10 ms·

I will take this time to write something I wrote on Steve Jobs death: go get a comprehensive health check today. In our community, we are data driven about ever

• istsehrgut 11y ago
  yeah ok, but seriously fuck pingdom.
• smm2000 11y ago
  What do you mean by comprehensive health check? What tests should I do? I do yearly physicals, but I feel they are mostly "feel good" exercises.
  • giarc 11y ago
    Do they draw blood and ask for a urine sample? Do they make you strip down and examine you from head to toe? Do they make you "turn and cough"? Do they listen to your heart and lungs? Do they look in your mouth? Do they look in your eye? Do they ask you about your health history? If some or all of these are "no", it's not a comprehensive exam.
    • carc 11y ago
      Some of these aren't even up to date. Lets stop acting like we're health experts here. If your doctor is still making you do "turn and cough", then your doctor is using out of date practices (source: my GF is a doctor). Similar to another person's post above, she cringes at posts like this. You SHOULD go to the doctor to get check up each year, but you should not just go get every test under the sun just in case. There's a reason when you go in for your yearly check up, the doctor does what they do. Perhaps it's more important in this discussion to say that there's a reason your doctor doesn't do every test under the sun on these checkups.
      • solipsism 11y ago
        Could we also stop acting like our girlfriend being a doctor makes us qualified to give medical advice? What evidence in particular, aside from your girlfriend, do you have for the claim that the groin exam for inguinal hernias is outdated? Is this subject in your girlfriend's field? What publications does she cite?
        • carc 11y ago
          Here's what she pointed me to: http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/testicular-cancer-screening http://www.uspreventiveservicestaskforce.org/Page/Topic/reco...
          • solipsism 11y ago
            Is that a joke? "Turn your head and cough" isn't a testicular cancer screening. It's to search for signs of inguinal hernias. You don't really have a doctor girlfriend, do you? :)
            • giarc 11y ago
              You are correct, I believe they also feel for any lumps or irregular growth of the testes.
  • franklinho 11y ago
    Usually it's a physical combined with a comprehensive blood test. They look for elevated enzymes that could be indicative of various issues.
  • shabda 11y ago
    They are feel good exercises, until they aren't ... Don't think of all OK result as money wasted, its insurance to catch any chronic illness in time. I would consider tests comprehensive if tests all major internal organs (kidney, liver, heart, spleen + common cancers depending on gender/age), you can come up with one after talking to a physician. Because I am based in India, I can only recommend India specific one, https://www.apollohospitals.com/preventive-health-care-check-up-packages.php https://www.apollohospitals.com/preventive-health-care-check... are generally good.
    • walterbell 11y ago
      Thanks for the pointer. How much does a comprehensive test cost in India and are the test records given to the patient? I've wondered whether traditional Ayurveda and modern medicine are complementary.
      • shabda 11y ago
        It costs about $200 and the test results are given to the people. Modern medicine is pretty reasonably priced in India.
  • coldtea 11y ago
    >What do you mean by comprehensive health check? What tests should I do? Start by NOT asking random people on the internet. Ask your doctor about what tests to do and he'll tell you based on your age / history, and you can trust him better than a random stranger or some web post.
    • brookside 11y ago
      Hacker news is a community of (from what I've seen) strong critical thinkers, with a poster in a thread often having a specific background in the field being discussed. Doctors aren't mythical beings, and discourse here about what medical tests are 'worth it' seems both appropriate and really interesting.
      • ams6110 11y ago
        Oh come on... outside of a few notable individuals, nobody really knows who anybody here is, or what their credentials are to talk about anything. Law and Medicine are two of the things most likely to precipitate a lot of online commentary by people who don't have the first clue of what they're talking about.
        • intrasight 11y ago
          Technology being a third thing
      • coldtea 11y ago
        >Hacker news is a community of (from what I've seen) strong critical thinkers If I met a community of strong critical thinkers about Chemistry or Civic Engineering I wouldn't ask them advice for my software stack. Besides, with the exception of a 20% or less who knows what they're talking about (and those only for narrow Computer Science or Engineering fields each), the others might as well be on Reddit. You can find tons of uninformed opinion about anything here. Plus a huge tendency to go with the latest fads (Rails, then JS, then Go, then Rust, etc). >Doctors aren't mythical beings No, just trained professionals.
