May is Health Screening month and it’s just around the corner, so let’s address what testing you should include with your next annual medical exam.
An annual physical with your doctor is your chance to identify how you are aging, how to increase your energy and mental sharpness, plus how to prevent cancer, memory loss, and heart disease. Yet too often, this opportunity is replaced with a quick blood pressure and weight check, brief lab work with results you might not even see, a quick listen to your heart, a pap smear or prostate check (and maybe not these either), and too little time to ask questions on things that are important.
Part of the challenge is that medical insurance does not normally pay to assess how you age, how to improve your quality of life, or how to prevent a future health problem, despite that this may be incredibly important to you. It does cover the diagnosis and treatment of a disease, with treatments that have been proven to be cost-effective. Sadly, there is an ongoing debate between doctors and health systems as to whether we should stop offering annual physicals altogether.
Your annual evaluation should clarify how you are aging, help you to achieve peak performance, identify the long-term health risks that you face, and give you the tools to avoid those same threats. Your yearly doctor’s appointment could be your opportunity to shift from:
- Tired,,,,,,to Energized
- Mentally Foggy,,,,,,to Sharp & Productive
- Worried About Your Health & Future,,,,,,To Confident that You’ll Live Life to the Fullest
Your annual assessment should cover the following areas:
- Weight control: identify your body fat percentage, lean mass, and both a short term and long term optimal weight goal
- Food and nutrient intake: Do you meet your key nutrients needs, and if not what foods and/or supplements could you take to achieve proper nutrient intake
- Fitness: Assess your strength, flexibility, and aerobic performance.
- How you are handling stress
- Blood sugar control
- Cardiovascular risk, the #1 killer for men and women
- Brain function and risk for memory loss
- Cancer Risk: in particular skin, colon, and GYN or prostate
- And depending on your history, it might also include your exposure to toxins, risk for bone loss and osteoporosis, safety risks, travel history, support systems, immunization status, and more
The minimum laboratory testing that I would suggest would include your fasting blood sugar level (as part of a CMP—chemistry profile), fasting cholesterol profile, inflammation marker (high sensitivity CRP), thyroid function (TSH), blood count (CBC), nutrient levels (such as vitamin D, ferritin, and perhaps vitamin B12 and RBC magnesium), and a measure of how you are handling stress (such as DHEA-S, and/or Heart Math testing). And at least once by age 50-60, bone density testing (DEXA) as well. Make sure to ask for this type of testing at your visit if it isn’t already performed.
Other additional optional testing that you might want to consider, although it may not be covered by insurance, would include: assessing your arterial plaque load (carotid intimal media thickness testing), computerized cognitive testing to assess your brain processing speed, whole blood mercury level, treadmill ECG and VO2max testing, bone density, and clarifying your hormone levels.
I like to offer a detailed head to toe physical every year, but I realize that this seldom occurs in this day and age.
The truth is that this type of comprehensive evaluation takes time, and time with your physician has been rationed in our new health system.
At my clinic, Dr. Tarin Forbes (my new physician partner and the medical director for our clinic) and I typically spend 3-4 hours of one-on-one time with a new patient to complete an evaluation, and the patient is in our office for nearly 7-8 hours. That evaluation includes all the testing noted above, plus nutrition and fitness. We clarify your unique health goals and come up with a realistic plan to achieve those objectives. But the reality is that most doctors don’t offer nutrition and fitness testing in their medical practice.
One option to have an optimal evaluation within a traditional medical setting is to see a nutritionist and exercise physiologist separately prior to your doctor visit and share those results with your doctor.
Have a local nutritionist evaluate your three-day eating plan for nutrient intake. During three typical days, write down everything you eat (breakfast, lunch, dinner, snacks, and beverages), and have the nutritionist identify your current nutrient intake. Clarify if you meet your needs for fiber, protein, vitamin D, B vitamins, vitamin K, fish oil, magnesium, probiotic, and zinc? Then work out a plan to ensure that you correct any obvious nutrient deficiencies, as much as possible with food, and use supplements to finalize your plan.
