EliteMedNow

EliteMedNow is redefining the physician relationship. We are focused on health preservation by helping you avoid chronic disease through precision medicine.

As experts in acute care we are able to intervene immediately to oversee and treat any acute process from minor complaints to significant events requiring hospitalization.

Chronic disease prevention is the greatest weakness in the US Healthcare system. Systemic inflammation, chronic stress, poor nutrition, and a sedentary lifestyle lead to cancer, heart disease, and stroke; the top three causes of morbidity and mortality.

Chronic disease is not inevitable. At Elite we use the following foundational strategies to deliver a unique precise care plan designed for you. We then guide, assess, and mentor your progress over time.

Genomics

By understanding your unique genetic foundation we unlock the natural way your body responds and interacts with the environment. It is possible to detect specific cancers and other disease states you have a higher predilection for. With this insight we can formulate a unique treatment strategy designed for you.

Understanding your genome can potentially help in preventing chronic diseases through several mechanisms.

Genetic Risk Assessment

Identification of Genetic Predispositions: Genome sequencing and analysis can reveal genetic variations (mutations, SNPs) associated with increased risk for certain chronic diseases, such as cardiovascular diseases, diabetes, cancer, and neurodegenerative disorders.
Early Intervention: Knowing genetic risk allows individuals and healthcare providers to implement targeted preventive measures and screening strategies at an earlier age or before symptoms appear.

Personalized Medicine

Tailored Treatment Plans: Genetic information can guide healthcare providers in selecting the most effective medications and therapies based on individual genetic profiles.
Avoidance of Adverse Reactions: Understanding genetic variants can help prevent adverse drug reactions by identifying medications that may be ineffective or cause harmful side effects based on genetic predispositions.

Lifestyle Modifications

Precision Nutrition: Genetic insights can inform personalized dietary recommendations that may mitigate genetic risks and promote better health outcomes.
Optimized Exercise Plans: Understanding genetic factors related to metabolism and muscle composition can help tailor exercise regimens that are more effective for an individual’s genetic makeup.

Screening and Early Detection

Genetic Screening: Genetic testing can identify individuals at high risk for specific diseases, prompting more frequent screenings and early detection efforts.
Proactive Healthcare: Early detection enables timely interventions or lifestyle changes that can potentially prevent disease progression or complications.

Family Planning

Reproductive Decision-Making: Knowledge of genetic risks can influence family planning decisions, allowing individuals to make informed choices about reproductive options and prenatal testing.

Understanding your genome provides valuable insights into genetic predispositions and risks for chronic diseases, facilitating personalized preventive strategies, early detection, and optimized treatment approaches. However, genetic information should be interpreted and utilized in conjunction with comprehensive medical assessment and ongoing healthcare guidance to maximize its benefits in disease prevention and management.

Epigenetics

Your epigenome reflects which genes your body expresses, this is a reflection of your lifestyle. It is possible to activate positive genes and turn down harmful ones through evidence based lifestyle modifications and we can track these endpoints over time.

Epigenetics provides insights into how current health conditions and environmental factors influence gene expression and overall health outcomes. Here’s how epigenetics reflects the current state of health:

Gene-Environment Interactions

Impact of Lifestyle and Environment: Epigenetic changes can be influenced by lifestyle factors such as diet, exercise, stress, and exposure to pollutants or toxins. These factors can modify gene expression patterns without altering the underlying DNA sequence.
Health Effects: Epigenetic modifications play a role in the development and progression of various diseases, including cancer, cardiovascular disorders, metabolic conditions like diabetes, and neurological disorders.

Biomarkers of Disease Risk

Predictive Value: Epigenetic markers (e.g., DNA methylation, histone modifications) can serve as biomarkers for disease risk assessment and prognosis. Changes in epigenetic profiles may precede clinical symptoms, providing early indicators of susceptibility to certain diseases.
Personalized Medicine: Understanding epigenetic signatures helps in tailoring personalized treatment approaches based on individual disease risks and response to therapies.

Developmental Origins of Health and Disease

Early Life Exposures: Epigenetic changes established early in life due to maternal health, nutrition, or environmental exposures can have long-term implications for health outcomes later in life. This concept underscores the importance of prenatal and early childhood health in influencing lifelong health trajectories.

