Advanced Corporate Wellness & Screening

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At ProPrecision Health, it’s our goal to provide an in-house, comprehensive wellness alternative that improves the overall health of your employees. As part of our unique partnership, our Biennial Comprehensive Screening Visits include:

  • Vitals signs
  • Electrocardiogram (ECG)
  • Review of general medical history and recommendations for healthy living
  • Determine risk factors for stroke, heart disease, and peripheral vascular disease including alcohol consumption, smoking, blood pressure, cholesterol, and family history
  • Comprehensive full-body ultrasound screening
     

What We Look for on the Ultrasound Screening

img_0014_edited.jpgThyroid Disease and Nodules/Cancer

Palpable thyroid nodules occur in 4-7% percent of the population, but nodules found incidentally on ultrasound imaging suggest this is actually around 19-67%. The majority of thyroid nodules are asymptomatic and benign. Ultrasound can also follow these for any change.

About 5% of thyroid nodules will be malignant, and roughly 66% of these thyroid cancers are contained within the thyroid. The 5-year survival rate is almost 100% for most of these localized thyroid cancers. For more aggressive anaplastic thyroid cancer (still contained within the thyroid gland), the 5-year survival rate is 31%. If thyroid cancer has spread to nearby tissues or organs and/or the lymph nodes, it is called regional thyroid cancer. The 5-year survival rate for most regional thyroid cancer types is greater than 90%. For regional anaplastic/aggressive thyroid cancer; however, the survival rate drops to 10%.
 

Carotid Artery Disease/Risk of Stroke/Risk of Coronary Artery Disease

There is a high prevalence of asymptomatic carotid artery atherosclerosis in the general population - approximately 25% of adults. Where the “classic risk factors” of atherosclerotic disease we know exist in the coronary arteries, they also are present and very similar in the carotid arteries. Risk factors associated with atherosclerosis include:

  • Older age
  • Male
  • Family history
  • Race
  • Genetic factors
  • High cholesterol
  • High blood pressure
  • Smoking
  • Diabetes
  • Overweight
  • Diet high in saturated fat
  • Lack of exercise

"Mild" carotid artery narrowing ranges from 15% to 49% blockage. Over time, this narrowing can worsen and lead to a stroke. Mild narrowing is a sign of early blood vessel disease and calls for preventive measures. Medicines that may be used to treat carotid artery disease include:

  • Antiplatelets. These medicines make platelets in the blood less able to stick together and cause clots. Aspirin, clopidogrel, and dipyridamole are examples of antiplatelet medicines.
  • Cholesterol-lowering medicines. Statins are a group of cholesterol-lowering medicines. They include simvastatin and atorvastatin. Studies have shown that certain statins can decrease the thickness of the carotid artery wall and increase the size of the opening of the artery.
  • Blood pressure-lowering medicines. Several different medicines work to lower blood pressure.

If a carotid artery is “moderately” narrowed from 50% to 69%, one may need more aggressive treatment, especially if there are symptoms.

Surgery is usually advised for “severe” carotid narrowing of more than 70% because this degree of narrowing places a person at a high risk for stroke. Surgical treatment decreases the risk for major stroke after one has had symptoms such as TIA or minor stroke. Carotid artery atherosclerosis is responsible for 20% to 30% of ischemic strokes. The risk of stroke has decreased significantly over the last 20 years. Improved control of blood pressure, smoking ban campaigns, and the widespread use of statins have reduced the risk of cerebral infarction to <1% per year. However, about 15% of all strokes are still secondary to a carotid stenosis, which can effectively be detected by ultrasound imaging.
 

