Health Check-Up in Thailand

Many of you may have questions about the annual health check, especially when you feel physically well. Perhaps you haven’t sought medical attention even during bouts of illness like the flu. The question arises: How crucial is a regular health check, and what aspects warrant examination?

An annual health check is a comprehensive assessment of our physical well-being. While external appearances may indicate good health, internal issues may be lurking, or the once robust protective mechanisms could be weakening. Neglecting in-depth assessments may expose us to potential health risks in the future. Identifying and addressing the early stages of certain diseases during health check-ups can prepare us for effective management. Early intervention not only helps in maintaining good health and preventing diseases but also minimizes associated costs and enhances long-term quality of life.

Understanding the significance of health examinations prompts the question: What specific aspects should we prioritize?

Preoperative evaluation for surgery

Any type of surgery, regardless of its scale, entails inherent risks. These risks encompass factors associated with the surgical procedure, potential complications arising from anesthesia, and medical complications that may manifest during the surgical intervention. In generally healthy patients without congenital diseases, the risks and likelihood of complications are minimal. However, these risks tend to escalate with age and the presence of congenital diseases, such as heart disease, high blood pressure, diabetes, lung disease, kidney disease, cerebrovascular disease, and others. Patients with these conditions face higher risks, and the potential for complications is heightened, sometimes reaching severe and even fatal outcomes.

When contemplating surgery, the surgeon will conduct a comprehensive assessment, encompassing a thorough medical history, physical examination, and preliminary laboratory tests. This evaluation aims to gauge the patient’s physical strength and identify any congenital diseases or abnormalities that may impact the surgery. In certain instances, the surgeon may refer the patient to an anesthesiologist for further evaluation, aiming to minimize the overall risk and chance of complications during the surgical procedure.

Patient Preparation Before Surgery

• The surgeon has identified anomalies in either the patient’s medical history, physical examination results, or preliminary laboratory tests, including blood tests, lung X-rays, ECG, etc.
• Patients with poorly controlled or severely symptomatic congenital diseases fall under this category.
• Individuals scheduled for extensive surgeries lasting more than 3 hours or surgeries carrying a heightened risk of complications are subject to further evaluation.
• Patients opting for surgery without a prior hospital stay necessitate additional scrutiny.
• A history of problems or complications arising from previous surgeries or anesthesia is a critical consideration.

Pre-Surgery Assessment by Anesthesiologist

When undergoing surgery, both physical and mental changes are inevitable. The anesthesiologist plays a crucial role in assessing your overall condition, evaluating the risks and likelihood of complications based on factors such as age, gender, congenital diseases, medication history, and other health conditions.

Comprehensive Evaluation

This assessment encompasses your drinking and smoking history, past surgeries, anesthesia experiences, as well as the results of physical examinations and laboratory tests. The aim is to furnish you with comprehensive information about potential risks and complications before the surgical procedure.

Preparation for Surgery

Moreover, the anesthesiologist is committed to preparing you for surgery, focusing on hazard prevention and risk reduction (Risk optimization). This often involves providing guidance on behavior modification, developing care plans to manage underlying diseases, explaining the anesthesia administration process, ensuring your understanding of the procedure, and alleviating concerns.

Medication Review

The anesthesiologist also reviews your medication regimen, offering advice on medications to discontinue before surgery and those that should be continued until the day of the procedure.

Pre-Hospitalization Preparations

In cases where surgery does not involve a prior hospital stay, the anesthesiologist provides essential advice on pre-hospitalization preparations, including fasting for 6-8 hours before surgery, discontinuing specific medications, and practicing deep breathing techniques.

Collaborative Patient Care

The collaborative efforts of anesthesiologists, surgeons, and nurses aim to optimize patient care and ensure the success of the surgical procedure.

Basic health check-up

Basic health check: What do you check? Many people, if they have the opportunity to go to the hospital, have probably seen billboards advertising health checkup packages. Many annual packages specify the disease screening program, and the sheer volume can be overwhelming. It prompts one to ponder: Is it truly necessary to undergo all these tests? And more importantly, when is the optimal time for a health check?

Complete Blood Count (CBC)

A complete blood count is a test that quantifies the number of red blood cells, examining their shape and size. It helps indicate anemia through the quantity count and types of white blood cells, revealing signs of infection and abnormalities that may signal diseases such as leukemia. Additionally, the test includes platelet count, crucial for halting blood flow when a wound occurs.

Fasting Blood Sugar (FBS)

FBS measures blood sugar levels after abstaining from food, serving as a screening tool for the risk of diabetes.

Hemoglobin A1c (HbA1c)

This test assesses the average accumulated sugar level in the blood over the past 2-3 months. By measuring excess sugar binding to proteins in red blood cells, it screens for diabetes and evaluates post-treatment sugar control in individuals with diabetes.

