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Nutrition Consultation at Cooper Clinic

August 11, 2014 Leave a comment

In this year’s Medscape survey, 50 percent of primary care respondents said they spent 16 minutes or less with patients. Cooper Clinic physicians spend up to two hours with every patient. We’re rounding out the blog series that broke down each of the six components of the comprehensive preventive exam at Cooper Clinic. If you haven’t followed along, read about the first five (of six) components to get caught up.

  1. Medical Exam & Counseling
  2. Laboratory Analysis
  3. Cardiovascular Screening
  4. Multidetector Computed Tomography (MDCT) Scan
  5. Skin Cancer Screening
  6. Nutrition Consultation

One-on-one consultations with a registered dietitian nutritionist (RDN) are designed to help patients gain the knowledge and skills needed to achieve a healthy lifestyle. This consultation includes nutrition coaching, a personalized action plan with diet recommendations and a computer analysis of a Three-Day Food Record to calculate the nutrients in your diet.

If eating well were easy, we would all be healthier and weigh less. But the bottom line is that staying faithful to mindful nutrition is hard. We may know what foods to choose, but just cannot find the strategy to make good choices. Or we may think we know the right food choices to make, only to find that a “healthy” bran muffin has as much fat and calories as a gooey cinnamon roll. Some of us would not know how to recognize a good fat from a bad fat if our life depended on it (which in some ways is kind of does).

Our RDNs can take the complex concepts of nutrition and translate them in simple terms as they apply to your individual dietary habits. Are there specific foods you love that need to be modified to be more nutrient dense? If your cholesterol is a tad high and you want to increase fiber in your diet for cholesterol lowering? An RDN can show you how to make simple changes in your food choices to make that happen. Are you on the go and prone to missing lunch? Our RDNs can tell you which of the meal bar substitutes (and there are a zillion out there) make the most sense for your nutritional needs, taste preferences and weight goals.

There is so much information online and in the news that it can be difficult to separate fact from fiction. Is it good to take calcium supplements to protect the bones or bad to take calcium supplements because of risk to the heart? Do I get enough calcium in my diet so I don’t even have to worry about supplements?

With a one-on-one consultation, your specific needs can be addressed. Are you a vegetarian worried about protein intake? Are you pre-diabetic and wonder which food choices will help you lower your blood sugar? Do you entertain clients at restaurants and need to find a way to eat a healthy meal from the menu without being a wet blanket? Surely nothing kills a party faster than having the host order a chicken breast with kale and a side of water.

Just as important as helping you make a road map for your nutrition journey, our dietitians are with you every step of the way. They are there for you if you need to come in to the clinic for a visit to brainstorm about roadblocks or you can schedule a phone consultation as frequently as would like to keep you headed in the right direction. The nutrition train is definitely one you want to get on board.

To learn more about Cooper Clinic’s preventive exam, click here or call us at 866.906.2667 (COOP).

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Skin Cancer Screening at Cooper Clinic

The Centers for Disease Control and Prevention (CDC) reports that skin cancer is the most common form of cancer in the U.S. and the American Academy of Dermatology (AAD) reports that one in five adults will be diagnosed with skin cancer in their lifetime. That should be powerful enough to have an annual screening and that’s why it’s is a vital component to the Cooper Clinic Comprehensive Exam. Read about the first four (of six) components to get caught up!

  1. Medical Exam & Counseling
  2. Laboratory Analysis
  3. Cardiovascular Screening
  4. Multidetector Computed Tomography (MDCT) Scan
  5. Skin Cancer Screening
  6. Nutrition Consultation

While beauty is more than skin deep, we must not neglect our skin—the body’s largest organ. Our skin provides an important barrier and immune protection plus hydration and vitamin-producing functions. A skin cancer screening identifies potential problems before they affect your health. Our board-certified dermatologists perform a meticulous screening for cancers, pre-cancers and atypical moles. With the physician you will also discuss information regarding your past sun exposure, sun protection measures and family history of skin cancer.

