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Health screenings: What first -- symptoms or tests?
Neither health care providers or the general “50-plus” public seem certain that imaging four critical body parts will help avert health disasters; but at least 90 Mercer Islanders were willing to take the ultrasound plunge to find out Jan. 15.
Pink inserts in the Mercer Island Reporter and radio ads entreated the Island’s senior citizens to have “Tests That Can Save Your Life.” When Life Line Screening’s mobile ultrasound unit came to Island House last Monday, the schedule was full for those wanting to test possible plaque buildup in their carotid artery, abdominal aortic artery ballooning, peripheral artery disease and osteoporosis. Such “silent” conditions can portend stroke, heart and vascular disease or loss of bone density.
Those screened paid $129 for all four non-invasive no-radiation procedures, which took about an hour. Outcomes will be mailed in about three weeks. Individuals determine what to do with the results, as the tests were self-ordered rather than through medical practitioners.
“We strongly support preventive health care and empowering individuals to be more informed and proactive in it,” said Susan Higley, education facilitator for Overlake Hospital and Medical Center, which sponsored the all-day screening. Higley said people with no symptoms or family histories of stroke and heart attack sometimes know friends who have had incidents and want assurance they aren’t headed down the same road.
The on-site attendant said screeners are not allowed to offer immediate comments. Exceptions are made if critical indications are found. Approximately two people at any all-day session of 75-100 customers are issued urgent alerts, so they may go directly to medical services.
Otherwise, the ultrasound tests are meant to detect vascular and bone risks early enough for physicians to begin preventive procedures. Yet, physicians typically don’t order such tests without clear evidence of symptoms or risk factors. These may include high blood pressure, heart rhythm abnormalities, high cholesterol, diabetes, obesity, smoking, numbness in extremities, sudden speech or vision problems, dizziness, fainting, intense headache, nagging back pain, rigidity or tenderness in the abdomen, among others.
Neither does insurance routinely cover such general screenings.
“I couldn’t order these screenings through Medicare without medical justification,” said Lester Sauvage, Jr., a physician at MI’s Senior Clinic. And, conventional rates for such lab testing would be hundreds of dollars more than Life Line’s fee, he added.
Sauvage said he believes the tests are valuable to some, even though the general screening readings are not detailed. In some cases the results can provide a diagnosis to justify further insurance-covered testing.
Charles Hansing, cardiologist who resides on MI said he believes “the sign of any cholesterol in any arteries means a much higher risk of heart attacks and strokes. The EBCT (electron beam computed tomography) heart scan is the most sensitive for cholesterol in the heart arteries, but costs anywhere from $375 to $500. If the ultrasound shows any cholesterol, then the client needs cardio-consultation and aggressive treatment to lower cholesterol and reduce the risk of heart attacks and strokes.”
“My concern is that people will use (these general screenings) as a substitute for seeking out regular primary care visits,” said Audrey Nordlie, naturopathic physician on Mercer Island. “The gold standard for bone mineral density is a DEXA (Dual Energy X-ray Absortiometry). It is the most widely used bone mineral density scan of the hip, not the ankle. You can't use (Life Line’s) ankle scan as a baseline and then compare it to a scan of the hip the following year. I would prefer patients seek out their primary care physician if they want any of these tests, so there is appropriate follow up.”
Karen Coshow, also a naturopathic physician, agreed the screenings “are considered appropriate for the senior population to find problems before they become a threat to life and quality of life,” and are more affordable than orthodox testing. “They are, however, only screening procedures. It is important to consult with your physician about the results, as a negative test may not rule out a problem and a positive test will require further evaluation.”
John Lind, a local dentist, suggested that the medical community has more comprehensive and precise ways to identify potential risks, such as genetics and family history, routine vital sign checks, coronary and bone scans, treadmill tests, blood work and regular contact with primary care and other consultants.
Rather than finding peace of mind, Lind worries that “someone who’s had a general scan may become a nervous wreck if tiny spots are discovered, and then they’ll have to have more costly procedures to find out whether it may, or may not, have been anything.”
Mercer Island is a niche market for such services, with more than 30 percent of its population over age 50 - around 6,700, according to the 2000 census. Many being tested said they came to do all they could to avoid stroke or heart events that had beset their friends or relatives with no warning. One woman said she comes every year, as earlier screenings had detected calcium deposits that routine procedures had missed.
“My husband and I found the tests simple, painless and practical,” said Marilyn Blue after her screening. “The one anxiety-producer is waiting 21 days to learn the outcomes.”
Life Line Screening, in business since 1993, has more than 45 ultrasound teams in 85 vans conducting around 19,000 screening events a year coast-to-coast, said Susan Vetrone, public relations agent for the Cleveland, Ohio business.
“We are a privately held company helping people become aware of undetected health problems. About 8-10 percent of our asymptomatic customers have significant vascular findings that require follow-up with their physician. There are far more with osteoporosis.”