Environmental Health

Exposure Assessment: Epigenetic studies can elucidate how environmental factors (e.g., air pollution, chemicals, dietary factors) influence health outcomes through epigenetic mechanisms. This knowledge informs public health strategies for mitigating environmental risks.

Therapeutic Potential

Disease Mechanisms: Epigenetic research advances our understanding of disease mechanisms, identifying potential targets for therapeutic interventions aimed at reversing or modifying disease-associated epigenetic alterations.
Precision Medicine: Epigenetic profiling contributes to the development of precision medicine approaches, enabling more targeted and effective treatments based on individual epigenetic profiles and disease characteristics.

Epigenetics provides a dynamic framework for understanding how environmental influences and lifestyle choices shape gene activity and impact health outcomes across the lifespan. Integrating epigenetic insights into healthcare practice holds promise for advancing personalized medicine, improving disease prevention strategies, and optimizing health outcomes in diverse populations

Biomarkers

Biomarkers are measurable indicators of biological processes, conditions, or diseases. They can be found in various body fluids and tissues, including blood, urine, and tissues, and are used to assess health, diagnose diseases, monitor disease progression, and evaluate the effectiveness of treatments.

Types of Biomarkers

Diagnostic Biomarkers

Used to detect or confirm the presence of a disease or condition.
Prostate-specific antigen (PSA) for prostate cancer.
Hemoglobin A1c (HbA1c) for diabetes.

Prognostic Biomarkers

Provide information about the likely course or outcome of a disease.
B-type natriuretic peptide (BNP) for heart failure prognosis.
Lipid Panel and atherosclerotic disease risk

Predictive Biomarkers

Predict how well a patient will respond to a particular treatment.
TSH normalization after synthroid therapy

Pharmacodynamic/Response Biomarkers

Indicate whether a biological response has occurred after a treatment.
Blood pressure as a biomarker for antihypertensive drug efficacy.
CRP reduction in response to anti-inflammatory treatment.

Safety Biomarkers

Indicate the potential for adverse effects or toxicity from a treatment.
Liver enzymes (ALT, AST) to monitor for drug-induced liver injury.
Creatinine levels to assess kidney function and potential nephrotoxicity.

Characteristics of Ideal Biomarkers

Specificity: The ability to accurately identify a particular disease or condition.

Sensitivity: The ability to detect even small changes or low levels of the biomarker.

Reliability and Reproducibility: Consistent results across different tests and over time.

Non-invasiveness: Ideally, biomarkers should be detectable in easily accessible body fluids like blood or urine.

Clinical Relevance: Direct correlation with disease presence, progression, or response to treatment.

Applications of Biomarkers

Early Disease Detection

Biomarkers can enable early diagnosis, often before clinical symptoms appear, improving treatment outcomes.
Elevated levels of troponin in blood can indicate early myocardial infarction (heart attack).
Personalized Medicine:
Biomarkers help tailor treatments to individual patients based on their specific biomarker profiles, enhancing treatment efficacy and minimizing side effects.

Disease Monitoring and Management

Regular monitoring of biomarkers can track disease progression and response to treatment.

Biomarkers give objective insight into organ health and highlight areas that need immediate intervention. A detailed understanding of your current health risk is extremely important. We can detect early liver, heart, kidney or metabolic disease and intervene before chronic illness begins. Immediate intervention and prevention of hypertension, type 2 diabetes, high cholesterol, and vascular inflammation will have lasting impact on overall health and longevity. This approach guides personalized treatments, and improves disease monitoring and management.

Biometrics

The most important part of disease prevention is the ability to measure interventions and outcomes. As physicians we believe we are accountable and responsible for your health. Outcome focused care is evidence based interventions that are directly correlated to longevity. The ability to measure and track lean muscle mass through DEXA Scan, resting metabolic rate, VO2 max, and sleep quality allows us to continually adapt and change our treatment strategy with precision.

VO2 MAX

VO2 max, or maximal oxygen uptake, is the maximum rate at which an individual can consume oxygen during intense or maximal exercise. It is a key indicator of cardiovascular fitness and aerobic endurance.

