Listed below, in no particular order, is more information on some of the
examinations and tests that we do. You will find links to this page
all over this website - click on the link and you will be taken
to the relevant paragraph.
Everyone over the age of 35 should have his or her blood pressure
measured every couple of years. A rise in blood pressure usually
causes no symptoms but can lead to heart disease, strokes and kidney
If your blood pressure is found to be high, you will be asked to
get it checked a number of times to see if the pressure is genuinely
raised. At the same time you will be given advice on how to reduce
your blood pressure without recourse to medication. (Keep weight
down, stop smoking, exercise regularly, reduce salt intake)
If medication is needed there is a huge number of possible drugs
to choose from - it should be possible to find something that suits
Body Mass Index (BMI)
The BMI is a number which is calculated from
measurements of your height and weight*. The ideal BMI is between
19 and 25. Over 25 you are classed as overweight, and over 30 you
are classed as obese.
*(It is actually your weight in kilograms
divided by the square of your height in metres)
The rectal examination is important to exclude conditions of the
anus and tumours of the rectum. The majority of cancers of the large
intestine occur in the rectum, particularly in men, and the majority
of these rectal cancers can be detected by rectal examination.
In men it is possible to feel the surface of the prostate gland
and to check that it feels normal.
Everyone feels uncomfortable about having a rectal examination
and this is understandable. However, as long as you are relaxed
and the doctor performs the examination gently and correctly, you
should not find the examination too unpleasant. The doctor will
ask you to lie on your left side and tuck your knees into your chest.
The skin around the anus and the anal muscle is examined. The doctor
then gently inserts a gloved finger into the rectum, and feels the
walls of the rectum (and the prostate) for any abnormality.
Pelvic examination enables the uterus (womb) and ovaries to be
examined. In women with no symptoms it is not a particularly useful
examination. One might hope to detect cancer of the ovary by means
of a pelvic examination, but in fact most of these tumours are small
and very difficult to detect by feel. Unfortunately, there is thus
far no reliable screening test for cancer of the ovary.
Very occasionally, abnormalities of the uterus (womb) are found.
It is also helpful to carry out a pelvic examination before doing
a smear test in order to feel where and how the cervix lies - sometimes
the cervix can be surprisingly difficult to find!
Cervical Smear Test
It is recommended that women between the ages of 20 and 64 have
a smear test done at least every three years. If you are resident
on the Island you will be contacted to remind you that your smear
test is due. You can arrange to have the test done free of charge
by your GP (who may ask the practice nurse to perform the test).
If, for any reason, you would prefer to come to IMS to have this
test done we will be pleased to accommodate you.
The ECG is a measure of the electrical activity
from the heart. It is painless and takes just a few minutes to do.
Wires are gently attached to your wrists, ankles and on the front
of your chest and the ECG machine then records the electrical activity
on graph paper.
In people with no symptoms the ECG has a limited ability to tell
us about your heart. It is possible to tell if you have had any
damage to the heart muscle in the past, and it can be very helpful
if your pulse is found to be irregular. It cannot predict whether
or not you are in danger of a heart attack in the near future.
So, why do we do the test. There are three reasons:
- To see if there is evidence of damage in the past
- To see if there is evidence of thickening of the heart muscle
(hypertrophy) - this commonly occurs in people with high blood
pressure, and is significant
- To obtain a baseline record for comparison with future ECGs
Pulmonary Function Tests
We do these tests using a machine that you blow into. It measures
Peak Expiratory Flow (PEF) - this gives an indication as
to whether there is any obstruction in the airways. Obstruction
occurs in asthma and damage due to smoking
Forced Expiratory Volume (FEV1) - the largest amount you
can breath out in 1 second from a full inspiration.
Forced Vital Capacity (FVC) - is the volume of air that
you can blow out from a full inspiration to a full expiration.
FEV1 and FVC are looked at together and can give useful information
on the presence of airways obstruction (which you might get in asthma
or emphysema),and restriction of the lung (which you might get in
certain conditions where there is scarring of the lung tissue.
At IMS we do not recommend chest X-rays for people who have no
chest symptoms. This is a widely held policy both in Europe, America
and Canada. The reason is that it is exceedingly unlikely that any
useful information is gained from the examination, and the examination
is expensive and exposes you to radiation.
If there seems a good reason to perform a chest X-ray, we can send
you to Nobles Hospital whose Department of Radiology has agreed
to accept referrals from IMS
At IMS we routinely check your urine for
sugar, blood and protein. Sugar (glucose) in the urine is indicative
of diabetes and will always require further investigation. Likewise
the presence of blood which can be an early sign of tumours of the
bladder. It is quite common to find very small traces of protein,
but any more that that would need investigation. Protein in the
urine can be a sign of infection or kidney or bladder disease.
Full Blood Count (FBC)
The FBC is a series of measurements on the red and white blood
cells. The most useful of the measurements are:
Haemoglobin - the chemical that is found in red blood cells
and which transports oxygen around the body. If you have too little
Haemoglobin you are anaemic. What are the causes of Anaemia?
Well, the list is very long - here are the commoner causes:
- Excessive blood loss If you have a heavy loss of blood, say
following an accident, and you do not receive a transfusion then
it is likely that you will be anaemic for a while until your body
makes new red cells. However, it is more common for people to
become anaemic from slight or moderate blood loss which is regular
and long term and which depletes the body of its iron stores.
