Executive Physical – Health Risk Assessment

I’ve been scheduled for an Executive Physical to help assess my current health and to help clue me in to problems that may arise down the road. It is an intensive battery of tests conducted in one day, tests that would otherwise take months to complete going through your family doctor.

The Health Risk Assessment is from MMPC (Michigan Medical P.C.) and covers the following:

Comprehensive Physical Exam
A one-hour appointment with an Internal Medicine physician in which your medical history form is reviewed and a thorough physical examination performed.

Health Risk -Consultation
As part of your exam the physician reviews your health risks are reviewed and recommendations are made for future lifestyle changes.

Laboratory Work
In-depth blood screening includes the following labs (15 minutes):

• CBC Measures the various components of your blood including, white cells, red cells, and platelets. Screen for anemia, infection, or leukemia.
• HS CRP High sensitivity C-Reactive Protein, indicates presence of inflammation to warn of heart attack.
• CMP Comprehensive Metabolic Panel: -proteins, calcium, glucose, kidney, liver panel, and electrolytes.
• Urinalysis Useful in diagnosis of urinary tract infection, dehydration, and kidney stones
• TSH Thyroid-Stimulating Hormone, indicates an over or under-active thyroid.
• Fasting Lipid Panel Basic Cardio check-up: cholesterol, HDL, LDL, VLDL, Risk Ratio, triglycerides
• PSA Prostate Specific Antigen (men over 40), assists in diagnosing prostate cancer.

Body Composition Analysis/ Bone Densitometry
Description: Dual Energy X-ray Absorptiometry (DEXA) uses a whole body scanner that has two low-dose x-rays at different sources that reads bone and soft tissue mass simultaneously. The sources are mounted beneath a table with a detector overhead. Procedure: The scanner passes across a person’s reclining body with data collected at 0.5cm intervals. It is safe and non-invasive with little burden to the individual, although, a person must lie still throughout the procedure. The bone density measures the strength of an individual’s bones and his or her fracture risk.
Time: 25 minutes

Chest X-ray
Description: A radiology test that involves exposing the chest briefly to radiation to produce an image of the chest and the internal organs of the chest. An x-ray film is positioned against the body opposite the camera, which sends out a very sma1l dose of a radiation beam. As the radiation penetrates the body, it is absorbed in varying amounts by different body tissues. Procedure: Patients will be asked to use an x-ray gown and remove metallic objects from the chest and neck areas. These objects can block x-ray penetration. Patients may be asked to take a deep breath and hold it during the chest x-ray in order to inflate the lungs to their maximum, which increases the visibility of different tissues within the chest. The chest x-ray procedure often involves a view from the back to the front of the body as well as a view from the side. The radiologist interprets the film upon completion.
Time: 15 minutes

Resting Electrocardiogram
Description: The electrocardiogram (ECG or EKG) is a non-invasive test that is used to reflect underlying heart conditions by measuring the electrical activity of the heart. By positioning leads (electrical sensing devices) on the body in standardized locations, information about many heart conditions can be learned by looking for characteristic patterns on the EKG. Procedure: EKG leads are attached to the body while the patient lies flat on a bed or table. Leads are attached to each extremity (4 total) and to 6 predefined positions on the front of the chest. A small amount of gel is applied to the skin, which allows the electrical impulses of the heart to be more easily transmitted to the EKG leads. The leads are attached by small adhesive patches and connected to the EKG machine that translates the electrical activity into line tracings on paper. The procedure is painless. In some instances, men may require the shaving of a small amount of chest hair to obtain optimal contact between the leads and the skin.
Time:,5-15 minutes