Importance of VO2 Max

Performance Indicator: Higher VO2 max values generally correlate with better endurance performance in activities such as running, cycling, and swimming.
Health Marker: It is used to assess cardiovascular health and can indicate an individual's aerobic fitness level.

Measuring VO2 Max

VO2 max can be measured through various exercise tests, often involving a treadmill or stationary bike, where the intensity is gradually increased while measuring the volume of oxygen inhaled and the volume of carbon dioxide exhaled.

Factors Affecting VO2 Max

Genetics: Inherited traits can significantly influence VO2 max.
Age: VO2 max typically declines with age.
Gender: Males generally have higher VO2 max values than females, primarily due to differences in muscle mass and hemoglobin levels.
Training: Regular aerobic exercise can improve VO2 max.
Altitude: Higher altitudes can influence VO2 max due to lower oxygen availability.

VO2 max is used to tailor training programs and to evaluate cardiovascular health and fitness. This can be compared to age matched individuals to track cardiovascular health and can be tracked over time to measure progress.

DEXA Scan

A Dual-Energy X-ray Absorptiometry (DEXA or DXA) scan is a medical imaging test used to measure bone mineral density (BMD) and body composition, including the distribution of fat and lean mass. It is widely regarded as a gold standard for assessing these parameters due to its accuracy and reliability.

How a DEXA Scan Works

Dual-Energy X-rays: The scan uses two X-ray beams at different energy levels to create images of the body. These beams pass through the body, and the amount of X-rays absorbed by different tissues (bone, fat, lean tissue) is measured.

Image Creation: The differences in X-ray absorption are used to create detailed images and data on bone density and body composition.

Uses of DEXA Scan

Bone Density Measurement:

Osteoporosis Diagnosis: DEXA scans are primarily used to diagnose osteoporosis and assess fracture risk by measuring BMD at the spine, hip, and sometimes the forearm.
Monitoring Treatment: Helps in tracking the effectiveness of osteoporosis treatment.

Body Composition Analysis:

Fat and Lean Mass: Provides detailed information on the distribution and percentage of fat and lean mass in the body.
Visceral Fat: Can measure visceral fat, which is the fat surrounding internal organs, associated with higher health risks.

Benefits of DEXA Scan:

Accuracy: Highly precise in measuring bone density and body composition.
Detailed Information: Provides a comprehensive analysis of body composition, including regional fat and muscle distribution.
Low Radiation: Safe for regular monitoring and follow-ups.

Interpretation of Results

Bone Density:

T-score: Compares the patient’s bone density to a young, healthy reference population. A T-score of -1.0 or above is considered normal, between -1.0 and -2.5 indicates osteopenia (low bone mass), and -2.5 or below indicates osteoporosis.
Z-score: Compares the patient’s bone density to an age-matched population. A Z-score of -2.0 or lower may suggest an underlying condition contributing to bone loss.

Body Composition:

Fat Mass: Indicates the total amount and percentage of body fat.
Lean Mass: Measures the amount of muscle and other lean tissues.
Regional Analysis: Provides detailed information on fat and lean mass distribution in different body regions.

A DEXA scan is a valuable tool for both clinical and fitness settings, offering detailed insights into bone health and body composition. Its high accuracy and low radiation exposure make it an excellent choice for monitoring bone density and assessing body composition. This allows us to monitor treatment and efficacy of diet and training program over time.

Resting Metabolic Rate (RMR)

Resting Metabolic Rate (RMR) is the amount of energy expended by the body at rest to maintain basic physiological functions such as breathing, circulation, and cellular metabolism. Measuring RMR can provide valuable insights into an individual's metabolism, helping to tailor nutritional and exercise programs.

Utility of Measuring RMR

Weight Management: Knowing RMR helps in designing an effective weight loss or maintenance plan by determining daily caloric needs.
Nutrition Planning: Tailors dietary intake to match metabolic rate, ensuring sufficient energy for bodily functions without excess calorie intake.
Exercise Programs: Helps in planning exercise routines that complement metabolic rate and overall energy expenditure.
Medical Conditions: Monitoring RMR can be crucial for individuals with metabolic disorders or conditions affecting energy expenditure.