Neck Lymph Nodes/Risk of Lymphoma or Other Head and Neck Disease

The most common cause of swollen lymph nodes is an infection, particularly a viral infection, such as the common cold. If infection is the cause of swollen lymph nodes and isn't treated, an abscess (localized collections of pus) may form. An abscess may require drainage and antibiotic treatment. Other possible causes of swollen lymph nodes include:

Common infections:

  • Strep throat
  • Measles
  • Ear infections
  • Infected (abscessed) tooth
  • Mononucleosis
  • Skin or wound infections, such as cellulitis
  • Human Immunodeficiency Virus (HIV)

Uncommon infections:

  • Tuberculosis
  • Certain sexually transmitted infections, such as syphilis
  • Toxoplasmosis — a parasitic infection resulting from contact with the feces of an infected cat or eating undercooked meat
  • Cat scratch fever — a bacterial infection from a cat scratch or bite

Immune system disorders:

  • Lupus — a chronic inflammatory disease that targets your joints, skin, kidneys, blood cells, heart and lungs
  • Rheumatoid arthritis — a chronic inflammatory disease targeting the tissue that lines your joints (synovium)
  • Cancers
  • Lymphoma — cancer that originates in your lymphatic system
  • Leukemia — cancer of your body's blood-forming tissue, including your bone marrow and lymphatic system
  • Other cancers that have spread (metastasized) to lymph nodes
     

Liver and Biliary Disease/Cancer

Nonalcoholic fatty liver disease (NAFLD) is an umbrella term for a range of liver conditions affecting people who drink little to no alcohol. The main characteristic of NAFLD is too much fat stored in liver cells. In the United States, it is the most common form of chronic liver disease, affecting about 25% of the population. Some individuals with NAFLD can develop nonalcoholic steatohepatitis (NASH), an aggressive form of fatty liver disease, which is marked by liver inflammation and may progress to advanced scarring (cirrhosis) and liver failure. This liver damage is similar to the damage caused by heavy alcohol use.

NAFLD usually causes no signs and symptoms. When it does, they may include fatigue and pain or discomfort in the upper right abdomen. Possible signs and symptoms of NASH and advanced scarring (cirrhosis) include:

  • Abdominal swelling due to fluid (ascites) buildup
  • Enlarged blood vessels just beneath the skin's surface
  • Enlarged spleen
  • Red palms
  • Yellowing of the skin and eyes (jaundice)

Imaging procedures used to diagnose NAFLD include an abdominal ultrasound, which is often the initial test when liver disease is suspected. Because NAFLD causes no symptoms in most cases, it frequently comes to medical attention when tests done for other reasons point to a liver problem. This can happen if your liver looks unusual on ultrasound or if you have an abnormal liver enzyme blood test.

Alcoholic liver disease is the accumulation of fat in the liver as a result of heavy drinking. Moderate drinking is defined as one drink a day for women and up to two drinks per day for men. About 5% of people in the U.S. have this form of liver disease. It can look and behave like NAFLD in its early stages. As it progresses though, it becomes more distinct and leads to liver cirrhosis.

Primary Liver Cancer/Hepatocellular Carcinoma (HCC). Worldwide, HCC is one of the most common cancers, with more than 500,000 new cases reported each year. It is considered the third leading cause of cancer related death. It is the fifth most common cause of cancer in men and the seventh in women. At least 20,000 new cases are diagnosed in the United States every year.  The incidence rates are generally 2-3X higher in men than in women. The incidence is rising in North America due to the obesity epidemic and the increased risk for developing nonalcoholic fatty liver disease (NAFLD). Overall, the 5-year survival from liver cancer diagnosis in the United States was 15% in 2002–2008.

Hepatitis B virus (HBV) infection is the most common risk factor for HCC, with more than 50% of all liver cancers attributed to HBV.  There is a less incidence of HCC associated with Hepatitis C virus (HCV) infection.

