Garri: Let us start with the basics! If you were speaking with a future longevity patient, what would you tell them to expect from their first appointment with a longevity physician?
Evelyne: When someone asks to embark on this longevity medicine path, they have already made the most important decision. They have chosen themselves and their health, and have intrinsic motivation to support themselves and make change. This is very important - otherwise, it will be challenging since this path, if done correctly, is not always easy.
As a longevity physician, my goal is to keep steady, or even improve, the quality of life. The fun has to be there – life is about more than just living longer – but a fun and fulfilling life can be healthy too. I’d also add that it is essential in longevity medicine to focus on physical health as well as behavioural and mental health. All pieces together make a healthy human.
During the first session, I take the time to conduct a very deep anamnesis. Anamnesis is a medical term for patient history, but it is more extensive than what you might typically go through at a doctor. It is similar to a life plan, but with a very detailed background history. So when a patient asks me, “What will happen when we have the first interview?” I usually tell them to set aside two to three hours, because I will ask a lot more questions than you might expect!
The second important part is to collect all the data the patient has available. So again, whatever the patient has in terms of medical data, even if it’s from 20, 40, 50, or 60 years ago, I want to see it. The more, the better. Blood results, notes from doctors’ appointments, scans, everything!
Garri: When you say you are taking a detailed assessment, are you really starting at the beginning? What are some examples of the questions you ask?
Evelyn: Any type of imaging, any type of blood results, any type of any other scan results – anything that they had ever done medically, I want a copy of. As for my questions, we go all the way back to their childhood. This is standard for taking any very good patient history, as childhood diseases, childhood allergies, childhood traumas, both physically and psychologically, can impact long-term health. We individualise treatment based on the patient’s story. If a patient tells me that they had a particular experience in childhood that triggered a current issue – of course, that is something we will work on.
For example, I work with a doctor and an athlete who grew up under severe conditions in a continent different from the one of her birth. I would have never known they grew up in a climate that predisposes them to a totally different response to triggers unless I asked. This is why I start with childhood - how you grew up definitely influences your physical and psychological development.
Overall, though, the questions in this background section are rather medical. We will go through your family history, any diseases you have or have had in the past, medical symptoms throughout your life, etc. We will also cover some more general topics too. Here’s something interesting: the kind of work and places you have travelled are important to your longevity as well. Have you had an office job for most of your life, or have you worked in factories/manufacturing locations? Have you travelled frequently for work? To where? All of these are questions I ask as part of my normal intake for a new patient.
Of course, part of the conversation is understanding the patient’s quality of life and habits so any treatment plan is not a shock to the system.
For example, maybe your success at work requires late business dinners, social events, and drinking alcohol a few times a week. I would be a poor physician to say that the patient must stop all of these activities - it isn’t realistic. I always try to find a way for my patients to enjoy these aspects of their lives while still improving their health. Otherwise, the changes will not be sustainable.
The structure of the treatment is critical as well. When I first see a patient, I determine if something needs to be “fixed” to bring them to the best possible state of health where we can start to optimise. This often means first diagnosing and treating any illnesses before moving on to optimisation. Baseline treatments precede any “optimisation” plans.
Garri: What would an example of treatment before optimisation look like?
Evelyne: Let's say a patient comes in, and the patient already has co-morbidities. This could be something like hypertension, high cholesterol, hypercholesterolemia, pre-diabetes, frequent gout, an underlying infection, etc. The first goal is to treat these diseases, but that also requires compliance from the patient to be successful.
I first try to bring the person to a level where they can live without medication, if it is not necessary. A great example of this is sleeping pills and underlying sleep issues. The first goal is always to focus on the root cause and move away from medication if possible. From that moment on, we can start to really optimise and bring them from their biological age to optimal performance. We can improve all areas of their life and physiology to help the patients feel their best.
I sometimes work with younger patients as well – in their twenties and thirties! These younger patients come in for an in-depth evaluation and full longevity screening. They are free from disease, so I can immediately jump into optimisation.
I also work with individuals who already have incurable diseases or chronic illnesses. I have patients with a history of cancer or type one diabetes. We need to consider those as a special population because not all optimisation techniques might work on them. In fact, they might even be harmful to this population. Because of this, step one is always bringing the patient from a reactive state to a good condition, and then optimising appropriately.
In our next blog, Evelyne will be sharing more about the testing and analysis she does to create a treatment plan that suits individuals' unique needs. Stay tuned!