Do all that the ultrasound report says really matter?

The premise on which health checks are advised to a person who “feels” normal, is that it may help pick up “early” disease, that may be easier to manage, providing a longer and healthier life.

They do indeed pick up quite a few health problems, which if addressed early, can make a positive impact on life. One, that is most convincing, is detection of hypertension, or high blood pressure. Numerous studies have shown that if the high BP is controlled, it brings down the risk of heart disease, stroke and renal disease significantly, and extends life expectancy. The same can be said of high blood sugar or diabetes.

The list is indeed long with thyroid disorders, heart problems, fatty liver and high blood lipids, all squeezing themselves to join into the list.

One test that however proves to be double edged, is the abdominal ultrasound. Data shows that around 5 (India) to 15% (in West) of people will discover that they have gallbladder stones and around 7% (India) will get to know that they have kidney stones. These have obviously formed quite a while ago but had been lying silent. Their discovery now drops the question: What needs to be done for them? Surgery?

Ultrasound also picks up a large number of other “problems” that the person was unaware of till now. They have acquired the term ‘incidentaloma’ as they are picked up incidentally. Around 20% of adults harbor cysts in their kidneys or liver: these are innocuous and need not be approached as a “disease”, but once you come to know of them, the mind does go to the site where the ultrasound probe said the cyst was.

Other common findings in the liver include hemangiomas, adenomas, old scars of previous infections and some benign “tumors”. These discoveries pose a new challenge, often prompting another set of detailed testing, to finally resolve matters. What goes on in the meantime is a good bit of uneasiness and worry in the patient’s mind.

A senior doctor who has become a good friend of mine, had such a harrowing experience when he reluctantly underwent a routine “check up” in 2015. Ultrasound examination showed a small tumor in the liver that had not caused him any symptoms. This finding led to a series of advanced tests such as CT scan and MRI that confirmed that it was a liver cancer. And there was not one, but three of them!

Several experts agree with the diagnosis. By way of treatment, advice has however ranged from getting the liver transplanted (he is 71 now) to getting drugs injected into the tumor repeatedly to destroy as many of the tumor cells as possible, in the hope of controlling or slowing the disease.

Unexpected discoveries are like the proverbial glass: Pessimists and anxious people see it as half empty, finding it difficult to reconcile new information about disease and health. Optimists however would see the glass as half full.