Health Check Results: Key Concerns for a 63-Year-Old Man

I would like to inquire about the health check results?

Hello Doctor, I would like to ask you about my father's health check-up report results: <1> Male, 63 years old, 180 cm, 72 kg <2> Electrocardiogram: Abnormal R wave, abnormal ST segment, heart murmur <3> Increased pulmonary markings bilaterally, mild restrictive ventilatory impairment <4> High-density lipoprotein cholesterol: 6.3, low-density lipoprotein cholesterol: 200 <5> Nucleus accumbens neutrophils: 31, lymphocytes: 63, white blood cells: 11.7, globulin: 2.2 <6> Total bilirubin: 1.2 <7> Mild proteinuria <8> Bone mineral density: -1.1 <9> Mild fatty liver.
These are the health check results! The data highlighted in red, what should we pay attention to? My father's daily routine is relatively normal (wakes up at 7:00 AM, sleeps at 10:00 PM).
He experiences long-term tinnitus and his legs shake before sleeping.
~~ I kindly ask for your help and suggestions! Thank you!

Juanjuan, 20~29 year old female. Ask Date: 2012/10/29

Dr. Chen Bozhang reply Family Medicine

Dear User,
Regarding the issues mentioned in your health check report, the points highlighted in red are summarized as follows:
1.
Electrocardiogram (ECG) Findings: Abnormal R wave, abnormal ST segment, and heart murmurs.
It is recommended to visit a cardiology clinic for a physician consultation and to arrange for an echocardiogram for further assessment of cardiac function.
2.
Increased Lung Markings at Bilateral Hilar Regions and Mild Restrictive Ventilatory Impairment: Does your father have a history of long-term smoking or past lung diseases that may have caused sequelae? If there is mild restrictive ventilatory impairment, it is advised to engage in cardiovascular endurance exercises regularly and to visit a pulmonology clinic for lung function evaluation and management recommendations.
It is best to avoid smoking, exposure to secondhand smoke, and air pollution.
3.
High-Density Lipoprotein (HDL) Cholesterol: 6.3 mg/dL, Low-Density Lipoprotein (LDL) Cholesterol: 200 mg/dL: Is the HDL value of 6.3 mg/dL accurate? The normal reference range is above 40 mg/dL.
It is recommended to reduce the intake of organ meats, seafood, egg yolks, and fried foods, while increasing the consumption of high-fiber foods, whole grains, and deep-sea fish oil.
Regular exercise should be incorporated to raise HDL levels, and a follow-up check should be done at a family medicine or general internal medicine clinic in three months.
4.
Elevated White Blood Cell Count with Abnormal Differentiation: This may indicate a systemic inflammatory response.
Please visit a family medicine or general internal medicine clinic for clinical evaluation.
In the presence of inflammation, urinary protein may also be detected.
5.
Bone Mineral Density of -1.1: This indicates bone loss.
It is advisable to increase the intake of calcium-rich foods, get moderate sun exposure, and exercise regularly while avoiding excessive smoking, alcohol, and coffee to prevent osteoporosis.
6.
Mild Fatty Liver: Your father is not obese (BMI within the normal range) but has fatty liver.
If there is a history of alcohol consumption, it is crucial to abstain from alcohol.
He should maintain a low-fat and balanced diet along with moderate aerobic exercise.
Annual follow-up with abdominal ultrasound and liver function tests is recommended.
A bilirubin level of 1.2 mg/dL is still within the normal upper limit, and the abdominal ultrasound did not report any biliary or gallbladder lesions, so observation is sufficient.
Health check reports should always be interpreted in conjunction with personal medical history and clinical presentation for the best assessment.
I hope these simple suggestions are helpful to you.
Sincerely,
Dr.
Chen Po-Chang
Department of Family Medicine
Keelung Hospital

Reply Date: 2012/10/29

More Info

Understanding health check results for a 63-year-old man involves careful consideration of various parameters that can indicate underlying health issues. Based on the provided health check results, several key concerns arise that warrant further evaluation and management.

1. Cardiac Concerns: The electrocardiogram (ECG) findings of abnormal R waves and ST segment changes, along with the presence of heart murmurs, suggest potential cardiac issues. These abnormalities could indicate ischemic heart disease or other cardiac conditions. It is crucial for your father to follow up with a cardiologist for a comprehensive evaluation, which may include a cardiac ultrasound (echocardiogram) and possibly a stress test to assess heart function and blood flow.

2. Pulmonary Health: The report indicates increased lung markings at the hilum and mild restrictive ventilatory impairment. This could be related to chronic conditions such as pulmonary fibrosis or other lung diseases, particularly if there is a history of smoking or exposure to environmental pollutants. A pulmonary function test (PFT) and possibly a chest CT scan may be needed to further evaluate lung function and structure.

3. Lipid Profile: The lipid levels show a high-density lipoprotein (HDL) of 6.3 (which seems unusually high and may need verification) and a low-density lipoprotein (LDL) of 200, which is concerning. Elevated LDL cholesterol is a significant risk factor for cardiovascular disease. Lifestyle modifications, including a heart-healthy diet low in saturated fats and cholesterol, regular physical activity, and possibly medication, should be discussed with a healthcare provider.

4. White Blood Cell Count: The elevated white blood cell count (11.7) and the differential showing a high percentage of lymphocytes (63%) could indicate an ongoing infection or inflammatory process. This warrants further investigation to rule out any underlying infections or hematological conditions. A follow-up with a primary care physician or a hematologist may be necessary.

5. Kidney Function: The presence of mild protein in the urine and elevated creatinine levels (not specified but indicated as concerning) could suggest early kidney dysfunction. Monitoring kidney function through regular blood tests and urine analysis is essential, and lifestyle changes, such as managing blood pressure and blood sugar levels, are critical to preventing further deterioration.

6. Bone Health: The bone density score of -1.1 indicates osteopenia, which is a precursor to osteoporosis. It is important to ensure adequate calcium and vitamin D intake, along with weight-bearing exercises, to strengthen bones. A referral to a specialist in bone health may be beneficial for further assessment and management.

7. Fatty Liver Disease: The report mentions mild fatty liver, which can be associated with metabolic syndrome, obesity, and alcohol consumption. Even though your father’s BMI is within a normal range, dietary habits and physical activity should be evaluated. A consultation with a nutritionist may help in managing liver health through dietary modifications.

8. General Health and Lifestyle: Your father’s daily routine seems stable, but the reported symptoms of persistent tinnitus (ear ringing) and leg tremors before sleep should be addressed. These could be related to anxiety, sleep disorders, or neurological issues. A thorough evaluation by a neurologist may be warranted to explore these symptoms further.

In summary, the health check results indicate several areas of concern that require further evaluation and management. It is essential for your father to have follow-up appointments with relevant specialists, including a cardiologist, pulmonologist, and primary care physician, to address these findings comprehensively. Additionally, lifestyle modifications focusing on diet, exercise, and regular monitoring of health parameters will be crucial in managing his overall health and preventing potential complications.

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