Understanding Investigations
	Blood tests Blood tests are performed at Stockett Lane Surgery by nurses and a phlebotomist (a person trained to take blood). When a blood test is required, the doctor or nurse will list the investigations required on the computer. Please see the receptionist to book your appointment; the necessary form will be available on the day of your appointment. The blood taking sessions are Monday, Tuesday, and Thursday mornings. Most results are received within 48 hours down a computer link from Maidstone Hospital. Some blood tests that are more specialist can take up to a month. Common slow results are thyroid (one week), HbA1C (diabetes test, two weeks), tests screening for arthritis (one month). You can ring to check your results. If the result is not back yet you will be asked to call back another day. ECG (Electrocardiogram) ECGs can be done at Stockett Lane Surgery by any of the Practice Nurses. Please book a 20-minute appointment if the doctor or nurse suggests you might benefit from one. The ECG is painless and involves sticky pads being placed on the chest wall, wrists, and ankles. These are then attached to chest leads which read the electrical activity across the heart. It is important to relax and stay still whilst this is being performed. If you are very hairy the Nurse might ask your permission to shave small areas of the chest to allow the pads to stick properly. The ECG is performed to look for damage to the heart (e.g. heart attack or angina) or to look for evidence of strain from high blood pressure. It can also be helpful for patients having palpitations or irregular heart beats. Having said that, because the ECG is a bit like a photograph it may miss the time that the heart is misbehaving. Your doctor may consider referring you to have a 24-hour ECG monitor fitted at the hospital. X-rays X-rays are performed at Preston Hall Hospital or the Opthalmic Hospital. You will be given a request form and you need to phone Preston Hall (01622 225686) or the Opthalmic Hospital (01622 226247) to be given an appointment at a convenient time. The results take two weeks to be sent to the Surgery. If the radiographer is concerned about the x-ray pictures they sometimes phone the Surgery directly. An x-ray is simple and painless. The only discomfort may be trying to get into a good position for the x-ray to be taken. It is not dissimilar to a photograph, but shows up particularly well broken bones or lung infections. Most chest infections resolve well and do not need an x-ray. Ultrasound Stockett Lane does not have facilities for ultrasound. Currently our patients go to Preston Hall and you will receive your appointment through the post. An ultrasound scan uses ultrasound waves to look at different parts of the body. It can be helpful to look for liver, kidney, gall-bladder and gynaecological problems. It is also used very widely to examine the babies of pregnant women to check they are growing normally. The examination is simple and painless. Conducting jelly is squirted on the area that the examiner wants to look at. A probe is then placed on the area and black and white pictures are viewed on a television screen. A report is then dictated which is sent to the doctors. This can take up to two weeks. Whilst a negative result is always reassuring, you should see your doctor for follow-up if your symptoms persist. You can telephone the Surgery to get your doctor's comment about the scan. If your doctor has requested a pelvic scan, this is done using a small vaginal probe. It does not have to go in very far to get much better pictures of the womb and ovaries than the same test done through the abdomen. You can ask for a chaperone during any examination if this makes you more comfortable. Spirometry This is a specialist breathing test which can be performed in the Surgery by Dotty, our Practice Nurse. She has undergone special training in lung diseases such as asthma and chronic obstructive pulmonary disease (smoke-related changes in the lung). The spirometry helps to distinguish between asthma and chronic obstructive pulmonary disease. It can help determine which inhalers will be of benefit to you. Sometimes it will be suggested that you should have a two-week course of steroid tablets after the spirometry and then have your readings repeated. The test is simple. You will be asked to blow at least three times into a tube connected to a machine which will record your lung function. To get the best results you need to take a deep breath and then blow as long and hard as you can. The test can be affected by various factors so, to make yours reliable, please remember the following rules: 1. The guidelines suggest that no smoking for 24 hours before the test will give the best results. Please tell the nurse if you have not managed to do this. 2. No reliever (blue inhaler, Salbutamol, Ventolin) for two-four hours prior to the test. 3. No long-acting reliever (Serevent, Oxis, Spiriva) 12 hours prior to the test. 4. Do not take chest medicines 12 hours before the test, e.g. Phyllocontin, Theophylline, Volmax, Singulair, Montelukast, Ventolin. 5. No alcohol four hours before the test. 6. No heavy meal two hours before the test. 7. Wear loose fitting clothing. 