Factors Influencing RMR

Age: RMR typically decreases with age.
Gender: Men usually have a higher RMR than women due to greater muscle mass.
Body Composition: More lean muscle mass increases RMR.
Genetics: Genetic factors can influence metabolic rate.
Hormones: Thyroid hormones, for instance, play a significant role in regulating metabolism.
Health Status: Illness, stress, and certain medications can affect RMR.

Measuring RMR provides a foundational understanding of an individual's metabolic rate, which is essential for creating personalized nutrition and fitness plans. Indirect calorimetry is the gold standard for measuring RMR due to its accuracy, but predictive equations and body composition analysis are useful alternatives when direct measurement is not feasible.

Anatomic Surveillance & Cancer Screening

Advanced imaging techniques through CT and MRI allow visualization of organ and vascular anatomy. The vascular system with emphasis on the brain and heart allows a direct non-invasive, way to prevent stroke and myocardial infarction. This technology also allows us to look for unique anatomic abnormalities and early detection of solid organ tumors:

CT Coronary Angiogram

CT Coronary Angiography (CTCA) is a non-invasive imaging technique used to visualize the coronary arteries that supply blood to the heart muscle. It involves the use of computed tomography (CT) scanning technology to obtain detailed images of the heart and its blood vessels. Here’s a brief explanation of CT Coronary Angiography:

Principles of CT Coronary Angiography

Imaging Technology:

CTCA utilizes a multi-detector CT scanner that rotates around the patient, capturing multiple X-ray images from different angles.
These images are processed by computer software to create detailed cross-sectional images (slices) of the heart and coronary arteries.

Contrast Agents:

Intravenous contrast dye (iodine-based) is typically administered to enhance the visibility of blood vessels and improve the detection of any narrowing or blockages in the coronary arteries.
The contrast dye highlights the blood vessels on CT images, allowing for clearer visualization of coronary artery anatomy

Procedure:

Preparation: Patients may need to fast for a few hours before the procedure. Heart rate-lowering medications may be given to control heart rate and improve image quality.
Scan: During the scan, the patient lies on a table that moves through the CT scanner. Multiple images are acquired rapidly as the scanner rotates around the body.
Analysis: After the scan, specialized software reconstructs the images to create a 3D model of the coronary arteries. Radiologists analyze these images to evaluate the presence of coronary artery disease (CAD), plaque buildup, and any narrowing or blockages.

Applications of CT Coronary Angiography

Diagnosis of Coronary Artery Disease (CAD):

CTCA is used to detect and evaluate the extent and severity of coronary artery disease, including the presence of coronary artery blockages (stenosis) and calcifications.
It can help determine the need for further interventions such as coronary angioplasty or coronary artery bypass surgery.

Assessment of Coronary Anomalies:

CTCA can identify congenital abnormalities or variations in coronary artery anatomy, which may affect treatment decisions.
Evaluation of Coronary Artery Stents:
It is used for post-operative assessment of coronary stents to check for proper placement and any complications such as restenosis (re-narrowing).

Advantages of CT Coronary Angiography

Non-invasive: Does not require catheterization or invasive procedures like traditional coronary angiography.
Rapid Imaging: Provides quick and detailed images of the coronary arteries.
High Accuracy: High sensitivity and specificity for detecting significant coronary artery disease.

CT Coronary Angiography is a valuable tool for diagnosing coronary artery disease and evaluating the condition of the coronary arteries non-invasively. It provides detailed images of the heart and blood vessels, aiding in treatment planning and monitoring of cardiovascular health.

Whole Body MRI

Whole-body MRI (WB-MRI) is a comprehensive imaging technique that allows for the evaluation of multiple body regions and organs in a single imaging session. It provides detailed anatomical information without the use of ionizing radiation, making it advantageous for certain diagnostic purposes.

Cancer Staging and Surveillance:

WB-MRI is increasingly used for staging various cancers, including lymphoma, bone metastases, and sarcomas.
It can detect metastases and monitor treatment response throughout the body.

Evaluation of Systemic Diseases:

Inflammatory and autoimmune diseases such as vasculitis and rheumatoid arthritis can be evaluated for disease extent and activity.
Infectious diseases like tuberculosis or abscesses can be assessed.

Assessment of Trauma and Musculoskeletal Conditions:

WB-MRI can evaluate traumatic injuries, fractures, and musculoskeletal disorders affecting multiple body regions.

