Your Physical Biomarkers

What does an annual physical mean to you? Confirmation that are all systems are go? An early warning system designed to catch a health-threatening problem before it has a chance to wreck havoc? The physical (annual or otherwise) is still held in high esteem by a great many patients and doctors. Many doctors feel that 90% of what is needed to diagnose a health problem in a patient can be gleaned through a physical and a family medical history.

But the physical is showing signs of strain in some quarters. Sure, kids must still get physicals that allow them to go to school and play school sports. But it seems that if you are really serious about finding out what might be going wrong inside you, an “executive physical” is in order, one complete with high-tech body scans. Even the name betrays a condescending view of “ordinary” physicals and the people who settle for them.

At the same time, however, there are medical experts who believe that there is scant scientific evidence that regular physicals actually save lives. And these are not fringe views. Even the chairman of the U.S. Preventive Services Task Force, Dr. Ned Calonge, cautioned that “there is very little evidence, if any, that doing [comprehensive] exams yearly on patients without symptoms is good for anything.” The concern is that routine, useless physicals waste time in an overburdened health care system that is missing too many people with symptoms and illness that demand immediate treatment.

And yet don’t expect physicals to go away anytime soon. The majority of patients and doctors will continue to believe in their preventive power. Routine physicals are also the best forum for ongoing patient-doctor conversations about lifestyle issues, such as diet, exercise and health habits (though it’s arguable whether doctors are the best health care professionals to do this). The real issue, however, is how to make these routine visits smarter and of more benefit to individuals by focusing more selectively on the risk factors most likely to affect a specific patient. LESS

.

skin and hair

The exam starts with the skin, and we are not just looking for skin cancer; we’re looking for the quality of the skin, the dryness, the oiliness, the thickness, for rashes or signs of infections inside the body. And we look at the scalp and the quality of the hair. If there’s hair loss or thinning, it might signify autoimmune disease or perhaps a vitamin deficiency. Again, we are looking for conditions that give us clues to what’s going on inside.

eyes

We look into the eye to see the retina and optic nerve, along with the tiny arteries that are supplying the eye with its own circulation and which give us a sense for the pressure inside the eye. We can see if there’s any damage to these arteries from diabetes or hypertension even before they have any other symptoms.
High blood pressure affects all of circulation, and one place you’ll see that is in tiny hemorrhages at the back of the eyes.

mouth

In the mouth there’s so much you can see, from the shape of the teeth, the shape of the tongue, or the crowding of the airway, which can indicate sleep apnea. When somebody opens their mouth wide, you should be able to look in the back and see the uvula, the little rounded blob in back that hangs down off from the top of the of the mouth. If you look in the mouth and you can’t see the uvula, that means things are crowded and that this person might be having breathing difficulties, especially in certain positions while they’re sleeping at night.

tongue

We look at the edge of the tongue because when you stick out your tongue, the edge should be smooth. If you see scalloping on the edge of the tongue, that means the teeth are indenting the edge of the tongue, and that’s another sign of crowding. So if there’s crowding in the mouth, that’s another sign that someone might have trouble with breathing during sleep. And sleep apnea can have repercussions on the rest of the body.

You can pick up so much from the tongue. Some people have a very smooth tongue. Other people have a tongue that looks, like a map, and in fact we call it a geographic tongue; you can almost see the outline of countries on the tongue. And that’s oftentimes a sign of allergy. A second sign of allergy is a cherry red spot on the tip of the tongue. Another sign of allergies can be increased fine lines and creases on the palms of the hands.

Different tongues have different coatings. Some are very shiny and have no coating at all. Some have a whitish coating, others have a yellowish coating and these differences have a lot to do with the things that we’re taking in our body. It might have to do with diet, but it might have to do with the body trying to get rid of certain infections. Sometimes you’ll see that on the tongue. So there’s a lot that you can tell about a person’s health from the tongue. The gums are also very important tooi f the gums are infected, that triggers inflammation in the body that can be dangerous in other ways.

belly

In the abdominal cavity, you feel important organs, like the liver, the spleen, the kidneys, the aorta. You can feel if the liver is enlarged; you can feel if it’s smooth or irregular; if it’s tender. You can feel the gallbladder or the spleen, one of the important organs for the blood and immune system. If the spleen is enlarged, that could indicate a viral infection (mononucleosis can enlarge the spleen) or it might be parasitic infection or certain kinds of cancer. If the aorta is enlarged, we might be concerned about a bubble in the aorta called an aneurysm, a very serious problem. LESS

.