What is Advanced Lipid Testing?

Advanced lipid testing may be recommended by your healthcare provider to optimize your cholesterol treatment. Advanced lipid tests are performed because standard cholesterol tests may not completely represent cholesterol-related risk for heart attacks and strokes. Some people—especially people with diabetes, insulin resistance, or cardiovascular disease—continue to have progression of cardiovascular disease, even when their low-density lipoprotein (LDL) cholesterol is at goal. Advanced lipid testing is usually performed in addition to a standard cholesterol test or “lipid panel,” which measures total cholesterol, LDL cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides. Two commonly used advanced lipid tests are apolipoprotein B (apoB) and LDL particle number (LDL-P).

How are advanced lipid tests performed and how often should I have testing?

ApoB and LDL-P are both simple blood tests and do not require fasting. Advanced lipid testing is offered at many labs and also may be available at your healthcare provider’s office. Insurance coverage can be discussed with your healthcare provider and insurance company. Some providers recommend advanced lipid testing at the initial visit and intermittently throughout treatment. Some providers recommend advanced lipid testing after you have successfully achieved your LDL cholesterol and non-HDL cholesterol goals.

What are good results and how do I achieve them?

As with standard cholesterol testing, your healthcare provider may recommend a specific target number based on your risk factors. As with cholesterol goals, advanced lipid goals are reached through a combination of healthy lifestyle and cholesterol-lowering medication.

How are advanced lipid tests different from regular cholesterol tests?

Cholesterol is carried in lipoprotein particles. Advanced lipid tests can be useful because some people do not have a lot of LDL cholesterol, but they have a lot of LDL particles. This can occur when they have mostly small particles or, alternatively, particles that contain less cholesterol per particle. A higher number of these lipoprotein particles make it easier for them to invade the walls of the arteries and induce a series of events that can lead to plaque formation. The LDL particle number measures the actual number of LDL particles that carry LDL cholesterol per liter of plasma. In addition to the number of LDL particles, advanced lipid tests report the size of these LDL particles, which may help your provider diagnose the cause of your cholesterol abnormality. For example, increased numbers of small, dense LDL particles can be caused by insulin resistance, a condition that raises your risk for developing diabetes. Understanding this information will help your healthcare provider utilize the right combination of diet and drug therapy to prevent onset or progression of disease. The apoB test measures the concentration of lipoprotein particles that have an apolipoprotein B on their surface. All of the particles that have the potential to cause disease are labeled with one molecule of apo B. ApoB, like LDL-P, can be a better measure of risk than LDL cholesterol in certain people.

What is Blood Pressure?

Blood pressure is the force of the blood on the artery walls as the heart pumps blood through the body. The arteries are the blood vessels that carry blood from the heart to the rest of the body. The heart pumps blood through the blood vessels by contracting. Each time the heart contracts, the blood pushes harder against the walls of the arteries than it does when it rests between beats. This means that the pressure of the blood on the artery walls is greatest each time the heart contracts.

Normal, healthy blood pressure is less than 120/80 (“120 over 80”).  Blood pressure can rise and fall with exercise, rest, emotions, or pain. However, if you have several measurements over 120/80, you probably have pre-high (pre-hypertension) or high blood pressure (hypertension).  The higher your blood pressure, the greater your risk of having a stroke and other serious medical problems.

We monitor blood pressure at every visit and also offer 24-hour ambulatory diagnostic tools to assist with hypertension monitoring. If your blood pressure is normal, check it once a year. If it’s above normal, follow the schedule for checkups recommended by your health care provider.

Try to reduce the amount of stress in your life by learning techniques to help you relax and cope with stress better. If you take medicine for high blood pressure, always follow your health care provider’s instructions. Don’t take less medicine or stop taking medicine without talking to your provider first. It can be dangerous to suddenly stop taking blood pressure medicine. Also, do not increase your dosage of any medicine without first talking with your provider.

What is bone mineral density testing?

A bone mineral density (BMD) test, also called a bone mass measurement, is a way to see if your bones are healthy and strong and is used to measure bone density and determine fracture risk for osteoporosis. It may also be used to determine how effective an osteoporosis treatment is.

Why is this test done?