8. Avoid vigorous exercise for at least 30 minutes before the test. If you realise that you are developing a chest infection or are currently on steroids, please postpone the test for at least four weeks. Endoscopy (Gastroscopy, OGD) This is performed at Maidstone Hospital. It is usually requested for patients having problems with indigestion or heartburn. The doctors at Stockett Lane follow local guidelines about who might benefit from one. The test can be done with the patient awake (usually the mouth is sprayed with a local anaesthetic spray) or under sedation. This involves an injection of a drug to make you sleepy, which is reversed at the end of the procedure. A flexible fibre-optic camera is swallowed by the patient guided by the doctor performing the test. This is usually a very straightforward procedure and is at worst a little uncomfortable. The doctor is able to see on a television screen any sore areas which might indicate excess stomach acid or stomach ulcers. Any sore areas might be biopsied - i.e. a small piece is removed and analysed in the laboratory. They also usually do a test on the stomach contents called the Clo test. This is to look for a bacteria called Helicobacter pylori. If this is found, the doctor may offer treatment to kill the bacteria. This can speed up the healing process. Full blood count (FBC) This test measures the haemoglobin in the blood that carries oxygen. It also checks the white cells (that fight infection) and the platelets (that help the blood to clot when you are bleeding). A low haemoglobin is called anaemia and can be due to a number of causes, such as low iron or vitamin levels. The doctor may well ask you to come back for another blood test to check these levels. ESR (Erythrocyte Sedimentation Rate) This test is a measure of inflammation in the body. It is a very non-specific test and it naturally gets higher as you get older. This can make it hard to interpret. It is useful for monitoring arthritis. U+E (Urea and Erythrocytes) This test measures how well the kidneys are working. It can be helpful to do after a period of illness or to guide changes in medications that can also affect the kidneys and the salts in the blood. Liver Function Tests This measures the activity of chemicals in the liver. The liver function can be affected by alcohol consumption, injections, gall-bladder problems, and medications. TFT (Thyroid Function Tests) The thyroid gland is situated in the neck and produces a chemical called Thyroxine. Some people have a family (genetic) tendency towards the thyroid gland becoming under- or over-active. An under-active thyroid gland causes weight gain, tiredness, and intolerance of the cold. An over-active thyroid gland can cause sweating, weight loss, palpitations, a tremor (shakiness), and intolerance to heat. Both problems can be treated. Patients on replacement Thyroxine are asked to have yearly TFTs to check that they still require the same dose of medication. Glucose This checks your blood sugar level. If too high this can suggest diabetes. A high result is usually repeated. The doctor may ask for this to be a fasting test. You may also be asked to do a glucose tolerance test. This means no food or drink apart from water the night before the blood test, after your evening meal. Glucose Tolerance Test You need to follow a normal diet for at least three days before the test. Fast from 10 p.m. but not before. Water may be taken during the fasting period and test. The test will take just over two hours. No smoking is allowed on the morning of the test. Patients should rest through the test, although short walks are permissible. Monospot This test is also known as Paul Burnell. It is a test to look for the viral infection glandular fever. This is a relatively common infection in teenagers. It is also known as 'the kissing disease' and presents with a severe sore throat and excessive tiredness. INR (International Normalised Ratio) This is an assessment of how thick the blood is. A normal level is one. Some patients take Warfarin to thin their blood and they are given a target range for the INR. The higher the level the thinner the blood. This is monitored on a regular basis and can become less stable after a period, or illness, or certain medications. Cholesterol and Fasting Lipids High levels of fat in the blood can speed up the onset of heart disease by 'furring the arteries'. The accepted normal range depends on whether you have any other risk factors for heart disease such as age, family history, smoking, and blood pressure. If you have diabetes, heart disease (previous heart attack or angina), or have had a stroke we like your cholesterol to be below 5. The blood test is usually done fasting; this means only water to drink (no food) after your evening meal until the blood test is performed the following morning. Bone Profile This is a test which looks at the calcium level and other chemicals related to turnover of your bones. PSA (Prostate Specific Antigen) This test looks at the amount of this enzyme secreted in the blood, giving an indication of disease in the prostate. Further information is available on www.dphpc.ox.ac.uk/crcpcerg CRP (C-Reactive Protein) This is a test to look for signs of inflammation such as active arthritis or infection. It can be used to assess response to some treatments.