• ffn 11y ago
  Yes, absolutely this. And I'd like to add that one should also practice sickness prevention in addition to health problem fixing. Just like you'd like to avoid writing imperative spaghetti code in programming, it's also a good idea to not live a "spaghetti" life-style. That is, avoid the urge to frequently overwork and under-sleep, the sedimentary life-style of excess food/drink and insufficient exercise, and the constant self-applied pressure that you have to be better than someone else right now. Instead, go for a balanced life of work and rest, plenty of exercise, and trust yourself that you're going at a good pace and all good things take time. Also, avoid being caught in modern media's constant drive toward polarizing sensationalism; your own life is actually fair simpler and more enjoyable than the internet and TV would have you believe (if you live in the first world)
• throwaway9324 11y ago
  I fail to see how screening of healthy, relatively young, people would be "data driven".
  • learnstats2 11y ago
    In game theory and probability, it is almost always considered better to have data about something so that you can act appropriately. (I admit there are some theoretical exceptions, but I don't think they apply here). Even if you are healthy and young, it's better to hold your own data than not. Sometimes, thanks to technology, we don't know who has access to our data and whether this is going to be used against us: for example, will we have an impossibly high insurance premium attached to us for life - with the data in our hands, we lose the right to use insurance to even out that risk. Sometimes, in medicine, there are ethical considerations, that the eventual treatment for a screened condition presents its own risk that people may not wish to decide and the healthcare system might not be well-equipped to manage. Nonetheless, I still personally prefer to have the data than not. I want to decide my own healthcare needs based on my own knowledge and understanding of my own risks. This is "data driven".
  • shabda 11y ago
    Most of chronic diseases progress slowly and have no external signs in early stages. Most of them are also much simpler to treat in early stages. > I fail to see how screening of healthy, relatively young, people would be "data driven". So just by looking at yourself, you don't know if you are healthy, only that you look healthy. The tests are to ensure that you are, and to give you time and flexibility of treatment if you are not.
• brador 11y ago
  What were the telltale signs?
  • shabda 11y ago
    I wouldn't like to go in the details now, but it was subset of this: http://www.mayoclinic.org/diseases-conditions/kidney-disease/basics/symptoms/con-20026778 http://www.mayoclinic.org/diseases-conditions/kidney-disease...
• kgwgk 11y ago
  > If you haven't had a health check, get it done today. Or you might want to postpone your visit to the doctor until you have an actual reason to go there: http://www.nytimes.com/2015/01/09/opinion/skip-your-annual-physical.html http://www.nytimes.com/2015/01/09/opinion/skip-your-annual-p... http://kaiserhealthnews.org/news/ritual-not-science-keeps-the-annual-physical-alive http://kaiserhealthnews.org/news/ritual-not-science-keeps-th...
  • izacus 11y ago
    How does that help you test for early stage cancer markers? That tests usually isn't in the batch of regular (and it's quite expensive), but it does make a difference between death an survival.
    • kgwgk 11y ago
      And how does testing for early stage cancer markers help you? It's not a rhetorical question, clinical studies have been unable to show the positive effect that you assume (and actually these tests may do more harm than good).
      • salgernon 11y ago
        As per my previous post, a CEA blood test would have shown mine two orders of magnitude higher than normal. Further non invasive tests would have found my tumor, possibly before it metastasized. Or maybe not. But for the cost of my chemo, you could do 100 CT scans. (And I have to have one every two months.)
        • kgwgk 11y ago
          Your CEA levels were two orders of magnitude higher than normal at a point were it was sufficiently advanced to be diagnosed from symptoms (as it fortunately happened in your case). If you want to diagnose early, you need a much lower threshold and the CEA test is not good enough. It's not like people have not been trying to find screening protocols... According to http://www.clinchem.org/content/47/4/624.full http://www.clinchem.org/content/47/4/624.full > CEA as a Marker for Colorectal Cancer > screening > In screening for colorectal cancer, the aim should be to detect disease at either Dukes’ A or B stage. Malignancy detected at more advanced stages is unlikely to be more treatable than that detected through the usual course of events. Using an upper limit of normal of 2.5 μg/L, Fletcher (19) calculated that CEA has a sensitivity of 36% and a specificity of 87% in screening for Dukes’ A and B colorectal cancer. These findings, combined with the low prevalence of this malignancy in unselected populations, render the positive predictive value of CEA unacceptably low and thus of little value in screening healthy subjects. For the present, therefore, we must rely on fecal occult blood and endoscopy to screen for colorectal cancer (20). What does 36% sensitivity and 87% specificity mean? Imagine that you test ten thousand 40-year olds and twenty-five of them do actually have colon cancer (this is more or less consistent with statistics telling that 0.23 of them will be diagnosed with colon cancer before turning 50). You will get a true positive result in 9 cases (out of 25) and a false positive in 1297 (out of 9975). So only 0.7% of the positive cases are real, and you missed two thirds of the cancers.
