Goin' to the doctor

[false_Aest]

I'm pretty sure that this has probably been covered before but humor me.

The last time I went to a real doctor was right before college . . . . 2001.

I finally have insurance, a new doctor and a physical scheduled.

Is there anything extra I should get checked---I'm puttin' in about 7k miles a year and racing every other week.

w0rd
TFT


Oh yeah, if this makes a difference, I'm still under 30.

[SEABREEZE]

When you do look out

Found myself in the hospital for 3 weeks this year, and I do have insurance.

What was interesting was Dr a, b, c comes in to see you, asks your name, how you filling and leaves the room, doesn't examine you, and you receive a bill for $_____

The orderally who use to come to the room every other day to clean up, mop etc, asked me the same questions, but no bill.

I was telling the story to a Dr freind of mine, He told me when he landed in the hospital, he would tell Drs unrelated to the case, its ok, I will discuss my health with my admitting Dr.

Needless to say he received bills also from these Drs, he told me he refused to pay, but paid the hospital bill...

Understand I know the difference when secondary Drs are asked to evaluate.
This wasnt happening, it was a joke. Milking the system

[1centaur]

My only advice is: watch out for medical staff who don't know what a healthy cyclist does/looks like. I've had cracks about being unusually thin and my BMI is in the middle of the healthy range. They don't know what electrolyte depletion from hardcore and frequent exercise looks like. I had a tech make a note on my chart that it looked like I was having a heart attack when hooked up to a regular EEG. Holter monitor and stress test later (just about the fittest person of my age they have ever seen) it was viewed as normal heart-skips-a-beat stuff. Basically anything subtle that's caused by cycling a lot they probably won't recognize and might not even acknowledge. My "normal" temperature has declined from 98.6 since I was a child to 97.8 today, and my doctor refuses to believe this is possible (since he won't believe my testimony that my temperature was taken scores of times as a child and normal was consistently 98.6, but every time I get it checked now it's below 98, so they are sure it's always been there). That of course means that 98.6 today would be a slight fever for me and 99.4 would be a significant fever, but they would not believe that either. I developed vertical ridges in my fingernails over the last 10 years (maybe dehydration from cycling too much) and got a confused shrug from my doctor when I mentioned it. The Web is WAY more helpful than the average doc. My triglycerides (fasting test) went from 115 to 10 over a year and I got a shrug because they're not 150+; it took the Web to tell me that fish oil must be largely responsible.

I tried looking for a doc personally involved in endurance sports so I'd have a chance at getting some understanding of what I do, but no luck. So don't be surprised to get the impression that everything must be fine with you because you are not fat, out of shape and smoke.

[rugbysecondrow]

Make sure he doesn't have unussually thick fingers...

I'm pretty sure that this has probably been covered before but humor me.

The last time I went to a real doctor was right before college . . . . 2001.

I finally have insurance, a new doctor and a physical scheduled.

Is there anything extra I should get checked---I'm puttin' in about 7k miles a year and racing every other week.

w0rd
TFT


Oh yeah, if this makes a difference, I'm still under 30.

[false_Aest]

Make sure he doesn't have unussually thick fingers...


Hrm,

I didn't think I was supposed to get my prostate checked until I'm 40.

[eddief]

heart rate monitor...unless your new doctor has a new approach.

[thwart]

... until I'm 40. ... 50.

[chuckroast]

I started bending over whan I was 40.... :)

But seriously, as a cyclist, you probably spend a lot of time outside in the sun. Have the MD look at your moles and freckles etc for signs of melanoma.

It's good that you're getting physicals. At your age there probably isn't anything to "really" look at but it gives your physician a chance to start to look for patterns over time.

[rugbysecondrow]

In the military, they used to check guys starting at 35, but we also had a lot of assholes... :)

[BCS]

as a cyclist, you probably spend a lot of time outside in the sun. Have the MD look at your moles and freckles etc for signs of melanoma.

This is great advice but if you really want a thorough, head to toe skin check, you would be much better suited seeing a dermatologist instead of your Internist/Family Practitioner.

@false Aest: The biggest issue that I see in my cardiology practice among young athletes is hypertension and issues with cholesterol. There is also a body of evidence regarding icreased incidence ofRight Ventricular dysfuction and atrial fibrillation in endurance athletes.

@ 1Centaur: not sure if there is a typo in your post but a triglyceride level of 10! This is far lower than I have ever seen and beyond what you would expect with fish oil alone, but good for you. If you really believe that the web is more useful than the average doc, I suggest you look elsewhere. Surely you ride with at least one Serotta-owning MD, or at least someone who has a good relationship with their physician. I personally love seeing athletes and people who actually care about healthy lifestyle choices

@ chuck roast: PSA testing, a blood test, is more accurate than the finger

@ Seabreeze: while I agree that your experience in the hospital was suboptimal, an exam is not a necessary condition for sending a bill. The exam is a component of a hospital visit, along with the history, review of systems, decision making based on available data, etc. But I think you still got jacked

[dsteady]

. . . .

