ME & THE MAYO EACH YEAR SOME 2,500 EXECUTIVES FLOCK TO ROCHESTER, MINN., FOR A DELUXE, SOUP-TO-NUTS PHYSICAL AT THE MAYO CLINIC. OUR MAN WENT FOR A TUNE-UP TO FIND OUT WHY.
(FORTUNE Magazine) – Veronique Roger, a consultant in cardiovascular diseases and internal medicine, is running late, but I hardly notice. I'm fascinated by the photo of two identical-looking beef dinners on the wall. The first pictures a ten-ounce prime rib; the second, four ounces of eye round. The broccoli on the first plate is topped with a cheese sauce, the broccoli on the second with a lemon wedge. There's a slice of cheese cake next to the first, a piece of angel food cake next to the second. Behind each plate is a beaker with the amount of fat each meal contains. The picture speaks thousands of words, and Dr. Roger agrees with each one. "Burger King and McDonald's are as bad for you as smoking," she says, using shorthand every red-blooded American understands.
I've been studying calorie, cholesterol, and fat tables since Hector was a pup (I'm 62), but that photo--along with the insights imparted by Dr. Roger and her colleagues--drove home the you-are-what-you-eat message in a way I'll never forget. That, I discovered, is a specialty of the Mayo Clinic, which treated more than 242,000 patients from 90 countries last year. (Some arrived via Mayo MedAir, a service the clinic runs that shuttles people in from London and the United Arab Emirates.) Arnold Palmer checked in a few months ago to have a cancerous prostate removed, and King Hussein of Jordan, Ronald and Nancy Reagan, Barbara Bush, Billy Graham, Sean Connery, and Muhammad Ali are a few of the other luminaries who drop by for regular tune-ups and care.
Some 2,500 executives also flock to the Mayo Clinic annually for a deluxe, soup-to-nuts physical that's a model of efficiency. Blood is drawn, X-rays are taken, and a great deal of probing and prodding takes place over a one- or two-day period. It carries a steep price tag. The typical executive physical costs $1,500 to $1,600, only part of which is covered by insurance, and some would argue it's all a bit much. But while the medical profession debates the need for an annual top-to-bottom physical, one person's extravagance remains another's wise investment. "We're practicing preventative medicine with a specific population," says Dr. Donald D. Hensrud, director of the Executive Health Program. "An annual urinalysis might not be right for everyone, but it has enabled us to pick up cancers and a variety of kidney problems. I doubt that any beneficiary would consider it overkill."
The clinic that William Worrall Mayo founded in Rochester, Minn., in 1859 today is a giant, not-for-profit group: 1,150 physicians, 1,000 residents, and another 15,000 technicians, nurses, students, and staffers conduct research and practice virtually every branch of medicine in the clinic, two hospitals, and the nearby buildings collectively known as Mayo Medical Center Rochester. The Executive Health Program itself is small potatoes, with 13 examining physicians and a staff of 17, but it can reach into any specialty practiced at the center.
Everybody at Mayo is salaried, which means they can spend time with each patient, and doctors work in ad hoc teams. Most executives can fly to Rochester, have a physical, and get home in less time than it would take to have a similar exam at a local hospital. The Executive Health Program typically has a six-month waiting list, even though it has never been advertised or promoted.
To find out whether it's all it's cracked up to be, FORTUNE decided to put me through the program. I was an obvious candidate. It was time for my annual checkup. Two back operations and the threat of a third mean I can no longer use basketball and squash to deal with stress, weight, and cholesterol. And I have other aches and pains that defy conventional analysis. Two weeks ago I set sail for Rochester. The executive summary: no brain tumors or heart murmurs. I've got what looks to be a 70% chance of avoiding further back surgery, and my eating habits have been overhauled.
7:00 A.M. I get to the reception area early, but a dozen or so eager beavers are already queued up. Everyone looks nervous. Three cheerful attendants suddenly appear. I'm handed an appointment folder with my name and ID number on the front. One of the women talks me through my 2 1/2-day schedule and hands me a bag containing a urine bottle.
