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Florida's Top Docs Talk Basics

Heart Health
Doctors at the Watson Clinic Executive Wellness Program in Lakeland look for red flags such as high cholesterol, high blood pressure and elevated glucose levels. If there is an indication of a heart concern, Richard Gould, clinical services director of Watson Clinic’s executive physical program, offers patients who are at high risk or show symptoms the option of a cardiac CT scan. The test gives doctors 3-D images of the coronary arteries without performing an invasive angiography. Gould says the test allows a physician to look at the heart from every angle, as if it were outside the patient’s body. Most important, it allows a doctor to look inside the ventricles and arteries for plaque or calcium buildup and even check the aorta for aneurysms.

Blood
Blood analysis can reveal a variety of medical conditions, including iron deficiency, kidney and liver function, thyroid problems and malignancy. Doctors recommend a basic blood test, known as metabolic panel, at least once a year along with a check of cholesterol levels. They also measure glucose levels through blood to determine the patient’s risk for diabetes. “A huge number of people are pre-diabetic and don’t realize it,” says Henrique Kallas, medical director at Douglas Williams Executive Health Program at the University of Florida. “What people don’t realize is that being diabetic or even pre-diabetic puts you at risk for heart disease.” Kallas suggests controlling blood sugar levels with diet, exercise and weight control during the pre-diabetic stage.

Colon
To maintain a healthy colon, physicians advise eating more fiber, drinking more water and exercising frequently. Doctors say colon/rectal cancer is common but preventable early by regular screening. Kallas at Douglas Williams suggests that executives get a colonoscopy beginning at age 50. However, if there’s a family history of colon cancer or polyps (abnormal growths), then he suggests earlier testing. Current guidelines recommend that African-Americans get tested at age 45. “The screenings help us to identify and remove polyps before they become cancer,” Kallas says.

Test Questions

» Blood chemistry and lipid panel: This may be the most basic and critical test physicians order as part of an executive health exam. To cater to executives, many programs will send a phlebotomist to an executive’s office or home to draw blood.

» Colonoscopy: This screening exam for colorectal cancer is recommended for men and women over 50. Along with the traditional “scope” — a camera mounted on a flexible tube —  newer CT or MRI scanning devices offer a non-invasive, virtual alternative, with no sedation or scopes. Patients still have to drink a laxative to clear out the colon beforehand, however. And physicians point out that a virtual colonoscopy does not allow the doctor to remove tissue samples or polyps as during the traditional procedure — if one shows up on the scan, patients will still need a follow-up scope.

Sleep Habits
Dr. Mark Moon, medical director at the Mayo Clinic’s Executive Health Program in Jacksonville, says lack of adequate, quality sleep contributes to early mortality and low sex drive. If you’re getting less than seven hours of sleep, awakening during the night or rising in the morning feeling fatigued, you may have a disorder such as sleep apnea. “We may have you see a sleep specialist,’’ Moon says. “When treated for sleep apnea, your energy improves and testosterone levels increase. At least once a week I see patients who have moderate or severe apnea who had no idea they had it.”

Belly Fat
Having a waist size of more than 40 inches can create serious medical problems. Moon at Mayo Clinic says carrying weight in your midsection can cause inflammation in your liver. Even more, he says, it can induce the pancreas to produce higher levels of insulin, promoting inflammation associated with other conditions, including malignancies. Dr. Dario Pancorbo, medical director for Baptist Outpatient Services’ Executive Health and Wellness program in Miami, says he spends time talking to patients about their eating and lifestyle habits. “I have found that many executives have a compulsive way of eating, and they tend to be sedentary.” Pancorbo brings in dietitians and fitness experts to counsel his patients. “We not only tell them what they need to do, we tell them how to do it.”

Test Questions

» Treadmill stress test: Dr. Mark Moon, medical director at the Mayo Clinic’s Executive Health Program in Jacksonville, recommends a treadmill stress test only after a consultation and discussion of family and personal history.

» Mammogram and pap smear: Most physicians suggest annual mammograms beginning at 40 unless there’s a family history of breast cancer. Dr. Dario Pancorbo, medical director for Baptist Outpatient Services’ Executive Health and Wellness program in Miami, says pap tests to screen for cervical cancer now are done annually along with HPV testing, which has recently been added.

 

Bone Density
Women over 50 are at risk of osteoporosis, a disease that causes bones to become more fragile and more likely to fracture. Dr. H. James Brownlee Jr., medical director of the Monsour Executive Wellness Center at USF Health in Tampa, says he orders a bone density test for most female executives 50 or older to measure calcium and minerals in a segment of bone. Women with a low body mass index, those who are thin, are at greater risk for osteoporosis, Brownlee says. Men in their 50s do not experience the rapid loss of bone mass that women do after menopause. Men’s ability to absorb calcium — and the risk for osteoporosis — doesn’t usually begin until at least age 65.

