Monthly Archives: January 2023

In The Lab, Medicine, Reviews

Cholesterol: How To Read The Lipid Panel Blood Test

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There are three general types of large molecules of which our body is composed. There are PROTEINS, essential components of the Nanomachines that power of our bodies, the CARBOHYDRATES which can form structures, as well as provide and store nutrients, and LIPIDS, which can function as a storehouse of nutrients.

Lipids, unlike carbohydrates and proteins, are essentially nonpolar, that is they have no profusion of charged molecules. The main characteristic of lipids is that they do not dissolve in water, thereby allowing for domains and structures to develop in the cell and beyond.

Cholesterol is a lipid that is essential to our cell membranes, and therefore to life. As people get older, however, cholesterol tends to accumulate and get stored in unwanted places, such as under the lining membranes of blood vessels. In this location, they can cause blockages that threaten the very life for which they are essential.

All of the lipids measured in the comprehensive lipid panel measure lipids in different forms that have different functions and significance in the body. The only one of the lipids that is almost always good, or at least neutral, is the high density lipoprotein, the HDL. The level of this lipoprotein is under genetic control and is increased by EXERCISE and FISH OIL, among other things.

“Good Genes”, healthy diet and exercise will help keep down the bad lipids, especially the LDL, and elevate the main good lipid , HDL.

Coronary artery disease and strokes are the main killers in mid and into later life, and are therefore very important to control. Many people do not seem to have the self-discipline that healthy diet and exercise requires. Fortunately, we have a miracle drug. the HMG- CoA inhibitors, the “statin” drugs, which most people tolerate without the muscle pain and myolysis side effect.

I have taken the statin drugs for years, ever since I discovered my cholesterol was 220, above the optimal level. Fearful of muscle effects, since I am a heavy exerciser, I started out on 1/2 of the lowest dose, 2.5 mg., of Rosuvastatin. This amazingly took my cholesterol level all the way down to 180, and my LDL down below 100, a powerful medication indeed.

My most recent Lipid panel results are below:

                                      Result value.              Ref. Range

Triglycerides.                    51 mg./dL.                <150 mg./dL

Cholesterol.                        186 mg./dL.                <200 mg./dL

HDL.                                    90 mg./dL.                  > 60 mg./dL

LDL direct.                          95 mg./dL.                  <100 mg./dL.

The authorities have lowered the normal range a couple of times during my lifetime. It is true that even lower values than mine show ever more benefit.

It is best to keep your lipids under control with diet and exercise, so stay healthy!

—Dr. C.

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Aging, Conditions, Medicine, Reviews

Conditions: Diagnosis & Care Of Osteoarthritis

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Osteoarthritis is the most common form of arthritis. It is more common in women than in men, with incidence increasing sharply around the age of 50.

January 30, 2023 – And it can cause complications – including the inability to perform activities of daily living and spinal stenosis in cervical and lumbar osteoarthritis.

So it is vital that we get the diagnosis and management of this condition right. In this BMJ Best Practice podcast on osteoarthritis, Kieran Walsh talks to Fadi Badlissi, Assistant Professor at Harvard Medical School and Director of the Musculoskeletal Medicine Unit at Beth Israel Deaconess Medical Center in Boston. 

Dr. C's Journal, In The Lab, Medicine, Reviews

Vitamin D: Importance Of Knowing Blood Levels

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Vitamin D Blood levels are seldom ordered by doctors, or demanded by patients, in spite of the fact that it is the “vitamin of the decade”.

Vitamin D is the sunshine vitamin, since the UVB light normally converts skin cholesterol into vitamin D. The white skin of peoples who migrated into temperate zones such as Europe was very likely a survival factor due to the low amount of sunlight in northern climates  compared to the African tropics, and white skin permits increased vitamin D production.

Vitamin D is most famous as the factor that prevents the childhood bone disease “rickets”. The industrial revolution resulted in kids being in factories, getting insufficient sun exposure, and having an epidemic of rickets.