7:30 A.M. I deposit the bottle at Station S and take the "subway"--a series of wide, brightly lit corridors that connect all 14 buildings in the clinic complex--to the Hilton Building. Another cheerful attendant--they're all cheery here--directs me to a seat in a huge, bustling auditorium where a technician soon finds me. He leads me into a private room and takes what he needs from my right arm. "On a typical Monday and Tuesday," he says, "we draw blood from between 800 and 1,200 patients."
8:00 A.M. I haven't had anything to eat since seven last night, so I swing by the cafeteria in the basement of the Mayo Building, where other former fasters--our arms sporting telltale gauze wraps--are wolfing down breakfast. I go for coffee and a bagel with cream cheese. I haven't seen the photo in Dr. Roger's office yet.
8:30 A.M. Like virtually everyone on staff, Don Hensrud, my supervising doctor, is slim, trim, and remarkably healthy looking. I filled out a huge questionnaire a month ago, so he already knows a lot about me. We talk about the items I'm concerned about, the drugs I'm taking, and the things I'm doing to stay healthy. Then I strip down to my shorts and undergo a thorough physical. As I'm dressing, he tells me he's adding a visit with a nutritionist to my schedule and is sending the MRIs and CAT scans I've brought with me to the spine center.
10:45 A.M. Over to the Plummer Building for an EKG. In and out in five minutes.
11:00 A.M. Back to the third floor of the Mayo Building for X-rays. The staging area is huge but efficient. We're picked up in groups of six, led into a big room lined with cabanas, strip to our waists, and wait to be called. A technician quickly takes pictures of my chest and sends me down the hall for X-rays of my sinuses. It's time for lunch.
12:30 P.M. The coffee shop in the hotel looks promising. Everyone is chugging down bulging cheeseburgers with French fries. I opt for a salad. Am I becoming a believer?
1:30 P.M. Dr. Jay C. Erie is straight from central casting. Slim and terminally serious, he's the perfect choice to play the ophthalmologist whose breakthrough exam turns up the reasons for my headaches and eye pain. But this isn't Hollywood, and he bats only .500. My intraocular pressure is a tad high, he says, so it would be a good idea to get a baseline visual field test when I get home. Then the good news: The dryness in my eyes is partly the result of a lower lid laxity that could be corrected with simple surgery, and the stinging I get each day is probably because I'm overmedicating with drops. Try preservative-free artificial tears. Great. What about the headaches? Sorry, the eyes aren't the culprit.
3:00 P.M. I've got a few minutes to kill before I touch base with Dr. Hensrud, so I drift over to the executive lounge. There are phones, a fax, and jacks for laptops, but I never see anyone on a computer; only a few Type A's bother to check in with their office. "One of the nice things about Mayo is that you're able to get away for a few days and focus on things you should be thinking about," says one of my fellow patients. "Gives you a chance to reflect."
3:30 P.M. Hensrud is pleased. My blood pressure is where it should be, which means the small dose of Accupril I'm taking each day is doing the trick. My EKG is right on the money, suggesting my heart is in good shape. My prostate is slightly enlarged, which is common for a man my age, but it's free of growths, and my PSA test, which screens for prostate cancer, is well within normal limits. My total cholesterol came in at 199, and my HDL--the good cholesterol--is a high 75, which leads Hensrud to suggest that I cut back the 20 mg of Zocor I'm now taking to 10 mg a day.
On the downside, my blood glucose is 113, vs. a normal 70 to 100, so maybe I should work out more and lose some weight. "A plant-based diet will do wonders," says Hensrud. So much for cheese. "Not necessarily," he says. "But make it an occasion. Have a great cheese once or twice a month. Just don't do it every day." As I'm leaving, Hensrud tells me the spine center wants me to get a lumbosacral X-ray tomorrow, and he's added a physical therapist to my dance card.