Your health care provider orders a bone mineral density test to check your bone health. It may be done for several reasons.  The National Osteoporosis Foundation recommends BMD testing for the following individuals:

• All women aged 65 and older regardless of risk factors.
• Younger postmenopausal women with one or more risk factors.
• Postmenopausal women who present with fractures (to confirm the diagnosis and determine disease severity).
• Estrogen deficient women at clinical risk for osteoporosis.
• Individuals with vertebral abnormalities.
• Individuals receiving, or planning to receive, long-term glucocorticoid (steroid) therapy.
• Individuals with primary hyperparathyroidism.
• Individuals being monitored to assess the response or efficacy of an approved osteoporosis drug therapy.
• As a routine screening test.
• When your risk for having weak bones is high.
• After you have broken a bone to see if weak bones were a cause of the break, which could mean you are at risk for more broken bones.

Your bones naturally lose some density as you get older. The loss of density weakens the bones. If your bones are somewhat less dense than normal, you have osteopenia. If your bones have lost a lot of density, you have osteoporosis.

Each year there are approximately 700,000 spine fractures and 250,000 hip fractures in the US. Most of these fractures occur in people who have osteoporosis. To help prevent such fractures, it is important to diagnose osteoporosis. Osteoporosis can then be treated with diet, exercise, and sometimes medicines to help make the bones strong again.

Bone mineral density tests are much more sensitive than normal x-rays. Normal x-rays do not detect bone loss until at least 30% of the bone mass has been lost. Bone mineral density tests allow health care providers to diagnose weakening bones at earlier stages. The test helps your health care provider decide if you need treatment for osteoporosis.

How do I prepare for this test?

• You don’t need to fast, stop taking any medicines, or limit your activity in any way before the test.
• Don’t wear clothing with buttons, snaps, or zippers from the waist down on the day of the test. If you wear pants with an elastic waistband or cloth tie, you won’t need to get undressed for the test.
• If you have recently had x-ray tests using barium or any nuclear medicine tests, you should have your bone density test at least a week after those tests.
• Tell your health care provider if you are or might be pregnant.

A Holter monitor is a battery-operated portable device that measures and records your heart’s activity (ECG) continuously for 24 to 48 hours or longer depending on the type of monitoring used. The device is the size of a small camera. It has wires with silver dollar-sized electrodes that attach to your skin. The Holter monitor and other devices that record your ECG as you go about your daily activities are called ambulatory electrocardiograms.

Quick facts:

• You may be asked to wear a Holter monitor to see if you have a slow, fast or irregular (uneven) heartbeat. Or, your doctor may use it to see how well your medicines are working to treat these problems. If you have a pacemaker and feel dizzy, your doctor may use a Holter monitor to find out if your pacemaker is working properly.
• This monitor has no risks and wearing it isn’t painful.
• The results of wearing a Holter monitor will help you and your doctor decide if you need more tests or medicines for your heart, or if you need a pacemaker or cardioversion procedure to restore a regular heart rhythm.

What does it do?

A specially trained technician will attach the Holter monitor and instruct you how to record your symptoms while wearing it.

• The technician first attaches the electrodes to your chest. If you have a hairy chest, he or she may shave some hair off to attach the electrodes firmly.
• Once the electrodes are in place, the technician helps you put the Holter monitor on and explains how to take care of it.
• You can carry the monitor in a pocket or pouch, slung across your shoulders and neck like a purse or camera, or attach it to your waist.
• Do your usual activities while you wear the monitor with these exceptions:
  • Don’t bathe, shower or swim while wearing the monitor.
  • Don’t have X-rays while wearing the monitor.
  • Stay away from high-voltage areas, metal detectors or large magnets.
• The technician will show you how to keep a diary of your activities and symptoms during the test. It’s important to keep an accurate diary. If you feel symptoms such as chest pain, shortness of breath, uneven heartbeats or dizziness, note in your diary the time of day they began and what you were doing. Your diary will be compared to the changes in your ECG recorded by the Holter monitor.

After the test period, return the monitor to the technician. He or she will process the record of your heart activity and prepare a report for your doctor. This will include the notes in your diary. You should get the results of the test in one or two weeks.

What are the symptoms?

Symptoms may include: thumping, pounding, or racing sensation in your chest fluttering sensation in your chest feeling of irregular beating or skipped beats.

Complete Physical Exams

The Complete Physical Examination defines the Preventive Visit as an exam specifically focused on promoting health and illness. The exam includes counseling, anticipatory guidance and risk factor reduction. A preventive service exam is for a healthy individual who presents with no acute problems (asymptomatic). Your lab work for an annual exam will not be done in advance of your exam.

This is done because our screening questions may change the types of lab work that’s needed to diagnose specific issues your clinician may determine.

Although a discussion of different problems sometimes arise during your visit, this discussion is usually considered counseling and is considered a component of the preventative medicine examination unless significant time is spent on the care of that particular problem.

