Using Athletic Testing to Monitor Your Progress

Athletic TestingWhether you’re a seasoned athlete or just starting your journey to fitness, you know that the more information you have about your performance, the easier it will be to build your diet and activity to yield maximum results. The superficial information is easy enough to get — it’s obvious when there are changes in your energy levels and appearance. But to know how your lifestyle is impacting your body’s internal systems, you need more thorough testing. At Any Lab Test Now, we have a series of tests that will help you determine where your body is starting from before you begin your fitness regimen, and ongoing testing to help you see what changes are going on under the surface as you train. Here are some ways Any Lab Test Now can help you in your athletic endeavors.

There are myriad tests you should undergo if you are starting a new fitness program, especially if you haven’t exercising regularly and are looking to make a dramatic change. In addition to giving you a full picture of the impact your current lifestyle is having on your body, comprehensive athletic testing can reveal underlying health issues that might make exercising or changing your diet challenging or risky. For example, if you have heart trouble that hasn’t been addressed, strenuous exercise can cause a heart attack. You should also get detailed information on your dietary intake by testing for nutrient deficiencies. This will help you build a targeted and detailed diet plan to meet your body’s needs.

You should continue testing to monitor your progress over time. Exercise and proper diet are known to lead to a reduction in risk factors for cardiovascular problems and metabolic disorders like diabetes, so continued testing should show a decrease in those panels. The micronutrient panel should show improvements, as should the hormone test, indicating that your body’s systems are functioning better. Another reason to continue testing is to help you make course corrections during your training. By helping you catch problems while they’re still relatively minor, these tests can save you time and discomfort, and help you keep your training on track.

This might sound complicated, but at Any Lab Test Now, we make it easy to keep track of what’s going on inside your body. So don’t stay in the dark about your health! If it’s worth going to the trouble of starting a fitness program, it’s worth knowing what would serve you best in your efforts. So find your local Any Lab Test Now to take a peek at your body’s inner workings with athletic testing!

The Importance of Cholesterol Testing

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Is your heart healthy? You may think the answer is “yes”, but do you really know? If you are an American male with an average American diet and lifestyle, the odds are not in your favor. In fact, the CDC says that 73.5 million adults (31.7%) in the United States have high LDL, or “bad,” cholesterol. And of those people, fewer than 1 out of every 3 adults (29.5%) has the condition under control.

You might be thinking, “So what? Who cares if my cholesterol is a little high?” YOU should care, and here’s why:

1. It can kill you. People with high total cholesterol have approximately twice the risk for heart disease as people with ideal cholesterol levels. Additionally, lowering your cholesterol can reduce your risk of having a heart attack, needing heart bypass surgery or angioplasty, and dying of heart disease.

2. Even if it doesn’t kill you, it can lessen your quality of life. You’ll suffer countless possible health problems, including chest pain, circulatory problems, digestive problems and gallstones.

So what is cholesterol?

Cholesterol is a fatty substance that travels through your blood on lipoproteins and is necessary for important bodily functions such as making hormones and digesting fats. Everyone needs cholesterol, but certain factors like poor diet can cause a person to have too much of it, and this can be a very bad thing. When you have too much cholesterol in your body, or high cholesterol, it will start to build up in plaque deposits along the walls of your blood vessels. Over time, this build-up causes the blood vessels to become narrower and narrower, allowing less blood flow to reach your heart and other organs. This can cause angina or even a heart attack if an artery becomes fully blocked by plaque.

Even if you think you’re healthy, it’s a good idea to get your cholesterol checked so that you can establish a baseline for monitoring your cholesterol in the future. And if you have high cholesterol, the sooner you learn about it, the better, so that steps can be taken to lessen your risk of death from heart disease.

At Any Lab Test Now, there are several options to choose from when it comes to cholesterol testing.

Our Lipid Panel provides a comprehensive look at your cholesterol levels, including testing for your total cholesterol, HDL, LDL, HDL/LDL ratio and triglycerides. The Lipid Panel is a great option for establishing a baseline from which to continuously monitor your cholesterol levels.
href=”https://www.anylabtestnow.com/tests/cholesterol-maintenance-panel/”>The Cholesterol Medication Maintenance Panel
and Basic Check-Up Panel are also excellent testing options for measuring your cholesterol levels. Talk to our experts at Any Lab Test Now to learn which cholesterol testing is right for you.