Types of Skin Cancer

There are many different types of skin cancer: actinic keratosis, basal cell carcinoma, squamous cell carcinoma and melanoma. Basal cell and squamous cell are the most common forms of skin cancer and if caught early and treated successfully, the cure rate is about 95 percent.

Melanoma is the most deadly skin cancer. According to the CDC, in 2010, 61,061 people were diagnosed with melanomas of the skin and 9,154 people died from it.

You are at higher risk for developing melanoma if you have been a frequent user of tanning beds, have a family history of melanoma, have atypical moles or lots of typical moles.

When melanoma is detected before it spreads, it also has a high cure rate. As is the case with most cancers, patients who have melanoma detected at an earlier stage have improved survival.

Melanomas can occur anywhere on the skin surface but are frequently located on the back and other areas that may be easy to miss with self-inspection. Screening examination of the total skin surface can increase the likelihood of detecting melanoma six-fold compared with partial examination. That is why a head to toe (and between the toes!) examination is very important. Did you know that melanoma can develop in the eye? When purchasing sunglasses, look for ones that block out 99 to 100 percent of both UV-A and UV-B radiation.

Symptoms of Melanoma
The most important warning sign for melanoma is a new spot on the skin or a spot that is changing in size, shape or color. The ABCDE rule is a guide for self-examination. Between your annual exams, be aware of the symptoms and contact your physician if you find a spot with any of the following features:

A is for Asymmetry: One half of a mole or birthmark does not match the other.

B is for Border: The edges are irregular, ragged, notched, or blurred.

C is for Color: The color is not the same all over and may include shades of brown or black, or sometimes with patches of pink, red, white, or blue.

D is for Diameter: The spot is larger than 6 millimeters across (about ¼ inch – the size of a pencil eraser), although melanomas can sometimes be smaller than this.

E is for Evolving: The mole is changing in size, shape, or color.

The AAD recommends that persons at highest risk perform frequent self-examination and seek professional evaluation of the skin at least once per year. Cooper Clinic board-certified dermatologists Dr. Rick Wilson, Dr. Flora Kim and Dr. Helen Kaporis can help you protect the health of your skin with preventive dermatology services.

To learn more about a preventive exam at Cooper Clinic, click here or call 866.906.2667 (COOP). Stay tuned for the last component of the exam, nutrition consultation.

Multidetector Computed Tomography (MDCT) Scan at Cooper Clinic

April 4, 2014 1 comment

Did you know Cooper Clinic patients who regularly get an annual exam live 13 years longer than the average male and seven years longer than the average female? Read about each of the six components of the comprehensive exam to learn why. If you haven’t seen the first three posts, get caught up!

  1. Medical Exam & Counseling
  2. Laboratory Analysis
  3. Cardiovascular Screening
  4. Multidetector Computed Tomography (MDCT) Scan
  5. Skin Cancer Screening
  6. Nutrition Consultation

Taking the cardio screening a step further, look inside at the health of your heart’s arteries with an MDCT scan. Calcification of the coronary arteries is a risk factor for developing heart disease and having a stroke.

Multidetector Computed Tomography (MDCT) Scan

An MDCT scan is an upper torso scan (between the shoulders and hip bones) that detects buildup in the heart’s arteries. The scan also evaluates the lungs and abdominal organs. Depending on the clinical history, this scan is commonly performed in men after age 40 and in women after age 50 and is repeated if clinically indicated thereafter.

Why do you need an MDCT scan? For your heart.

Among other things, the MDCT scanner can detect the presence of calcification in the coronary arteries or “CAC”. The amount of CAC is measured and converted to a score called a CAC score, also known as the Agatston score. Many studies have demonstrated that the more calcification detected, the risk of atherosclerosis in the heart arteries and the higher the risk of having future cardiovascular disease events. Learn more about CAC scores here.

