The Annual Exam with a Purpose

author : AMSSM

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The purpose of the annual exam is to identify predisposing medical concerns that potentially can distract or diminish the training effectiveness of the triathlete.

By Nicholas A. Piantanida, MD
Member AMSSM 

The intent of the annual exam is to help the athlete accomplish preventive health and definitive care measures to support training and competitive milestones.  Its purpose is to identify predisposing medical concerns that potentially can distract or diminish the training effectiveness of the triathlete.  Above all, underlying cardiac abnormalities are associated with a small subgroup of disorders and high-risk behaviors.  Age, gender, and underlying risk factors are key indicators for sudden death.  The American Heart Association has provided screening recommendations to provide practitioners with a standard for performing cardiac health screening.

Make sure your physician is your primary care manager

The first step in any annual exam is to ensure you establish a professional relationship with a physician who knows you and your health goals.  In this era of “patient centered care”, your medical team should know you by name and serve you in a continual relationship of optimal health achievement.  A question you should ask in this step as you make the appointment is if this physician is your primary care manager.

Provide personal and family history

The second step in the annual exam is to provide your physician with an overview or update of your personal and family history.  This history can reveal 64% to 78% of the conditions that could deter or alter triathlete performance.  A question you can ask in this setting includes defining differences in your own personal health risks and those in your peer group.  In this way you can draw the physician into a discussion that centers on preventive health measures such as a detailed nutritional review, sun protection practices, immunization deficits, and past or future diagnostic tests that merit attention such as laboratory or age appropriate screening studies (DEXA Scan, mammogram or colonoscopy).

The necessary tests

Finally, the annual exam for a triathlete includes standard components of the cardiovascular screen including blood pressure, assessment of pulses, and a cardiac examination to include rate, rhythm, and presence of any murmur or abnormal heart sounds.  A joint specific musculoskeletal assessment should follow based on personal history of prior injury or performance limitations due to pain.  Questions you can ask in this step include if continued exercise will aggravate the condition identified or if there is any physical reason that you should be prohibited from exercising.  In this way you can enter the physician into a discussion focused on a rehabilitation plan or a discussion of further testing such as an electrocardiograph (ECG).

Nicholas A. Piantanida, MD
Chief, Primary Care
Evans Army Community Hospital
Fort, Carson, CO 80913

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date: January 17, 2012