The Covid pandemic resulted in orders of magnitude more deaths among the elderly, especially those in sunless retirement homes. Eventually, vitamin D became implicated in immune deficiency, and the ability to survive Covid.

Vitamin D Is suspected as a factor in multiple sclerosis, tuberculosis, and even seasonal affective disorder, where there is a great increase in depression during the dark months of winter in extreme northern climates.

The NFL, ever striving to keep their players in top physical condition and accelerate recovery from injury, now supplements their players, and, I hear, requires blood levels of 60 ng./ml and above, more when they are injured. Vitamin D thought to improve muscle strength, and the rate of repair in muscle injury.

A lot of studies have failed to show the benefits claimed for vitamin D, but  a recent large study from Harvard showed that the beneficial effects of vitamin D occur only among thinner individuals with a BMI of less than 25, which is a shrinking percentage of our population. It seems that already healthy people who are not overweight are the only recipients that can benefit from vitamin D, a fat soluble vitamin, which may be tightly held by the excess fat of overweight people.

Although I am waiting for more and better studies, I obtain yearly vitamin D blood levels. in fact, I was rather worried recently that my 5000 i.u./day supplementation might be excessive. Not so; it came back as 51 ng/mL The normal level is now considered to be above 30 ng/mL. This was determined in part by finding that the parathyroid hormone blood level was elevated with lower levels of vitamin D, and reached normal only at 30 ng.

How much is too much? It has been documented that most lifeguards in the summer have levels above 100.ng/ mL and there has never been Vitamin D toxicity based on with sun exposure as the sole source of elevation in vitamin D level. “

Getting your vitamin D by sun exposure can lead to skin cancers in later life, however, and my opinion is that VITAMIN D BY ORAL SUPPLEMENTATION IS SAFER.

Checking  your blood vitamin D level should be done at least twice. Once to check the baseline, and, since most people in our mostly inside, sunscreen-using population will not have an adequate level, a second test to be sure that you are adequately and not excessively, supplemented.

My recent results:

Result Value: 51 ng/mL (Vitamin D, 25 Hydroxy)

Reference Range: 30-100 ng/mL (1 ng/mL =  0.83 IU/mL)

Deficiency is  < 20  ng/mL.                 

Insufficiency     20-29  ng/mL

Sufficiency         30-100 ng/mL

—Dr. C.

In The Lab, Medicine, Reviews

Tests: The Comprehensive Metabolic Panel Report

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This is a big one, and produces a lot of information.

Your metabolism is the workhorse of your body, and this panel measures certain critical chemicals and waste products that make metabolism and life possible.

Sodium -The main element in the fluid outside your cells. It draws water into vessels, supporting blood pressure. Drinking water is critical to life, and a recent study used the serum sodium as a proxy to indicate whether you are drinking an adequate  amount. If the level is below 142 mmol/dl,  you are adequately  hydrated and your life expectancy is higher.

Potassium – The main element in cells. There is a pump in the membrane of the cell that pumps potassium into the cell, and sodium out, to maintain a critical electrical charge across the cell membrane. Even small deviations in serum potassium can be worrisome.

Chloride – The anion that Electrically balances sodium and potassium. Can be important in acidosis.

Glucose – The major Energy source of the body. Too little, and you pass out. Too much is a long-term stress on the body, as in diabetes.

Carbon dioxide – As bicarbonate, important in adjusting the acidity of fluids outside the cell.

Anion gap – an important check for doctors.

BUN – A Measure of excess protein in the diet, and can be very elevated in kidney disease. I usually have an elevated BUN, because I eat a lot of protein due to  my age. My creatinine is always normal.

Calcium – important for bones, and many other processes, including cellular signaling.

Albumin – An important blood protein that supports blood pressure.

Creatinine – A waste product that is used as a measure of kidney function.