Exercise Treadmill (Electrocardiography)
Description: Initial screening for coronary artery disease (CAD) involves stressing the heart under controlled conditions. These stress tests are able to detect the presence of flow-limiting blockages in the coronary arteries, generally in the range of 50% reduction in the diameter of at least one ofthe three major coronary arteries. Procedure: EKG leads are placed as above for the resting EKG. A blood pressure cuffwill be wrapped snugly around your aIm so that your blood pressure can be checked every few minutes during the test. You will walk on a treadmill while being monitored by an EKG machine. The test is usually performed in a series of stages. Each stage usually lasts 3 minutes. At the end of each stage your EKG is recorded. The test progressive increases in intensity until you reach your maximum heart rate or until you show symptoms of fatigue, shortness of breath, or angina. The test may also be stopped if you experience irregular heart rhythms.
Time: 60 minutes including prep and recovery

Coronary Artery CT Scan (Cardiac Scoring)
Description: A computerized axial tomography scan is more commonly known by its abbreviated name, CAT scan or CT scan. It is an x-ray procedure which combines many x-ray images with the aid ofa computer to generate cross-sectional views and, if needed, three-dimensional images of the internal organs and structures of the body. A CT scan can be used to define normal and abnormal structures in the body. Procedure: A large donut-shaped x-ray machine takes x-ray images at many different angles around the body. These images are processed by a computer to produce cross-sectional pictures of the body. In each of these pictures the body is seen as an x-ray “slice” of the body, which is recorded on film.
Time: 20 minutes

Exercise Prescription and Flexibility Assessment Description: An individual review of current exercise program with recommendations for improving your cardiovascular fitness and tips on how to burn stored fat more efficiently. We will measure your range of motion ofa number of your joints and provide recommendations specific to your activity goals.
Time: 30 minutes

Nutrition Consultation Description: An individual consultation with a Registered Dietitian to review dietary needs, caloric intake and general nutrition.
Time: 30 minutes

Colonoscopy (Additional $1,100)
Description: A procedure that enables an examiner to evaluate the appearance ofthe inside of the colon. Procedure: This is accomplished by inserting a flexible tube that is about the thickness of a finger, into the anus and then advancing it slowly, under visual control, into the rectum and through the colon. Extensive cleansing of the colon is required before the procedure.
Time: 2-3 hours

Mammography [NA]
Description: A mammogram is an X-ray test that produces an image of the inner breast tissue on film. It is used to visualize normal and abnormal structures within the breasts, which can help identify cysts, calcifications, and tumors within the breast. Procedure: The patient’s breasts are placed on a firm flat x-ray surface and a gentle, but firm pressure is applied to the breast using a mammogram compression device. This compression can cause a degree of discomfort in some women, but is usually a painless procedure. The compression spreads the breast tissue out so that the x-rays display the inner breast tissue with good resolution. Time: 20 minutes

There is a lot of focus placed on Vascular Screening with the goal of providing access to vascular testing in a limited capacity. Screening for vascular problems including abdominal aortic aneurysm, carotid artery disease and peripheral vascular disease.

They note that Vascular Screening tests are for screening purposes only and are not for patients that are currently experiencing symptoms of stroke or vascular disease.

Potential Benefits: Early identification of vascular disease leads to prompt intervention. This in return may prevent the devastating effects of a stroke, aneurysm or significantly blocked blood flow to the lower extremities.

What is a vascular screening?
A vascular screening is a “quick” evaluation using ultrasound on the carotid arteries (in your neck) and the aortic artery (in your abdomen). Ultrasound is the same technology used by physicians to view unborn fetuses in pregnant women. Ultrasound is also one of the best predictors of vascular disease in these arteries. For the ankle / brachial index (ABI), a blood pressure cuff and Doppler ultrasound device will be used to test for lower extremity arterial disease. These are quick evaluations and should not be considered a full vascular study. If a significant finding is identified, your family physician may refer you for a complete in-depth study.

Preparing for vascular screening:

• Take all prescribed medications as you normally would.
• Fast for four (4) hours prior to the screening.
• The meal that you eat four (4) hours prior to the screening should be a light meal which is about half of what you would normally eat. Avoid foods that could make you gassy.
• If you are thirsty during the fasting period, feel free to have a moderate amount of water.
• If diabetic patients require food during the normal fasting period, please limit yourself to a “diabetic meal” such as apiece of toast and one (1) cup of juice. When in doubt follow your diabetic care plan.
• For your comfort, please wear a 2-piece, loose fitting outfit to your screening.

