How To Prepare For Your Annual Visit

Transcription:

Melanie Cole, MS (Host):   Having an annual physical and wellness exam is so important to your overall health, and it’s one of the best ways to be proactive and to be your own best health advocate. Hello, welcome to Sound Advice, the podcast series with Highland Medical P.C. I’m Melanie Cole and today we’re talking about annual wellness exams. My guest is Dr. Dana Corriel. She’s a board certified primary care physician with Highland Medical P.C. Dr. Corriel, I'm so glad to have you on with us as many people don’t think to visit their physician until they're sick. Please tell us why annual wellness exams are so important and at what age should we really be starting them?

Dana Corriel MD (Guest):   So annual exams are important at every age. So the way that I explain it to people is you have to remember the concept of screening and prevention. It’s like Sherlock Holmes. The point is basically to identify key pieces of evidence that could indicate either current or future disease. So the point of checking in with your doctor for a yearly annual exam isn’t necessarily to go because you're sick. It’s to go because you're healthy and because you want to maintain that good health.

Host:   Really well put. So what are the most important components? What is it that you’re looking for at that annual wellness exam? Are you discuss family history with me? Why is it so important that we know our numbers? We’ve heard that term know your numbers. What does that even mean?

Dr. Corriel:   Right. So there are important components to an annual visit. Again, I can bring in that metaphor of being Sherlock Holmes. So Sherlock Holmes knows exactly what key evidence pieces to pick up, what clues to look for, with all the training that we did. So we’ll be talking about the screenings. What tests are useful for prevention? We’ll be covering family history. We would, in an annual visit, do a review of systems where we kind of go over your entire body and ask you how you're feeling all in all. We go over vital signs. So some key evidence, objective pieces of evidence. We’ll go over your medication, do a review there. We’ll do a physical exam. We go over any labs that you want to discuss from past, abnormal labs. We’ll also go over an immunization schedule. So it’s a very thorough visit where we’re sort of going through each important component of your health and kind of piecing it together into one major diagnosis. Something that’s important to tell you about and to tell the audience about is that before you do go to an annual visit, you should certainly find out what’s covered especially in this day and age. Because a lot of people are covered by specific insurances. There are so many insurances out there and there’s little caveats in each. So it’s important to know what is going to get covered versus what isn’t.

Host:   Great point. That’s really great advice. So let’s start with the blood work. When you're screening people for blood work, what are you looking for? We hear about cholesterol. We hear about all of these things—lipids and triglycerides and glucose. So the bloodwork is pretty comprehensive. What is it that you're looking for?

Dr. Corriel:   So you're screening. What you're doing is that you're trying to pick up on these clues we spoke about. So your screening for different conditions. You're looking at things like blood count and looking at how your organs function. So things like your kidneys and your liver and your spleen. You're looking at electrolytes. You're also screening for conditions. There are lab values that can screen for conditions like diabetes or hyperlipidemia, your cholesterol. Sometimes you would want to screen for a thyroid condition if it’s indicated. Then anything else that comes up in that talk part of your annual visit could indicate that someone may need something else done in your lab work. Again, like Sherlock Holmes you need to sort of know where to go and what path to navigate through. So every patient sort of has their own lab profile that is taken depending on their history and what they say.

Host:   Well, so as long as we’re on the topic of bloodwork. I mentioned lipids, triglycerides. People don’t know what cholesterol is, Dr. Corriel. They don’t know what a normal level is. It seems to change. Really how to achieve it. Give us a little lesson in cholesterol. What is it and what do those numbers mean?

Dr. Corriel:   Yeah. So cholesterol’s actually a topic that’s constantly being debated. There's new research coming out about it like all the time. So there's not a specific number. Just as a general rule, there are a few things that I follow. It depends on your specifics. So for example, an LDL count—your bad cholesterol, your LDL—in a healthy person, I do like to keep that under 130. In someone with heart disease, I like to keep that under 100. Then in diabetics we really want to tighten up that cholesterol as a cardiovascular risk factor and go under 70. We kind of use a total cholesterol number of 200 as a threshold these days and try to keep it under 200, but that’s like a loose interpretation of our cholesterol levels we need to be. The last thing that we use is something very important. It’s called an ASCVD risk calculator. What it is is it calculates your 10 year cardiovascular disease risk. Your doctor has that calculator. It basically uses many things that are specific to you including what gender are you, what’s your age, what's your blood pressure values, what are your cholesterol numbers? Then it gives you a percentage to tell you how likely are you in the next 10 years to have cardiovascular disease. That sort of helps me as a physician determine who’s going to benefit from medications to lower their cholesterol.  

