You know the feeling. You take off hours from work to go in for your annual physical exam, and then sit on the hard, paper-covered table while answering the same questions you answered at last year’s physical. After a few minutes of gentle poking and prodding, your doctor tells you you’re in good shape. See you next year, he says. But that reassurance isn’t necessarily justified, for it only gives you a momentary snapshot, rather than a real sense of where your health is headed in the weeks, months, and years ahead.
I recently met a 55-year-old patient, an athlete his whole life, thoughtful about food and sleep. He wants to feel excellent and live well for a long time. For years, his cholesterol panel had been looking increasingly abnormal, but his doctor had shrugged it off as not yet urgent enough to act on. Eventually, he had to get more advanced cardiac testing, which found significant coronary artery disease. Since learning he had plaque in his arteries, he has struggled to tolerate different lipid-lowering medications and felt frustrated by how little control he seems to have.
I encourage all my patients to keep their own spreadsheets of lab results, since trends tend to tell stories that snapshots miss. Once my patient pulled together his records, a decade of results emerged. Buried in them was a letter after his 2014 annual physical: Your cholesterol panel is abnormal. The recommendation would be to eat healthy, exercise, and sleep, which are all things you are already great at. See you in a year! What followed was a decade in which closer monitoring, a more individualized assessment of risk, targeted lifestyle changes, and medication could have been considered.
