Category Archives: Opinion

Screening Tests: What Makes Up A Urinalysis?

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

Opinion: Your Laboratory Tests And What They Mean

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.

Reviews: The Lancet On Top Five Health Priorities

The Lancet (January 2023) – For our 200th anniversary year we have identified five Spotlight subjects of particular importance. Watch as Richard Horton, Editor-in-Chief, and other Lancet Editors around the world outline these Spotlights and discuss priorities for the future of health.

The Lancet Infectious Diseases | Journal | ScienceDirect.com by Elsevier

This year, we draw attention to the most critical issues impacting health globally, the extraordinary people involved in tackling them, and the voices of those most impacted. For five Spotlights, we will run a programme of activities to bring these issues to life and convene the right people and resources in order to drive change in these areas.

Spotlight on Universal Health Coverage
Ensuring all populations globally have access to affordable, quality health care

Spotlight on Research for Health
Prioritising evidence to guide and inform decision making

Spotlight on Child and Adolescent Health
Prioritising the health needs of children and adolescents now

Spotlight on Health and Climate Change
Tackling climate change through the lens of human health

Spotlight on Mental Health
Implementing sustainable global mental health in a fragmenting world