But seriously, as a cyclist, you probably spend a lot of time outside in the sun. Have the MD look at your moles and freckles etc for signs of melanoma.
. . . .

+1 I started getting skin checks around 35. Scots-Irish, mole-y skin, a lot of time in the sun as a kid etc... Now I'm 40 and have to go in every 6 mos, usually to get something shaved off. It's a bit of a pain but much better than melanoma.

A family in-law died very young of melanoma so I know that it is very real, and very tragic if it isn't dealt with early. Now that you're in LA you might want to take this precaution too.

dn'l

[JMerring]

@false Aest: The biggest issue that I see in my cardiology practice among young athletes is hypertension and issues with cholesterol

That would seem counterintuitive to me, but I am a doctor of laws, not medicine. Is there any particular reason for this? Just curious.

[BCS]

That would seem counterintuitive to me, but I am a doctor of laws, not medicine. Is there any particular reason for this? Just curious.

When a young athlete comes to see a cardiologist, it is unlikely to be due to congestive heart failure, coronary artery disease or valvular issues. The typical problems with which they present are what I have listed. That is not to say that athletics predisposes the patients to these conditions more than the elderly and obese--quite the opposite. My statement is basically an example of selection bias. If you are fit and young but end up getting referred to me, the likely reasons are hypertension, dyslipidemia or arrhythmia.

[JMerring]

When a young athlete comes to see a cardiologist, it is unlikely to be due to congestive heart failure, coronary artery disease or valvular issues. The typical problems with which they present are what I have listed. That is not to say that athletics predisposes the patients to these conditions more than the elderly and obese--quite the opposite. My statement is basically an example of selection bias. If you are fit and young but end up getting referred to me, the likely reasons are hypertension, dyslipidemia or arrhythmia.

Thanks. I think I get it but to dumb it down further (for myself) are you saying that the young, fit athletes who come to you exhibitng, dyslipidemia or arrhythmia likely have those symptoms due to genetics or lifestyle choices unrelated to their athletic pursuits (ie, not because of eating too many carbs, exercising too much, etc.)?

[SEABREEZE]

Hey Bc, I think you are the man who operated on a individual for 8 hrs, and when he awoke he was complaing about missing his meal. Forgetting about how you just saved his life. Thank you Sir...

Quick question, You always here the coach potato will out live the athelete.

Any truth to that. The highly driven athelete is consatantly tearing down his body. Cells dying off, needing proper detoxifing and rebuilding time. However most dont give there body the proper rest to regenerate properly. They listen to there brain insted , which tells them keep training.

Your thougts on that.

[BCS]

Thanks. I think I get it but to dumb it down further (for myself) are you saying that the young, fit athletes who come to you exhibitng, dyslipidemia or arrhythmia likely have those symptoms due to genetics or lifestyle choices unrelated to their athletic pursuits (ie, not because of eating too many carbs, exercising too much, etc.)?
ATMO, genetics are the biggest factor in these patients.

" You can feed a mule oats but it will never win the Kentucky Derby."

[BCS]

Quick question, You always here the coach potato will out live the athelete.

Any truth to that. The highly driven athelete is consatantly tearing down his body. Cells dying off, needing proper detoxifing and rebuilding time. However most dont give there body the proper rest to regenerate properly. They listen to there brain insted , which tells them keep training.

Your thougts on that.
The short answer is I really don't know. Intuitively, I believe that excessive high-intensity training is potentially harmful and that rest is an important component to any training program. The following link describes the adverse effects of prolonged endurance training on arterial stiffness.

http://www.usnews.com/health/family-health/heart/articles/2010/03/13/marathoners-face-greater-risk-of-artery-stiffness.html

Despite this data, I am still going to ride a 600K brevet in three weeks.
Bottom line for me is to live in moderation and do what makes me happy. YMMV

[Skrawny]

FWIW, 1+ to what BCS said.

At your age (judging from when you graduated college), the best things to check are: a basic exam, blood pressure, cholesterol, and for any skin cancers or pre-cancers.

I'm not sure I would include a PSA (and certainly not a digital exam!). The likelyhood of a false positive is higher than a true positive.

I would also concur that there is a growing body of evidence that shows higer incidence of atrial fibrillation in elite endurance athletes (distance runners, cyclists, etc.). Not sure why; higher vagal tone, heart chamber remodeling, . . .

-s