Clinically significant amounts of atherosclerosis, frequently an indication for more aggressive risk factor management, is often defined by a CAC score ≥100 or a high score for someone your age and gender. A CAC score ≥400 may suggest the need for further diagnostic evaluation depending on the presence of other clinical symptoms or factors.

CAC is not uncommon in adults. A study from the National Institutes of Health evaluating CAC measured in 3,238 white adults in age groups ranging from 45 to 75 years of age found that 32 percent of women and 52.9 percent of men had some evidence of calcified plaque. CAC can even be detected in patients who are otherwise low risk when using traditional risk factors. For example, they have normal and/or cholesterol and don’t smoke.

Atherosclerosis that is not yet calcified (called “soft” plaque) is not detected by the MDCT scan. Thus, the absence of coronary calcification does not mean that the arteries are totally normal; however, the absence of CAC confers a very low risk for future cardiovascular events.

Why do you need an MDCT scan? For your lungs.

The MDCT scan is also a good tool for evaluating the presence of lung disease, specifically at early detection of lung cancers.

It is now recommended that even in the absence of worrisome symptoms (such as chronic cough), current or former smokers with significant smoking history receive low-dose CT scans to screen for lung cancer. These recommendations follow the publication of results from the National Lung Screening Trial (NLST) in 2011, which found reduced deaths from lung cancer among patients who received a low-dose CT screening compared with those given chest X-rays.

Chest X-rays are not recommended for lung cancer screening because they often do not demonstrate a lung cancer until it is far advanced. If you have been a longtime smoker and you have a normal chest X-ray, you should not assume that you are lung cancer free.

Combining the latest scientific technology with an unparalleled level of personal care and attention, Cooper Clinic delivers a truly unique patient experience. The MDCT scan is performed in a matter of minutes and is noninvasive. Unlike some clinics that make patients wait days or even weeks for results—results to celebrate or results that could change everything—Cooper Clinic provides all results the same day, many times within hours. That gives you time to review the information and discuss next steps with your Cooper Clinic physician.

To request an appointment or to receive more information from Cooper Clinic, click here.

Treadmill Stress Test at Cooper Clinic

March 24, 2014 3 comments

Did you know that more than 100,000 patients have done the treadmill stress test at Cooper Clinic? A few weeks ago we began a blog series to dive into each of the six components of Cooper Clinic’s comprehensive preventive exam. To get caught up, read about the first two components.

  1. Medical Exam & Counseling
  2. Laboratory Analysis
  3. Cardiovascular Screening
  4. Multidetector Computed Tomography (MDCT) Scan
  5. Skin Cancer Screening
  6. Nutrition Consultation

Component #3: Cardiovascular Screening

Since Cooper Clinic opened in 1970, we have used the treadmill stress test to help detect heart artery blockages and assess patients’ overall risk of developing heart disease in the future. Dr. Cooper was the first physician in Dallas to routinely use the treadmill stress test for this purpose. And since then our research has proven the importance of having this test done annually.

The stress test is a standardized walking or cycling test used to determine cardiovascular fitness, assess functional capacity and the conduction system of the heart and identify possible underlying coronary artery disease. Before, during and after the stress test, the electrocardiogram (EKG) is monitored continuously and blood pressure is measured frequently to assess the cardiovascular response to exercise.

On the Treadmill

At Cooper Clinic we use a modified Balke treadmill protocol for the treadmill stress test. With this protocol, the treadmill speed remains at 3.3 mph. We increase the work of the heart by adding elevation.

  • First minute—Zero percent elevation
  • Second minute—Two percent elevation
  • Third minute—Three percent elevation

After the second minute, we increase the elevation by one percent for each minute up to a maximal incline of 25 percent. As you can imagine, that is a pretty steep hill! For those few individuals who can exercise beyond 25 minutes, the incline stays at 25 percent and then the speed increases 0.2 mph/minute until exhaustion. We use this protocol rather than the Bruce protocol, which is used in most cardiology offices for the diagnosis of coronary blockages. Why? Because the Balke treadmill protocol has a more gradual increase in cardiac workload so that even our most unfit patients can participate to provide the data to write an exercise prescription.

