According to an August 12, 2003 New York Times article by Gina Kolata the annual physical checkup may be an empty ritual. The article states, in part:
"Checkups for people with no medical complaint remain the single most common reason for visiting a doctor, according to surveys by the Centers for Disease Control and Prevention. In 2000, they accounted for about 64 million office visits, out of 823.5 million visits over all. At $120 to $150 per visit (and $2,000 or so for the gold- plated "executive physical" that many companies offer to top executives), that adds up to more than $7 billion a year.
"Yet in a series of reports that began in 1989 and is still continuing, an expert committee sponsored by the federal Agency for Healthcare Research and Quality, an arm of the Department of Health and Human Services, found little support for many of the tests commonly included in a typical physical exam for symptomless people.
"It found no evidence, for example, that routine pelvic, rectal and testicular exams made any difference in overall survival rates for those with no symptoms of illness.
"Dr. John K. Min, an internist in Burlington, N.C., tells the story of a 72-year-old patient who came to him for her annual physical, knowing exactly what tests she wanted. She wanted a Pap test, but it would have been useless, Dr. Min said, because she had had a hysterectomy. She wanted a chest X-ray, an electrocardiogram. Not necessary, he told her, because it was unlikely that they would reveal a problem that needed treating before symptoms emerged. She left with just a few tests, including blood pressure and cholesterol.
"Dr. Min was proud of himself until about a week later, when the local paper published a letter from his patient -- about him. "Socialized medicine has arrived," she wrote."
Amusing and thought-provoking as this article may be--and I always believe in challenging the hallowed traditions of medicine--it misses an important point about the essence of preventive medicine the way we practice it at the Hoffman Center. The physical exam is a starting point for an extensive evaluation, not just to pinpoint life-threatening diseases, but to provide patients with a report card relevant to optimization strategies to preserve health and to fend off degenerative conditions.
For example, a careful physical exam can yield clues about circulatory problems, which if caught early, can be treated or reversed with the Salad and Salmon Diet, exercise, supplements, chelation therapy; only if necessary should medications and/or surgery be employed. Alternatively, thorough examination of the hair, skin or nails can predict various nutritional deficiencies or hormonal imbalances like thyroid disease. The condition of muscles and degree and location of subcutaneous fat stores, if noted, can provide important clues about cardiovascular risk. Discovery of a heretofore hidden heart murmur can lead to a diagnosis of mitral valve prolapse, a condition that explains a wide array of otherwise "weird" symptoms and complaints.
It should be emphasized, however, that not every patient receives every test. A plan will be customized to the patient's situation. Whatever conventional tests required will be ordered (blood tests, ECG, bone density, Ultrafast CT scan of coronary arteries, etc.) and the entire prior work-up of the patient reviewed, since many patients have been thoroughly evaluated by their primary physician and/or specialists.
Various test panels can then be used to reinvigorate the tired "routine" physical.
Body composition analysis. Using state of the art bio-impedance technology, the patient is precisely weighed and body fat vs. muscle percentage is calculated painlessly via skin surface measurement. The test is an important early warning for excess body fat accumulation, and it helps establish realistic weight goals for overweight patients. Interestingly, when exercise is teamed with an appropriate weight loss diet, and supported by vitamins, appropriate supplements, and hormonal support with DHEA and/or testosterone, body composition improves with or without dramatic weight changes. This is the "My Clothes Fit Better!" syndrome, which can be monitored effectively via sequential body composition determinations. Body composition more effectively predicts cardiovascular disease and cancer risk than weight alone.
DHEA: The DHEA blood test is important for patients suffering from fatigue, autoimmune conditions, depression, chronic stress, and as a measure of biological aging. Patients who take or have taken steroid medications, or those with adrenal "burnout", are prime candidates for DHEA deficiency. Replacement of DHEA with oral supplements has been shown to improve mood and energy and to ameliorate autoimmune diseases like lupus.
Testosterone and free testosterone: Both men and women require testosterone, in differing amounts, for optimal health, energy, mood, sexual performance and physical appearance. While the traditional testosterone blood test reveals severe deficiencies of the hormone, only free testosterone reveals more subtle imbalances.
Glucose tolerance test (GTT) with insulin: Patients with a myriad of unexplained symptoms (fatigue, anxiety, palpitations, hot flashes, even seizures, to name but a few) may be suffering from unpredictable dips of blood sugar, commonly referred to as hypoglycemia. Alternatively, some patients may show early progression to diabetes that is not revealed by traditional fasting glucose blood tests. Additionally, high levels of insulin that appear after a carbohydrate challenge are predictive of Syndrome X, a metabolic imbalance leading to cardiovascular disease and cancer. The GTT with Insulin at the Hoffman Center is requires five hours and is performed painlessly without repeated needle sticks. Results form the basis for a comprehensive health evaluation by Dr. Ronald Hoffman and his associates.
IgG RAST foods: At the Hoffman Center, we find that food intolerances are responsible for a wide gamut of health problems, not just the traditional, obvious allergies identified by conventional medicine. Fatigue, joint and muscle pain, headaches, inflammatory problems, skin disorders, urinary and gastrointestinal symptoms and even behavioral problems are commonly alleviated by elimination of culprit foods. The IgG RAST blood test identifies not just immediate reactions like classic nut or shellfish allergies which lead to anaphylaxis, but also more insidious slow reactions that cumulatively challenge immune system function.