Total Cholesterol

This measurement reflects overall cholesterol levels, with results requiring interpretation. Elevated total cholesterol may be attributed to high levels of bad fats or the beneficial, high-density type. Dietary sources of cholesterol include egg yolks, seafood, animal organs, fatty meats, and high-fat dairy products.

LDL-Cholesterol

Known as bad cholesterol, LDL is fat that accumulates on blood vessel walls, leading to arterial hardening and narrowing, contributing to cardiovascular and brain diseases.

HDL-Cholesterol

Recognized as good cholesterol, HDL helps reduce fat accumulation on arterial walls. It transports cholesterol from various tissues to the liver for expulsion from the body, thereby playing a crucial role in reducing the risk of cardiovascular and brain diseases.

Triglycerides

Triglycerides, a type of fat, store energy from consumed food. Excessive levels pose a risk for artery hardening, contributing to cardiovascular and brain diseases. High triglycerides result from starch-heavy diets, excessive sugar intake, and insufficient physical activity.

High Sensitivity C-Reactive Protein (hs-CRP)

The hs-CRP test is an exceptionally sensitive measure of CRP protein levels, even in low concentrations. Elevated CRP indicates inflammatory processes at the cellular level, enabling the assessment of heart disease risk, particularly in individuals with heightened cardiovascular risk factors such as high blood fat, diabetes, high blood pressure, and smoking.

Uric Acid

Uric Acid measurement in the blood is linked to various diseases like gout and urinary tract stones. Increased uric acid levels, influenced by genetic factors and the consumption of purine-rich foods such as poultry, organ meats, certain vegetables like mushrooms and vegetable shoots, and alcohol, can be indicative of these conditions.

Blood Urea Nitrogen (BUN)

BUN measures waste levels in the body. In a healthy state, efficient waste excretion occurs. Elevated BUN levels, however, signify abnormal kidney function, where waste products accumulate due to impaired excretion.

Creatinine (Cr)

Creatinine assessment gauges the levels of waste product from muscles, excreted by the kidneys. Elevated values, unrelated to muscle abnormalities, signal impaired kidney function.

Liver Function Test (Alanine Aminotransferase: ALT)

ALT measurement focuses on the enzyme abundant in the liver and kidneys. Elevated ALT levels may indicate liver damage or inflammation, with ALT being less prevalent in muscles, heart, and pancreas.

Liver Function Test (Aspartate Aminotransferase: AST)

AST examination assesses the enzyme found in the liver, kidneys, and various tissues. Increased AST values may be associated with heart disease, hepatitis resulting from alcohol consumption, or excessive exercise.

Alkaline Phosphatase (ALP)

ALP, an enzyme abundant in the liver, biliary tract, bones, and small intestine, sees elevated values suggesting abnormalities or diseases affecting these organs.

Testing for infection and immunity to Hepatitis A, B, C (Viral Hepatitis Profile)

This screening test assesses infection and immunity levels, reducing the risk of chronic liver inflammation—a precursor to potential liver cancer.

Specialized Medical Examination

What are the specialized health examinations?

Specialized health examinations are typically tailored to individual risks, taking into account factors such as age and genetic history, or the presence of abnormal symptoms. These examinations include the assessment of cancer markers and radiological examinations.

Alpha-Fetoprotein (AFP)

The Alpha-Fetoprotein test screens for liver cancer by measuring the levels of AFP in the blood. Elevated AFP levels may indicate a potential risk, requiring further examination by a specialist in gastrointestinal and liver diseases.

Carcinoembryonic Antigen (CEA)

The CEA test is utilized to screen for colon cancer. Elevated CEA levels may also be observed in patients with lung, liver, and pancreatic cancers, as well as long-term smokers. If the CEA value surpasses the standard, a detailed examination, such as a colonoscopy or computed tomography, is recommended.

Prostate-Specific Antigen (PSA)

The PSA test is a screening tool for prostate cancer. Elevated PSA levels may be attributed to conditions like prostatitis, urinary tract infection, or the use of certain medications. Men over 50 years of age are advised to undergo this test annually.

Cancer Antigen-125 (CA-125)

CA-125 is a screening test for ovarian cancer. Elevated CA-125 levels may be associated with conditions such as ovarian cysts or pelvic inflammation. A detailed examination with a gynecologist is recommended if the CA-125 level is high.

Cancer Antigen-153 (CA 15-3)

The CA 15-3 test is employed for breast cancer markers, often used in the diagnosis of metastatic breast cancer and monitoring treatment progress. It is not commonly used for early-stage screening. X-ray examinations and breast ultrasounds (mammograms) are considered more reliable for initial screenings.

