The Life Plan (71 page)

“My dad died in his 50s from heart disease. Don’t you think I should get a calcium score . . . or perhaps a carotid artery ultrasound scan?”

In my office I exclusively practice age management medicine. Because my patients come from all over the country, I cannot always act as their primary care physician. Instead, I act as a resource—they talk to me about problems they have. If my patients need to be admitted to a hospital, I refer them back to their primary care provider or, when necessary, directly to a hospitalist, who is a physician who works exclusively within a hospital setting caring for hospitalized patients, as needed.

Men who come to my office for the very first time experience a thorough checkup, and I mean it. A typical first visit can last as long as seven hours. Before he comes in, each patient submits the blood work I have ordered, which includes 90 different tests, including hormone blood levels. In my office, each man then undergoes further diagnostic testing, including strength testing, ultrasound testing for blood vessel health, and a DEXA scan that measures body composition in terms of body fat and muscle mass. Then he meets with my exercise and nutrition specialist to develop a program that is specifically designed to meet his goals. After lunch I introduce the Life Plan. We then move to my office, where I discuss his goals, diagnostics, and lab work and create a blueprint for how he is going to modify his lifestyle for the best possible results based on his current health.

I know that many doctors are unable to provide this same level of care. Here is a list of the minimum requirements that your doctor should be providing in an annual checkup. Be prepared for an exam that should take at least sixty minutes. During this time, your visit should include:

The list of diagnostic testing (see list below).

A thorough physical exam, including a digital rectal exam of the prostate.

A detailed questionnaire, like the quiz in

Chapter 1

, that helps your physician detect early warning signs of premature aging or underlying illness.

Take the Life Plan with you to your annual checkup, and make sure to review with your doctor your list of personal goals that you are trying to achieve. Show the doctor your worksheets and journal entries to show him or her what you’ve already accomplished.

The chart below lists all of the tests you should request as part of your routine medical care. These markers will help you take action early to prevent disease. What’s more, they will create a wealth of baseline information that you can use to stay vital as you age and limit your exposure to “surprise” illnesses. These early warning tests can be used to prevent or delay their onset.

Bone Density Test or DEXA Scan: Skeleton, Lumbar Spine, and Hips

This test determines whether you are at risk for osteoporosis, which causes bones to become fragile or break. A DEXA scan can also be used to monitor osteoporosis treatment as well as compute body composition (body fat percentage and muscle mass). The DEXA scan is a fast, painless, noninvasive procedure. It is not the same as a bone scan, which detects fractures, cancer, infections, and other abnormalities. Men over 45 should complete a DEXA scan annually.

T Score
>
0

Complete Eye Exam (Glaucoma Testing and Amsler Grid)

This series of tests is designed to evaluate your vision and check for eye diseases. It is recommended that you have a complete exam every two to four years if you are between 40 and 65.

Negative

Blood Pressure

Blood pressure is the force exerted by circulation blood on the walls of blood vessels and is one of the principal vital signs. Maximum blood pressure is called systolic and minimum is diastolic. It is typically measured in millimeters of mercury.

120/80 or less

Colonoscopy

This test provides an inside look at your colon and rectum. Preparation for the test and the test itself are painless. If polyps (possible precancerous growths) are detected, they can be easily removed. This procedure is recommended for men starting at age 50 and should be repeated every 5 to 10 years. Men with a family history of polyps or certain cancers should consult their health professional to determine when to start and how often they should repeat their colonoscopies.

Negative

Digital Rectal Exam of Prostate

Used to screen for overall prostate health and prostate cancer in its early stages. This exam is done during a typical physical. It is recommended that African-American men and any man with a family history of prostate cancer begin having annual digital rectal exams at the age of 40. Caucasian men without a family history of prostate cancer should start at age 50.

Negative

Prostate Specific Antigen (PSA)

PSA is a protein produced by the cells of a prostate gland. This test measures the amount of PSA in the blood and is used primarily to screen for prostate cancer before symptoms occur. Prostate cancer, enlarged prostate, or prostate infections can increase the PSA level in men. This test is recommended starting at age 45, or in men at age 40 if they have a history of prostate cancer or are of African-American heritage.

0–3 ng/ml

Hemoglobin A1c (Glycohemoglobin)

This test provides a long-term look at blood sugar control and reflects the role nutrition, activity, medication, and stress play in blood sugar control. This test should be obtained 3 to 4 times a year.

<5.5%

Insulin (Fasting)

This test provides information about your body’s sensitivity to insulin. Elevated levels can indicate insulin resistance, a major cause of type 2 diabetes.

<5 uIU/ml

Glucose (Fasting)

A blood glucose test is used to measure the amount of glucose (sugar) in the blood at the time of collection. If blood glucose levels remain high over a period of time, they can damage the eyes, kidneys, nerves, and blood vessels. High glucose levels indicate diabetes.

