Concerns Regarding Michael O Sigler, and the Importance of a Comprehensive Executive Health Evaluation in 2014
Michael O Sigler, M.D.
In April of 2007, I was asked to write an article regarding the "Importance of a Comprehensive Executive Health Evaluation" by the e-Journal of Age Management Medicine. In my personal review of 2013 and looking forward to 2014, I thought it would be a good idea to update the article where needed and share it again with my colleagues.The science and technology of Age Management and medicine as a whole is growing by leaps and bounds, and Alternative Medical Practitioners are becoming more and more accepted and thus Alternative medical solutions are more widely practiced. Even your hardcore medical practitioners are realizing that the practice of preventative medicine that corrects the problems, rather than the reactive mode of medicine that only relieves the symptoms. This radical change in practitioner attitudes makes the Comprehensive Executive health Evaluations are even more important in 2014.
Today's physician should be able to evaluate and address disease risk markers to evaluate a patient in order to implement proactive strategies to improve health and lower disease risk. Prior to evaluating a patient, one should assess the subjective and objective data points for what is being measured and compare them to the conclusion. Ask yourself, are they evidenced based? Do their conclusion outcomes improve health and lower disease risk?
Age management as a whole is interested in improving patients’ interval survival, not their maximum life span. We are not taking care of patients before birth, we are meeting them as adults and using actuarial and literature based data to analyze their disease risk, identifying strategies to lower that risk, incorporating "normal" risk as a risk and including hormone markers as markers of disease risk. The ultimate goal of the executive health evaluation is to minimize the patient’s disease or mortality risk.
Determine Markers of Disease Risk Implementing Patient Care
- Literature Based Decision Making
- Standardized and Repeatable Markers
- Utilize Actuarial Data
- Utilize Population/Epidemiological Data
- Prioritize Patient Risk Factors
One cannot overestimate the importance of a comprehensive history and adequate physical exam looking for signs and symptoms and physical findings consistent with low hormone states or high disease risk states. It is paramount to provide a clinical context for the evaluation and treatment, and to contextualize your outcome measurements.
Age management protocols also look for problems that would exclude therapy. Each patient is unique and we cannot continue to provide a one-size-fits-all treatment protocol. We need to provide proper lab and diagnostic testing, formulate and individualize a treatment plan, and then diligently be appropriate with regards to follow up measures.
When he was asked why he robbed banks, Willie Sutton replied, "Because that's where the money is." The same can be said of choosing relative risk disease markers with regard to implementing age management medicine protocols.
The most frequent cause of death in America is heart disease, killing almost one million men and women per year. (Table 1.) As you look throughout this data accumulated from the 2002 census on most frequent causes of death, you will see that it is a valuable resource for the expected impact of disease risk modification with regard to certain outcomes.
Currently diabetes kills only 3% of all those who die, but it is also associated with disproportionate expense, loss of independent function and loss of productivity. It’s currently an epidemic and it is predicted that over time this will be the most rapidly raising cause of death in America.
Table 1. National Vital Statistics Reports
A physician needs the knowledge and tools in order to lower disease risk in his or her patient and should be current on evidence based literature identifying specific markers of disease risk.
The most prominent among disease risks for mortality are coronary artery disease risk markers. Laboratory parameters for coronary artery markers are many. Lipid values are well known and now C Reactive Protein has become an accepted marker of disease risk as well.
Many patients are unaware that insulin and glucose are independent markers of disease risk and both are important to incorporate into a global health care evaluation. Additionally, it is important to identify as many markers of increased cardiac disease risk as we can and endeavor to lower each marker into the lowest risk category.
There is more to cardiac disease risk than laboratory markers. Non-laboratory disease risk markers must be addressed as well, through a history of tobacco use; patient's review of activity level and exercise recommendations; family history; gender related risk; past medical history including DM, CAD, and HTN; history of obesity and non-laboratory measurements such as waist to hip ratios; and social factors including stress factors, diet and the importance of nutritional intervention with regard to minimizing disease risk and an adequate and complete review of systems.
For other disease risk, many times there is not a guaranteed certain laboratory result that relates to a positive risk. Proper standardized measures for cancer screening such as colonoscopy, serum psa, mammography, and keeping up with routine physical exam findings are part of a global approach to minimizing disease risk.
Now, with electronic testing we can screen for dementia and are able to identify a condition called mild cognitive impairment, which is screened using an early cognitive possessing speed measure that is associated with dementia risk. It has also been found that early cognitive intervention is associated with better long-term outcomes.
The comprehensive evaluation should also include body composition measurements including screening for osteoporosis evaluation through bone mineral density.
Measures of mood should be included as they are also associated with global outcome and overall patient satisfaction as well as quality of life measurements.
General health screening, vaccination status and quality of life measurements are necessary to complete a comprehensive evaluation.
Many of these are not exactly glamorous age management methods, but again we are trying to identify as many causes of increase health or mortality risk as possible and minimize them all.
The Cenegenics Physician Training & Certification AMA/PRA Level 4 Classifications (in accordance with the American Medical Association guidelines for Continuing Medical Education on New Procedures and Skills) trains physicians in how to incorporate specific disease risk stratification's into a new or an existing medical practice utilizing current evidenced based information.
References:
Original Article Published as a featured article in the e-Journal of Age Management Medicine - April 2007
Dotson, A. The Cenegenics Evaluation of the Age Management Patient. Cenegenics Education and Research Foundation Web Site 2007. Available at: www.cenegenicsfoundation.org Accessed April 22, 2007.
Michael O. Sigler, M.D., is Executive Director, Age Management Panama Consultorios Médicos Punta Pacífica and Co-founder, Age Management Panama & Live Well Pharmaceuticals. Dr. Sigler received his medical training both domestically and internationally, at prestigious universities including Stanford, University of California–San Francisco, University of Miami School of Medicine, University of Toronto, University of Cambridge, England, and Saint Eustatius, Netherlands. He has treated thousands of patients abroad and in the community of South Florida throughout his training in surgery and rehabilitation at Mount Sinai Medical Center, Jackson Memorial Hospital, Hollywood Memorial Hospital and the VA Hospital. He has published manuscripts in peer reviewed plastic surgery journals and written book chapters for surgical texts. Located at the Consultorios Medicos Punta Pacifica Dr. Sigler helps people across the globe specializing in Age Management Medicine & Rejuvenology. His comprehensive, interdisciplinary approach includes Hormonal Therapy – Growth & Bio-identical, Men's Health – Andropause & Sexual Function, Women's Health – Menopause & Peri-menopause, Health & Lifestyle Assessment – Nutrition & Exercises, Executive Health Evaluations, and a wealth of Rejuvenology aesthetic medical spa surgical procedures, all helping lead the art and science of appearance, health and performance enhancement. Dr. Sigler is Past Research Fellow for Cenegenics Education and Research Foundation (CERF).
References Upon Request. msigler@agemanagementpanama.commsigler@agemanagementpanama.com
Dr. Michael O. Sigler, Consultorios Punta Pacifica, Panama City, Rep. Panama