If a treatment plan is required to be changed based on an acute problem, your PCP (Primary Care Provider) is required to bill a consult visit with your Preventive Physical Exam. This can result in a co-pay for your visit.

This office will then bill for a Preventive Exam and a sick visit on the same day which may result in two co-pays for that visit. This is an acceptable insurance practice.

Note: Complete Physical Exams are a specific type of check up, which aids in identifying problems that may occur in the future based on your results.

Complete Physical Exams and Annual Wellness Exams are not the same. Annual Wellness Exams are a yearly appointment to create or update a personalized prevention plan. This plan may help prevent illness based on your current health and risk factors. Annual Wellness Exams are not a head-to-toe physical.

At your Annual Wellness Exam, your Clinician may:

• Check your weight and blood pressure
• Update the health risk assessment you completed
• Update your medical and family history
• Update your list of current medical providers and suppliers
• Update your written screening schedule
• Screen for cognitive issues
• Provide health advice and referrals to health education and/or preventive counseling services

Continuous Glucose Monitoring for Diabetes

Glucose meters are a great tool, but sometimes you need to keep a closer eye on your blood sugar levels. That’s where a device called a continuous glucose monitor (CGM) can help. This FDA-approved system tracks your blood sugar levels day and night. It collects readings automatically every 5 to 15 minutes.

It can help detect trends and patterns that give you and your doctor a more complete picture of your diabetes. The data can help you find ways to better manage your condition.

Several devices are available for adults and children. You need a prescription from your doctor to get one.

What Does It Do?

CGM measures the amount of glucose in the fluid inside your body. Different devices collect the information in different manners using tiny sensors. In some cases, the sensor is placed under the skin of your belly in a quick and painless fashion or, it can be adhered to the back of your arm. A transmitter on the sensor then sends the information to a wireless-pager-like monitor that you can clip on your belt.

The monitor displays your sugar levels at 1-, 5-, 10-, or 15-minute intervals. If your sugar drops to a dangerously low level or a high preset level, the monitor will sound an alarm.

In the past, only doctors could see the readings CGM systems collected. Now anyone can use the devices as part of at-home diabetes care. You can download data on your computer, tablet, or smartphone to see patterns and trends in your sugar levels. The information can help you and your doctor make the best plan for managing your diabetes, including:

• How much insulin you should take
• An exercise plan that’s right for you
• The number of meals and snacks you need each day
• The correct types and doses of medications

CGM doesn’t replace traditional home monitors. You’ll still need to measure your blood sugar with a regular glucose meter a few times a day to help the monitor stay accurate. Most monitors still require a finger stick and you should also replace the sensor under your skin every 3 to 7 days.

If you use an insulin pump, you can also link it to your CGM system for continuous care. You won’t need to manually program the pump as with the other finger-prick methods. This is called a “sensor-augmented pump.

Why Use CGM?

Unlike traditional glucose meters, CGM records your blood sugar levels throughout the entire day and night, showing your highs and lows throughout the whole week. The systems can help:

• Record dangerously low overnight blood sugar levels, which often go undetected
• Track high levels between meals
• Show early morning spikes in blood sugar
• Evaluate how diet and exercise affect you
• Determine if your treatment plan works on a day-to-day basis

CGM isn’t right for every person with diabetes, though. They’re more expensive than glucose meters and your insurance or Medicaid might not cover one. You may also need some extra training and practice to use the technology correctly. Talk to your doctor about whether CGM is a good fit for you.

Who Can Use a CGM?

Your doctor may recommend CGM if you have:

• Major highs and lows in your blood sugar levels for no clear reason
• Gestational diabetes, which happens during pregnancy
• An insulin pump
• Blood sugar levels that are very low, called hypoglycemia, or very high, called hyperglycemia

The device can be used by adults and children ages 2 and older. The FDA recently approved smartphone apps to pair with the CGM. Information on blood glucose is shared immediately. It’s expected to be a great help to parents and caregivers who can’t always be in the same place with the person who has diabetes.

What Does a DOT Physical Consist Of?

If your employees are designated as “safety-sensitive” for the Department of Transportation (DOT) – meaning their job can impact both their own safety and the safety of the public – they are required to have a regular physical to be compliant and keep working. A DOT physical follows strict guidelines mandated by the Federal Motor Carrier Safety Administration (FMCSA), ensuring that commercial drivers and other safety-sensitive employees are in good health to work safely.

With these strict guidelines, DOT physicals can sometimes seem overwhelming. To help simplify the process, here is a brief overview* of what your employees should bring to the exam, and what to expect once they get there.

