Temecula Center for Integrative Medicine (TCIM) takes a fresh approach to helping people obtain and maintain physical health. We use a functional medicine approach that focuses on finding the root cause of a health issue and resolving it, rather than just treating symptoms. Additionally, we emphasize prevention, early detection, and early treatment.
Prevention is easier and less expensive than trying to remedy something after it's gone awry. Preventive measures often include minor changes in food choices, adding a nutritional supplement to the diet, or becoming more physically active, perhaps by taking frequent walks. Being healthy is less costly in terms of time, money, and worry than being chronically ill.
Early detection of an acute or chronic condition saves lives, as many chronic conditions result in a shorter lifespan. Almost half of all Americans have one chronic condition (such as type 2 diabetes, high blood pressure, and kidney disease, among others) (1). According to 2018 statistics, almost a quarter of Americans have two or more concurrent chronic illnesses (2). The expense can add up for a chronic illness, making early detection a way to save money. For example, managing diabetes can cost roughly $4,800 a year (3). Imagine being diagnosed with type 2 diabetes at age 38, and managing it throughout your life. By age 68, you would have spent about $144,000 (without accounting for inflation).
However, suppose certain, specific actions are taken when the early signs of diabetes are noticed. In that case, you may be able to regain healthy blood sugar and avoid the diagnosis of type 2 diabetes altogether.
Early detection allows for early treatment of many illnesses, sometimes allowing a complete reversal of the condition. Waiting too long to address a health issue can increase the risk of being unable to reverse something that might have been reversible if it had been addressed earlier. The earlier a course correction can be done, the easier the treatment will likely be.
Early detection of a health issue combined with quick action can prevent it from becoming extremely expensive, burdensome, or irreversible. Early treatment makes a positive outcome more likely. The primary way we accomplish early detection is with our Executive Physical.
This deserves repetition - some early interventions can completely reverse the disease state and bring a person back to good health! As doctors, we hear many regrets from people who decided (for one reason or another) to delay seeing a doctor for something. We understand that some symptoms are frightening, but they are an indicator that you should make an appointment.
The Annual Physical - One of the Best Tools a Doctor Has
The annual physical is one of the best tools for detecting health issues early in the progression of the disease. They provide a baseline measure to compare from year to year and allow providers to spot early warning signs. Blood tests are a routine part of the annual exam that detect conditions early; for example, rising blood sugar or A1C tests show when the pre-diabetes stage has been reached. Cholesterol tests can show abnormalities that can be addressed through diet, supplements, or medication if necessary.
The Executive Physical
At TCIM, we offer the annual Executive Physical for adults that is far more comprehensive than a basic physical and goes beyond the basic screening for common conditions. A TCIM doctor will thoroughly assess your health and determine potential risk factors, then possibly recommend advanced tests based on your individual profile. We screen for health conditions that are not as common but are potentially life-threatening, such as the abdominal aortic aneurysm. We also have more extensive screening for heart and liver-related issues than most doctors' offices.
A base core of tests is performed for all patients. Many of these core tests, such as the comprehensive blood panel, screen for common chronic illnesses. Please note that TCIM's Executive Physical is accomplished in at least two appointments. The patient returns for a second appointment so the doctor may review the results of the tests performed or ordered at the first appointment. At the second appointment, personalized health recommendations are made, tailored just to this particular individual.
During the first appointment for the physical, other tests might be identified that can be performed that day (or very soon if some preparation is needed). Advanced tests are selected just for you. We won't perform tests that aren't required, but more importantly, we will choose tests based on your reported symptoms, risk factors, family history, and personal medical history.
Advanced tests are more specific and unnecessary for everyone to undergo, so they are not automatically part of our Executive Physical. However, advanced tests are available if the doctor determines they would be in your best interests, and you agree.
TCIM Advanced Testing Options
During the physical at TCIM, the doctor may see a pattern of warning signs based on symptoms, family history, or personal medical history. If appropriate, the doctor may offer advanced tests to positively identify a condition (or rule it out). These advanced testing options typically center around cardiovascular screening, imaging that might pick up tumors or cancerous growths, testing lung function, or determining if allergies are present.
Many cardiovascular diseases and chronic illnesses are very common in the US, and we have ways to detect and treat them. Advanced tests help determine if a disease is present, sometimes before any symptoms are noticed, and possibly indicate the severity of the condition. Meanwhile, the tests that all patients receive (the core set of tests, including the comprehensive blood panel) can serve as an early warning and a signal to get some advanced testing.
Below are some common illnesses or diseases diagnosed by advanced testing, with some information about the type of tests used at TCIM.
Lung diseases
Chronic obstructive pulmonary disease (COPD) is a lung disease that has made the list of one of the leading causes of death in the US, making up most of the incidences of chronic lower respiratory diseases (4). Information about different types of lung diseases is found in a previous article. Blood oxygen saturation level can be measured during any office visit, with low levels indicating a potential lung issue.
Advanced test: The spirometry test is performed using a device that measures lung capacity and strength. It is non-invasive and easy to perform in the office.
Heart Conditions
TCIM takes heart conditions very seriously and has produced educational articles about artery health, issues of artery linings, atherosclerosis and stroke risk, cardiovascular events, coronary artery disease, and regenerative medicine for heart failure. The CDC notes that 47% of Americans have "at least 1 of 3 key risk factors for heart disease: high blood pressure, high cholesterol, and smoking” (5).
Sometimes you may be asked to take an advanced test based on your personal or family health history that puts you at higher risk, or we notice something during your exam or in your comprehensive blood panel results. Depending on the circumstances, there are several options for testing.
