Wednesday, January 27, 2016

Wisdom Wednesday: Annual Laboratory Testing

I highly recommend that you have annual lab work to access your current state of health, predict future health issues and hopefully avert them in the process.

My practice uses functional neurology as a framework. This requires physical testing of patients in the office. I then compare my findings against the patient history and laboratory testing. Laboratory testing is standardized and repeatable giving absolute benchmarks above and beyond the patient’s symptoms and their ability to convey them to the physician.

Here is a list of some of the more common tests I recommend and a brief explanation of why they are of value:
  • Comprehensive Metabolic Panel (CMP) – these fasting tests include the glucose, kidney indicators (uric acid, BUN, creatinine, & eGFR), electrolytes (sodium, potassium, chloride, carbon dioxide, calcium, phosphorus & magnesium), protein (albumin & globulin), bilirubin, alkaline phosphatase, LDL, liver enzymes, and iron indicators (iron binding capacity, UIBC, serum iron, iron saturation & ferritin). Abnormalities of any of these tests are related to metabolic issues like hepatitis, impaired kidney function or anemias.
  • Glycohemoglobin A1c – measures the glycosylation of the hemoglobin molecule on red blood cells. This test effectively measures your average blood glucose levels over the past two months. It is now considered the gold standard for diagnosing pre-diabetes and type 2 diabetes.
  • Serum Lipids – total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol and VLDL cholesterol. Traditionally, these tests are used as a basis to prescribe statin drugs. I use them as a measure of cholesterol metabolism as it relates to thyroid, liver, digestive, and endocrine function.
  • Thyroid Panel – the TSH (thyroid stimulating hormone) is the minimum test. I also like to run the T3 and T4. If I am concerned about autoimmune disease (Hashimoto’s thyroiditis), I also include the TPO (thyroid peroxidase) and thyroid autoantibodies.
  • Vitamin D – measures the serum level of 25-hydroxy vitamin D, the inactive form of vitamin D after conversion from either D2 or D3. Vitamin D is really a hormone and deficiency is very common. Adequate levels are vital to proper function of the immune system in addition to calcium and bone metabolism.
  • CBC (compete blood count) – includes white blood cells (WBCs), red blood cells (RBCs), hemoglobin, hematocrit, volume indices, and white blood cell types. This test shows anemias, infection fighting, and even vitamin B12 and/or folic acid deficiency.
  • C - reactive protein (CRP) – this is an inflammatory marker that is fairly specific for vascular inflammation. It is an important indicator of cardiac risk.
  • Homocysteine – an intermediate metabolite of sulfur amino acid metabolism. It is very dependent on vitamin B12, folic acid, and vitamin B6 status. It is also an important indicator of cardiac risk.
  • Urine Analysis – reveals signs of infection fighting (UTI), acid demand from the diet, and possible kidney stone formation.

Obviously, there are many more tests that can or should be run, depending on your history. I still believe the PSA (prostatic specific antigen) is a good test for men over the age of 40. If you have been advised to take or are taking a statin, then an L(p)a is highly recommended.

The Bottom Line:
Please have routine laboratory testing run annually.

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