Natural born killers

DID you know that many of our most common killer diseases creep up silently and lurk unnoticed in their early stages – when you’re most able to do something about them?

This is not a pleasant thought. But there are some easy ways to check for trouble and get help defusing your body's “time bomb” before it's too late.

Cardiovascular disease – manifesting in heart attack and stroke – remains an enduring chart topper on the ‘hit parade’ despite overall declines in death rates in the past 30 or so years – due in no small measure to reduced smoking levels. Stroke remains the leading cause of disability in those aged 50 or over.

For too many people, the first sign of heart disease is death. Yes – this is true. Two of the major risk factors, high blood pressure and high cholesterol levels, often have no warning signs. Prevention, or reduction in severity, of heart attack or stroke, is possible – but only if you know you are at risk in the first place and adjust your lifestyle or take medications accordingly.

So, instead of finding out the hard way, visit your GP for a thorough examination, including blood pressure and cholesterol testing, have your weight, BMI and waist measurement taken and ask for an exercise stress test. Repeat the process each year, or more often if your doctor advises.

Further, learn to recognise the signs and symptoms of heart attack and stroke so you can be on alert for yourself and others. Too often, these go unrecognised and the opportunities offered by early, appropriate treatment are lost.

This is the catchcry of the Australian Stroke Foundation (see contacts below). As the Foundation points out, “time is brain”. The best chance of a good recovery and to reduce disability due to stroke is to get help within three hours of its onset and the sooner, the better.

Symptoms can include numbness on one side of the face or body, difficulty speaking or understanding when spoken to, dizziness, an unexplained fall, loss or blurring of vision and difficulty swallowing.

If you do suspect someone near you is having a stroke, ask the following three questions. To help you remember, use the simple acronym STR: S (smile); T (talk); R (raise your arms).

1. Can you smile? (S)
2. Can you speak a simple coherent sentence? (T)
3. Can you raise both arms above your head? (R)

If you or another person has trouble with any of these three simple actions, suspect stroke and call 000 immediately. Tell the operator of your concerns. If possible, ask the ambulance to go to a hospital with a specialist stroke unit – these are equipped with the latest life and brain-saving treatments.

The National Stroke Foundation offers information about stroke treatment and support groups at www.strokefoundation.com.au or call 1800 787 653.

More than half of heart attack patients experience symptoms before the attack actually hits – sometimes days or weeks in advance. Unfortunately, many people don’t recognise them. Symptoms commonly include:

• Uncomfortable pressure, fullness, squeezing, or pain in the centre of the chest. The pain may last for a few minutes, or it may go away and return.
• Pain that spreads to the shoulders, neck, or arms.
• Chest discomfort accompanied by light-headedness, fainting, sweating, nausea, or shortness of breath.

The Heart Foundation offers comprehensive information about heart disease prevention and treatment at www.heartfoundation.org.au.

Type 2 or adult onset diabetes is the world’s fastest growing chronic disease and in this country an estimated three million people either have it or are showing signs of its precursor condition, pre-diabetes. Pre-diabetes is characterised by high blood glucose levels and if left untreated may develop into full diabetes within five to ten years.

Scarily, around half of those three million people don’t know they have diabetes or are at high risk. Like our other killers, diabetes shows few if any signs in its early stages. And, like out other killers, it’s in the early stages that you have the best chance of halting its progress altogether or minimising its negative impacts, generally through lifestyle changes and/or medication.

Symptoms if they are experienced – and often there are none noticed – may include excessive thirst and urination, unexplained weight loss, weakness and fatigue, irritability, blurred vision, skin infections, slow healing, tingling and numbness in the feet.

The reason you want to catch diabetes early is that, once it progresses, it’s far from symptom free. It’s a leading cause of blindness and visual impairment, predisposes you to cardiovascular disease (a very high percentage of those with diabetes will die of related cardiovascular complaints) and causes kidney failure. It is a leading reason of amputation of the feet and legs due to the effect of high glucose levels on the fine blood vessels of the extremities – in short, it kills feeling and function and the limbs ‘die’ as a result. It is also a cause of erectile dysfunction.

A simple pin-prick blood test next time you see your GP can establish if you should be concerned about diabetes and whether further investigation is required. On the plus side, if caught early and you take action to manage it straight away, in many cases its effect on your life can be minimal.

To establish your diabetes risk, visit The Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK). This downloadable questionnaire is a good starting point to establish whether you are at low (that is, one in 100) or high (one in three) risk of diabetes, and points in between.

While it’s no substitute for a doctor’s visit, it may be food for thought – and a useful addition to your “bomb defusing armoury”.

Or so the refrain goes.

One in two men and one in three women are likely to go head-to-head with the big C in their lifetimes. And those most likely to win the battle are the ones who catch their cancer early – again, often before there are obvious symptoms.

How to do this?

The answer is sensible screening and testing that’s matched to your age and other individual risk factors. The best person to advise you on this is, once again, your GP.

Broadly speaking, however, by the age of 50 (and earlier if you have family history of certain cancers) you should be thinking about:

• bi-annual mammograms to screen for breast cancer and bi-annual pap tests for cervical cancer for women.
• for men, talking to your doctor about the ins and outs of PSA testing for prostate cancer; and perhaps having a baseline PSA test for future reference even earlier – around age 40.
• talking to your doctor about blood testing for ovarian cancer. Although not conclusive there is a test that can indicate whether you are at high risk.
• a regime of regular testing for bowel cancer that should include at the least a faecal occult blood test (FOBT) for blood in the stools; and, depending on your individual circumstances, regular colonoscopies.
• regular skin checks for melanoma and other skin cancers.

Your doctor may also recommend that you have testing or screening for other cancers. The more detailed the family medical history you can provide, the better placed your doctor will be to help you decide what testing or screening may be right for you.

For more information on cancer, and in particular the latest on cancer prevention, visit The Cancer Council at www.cancercouncil.org.au.

Perhaps the ultimate ticking time bomb is to be found in our genes. Genetic testing and counselling to assess your personal risk of breast, bowel and prostate cancer is commonly available, as it is for various congenital conditions. In coming years, this area will grow apace – and hopefully so will our understanding of the complex genetic information it reveals and the social support mechanisms to go with it.

As matters currently stand, in the case of many cancers and a number of other conditions, having a gene that disposes you to an illness or disease does not always mean you are certain to develop it.

Because so many other factors play into the cancer equation (environment, lifestyle, even personality type) sometimes a family history can reveal as much about your risk of cancer as an expensive but less-than-conclusive genetic test. If you take such a test, ensure results are thoroughly explained to you by a qualified genetic counsellor who can then direct you to seek further help and information if you need it.

There’s an increasing trend in (where else) the US to get online genetic testing for a whole host of conditions – you plug in your credit card details, they send you a swab and a test tube and you swipe your cheek and send it back for testing. Voila! Some time later the genie is out of the bottle and you get the news.

Without the appropriate interpretation, counselling and explanation to go with this type of online testing its value may be negligible. It may even do more harm than good. Knowing your enemy can help you arm yourself against it. Having a bogey man under the bed is a different thing altogether!