• CatDevURandom 11y ago
  My spouse -- an md -- cringed a bit when I read your post. And not because it's not well meaning, or important, but because without qualifying what "comprehensive health check" means, that check could very well do you more harm than good. So, yes. Please find a good primary care physician you trust and visit on an annual basis. Make sure you update that phsyician with what's going on in your life. That includes any family history, pain, issues etc. When in doubt, see another physician. But please don't go out and get a full MRI of your body just because (which, you are not saying, but does happen). There are enough VOMITs[0] in the course of normal defensive medicine. Don't go looking for problems because -- although they'll definitely help you look -- you might not be better off for it. [0]: http://messybeast.com/dragonqueen/medical-acronyms.htm http://messybeast.com/dragonqueen/medical-acronyms.htm
  • adevine 11y ago
    I would actually be more critical of "regular checkups" than your post. If we are looking at being "data driven" when it comes to our health, the jury is definitely still out on even having annual physicals for otherwise relatively young, symptom free individuals: http://www.nytimes.com/2015/01/09/opinion/skip-your-annual-physical.html http://www.nytimes.com/2015/01/09/opinion/skip-your-annual-p... A central problem is that you get loads of false positives when you are screening symptom-free individuals, and these false positives can cause real harm: beyond anxiety, they often bring on potentially painful, expensive and side-effect causing treatments. Just see the recent recommendations over the PSA test: http://en.wikipedia.org/wiki/Prostate_cancer_screening http://en.wikipedia.org/wiki/Prostate_cancer_screening. Definitely go to the doctor if you notice any symptoms or worrisome changes. For other types of screenings, be aware that the recommendations often change and that there is a real cost/benefit analysis (even in terms of your own body, not just financial cost) to be done.
    • calinet6 11y ago
      As a recent sufferer of health anxiety, I couldn't agree more. You can really go overboard with tests that are often harmful, and without a really deep understanding of statistics, it's difficult to understand exactly what they mean. I am thankful every day that I had a great GP who both did enough to be prudent, and also helped me stay balanced and not go overboard, in just the right way. I could have been a lot worse off had I continued to pursue treatment. That said, in a state where anxiety is controlled and my health is now stable, it's still important to be aware of changes and new symptoms, and to have an annual standard physical with a doctor you trust and stick with consistently so they know you and your body over time. Just don't go overboard.
• imjk 11y ago
  He's not the most popular guys around here, but Mark Cuban shares a similar sentiment about quarterly blood tests: http://www.businessinsider.com/mark-cubans-on-blood-tests-and-screening-2015-4 http://www.businessinsider.com/mark-cubans-on-blood-tests-an...
  • mikeyouse 11y ago
    He got a ton of flack for that, mostly from doctors and epidemiologists; http://healthblog.dallasnews.com/2015/04/mark-cuban-is-wrong-more-testing-isnt-a-good-thing.html/ http://healthblog.dallasnews.com/2015/04/mark-cuban-is-wrong...
• godzillabrennus 11y ago
  Shabda, Thanks for sharing! Having known and worked with you for years I could not agree more. I ran the startup life for 6 years and it'll eat you alive if you let it. Regards, Lane
• brianwawok 11y ago
  Flip side - Many doctors will see a high cholesterol number and immediately try to put you on statins. Which is not really that clear cut, statins have a lot of side effects that are downplayed by the sellers - and a lot less potential upside in otherwise healthy people with high cholesterol (because the fundamental cholesterol test given is flawed, the better tests are more expensive and harder to read (variables like cholesterol size and such matter a lot, but not even in the standard test)) So sure - get health checks done. Then be prepared to spend weeks or months double checking what your doctor is telling you, and possibly getting 2nd opinions and more tests. Personal story: Head health test. High A1C. Diagnosed Diabetic, despite being a very fit triathlete who hasn't drank soda in 6 years and eats < 20g of sugar a day. Literally had near 2 weeks of full blown panic attack. Tried to change my diet to crazy low glycemic index food and eat 8 times a day to try and get my A1C down without medicine. 2 weeks later got into a 2nd doctor for another opinion. Turned out my test was just bunk. A1C is fantastic. Apparently it happens all the time (a bad test). My first doctor did not tell me this at ALL.. just told me I was a diabetic and to stop drinking so much Soda. My takeaway? If not showing signs, don't bother with routine tests. Too many medical quacks.
  • paulsutter 11y ago
    Maybe a better lesson would be to get a second opinion on major diagnoses. Doctors are also human, and medical diagnosis is difficult. It's a good question what are the best tests to do periodically. I doubt that "none" is the right answer.