Gallstones are very common, affecting 10-15% of the U.S. population. Gallstones are the most common gastrointestinal disorder requiring hospitalization. The annual cost of gallstones in the United States is estimated at 5 billion dollars. About 25% of the nearly 1 million people diagnosed with gallstones each year will need to be treated. If left untreated, gallstones can be deadly. Treatment for gallstones usually involves gallstone surgery. Risk factors for gallstones include:

  • obesity
  • female
  • recent fast weight loss, like from weight-loss surgery
  • diet high in calories & refined carbohydrates and low in fiber

Many people do not have symptoms of gallstones until they have complications. Complications of gallstones can include:

  • inflammation of the gallbladder
  • severe damage to or infection of the gallbladder, bile ducts, or liver
  • gallstone pancreatitis, which is inflammation of the pancreas due to a gallstone blockage

Gallbladder carcinoma is the fifth most common gastrointestinal malignancy. Cholangiocarcinomas (CCAs) are malignant tumors that arise from the bile ducts. It is a relatively uncommon tumor with incidence rates ranging from 0.8 to 2 per 100,000 in the Western world, thus making up less than 3% of all gastrointestinal cancers. Its peak incidence rate is in the seventh decade, and slightly more prominent in males.

Because gallbladder carcinoma and CCAs have late symptomatology and anatomic proximity to other organs, they have a late diagnosis and poor prognosis. Only about 20% of gallbladder cancers is found in the early stages, when the cancer has not yet spread outside the gallbladder. The overall 5-year survival rate for these people are 5-19% ranging from 65% survival for localized cancers to 2% survival for these cancers with distant spread. The American Cancer Society’s estimates for cancer of the gallbladder and nearby large bile ducts in the United States for 2021 are:

About 11,980 new cases diagnosed: 5,730 in men and 6,250 in women

About 4,310 deaths from these cancers: 1,770 in men and 2,540 in women
 

Pancreas Disease/Cancer

Before 2030, pancreatic cancer is expected to become the second-leading cause of cancer-related deaths in the United States, second only to lung cancer. Because the pancreas lies deep in the abdomen, a doctor performing an examination on a patient would not be able to feel a pancreatic tumor. Pancreatic cancer has no early warning signs as it grows insidiously and initially does not cause symptoms. There are currently no effective screening tests. As a result, pancreatic cancer is usually discovered late, once the cancer has spread to other areas of the body. Pancreatic cancer is the fourth most common cause of cancer death in men and the fifth in women. It accounts for more than 37,000 new cases per year in the United States. Cancer of the pancreas is resistant to many standard treatments including chemotherapy and radiation therapy. The classic presentation of pancreatic cancer is referred to as painless jaundice, a yellowish skin discoloration with no other symptoms. The diagnosis is usually made using different radiographic imaging techniques. If detected in the early stages, pancreatic cancer can be cured by surgical resection. Unfortunately, early detection is more the exception than the rule. At later stages, treatment can improve the quality of life by controlling symptoms and complications.
 

Spleen Disease

Many different conditions can cause the spleen to enlarge, especially diseases that cause blood cells to break down too quickly. An excess destruction of blood cells can overwork the spleen and cause it to enlarge. Conditions that can affect the spleen include:

  • bacterial, viral, and parasitic infections such as syphilis, tuberculosis, endocarditis, mononucleosis (mono), and malaria
  • blood cancers such as Hodgkin's disease, leukemia, and lymphoma
  • liver diseases like cirrhosis
  • hemolytic anemia

Other causes of an enlarged spleen include:

  • Inflammatory diseases such as sarcoidosis, lupus, and rheumatoid arthritis
  • Trauma, such as an injury during contact sports
  • Cancer that has spread (metastasized) to the spleen
  • A cyst - a noncancerous fluid-filled sac
  • A large abscess - a pus-filled cavity usually caused by a bacterial infection
  • Infiltrative diseases such as Gaucher disease, amyloidosis, or glycogen storage diseases
     