How Performance Provides Results

Patients will often ask, ‘how long do I need to walk on the treadmill?’ In order to obtain an adequate test for the diagnosis of coronary blockages, a patient should reach a heart rate of at least 85 percent of their predicted maximal heart rate. The predicted maximal heart rate is estimated using the equation “220 minus age”. For example, if you are 50 years old, your predicted maximal heart rate is 220-50 or 170 beats per minute. However, we often exercise patients beyond this threshold value of 85 percent of predicted maximal heart rate because we stop the treadmill based on the patient’s exertion level rather than a predetermined heart rate. For many of our very fit patients, if we stopped the test when their heart rate reached 85 percent of their predicted maximal heart rate, we would have a result that didn’t reflect how hard they work when they exercise and we couldn’t create a realistic exercise prescription for them.

Scientifically Proven

A recent study from Cooper Clinic involving 25,642 individuals followed for 7.2 years, showed that in addition to assessing changes on the EKG during a stress test, other non-EKG measures helped predict the risk of death from all causes or from cardiovascular disease. Including:

  • Functional capacity (how long you exercised on the treadmill)
  • Resting heart rate
  • If the heart rate increased appropriately during exercise
  • How fast the heart rate recovered after exercise

Unlike its use in other settings, the treadmill stress test at Cooper Clinic is used as an objective way to measure fitness. Sure, we can ask you how often you exercise; we can ask you how hard you work during exercise, but nothing provides a real measure of fitness like your performance on the treadmill.

In 1989, a landmark paper from The Cooper Institute 501(c)(3) nonprofit examined 10,224 men and 3,120 women who had undergone fitness (treadmill) testing. After a follow-up of slightly more than eight years, research showed the risk of death from any cause decreased as fitness increased in both men and women. In addition, cardiovascular and cancer death rates were lower among the higher fit individuals.

Since that time, numerous scientific publications from The Cooper Institute have demonstrated the benefits of being fit and the risks of being unfit:

  • Men who maintained or improved their fitness were less likely to die from anything or from cardiovascular disease versus the unfit men who remained unfit over time.
  • The health benefits of fitness include reduced risk for developing risk factors for heart disease including diabetes, high blood pressure and high cholesterol.
  • The risk of low fitness approaches the risk of smoking.
  • Being fit reduces the risk of stroke and depression.
  • Being fit reduces the risk of dying from lung and gastrointestinal cancers.

Most recently, The Cooper Institute has shown that fitness at mid-life (average age in the upper 40s) impacts health—including the development of heart disease, stroke, diabetes mellitus, Alzheimer’s disease—and is a predictor of health care costs in later life. The average follow-up was between 24-26 years.

Given the proven health benefits of fitness, most experts recommend that a fitness evaluation should be part of routine preventive care as an independent “vital sign” that can be directly modified by routine physical activity. At Cooper Clinic, we do exactly that. Once we measure your fitness, we can use that information to create an individualized exercise prescription to improve your fitness or keep you fit.

To learn more about the treadmill stress test at Cooper Clinic, click here.

How Do Blood Tests Fit Into the Comprehensive Exam?

Cooper Clinic’s in-house lab provides same-day results for the patient to review with their physician.

We began a blog series to define the components of the standard-six comprehensive preventive exam at Cooper Clinic with, ‘What Does a Comprehensive Exam Entail?.’ In this post, we introduced the series and covered the first of six components, Medical Exam & Counseling. Our second component of six is Laboratory Analysis.