The commonest cause of this is heavy menstrual loss in women -
but there may be more sinister causes such as blood loss from
a bowel tumour, or stomach ulcer. That is why Iron Deficiency
Anaemia should be investigated.
- Reduced blood manufacture The body needs Iron and Vitamin B12
to manufacture red cells. A deficiency in either of these essentials
will result in anaemia. Diseases of the bone marrow itself such
as leukaemia (which is a sort of cancer of the white cell producing
part of the marrow) or spread of other tumours to the marrow can
also affect red cell production. Even chronic ill-health or inflammatory
disorders such as Rheumatoid disease can affect production.
Mean Corpuscular Volume (MCV) This test gives an idea of
the size of the red cells and it is useful to help differentiate
between Iron Deficiency Anaemia and Vitamin B12 Deficiency Anaemia.
In the former, the cells are small (and may look pale, or hypochromic)
and in the latter the cells tend to be abnormally large. The MCV
can be raised for other reasons - long term excessive alcohol consumption
will push the red cell size up.
The White Blood Cell Count (WBC) and Differential In these
tests a measurement of the total count of white cells is made along
with a breakdown of the types of white cell. The total count might
be raised during infections and due to leukaemias.
Certain conditions tend to raise the count of specific types of
white cell e.g.
- Monocytes - chronic infections, Hodgkin's disease, protozoan
- Neutrophils - Bacterial infections, inflammation, upsets in
the metabolism (e.g.. kidney failure, steroid therapy.
- Lymphocytes - infection in children, glandular fever, German
measles, whooping cough
- Eosinophils - Allergic diseases, worm infestations,during recovery
- Basophils - Rare for these to be increased. Can occur in chickenpox
and low thyroid states
and Creatinine (U & Es, Creatinine)
The Electrolytes measurements are the levels of Sodium and
Potassium in the blood. It is very unusual for these to be abnormal
in people who have no symptoms and who are not on any medication.
In Addison's disease (where there is a problem with the production
of certain steroids in the adrenal gland) the potassium level may
be very high. It may also be raised in kidney failure. It may be
low as a result of taking certain medicines such as diuretics.
Urea and Creatinine give an idea of kidney function. They
are both raised in kidney failure.
Liver Function Tests
Several substances are measured in this set:
Bilirubin - a breakdown product of red blood cells which
is extracted out of the blood by the liver, processed and then excreted
into the intestine in the form of bile. High levels of bilirubin
can result from liver disease, or form obstruction of the outflow
of bile into the intestine. If the level of bilirubin in the blood
gets high the skin and the whites of the eyes turn yellow - this
Several enzymes are measured:
Aspartate Transaminse (AST), Alanine Transferase (ALT), Alkaline
Phosphatase (AP) an Gamma Glutamyl Transferase(YGT). These enzymes
might be raised in any instance of liver damage - from excessive
alcohol to viral hepatitis. We can get a clue as to the problem
by looking at which of the enzyme levels is highest; in general
AP is usually highest in conditions where there is physical obstruction
to the outflow of bile from the liver, and the others are highest
when there is liver cell damage. To confuse matters, Alkaline Phosphatase
is also produced by the bones and so a raised level of AP might
actually indicate bone disease rather than liver disease. It is
possible to distinguish between the two APs, but this requires a
further blood test.
If you are concerned about the amount of alcohol you are drinking,
don't be falsely reassured by a normal set of LFTs. It is common
for the LFTs to be quite normal, even in the presence of excessive
Thyroid Function Tests
(T4 and TSH)
Thyroid Function testing involves the measurement of Thyroid
Hormone (T4) and Thyroid Stimulating Hormone (TSH). TSH
is produced by the pituitary gland, which is a small gland that
is connected to the base of the brain. The TSH circulates in the
blood and reaches the thyroid gland, which is situated in your neck
(at about the position that a bow tie would sit). The TSH stimulates
the thyroid to produce T4 into the blood stream. T4 is a very important
hormone and can be viewed as a regulator of the body's metabolism.
If there is too much T4 you can feel hot and jittery, suffer from
diarrhoea and palpitations, and lose weight. If there is too little
T4, you can feel sluggish and you may gain weight along with other
changes in your appearance. There can also be significant rises
in your level of Cholesterol, with possible consequences for your
heart. It is possible for the level of T4 to be abnormal with very
few symptoms. It is also possible for the levels of T4 to be normal,
but for the TSH level to be raised - this might indicate that the
thyroid gland is struggling and requires more stimulation from the
TSH. This situation would need monitoring, and some would recommend
giving T4 supplements at this stage.
Lipids - Including
The lipid profile consists of measurements of total cholesterol,
HDL Cholesterol (High Density Lipoprotein - the so-called "good"
cholesterol), LDL Cholesterol (Low Density Lipoprotein - the so-called
"bad" cholesterol) and Triglycerides. We calculate the
ratio between total cholesterol and HDL cholesterol and this figure
is used in the QRisk algorithm that calculates your personal calculated
risk of heart attack and stroke over the next 10 years.
Prostate Specific Antigen
We offer this test to men over the age of 50. It is a test that
can identify the presence of cancer of the prostate but it does
have to be interpreted with care - some cancers will not result
in a rise in PSA and there are benign conditions that can cause
a rise. The doctor will explain the pros and cons of the test at
the time of the examination.