Kidney Stones/Cancer

People are most likely to develop kidney stones between ages 40 and 60, though the stones can appear at any age. Research shows that 35-50% of people who have one kidney stone will develop additional stones, usually within 10 years of the first stone. In the United States, 9% of women and 19% of men develop kidney stones in their lifetime. Caucasians are more likely to develop kidney stones than African Americans. In most cases, kidney stones occur without any other health issues. However, some people develop kidney stones as part of another condition. About half of people who develop calcium stones have high levels of calcium in the urine (hypercalciuria). Hypercalciuria often runs in families. Some other health conditions that increase the risk of kidney stones include obesity, type 2 diabetes, inflammatory bowel disease, gout, hyperparathyroidism, renal tubular acidosis (kidney dysfunction that leads to too much acid in the blood), and recurrent infections.

Kidney cancer is among the 10 most common cancers in both men and women. Overall, the lifetime risk for developing kidney cancer in men is about 1 in 46 (2.02%). The lifetime risk for women is about 1 in 80 (1.03%). The American Cancer Society’s most recent estimates for kidney cancer in the United States for 2021 are:

About 76,080 new cases of kidney cancer (48,780 in men and 27,300 in women) will be diagnosed.

About 13,780 people (8,790 men and 4,990 women) will die from this disease.

Most people with kidney cancer are older. The average age of people when they are diagnosed is 64 with most people being diagnosed between ages 65 and 74. Kidney cancer is very uncommon in people younger than age 45.

For reasons that are not totally clear, the rate of new kidney cancers has been rising since the 1990s, although this seems to have leveled off in the past few years. Part of this rise was probably due to the use of newer imaging tests such as ultrasound and CT scans, which picked up some cancers that might never have been found otherwise.

Risk factors for the development kidney cancer include:

  • Smoking
  • Obesity
  • High blood pressure
  • Family history of kidney cancer
  • Workplace chemical exposures
  • Gender
  • Male race
  • African American heritage
  • Acetaminophen abuse
  • Advanced kidney disease

Many kidney cancers are found fairly early, while they are still limited to the kidney, but others are found at a more advanced stage. There are a few reasons for this:

These cancers can sometimes grow quite large without causing any pain or other problems.

Because the kidneys are deep inside the body, small kidney tumors cannot be seen or felt during a physical exam.

There is a 75% overall 5-year survival rates for kidney cancer, ranging from 93% for cancer contained within the kidney to 13% for kidney cancer that has spread to other parts of the body. The survival rate for localized kidney cancers is very high because they are usually found at a very early stage.
 

Urinary Bladder Disease/Cancer

There are several bladder issues that ultrasound imaging can help diagnose. The most common are:

  • Bladder outlet obstruction from an enlarged prostate
  • Bladder prolapse in women
  • Bladder stones
  • Bladder cancer

Bladder cancer is the fourth most common cancer in men, but it's less common in women. The American Cancer Society’s estimates for bladder cancer in the United States for 2021 are:

About 83,730 new cases of bladder cancer (about 64,280 in men and 19,450 in women)

About 17,200 deaths from bladder cancer (about 12,260 in men and 4,940 in women)

Bladder cancer occurs mainly in older people. About 9 out of 10 people with this cancer are over the age of 55. The average age of people when they are diagnosed is 73. Overall, the chance men will develop this cancer during their life is about 1 in 27. For women, the chance is about 1 in 89. But each person’s chances of getting bladder cancer can be affected by certain risk factors. About half of all bladder cancers are first found while the cancer is still localized to the inner layer of the bladder wall and considered non-invasive. About 33% of newly found bladder cancers have spread into deeper layers but are still only in the bladder. In most of the remaining cases, the cancer has spread to nearby tissues or lymph nodes outside the bladder. Rarely (in about 4% of cases), it has spread to distant parts of the body.

Smoking is the most important risk factor for bladder cancer. People who smoke are at least 3 times as likely to get bladder cancer as people who don't. Smoking causes about half of all bladder cancers in both men and women. Workplace exposure to certain industrial chemicals have been linked with bladder cancer. High-risk industries include makers of dyes, rubber, leather, textiles, and paint products and printing companies. Other workers with an increased risk of developing bladder cancer include painters, machinists, printers, hairdressers (exposure to hair dyes), and truck drivers (exposure to diesel fumes).