Advanced tests:
Electrocardiogram (ECG or EKG) - The EKG device measures the electrical signals of the heart. It produces the graph you've probably seen, where spikes indicate the heartbeat. It's such a sensitive tool that even slight abnormalities can be detected.
Plethysmography - This is a specialized non-invasive test that screens for endothelial dysfunction using a finger clamp similar to the one used to track pulse. It can help detect restrictions in circulation or hardening of the arteries.
Carotid Intima-Media Thickness (CIMT) - The CIMT is an ultrasound imaging of the thickness of the artery walls in the neck that lead up to the head. The thickness of your artery is compared against the artery lining widths of other people, revealing if your arteries are "older" than your physical age. It can also reveal if plaque is building up within the artery.
Fatty Liver Diseases (FLD), Cancerous Liver, Liver Damage
As we've written about in a previous article, liver diseases can sneak up on people because not everyone experiences noticeable symptoms. The comprehensive blood panel includes a section on liver health, which measures certain liver enzymes that alert the doctor to liver tissue damage when high amounts are found.
Advanced test: An ultrasound on the liver is performed, where sound waves produce an image that can be examined. The image can show evidence of scar tissue, tissue damage, cysts, and tumors.
Thyroid Diseases, Nodules, or Cancers
Thyroid issues are relatively common, including thyroid nodules. Most nodules (close to 95%) are not cancerous, so the odds are good that lumps on the thyroid are benign (9). Basic thyroid function tests are performed with a blood test, and there are advanced panels that measure multiple thyroid hormones and antibodies to the thyroid hormones. The thyroid blood panels are an early warning system for more severe issues. The doctor may attempt to feel the thyroid through the skin around the neck. Medications are often used to treat an under-functioning or over-functioning thyroid.
Advanced tests: An ultrasound is performed on the thyroid, where sound waves produce an image the doctor can examine. Sometimes, a more in-depth blood test can detect issues with imbalanced thyroid hormones or pick up antibodies to thyroid hormones. High levels of specific thyroid antibodies can indicate the body's immune system mistakenly targets the thyroid, indicating autoimmune disease.
Environmental Allergies
Many people have immune reactions (allergies) to things in their environments that do not cause a response in other people, such as pet dander, tree pollen, or dust mites.
Advanced test: Skin allergy testing can be performed in the office. This test involves lightly pricking the skin with the suspected allergen. If the skin turns red, it indicates an immune reaction to the substance. Depending on the allergen, there may be an in-office test, or you may be referred to a specialist for other testing possibilities.
Abdominal Aortic Aneurysms
An abdominal aortic aneurysm is another condition that can lie hidden or silent for many years before becoming noticeable, sometimes in a dramatic or life-threatening way. The aorta lining can become thin and even rupture (called an aneurysm). Aortic aneurysms are life-threatening unless addressed by surgery immediately, so spotting early bulges in the aorta, before they rupture, is critical. Screenings for this condition are recommended if the patient fulfills specific criteria: men, 65-75, who have ever smoked cigarettes, or who have a family history of this condition.
Advanced test: Ultrasound, the same technology used to see a growing baby during pregnancy, is used to produce the image of a patient's aorta (a massive artery structure) as it leaves the heart, goes through the trunk of the body, and splits to go down each leg. (This large artery is the primary way blood flows to the lower half of the body.) Ultrasound is the most commonly used diagnostic tool for abdominal aortic aneurysms (11).
Organs that are Enlarged, Have Damaged Tissue, Tumors, or Cancerous Growths
Because ultrasound can see other organs near the abdominal aorta, this method can be used as a screening. Doctors examining the abdominal aorta spotted abnormalities in nearby organs, so it's been adopted as a screening method. Some abnormalities spotted include signs of tumors or cancers of the liver, biliary tract, pancreas, spleen, kidneys, abdominal aorta, bladder, uterus, ovaries, and prostate” (12). Spotting potential cancerous or tumorous growths on other organs would be a signal to get a diagnosis by an oncologist and perhaps different diagnostic tests such as an MRI or a CAT scan.
Advanced test: An ultrasound is performed along the route of the abdominal aorta. Sound waves produce images of nearby structures and organs that the doctor can examine.
Insurance Coverage
Insurance typically covers many types of advanced testing when certain risk factors exist. TCIM will work with you to find tests that maximize your insurance coverage. That said, there may be some things that insurance does not cover.
Luckily, many services not covered by insurance are within reach of the average budget, especially if you remember that prevention, early detection, and early intervention can save you from wallet-draining chronic illnesses, and may even save your life. Considering the time spent on appointments, money paid for hospital and doctor bills, and the physical pain you save yourself by early detection and treatment, it's easier to justify paying out-of-pocket for some expenses.
Scheduling an Executive Physical
TCIM is proud to offer the Executive Physical because we know from experience that addressing issues caught early by our doctors has helped save lives and allowed people to live healthier, with less pain, expense, and struggle. If you have a personal or family history of any of the conditions above, we especially encourage you to get our two-step Executive Physical. We would be privileged to help you gain optimal health.
Jonathan Vellinga, MD is an Internal Medicine practitioner with a broad interest in medicine. He graduated Summa cum laude from Weber State University in Clinical Laboratory Sciences and completed his medical degree from the Medical College of Wisconsin.
Upon graduation from medical school, he completed his Internal Medicine residency at the University of Michigan. Dr. Vellinga is board-certified with the American Board of Internal Medicine and a member of the Institute for Functional Medicine.
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