By Leigh Savage
Physicals can uncover important information about what patients can do to improve or maintain their health. But for some people — especially those with certain risk factors — an advanced physical is the only way to get a full and revealing picture.
Dr. Jack Durham, who has been in practice for 35 years, the last five with PartnerMD, said some patients are asking for a more advanced physical. It is something he recommends to those with a high risk for coronary artery disease.
“People at higher risk would be smokers, those with a sedentary lifestyle, high blood pressure, obesity, a lack of exercise,” he said. “And we see people who don’t have those risk factors but have a family history.”
Routine physicals include complete blood count, a metabolic panel to check kidney and liver function, and tests for cholesterol and other health indicators. These all provide excellent information, Durham said. Advanced physicals go above and beyond by adding less common tests such as an expanded lipid panel, genetic testing, and a critical vessel screening.
The expanded lipid panel can find people who may have heart disease but have normal cholesterol levels.
“It checks subfractions of cholesterol, and can give us a heads-up — the subfractions can show if they are at greater risk for heart attack or stroke, and we can talk about changes they can make, through lifestyle or medication, that would do them good,” Durham said.
Genetic testing is another important component, and can show whether people are more susceptible to certain diseases, he said.
“For people with a family history, it’s another thing we can add that tells us how aggressive we need to be to prevent future problems,” Durham said. “Half of people who have issues with their heart never realized that there was something that predisposed them to have the issue.”
The genetic testing allows doctors to do the job of preventing disease, rather than waiting to diagnose and treat it, he said.
Critical vessel screening tests the carotid arteries, which provide the blood supply to the brain. The test looks for developing plaque or blockages there, as well as the abdominal aorta and the ankle brachial index, or ABI, which checks for different blood pressure in the hands and feet, which can point to blockage. Understanding the results of these advanced tests often leads to lifestyle changes for patients, such as quitting smoking, adding exercise, or boosting nutrition.
“We always start with lifestyle changes,” Durham said. “Losing weight can help a lot, but as they say, you can lead a horse to water but you can’t make him drink. Some patients, it strikes a chord, and they walk out of here and they are on board with it.”
Other people find they need medication, such as statins, which can help reduce cholesterol.
If risk factors cause the doctor to suggest the test, insurance companies will often cover it, he said. While every patient doesn’t need the advanced physical, for those who do, the information can be life-altering.
“It gives you a path to follow,” he said. “The earlier you do it, the better.”