Vitamin D
Gould at Watson says low vitamin D levels are more prevalent these days, putting more men and women at risk for high-blood pressure, cancer and weak bones. Working indoors contributes to vitamin D-deficiency because the body makes vitamin D when exposed to sunlight. Some foods, such as milk, are fortified with vitamin D; however, when there is a deficiency, Gould typically recommends a supplement.

Ears and Eyes
Medical directors say they have begun to include hearing and vision tests as part of executive health exams. “It’s amazing how many people over
the age of 40 have some hearing loss,” says Brownlee. In some instances, significant hearing loss on one side can indicate pressure on the inner ear. Brownlee says he refers those patients to an ear, nose and throat specialist for evaluation. “When a leader sits around a conference table and people start to have cross conversations, he may start to lose word discrimination, and that’s an important part of hearing well.” Just as important is an eye exam, Brownlee says. He also asks ophthalmologists to check vision and look for glaucoma. “In the rat race, that’s something people tend to put off.”

Test Questions

» Hepatitis C: Baby Boomers account for 75% of hepatitis C cases in the United States, even though they make up only 27% of the population. Dr. H. James Brownlee Jr., medical director of the Monsour Executive Wellness Center at USF Health in Tampa, says he includes a one-time blood test to screen for hepatitis C as part of every routine executive health exam. The Centers for Disease Control says many Baby Boomers were infected with the virus decades ago without knowing it and could eventually develop liver cancer or other liver diseases.

Family Medical History
Dr. Stephen Avallone, medical director of the Huizenga Executive Health Program at Cleveland Clinic Florida in Weston, says physicians who examine executives spend at least an hour discussing the patient’s medical history and whether close relatives have heart disease, diabetes or cancer. Hereditary concerns play a big role in what tests he orders and how aggressive he may be in following up on a test result. Mammograms usually are recommended after age 40, but “if there’s a family history of breast cancer and her mom died at 45, then the 35-year-old executive is going to have a mammogram,” Avallone says. “The vast majority of correct diagnoses are not based on test results, but on the physician spending time to take a good family history.”

Testosterone
Along with decreased sex drive, low testosterone can cause fatigue, insomnia, weight gain and headaches. Pancorbo at Baptist Executive Health says if testosterone levels are moderately low, he suggests lifestyle and dietary changes. If levels are extremely low, he recommends a supplemental gel, patch or injection aimed at boosting the male hormone.

Test Questions

» PSA: The PSA test measures the level of a protein produced by the prostate gland that can indicate the presence of cancer. Many physicians still recommend regular PSA testing for men between 50 and 75. But others see the PSA as a flawed test that saves few lives and leads to unnecessary biopsies. Dr. Stephen Avallone, medical director of the Huizenga Executive Health Program at Cleveland Clinic Florida in Weston, typically couples results with family and personal history to decide whether follow-up is needed.

» Full-body CT scan: Physicians typically advise against this test. Avallone says he advises against it for young executives who want to have children. “There’s quite a bit of radiation involved,” he says. Even more, he says, “the test often finds little things that require more imaging and usually amount to nothing.”

 

Health Tips

» Doctors say limit caffeine to less than two cups of coffee a day.

» If you spend most of your day at your computer, get up and move around at least every two hours.

» Doctors in executive health programs say they notice most professionals eat poorly, often on the go. They recommend eating more slowly, smaller portions and a diet of mostly whole grains, fish, fruit and vegetables and at least 48 ounces of water a day.

» Doctors with executive health programs recommend seven to eight hours of sleep a night.

» Despite time constraints, executives should complete a minimum of three hours a week of aerobic activity, along with weight resistance and stretching exercises.

» Physicians suggest smokers set a target date for quitting. After that, they recommend staying away from smokers and events that trigger a desire to smoke.

» Florida doctors recommend residents get screened annually for skin cancer, particularly if you have a new or changing skin lesion.

» Highly stressed professionals should be aware that nausea, dizziness and fatigue are the more subtle signs of heart concerns especially for women.

» Doctors say an optimal blood pressure is 120/80 or lower. Losing as little as 10 pounds and lowering salt intake can reduce your blood pressure to a healthier level.

» Cortisol, the primary stress hormone, increases sugars in the bloodstream and can disrupt almost all your body’s processes. Doctors say is it crucial to learn healthy ways to cope with stress in your life.

» Most people don’t get enough calcium, which is important for strong bones as you age. Henrique Kallas at Douglas Williams Executive Health Program at UF suggests lots of low-fat milk products, sardines, nuts and leafy green vegetables.