Tag Archives: Testing

Medical Screening: The Thyroid Function Test

When you are low on your thyroid, or hypothyroid, you may feel sluggish, gain weight, and think slowly. When your body produces too much thyroid hormone, and you have hyperthyroidism, you may feel nervous, shake, and lose weight.

During a physical examination, the doctor should palpate, or feel, your thyroid gland, which is in the neck, straddling the wind pipe, below the larynx, or voice box. If it is enlarged or bumpy, there may well be an abnormality,  most common of which is a generalized enlargement, usually due to Hashimoto’s thyroiditis, which eventually leads to hypothyroidism, or a low functioning of the thyroid.

Because of its importance, thyroid function is often taken as a screening test.

When there is not enough thyroid hormone in your bloodstream, the pituitary, or master gland  increases the TSH, or thyroid stimulating hormone. Less commonly, when the function is excessive, the TSH drops to an excessively low level.

The thyroid panel usually consist of FT4, or free thyroxin, and a TSH, as a counter check.

Sometimes, often in older people, the TSH rises for seemingly no reason, although the FT4 remains normal. The doctor then determines clinically whether or not your thyroid  is low and you need to have oral thyroid supplementation.

                      Result value.                Ref. Range.

FT4.                  1.03 ng./dL.              0.76 – 1.46 ng./dL

TSH.                  12.10.  (H).                0.36 – 3.74 uIU/mL.

I am Currently not taking any thyroid supplements. I feel a little fatigued much of the time, but I’m losing, rather than gaining weight, and sometimes I feel pretty peppy. I also have atrial fibrillation, and have had NSVT, which could be worsened by thyroid supplementation. With my age, my physician is comfortable not giving me thyroid, and so am I.

—Dr. C.

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

HEALTH: ‘AT-HOME COVID-19 TESTS’ – ON THE WAY (VIDEO)

OraSure Technologies has blazed a trail in at-home diagnostic tests. Now, the Pennsylvania-based biotech company is working to produce a quick, over-the-counter coronavirus test that consumers can take in the privacy of their home with results available in minutes. NPR’s Allison Aubrey reports.

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.

Coronavirus : The Race To Expand Antibody Testing, Public Health Investment

Benjamin Thompson, Noah Baker, and Amy Maxmen discuss the role of antibody tests in controlling the pandemic, and how public-health spending could curtail an economic crisis. Also on the show, the open hardware community’s efforts to produce medical equipment.

In this episode:

02:08 Betting on antibodies

Antibody tests could play a key role in understanding how the virus has spread through populations, and in ending lockdowns. We discuss concerns over their reliability, how they could be used, and the tantalising possibility of immunity.

News: The researchers taking a gamble with antibody tests for coronavirus

10:25 Economy vs public health, a false dichotomy

Jim Yong Kim, former president of the World Bank, argues that strong investment in public health is crucial to halt the ongoing pandemic and to prevent a global financial crisis. We discuss his work with US governors to massively increase contact tracing, and his thoughts on how researchers can help steer political thinking.

News Q&A: Why the World Bank ex-chief is on a mission to end coronavirus transmission

19:00 One good thing this week

Our hosts talk about staying positive, and pick a few things that have made them smile in the last 7 days, including a tiny addition to the team, a newspaper produced by children in lockdown, and a gardening update.

Six Feet of Separation, the newspaper staffed by kids

22:51 Open hardware

Researchers are stepping up efforts to design and produce ventilators and personal protective equipment for frontline medical staff. We hear how the open hardware movement is aiding these efforts, and the regulations that teams need to consider if their designs are to make it into use.

Technology Feature: Open science takes on the coronavirus pandemic

COMMENTARY

Coronavirus Testing and Tracking (1) are the two pillars of surveillance which will hopefully replace the “shotgun” method of universal distancing that America has tried so far. Quarantining only those who are contagious makes much more social and economic sense than quarantining everybody, and it seemed to work in South Korea (2) and Taiwan (3).

There are problems both with testing-accuracy and availability- and tracking, which is in tension with individuality and freedom.
Still we have no choice but to try, because people and businesses need to socialize and make some money.

Some epidemiologists predict that Covid 19 will smolder on, hopefully not overtaxing our health system, until “herd immunity” gets to 60-70 percent of the population.

As a highly susceptible octogenarian, I plan to keep my distance and become one of the minority protected by herd. And maybe an effective immunization or drug will come along.

—Dr. C.