Bill Adamson, the poster boy for preventive health screenings, came to the Abdominal Aortic Aneurysm screening day at Eastern Plumas Health Care, only to find out he has a small aneurysm. Because he caught it early, he’ll be able to monitor it through yearly screenings, and have a manageable treatment plan if it increases in size later on. An AAA, if it becomes very large, is like an old bicycle tire with a balloon at a weak point. If it bursts, it is lethal. Said Adamson, “My mother lived to age 97, and there’s longevity on my father’s side—I have no desire to cash in the chips!”
Eastern Plumas Health Care’s Saturday Preventive Health Clinic, held every third Saturday of the month, is the brainchild of Dr. Michelle Kim. “In our busy clinic practice for sick and urgent patients, we don’t often have the time to address health maintenance and the importance of keeping somebody healthy for the future,” she said. The Saturday clinics give EPHC the opportunity to address this, with a different preventive health service highlighted each month. Preventive health care is targeted as an essential health benefit under the Affordable Care Act and, therefore, these tests and screenings are available for free to most insured patients.
Each Saturday screening begins with an appointment with Dr. Kim. These appointments are either free to patients or have a small co-payment. At the appointment, Dr. Kim discusses the patients’ risk factors for the preventive service that month, performs a brief accompanying exam, and provides some important education regarding health maintenance and prevention related to that particular health issue (for instance, a breast exam, and discussion of breast health and risk factors accompany the mammography screening).
In the first three months, Saturday Clinics for breast cancer (mammogram), Abdominal Aortic Aneurysm, and bone density (dexascan) have screened 66 patients.
“The whole basis of health maintenance,” she explained, “is taking a healthy person and looking ten years down the line to see what they’ll be at risk for—catching it in the earliest stages before it becomes an emergency. With a ruptured Aortic Aneurysm, it’s game over—it’s lethal.” But, when found early, an AAA is easy to monitor and treat. The importance of these screenings came shining through when one of the patients at the Saturday AAA Clinic showed positive for an aneurysm in its early stages.
Bill Adamson, agreed to talk about his experience in the hopes that it will encourage others to get screening tests for conditions for which they have significant risk factors (for AAA it’s any male 65 and over who has smoked at least one pack of cigarettes any time in his life). He explained that “[Dr. Kim] gave me a call and told me that I’m pressing a limit on the size of the aneurysm. Today, there’s no need for alarm.” He added that Dr. Kim told him, “It’s just on that edge of a little bit larger than what we’d like to see, so let’s keep an eye on it.”
“It was a positive experience discovering that . . . it would be my personal recommendation that everybody give themselves a chance to see what’s going on on the inside,” said Adamson, reasoning that people easily go to the doctor for a broken arm, but “if they’ve got something broken on the inside, an enormous amount of people would rather run away than to actually see they’re okay or there’s something there they ought to deal with.”
Dr. Kim concurs. All of these tests screen for conditions that aren’t obvious through a physical exam. And all, when caught early are treatable, whereas if they’re left untreated, they can be deadly. If she can actually feel an AAA during a physical exam, said Dr. Kim, it’s at the very dangerous stage. “A pulsatile abdominal mass—that means it’s beating like your heart and feels like a balloon in your stomach—that is not a good feeling.”
On the other hand, screening recommendations have evolved over time. The medical profession tries to walk a fine line between over testing and not testing enough, which means potentially missing something that could have saved someone’s life. “We don’t want to give them more screenings, tests, anxiety, and radiation than needed just to catch the very few.” The AAA test requires no radiation, and contemporary digital mammography and dexascans use very low doses of radiation. Still, health care professionals are pulling back somewhat from previous recommendations—always trying to balance the risks and the benefits. But, it’s a difficult line, Dr. Kim admits, because “you never want to be on the wrong side,” and miss something vital.
As far as Bill Adamson is concerned, he had nothing to lose and everything to gain. “At my age, I don’t want to quit. I’m having too much fun being alive. If there’s something there, let’s address it so I can keep on having fun and being alive,” he said. As an added bonus, the test wasn’t uncomfortable, and “I came out on the good side, because they gave me some goodies (granola bars, trail mix, and a travel cup) when it was all over.
Staff members volunteer to work on Saturday at the Preventive Clinics. They try to make it special for patients with a raffle prize drawing, healthy snacks, interesting health education materials, and other give away items. “It’s kind of a fun thing for patients,” said Dr. Kim. “They’re the only ones in the clinic. It’s about them. It’s an ‘I’m special today, the clinic’s open just for me’ kind of thing. All staff are there just for that purpose, because we want to be there. The feeling is, ‘We care about your health too.’ It’s a special day, set aside for a screening test that could help save someone’s life.”