What tests should you get as part of your annual exam?

Physical Exam by Afshine Ash Emrani, MD, FACC Los Angeles CardiologistWhat is the LAHS executive physical?

The LAHS physical is a comprehensive exam and assessment of your health conducted in a single weekend day. It's designed to accommodate the busy schedules of executives who may not be able to squeeze in multiple appointments and lab work during their work week.

The executive physical includes:

An extended, in-depth physical exam with an internal medicine specialist Comprehensive lab testing, including urinalysis, blood counts and complete chemistry panels to assess organ function and look for early signs of diseases Cardiovascular assessment including an electrocardiogram and other testing Pulmonary function testing Lipid and nutritional analysis Prostate exam and screening Osteoporosis screening (women over 40) Comprehensive written report detailing results Referrals for additional screenings such as mammography and colonoscopy as needed What are the benefits of a LAHS checkup?

At Los Angeles Heart Specialists, we've designed our physical exam and checkup services to meet the needs of busy executives who simply find it too difficult to schedule an exam and a complete battery of testing over the course of several days. Our offices are equipped with state-of-the-art technology used in advanced diagnosis and disease management, so everything can be completed in a single day, without disruption of your work schedule. Plus, because your assessment is performed by one practice, your treatment recommendations will be based on your complete health profile for a more customized approach and optimal results. I'm in good health; why is having a routine physical exam so important? Most serious diseases start off “small,” with few and sometimes no discernible symptoms. Heart attack and stroke, two leading causes of death, are both associated with high blood pressure and high cholesterol, neither of which causes symptoms on its own.

Having routine annual physicals is the best way to “catch” diseases and treat them before serious problems occur.

Have your doctor run the following tests, all of which can be obtained through a simple blood draw: Fasting lipid profile: This is a group of tests that are often ordered together to determine the risk of coronary heart disease; they include your cholesterol and triglyceride numbers. You have to fast for about twelve hours prior to the test, but you can drink water. Levels of high-sensitivity C-reactive protein: As previously indicated, this is a biomarker of inflammation, which can point to your risk for cardiovascular trouble, among other things, if your levels are high. Comprehensive metabolic panel (CMP): This is a frequently ordered panel of tests that gives your doctor important information about the current status of your kidneys, liver and electrolyte and acid/base balance as well as all of your blood sugar and blood proteins. Complete blood cell count (CBC): This is one of the most commonly ordered blood tests, which is the measure of the concentration of white blood cells, red blood cells, and platelets in the blood. The size of your red cells can be a good indicator of nutritional deficiencies. You want this number, called the mean corpuscular volume, or MCV, to be between 85 and 95 fl. You also want to see that your red cells come in all different sizes, which shows cells at different stages in their lifespan. Thyroid stimulating hormone (TSH) test: Your thyroid is your master metabolism hormone. If it's out of balance, guess what? So is your whole system. An underperforming thyroid (hypothyroidism) is one of the most underdiagnosed conditions in America, yet it's incredibly common -- especially in women. It's believed that 20 percent of all women have a "lazy" thyroid, but only half of women get diagnosed. Unfortunately, no single symptom or test can properly diagnose hypothyroidism. To arrive at a trustworthy diagnosis, you'll also need to look at your symptoms. These can include weight gain, fatigue, constipation, hair loss, and even shortened eye-brows, as one of your thyroid's functions is to regulate how quickly your cells replenish themselves. When your levels of thyroid hormone drop below normal, the effect can be seen in almost every cell in your body, including your hair follicles. To fix a thyroid problem, you'll also need to look at the whole picture -- all the things that make up your lifestyle. (A rarer condition called hyperthyroidism happens when the thyroid goes into overdrive, producing too much thyroid hormone. This also has negative effects on the body, triggering heart and bone problems among other things). Hemoglobin A1C: To understand what a hemoglobin A1C is, think in the following simple terms: Sugar sticks to things, and when it's around for a long time, it gets harder and harder to remove. In the body, sugar also sticks, particularly to proteins. The red blood cells that circulate in the body live for about a hundred days before they die, and when sugar sticks to these cells, it gives doctors an idea of how much sugar has been around for the preceding three months. In most labs, the normal range is 4 to 5.9 percent. In poorly controlled diabetes, it's 8 percent or above, and in well-controlled patients it's less than 7 percent. The benefit of measuring hemoglobin A1C is that it gives a more reasonable view of what's happening over time (about three months), and the value does not bounce as much as finger-stick blood-sugar measurements. When there are no guidelines for using hemoglobin A1C as a screening tool, it gives a physician a good idea that someone is diabetic if the value is elevated. It's one of the few tools doctors can use to look at an "average" in you that you cannot fib. Diabetes can just happen. It's not just about being overweight, so if you suddenly develop this disease for whatever reason, you don't want to miss that. Although your doctor will test your vitals, you need to remember that she is only testing these metrics at one particular moment in time. She won't have running averages for your numbers over the past six months. While it's common for many of us to keep track of our weight throughout the year, we might also want to track other metrics -- and should -- if we're at risk for certain things. You can easily track your temperature and blood pressure using kits you can buy at your local pharmacy. You may want to check your blood pressure at different times of the day two or three times a week to see what kind of fluctuations you're getting. Make a spreadsheet and start to record the numbers at certain intervals throughout the day. Add notes to indicate what's going on when you take the test, such as that you've just had a relaxing glass of wine or just got off a troubling phone call that made you tense. Bring that spreadsheet with you to your doctor. NOTE for Men ONLY: When you get a PSA test, have your testosterone levels checked as well. Testosterone controls levels of PSA, so your body's production of testosterone will affect your parameters for "high" versus "low" levels of PSA. What's considered high for one person might not be the case for another person. Also, abstain from sexual activity and bicycle riding for several days prior to the test. While these activities don't affect the PSA level of everyone, they can negatively influence results and cause undue stress if you're told to repeat the test.

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