Top care, top dollar
Los Angeles Times – July 12, 2004
Infrared technology lets farmers know just how much nitrogen plants require.
Tailored physical exams offer high-tech screenings -- plus an emphasis on wellness.
By Hilary E. MacGregor, Times Staff Writer
What do you get for a $7,500 executive physical?
Doug Shafer, a stressed-out Napa Valley vintner, was willing to fork over the cash to find out.
At 7:35 a.m. on a recent Wednesday, Shafer pulled a black BMW X5 into a reserved parking space at St. Helena Hospital, a regional medical center overlooking vineyards. A nurse escorted him to his room, where every detail was personalized.
The medical staff wore blue, his favorite color. His room was blue too. The stereo was blasting the Rolling Stones, his favorite group. Inside a gym bag, emblazoned with his initials, was a golf magazine (he loves golf) and a biography of JFK (he's a fan). There was also a heart-rate monitor, a pedometer and a strengthening tool that could fit into the suitcase of a man who travels a lot.
Shafer would spend the next 11 hours being tested, diagnosed, analyzed and counseled. He would meet with a nutritionist, a behavioral psychologist, an exercise physiologist and the Harvard-trained doctor who runs the program. His body would be scanned by the most up-to-date technology; his blood would be drawn and sent to specialized labs. There would lots of time with the doctor - and no waiting. At the end of the day, Shafer would leave with a 3-inch-thick binder containing a personalized plan on how to live a more healthful life.
And just in case Shafer might be tempted to stash the binder and his new heart-rate monitor in a back closet, the doctor would follow up four times during the year to make sure he was staying on track to meet his new goals.
The One program at St. Helena offers a peek at preventive medicine at the very top tier. It's what medicine would look like if everyone had access to the latest technology, the latest tests and research, and a team of physicians and nurses who would spend hours focusing on your health and your life.
There would be no crowded waiting rooms, no surly, overworked office staff, no interruptions. It wouldn't take three phone calls to find out your test results. The doctor would listen, without distractions, as you spoke of ailments that bother you - both real concerns and the little nagging ones that you weren't sure were worth mentioning. You wouldn't have to worry if your medical insurance (if you had it) would cover the costs of diagnostic tests. Here, the doctor would sit down and talk to you about your life, then coach you on how to live a more healthful life, even when there are no signs of anything going wrong yet.
The One program at St. Helena is among a small but growing number of locations across the country that are taking the notion of the executive physical a step further. These programs combine top-notch doctors and cutting-edge medical screenings - long available at a host of places, from the Mayo Clinic in Minnesota, Florida and Arizona to Scripps Health in La Jolla - with a new emphasis on wellness programs that include counseling on nutrition, fitness and lifestyle change. And some of these programs add another enticement: scenic locales and the pampering services of a luxury spa.
In the last year, Canyon Ranch, the high-end spa in Tucson, and St. Helena Hospital in Napa have launched executive health packages that pair traditional medical services with the growing demand for preventive and nontraditional healthcare. Scripps plans to open the Dickinson & Gooding Center for Early Detection in September, which will offer similar health packages, and Green Valley Spa in St. George, Utah, broadened its medical assessment and lifestyle modification program two years ago. The Raj, a spa in Fairfield, Iowa, which specializes in ayurveda, the traditional healthcare system of India, now offers an eight-day Executive Health Program that includes standard medical tests, a health analysis by an ayurvedic physician, a lifestyle plan and a course in transcendental meditation for managing stress.
"Most of today's major illnesses are related to lifestyle," said Dr. Heather Pena, a former medical director at the Pritikin Longevity Center in Santa Monica before helping to found the St. Helena program in 2003. "For some reason, people have lost their footing as far as knowing how to have a healthy lifestyle."
Before launching its executive health program, Canyon Ranch officials met with corporate medical directors and asked them what worked for employees - mostly senior executive types - at existing programs and what didn't. "No one was complaining that they were not getting enough data," said Gary Frost, executive vice president at Canyon Ranch. Employees "leave with a lot of numbers, but they don't have a prescription for the lifestyle changes that will really impact their quality of life."
Because of the prohibitive cost - the programs range from $4,695 to $7,800 - most of us may never experience such a thorough medical and lifestyle makeoveror have the luxury of spending more than a few rushed minutes with our physicians to ask questions.
"If there is any downside to this, it is that it costs a lot of money," said Tedd Mitchell, medical director of the Cooper Wellness Program at the Cooper Aerobics Center in Dallas. "A lot of patients need that type of attention, and it is just beyond their means to pay for it."
But if you could afford it, here is a glimpse of what the experience might look like.
Patient questionnaire
A month before his appointment at St. Helena, Shafer received a 14-page questionnaire that asked him to keep a three-day food diary, interview both his parents about the family's medical history and send in samples of his current medications and nutritional supplements. He also had an hourlong phone consultation with Pena. After the questionnaire and phone call, a five-person team - consisting of Pena, a nurse, a behavioral psychologist, an exercise physiologist and a nutritionist - met to discuss Shafer's life, health and his goals in each area.