Caucasians are about twice as likely to develop bladder cancer as African Americans and Hispanics. Asian Americans and American Indians have slightly lower rates of bladder cancer. The reasons for these differences are not well understood. The overall 5-year survival rate for bladder cancer is 77% and ranging from 96% for superficial cancer to 6% for bladder cancer that has spread to other parts of the body.
 

Peripheral Arterial Disease (PAD)

Both men and woman are affected by PAD; approximately 6.5 million people age 40 and older in the United States have PAD. While many people with PAD have mild or no symptoms, some people have leg pain when walking (claudication). Lower extremity PAD affects approximately 10% of the American population, with 30% to 40% of these patients presenting with claudication symptoms. The prevalence of PAD increases with age and the number of vascular risk factors. More importantly, it is a marker of global atherosclerotic disease burden, and is associated with increased mortality from cardiovascular and cerebrovascular causes. There have been recent advances in noninvasive imaging for all types of atherosclerotic disease with ultrasound being a workhorse tool for screening and diagnosis.

Peripheral artery disease signs and symptoms include:

  • Painful cramping in one or both of hips, thighs or calf muscles after certain activities, such as walking or climbing stairs
  • Leg numbness or weakness
  • Coldness in lower leg or foot, especially when compared with the other side
  • Sores on toes, feet or legs that won't heal
  • A change in the color of legs
  • Hair loss or slower hair growth on feet and legs
  • Slower growth of toenails
  • Shiny skin on legs
  • No pulse or a weak pulse in legs or feet
  • Erectile dysfunction in men
  • Pain when using arms, such as aching and cramping when knitting, writing or doing other manual tasks

If PAD progresses, pain may even occur when at rest. It may be intense enough to disrupt sleep. With progression to a severe state, PAD can cause critical limb ischemia. This condition begins as open sores that don't heal, an injury, or an infection on the feet or legs. Critical limb ischemia occurs because of ischemic tissue death, sometimes requiring amputation of the affected limb. The atherosclerosis that causes the signs and symptoms of peripheral artery disease isn't limited to the legs. Fat deposits also build up in arteries supplying blood to the heart and brain. With advanced progression of atherosclerosis in these arteries, one is at risk for stroke and heart attack.

Factors that increase one’s risk of developing peripheral artery disease include:

  • Smoking
  • Diabetes
  • Obesity (a body mass index over 30)
  • High blood pressure
  • High cholesterol
  • Increasing age, especially after age 65
  • A family history of PAD, heart disease or stroke
  • High levels of homocysteine, an amino acid that helps the body make protein and maintain tissue

The best way to prevent claudication is to maintain a healthy lifestyle. That means:

  • Quit smoking
  • Keep diabetic blood sugar in good control
  • Exercise regularly (30 to 45 minutes of exercise several times a week)
  • Lower cholesterol blood pressure levels
  • Eat foods that are low in saturated fat
  • Maintain a healthy weight

Symptoms of PAD can be evaluated with an ultrasound. Arterial duplex ultrasonography is one of the most common noninvasive approaches used by vascular laboratories to define anatomy, hemodynamics and lesion morphology. The accuracy of duplex ultrasonography in detecting arterial occlusions and stenoses have been reported to be between 92% and 97%.
 

Abdominal Aortic Aneurysm

Aortic aneurysms were the cause of 9,923 deaths in 2018. About 58% of those deaths were among men. A history of smoking accounts for about 75% of all abdominal aortic aneurysms. The U.S. Preventive Services Task Force recommends that men 65 to 75 years old who have ever smoked should get an ultrasound screening for abdominal aortic aneurysms, even if they have no symptoms. The same risks for PAD affect the development of an abdominal aortic aneurysm. Smoking is the most important behavior related to aortic aneurysm. Other factors include high blood pressure and high blood cholesterol. A family history of aortic aneurysms can also be important.

