Cardiovascular health begins with a detailed history and physical examination. Laboratory studies are ordered as standard or in special cases of personal and family history of cardiovascular events. Once a comprehensive current risk stratification is performed, an individualized plan for management of blood pressure and lipids can be instituted and monitored on at least a yearly basis.
Metabolic health is primarily linked to insulin sensitivity or lack thereof. Maintaining a healthy weight with nutritional measures and exercise is always the first step towards achieving this. If nutrition and exercise alone aren’t enough, then adding medication to lower weight and improve insulin sensitivity are used. Once the system is working in the right direction, the use of continuous glucose monitoring can help you tailor your nutritional program for your own individualities inherited in your genetics. Thyroid hormone deficiency has implications in overweight conditions and is screened for in the intake exam.
Other hormone treatments get a lot of attention. There is ample evidence that some women and men can benefit from hormone replacement therapies in the late 40s through later in life. The decision to initiate treatment, what to treat with, and the duration of treatment is an extremely nuanced and personal decision which requires thorough evaluation and individualized treatment plans. Frequent monitoring is required especially upon initiation of treatment. Specifically provided are counselling regarding treatment as well as estrogen for perimenopausal women with and without progesterone as well as testosterone and estrogen blockers for men. Human growth hormone (HGH) for adults has a very narrow indication and is primarily reserved for the non-surgical treatment of acute musculoskeletal injuries and is used in short durations.
Cancer screening is part of a comprehensive risk reduction strategy and involves all current recommended annual screening for both men and women. Patients with higher risk family histories are likely to require early initiation and or more frequent screening. There is emerging evidence for the use of specific hardware diffusion weighted MRI for the evaluation of solid tumors throughout the body. While not typically covered by insurance, patients can make the decision to pursue this, and the cost is relatively affordable.
Cognitive decline, especially early onset, can have dramatic implications for quality of life. There is a screening test which can indicate if you are at increased risk of development of certain neurodegenerative conditions but currently there are no preventative measures beyond those I recommend for every patient. As such, the decision to undergo genetic testing for this predisposition is individual and based mostly on the personality of the patient. I am not getting the test myself, rather I am optimizing the things that I can control.
