Going Abroad? Make sure to book an appointment with us at least 4 weeks before you travel. Contact clinic: 01-6314500

The D2 Medical Centre                 

Executive Medicals

Executive health checks - what to expect at the D2 Medical.

The purpose of your health assessment  Our comprehensive health assessments aim to identify illness or ‘high risk’ in the early stages. We aim to:

• Identify your high risk factors and identify signs of early disease (if present) before you get symptoms
• Use our medical expertise to deal with any urgent health issues or concerns,
• Educate you about your risk factors for major, preventable diseases, and
• Help you implement a program to avoid developing a preventable disease or becoming a high-risk individual.

Before your visit You will be asked to have some screening pathology which will address:

• your full blood count including  inflammatory proteins   
• your biochemistry including kidney, liver and calcium 
• your sugar level
• your cholesterol and other lipids
• your thyroid
• urine sample, as well as 
• a prostate blood test for men
• any other pathology on a needs basis ( may be added after the assessment if indicated by your checkup)      

Your appointment When you arrive, you will be asked to fill out a three-minute questionnaire. You will then spend approximately half an hour with your doctor discussing:

• your current state of health, 
• your past history, 
• your family history, 
• your nutritional intake, 
• your activity level, 
• medications (including any supplements you take), and 
• any specific health concerns you have.                

The physical examination Our doctors will examine your neck, heart, chest, breasts ( in women), abdomen, lymphatic system, groin and prostate (if indicated in men), lower limbs including arteries, and joints ( if indicated) and skin.  You will also have your height, weight, waist circumference , body fat ( if indicated) and blood pressure measured.  Many female patients opt to have their annual PAP test done at this time

The cardiac exercise or stress test  After a resting ECG, you will be asked to undertake an exercise bicycle  stress test so we can assess: only if it is clinically indicated. 

• evidence of narrowed coronary arteries your level of fitness, 
• blood pressure response to exercise and also 
• evidence of heart rhythm disturbance during peak exercise. 

Reviewing the results After the initial consultation, physical examination and stress test, our doctors will:

• review the results of your blood tests and explain what they mean,   
• educate you about how your results compare to the established targets based on internationally agreed expert opinion, and 
• formulate an agreed upon  management plan, if necessary, to further improve and optimise your health.

Benefits of an executive health check versus a traditional medical examination

1. One-stop shop – cancer surveillance (top 6 cancer killers of Ireland are lung, bowel, prostate, breast, lymphoma and melanoma, in that order), which are screened for on an annual basis at least.

2. Risk factor reduction for coronary artery disease – 30-50% of Irish people serviced in traditional medical practices do not achieve targets for blood pressure and cholesterol control, hence placing themselves at a much higher risk of coronary artery disease – when LDL (bad cholesterol) is reduced by 1 mmols per litre, the risk of future coronary artery disease reduces by 30%, hence the significance of achieving targets.

3. Minimise waiting time – our patients are either seen on time or at most 15 minutes waiting time on busy days.

4. Other current medical issues dealt with at your annual visit e.g. musculo-skeletal problems, hearing etc.

5. Use of up-to-date technologies indicated e.g. coronary CT scanning on a needs basis to predict future events in higher risk patients.

6. Basic expertise of cardiology, dermatology, urology for prostate cancer etc. offered in the one visit – whilst we cannot hope to match the knowledge of a specialist in one field, we certainly have sufficient knowledge and expertise to provide a reasonable in depth assessment on your annual visit.

7. Referral to only the best specialists that we personally have a professional relationship with and have screened for technical knowledge and practice style with the Blackrock clinic, St Vincents private and the Beacon clinic.

What's involved with a health assessment?

Your appointment.

When you arrive, you will be asked to fill out a three-minute questionnaire. You will then spend time with your doctor discussing:

• your current state of health,
• your past history,
• your family history,
• your nutritional intake,
• your activity level,
• medications (including any supplements you take), and
• any specific health concerns you have.

The physical examination

Our doctors will examine your neck, heart, chest, abdomen and groin (in men), lower limbs and skin.  You will also have your height, weight, waist circumference and blood pressure measured.  Many female patients opt to have their annual PAP test done at this time.