Host:   That’s so interesting. Just tell us a little bit now about blood pressure because that seems to be a risk factor for so many other comorbidities and diseases. Tell us about blood pressure. Those guidelines have also recently changed. What’s normal and how best do we achieve that good blood pressure?

Dr. Corriel:   Yeah. It did change around 2017. The American Heart Association and the American College of Cardiology lowered the thresholds for hypertension diagnosis. They basically decided that normal blood pressure was under 120/80. So at this point, elevated blood pressure is defined at 130 systolic or above or 80 diastolic or above. So that basically tightens up blood pressure guidelines and makes more people hypertensive. Of course, again, it is person specific. So if I have like an elderly patient sitting in front of me, it depends on their situation. Sometimes with the elderly population, I allow a little bit more wiggle room because of side effects of having lower blood pressure. That’s more or less the new threshold for blood pressure according to these big associations.

Host:   As long as we’re talking about blood pressure, cholesterol, and heart disease, it used to be that you were checking for inflammation. We’re learning more and more about how inflammatory states in our body can contribute to heart disease. It used to be homocysteine and then they were using CRP markers. Are we still using that? What are they? How do we know?

Dr. Corriel:   Yeah, I mean you can use CRP markers. They're not specific. So it’s not so useful. We know because—First off, we don’t know everything. We’re not ever 100%. You can sort of take a person’s risk factors and you can weigh those against things like their age. You can take their genetics, you can take their lifestyle, right. So there are some things that are modifiable and some things that aren’t. So things like genetics are not modifiable. We can't change our genes. Things like lifestyle are things that I speak about regularly at annual visits. Things like smoking or things like how much you way or things like how much exercise you get. Those are thing that we can modify and reduce our heart disease risk factors. Then there’s other clues in the exam that I can use. Things like EKG, things like lab work.

Then if I really want to assess your risk for heart disease, there are other options. Like I could send you to the cardiologist for possible testing like echoes and stress tests. But there's now also calcium scores, which are the new way to risk stratify your cardiovascular disease risk which is a low dose CAT scan of the arteries that supply the heart to assess how much calcium buildup is there. It risk stratifies you. So if you get a really good score, that means that you have much less chance of having cardiovascular disease in the next few years. Whereas if you get a higher score, then you probably should be worked up more aggressively and also treated with medication more aggressively.

Host:   Wow, thank you for clearing that up. So now onto vitamin D. As we’re using more sunscreen and we’re trying to protect ourselves from skin cancer, are you checking for vitamin D in everybody or only certain people are certain times of the year. Tell us about that.

Dr. Corriel:   Yeah. The argument sort of is still playing out in the research field in medical research. We don’t know the right answer, but right now yeah. I do screen with vitamin D. It’s been linked with a lot of chronic disease states. It also helps with bone strength. Because we live on the east coast, we have a lot of low vitamin D states because we don’t have a lot of sun exposure. So yes. I do not only check it but try to keep levels up within normal range.

Host:   Such great information. So important for people to hear. As we wrap up, Dr. Corriel tell patients what you would like them to know about the importance of that annual wellness exam and why it’s so important also to be honest with their primary care providers, talk about their family history, their lifestyles, their behaviors, and be their own best health advocate.

Dr. Corriel:   I think it’s important now more than ever to be your own health advocate. Also just find a physician that’s a right fit in terms of an internist or a primary care doctor. I think that you want to come to see someone that you trust that you can be completely honest with because at the end of the day, you're a team. If you don’t have complete trust then you can't really move forward towards better health. So I think it’s important now more than ever to take your health seriously to find someone that makes a good teammate and to move forward together.

Host:   Thank you so much for coming on, Dr. Corriel, and giving us such great information. That wraps up another episode of Sound Advice on the podcast series with Highland Medical P.C. Head on over to our website at highlandmedicalpc.com/highland for more information and to get connected with one of our providers. If you found this podcast informative, please share with your friends and family and on your social media and be sure to check out all the other interesting podcasts in our library. I'm Melanie Cole.