Wellness and Annual Checkups

Anit Garg, MD discusses why it's important to schedule your annual wellness exams and shares important tips on how to age well and live  longer and healthier with a better quality of life. Learn more about BayCare's primary care services.
Wellness and Annual Checkups
Featured Speaker:
Anit Garg, MD
Dr. Anit Garg is board certified in internal medicine. He is a native of Pinellas County and his clinical interests include diabetes, hypertension, heart disease, hypothyroidism and obstructive pulmonary disease. Dr. Garg strives to provide optimal up-to-date, evidence-based health care with the highest regard of compassion for his patients, while not prescribing narcotics or tranquilizers as part of his practice. He is a diplomate of the American Board of Internal Medicine and a member of the American Medical Association, the Florida Medical Association and the Pinellas County Medical Association.

Learn more about Dr. Anit Garg

Melanie Cole (Host): Having an annual physical and wellness exam is crucially important to your overall health and one of the best ways to be proactive and be your own best health advocate. My guest today is Dr. Anit Garg. He’s an internist with Baycare Health. Dr. Garg, tell us what is the importance of that annual wellness exam and why do you feel that patients really need to be their own best health advocate and make sure they keep to those wellness exams and regular checkups?

Dr. Anit Garg (Guest): Well Melanie it’s very important to have annual wellness exams for a number of reasons. One of the big reasons is to assure that you have ongoing good health. A lot of us come to the doctor thinking that we just need to come to the doctor for sick visits, but there’s a lot of things that we do in the annual wellness exam to detect early problems that can be occurring with health and we do this by preventative testing and making sure you have the right vaccinations per age, gender and your risk factors.

Melanie: Tell us about some of things that you do at the wellness exam and that annual physical. Let’s start with blood work because that seems to be a source of confusion for many patients. They don’t know what you’re checking and why, so speak about the blood work and what you typically check.

Dr. Garg: Okay so the annual wellness exam is really a review of medical issues that may come about. So what we’re doing for blood work related to an annual wellness exam is screening for high cholesterol. We screen for diabetes. Depending on what is present during that annual wellness exam, we will screen for vitamin deficiencies. We can also screen for thyroid abnormalities as well. Depending on the age for example, if you’re a male that’s age 50 or older we get concerned for screening for prostate cancer. Prostate cancer screening is usually done with a manual rectal exam but it also includes something called a PSA which is important to get on the labs because that can be elevated and indicate prostate cancer even if an exam is negative. So those are some of the things we look on the annual labs.

Melanie: So people see that number and let’s just pick it apart just a little bit. Blood pressure, so important. So you take blood pressure, sometimes it’s high, there’s a little white coat reaction. When do you determine if somebody maybe does have high blood pressure?

Dr. Garg: That’s a good question. So high blood pressure and the definition of high blood pressure has changed over the years and it continues to change. High blood pressure is defined as anything 140/90. So the top number is known as your systolic blood pressure and that bottom number is called your diastolic blood pressure. The blood pressure is important to be regulated and at a good level to prevent certain other things from occurring such as heart attacks, stroke, those are some big things that we don’t want to happen. So typically anything less than 140/90 is not considered high blood pressure; however, we do have a middle ground area where if the blood pressure is running 120-139 on that top number or that lower number, the diastolic number, is 80-89, that we can sort of prehypertension and it puts our patients at a higher risk of going onto hypertension and having those secondary illnesses such as stroke and heart attack. So we really, when we have a patient in this prehypertension area, we want them to maintain a healthy weight, exercise daily if possible, at least for 30 minutes a day, making sure they’re taking a diet with a low sodium but high in fruit, vegetables, whole grains but the low sodium is very important. So I typically have my patients do what’s called a blood pressure log. So they get hold of a blood pressure machine, which they can either get at the local pharmacy or they can even take their blood pressure at the local pharmacy and then they log that blood pressure in for about one to two weeks and they bring it back to me in the office and then I determine if indeed they’ve been running high blood pressure at home too. If they have, we either make the proper dietary changes if it’s in the prehypertension area. If it is true high blood pressure, that’s where we sit down and talk about what can be done as far as medications being added to their lifestyle.

Melanie: Dr. Garg, one of the things that we’ve been hearing about is inflammation and our risk for heart disease and stress. As an internist, do you discuss stress, risk of heart disease, even in the blood checking like CRP, are you looking for these markers of inflammation and how do you explain to your patients what that even means?