Reviewing the results

After the initial consultation, physical examination, our doctors will review the results with you in detail.  We will:

• review your blood test results and explain what they mean,  
• educate you on how your results compare to the established targets based on internationally agreed expert opinion, and
• formulate a management plan, if necessary, to further improve and optimise your health.

Ongoing care (on an ‘as needs’ basis)

If there are any health concerns identified during the consultation, we will take pro-active measures to address them.  Where appropriate we will refer you to appropriate specialists and oversee the management of any major health issues identified.

Optimise your food intake advice from D2 Medical

• Eat nuts most days - at least 25 grams.  It doesn’t matter what type of nut you eat.  In some studies those that ate 25 grams of nuts more than 4 days a week had a 50% lower risk of death from heart attack than the non-nut eaters.
• Eat legumes and lentils (beans, peas, chick peas, dahl, soya beans) most days. Eating 25 grams daily has reduced annual rate of death by up to 8% in some studies.
• Eat lots of vegetables, salads and fruits - AT LEAST 5 varieties (preferably 15) daily, with an assortment of different colours (red, orange, green, yellow). 
• Eat fish 2-4 times a week (including tinned fish).
• Eat lots of olive oil.  Extra Virgin is best.
• Meats are a condiment – not the main meal! The amount of meat you eat ought to be about the size of the ‘palm of your hand’.  
• Minimise the amount of saturated fats in dairy products.  Try choosing low fat versions most of the time. 
• Minimise the amount of highly refined carbohydrates you eat. - white bread, pasta, white rice.  Try and aim for wholegrain carbohydrates instead. Choose carbohydrates with low glycaemic index.
• Consider taking a quality, plant-based, effective potency multivitamin/multimineral daily, and a fish oil supplement (Omega 3 fatty acid) two-three times a day.

Understanding your cholesterol reading

Your cholesterol reading on your blood test is made up of good cholesterol ( HDL), bad cholesterol ( LDL), some other minor lipid particles that are not routinely measured on pathology testing, and finally triglycerides.

LDL - bad cholesterolVascular risk is mainly concerned with your bad cholesterol (LDL). And for most people, your LDL should be around 3.0 mmols per litre.

If you have had previous coronary heart disease e.g. heart bypass surgery or stenting, your target LDL should be around 1.7 - 1 .8 mmols per litre. In addition, other high-risk scenarios such as Diabetes Mellitus warrant an LDL probably under 2.5. Your LDL should go down by reducing your saturated fat intake, which mainly comes from red meats, full-fat dairy products, and unseen fats in restaurant and take-away foods, in particular.

HDL - good cholesterol
Your good cholesterol (HDL) is also important. Generally, the higher the HDL, the better. Therefore, if your HDL is above 1.5 (more common in women), one can often tolerate a slightly higher LDL, than that mentioned in the paragraph above.

Another possible scenario is a very low HDL under 1.0. This is potentially a risk factor, because your protective HDL (which tends to mop up bad LDL from your arterial walls) cannot therefore buffer any LDL available.

Triglycerides An isolated high triglyceride level is something that is not commonly seen -- while it probably can pose some added risk to heart attack and stroke, currently we don't know exactly how much risk, if not accompanied by a high LDL or low HDL.

We occasionally see a person with a profile of a high triglyceride (more than 1.7 mmols per litre), combined with the low HDL, which is also a risk pattern seen. Triglycerides seemed to be quite responsive in most people to reducing, particularly white carbohydrates, e.g. white rice, white bread, pasta and potatoes - swapping these food groups to low GI carbohydrates e.g. wholegrain or multigrain bread, brown rice, sweet potatoes.

Generally speaking, reduce your LDL by one mmol/ litre, reduces your risk of heart attack by up to 30% - hence its significance. Keep in mind that the risk of coronary heart disease or stroke interplay between multiple risk factors, which include family history, your age (older is high risk), your gender (male is worse), how your body handles sugar (Diabetes Mellitus being worse than impaired fasting glucose), smoking history (current smoker is worse than ex-smoker is worse than never smoker) and other minor risk factors.

The main points to remember are:

1. The target for LDL, your bad cholesterol, ought to be around 3 mmols per litre - unless you have added risk factors such as Diabetes Mellitus or a previous cardiovascular event.