AST (SGOT) – A liver enzyme used to measure inflammation of the liver.

ALT (SGPT) – A counter check to the AST.

Estimated GFR – Based on creatinine, it is a measure of kidney function.

Total protein – Includes albumin + the amount of globulin. The latter includes proteins involved in immunity, measured by subtracting the albumin from the total protein.

The metabolic panel is used to give clues to a whole host of diseases such as diabetes, liver disease, Kidney disease, immune deficiencies, endocrine diseases, vitamin and mineral deficiencies, and the like. It is so useful that Medicare pays for it, usually.

—Dr. C.

In The Lab, Medicine, Opinion, Reviews

Screening Tests: What Makes Up A Urinalysis?

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The urinalysis is a very good screening test, and therefore often ordered with an annual physical examination. It gives insight into a very vital organ, the kidney.

It is the definitive test for a urinary tract infections, which are very common particularly in women, with their short urethras, and is also very good at reflecting abnormalities in the body of various sorts.

Urine color– very helpful in many conditions, such as liver disease, hemolytic anemia, porphyria, and Homocystinuria. When I had my bladder cancer bleed, the urine was red in color of course.

Clarity – The presence of many small particles, such as white blood cells or bacteria will make the urine cloudy.

Urine specific gravity – Will be high if you’re drinking insufficient water.

Urine pH — Will be out of range in several conditions, such as urine infections and somatic acidosis, which can happen in diabetes.

Urine protein – Gets into the urine in some kidney conditions such as nephrosis.

Urine glucose – Is positive mainly in diabetes, which was very important to follow when I was practicing in order to follow the diabetes. It is still important in the early pick up of diabetes and people that didn’t know they had it. Blood sugars are much more used these days to follow diabetes.

Urine ketones – Can indicate out of control diabetes. Can also Occur with certain very low carbohydrate diets; keto diets are named for this effect.

Urine blood -A counter check to the microscopic examination for red blood cells.

Urine nitrite – Elevated with urinary tract infections, a check on microscopic white blood cells.

Urinary Urobilinogen – Elevated in certain liver diseases.

Urinary leukocytic esterase -A check on urinary white blood cells

Urinary microscopic examination:

Urinary RBC – Elevated in urinary tract bleeding in certain  kidney and bladder diseases.

Urinary WBC – Elevated with urinary tract infections

Transitional epithelial cells – Sometimes have significance to doctors

Urinary bacteria – Of course Indicates urinary tract infection

Urinary yeast and hyphae – May indicate a fungal infection.

The urinalysis I obtained when my red urine due to my bladder cancer alarmed me showed Red urine color 30 mg/dL urine proteins, large amount of blood, 10-15  red blood cells, (elevated) and a few bacteria and yeast, a spurious finding.

When you go in for a general physical, assuming that you are well, it is always comforting to have a negative urinalysis, a broad screening test for all kinds of different problems.

— Dr, C

In The Lab, Medicine, Research

RESEARCH: ‘SINGLE DROP’ BLOOD TESTING ADVANCES

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“Even more importantly, we’ve shown you can collect the blood drop at home and mail it into the lab,” said Michael Snyder, PhD, director of the Center for Genomics and Personalized Medicine and senior author on the research, which was published in Nature Biomedical Engineering on Jan. 19.

Stanford Medicine (January 19, 2023) – Researchers at Stanford Medicine have shown they can measure thousands of molecules — some of which are signals of health — from a single drop of blood.

Unlike finger-prick testing for diabetes, which measures a single type of molecule (glucose), multi-omics microsampling gives data about thousands of different molecules at once.

finger prick
A single drop of blood can yield measurements for thousands of proteins, fats and other biomarkers, researchers at Stanford Medicine found.

The new approach combines a microsampling device — a tool used to self-administer a finger prick — with “multi-omics” technologies, which simultaneously analyze a vast array of proteins, fats, by-products of metabolism and inflammatory markers.

