October 16, 2014

Five health tests you need now

By Terri Yablonsky Stat

You’re in recovery and on a path to wellness. Part of this journey includes acknowledging that substance abuse may have negatively affected your body’s organs.

It’s time to see a primary care doctor or internist about your over- all health. But what medical tests do you need? And how should you talk to your doctor about your history of addiction?

Experts agree that a complete physical examination is in order. Substance abuse can take its toll on a variety of your body’s organs and systems, and the extent of the damage may not be clear until you enter recovery.

“Your health cannot be accurately assessed during detox, because your body is in acute withdrawal and things have to calm down like the liver, nerves and brain,” says Aaron Michelfelder, MD, a family physician and associate professor in the Department of Family Medicine at Loyola University Medical Center in Chicago.

Dr. James Golden, director of inpatient medical services at the Betty Ford Center in Rancho Mirage, Calif., agrees. “The tests you need should be determined on an individual basis,” he said. “after a comprehensive initial assessment by a physician who has experience working with patients in recovery.”

For many in recovery however, doctors recommend the following tests:

1.  Full blood workup.This includes a complete blood count (CBC), which tracks how well your immune system is working. Blood work also reveals deficiencies in vitamins and minerals, such as vitamin B12, iron and folic acid. Other tests include thyroid-stimulating hormone (TSH), lipid panel (triglycerides and cholesterol), and glycohemoglobin for diabetes.

2.  Liver function tests.Alcohol and drug abuse can wreak havoc on the liver, but damage can be stabilized and even reversed. Liver function tests measure enzyme levels and the clotting factors prothrombin time (PT) and partial thromboplastin time (PTT). Abnormal liver tests are common, says Dr. Golden, and should probably be repeated sometime within 3 to 6 months to be sure they normalize. “Most of the time they are abnormal due to alcohol effect, but other conditions can have an effect, so we don’t make assumptions about abnormal liver tests in general,” he says. Golden also recommends testing for hepatitis.

3.  Nutritional evaluation.If you’ve abused drugs or alcohol, you may have depleted your body’s store of vitamins and minerals. Following a proper diet while in recovery not only helps replenish essential nutrients, but helps your brain chemistry regain balance. Proper nutrition also gets your metabolism and organ function back on track. A balanced diet can also help stave off weight gain, which is common in recovery.

4.  Screening for mental health issuessuch as depression and anxiety. Treating these disorders is essential to your recovery. You may have had an underlying psychological disorder before sub- stance abuse, or it can happen after treatment. Becoming sober can increase anxiety and depression, especially if you abused alcohol, says Dr. Michelfelder. Alcohol changes the brain’s levels of serotonin and norepinephrine. It can take up to a year for these brain chemicals to level out.

5.  Neuropsychological tests.Substance abuse can lead to poor cognitive function. Tests can measure short-term memory, psycho- motor speed and task switching, among other things. The timing of these tests is important, especially if you’ve been dependent on alcohol. It can take 3 to 6 months or longer for your cognitive function to improve.

Other tests you may need:

Hormone testing.Men with a history of using opiates, alcohol or marijuana may feel depressed or “weak” due to decreased testosterone. Women may need their estrogen and progesterone levels checked, because alcohol can affect menstrual cycles and hormone levels.

Sleep study.Sleep varies with drug and alcohol use, so sleep studies can show changes in sleep patterns and sleep quality during recovery.

STD testing.If you have a history of stimulant use, injection drug use, or alcohol abuse, you may need testing for human immunodeficiency virus (HIV).

Hepatitis A and B vaccine.Anyone with liver damage should have these vaccines. You should also consider testing for hepatitis C antibody.

Tuberculin skin testing.Anyone who has potentially been ex- posed to tuberculosis, such as an injection drug user, should have a tuberculin skin test.

Tell your dentist you’re in recovery, too.Regular dental cleanings and examinations are important, especially if your history includes poor nutrition and dental hygiene. Many drugs decrease saliva and cause dental disease such as gingivitis. Your dentist may discourage the use of nitrous oxide because it can lead to cravings and potential relapse. You and your dentist must balance the potential for relapse with the need for pain control. Both pain medications and pain itself can potentially trigger relapse.

How to talk to your doctor about your addiction.

Your doctors need to know about your addiction history to give you the best treatment possible. Be honest with them. They are trained to focus on your health and wellness and will not judge you or be critical of your history.

“We tell our patients to tell every health care practitioner they see that they’re in recovery and their history of substance abuse,” says Michael Pantalon, an addiction expert and psychologist at the Yale School of Medicine in New Haven, Conn. You should either discuss it directly with your doctor, or give your main point person – your addiction specialist – permission to discuss it with your doctor.

“Say, ‘I’m in recovery. This is what I’ve used and this is how long I’ve been sober. I’m worried that many things may have been negatively affected by my addiction. Can I have a full workup?’” says Pantalon.

Testing will need to be done over time, not in just one visit, says Michelfelder. Be patient and establish a relationship with your physician so they can work on these issues with you.

“I’ve always appreciated it when a patient says I’m an addict in recovery and I do not want to be prescribed addictive medications such as narcotics,” says Michelfelder. “We have other options now. It’s really important for the addict in recovery to be diligent about their own health with their doctor. People need to advocate for themselves.”

Terri Yablonsky Stat has written about health, wellness, parenting and lifestyle issues for 25 years. She recently launched The Professional Hypochondriac, a health blog for women found at www.theprofessionalhypochondriac.com.


Other articles you might be intereseted in…

Identifying addiction in the medical community 

In sickness and in poor health

Report shows addiction still widely misunderstood 

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