Is it time for another check-up?

It’s possible your car gets tested more regularly than your body. Cars are replaceable. You are not. That’s why check-ups with your doctor should be high on your to-do list. Routine testing can pinpoint problems early and help you live a longer, healthier life.

In May, 1999, Riley Bell was, he says, “54 and fit as a fiddle”. What propelled him to the doctor’s surgery was merely solidarity with his wife, Anne, who’d had a routine mammogram. It was probably sensible to have a few checks himself, he pondered, feeling nothing but virtuous and confident.

Men should ask for more tests

As a long-serving Air New Zealand pilot, he was already having regular medical exams and knew his heart, lungs, eyesight and coordination were beyond reproach. This time, his GP decided to order blood tests to assess his glucose levels, cholesterol and PSA (prostate specific antigens).  When the doctor rang back to say Bell’s PSA levels were elevated, Bell had to ask a simple question: “Prostate? What’s that?”

The prostate gland produces the fluid that transports sperm. It is located in front of the rectum, just below the bladder and normally it is the shape and size of a walnut. Although elevated PSA levels can also be the result of a non-cancerous condition called benign prostatic hyperplasia, they can also indicate prostate cancer.  A normal PSA count is 4; Bell’s was 9. Although marginal – PSA levels can rise to 60 – Bell’s urologist decided careful monitoring was required. When, after a month, the PSA levels were still higher than normal and increasing, the surgeon decided that a biopsy was in order.

“That was probably the worst part of this whole story,” says Bell. “It’s not fun having eight needles fired through your rectum.”

Five days later, Bell’s urologist rang back with the results. The news was bad. All eight tissue samples revealed cancerous cells.

Having thought prostate cancer was rare, Bell was stunned to discover it is as common as breast cancer. Mortality is slightly lower but it’s six times higher than the rate for cervical cancer.  Because it often grows very slowly, older men can die “with it, not of it”. But three acquaintances, he found out, had died from it.

Treatment choices

Bell had to have treatment, but there were hard choices to make. “These days there is something called brachytherapy [the permanent implanting of radioactive seeds into the prostate gland in order to treat the cancer at its source], but that became available a bit later. My choices were surgery or radiation. I chose surgery, because it becomes impossible once you’ve had radiation.”

The consequences were going to be significant.  “It’s major surgery – five or six hours. And while it’s not guaranteed that you’ll be incontinent afterwards (it can depend on the skill of the surgeon), it is guaranteed that you’ll face erectile dysfunction.” It is this prospect that makes treatment so unpalatable for many men. Bell decided he could manage the impact on his sex life. Staying alive was more important.

Seven years on, he feels well and energetic, works as a flight simulator instructor and still enjoys sex. He gets his PSA levels tested twice a year and the reading is so low it doesn’t actually register. He wishes more men – and more doctors – were as vigilant about testing. “No doctor should refuse to tick that box on the lab form asking for a PSA test.”

Listen to your body

Women have their own list of must-do tests. At 61, Lovonny Gray has the vitality and appearance of someone at least a decade younger. She has never taken her health for granted. For the three decades that she used ‘the pill’ she was regularly seeing her GP about her prescription and would always have other basic health checks at the same time.

“I was never a hypochondriac – if I got a headache, I’d go for a walk or have a nice cup of tea instead of taking a Disprin – but I liked to know that everything was okay.”

In June 1997, Gray had a standard smear test done. The results were normal. At 52, and with the assistance of HRT (hormone replacement therapy) pills, she was breezing through menopause. But about two years later she began to notice some unusual “spotting” – a discharge of dark blood from the vagina. Her GP, whom Gray credits with being an alert physician and a straight talker, sent her for a hysteroscopy (examination of the uterus) and a D & C – “just a general look around and tidy-up”. All seemed well and a later smear test, in May 2000, returned a normal result, meaning that the vigil could be relaxed for another three years.

By the time the recall letter came from her GP in 2003, however, Gray had been noticing vague symptoms that she couldn’t attribute to anything in particular: “desperate” tiredness, limp hair, brittle nails and a generally run-down feeling.

She put it down to the stress of running a busy event-management company, but was concerned enough to mention it to her GP, who ordered further tests. This time the smear showed some abnormality in cervical cells.

Subsequent surgery found that cancer had infiltrated one-third of the cervix and was close to invading her bladder. Gray’s request to her surgeon was to “make her safe”, to remove anything that could threaten her life in future. Waking from anaesthesia, she was told that he had removed her uterus, ovaries, Fallopian tubes and some pelvic nodes.

“You’re safe now,” he said. “Go home and live well.”  After surgery, Gray underwent 25 radiology sessions – “ten minutes every day for five weeks” – she remembers, as extra insurance against a relapse.

Her surgeon says she is not just in remission, but actually cured. “All the bits the cancer could have spread to have been removed.”

Keep in contact with your doctor

From time to time she reminds herself to keep her stress levels down in order to give her immune system the best chance of protecting her from further illness.

“I owe my life to listening to my body and a GP who believed in me and paid attention when I had those vague symptoms. Even though the first tests came back normal, she never gave up looking for what was making me feel unwell.”

Reprinted by permission. Copyright 2007 Plenty magazine Autumn 2007