my doctor with results sent to me directly.
I’m sent a personal invite for each of 1, 2 & 3.
4. Regular blood tests – generally every year but on request. Blood is taken at a local medical laboratory – easy to book an appointment and results the same day for standard tests, accessed on line. To get it covered by insurance you need a doctor’s prescription.
5. Blood pressure test – my doctor tends to do this every visit, so it is dependent on organising a visit. We also have a blood pressure monitor at home (getting dusty in a draw, need to dig it out).
6. Regular dental check – I’m registered with a local dentist and get regular invites for check-ups. In France, depending on your health care insurance, some or all dental costs may be covered (but, as mentioned, we do pay for the insurance in France).
So how am I doing?
Cancer screening - well, right now I’m doing OK here. I am within the recommended time limits for each of the 3 cancer screenings and have not had any results which have indicated a problem. As I write, I have my next mammogram in a month. However, it hasn’t always been like this. Either fear or workload or prevarication (or all 3) have meant that in the past I have not organised these checks or have left it much longer than recommended between checks. Now I’m trying to think about the screening appointments as regular diary appointment and not to attach an emotional weight to them. I appreciate that this is a very complex issue for some people.o
I’m good on dental partly due to having an infected root canal last Autumn which was one of the most painful things I’ve ever experienced!! The dental check is about more than just fillings, it can alert me to things like gum disease, infections or even more serious conditions so I’m convinced it’s a very good overall health check to do regularly.
On blood tests I’m due another set (last test was 16 months ago). In the past I’ve just had the standard tests my doctor has ordered. This time I’m going to ask for some extra ones related to my hormone balance and any inflammation markers. When I get the results I’m going to take more time to try to understand them and will go back to my doctor if anything isn’t clear or needs further investigation.
Blood pressure is interesting. All my adult life I’ve had white coat syndrome. My blood pressure used to go through the roof as soon as anyone clutching a blood pressure cuff in a white coat (or lycra in a gym) came near me. The blood pressure results taken by my current doctor are always 5*/top marks readings and much better than when I use our home machine. I’m wondering if his machine actually works but I’m taking the results anyway! He will calibrate our home machine if I take it when I next go to see him so I’ll do this.
Even these 6 important areas for screening/tests feel like a lot to think about when I set them out here. Of course, within each of them, and in particular blood tests and blood pressure, there are lots of potential topics to explore such as blood glucose/insulin markers, cholesterol and more. Similarly, there are lots of ways to spot potential issues and alter course, many involving relatively simple lifestyle changes.
My Week 5 Take Aways
I'm very fortunate to live somewhere with good, accessible, health care. Amongst EU countries only Norway performed better in relation to treatable causes of death (latest data from 2016) and France performed above the EU average for preventable causes. Despite this less than 2% of overall health care spending in France is spent on organised prevention programmes.
Some tests that can alert me to health issues are important, and I should prioritise them. For me they are the “standard” tests as I’m not aware of any health/genetic/familial conditions that indicate additional tests (apart from my brain cavernoma - Week 5 Cautionary Tale).
In France there is a national programme to offer screening for some cancers and I should continue to take full advantage of this.
I can also get regular non-cancer related check-ups and tests for important health conditions (including dental checks) and should treat booking these as regular, non-emotional diary dates.
I should ask for tests that specifically relate to me, a woman in my 60s, such as bone density screening (DEXA scan), thyroid checks and hormone regulation.
I need to understand the results of any tests or screening that I have and ask my doctor any follow up questions I have.
If I feel blocked or stressed about getting a test or about any test results I’ll talk it through with Jack or a friend and follow up with my doctor.
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