Component #2: Laboratory Analysis

Comprehensive lab testing includes cholesterol profile, blood sugar level, complete blood count, homocysteine, urinalysis, high sensitivity C-reactive protein, thyroid stimulating hormone, vitamin D, omega-3 and other important tests. Cooper Clinic’s in-house lab provides same-day results for our physicians to review with the patients. Depending if the patient is new or returning, we examine up to 70 blood tests.

There are a number of risk factors for the development of chronic disease that can only be identified by blood tests. You certainly would not want to find out that you have high cholesterol by having a heart attack!

Cholesterol
A complete cholesterol panel is an important test for prevention. Knowing the numbers in your cholesterol profile (total cholesterol, HDL (good) cholesterol, LDL (bad cholesterol) and triglycerides) helps define your risk for heart disease and stroke.

Almost 32 million adults have significantly high cholesterol levels (≥240 mg/dL). More than one of four adults has high triglyceride levels (risk factor for heart disease and stroke). An HDL cholesterol level <40 mg/dL in adult males and <50 mg/dL in adult females is considered low and is a risk factor for heart disease and stroke; about half of all adults have an HDL cholesterol < 52 mg/dL. What side of 52 mg/dL median level is your HDL? Given that in more than a third of patients, the very first sign of heart disease is death, this is definitely a chronic disease you want to prevent.

Fasting Blood Sugar
A fasting blood sugar measurement and a hemoglobin A1C measurement (which estimates your average blood sugar over the last three months) are important tests for prevention. An estimated 20 million American adults have been diagnosed with diabetes (fasting glucose ≥ 126 mg/dL). Another eight million adults have full blown diabetes, but don’t know it. More than 87 million adults (38 percent of the population) have prediabetes (fasting blood glucose 100-125 mg/dL). If you have prediabetes, you can take active steps in improving lifestyle to significantly lower your risk of developing full blown diabetes. Given that the presence of diabetes can result in vision loss, kidney dysfunction, heart attacks, strokes, poor circulation and amputations, this is definitely a chronic disease you want to prevent.

Kidney disease is another chronic condition that is detected by changes in blood work long before symptoms occur. More than 26 million adults (13 percent of the population) have chronic kidney disease and many do not even know it. Another 20 million are at risk for developing kidney disease because they have risk factors for kidney disease like diabetes or high blood pressure. Chronic kidney disease is a risk factor of heart disease and stroke.

The sooner you know if your kidney blood tests are abnormal, the sooner you can take proactive steps to protect your kidneys from further damage. Given that chronic kidney disease may require treatment with dialysis or kidney transplantation, this is another chronic disease you can prevent.

Vitamin D
Vitamin D is a fat-soluble vitamin that has helps keep calcium and phosphate levels in the blood normal which is important for healthy bones. Although more research is needed in these areas, preliminary studies have demonstrated that vitamin D deficiency is associated with increased risk of death from all causes, cardiovascular events including sudden cardiac death and stroke, diabetes, hypertension and impaired function of the immune and musculoskeletal system.

If you visit clinicaltrials.gov, where all on-going clinical trials are listed, and search vitamin D, you will see that vitamin D deficiency and vitamin D supplementation is being studied in countless conditions including  preventing diabetes, improving periodontal (gum disease), reducing hot flashes and improving fatigue! It is clearly the “it” vitamin of this decade.

Vitamin D is made in the skin in the presence of sun exposure. We can also get vitamin D from natural sources like fatty fish (less commonly) and more commonly from fortified foods (milk, breads and cereals). Despite the fact that sun exposure is not hard to come by and that fortified foods are generally available, vitamin D deficiency is shockingly common. A recent national survey of American adults (NHANES survey) identified that 42 percent of adults were vitamin D deficient.

Identifying vitamin D deficiency is simple (with a single blood test) and improving vitamin D levels is  easy too once you know you need to do it! Given the myriad of on-going clinical trials  involving vitamin D, who knows how many chronic diseases vitamin D levels may influence.

