General wellness – unlike all other health checks the key initial questions we have are: what are your worries, any health matters you would like to discuss, and what were you hoping to achieve from this.
Mental health – we always look at aspects such as depression and anxiety, and other mental health problems in men, as this is such a big area and is poorly managed in the NHS where time is often a limiting factor.
Cardiovascular health – we want to keep your heart as healthy as possible and detecting reversible causes earlier is key and also important as after women go through menopause, our risk of heart attacks and stroke increases. We look at lifestyle factors, family history, symptoms, sleep, exercise diet and nutrition. We measure blood pressure, pulse, heart sound, perform an ECG, and carry out blood tests for cholesterol, testosterone, diabetes and pre-diabetes.
General health at the next level – as you’d expect, we look for core health markers such as anaemia screen, immunity, kidney and liver function. But we do it properly. For example, we look at the underlying causes of anaemia including B12, folate, iron levels.
We look for true markers of Ovarian pathology and the renal system – we check urine for protein and blood for markers of kidney disease, we test kidney function, we measure BP (closely related to kidney disease). Detecting and disease earlier is vital, but never more so with cancers. Ovarian cancer is often detected late in the disease and it has often already spread around the body. There is no screening for Ovarian cancer, but we can measure the ovarian markers to determine if these are elevated, and then further investigation would be required.
Diabetes screening – the cheap/historical way to look for diabetes is to do a finger-prick blood test for glucose. However, this is not only old fashioned but also not that effective. We now have far more advanced ways of screening diabetes, and pre-diabetes by using an HBA1c blood test which can pick up early markers of diabetes years before you get symptoms. However, we know there is more to diabetes than just blood sugars. For many women, type 2 diabetes is an indicator of what is known as “metabolic syndrome”, which is actually a devastating process that puts us at risk of stroke, heart attack, kidney disease, peripheral vascular disease, fatty liver disease, and other problems. We assess patients for this by looking at their overall cardiac risk (Qrisk score), blood pressure, cholesterol, HBA1c, renal function, lifestyle, bodyweight, BMI, percentage fat, etc.. then we look at how to tackle it either via medication or referral to our nutritionist, exercise plans etc.
Women’s health – whilst checking hormone levels are not a good indicator of whether you are perimenopausal or postmenopausal, it can give the team a snapshot of what is happening at the particular moment. It also gives us a baseline to work with. These are not mandatory before considering HRT, but can be useful when guiding treatment or the addition of other hormones in the future.
Cancer – no matter what health check you do you cannot screen for all cancers. Any screen that boasts this should be questioned – even a “full body MRI” would still potentially miss some forms of cancer. What we should be doing is screening for those forms of cancer that we can look for, but then look for other markers of general health that might point us towards an underlying cancerous process, or other serious diseases. But just screening for a cancer is only part of the battle. We look for ways to reduce the risk of cancer – prevention is always better. We want to complement what the NHS screening programmes already are doing. Bowel cancer screening, Cervical cancer screening and breast cancer screening are all offered routinely on the NHS.