Similarly, meet yearly with an exercise physiologist at a gym and have them assess your strength, endurance, flexibility, and aerobic fitness. With that information in hand, have that fitness expert develop a plan to enhance your fitness over time. Of course, you’ll have to do the work, so make sure they make recommendations that are realistic for you and your schedule.
One of the keys to getting a good evaluation with your physician is to clarify up front, as you schedule your appointment with the receptionist, and as you begin speaking to your physician, that you want to optimize your health through healthy eating, essential nutrients, fitness, and proactive stress management, and that you are hoping that your physician can guide you on your way. That you would be willing to pay out of pocket for a few of the laboratory studies recommended if needed.
Please don’t sabotage your assessment by bringing a laundry list of complaints to your annual evaluation, such as headaches, rashes, or other health issues that are designed to be covered by a medical visit covered by your insurance. During my all-day assessment, I have the time to cover these type of concerns, but a regular doctor seeing 30+ people per day can’t do both, and dealing with aches and annoyances somehow takes priority over long-term health. If needed, make a separate appointment for any chronic medical problems, so that your physical can focus on your long-term health issues.
My hope is that addressing your key health issues (food, nutrients, fitness, stress management, and toxic avoidance) will help to transform your relationship with your physician for the better. This is your chance to step away from the traditional disease management focus, and instead, address your long-term health goals and aspirations.
I believe that you deserve the best of health. An annual health evaluation, with the proper attention, can help you to achieve your goals, and improve your quality of life for decades to come.
I wish you the best of health!
Steven Masley, MD, FAHA, FACN, FAAFP, CNS
If you’d like to have the best, most comprehensive physical evaluation of your life, to clarify how you are aging on the inside and what you could do to OutSmart Aging, then consider an Optimal Health Evaluation at the Masley Optimal Health Center, in St Petersburg, FL. Schedule by the end of May 2018 and receive $500 OFF your first full day evaluation, and get ready to transform your life for the better. Call Toll Free 844-300-2973, to schedule your appointment.
Great post! Thank you so much! As a health coach, not even I knew to meet with an exercise physiologist. Thank you!!!
I’m curious about the whole blood mercury level test. I was under the impression that no single test (blood, urine, or challenge) gives an accurate reflection of the total mercury burden a body carries. Is there validation for the whole blood mercury test? Does it give a reflection of what the body caries rather than a snapshot of what’s going through the blood at a moment in time? Thanks, James, for your fine work
Bob, That is a good question.
The whole blood mercury test is a great way to assess your mercury intake over the prior 3-4 months, but it doesn’t clarify how much mercury you might have stored from the past. To do a mercury body load test, you would need to do a single dose chelation challenge. In our office what we do is we have a person empty their bladder, then take a DMSA 500 mg capsule, hydrate well, and collect their urine for the next six hours. Then we send to the lab to measure mercury load. The doctor performing this test needs to have a special reference range to determine normal and high mercury levels, as most labs only provide results for a person without a chelation challenge. If you don’t interpret it properly, it makes everyone look overloaded.
Steven Masley, MD
Does medicare cover any of your tests and you should give a range of the cost of what is not covered in your comprehensive test.
Generally speaking, medicare only covers testing to diagnose and treat a disease, such as pneumonia or hypertension. Their prevention screening is very limited. Although if you get hospitalized, having medicare insurance is great. However, if you want to stay healthy long term, you have to go beyond treating diseases and proactively take care of your health.
For an example of testing, visit my clinic website at: http://clinic.drmasley.com/evaluations/. If you did a 6-8 hour evaluation with a clinic like mine, with all these tests, it would likely cost $3,000 to $5,000, depending upon your age and what testing you have already had in the last year. (You don’t need to repeat normal tests.) Less expensive would be to see a nutritionist and exercise physiologist separately, and ask your own doctor to order some of these tests. Just make sure you get an estimate in advance, so you don’t get over charged. Unfortunately, some medical groups grossly overcharge cash paying patients when they are not using their insurance–so be cautious.