How Vascular Screening Works:
You will be asked to sign a consent form prior to testing. The testing will take approximately 15-20 minutes. When scanning the aorta, gel will be placed on your abdomen and a probe will move over the area. The technologist will push down on your abdomen to obtain optimal images. When examining the carotid arteries, gel will be placed on both sides of your lower neck and a probe will be used in a similar fashion. When scanning the lower extremities, blood pressure cuffs will be placed on both ankles and upper arms. Pressures are obtained through the use of an ultrasound probe placed on the skins’ surface.
Study results will be mailed to you. If you request it, a copy the results will also be mailed to your physician.

The entire day will cost a total of $3,000, if I choose to add the Colonoscopy, it will run $4,100. Other fees are:

Specialty Consults $200.00
Foot &Ankle
Ophthalmology
Pulmonary
Sleep Center
Cardiology
Gastroenterology
VeinSolutions

Specialty Testing:
Colonscopy: (requires preparation and driver; scheduled on aseparate day): $1,100
Pulmonary Function Testing: $300.00
CTAngiogram of the Heart: $900.00

Immunizations:
Flu-$40.00
Pneurnovax -$56.00
Shingles-$208.00
TDAP – $78.00

This all looks fine, but while reviewing the documents I must sign, I find that I’m giving up a lot of information! Here is the GXT Cardiac Stress Test consent form allowing them to publish any pictures they may take and allow observers.

INFORMED PROCEDURE CONSENT
I hereby authorize mmpc Cardiology to perform upon the patient the following procedure.

GXT Cardiac Stress Test

If any unforeseen condition arises in the course of this procedure in addition to or different from those now contemplated, I further request and authorize him/her to do whatever he/she deems advisable.

1) The procedure has been fully explained to me by my primary care physician or the staff of mmpc Cardiovascular. I have been given the indications for the test as well as possible alternative methods of testing. I acknowledge that no guarantee or assurance has been made as to the results that may be obtained.
2) I consent to the taking and publication of any photographs / echo images in the course of this procedure for the purpose of advancing medical education.
3) For the purpose for advancing medical education, I also consent to the admittance of observers to the testing center.

I CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND AND THE ABOVE INFORMED PROCEDURE CONSENT, THAT THE EXPLANATIONS THEREIN REFERRED TO WERE MADE, AND THAT ALL BLANKS WERE COMPLETED AND FILLED IN, AND ANY QUESTIONS I HAD WERE ANSWERED BEFORE I SIGNED. I UNDERSTAND THAT IT IS IMPORTANT THAT MY CONSENT BE GIVEN WITH FULL INFORMATION.

And here is another…

ACKNOWLEDGMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES

I understand that, as part of my healthcare, Michigan Medical, P.C. (“MMPC”) originates, obtains and maintains health information and medical records describing my health history, symptoms, examination and test results, diagnoses, treatment, and any plans for future care or treatment. I was able to review MMPC’s Notice of Privacy Practices that provides a more complete description of how MMPC uses and discloses my health information. I understand that I have the right to review the Notice of Privacy Practices prior to signing this and that I can ask for a copy of the Notice to take with me. I understand that MMPC reserves the right to change this Notice and prior to implementation will post a copy of any revised Notice in its waiting rooms and will provide me with a copy upon my request. I understand that I have the right to request restrictions as to how my health information is used or disclosed to carry out treatment, payment, or healthcare operations. I understand that MMPC is not required to agree to the restrictions requested. MMPC will consider my request, but I should be aware that MMPC is not legally required to accept it and will, given the complexity of multiple methods of dealing with information, most likely elect not to treat me or to disregard it in an emergency situation.

I’m not entire comfortable with those privacy policies and still looking into the dangers of a CT Scan. I’ll post more as I obtain information…