2. For your HDL (your good cholesterol), the higher the better. Occasionally we see people with HDL above 2.0 e.g. 2.7 - 3.0. Generally, this is genetically determined. Women tend to run at a higher HDL than men. Factors that can increase your HDL can include a lot of exercise, and possibly fish oil supplementation. Generally, regarding improving cholesterol readings, most of the leverage is in dropping LDL.

3. Triglycerides have some importance, although not as important as LDL and HDL. Generally, triglycerides go down with reducing carbohydrates and alcohol.

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Healthy Eating

 A healthy diet helps to prevent, or reduce the severity of,
diseases such as heart disease, stroke and diabetes.
A healthy diet may also help to reduce the risk of developing some cancers.
Also, a main way of combating obesity and overweight is to eat a healthy diet.

Eat plenty of starchy foods (complex carbohydrates)

Starchy foods such as bread, cereals, potatoes, rice, and pasta, together with fruit and vegetables, should provide the bulk of most meals. Some people wrongly think that starchy foods are 'fattening'. In fact, they contain about half the calories than the same weight of fat. (However, it is easy to add fat to some starchy foods. For example, by adding butter to jacket potatoes or bread, or by adding oil to potatoes to make chips, etc.)

Also, starchy foods often contain a lot of fibre (roughage). When you eat starchy foods, you get a feeling of fullness (satiety) which helps to control appetite. Tips to increase starchy foods include:

• For most meals, include generous portions of rice, pasta, baked potatoes, or bread.
• For more fibre, choose wholemeal bread. When baking, use at least 1/3 wholemeal flour.
• If you have cereals for breakfast, choose porridge, high fibre cereals, or wholemeal cereals (without sugar coating).
• Have tea breads, and plain or fruit scones, instead of sugary cakes and biscuits.

Eat plenty of fruit and vegetables

Is is recommended that we eat at least five portions, and ideally 7-9 portions, of a variety of fruit or vegetables each day. If you eat a lot of 'fruit and veg', then your chance of developing heart disease, a stroke, or bowel cancer are reduced.

In addition, 'fruit and veg':

• contain lots of fibre which help to keep your bowels healthy. Problems such as constipation and diverticular disease are less likely to develop.
• contain plenty of vitamins and minerals, which are needed to keep you healthy.
• are naturally low in fat.
• are filling but are low in calories.

One portion of fruit or vegetables is roughly equivalent to one of the following.

• One large fruit such as an apple, pear, banana, orange, or a large slice of melon or pineapple.
• Two smaller fruits such as plums, kiwis, satsumas, clementines, etc.
• One cup of small fruits such as grapes, strawberries, raspberries, cherries, etc.
• Two large tablespoons of fruit salad, stewed or canned fruit in natural juices.
• One tablespoon of dried fruit.
• One glass of fresh fruit juice (150ml).
• A normal portion of any vegetable (about two tablespoons).
• One dessert bowl of salad.

Some tips on how to increase fruit and vegetables in your diet include:

• Try some different types which you have not tried before. The variety of tastes and textures may be surprising. Juices, frozen, canned, and dried varieties all count.
• Try adding chopped bananas, apples, or other fruits to breakfast cereals.
• Aim to include at least two different vegetables with most main meals. Do not over-boil vegetables. Steaming, stir-frying, or lightly boiling are best to retain the nutrients.
• Always offer fruit or fruit juice to accompany meals.
• Try new recipes which include fruit. For example, some curries or stews include fruit such as dried apricots. Have fruit based puddings. Fruit with yoghurt is a common favourite.
• How about cherry tomatoes, carrot sticks, dried apricots, or other fruits as part of packed lunches? A banana sandwich is another idea for lunch.
• Fruit is great for snacks. Encourage children to snack with fruit rather than with sweets.

Eat plenty of fibre (roughage)

Fibre is the part of food that is not digested. It is filling, but has few calories. It helps the bowels to move regularly, which reduces constipation and other bowel problems. Fibre may also help to lower your cholesterol level. Starchy foods, and fruit and vegetables contain the most fibre. So the tips above on starchy foods and fruit and vegetables will also increase fibre. Have plenty to drink when you eat a high fibre diet (at least 6-8 cups of fluid a day).

Eat protein foods in moderation

Meat, fish, nuts, pulses, chicken, and similar foods are high in protein. You need a certain amount of protein to keep healthy. However, most people eat more protein than is necessary. Beware, some meats are also high in fat. Choose poultry such as chicken, or lean meat. Also, many meat based recipes include creamy or fatty sauces which are high in calories.