What to Bring to a DOT Physical

Commercial drivers need to bring a complete list of their medications, including the dosage regimen, dosages, and their doctors’ names and addresses. To save time, it’s also recommended that drivers fill out the health history questionnaire before coming to the clinic. 

To make sure the exam runs as smoothly as possible, drivers with certain medical issues need to bring the appropriate documents or items. For example:

• Drivers with vision or hearing problems must bring their eyeglasses, contacts, or hearing aids
• Drivers with diabetes must bring the most recent lab results from their Hemoglobin A1C (HgAIC) and their blood sugar logs
• Drivers with heart-related issues must, at minimum, bring a letter from their cardiologist that outlines their medical history and current medications, and indicates that they are safe to work.

What the DOT Physical Covers

1. Vision

Drivers are required to have at least 20/40 acuity in each eye with or without correction. They are also required to have at least 70” peripheral in the horizontal meridian, measured in each eye.

2. Hearing

Drivers must be able to perceive what is known as a “forced whisper” at a distance of 5ft or less, with or without a hearing aid. This standard equates to an average hearing loss in the better ear of less than 40 dB.

3. Blood pressure/pulse rate

The medical examiner will check the driver’s blood pressure and pulse to look for high blood pressure and irregular heartbeats.

4. Urinalysis

A urinalysis is required. The test looks for indications of underlying medical conditions such as diabetes.

5. Physical Examination

The physical exam will cover a dozen different categories:

• General appearance
• Eyes (cataracts, glaucoma, macular degeneration, etc.)
• Ears (scarring of tympanic membrane, perforated ear drums, etc.)
• Mouth and throat (to look for problems breathing or swallowing)
• Heart (murmurs, extra sounds, pacemaker, etc.)
• Lungs and chest, not including breast examination (abnormal breathing, impaired respiratory functions, cyanosis, etc.)
• Abdomen and Viscera (enlarged liver, viscera, muscle weakness)
• Vascular (abnormal pulse, carotid, varicose veins)
• Genito-urinary (hernias)
• Extremities (limb impaired)
• Spine, other musculoskeletal (previous surgery, limitation of motion, tenderness, etc.)
• Neurological (impaired equilibrium, coordination or speech pattern, ataxia, asymmetric deep tendon reflexes)

A DOT physical can only be completed by a medical examiner certified by the FMCSA. It is up to the Medical Examiner to determine if a candidate meets all the requirements, and to mark the report to the best of their knowledge.

DOT Physical Forms

There are several forms associated with DOT physicals. These forms are available online, so that drivers and employers can review them before a visit. They include:

Medical Examination Report (MER) Form, MCSA-5875

The MER contains the driver’s information and health history, as well as the findings of the medical examiner during the DOT exam.  At Concentra®, the MER is completed online at the center and does not need to be printed and completed beforehand.

Medical Examiner’s Certificate (MEC), Form MCSA-5876

Certified drivers will receive this certificate after passing a DOT exam. 

Insulin-treated Diabetes Mellitus Assessment, MCSA-5870

Commercial drivers with insulin-treated diabetes must have this form completed by their treating clinicians no more than 45 days prior to examination by a certified medical examiner (CME). A Medical Examiner’s Certificate can’t be issued to the driver without this form.

For additional information, please visit www.fmcsa.dot.gov.

*This document is an overview and does not constitute legal or medical advice. Examination may differ.

PRE-EMPLOYMENT EXAMS

If you’re job hunting, you may be asked to pass a physical exam, either before an employer extends a job offer or during the interview process. Depending on the type of exam, the nature of the job and other factors, it’s often legal for a prospective employer to ask candidates to take a physical exam. But there are conditions regarding what the employer can ask, what type of exam can be performed, and when an examination can take place.

Most of the rules pertaining to pre-employment physical exams are covered by the Americans with Disabilities Act (ADA). The ADA applies to private companies with 15 or more employees. It also applies to state and local government employers, employment agencies, and labor organizations.

This legislation makes it illegal to discriminate against employees, or job seekers, based on disability. It also covers a number of other potential areas of discrimination, such as transportation, public accommodations, and access to state and local services.

Legal Guidelines for Pre-Employment Physical Exams

To protect job applicants against discrimination, the ADA prohibits requiring a medical exam prior to extending a job offer. However, employers are allowed to ask prospective employees to take a medical exam after a conditional job offer is made, as long as they require all applicants for the same job to undergo the same exam. Employers can also ask job applicants to describe, or demonstrate, how they would perform specific job functions prior to extending an offer.