    • brianwawok 11y ago
      Of course. Here is a good article I read today on the topic: http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande http://www.newyorker.com/magazine/2015/05/11/overkill-atul-g... Basically.. lots of things can be found by a test (say a slow or non-growing tumor) that the risk of removing them is > than the risk of leaving them alone. Of course doctors are paid for doing work not for leaving it alone, so which do you think they will choose?
  • downandout 11y ago
• brandonb 11y ago
  I find the discussion in this thread so frustrating (not your or anybody's fault). It's 2015, and there's still no general agreement on which tests to run to tell if you are healthy or not. We don't even have firm evidence whether your annual physical with a doctor is a net positive or negative. Meanwhile, people are dying decades prematurely due to uncaught illnesses that we know how to fix. We have a check engine light for our car engine. Why on earth don't we have one for our bodies yet?
  • timr 11y ago
    Because biology is much harder and more complicated than even the most complex mechanical system.
  • ams6110 11y ago
    Click and Clack would refer to the check engine light as the "empty your wallet light" (paraphrasing). If your car starts easily and runs well, has no changes in fuel economy, and you have been keeping up with basic maintenance, it's probably fine. Same with people. Sure there are some people who just drop dead out of the blue. But most people have symptoms. Unexplained weight gain or loss. Fatigue. Difficulty sleeping. Changes in bodily functions. For most people, if you have no symptoms and feel healthy, you most likely are. If you have family history of certain problems, of course be more vigilant about that. We can't possibly continually test everybody for everything that might possibly be wrong with them, at least not until we have Star-Trek style medical devices. Unjustified testing in the absence of symptoms will simply further drive up the cost of medical care for those who really need it. One could argue that it already has.
    • mhb 11y ago
      There are two questions - whether someone who can afford it would receive a net benefit from more testing and whether we want to pay for that for everyone. Many of the answers given to the question of whether more tests are worthwhile don't make this distinction.
• sithu 11y ago
  What a sad and terrible loss, my heartfelt condolences to Sheryl and her family.. I wanted to add my thoughts about false positives and executive health checkups, which fall under the larger umbrella of screening. I conduct executive checkups fairly regularly, but i’m not promoting anything here. I just want to share a personal philosophy that you, as a patient, could adopt to reduce risk. Firstly, it should be stated that the utility and performance of any diagnostic test that has a binary outcome (eg. diseased/healthy) depends on 1) its intrinsic test characteristics 2) the prevalence of the disease in the population being tested[1], 3) the available diagnostic/treatment options for positive people, and 4) the threshold chosen to call something ‘positive’ since you are virtually always measuring a continuous variable. People talk about false positives often, but you should know that there is some room for judgement here. The typical threshold for PSA has historically been 4.0 ng/mL. Above this is considered a positive screen, and you are recommended further testing to confirm prostate cancer, which can be invasive and lead to complications (bleeding, nerve damage, etc). This kind of two-stage testing is a common theme. The issue is that PSA values in people with cancer and people without cancer are normally distributed and have some overlap. A value of 4.0 is in the overlap zone, and the vast majority of people with 4.0 will not have cancer. However, lets say hypothetically that guidelines changed and we now use 20. At this level, most people who test positive probably have something bad, and the risk:benefit ratio is in favor of confirmatory testing and probably in favor of treatment too. I won’t bother going into it, but there’s a fair amount of liability, psychology and economics at play when choosing thresholds. Biochemical tests like PSA do have some variance, but are mostly reliable. It’s more complicated with imaging and amorphous things like mammograms that have some operator variability in judgement (and hence more liability). This was a long-winded way to say that information is not necessarily bad, but it’s what you and your doctor choose to do with it. There’s room for discussing probabilities, and the various available pathways. Trust is huge. Your doctor will act in your best interests when he feels safe from lawsuits, otherwise he'll be focused on not missing anything regardless of likelihood or cost. The financial misalignment of our system doesn’t help in building trust either. Most first-stage screening tests have very minimal risk involved. Things like checking your blood pressure, cholesterol, glucose, doing a treadmill stress test, reviewing your meds, vaccinations, etc which are part of these annual checkup programs are, on balance, usually good ideas. [1]http://en.wikipedia.org/wiki/Sensitivity_and_specificity http://en.wikipedia.org/wiki/Sensitivity_and_specificity
• carc 11y ago
  Getting unnecessary tests can do more harm then good. Please don't try to get every test 'just because'. Here is a good resource that recommends what preventative measures are recommended for people of different age groups and such (recommended by my MD girlfriend): http://epss.ahrq.gov/PDA/index.jsp http://epss.ahrq.gov/PDA/index.jsp