Cancer Antigen 19-9 (CA 19-9)

CA 19-9 is a test for detecting gastrointestinal cancer indicators, such as those related to the pancreas. While not recommended for pancreatic cancer screening due to its low sensitivity, it is utilized for monitoring treatment. If the CA 19-9 level exceeds the standard, a detailed examination with a gastrointestinal and liver disease specialist is recommended.

Electrocardiogram (ECG)

The Electrocardiogram is a test that evaluates the heart’s electrical signals, aiding in the identification of preliminary abnormalities such as irregular heart rate or myocardial ischemia. If abnormalities are detected, a thorough examination with a cardiologist is advised.

Chest X-ray (CXR)

The Chest X-ray is an examination using X-rays to identify lumps or abnormal spots in the lungs, assess heart size, and detect pleural effusion and rib disorders. However, it may not effectively detect lung cancer. In cases of doubt, additional CT scans are recommended for accurate diagnosis.

Abdominal Ultrasound

The Abdominal Ultrasound is a non-invasive examination to identify abnormalities in internal organs, including the liver, gallbladder, kidneys, and reproductive organs. It has limitations for some organs, and for precise examinations, additional procedures such as gastroscopy and large intestine examinations are recommended.

Bone Densitometry (BMD)

The Bone Densitometry test assesses bone density using low-energy X-rays. This test is recommended for women undergoing menopause, individuals over 60 with a family history of osteoporosis, those using steroids long-term, and individuals engaging in risky behaviors like frequent alcohol consumption and heavy smoking.

For individuals (ages 20 – 60 years)

For individuals in the working age group (ages 20 – 60 years), the recommended tests for maintaining overall health are as follows:

1. Complete Blood Count (CBC): This test examines the characteristics of red blood cells, white blood cells, and platelets to assess their completeness. It helps identify conditions such as anemia and inflammation in the body.
2. Checking Blood Sugar Levels (Fasting Blood Sugar): This test evaluates the risk of diabetes, particularly for individuals aged between 40 and 70 years.
3. Checking Blood Lipid Levels (Lipid Profiles): This test is crucial for assessing the risk of cardiovascular disease. Elevated lipid levels increase the likelihood of cardiovascular issues.
4. Check Liver and Kidney Function: Since the liver and kidneys play vital roles in eliminating waste from the body and maintaining a balance of mineral salts, it is essential to assess their function. Normal values indicate effective waste elimination. Any abnormalities in these values should prompt further investigation by a healthcare professional to identify the underlying cause.

Additional Health Check

For Males – It is strongly advised to enhance prostate cancer screening, especially for individuals in the at-risk group aged 55 to 69 years.

For Females – Cervical cancer screening is highly recommended, particularly for those over 35 years of age or women who have engaged in sexual intercourse, due to the risk of contracting the HPV virus. Additionally, breast cancer screening is recommended, and women between the ages of 50 and 74 are encouraged to undergo mammography (X-ray of the breast with low doses of radiation).

Moreover, individuals of working age employed in various establishments should undergo screening for occupational risks. This includes exposure to dust, chemicals, certain heavy metals, or loud noises. Screening should be tailored to the specific risks associated with each department or individual. Beyond being a preventive measure, these screenings also serve as a means of compliance with legal requirements.

Identify health examinations to avoid

1. Lung X-ray: This examination poses a high risk of providing inaccurate results, causing unnecessary anxiety, and being wasteful. Additional verification is often required.
2. Prostate Cancer Screening (PSA Test): Testing PSA levels in the blood for screening may yield incorrect results, leading to the need for complicated repeat tests, such as biopsies, which can increase the risk of infection from the wound.
3. Uric Acid Level Testing: Results from this test are often uncertain, and there is a risk of receiving more uric acid-lowering medication than necessary. There’s also a risk of a severe allergic reaction to the drug, potentially leading to a fatal outcome.
4. Blood Urea Nitrogen (BUN) Testing: This test is not useful for screening kidney deterioration.
5. Liver Enzyme Testing: No benefits have been found in screening for normal individuals. Therefore, liver enzyme testing is not considered a necessary and useful health checkup item.
6. Triglyceride Level Testing: There is minimal benefit in assessing the risk of cardiovascular disease through this test.
7. Electrocardiogram (EKG): This test has a high chance of being inaccurate and is deemed necessary primarily for individuals with congenital and chronic diseases such as diabetes, high blood pressure, and heart disease.
8. Tumor Marker Testing: Doctors use this test to monitor treatment results and the recurrence of colorectal cancer.

Keywords: preoperative assessment, preoperative preparation, perioperative risk, anesthetic risk