8:00 A.M. Breakfast is orange juice, coffee, and a bagel with light cream cheese.
9:00 A.M. Steve DeBoer, my nutritionist, would have preferred something else. A man who puts his money where his mouth is (he bakes his own salt-free bread and seasons his air-popped popcorn with Pam and powdered herbs), he's loaded with warnings. "Your blood sugar is a little high. Try to keep your portions under control." A portion of red meat should be the size of a deck of cards. Cheese is worse than beef in terms of fat. And instead of a hamburger, try a veggie burger made with grains and soy products. "It's not all that bad, and you can doctor it up with salt-free ketchup."
Yup, there's more. All tomato products contain lycopene, which has a protective influence on the prostate. Green beans and fruit with seeds have fiber, which is good too. "Every ten-gram increase in your fiber intake translates into a 10% drop in the likelihood of a heart attack." As I'm leaving, DeBoer gives me a 64-page Mayo publication titled "Guidelines for Reducing Sodium, Cholesterol, and Fat Intake" with the sections he wants me to focus on highlighted.
10:00 A.M. Next stop is the second floor of the Baldwin Building for a stress test. I'm pretty confident about what's going to happen. After all, I do 20 minutes on a treadmill three times a week. But Juliann and Robert throw me a curve ball and start the machine on a steep incline. "If we didn't," says Robert, "we'd be here all day." My job is to keep going as long as I can. Their job is to keep increasing the pace and the incline, monitoring my vital signs as I jog. I hold out for nine minutes. Juliann and Robert offer their congratulations. I did 98% of what's expected for "someone your age," a phrase I'm beginning to dislike.
11:30 A.M. Dr. Roger, who arrives while I'm studying the photo of the steak dinner on the wall in her office, reviews the stress test. It's not foolproof, she says, but the pickup rate of people with potential heart problems is in the 70% range. We turn to my Cardiovascular Health Profile, which suggests that my time on the treadmill was acceptable. My body fat is 19.8%, also a decent number. But while I'm doing a good job in the gym, it could be better. Rather than 20 minutes on the treadmill, she urges me to goose it to 30, and the machine should be at a steep enough incline and a fast enough speed so that I'm sweating and can't carry on a normal conversation. How often should I work out? "Shoot for seven days a week and take what you can get," she says.
2:00 P.M. After a quick sandwich in the cafeteria (lean roast beef on whole wheat, hold the mayo), I link up with Deb Walters-Smith, an audiologist. She fits me out with headphones and spends the next half-hour or so beaming a variety of sounds and words my way. I'm able to hear just about everything until we move into the higher frequencies, at which point there's a falloff that worsens when background noises are added. This type of hearing loss is common, she says, in someone my age.
2:30 P.M. Dr. Steven G. Harner gives my ears, nose, and throat a going-over, then cuts to the chase. The ringing I've started to hear in my ears--a condition called tinnitus--is a result of the hearing loss. "It's like a phantom limb," he says. "Your nerves are sending electrical signals to your brain, but the tones you can no longer hear come through as a ringing sound." Not serious but not much to do about it. The sinus X-rays are fine, and the fullness would be helped by regular use of a steroidal spray. What about the headaches? Can't blame the ears. The headaches are stress-related, he reckons. Try heat, cold, pressure, rest, Tylenol. Whatever works.
4:00 P.M. Back to the third floor of the Mayo Building for the X-rays the spine department requested. Then I'm on my own, which translates into a swim at the hotel, a healthy dinner (tossed salad and grilled salmon), and then to bed.
7:15 A.M. It has been only 48 hours, but I feel like a veteran. I nod knowingly at the newcomers with gauze on their arms (been there, done that). I toss a "Right back at you" to the smiling woman at the cash register in the cafeteria who hopes I have a great day. Breakfast today consists of coffee, a banana, half a grapefruit, and two slices of dry whole wheat toast.
