Discovering Silent Diseases

By Bhavna Vaidya-Tank, MD

We read so many articles about the symptoms you would have if you were having a heart attack or a stroke. Most of us know that if we were having chest pain or shortness of breath there must be something wrong and we need to get help.

Thoroughness is a hallmark of physical exams provided by Dr. Tank. But what if we felt fine? Many of us are chronically tired so when we have some pains we attribute it to being tired. Similarly we may have nights where we cannot sleep soundly, gain weight for no apparent reason, become fatigued when we climb a flight of stairs, or have headaches—for all these ailments we can always find an explanation.

There are many diseases that have the above symptoms and others that may have no symptoms at all. Culturally, we are accustomed to getting help when we have an actual event such as a heart attack or high blood pressure that causes really bad headache or even worse a stroke.

HIDDEN DISEASES

Hypertension, type 2 diabetes, sleep apnea, Vitamin D deficiency, and hypothyroidism are just a few diseases that one may have for many years without being aware of it. All the while, they may be causing damage to your blood vessels, heart, kidneys and other organs and you may not even know until the disease manifests in an actual stroke or heart attack.

What is so surprising is that even many of the medical tests that we perform in a routine physical may not be able to detect these hidden diseases.

Let’s take a look at these tests. When you go for a physical the usual blood tests monitor the following: blood count, fasting glucose, some basic electrolytes, kidney and liver function, thyroid stimulating hormone, total cholesterol, good and bad cholesterol, triglycerides and maybe vitamin D. You will have your vital signs and weight checked. If required you may even get an EKG.

Your doctor will examine you and remind you and make you aware about the routine things you can do to ensure your health. For example if you are above your expected BMI she will speak to you about monitoring your weight. If you have a good relationship with her, you may touch on one or two things that are bothering you. However, most doctor visits are between 15 to 20 minutes long and if you do not have a good existing relationship with your doctor, that leaves so much that could potentially be missed

CHOLESTEROL, DIABETES, SLEEP APNEA

Let’s look closer at one of those things: cholesterol. Do you know that 51 percent of people who end up in the hospital with an event like a heart attack or stroke actually have normal or low cholesterol levels? Lipids are complex, and there are many people who live normal healthy long lives with very high cholesterol levels.

The specific type of bad cholesterol particles in your body contribute to your chances of developing plaque. Small dense particles cause much more plaque than large fluffy particles. The amount of inflammation that is present in your body, genetic and familial factors, how your body absorbs and makes cholesterol and the health of your arteries are all contributing factors to your risk of developing heart disease or stroke. Also, the treatment of high cholesterol varies depending on some of these factors.

Similarly, we can look more closely at diabetes. The diagnosis of Type 2 diabetes is established after two readings of fasting blood sugar of 126 or more or a random blood sugar level of more than 200.

However, this process starts with insulin resistance and may have begun years ago, again producing no symptoms. All that time the damage to your vital organs such as your kidneys and blood vessels had already begun at a microscopic level. There is so much that could be done years before the diagnosis of type 2 diabetes but many times this is missed because the “routine” blood tests are normal.

Sleep apnea is another silent disease that may go undetected as it is asymptomatic. Many times sleep apnea causes other diseases, such as hypertension, that themselves are treated without uncovering the actual cause of the disease.

UNCOVERING SILENT DISEASES

It is essential to have a relationship with your primary care physician that allows you and your physician to uncover these silent diseases. This ensures having the appropriate time to talk to her about your symptoms however minor and having access to the information about advanced testing of cholesterol and testing for sleep apnea, diabetes, or insulin resistance, and genetic predisposition to certain diseases. Finally, tests to uncover subclinical hypothyroidism and vitamin deficiencies are crucial in actually uncovering these critical issues.

In our office we strive to have a relationship with our patients that allows us to get to know them and over time be able to uncover many of these silent diseases before they cause a problem that is permanent.

There are also many tests available that enable the doctor and patient to pro-actively deal with these diseases. The vast majority of these tests are non-invasive and provide very good visual information which allows the patient to take control of their risk and disease.

One such test that we perform on a routine basis is advanced lipid testing. This test identifies the size of cholesterol particles, inflammation, vitamin levels and genetics that may affect one’s risk factors.

Complimentary to this is the CIMT. This 15-minute ultrasound of the carotid arteries with special equipment can visually indicate the health and inflammation in the arteries. It also provides information on the amount and stability of plaque and is a window into what is happening elsewhere in the body.

At-home testing for sleep apnea is an efficient detection method for this disease. The Corus CAD blood test has a 95 percent sensitivity in assessing the likelihood of having obstructive heart disease, more so than even the far more time consuming and invasive stress test that varies anywhere between 50 percent and 80 percent depending on the type performed.

We measure insulin levels and other factors that enable us to predict your chances of developing type 2 diabetes. These levels also help us identify insulin resistance, which we can treat before diabetes develops.

IDENTIFYING PROBLEMS

There is a huge advantage from identifying vitamin and mineral deficiencies, not only through tests but also through symptoms. Treating these symptoms by making aggressive lifestyle changes can lead to identifying these hidden problems.

Having access to these tests and the knowledge of how to use them has made a measurable difference in our patients’ risk and has significantly decreased the number of events they have. It has also made our job immensely satisfying because we know that what we do for our patients is exactly what we would want for our own health and well-being.