Pre-Employment examinations may include physical exams as well as health inquiries including drug and alcohol tests, psychological tests, and physical or mental health assessments.

Additionally, employees may be required to have physicals if health or fitness is a job requirement. For example, police officers or firefighters may be asked to demonstrate physical fitness necessary to perform their jobs.

Employer Requirements for Pre-Employment Physical Exams

A physical examination can be required by a company for new hires if all other candidates for the same job category were also required to have an examination.

The results of the exam cannot discriminate against the worker, and their medical records and history must be kept confidential and separate from their other records.

It is expected that the person administering the assessment fully understands the expectations of the job to determine if the potential employee would be able to complete the duties required by the position.

Employers are also required to make “reasonable accommodation” for candidates with disabilities to enable them to be considered for a job opening. They cannot refuse to consider candidates with disabilities who require accommodation.

Drug and Alcohol Tests

Employers administer drug tests for a variety of reasons, such as decreasing absenteeism and on-the-job accidents, improving productivity, and reducing liability for the company.

Employment candidates may be asked to take a variety of drug tests. These include urine drug screening, hair, drug or alcohol testing, saliva drug screening, and sweat drug screening.

SCHOOL PHYSICALS

Our providers can handle your school and sports physical needs too! Our highly trained staff can complete your child’s exam and any forms you need for the coming school year. We can also administer many of the vaccines and required immunizations.*

For children heading back to school, a proper checkup is important to evaluate any issues your growing child may be dealing with. For example, a back to school physical can touch on whether a child’s vision is developing properly and address any other physical development issues that are important to a growing child.

What To Expect

Back to school physical exams will vary based on the child’s age, but typically the provider will:

• Record your child’s height, weight, blood pressure, pulse, and BMI
  • Check your child’s heart, lungs, lymph nodes, abdomen, skin, eyes, ears, nose, and throat
  • Evaluate your child’s vision, joints, muscles, and spine
  • Discuss the medical history of your child and your family

What To Bring

You should bring your child’s immunization records and a list of any medications your child takes, including prescription medications and over-the-counter medicines.

Telemedicine means medical care through the latest technology. With telemedicine, you communicate with Family Medical Center using your smartphone, tablet, or computer.  You won’t need to download any app to your smartphone or computer.

Thanks to telemedicine appointments, you can see your health care provider in real time (and they can see you), but you never need to leave your home. 

See below for instructions on using telemedicine to visit with your provider.  You will simply enter your clinician’s corresponding web address in your browser and follow the instructions.

• Dr. Corredera – Connect with Dr. Corredera Now
• Dr. Montero –  Connect with Dr. Montero Now
• Cheryl Carter – Connect with Cheryl Carter Now
• Heidi Smith – Connect with Heidi Smith Now

What is a wellness exam?

An annual exam is a comprehensive preventative exam with your primary care provider for the sole purpose of preventative care. An annual exam does not include discussion of new problems or detailed review of chronic conditions.  Annual exams may also be called routine check-ups, yearly exams, an annual pap, or preventive visit.

Will my insurance pay for a wellness exam?

Most health plans will pay for one wellness or preventative exam per year. Your insurance provider may consider this to be once per calendar year or one year and one day since the date of your last wellness exam. If you have had any other visit billed as preventative during this time period, your plan is likely to deny your wellness exam. This would include a well-woman exam or annual pap smear. Your plan may not pay for all testing and/or labs ordered during your wellness exam. If your provider has a concern and orders diagnostic testing and/or labs during your exam you may be held financially responsible. It is the patient’s responsibility to check with their insurance provider to see what is covered under their wellness benefit and to ensure they are eligible prior to scheduling their annual wellness exam.

What is the difference between a wellness exam and a problem visit?

Preventative visits and tests ordered by your provider can help you stay healthy and catch problems early. Diagnostic visits and testing are used to diagnose a current health problem. Diagnostic tests are ordered by your provider when you have symptoms and they want to find out why.  For example, your provider might want you to have a test because of your age or family history, that’s preventive care, but if it’s because you’re having symptoms of a problem, that’s diagnostic care.

Can I have a wellness exam and problem visit at the same time?

No. Billing issues prevent your provider from doing a wellness exam and a diagnostic visit on the same day. This is for your protection as your insurance carrier may deny one of these visits forwarding the financial responsibility to you. This does not prevent you from asking a simple question or requesting refills of any maintenance medications; however, we ask that you please schedule a separate appointment, on a different day, if you have any new concerns or other ongoing health problems that need more attention. Should your wellness exam turn into a diagnostic or problem-oriented visit we will bill accordingly.