Celebrating Men’s Health Month!

Screen Shot 2015-06-01 at 10.26.17 AMSocietal expectations promote the idea that men should be tough and self-reliant, causing many to avoid visiting their doctor for routine check-ups and screenings. This June, the Men’s Health Network is celebrating Men’s Health Month to raise awareness about preventable causes of death in men and to encourage men to seek screenings that can help them live longer healthier lives.

According to the Centers for Disease Control (CDC), the top five preventable diseases that affect men are:

1. Heart disease. The number one killer of men is heart disease. Sadly, about 47% of the deaths from heart disease occur outside of the hospital. This means that men are not reacting to, or not experiencing, cardiac distress symptoms, like chest pain, nausea, cold sweats, upper body discomfort, lightheadedness or shortness of breath. So that men are better prepared to make a decision about seeking care, it is critical that they understand their heart health today and be aware of how it is changing over the years.  We recommend you consider the LPP Basic or LPP Plus Test!

2. Cancer. While men can be affected by many forms of cancer, skin and prostate cancer are the two most common. In fact, about one in seven men will be diagnosed with prostate cancer. Fortunately, prostate cancer is a relatively slow-growing cancer, and with early detection survival rates after five years are at 90 percent. We recommend you consider our PSA Test.

3. Chronic lower respiratory diseases. Smoking is the primary cause of chronic lower respiratory diseases. For this reason, men should quit smoking, or work with their doctor to get help in doing so. Chronic lower respiratory disease includes both chronic bronchitis and emphysema and is commonly referred to as Chronic Obstructive Pulmonary Disease (COPD).

4. Stroke. Every four minutes someone in the United States dies from a stroke: strokes are also the leading cause of preventable disability in the country. Strokes are caused by blocked blood vessels or from blood leaking into the brain. A health lifestyle that limits alcohol and avoids smoking may help to prevent a stroke from occurring.

5. Diabetes. Routine monitoring of diabetes symptoms is critical for living well with diabetes. By staying on top of the body’s needs, the 1.4 million people living with diabetes can help to stave off serious complications, such as nerve and kidney damage, cardiovascular problems or death. We recommend our Glucose or Hemoglobin A1C Test!

Men may feel that society dissuades them from seeking routine medical care and screenings. In reality though, by taking advantage of walk-in tests, like those offered by Any Lab Test Now, and gathering information about their health men may actually live stronger and more self-reliant lives longer.

Top Five Diseases That Affect Women’s Health

ALTN May corp(1)As women race through their days, many don’t stop to focus on their own health and well-being. For this reason, the U.S. Department of Health and Human Services’ Office on Women’s Health has designated May 8-14 as Women’s Health Week. This marks the 17th time the week has been recognized in an effort to encourage women to take ownership of their health.

While women’s health concerns may change as they age, five of the top health concerns faced by women include:

Heart disease. Heart disease accounts for more than 22 percent of female deaths according to the Centers for Disease Control and Prevention. There are multiple contributing factors to heart disease: high blood pressure, high cholesterol and diabetes. Exercise and other healthy lifestyle choices can help reduce your risk of heart disease.

Cancer. The Susan G. Komen foundation shares that one in eight women who lives to the age of 85 is at risk for breast cancer. Fortunately, with early detection, survival rates can be quite high. To protect themselves, women regularly should be completing self-breast exams, scheduling routine mammograms and seeking testing to see if they have any markers that could signify malignant tumors in any area of the body.

Chronic Lower Respiratory Diseases. This is often more recognizable as chronic obstructive pulmonary disease (COPD) and includes both emphysema and chronic bronchitis. While pollutants and chemical toxins may contribute to the development of these diseases, smokers get COPD nearly 12 times as frequently as non-smokers.

Stroke. Strokes are caused by blood clots that prevent blood from reaching the brain. According to Harvard Medical School, high blood pressure is the No. 1 risk factor for developing blood clots. Be sure to have your blood pressure checked regularly, especially if you are a smoker or using oral contraception. In addition, having a healthy lifestyle, which includes not smoking, can help reduce the chance of developing a blood clot.

Alzheimer’s disease.  According to the Alzheimer’s Association, women are twice as likely to be diagnosed with Alzheimer’s. Age, family history and heredity are the most common risk factors. While there is still much to learn about the disease, scientists are looking at the impact of exercise, diet and brain-engaging activities as potential ways to help keep the disease at bay.

