Tag Archives: In The Lab

BLOOD TESTS: THE BENEFITS THAT “COMPREHENSIVE METABOLIC PANELS” REVEAL

One of my nurses who was usually in good health developed chronic complaints. She felt tired all the time and had a variety of aches and pains. She has been going through menopause for a long time but this set of problems seem different. Then she broke her arm after sustaining a minor fall. An investigation was in order. I should order some tests, but which ones?

Anemia would explain the fatigue so a CBC was a no brainer. With the surprise fracture, I wanted to cast the net wider, so I ordered a comprehensive metabolic panel.

This is an automated test that was a good value for the amount of information provided, I thought.

Nobody was more surprised than I when the test provided results that were the key to her very rare diagnosis. Her serum CALCIUM was very high, and her alkaline phosphatase was also elevated.

Further evaluation showed her diagnosis to be PRIMARY HYPERPARATHYROIDISM.

Removal of her abnormal parathyroid gland was curative. I have been a big fan of the Comprehensive Metabolic  Panel ever since.

The Panel of 14 tests includes:

  • Glucose – an essential test to check in Diabetes, Seizures and Coma.
  • Sodium, Potassium, Chloride, and CO2 and the associated Anion Gap – can be abnormal in a variety of accidents, and other conditions.
  • BUN and Creatinine – cleared by the kidneys, and become elevated in Renal, or Kidney conditions.
  • Calcium and alkaline phosphatase – reflect bone metabolism, and are sensitive to Vitamin D and parathyroid hormone, as in my nurses case.
  • Albumin and Globulin – important blood proteins. Globulins contain the   important immunoglobulins. A variety of conditions will influence their values.
  • AST (SGOT) and ALT – elevated in liver disease

Type in “Comprehensive Metabolic Panel” in google, and choose from the variety of “hits” to get more information about this “ Sherlock Holmes’ Magnifying Glass” for Physicians.

Medicine would be hard pressed to do without it!

Dr. C.

IN THE LAB: TESTS FOR AND DIAGNOSING “aNEMIA”

I should have known something was wrong.

I was getting short of breath with a third of a 45-minute exercise I had done for years, but I rationalized it away. I reasoned that I hadn’t been sleeping well, I am getting old. And my heart isn’t working as well because of the Atrial Fibrillation.

Physicians have a big armamentarium of excuses they can generate, and besides it is their Karma to GIVE Medical care rather than to RECEIVE it.

The AHA moment came when I bumped my leg, and peeled back some skin. My skin is old and fragile, and I’m always tearing it in small areas.

This time, I got to see the blood run all the way down my leg like a drop of grape juice, not the thick blood I’m used to. If anything, my blood should be thicker, more viscous, since my average Hemoglobin is 16 gm., on the high side of normal.

I got my blood drawn, and ordered a CBC and a ferritin. The CBC shows the Hemoglobin level, and a number of other measurements bearing on anemia, and the ferritin gives a measure of IRON STORES.

I can’t remember the first time my ferritin was ordered, or why, but it has for years been borderline, just barely in the normal range, dipping down as low as 18, and rising as high as 35.

Since a common cause of low iron stores with a good diet is colon cancer, I had about 3 colonoscopies to rule out cancer over a period of 6 years; lucky me.

At least they were all negative, and without polyps.

This time the ferritin was 12, well into the abnormal range, and the Hemoglobin was 8.6 gm. little more than half my usual.

I had been fibrillating for 5 months, and been on 5 mg. Eliquis ( an anticoagulant/blood thinner) for the same period. Having a recent normal colonoscopy, the most likely diagnosis was AVMs (arteriovenous malformations) of the small bowel, with bleeding accelerated by the Eliquis,

Since small bowel surgery contraindicated a diagnostic videocapsule, this diagnosis would have to remain an assumption.

I reduced the Eliquis by 25%, calculated my blood loss rate and started 2 capsules of feosol alternating with 3 capsules daily. Over a period of 4 months, my Hemoglobin came back up to 15 gm., and my ferritin came up to 50. I am due another test as soon as I get enough nerve to brave the Covid and go to the lab.

This story is a good illustration of treating one illness, and thereby creating another in this world awash with medication. How much better it is to stay as healthy as possible.

However, I am becoming increasingly aware of the fact that Health is not often the top priority in most peoples lives.

As an illustration, I refer to todays’ Sunday New York Times, which reviewed 2 books on walking, one written to praise its’ health benefits. To quote the reviewer, “

The issue with ‘ in praise of walking’ is Mr. O’Mara’s assumption that how good an activity may be for us is the most essential measure of its worth”. Praising health raises an issue?

Personally, my main exercise is walking, and I do it expressly for health. That doesn’t mean that I don”t enjoy walking and have other motivations. I would not be walking as FAST, however, it it were not so healthy.

–Dr.C.