The main risk of an abdominal aortic aneurysm is rupture, which is often fatal. Ruptured abdominal aortic aneurysms are associated with an overall mortality rate of over 80%. The risk of rupture is dependent on the aneurysm size.  The relative risk of aortic aneurysm rupture ranges from 1% at 40-49 mm diameter to 33% at > 70 mm diameter.

Ultrasonography is the primary method used for screening AAA and is highly sensitive (95%) and specific (100%). Screening should be considered at an earlier age for those at higher risk for AAA.
 

Venous Thrombosis/Reflux Disease/Varicose Veins

A Deep Vein Thrombosis, or DVT, is a blood clot that occurs in a vein. DVT blood clots usually occur in the leg, though they can occur in the arm or other veins. The clot can block blood flow and lead to painful swelling in the affected limb.

DVTs are often caused by a change or slowing of blood flow. Blood flow can slow down enough to form a clot when sitting on long flights, after surgery, or a long time in bed because one is sick or hospitalized. DVT blood clots are also more common in women who are pregnant or taking birth control or other hormonal drugs, overweight people, or people with cancer or autoimmune disorders. People with a family history of DVT are also at risk.  One-third to one-half of people who have a DVT will have long-term complications caused by the damage the clot does to the valves in the vein called post-thrombotic syndrome (PTS). People with PTS have symptoms such as swelling, pain, discoloration, and in severe cases, scaling or ulcers in the affected part of the body. In some cases, the symptoms can be so severe that a person becomes disabled. It is estimated that between 300,000 and 600,000 Americans per year are affected by DVT and this causes approximately 100,000 deaths per year. These conditions are the third-most-common diagnoses related to blood vessels after heart attack and stroke.

The most serious complication of DVT happens when a part of the clot breaks off and travels through the bloodstream to the lungs, causing a blockage called pulmonary embolism (PE). If the clot is small, and with appropriate treatment, people can recover from PE. However, there could be some damage to the lungs. If the clot is large, it can stop blood from reaching the lungs and is fatal. For some people, DVT and PE can become a chronic illness; about 30% of people who have had a DVT or PE are at risk for another episode.

Chronic Venous Insufficiency (CVI) and Varicose Veins. The leg veins carry blood back to the heart. They have one-way valves that keep blood from flowing backward. In chronic venous insufficiency (CVI), the valves don’t work like they should and some of the blood may go back down into the legs. That causes blood to pool or collect in the veins. Without adequate flow, the blood can pool in the leg veins and result in common conditions, such as spider veins, reticular veins and varicose veins. Over time, CVI can cause pain, swelling, and skin changes in the legs. It may also lead to open sores/ulcers.

A blood clot in a deep leg vein can damage a valve. Lack of exercise, as well as sitting or standing for long stretches of time can raise pressure in the veins and may weaken the valves. Chances of developing CVI might be higher if one is:

  • Obese
  • Over age 50
  • Pregnant or have been pregnant more than once
  • From a family with a history of CVI
  • Someone with history of blood clots
  • A smoker

Symptoms:

  • Swelling or heaviness
  • Pain
  • Itchiness
  • Varicose veins (twisted, enlarged veins close to the surface of the skin)
  • Skin that looks like leather

Without treatment, the pressure and swelling will burst the tiny blood vessels in the legs called capillaries. That could turn the skin reddish-brown, especially near the ankles. This can lead to swelling and ulcers. These ulcers are tough to heal. They are also more likely to get infected, which can cause more problems. ​​​​​

Want to Learn More?

If you’re ready to see the benefits of your company offering a board-certified, physician-managed corporate wellness and screening program, Dr. Frank is ready to speak with you.

Opportunities are limited. Call today! 832.418.6067