He is stressed out, they agreed. Clearly, he needs more exercise. His cholesterol was high in the past - it would be important to check that again. He loved basketball but stopped playing because of bad knees; he misses the camaraderie. Could cycling be an option? They knew what they wanted to cover before he ever walked through the door. Today, they were ready.
'Strung out, stressed out'
Shafer is a tall man who radiates good health. He has the lope of an athlete and an amiable, easygoing manner. But beneath his laid-back exterior is a Type A adrenaline junkie who is overwhelmed by family and work. He has worked in the family business, Shafer Vineyards, for 10 years, moving from head winemaker to actually running the firm after his father retired. He's the company's chief salesman, charged with selling his high-end wines to the "Spagos of the world." That means frequent business travel - up to three months a year - to meet and nurture relationships with restaurant owners and chefs who wine and dine him with lavish meals.
When he's not on the road, life at home also is demanding. He is married, with four children - ages 3 to 19 - from two marriages and a dog. He shuttles his children to football practice and fields calls from the nanny. He smoked for about five years and, despite having quit, still worries about the effect.
"I'm strung out, stressed out, and I'm 48," Shafer said on a recent afternoon at the Shafer Winery. "I keep farmer hours. I get up at 5:30, I'm at work by 6. I blow out of here about 5:30 p.m. Then I have the kid thing going on. Trying to get to the gym - what a joke! I'm a very lucky guy. I feel like I should be appreciating what is going on around me more. And I'm not."
Several years ago, his older brother died at age 46 of skin cancer. It made him think of his own mortality.
"I want to teach my grandkids how to snow ski," Shafer said. "I want to be water-skiing on one ski at 65."
He got a physical a few years ago from his family doctor. But Shafer said his doctor has "a different attitude toward medicine," one he described as: "If a symptom comes up, I'll deal with it."
Shafer wanted more: a game plan for keeping him healthy.
"I know it's morbid," he said, "but it would be nice if they said nothing is going to kill me in the next few years."
A full day at St. Helena
In the first hours of what will be an 11-hour day, Shafer had his blood drawn, his hearing and vision tested, his flexibility measured and performed a cardiac stress test. While Pena stood by, Lisa Hellie, an exercise physiologist, increased the incline and intensity of the treadmill every three minutes while taking his pulse. From this they were able to calculate his target heart rate for exercise and measure his physical fitness. Then Shafer breathed into a special machine that would determine his base metabolic rate and stood on a machine to gauge his body makeup: how much muscle, how much fat. Next, he met with a therapist for 30 minutes to talk about his emotional well-being. Between sessions, Shafer downed a special fruit smoothie packed with five "power foods."
At 11 a.m., Shafer met Pena, the program's Harvard-trained internist and medical director, who now had results from the morning tests and the recommendations of the team. In a 45-minute meeting, she reminded him of the importance of exercise and diet and cited numerous studies that backed her up. She showered him with specifics designed to motivate him. "Starting an exercise program increases brain function within 90 days," she said, reading from one. "For men, sedentary living raises the risk of dying young by 700%," she read from another. She handed the studies to Shafer to read later. She talked to him about his troublesome knees, which have cartilage damaged from sports injuries and several surgeries, and his cholesterol. He was told he had high cholesterol in 2001 but never followed up. Then, she took a break to teach him a special breathing technique that could release stress during the day.
"It may seem strange to have a physician take this time," said Pena, a dark-haired woman with intelligent eyes and a relaxed but focused manner. "But I feel it is important enough to learn this abdominal breathing technique. And here's the thing: You can do it with your eyes open. So you can do it while you are driving, 10 times a day for three to five breaths."
After a lunch of grilled vegetables, wheat pita and hummus, Shafer went upstairs to have an ultrasound taken of his carotid artery, a screening test indicated by his high cholesterol. He sat for a brief two minutes in the waiting room before being called for the test.
He lay on his back in a darkened room as the technician scanned his neck. The images would be sent on a CD to a Harvard Medical School specialist who has devised a technique to look at the thickness of the lining in the carotid artery as a predictor of vascular disease.
When the preliminary scan results were in from the ultrasound technician, Shafer was relieved: The test showed no obvious thickening of the lining. A CT scan showed his heart and internal organs were healthy too.
Shafer was ready to break out the champagne. "Everything is OK," he said. "I'm surprised. You just wonder. I'm really jazzed. Everything is OK."
At the end of the day, Shafer left with recommendations that included more exercise, less wine and perhaps the hiring of a personal assistant. He was advised to eat less protein and more (unprocessed) carbohydrates and to lift weights four times a week in addition to his aerobic workouts. And Pena told Shafer to switch brands of the multivitamin he takes because the one he was using contained too much iron, high doses of which can be bad for men.
Then, a few days later, Pena called with some news that dampened Shafer's spirits a bit. The blood tests showed Shafer's cholesterol was even higher than it had been before. That really motivated him.
In a phone call two weeks later, Shafer said he was walking every morning and "had an awareness of what he was putting in his mouth." At first, he was scared to eat. He abandoned his late-night cookie binges and started reading food labels. "The first few days, I felt like I was starving," he said. "But psychologically I feel better. I'm taking control of things."
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