7:45 A.M. Up to the 15th floor of the Mayo Building, where the action begins with a four-page Spine Center Self Report that asks me to put an X next to all the types of pain treatment I've ever received, ditto for all the drugs I've taken, and another X next to the activities that help or worsen the pain. The last page contains drawings of a body on which I'm to use symbols to show the exact whereabouts and nature of what I feel: ooooo for pins and needles, ///// for stabbing pain, xxxxx for burning, and zzzzz for deep ache.
8:15 A.M. Dr. Karen Newcomer-Aney, who adds the questionnaire to the fat pile of X-rays and reports that now fill my file, asks more questions. She has me walk the length of the room on my toes, next on my heels, and puts me through a rigorous exam. Then we go to the film. She places one of my old X-rays on top of the new one. They're identical, which suggests that the pain I experienced in January was not related to spondylolisthesis, a hairline crack in the base of my spine that has caused my vertebrae to move slightly out of line. If the crack were to widen and bring on severe pain, the answer would be a fusion, but the fact that the X-rays line up suggests that things are under control.
Dr. Newcomer-Aney puts one of my CAT scans on the light box and points to what she says is a small herniation in the disk located between my second and third lumbar vertebrae. "The best way to visualize it is to think of a disk as a jelly doughnut and that some of the jelly has oozed out and is pressing on a nerve. If it presses too hard, you'll feel it." I felt it in 1991 and in 1993, when portions of the disk had to be removed, and again this January when a fresh burst of pain had me scheduled for a third operation. "The body treats the extruded material--the jelly--as a foreign substance," says Dr. Newcomer-Aney. "Given time and the right circumstances, it can often be absorbed back into the system." I'm pain-free now, which suggests that my doughnut has pulled itself together. Is it apt to rupture again? "Given the weakness in your disk, there's a 30% likelihood that you'll have a recurrence." Sounds as if I should forget squash. "If it were me, I'd look for therapy that would build up my back."
10:30 A.M. Enter Ann Helsey, a white-haired bundle of energy. I describe and demonstrate the stretches, crunches, leg raises, and other contortions that constitute my exercise routine. She sighs. The key to everything, says Helsey, is dynamic lumbar stabilization, which is a fancy way of describing a procedure that gets your spine into a neutral position at the start of each exercise. "You use your abdominal muscles to rotate your pelvis back and forth until you're in a pain-free, midrange position." She shows me how, and I do it. Then we double back and apply what I've just learned to each of my exercises. Suddenly we're out of time. Armed with diagrams of the exercises Helsey thinks I should be doing and a video called "Be Good To Your Back," I bolt out of physical therapy and hustle upstairs for my wrap-up with Dr. Hensrud.
11:15 A.M. My bulging master file is now in command central, and Hensrud reviews the team's findings: the diet suggestions, the recommendations for dealing with my eye and ear problems, headaches, blood pressure, cholesterol, prostate, and the cranky back. "Bottom line," he says, "you've got a fair amount of problems, but none is life-threatening. Your overall health is quite good. You're in very good shape for a man your age."
DAY ONE PLUS TWO WEEKS
The bill totals $3,100, with the bulk of the overage reflecting the spine and sinus X-rays and tests. Dr. Hensrud sends me a five-page letter I'm to share with my internist. Dr. Erie sends a separate letter for my ophthalmologist, in which he suggests a number of baseline tests.
I'm also doing my bit. I've added a baby aspirin to the vitamin C, E, and calcium supplements I take each day. I've outgrown my disdain for sunscreen. Not much headway yet on the salt front, but my fruit and veggie intake is up, and very little animal fat is passing my lips. I'm medicating less and exercising more. I'm making it to the gym four times a week, where I'm spending 25 minutes on an inclined, souped-up treadmill and doing my crunches to the beat of dynamic lumbar stabilization. Along the way I've shed five pounds. Wait till they see me next year.