Fish. There is some evidence that eating oily fish helps to protect against heart disease. Oily fish include: herring, sardines, mackerel, salmon, fresh tuna (not tinned), kippers, pilchards, trout, whitebait, anchovies and swordfish. It is probably the 'omega-3 fatty acids' in the fish oil that helps to reduce the build up of atheroma (furring of the arteries) which causes angina and heart attacks. Aim to eat at least two portions of fish per week, one of which should be oily.

Do not eat too much fat

A low-fat diet helps to reduce the chance of developing diseases such as heart disease and stroke. It will also help you to reduce weight. The total amount of fat should be low. Also, the type of fat is important. You should not have much saturated fats such as butter, lard, dripping, and unspecified margarine. Unsaturated fats are better such as corn oil, sunflower oil, olive oil, and low fat spreads. Tips to reduce fat in your diet include the following.

·         Whenever possible, do not fry food. It is better to grill, bake, poach, barbecue, or boil food. If you do fry, use unsaturated oil. Drain the oil off the food before eating.

·         Choose lean cuts of meat, and cut off any excess fat.

·         Avoid adding unnecessary fat to food. For example, use low fat spreads, spread less butter or margarine on bread, measure out small portions of oil for cooking, etc.

·         Watch out for hidden fats that are in pastries, chocolate, cakes, and biscuits.

·         Have low-fat milk, cheeses, yoghurts, and other dairy foods rather than full-fat varieties.

·         Avoid cream. Use low fat salad cream, or low-fat yoghurt as a cream substitute.

Do not have too many sugary foods and drinks

Sugary foods and drinks are high in calories, and too much may cause weight gain. It isn't just the amount of sugar that may be bad. Eating small amounts of sugary foods (sweets etc) too often is bad for teeth. Tips include:

·         Try not to add sugar to tea, coffee, and breakfast cereals. Your taste for sweetness often changes with time. Use artificial sweeteners only if necessary.

·         Reduce sugar in any kind of recipe. Use fruit as an alternative to add sweetness to recipes.

·         Try sugar-free drinks. Give children water as their main drink.

·         If you eat chocolate or sweets, try and keep the quantity down. Eating them as part of a meal, and then brushing your teeth, is better than between meals as snacks.

Do not eat too much salt

Too much salt increases the risk of developing high blood pressure. Government guidelines recommend that we should have no more than 5-6 grams of salt per day. (Most people in the UK currently have more than this.) If you are used to a lot of salt, try to gradually reduce the amount that you have. Your taste for salt will eventually change. Tips on how to reduce salt include:

·         Use herbs and spices to flavour food rather than salt.

·         Limit the amount of salt used in cooking, and do not add salt to food at the table.

·         Choose foods labelled 'no added salt'.

·         As much as possible, avoid processed foods, salt-rich sauces, take-aways, and packet soups which are often high in salt.

Keep alcohol within the recommended limits

There is some evidence that drinking 1-2 units of alcohol per day may help to protect against heart disease. But, drinking above the recommended limits can lead to serious problems. For example, drinking heavily can damage the liver, brain, stomach, pancreas, and heart. It can also cause high blood pressure. Also, alcohol contains a lot of calories, and too much can cause weight gain.

·         Men should drink no more than 21 units of alcohol per week (and no more than four units in any one day).

·         Women should drink no more than 14 units of alcohol per week (and no more than three units in any one day).

·         Pregnant women - the amount that is safe is not known, so many women have little or no alcohol when they are pregnant.

What is a unit of alcohol?
One unit of alcohol is 10 ml (1 cl) by volume, or 8 g by weight, of pure alcohol. For example:

·         One unit of alcohol is about equal to:

o    Half a pint of ordinary strength beer, lager, or cider (3–4% alcohol by volume), or

o    A small pub measure (25 ml) of spirits (40% alcohol by volume), or

o    A standard pub measure (50 ml) of fortified wine such as sherry or port (20% alcohol by volume).

·         There are one and a half units of alcohol in:

o    A small glass (125 ml) of ordinary strength wine (12% alcohol by volume), or

o    A standard pub measure (35 ml) of spirits (40% alcohol by volume).

                                                                                                                  Dr John J Ryan Medical Director