Preventive Health Care: What You Don't Feel Can Still Matter

Sep 23

6 min read

Why Feeling Well and Being Well Aren't the Same Thing

Recently, a good friend of mine bought a new home. She did what most of us would consider the right due diligence. She hired an inspection company, reviewed the report, and moved forward.

Then the surprises started.

A new water filtration system revealed that the well needed to be replaced. New pool tile uncovered the need to refinish the pool. Emptying the septic tank revealed that it was collapsing, and new regulations meant she would need to connect to the community sewer system. When she began planning for storm-safe windows, termites were discovered.

Ka-ching, ka-ching.

Three months later, the house she thought she understood had become a money pit.

The previous owner had not intentionally hidden a disaster. Much of what was happening had simply been developing quietly behind the scenes, until someone looked more closely or something finally stopped working.

We can make a similar mistake with our health.

Many people have an annual physical and routine blood work. They stay current with appropriate preventive screenings such as mammograms and colonoscopies. They exercise, feel well, and reasonably assume that if something important were changing, they would know.

But routine testing is a little like checking the tires, the oil, and the radiator fluid in a car. Those checks matter, but they do not tell you everything that may be happening under the hood. In conventional medicine, the deeper evaluation often does not happen until there is a reason to look more closely.

Feeling well and being well are not the same measurement. And the space between them is often where we have the greatest opportunity to be proactive, while the choices are still relatively simple.

Your Body's Job Is to Keep You Feeling Normal

Here is the part that surprises people. The body is not built to report problems early. It is built to absorb them. Your body is constantly compensating.

Blood pressure, blood sugar, breathing, hydration: all of it runs on feedback loops designed to keep things steady even while something behind the scenes is beginning to drift.

When those systems are working, you can feel completely normal. That is not a flaw in the design. That is your physiology doing exactly what it is supposed to do.

The problem is that the same processes that keep you stable can also delay the warning signs.

Coronary artery disease is a good example. You can run, play tennis, cycle, and feel terrific while plaque is quietly developing in your arteries. Exercise is enormously protective, but it does not cancel everything else you do.

Around here, someone can finish a run with the local club and then head to the pub for wings and a couple of beers. The run absolutely helped. But exercise does not erase the effects of everything else we do. Cardiovascular risk is shaped by the combination of our activity, nutrition, inflammation, genetics, sleep, alcohol use, and other factors over time.

Genetics can add another layer. Lipoprotein(a), or Lp(a), is largely inherited and is not included on a standard cholesterol panel. You can exercise regularly, feel terrific, and have reassuring cholesterol numbers while still carrying an important cardiovascular risk factor you would never know about unless someone thought to look.

Your brain can hide change in a different way. Being able to solve Sudoku or crossword puzzles does not necessarily mean your cognition is unchanged. In the most common form of Alzheimer's disease, one of the earliest signs is difficulty learning and retaining new information.

That may look surprisingly ordinary. The new TV arrives and you cannot remember how to find ESPN. You get a new phone and keep forgetting how to turn the ringer off. Meanwhile, things you have known for years can remain remarkably intact. These subtle changes can appear long before the more obvious problems people associate with dementia, such as difficulty managing bills, repeating questions, or forgetting familiar people and places.

Everyone has moments like these. What matters is a change from what's normal for you.

Quick Tip: Bring Your Family History

Before your next physical, find out what you can about your parents' and siblings' health: early heart attacks or strokes, high cholesterol, diabetes, or dementia. It's one of the most useful things you can bring to a visit, and it costs nothing.

How Changes Can Go Unnoticed

There are a few common reasons important changes can be easy to miss.

One of these is drift. Change that happens slowly is easy to normalize. Blood pressure can creep upward over years without a single day feeling dramatically different from the one before it. Hearing often fades the same way. People do not always notice that their hearing has changed. They notice that everyone seems to mumble and restaurants have become unbearably loud. Night vision, grip strength, waistline, and blood sugar can all shift gradually enough that the new normal simply becomes normal.

Another is misattribution, and for active adults this may be the most common. You do notice something, but there is an easy explanation for it. Recovery takes longer because you entered a new decade. You gained weight during recovery from shoulder surgery. Your energy is off because of work, travel, or the new puppy.

Sometimes that explanation is exactly right. Sometimes something treatable is hiding behind it: iron deficiency, thyroid changes, sleep apnea, nutritional gaps, or hormonal shifts.

Perimenopause is a good example. Its symptoms are often blamed on stress, family obligations, poor sleep, anxiety, depression, or simply getting older. The problem is not that those explanations are impossible. It is that they can become the default before anyone asks whether a hormonal transition is part of the picture.

Quick Tip: Question the Easy Explanation

When you notice a change and already have a reason for it, ask one more question: If that reason went away, would I expect this to get better? If the answer isn't clearly yes, it's worth mentioning to your physician.

Fitness Is Excellent Camouflage

Active people are often very good at pushing through discomfort. That can be an asset in training, but it can also make subtle changes easier to dismiss.

A slower recovery gets blamed on age. A little more shortness of breath gets blamed on being out of shape. A nagging ache gets worked around. "No pain, no gain" may be useful motivation in the gym, but it is not always a good medical strategy.

None of this is an argument against exercise. Quite the opposite. Exercise remains one of the most powerful tools we have for protecting long-term health. The point is simply that being fit is not the same thing as having had a complete evaluation.

Preventive Health Care: The Temptation, and the Discipline

The obvious conclusion from all of this is to test everything. That is not the answer either.

More testing does not automatically mean better health. Every test should answer a meaningful question, and ideally the result should have the potential to change what we do next. Otherwise, we are simply collecting data.

The opposite mistake is assuming that a handful of normal results means there is nothing more to understand. A standard cholesterol panel, a fasting glucose, an A1c, or a blood pressure reading can all be useful. But each one answers a limited question. None of them tells the whole story by itself.

Good preventive health care is not about testing everything. The discipline is knowing when to look deeper and when not to. Your family history, lifestyle, nutrition, genetics, symptoms, medications, and goals all help determine what deserves a closer look.

The goal is not more data. It is targeted testing, followed by targeted interventions based on your health, your risks, and your goals.

Why Early Matters

The reason to look earlier is not to label someone with a diagnosis. It is to interrupt the process that leads to disease.

A change caught early also gives us room to use simpler, gentler interventions. Blood pressure that is beginning to drift upward may lead to a conversation about sleep, alcohol, sodium, exercise, stress, or weight before medication is even part of the discussion. Blood pressure discovered at 178/102 in an urgent care waiting room is a different conversation.