Medicine, Opinion

Opinion: Your Laboratory Tests And What They Mean

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A lot of people can read the annual report of the financial health of a company. I could make a good argument that you should also be able to read your laboratory reports which report on the health of your body, just as important to you, or more so, than the health of your investments.

There are more and more laboratory tests to help doctors with your diagnosis. These laboratory tests automatically flag results that are outside the “normal range” of healthy people. There’s also a profusion of information on the Internet available these days, some of which discuss specific abnormalities of these laboratory results. People move and change doctors a lot, and the information transfer from one Dr. to another may be imperfect. For these reasons it would seem reasonable for all people except for the most confirmed technophobes to keep track of their laboratory tests.

Ask for duplicates from the doctor, and keep them in a special  3-ring binder. A side benefit of doing this is to let the doctor know that you are an Informed consumer. She may well take more time with you.

I will go over the different common laboratory tables and discuss things that you should look for, starting with the hemogram, or blood count.

  • White blood cell count— White blood cells have diverse function, usually fighting infection. The total count is often elevated with bacterial  infection and diminished with viral infection. Out of range values are flagged.
  • Red blood cell count- Red blood cells carry oxygen to your tissues, and are diminished in anemia.
  • Hemoglobin and hematocrit- The hemoglobin is the vital oxygen carrying protein. The hematocrit measures the volume of the packed red  cells. Both measure the same thing as the red cell count, but in a different way.

Comment: about a half dozen years ago, I became more and more short of breath when walking my usual exercise routine. Eventually, I could only walk about a third of the distance, and ordered some lab work. I came back very anemic, with a hemoglobin of 8.5, far below the normal range.

Iron deficiency anemia is the most common kind, and so I ordered a ferritin level, which measures iron stores. It also was very low. I started myself on oral iron, and consulted a hematologist/oncologist who takes care of blood problems, and he had me continue on the same program. I had to take two of the standard Feosol tablets, each containing 200 mg of ferrous sulfate, and 65 mg of elemental iron. After several months, my hemoglobin came back up to its normal range over about 15g/dl, and the ferritin up to 63ng/ml.

I had a endoscopy of my colon, esophagus and stomach. Nothing was found, and the presumption is a small intestinal blood leak, taking blood and iron out of my body faster than a normal diet could replace it.

  • The MCV, MCH, MCHC, and or RDW are measures of red cells that are of concern to doctors, but which are not commonly important.
  • Platelet count- platelets are essential for normal blood clotting. They are usually not a problem unless you are on chemotherapy, which reduces platelets.

The different types of white cells—neutrophils, lymphocytes, monocytes, eosinophils, Basophils, and nucleated RBC are specific types of cells important in certain special conditions. Neutrophils are commonly elevated with bacterial infection, and reduced with viral infection.

When I was going to medical school, we did our own blood cell counts manually, by looking through a microscope at the blood cells on a special slide. Now there are amazing machines that do it much more rapidly and presumably accurately.

The blood count, or hemogram is important if you are sick, and it is a good idea to know your normal values when well, which then presumably are within the normal ranges printed on the laboratory report. Each laboratory uses a little different machinery, and therefore has its different normal ranges.

Next time I will talk about the urinalysis.

—Dr. C.

Conditions, Medicine, Reviews, Videos

Ear Health: Diagnosing And Managing ‘Tinnitus’

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Mayo Clinic – About 1 in 5 people experience the perception of noise or ringing in the ears. It’s called tinnitus. Dr. Gayla Poling says tinnitus can be perceived a myriad of ways. Hearing loss can be age-related, come from a one-time exposure, or exposure to loud sounds over a lifetime.

Dr. Poling says the tiny hairs in our inner ear may play a role. Dr. Poling says there’s no scientifically proven cure for tinnitus, but there are treatment and management options. Other options include using a sound generator or using a fan at night. If ringing in your ears bothers you, start by seeing your health care provider for a hearing test.

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