So, ladies, celebrate Women’s Health Week by becoming more informed about the state of your own health, working with a doctor to address any issues and making lifestyle changes that will help you live your healthiest life yet!

The Dangers of High Blood Pressure

High blood pressure is a medical condition that rarely has noticeable symptoms but can have an outsized impact on your body’s systems. High blood pressure damages your heart and arteries, since the condition is a problem within the circulatory system. But your blood supplies every part of your body with oxygen, so when flow is affected it takes a toll on the body. For example, did you know high blood pressure could lead to memory loss? Read on to discover some of the more hidden dangers of high blood pressure.

Kidney damage

Your kidneys filter and remove the waste from your bloodstream. When a person has high blood pressure, however, the arteries in the kidneys become damaged, keeping oxygen from reaching the finger-like projections that filter the blood. Damaged kidneys also produce less of the hormone renin, which helps the body regulate blood pressure. The damage from high blood pressure then continues to affect the body.

Fluid in the lungs

If your heart is not able to pump oxygenated blood effectively, it will push fluid back into the lungs, in a condition known as pulmonary edema. This fluid prevents the full absorption of oxygen from inhaled air. This can cause a buildup of fluid in other parts of the body, as the heart becomes weaker and less able to transport blood. In the worst cases, the fluid buildup in lower extremities can cause liver congestion and swelling, which damages the liver. Pulmonary edema can be fatal.

Erectile dysfunction

Erectile dysfunction has two main types of causes — psychological and medical. Proper blood flow is absolutely vital to the function of sexual organs. But with damaged arteries, the body is unable to provide adequate blood flow to achieve and sustain an erection. In fact, most medical causes for erectile dysfunction have roots in the circulatory system.

Memory loss

If you feel like you’re constantly in a fog or forgetting things, the cause could be your blood pressure. Pressure and damage to the arteries and blood vessels in and around the brain often begin to deprive the brain of oxygen, which can lead to fatigue, memory loss and an inability to focus. In the worst cases, it can even lead to a stroke, which can destroy a person’s ability to speak, dress and feed themselves. In the worst cases, a stroke can lead to a coma or death.

Vision loss

High blood pressure can subject the eyes to heavy force from the movement or buildup of blood, causing damage to blood vessels and optic nerve. Over time, this can cause swelling of the optic nerve or degradation of the parts of the eyes, like the rods and cones that help detect movement and color. This is a scary effect of high blood pressure, and its only treatment is to lower blood pressure. And because the eyes are so sensitive, any damage to them is likely to be permanent.

So here are five really good reasons to get your blood pressure checked frequently! The lack of direct symptoms of high blood pressure can make it hard to detect, until it starts damaging other organ systems. So if you’ve noticed any of these changes in your body, it’s a good idea to get your blood pressure tested!

Give Your Heart Some Love

Feb. newsletter heart smallFebruary is full of hearts. Heart-shaped candies and cards, notes from loved ones signed with hearts, red and pink hearts in advertisements — they’re everywhere you look! And with mobile technology on the rise, you’re even getting hearts in your inbox! Love is in the air, and Valentine’s Day certainly puts the heart at the top of everyone’s mind, but are you thinking about the most important heart of all?

February is American Heart Month, and it’s time to start thinking about the heart. No, we’re not talking about the cutesy Valentine’s Day hearts you’re seeing everywhere these days. We’re talking about the heart beating inside you. The heart that’s keeping you alive. The heart that we’re guessing you haven’t given much thought about this month, or ever, for that matter.

So, why should you be thinking about your heart? Because heart disease is the leading cause of death in Americans, killing more people than every form of cancer combined. One in every four deaths in America is caused by heart disease, and if you aren’t concerned by this number, you should be.

There’s a reason heart disease is so prevalent in America. The most common cause of cardiovascular and heart disease is a buildup of fatty plaques in the arteries. And this plaque buildup is in turn commonly caused by certain lifestyle choices like:

  • having an unhealthy diet
  • lack of exercise
  • smoking
  • being overweight

It comes as no surprise that with an obesity epidemic overtaking the country, heart disease is right around the corner for millions of Americans. And the fact of the matter is, most people aren’t living a perfectly healthy lifestyle. According to the Centers for Disease Control and Prevention, more than one-third of U.S. adults are obese. That’s more than 78 million Americans who are at risk for having heart disease just because of their weight. Whether it’s a desk job, overly large portion sizes and unhealthy dietary choices, or maybe those hours spent watching TV every night, it is clear that something needs to change for a lot of people. But the question is, are you one of them?