To learn more about a preventive exam at Cooper Clinic, click here or call 866.906.2667 (COOP). Stay tuned for the third component within the exam, cardiovascular screening.

What Does a Comprehensive Exam Entail?

February 24, 2014 5 comments

Did you know that Cooper Clinic patients who regularly get an annual exam live 13 years longer than the average male and seven years longer than the average female?

Cooper Clinic in Dallas has offered comprehensive preventive exams for more than 40 years—and it’s a great way to get a health status baseline and 2014 game plan. While every phase of the physical exam is important, the following six standard components outlined by our expert physicians are critical to providing an accurate, in-depth look at your overall health. These foundational elements are required for new patients.

  1. Medical Exam & Counseling
  2. Laboratory Analysis
  3. Cardiovascular Screening
  4. Multidetector Computed Tomography (MDCT) Scan
  5. Skin Cancer Screening
  6. Nutrition Consultation

In the following series of posts, I will break down each component and discuss why it’s a critical piece of your health status evaluation. Let’s get started with the first component!

Component #1: Medical Exam & Counseling

This part of the preventive medicine exam consists of a review of a completed medical history as well as a thorough physical examination performed by a Cooper Clinic physician. A medical history questionnaire is an important health assessment tool that provides framework from which your health care provider can assess your health and address disease. It gathers important information regarding symptoms, prior medical history, family history, medication use and lifestyle habits (alcohol, diet, smoking, exercise).

Medical Exam

A physical examination is an important health assessment tool as well. During the exam, health problems can be detected before they are symptomatic. For example, in one study, the build-up of atherosclerosis or hardening of the arteries in the legs (called peripheral artery disease), detected by reduced pulses in the feet and ankles, was present in 50 percent of patients who had no symptoms. Early detection of this problem is the only way to control risk factors for the progression of this disease which can cause debilitating symptoms for patients who have risk factors such as smoking or diabetes.

Medical science is complicated. Great medical care requires a partnership between you and your health care provider with comprehensive discussions about your past health, your current clinical status and your goals for preventing disease in the future. The medical history questionnaire and the physical exam are important tools for directing that dialogue.

Counseling

As a patient, you may not know what symptoms are important to mention to your doctor or you may not remember that you have a symptom until you see it listed. For example, your voice is hoarse now and then but you figure it may just be because of post nasal drip and allergies. It may well be. But if you have a history of smoking and heavy alcohol use, you are at increased risk for cancers in the throat that can cause hoarseness. By reviewing your complete medical history including the presence of chronic diseases, symptoms, lifestyle factors, family history and medication use, your health care provider can decide which symptoms need further evaluation and what treatments might be necessary to elevate symptoms.

Have you ever broken a bone? Some fractures are a function of bad luck (dropping a bowling ball on your foot) but some fractures may be the result of low bone mass (osteoporosis). A history of a so-called fragility fracture (breaking your wrist after tripping over a curb) may trigger your health care provider to screen for osteoporosis and make lifestyle or medication recommendations to strengthen bone.

Some diseases can run in families. This can affect your risk of developing that disease and certainly can effect when your health care provider will start screening you for that disease or treating you for risk factors that increase your risk of developing that disease. For example, if you have a family history of colorectal cancer, you have an increased risk of having colorectal cancer which can occur earlier in life, sometimes in the 40s or even the 30s. Unless you complete a careful family history in medical history questionnaire, your health care provider won’t know the best strategies for preventing diseases with a genetic predisposition.

Many chronic conditions develop because of poor lifestyle choices. Smoking, excessive alcohol intake, poor dietary habits and physical inactivity can all sabotage your health. Listing specifics about your alcohol intake or your exercise program is the perfect springboard for a discussion with your health care provider about how to modify those lifestyle choices to enhance your health and prevent disease.

To learn more about a preventive exam at Cooper Clinic, click here or call 866.906.2667 (COOP). Stay tuned for the next component within the exam—laboratory analysis.