Dr. Garg: So yeah there’s a lot of talk about the inflammatory markers. I don’t in particular as an internal medicine doctor on an annual wellness exam go into too much detail about inflammatory measures. Typically it measures CRP and ESR, those are inflammatory markers. Patients typically will have some other things occurring in their body that would indicate that those would need to be checked. Those are not labs that we typically check on a routine basis. There would have to be a reason for me to check those. Now as far as stress, I think that’s an important component that can lead to high blood pressure. I often have patients that have had a stressful life event, let’s say a family death, loss of a job, or another stressful situation that has caused their blood pressure to be elevated. Well then we really have to look at it and see if it’s really the stress and anxiety that has to be treated, and if that can be treated at times we can have that blood pressure come down as well. In my office, we are very good about sending our patients to counseling as well. If they do have a true stressful situation in life, that often can help as well. Sometimes we find that patients that are under high stress have underlying anxiety or depression and when we treat that, that blood pressure can also improve.

Melanie: And as you’re talking about the things you discuss with your patients, exercise, staying active, weight management, are such important aspects of this and the American College of Sports Medicine says exercise is medicine. So do you use this as a vital sign and ask your patients, hey are you exercising and looking at their weight and discussing some of these factors with them?

Dr. Garg: Yes I do, I think it’s very important for weight management. I discuss actually quite a few things with the patients, not just exercise. A lot of my patients that come in aren’t eating properly, maybe eating too much. Here and if you go to – out for a meal our serving sizes are so big here in the United States, so I always patients to start with maintaining a food diary. There’s a lot of different apps that are available on the smart phones that can be utilized to make that food diary. That really helps people to stay within a certain calorie range, making sure that they’re eating the proper nutrients with the fruits, vegetables, and proteins that you need on a daily basis as well as limiting the amount of saturated fats that you’re having in a day. I recommend that you shop at a grocery store with a list only. Eat smaller servings. When you do go to that restaurant, that you box half of your meal. I also think it’s important in the way the world is right now, that we remember that slow, modest weight loss is really the best way to lose weight and to keep it off and rather than doing a fad diet. Some other things that are important is making sure that you stay active. It’s not – I always tell my patients it’s not so much that they need to be in gym for 60 minutes at a time, just getting up and getting going is important. For example, we know that 10 minutes of exercise can make a difference. So if we have – I tell my patients get up in the morning before work, take a brisk walk for 10 minutes. Take a brisk walk at lunch for 10 minutes and do the same in the evening for 10 minutes, and there you go, you’ve got 30 minutes of exercise. I also recommend tracking your steps. I think that’s an important part of losing that weight with physical activity.

Melanie: What great advice, Dr. Garg, it’s really so important for patients to hear and it will help them to be their best advocate so that they know why it is that it’s so important for them to take these wellness visits and make sure that they attend their regular checkups. Wrap it up for us with your best advice about recommended preventative medicine; what you would like people to know about that blood work, about weight management, alcohol, smoking cessation and how as an internist, you’re helping them to achieve their goals?

Dr. Garg: Well what I like to do is actually give a little, an anecdote, a true story, a couple true stories that I’ve had that sort of highlights the importance of annual screening and they relate to prostate cancer screening and colon cancer screening. I had a younger gentleman that came into the office not too long ago at age 60 and he had come in complaining of a little abdominal pain, and through is workup, it turned out that he had both prostate cancer and colon cancer that had spread throughout his body. Similarly I had another gentleman that came in with screening and we found out that he had prostate cancer and he wasn’t screened until age 65. These patients if they had come in for their regular annual wellness exam, we could have screened them for prostate and colon cancer and prevented the cancer from occurring or caught it early enough where it wouldn’t have become a situation where it could become life threatening. Similarly with women I’ve had similar situations, women not getting their mammograms done every two years can also lead to a situation where you have advanced breast cancer. So I think that highlights the importance of screening. I’m a big advocate about cancer screening, especially the ones that we can prevent and treat if caught early. The other thing that I’m a big advocate of is making sure we screen our women as well as our men for osteoporosis. As we get older, especially at age 65 and older, we’re at a much higher risk of getting osteoporosis and having a fracture just with the minimal fall or tear so you don’t want that happening. You want to keep our patients healthy, get screened, we’re hear for you at Baycare to keep our patients healthy and keep you going.

Melanie: Thank you so much. Really great information, so important for listeners to hear. Thank you again Dr. Garg for joining us today. You’re listening to Baycare Health Chat. For more information, please visit baycare.org, that’s baycare.org. This is Melanie Cole, thanks so much for tuning in.