How healthy is your heart? Do you really know the answer to that question? If not, you could be one of the millions of Americans with heart disease or at risk for developing heart disease. No one ever thinks it will be them, but the numbers don’t lie. There’s a possibility that you could be the one out of four who dies from heart disease unless you take the actions necessary to prevent it. The good thing about these odds, however, is that you can make the choice to actively change them. And the first step to taking control of your health is to get tested.

At Any Lab Test Now, there are lots of ways you can get started taking care of your heart! It is incredibly important to get tested if you think you could be at risk for heart disease. Once you have your results, you can begin making a plan for what you need to do to stay healthy.

The Heart Health Panel is a great option for those looking for a clear picture of their overall heart health. This panel can determine your risk for heart or cardiovascular disease by monitoring any electrolyte imbalances, and current cholesterol status in your body. It consists of four tests:

  1. VAP® (Vertical Auto Profile)
  2. Chemistry Panel (16 essential tests)
  3. C-Reactive Protein
  4. Homocysteine

If you’re interested in determining the health of your heart, you may also want to consider the C-Reactive Protein (High Sensitivity, Cardiac) test. It is a blood test that can assess your risk for cardiovascular disease, as well as your risk of having a heart problem or heart attack.

So, take some time off from thinking about all those Valentine’s Day hearts and give some love to the heart that matters most — the one inside you! It’s time to take control of your heart health and get tested so you can live your best life, for many more Februarys to come.

Eating Your Way Through The Holidays? You Might Want to Check Your Sugar Levels First

‘Tis the season — the season of eating, that is! We all get excited about our favorite foods when the holidays come around. There’s just something special about sharing a meal with family and friends, often with beloved family recipes that have been passed down through the generations. And there’s nothing wrong with enjoying a special meal with loved ones. The problem comes when these meals are high in unhealthy fats, added sugars and other not-so-good-for-you ingredients. Not to mention the fact that the spirit of the season has come to include a tradition of rampant over-indulgence in our favorite holiday treats. (Seconds, anyone?  Leftovers tomorrow?) This time of year is especially difficult if you have diabetes or prediabetes. You may want to reach for that pumpkin pie, but it is imperative to your health that you keep your sugar levels under control. So how can you enjoy the season and all the delicious foods it has to offer while keeping your health in check? Knowing your sugar levels ahead of time will help you decide what is safe to eat and what you should avoid.

Why should you check your sugar levels?

If you have diabetes or prediabetes, you know how important it is to keep your sugar levels down. Insulin is a hormone that helps get glucose (sugar) to your cells to use as energy. With diabetes, your body does not make or use insulin well. Without insulin, the glucose remains in your blood, raising your blood glucose (blood sugar) levels. Having high blood sugar can cause a number of serious problems to your health including, damage to your eyes, kidneys and nerves as well as heart disease, stroke and even the need for amputation.

One of the best ways to keep your blood sugar levels in check is to stick to a diabetes-friendly diet that limits foods high in sugar, fat, salt and carbohydrates. Everyone’s body is different, and it’s best to consult with a dietician to find a meal plan that’s right for you. But before you can know what you can and can’t eat, you need to know your blood sugar levels. This will give you an idea of how well you are managing your diabetes or if you are in danger of becoming diabetic.

The best way to know your sugar levels? Get tested!

If you are unsure of your blood sugar levels and you are concerned about your health, it is best to get tested before that big holiday dinner. When you are aware of your health, you can be proactive about preventing any serious problems. Would you rather have that second helping of sweet potato casserole or keep your left foot? It may sound extreme, but this is the situation you could be facing if you don’t keep your sugar levels under control as a diabetic or prediabetic. But if you want to take control of your health, you’re in luck! Any Lab Test Now has several testing options to help you monitor your blood sugar levels quickly and easily, no appointment necessary!

The Hemoglobin A1c Test is a valuable measure of the overall blood glucose levels over a period of time (two?three months). This test can be used to help detect prediabetes and diagnose diabetes. If you’re diabetic, this test can help determine if your disease is under control.