Comprehensive cardio panel: Multiple risk factors contribute to cardiovascular disease risk, not just cholesterol alone. Even the traditional cholesterol profile can be "sliced and diced" into LDL, HDL, and even high-risk and low-risk LDL and HDL subfractions. Highly-sensitive C-reactive protein (hs-CRP) is a marker of inflammation, which, especially for women, is an important determinant of susceptibility to heart attack and stroke. Fibrinogen predicts "stickiness" of blood platelets, which leads to clotting. Homocysteine, when elevated, is an additional predictor of circulatory problems, and can be corrected with nutritional support. Lipoprotein (a) or Lp (a) is an important hereditary risk factor. And elevated insulin, as ascertained via the Glucose Tolerance Test with Insulin, is a major risk factor for the progression of cardiovascular disease. Knowledge is power: each of these risk factors can be targeted with specific interventions to prevent circulatory disease, or even reverse existing blockage.
Vitamin D: Traditionally associated only with bone strength, the multiple roles of vitamin D are only now being appreciated. Because of widespread dairy intolerance or inadequate sunlight exposure (which is universal during prolonged Northern winters), there is an epidemic of vitamin D insufficiency among Americans, especially the old, and of both sexes. Vitamin D supplementation prevents osteoporosis, but it may also have vital preventive effects in such diverse conditions as cancer (especially prostate and colon), psoriasis, fibromyalgia, multiple sclerosis, and polycystic ovarian syndrome (PCOS).
Ionized Ca and magnesium: A sophisticated test which reveals your "available balance" of these key minerals. Other conventional tests for calcium and magnesium are less sensitive for picking up departures from optimal. Magnesium deficiency is associated with panic disorders and agoraphobia, migraine headaches, muscle spasms, back and neck pain, fibromyalgia, fatigue, PMS, hypertension and heart disease. While bone density is best for spotting inadequate calcium intake and absorption, too high a calcium is predictive of hyperparathyroidism, associated with kidney stones and mood disturbances, and surprisingly--osteoporosis.
Ferritin: A sensitive marker for iron status. Commonly thought synonomous with anemia, iron deficiency is prevalent in many with apparently normal blood counts. Vegetarians, children and young women are especially at risk for iron deficiency. Inadequate iron can impair memory and cognition, worsen learning disabilities, cause debilitating fatigue, and recently has been implicated in Restless Leg Syndrome. On the other hand, excess levels of Ferritin may be the clue to a common, treatable genetic tendency toward iron overload, which may damage the liver, accelerate atherosclerosis, and even predispose to Alzheimer's and Parkinson's.
IgE RAST inhalants: This blood test provides a quick way of ascertaining the presence and extent of allergies to dust, mold, trees, grass and weeds--common environmental inhalants which trigger nasal congestion, chronic sinusitis, asthma, and even fatigue, headaches, and "brain-fog". Positive results on this test might then entail a referral to the Hoffman Center Environmental Medicine Department for skin testing and treatment with sublingual extracts of the offending substances.
Skin testing for foods, inhalants, and candida: (See also Environmental Medicine Department) For over fifteen years, patients with challenging medical conditions have been coming to the Hoffman Center's Environmental Medicine Department for diagnosis and treatment of allergic factors that contribute to their problems. Using sublingual drops providing safe, tiny dilutions of foods, Candida, and inhalants, patients have achieved relief from such diverse conditions as respiratory problems, gastrointestinal disturbances, fatigue and fibromyalgia, headaches, arthritis, and skin maladies.
Estrogen, progesterone: Levels of these key female hormones are essential to women's well-being. A common pattern of imbalance in women over 35 is excessive estrogen and inadequate progesterone which leads to emotional volatility and anxiety, unstable blood sugar and carb cravings, weight gain (especially around the hips), rosacea, headaches, PMS, infertility and heavy or irregular menstruation.
Anti-gliadin antibodies: A sensitive test for gluten sensitivity. Even gluten-intolerant patients not suffering from the overt syndrome of celiac sprue can suffer abdominal bloating or pain, diarrhea, constipation, gaseousness, or acid reflux. Other symptoms include chronic sinusitis, asthma, skin disorders, fatigue, joint pains, mouth ulcers, bone pain, osteoporosis, iron deficiency anemia, abnormal menses in women, and infertility. Because gluten triggers immune system problems, any autoimmune disease, including those affecting the nervous system like MS or peripheral neuropathy, can be related to gluten intolerance. In susceptible individuals, gluten may even set the stage for certain cancers.
Neurotransmitter profile: Imbalances in such neurotransmitters as serotonin, epinephrine, norepinephrine (adrenalin), dopamine and GABA can be responsible for depression, anxiety, fatigue, ADD, insomnia, migraines, and fibromyalgia. By analyzing a morning urine collection, recommendations for specific nutrient support can be formulated, and progress monitored.
Heavy metals: Toxic accumulations of lead, mercury, cadmium, arsenic and other toxic elements can contribute to many ailments including hypertension, Alzheimer's disease, cognitive impairment, and kidney disease. Regular blood tests reveal only very high levels of toxic metals and do not reveal how much is stored in tissues. A provocative chelation with an oral chelator, Captomer, followed by morning urine collection, is a better reflection of body burden of toxics.
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