65–99 mg/dl

OGTT (Oral Glucose Tolerance Test)

A 1-hour and 2-hour glucose tolerance test can detect insulin resistance and new onset diabetes.

2hrs<140mg/dl

CIMT (Carotid Intima-Media Thickness)

This test consists of an ultrasound of the carotid arteries and measures the thickness of the intima-media, a marker for atherosclerosis (plaque). It can detect accelerated disease processes and subclinical disease. It is a valuable tool for physicians to clarify cardiovascular risk of their patients, optimize prevention measures, and monitor the atherosclerotic process.

Negative

ABI (Ankle-Brachial Index)

A simple test that compares the blood pressure in your arm with the blood pressure in your ankle. Test detects peripheral artery disease and predicts cardiovascular mortality.

>
0.90

AAA Screen (Abdominal Aortic Aneurysm Screen)

An ultrasound of the abdominal aorta to detect aneurysms. Recommended for men age 50 to 69 with at least one cardiovascular risk factor or African-Americans and all men 70 or older.

Negative

Cardiac Stress Testing

This test evaluates blood flow and determines if there are blockages interfering with the supply of blood and oxygen to your heart. It also provides valuable information regarding the fitness of your heart, blood vessels, and lungs. The test is performed on a treadmill or bike, while heart rate, blood pressure, and oxygen levels are monitored and recorded. This test can be completed in a clinic or hospital. Men age 45 and over should perform this test on a periodic basis.

Negative

Coronary Calcium Scoring

This test utilizes a CT Scan to assess coronary calcification and provides a score that is an anatomical test for total plaque burden. A positive score deserves additional evaluation and workup.

Zero

Homocysteine

High homocysteine levels are indicators of your risk for having heart disease, Alzheimer’s disease, stroke, and vascular disease. These levels are strongly influenced by diet and genetics. It is recommended that men get tested if there is a family history of cardiovascular disease. Homocysteine levels should be checked every year.

<9 umol/l

Cardio C-Reactive Protein

Elevated C-reactive protein (CRP) indicates “silent inflammation”: inflammation that is not linked to pain or infection. This blood test is used to assess risk for cardiovascular disease, aging, and all age-related diseases. CRP is typically tested at the same time a cholesterol screening is performed and is recommended as part of all routine blood chemistry screening.

<1.0 mg/l

Lp(a)-C

The lipoprotein (a)-C test provides additional information about your risk of developing heart disease. It is not included in routine blood work. This test is beneficial for men with existing vascular disease or who have a family history of coronary artery disease.

0–10 mg/dl

LDL-C

LDL (bad cholesterol) is obtained as part of your cholesterol panel and is also used to predict your risk of heart attack or stroke.

<70 mg/dl

HDL-C

HDL (good cholesterol) is obtained as part of your cholesterol panel. Low levels put you at risk for heart disease.

>
50 mg/dl

Non-HDL-C

Total cholesterol minus HDL-C. May be used as a close surrogate to the ApoB. It is a better predictor of cardiovascular events than LDL-C.

<130mg/dl

Triglycerides

Triglycerides are the fat that is found in body fat tissue. Excess triglycerides are linked to coronary artery disease, diabetes, inflammation, cancer, and Alzheimer’s disease. Triglycerides are measured along with cholesterol as part of a routine lipid panel test.

<100 mg/dl

ApoB

A blood test that is the single most significant and consistent lipid measurement to predict heart disease risk. A powerful marker of vascular disease and a better guide to the adequacy of therapy than any other lipid index. It represents the total burden of atherogenic lipoproteins.

<60

GFR (Glomerular Filtration Rate)

A blood test that assesses kidney function. It is a predictor of cardiovascular risk.

>
60

F
₂
-isoprostanes

A blood test that predicts risk of coronary artery disease. A measure of oxidative stress.

>
0.86 ng/mg

Vitamin D, 25-OH

Vitamin D deficiency increases heart attack risk in men.

50mg–80/dl

LpPLA2 (PLAC 2)

A blood test that is a cardiovascular-specific inflammatory enzyme involved in the formation of vulnerable rupture-prone plaque. It predicts risk for a stroke.

<80

Microalbumin-Creatine Ratio (ACR)

A simple and inexpensive urine test that is excellent for predicting cardiovascular disease risk.

<4.0μg/mg

Fibrinogen

A blood test that is a sensitive indicator of inflammation.

<450

Myeloperoxidase (MPO)

A blood test that is a strong indicator of a heart attack occurring over the next six months in seemingly healthy men.

<640

NT-proBNP

Valuable test for ventricular dysfunction—the “heart happy” test.

<125 pg/ml

TCF7L2

Genetic risk test for type 2 diabetes.

Negative

APO E Genotype

Genetic test used to guide therapy for CAD.

Results vary depending on genotype

KIF6

Genetic test that is a valuable predictor of risk for CAD.