The Glucose (Serum) Test, also known as the Fasting Blood Glucose Test, is the most common test used to diagnose hyperglycemia (higher than normal levels of blood sugar), hypoglycemia (lower than normal levels of blood sugar) and diabetes. Diabetics self conduct this test multiple times a day to monitor their blood glucose, which is conducted as a finger stick and measured with a home glucometer. This test will determine if your blood glucose level is within a healthy range. It will also screen for, diagnose and monitor prediabetes, diabetes, hyperglycemia and hypoglycemia.

The Diabetes Maintenance Panel is an effective panel for both diabetics and for those who want to see if they have diabetes. This panel includes four tests: The Complete Blood Count (CBC), the Fasting Glucose, the Hemoglobin A1c and the Diabetic Urinalysis. The information gained from the four tests in this panel will give you and your physician the necessary information to help monitor and/or adjust your diabetic medications.
Talk to our experts at Any Lab Test Now to find out which test is right for you! The sooner you know your blood sugar levels, the sooner you can take control of your health this holiday season.

Have heartburn? You might want to check for Helicobacter Pylori (H. Pylori)

Helicobacter pylori. You’ve probably never heard of this crazy-sounding word, but it may be closer to you than you think! Helicobacter pylori (H. pylori) is a potentially dangerous bacteria that thrives in the acidic environment of the stomach. It can cause painful symptoms, including stomach pain, nausea and even heartburn. Yes, that’s right. These common symptoms could actually be caused by an H. pylori infection in your stomach! So if you have frequent heartburn, it’s time to put down the antacids and find out what’s really going on!

What Is Heartburn?
Heartburn is a burning pain in your chest, right behind the breastbone. Typically, the pain is worse when lying down or bending over. Occasional heartburn is incredibly common and can usually be reduced through lifestyle changes and over-the-counter medications. However, if you are experiencing frequent heartburn, especially if it interferes with your daily routine, this may be a symptom of something more serious. If you have any of these symptoms, you may want to talk to your doctor about other possible causes of your heartburn, including the H. pylori bacteria:

  • Your heartburn occurs more than twice a week
  • Your symptoms continue despite use of over-the-counter heartburn medications
  • You have difficulty swallowing
  • You have frequent nausea or vomiting
  • You have lost weight because of poor appetite or difficulty eating

Could You Have A Helicobacter Pylori Infection?
Helicobacter pylori is a type of bacteria that can infect your stomach and is a common cause of peptic ulcers. In fact, while many try to blame their ulcers on stress or spicy food, 80 percent of stomach ulcers and 90 percent of duodenal ulcers (in the upper end of the small intestines) are caused by H. pylori. The H. pylori bacteria may also cause gastritis and even gastric (stomach) cancer.

Most people with an H. pylori infection never have any signs or symptoms, so they don’t realize they have it. However, if you develop signs of a peptic ulcer, you may have the infection. When symptoms do occur they can include:

  • Pain (an ache or burning) in your abdomen, just under the ribs
  • Abdominal pain that becomes worse when your stomach is empty
  • Loss of appetite and unintentional weight loss
  • Nausea
  • Frequent burping, heartburn and indigestion
  • Bloating

Should I Get Tested For H. Pylori?
If you are experiencing any of the symptoms listed above, you should consider getting tested for H. pylori. Any Lab Test Now offers several testing options if you suspect you may have an H. pylori infection or are suffering from chronic heartburn and want to know why:

  • The H. Pylori Stool Test can be used to detect the presence of the H. pylori antigen in stool specimens.
  • There is also a Urea Breath Test (UBT), which can be used to indirectly detect the presence of H. pylori urease by measuring carbon dioxide in the patient’s breath.

Both the Stool Test and Urea Breath Test are recommended by both the American Gastroenterological Association (AGA) and the American College of Gastroenterology (ACG) as non-invasive tests for diagnosis and confirmation of eradication.

If you are suffering from chronic heartburn, you need to talk to your doctor or gastroenterologist before it’s too late. H. pylori is a highly destructive bacterium that can lead to ulcers, gastritis and even stomach cancer. Talk to the experts at Any Lab Test Now to find out how you can get tested for H. pylori and end your heartburn suffering, once and for all!