Advantages of Whole-Body MRI

Non-ionizing Radiation: Unlike CT scans, WB-MRI does not use ionizing radiation, reducing potential risks associated with radiation exposure.
Comprehensive Evaluation: Provides a comprehensive assessment of multiple body regions in a single session, potentially reducing the need for multiple imaging modalities.
Soft Tissue Contrast: MRI offers excellent soft tissue contrast, making it ideal for visualizing organs, muscles, and joints.

Whole-body MRI is a powerful imaging tool that provides detailed anatomical information across multiple body regions in a single imaging session. It is particularly valuable for oncologic staging, systemic disease evaluation, and comprehensive assessment in certain clinical scenarios where detailed whole-body information is beneficial. Ongoing advancements in MRI technology continue to enhance its utility and clinical applications.

MR Angiography

Whole-body magnetic resonance angiography (MRA) is a specialized imaging technique used to visualize and evaluate blood vessels throughout the entire body using magnetic resonance imaging (MRI) technology. It provides detailed images of arteries and veins without the use of ionizing radiation, which is advantageous for evaluating vascular conditions.

Importance of Whole-Body MRA

Vascular Disease Evaluation:

Whole-body MRA is used to diagnose and evaluate a wide range of vascular conditions, including:

Atherosclerosis: Narrowing or blockage of arteries due to plaque buildup.
Aneurysms: Abnormal bulges or weakening of blood vessel walls.
Peripheral Artery Disease (PAD): Narrowing of arteries in the limbs.
Venous Thrombosis: Blood clots within veins.

Screening and Surveillance:

- It can be used for screening high-risk populations, such as patients with a family history of vascular disease or those with known risk factors like hypertension or diabetes. Whole-body MRA is a valuable imaging tool for assessing vascular health and diagnosing various vascular diseases across multiple body regions. It offers detailed visualization of blood vessels without exposing patients to ionizing radiation, making it a preferred choice for evaluating vascular conditions

Liquid Biopsy

Liquid biopsy refers to a non-invasive diagnostic technique that involves analyzing various biomarkers, such as circulating tumor cells (CTCs), cell-free DNA (cfDNA), and extracellular vesicles (EVs), that are present in body fluids like blood, urine, or cerebrospinal fluid. The primary purpose of liquid biopsy is to detect and analyze genetic alterations and biomarkers associated with various diseases, particularly cancer.

Liquid Biopsy Background

Cell-Free DNA (cfDNA):

Origin: When cells die, they release DNA into the bloodstream. Tumor cells also shed DNA fragments into circulation.
Analysis: cfDNA can be isolated from plasma and analyzed for genetic mutations, such as those found in cancer cells, to detect the presence of cancer, monitor treatment response, and track disease progression.

Circulating Tumor Cells (CTCs):

Origin: Cancer cells detach from primary tumors and enter the bloodstream as CTCs.
Analysis: CTCs can be isolated from blood samples and studied to understand tumor characteristics, such as aggressiveness and metastatic potential, and to monitor treatment effectiveness.

Extracellular Vesicles (EVs):

Origin: EVs are small membrane-bound vesicles released by cells, including cancer cells, into the bloodstream.
Analysis: EVs contain proteins, RNA, and DNA that can provide information about tumor biology, such as signaling pathways and drug resistance mechanisms.

Importance of Liquid Biopsy

Early Cancer Detection: Liquid biopsy can detect cancer at an early stage when tumors are smaller and more treatable.
Monitoring Treatment Response: It allows for real-time monitoring of tumor dynamics and response to therapy, helping clinicians adjust treatment strategies.
Detection of Minimal Residual Disease: After treatment, liquid biopsy can detect small amounts of residual disease that may indicate the potential for recurrence.
Characterization of Tumor Heterogeneity: Liquid biopsy provides insights into the genetic and molecular diversity of tumors, which can guide personalized treatment approaches.
Prognostic Information: Biomarkers identified through liquid biopsy can provide prognostic information about disease progression and patient outcomes.

Early Cancer detection technology is evolving rapidly. Through advanced screening and liquid biopsies we can continually monitor for early stage cancers and give the highest chance for survival if one is discovered.