I wanted to share how lucky I am. The first time I saw my primary care physician, she spent 2 hours 45 minutes with me. I believe this is pretty much unheard of in today’s medical world. She took the time to speak with me about my lifestyle and what I had been through medically over the previous 5 years. She gave me several examinations and also referred me to a few specialists. I had triple by-pass surgery 3 months prior, so she had many concerns. She was not affiliated with any of the hospitals in the area which meant nobody was watching the clock except her. This was 7 years ago and she’s still my PCP and will be until my time runs out. Judging by the way she takes care of me, she may retire before that happens.
unfortunately not in my neck of the woods, and at 88yrs I still am in pretty good health, I now have developed an allergy which will be checked out by my PCP tomorrow, I cook my food fresh, eat salads, some meat little dairy except some goat cheese and some eggs. Had an allergy test taken and found that all my food intake is in the – no Reaction – column.
Thanks for all your input much enjoyed
Even at 88, it is never to late to take care of yourself. Keep eating super healthy, stay active, and be sure to meet your nutrient needs!
Steven Masley, MD
I love your work and perspective. Thanks for all that you do. Would you also recommend cardiac calcium scan to an evaluation and at what intervals if it is abnormal?
Good question. I plan to write a blog about this next month. the quickie answer is that I prefer carotid IMT testing, half the price, no radiation, and similar information.
Steven Masley, md
I am searching for my 56 year old son, who had a heart attack, and 3 stents put in. He is on Statins, even though his cholesterol was not too high, and is having problems with it, Pain attacks where he said the pain burns, and his muscles are frozen so he can not move. They last a short while and come in clusters. He had a blood test and will have an appointment with the regular GP. His cardiologist is on vacation.
I just got back from a 10 day vacation as well, so sorry for the delay in responding. People with muscle pain while on statins should check a CPK level, as rarely they can have serious muscle break down and injure their kidneys. Depending upon the situation, if a patient of mine needs a statin medication (the benefits out weigh the many side effects of statin medications) and they develop muscle aches, I usually have them first stop the statin med for one week and see if the pain goes away. If it does, then I may have them start red yeast rice extract and then retest their inflammation and cholesterol profile and see if I can meet their goal without a statin drug. The healthier your lifestyle, the less you would qualify for a statin drug. Be sure to read through my book, The 30-Day Heart Tune-Up for detailed information.
Steven Masley, md
Thyroid tests should be a fasting test of FREE T3, FREE T4 and Reverse T3. TSH isn’t really a true picture of what’s going on with one’s THYROID, AND just testing this pituitary gland signal can keep people suffering from being UN-diagnosed or under treated for thyroid issues for decades, as I and many others were. Ask the patient how “they feel” if they have a multitude of thyroid symptoms, cold and below normal body temps, hair loss, no eyebrows, weight gain, insomnia, constipation, etc. they should be checked further for antibodies, TBG, and or SHBG. And no giving antidepressants and a pat on head! Oh and Synthroid isn’t the “one size fits all” answer either! Natural Desiccated Thyroid and/or Cytomel have been a life saver for many. Thanks for all you do Dr. Masley
These are excellent points and I agree. I am ok with someone with zero thyroid symptoms trying to save money and monitoring their TSH alone. But anyone with low thyroid symptoms deserves a full thyroid panel as you describe.
Steven Masley, MD
Longtime follower and customer looking for some advice…
I’ve watched your shows and purchased your books.
With so many websites, articles and information about healthy eating/lifestyle I believe most people are totally confused. So many supplements, vitamins, medicines, quick fixes, eat this, don’t eat that, ect, ect. it is totally out of control. No one knows what to do!
I really wish you could come up with a grocery list/meal plan for 14 days to cover exactly what you should be eating at each meal to be heart healthy and meet all nutrition needs. Something simple to take away all the guesswork, research and bad information. Do you have such a list or do you know of any plan that you could post on your website. Maybe you know of an app that you trust that you can share with your followers. I don’t want to think, worry, analyze, guess anymore because I just don’t know.
Thanks for all your work!
I agree with you that there is a great deal of confusion, and I’ve worked hard to help you make better choices.
On my website, http://www.DrMasley.com, I am currently offering a Better Brain Shopping guide as a free gift. short guide aims to show you what to buy and what to avoid every time you shop. To meet your nutrient needs, you still need to take a supplement as well, and the supplement chapter in Better Brain Solution gives you the latest information on what to take for your heart and your brain. Unfortunately, I do not know of an app that would do this for you.