*Some locations are unable to offer the H. pylori blood test, so please check with your local Any Lab Test Now to learn about your testing options.

Why Becoming A Bone Marrow Donor Is So Important

September is National Blood Cancer Awareness Month, and this means it’s time to start thinking about what you can do to help the thousands of people every year who suffer from this disease. Every three minutes in the United States, someone is diagnosed with blood cancer — more than 175,000 new cases each year. More than 55,000 people will die from blood cancer in this year alone. A bone marrow transplant is many of these patients’ best hope for survival, but only about 30 percent of patients are able to find a matching donor within their families. The other 70 percent have to rely on donations from strangers, and sometimes there just aren’t enough to go around. Around 3,000 people die each year while waiting for a match. By donating bone marrow this month or becoming a part of the bone marrow registry, you could save someone’s life.

Blood cancer encompases all malignancies of the blood, bone marrow or lymph nodes that affect normal blood cell production or function. As the diseased blood cells multiply, they cause life-threatening damage to the immune and circulatory systems. There are many different types of blood cancers, including leukemia, lymphoma and multiple myeloma. Patients with any of these types of blood cancer require bone marrow transplants for the best chance of beating the disease.

Any Lab Test Now is proud to support Delete Blood Cancer in its mission to provide help to those suffering from blood cancer. We have partnered with Delete Blood Cancer to encourage our local communities to become a part of the bone marrow registry, and we encourage you to do the same. We also collect specimens on behalf of Delete Blood Cancer and hold Swab Parties periodically throughout the year to build awareness of the need for bone marrow donors.Did you know that it only takes a simple swab from the inside cheeks of your mouth to be entered into the registry?  Yes, it is that simple.  And, did you know that about 75% of bone marrow donations are through a process similar to collecting platelets? With just one donation and a few hours of you time, you could give someone suffering from blood cancer an entire lifetime.

Are you concerned about your own health? At Any Lab Test Now, we have several cancer screens that may help you get the answers you need. Talk to your doctor or our experts at Any Lab Test Now to find out which test is right for you.

What are the Differences between a Lipid Panel, VAP® Test and PLAC Test?

So you’ve been told you may need to have some cholesterol tests done.  Or, maybe you are getting ready to get in shape and eat right, and want to set a baseline to measure what’s going on inside. Getting tested is the first step to becoming a healthier, happier you. Any Lab Test Now is here to help you Take Control of your Health® with the Lipid Panel, VAP Test or PLAC Test – three different tests to measure your cardiovascular health. But which test is right for you? Read on to learn more about each of these tests.

Lipid Panel
A Lipid Panel is used to determine if you have abnormal cholesterol or triglyceride levels. These measurements can help your doctor determine if you are at risk for heart disease or other coronary illnesses. A Lipid Panel includes five tests: Total Cholesterol, HDL, LDL, HDL/LDL ratio and triglycerides. When evaluated together, these tests can help your doctor determine if you would benefit from a cholesterol maintenance medication. You are required to fast for at least eight hours prior to the tests. A Lipid Panel costs only $49 at Any Lab Test Now.

VAP Test
A VAP Test, or Vertical Auto Profile test, is used to provide an extremely accurate picture of an individual’s potential for heart disease and diabetes. Not only does this test include the basic cholesterol tests seen in the Lipid Panel, but it also gives a detailed report of individual lipoprotein subclasses and apolipoprotein subclasses. It identifies any cholesterol abnormalities that may be a precursor to heart disease or diabetes and can help your doctor provide the proper care to prevent future heart attacks. Best of all, you are not required to fast for this test so can come in anytime during the day. A VAP Test costs $79 at Any Lab Test Now.

PLAC Test
A PLAC Test measures the increase of an enzyme present when your arteries are inflamed. This test can help your doctor better assess your risk for heart attack and stroke, as well as determine any necessary medication or lifestyle changes. The U.S. Food and Drug Administration uses this test to assess the risk of coronary heart disease and ischemic stroke, associated with atherosclerosis. The PLAC Test is usually an “add on” to other tests, and no additional blood work is necessary if done with another blood test or panel. You are not required to fast for this test. A PLAC Test costs $139 at Any Lab Test Now.

Ignoring it won’t make it better!  If you haven’t had your cholesterol checked lately, now is the time to do it – for you and your family.