Monday, December 22, 2008

The Spy Within: Your Blood Sees All -- and Tells the Ultimate Inside Story.

Needles give me the creeps. The VA phlebotomist, pleasant enough considering, has me make a fist. She holds the needle up, lovingly it seems to me. I see imminent invasive pain. Just before she is to stab me in the arm, I close my eyes and look away.

While I transport myself to a beautiful, magical place where there are no needles and no pain, she jabs me – ouch-- and draws out my... my... BLOOD. My precious bodily fluids! Into a bloody needle!

It's downright vampiric, only without the bloodthirsty night creatures. Yet when it comes to the state of my health, the blood drawn into that needle knows me better than my wife and my family. Better than my best friend in the world. Better than I know myself. Maybe even better than my doctors -- who depend greatly on what my blood tells them.

Marion Connors, a former nursing director at a large Massachusetts hospital who today often explains blood tests to elderly patients – and is my sister – says that the blood test is both simple and complex. It is simple, she says, because it is easy for the physician to order, for the patient to take, and to get quick results from the lab.

Marion says the blood test is also complex because “it tells so much ... because blood does so much in our bodies. It is the fluid pumped by the heart with each beat. Blood carries oxygen to every cell in our bodies. The cells cannot live without oxygen. Blood flow to the brain allows us to function. If the blood supply to the brain ceases, we dies within minutes. I could go on ...”

She says that the composition of the blood varies depending how our bodily systems are functioning. “That's why blood testing is a basic tool ... to get a cursory overall check of bodily function.” From hundreds of blood tests, physicians order only those they need to monitor and diagnose, according to Marion. “Blood testing is a great general screening tool. The doctor may order more specific tests based on the general screeding tests or stated patient symptoms.”

Pumped by the heart, constantly flowing through our veins and capillaries dispensing oxygen and nutrients, our blood visits every organ and crevice. When things are as they are supposed to be, blood is happy and goes dutifully and uneventfully about its vital work. But when anything is different or out of the ordinary, it notices – and reacts.

A few cells acting strangely? An invader from the outside? White blood cells converge, sounding the alarm. In the blood test, a high white cell count can be a sign of infection. On the other hand, a low white count can signal bone marrow disease or an enlarged spleeen.

The average adult has a gallon of blood, but the phlebotomist draws out no more than a teaspoon. We don't even miss it and, in fact, our bodies replace this teaspoon of blood in about an hour. But at the lab, this small amount of blood is enough to describe the state of our health in remarkable detail. Which is probably why many millions of blood tests are performed each year in the U.S.

Red blood cell count low? It could be an indication of anemia. C Reactive Protein high? CRP is a marker for inflammation and a widely used predictor of vascular disease, heart attack, and stroke. Blood sugar, or glucose, up? This could be a precursor to diabetes, or Impaired Fasting Glucose (IFG). Or, if the count is higher, it could be diabetes itself.

Cholesterol, a fat-like substance, building up in the blood? It is generally considered a major risk factor for heart and blood vessel disease. As blood cholesterol increases, so does the possibility of plaque build-up leading to “hardening of the arteries” or atherosclerosis. Plugged arteries feeding the heart can cause a heart attack. Plugged arteries leading to the brain can cause a stroke. The blood test shows the extent of the cholesterol build-up.

That's why the cholesterol count is such an important part of just about every general “check-up” blood test. I was certainly wondering what my cholesterol count was after a year of taking a statin to control it. Six months after taking the statin, Simvastatin, which is the generic form of Zokor, my cholesterol count was down to well within “normal” levels. I and my VA primary care provider were all smiles.

My blood test has many more specific counts, four single-spaced pages of them, all of them telling me something, all of them important. It is almost impossible for the average person, in which I include myself, to make sense of them. The story is embedded in abbreviations for big, undecipherable medical terms. Normal ranges are given so we can jump out of our skins with fear when a count is above or below “normal.”

However, what is normal constantly changes. New guidelines for cholesterol, for example, come out regularly – setting the desired count at lower and lower levels. And what is normal for me may not be normal for you and vice versa. Sometimes blood tests identify abnormalities that are not really abnormal, leading to a fixing of things that don't need fixing. There are false positives and false negatives. Results vary from lab to lab.

I am me and you are you and, as much as a blood test can tell us, it cannot account for all of our often significant differences. It cannot say with certainty what is normal for each of us, only what appears to be normal over a large population. Yet we all owe it to ourselves to listen and take seriously what our blood is telling us. It certainly is potentially life-saving feedback.

I found an ingenious web site that was a great help in deciphering a blood test. It shows a typical blood test and all the things it tests for. Click on any specific abbreviation, such as “GLU” and a box pops up with a good explanation in plain English. I found the site very helpful in understanding my blood test.

But the site is no substitute for sitting down with a medical professional. Here is an informative video about one woman, who had previously had a stroke, sitting down with her doctor and going over her blood test results.

With blood test results in hand, I went to my appointment with my VA primary care provider. She had ordered my annual blood test and already had the results in her computer along with the rest of my medical history.

“Hey, how come you cancelled twice?” I asked as I walked through the door. “You don't love me any more?”

“I was sick,” she said, looking at the computer screen where my file was already up

“Oh.”

Respecting “professional distance,” I stifled an urge to ask about her sickness.

“So what do you think?” I asked.

Her attention fixed on the screen, she said, “I think that, all things considered – the TIA(Transient Ischemic Attack or “mini” stroke) you had in Seattle, diabetes in your family, the fact that you have Impaired Fasting Glucose, you are doing very well. At 117, your glucose is a little high. It should be under 100. Your complete blood count and urinalysis are perfectly normal. Liver function tests are perfect.
Your PSA is 2.10, perfect.”

“Cholesterol?”

“Well, your HDL or good cholesterol is 51, which is quite good. But your LDL is 123 which should be lower.”

“But it's better than it used to be, right?”

“Yes, definitely.”

She motioned for me to look at the screen. It showed a graph of my cholesterol over the past ten years, ever since I had been going to the Worcester, Mass. VA. That's one of the many things great about the VA, it's technology.

“Look what your cholesterol was in 1997,” she said, pointing to the bar for that year, which stood out like a skyscraper compared to the other bars. “You were a heart attack waiting to happen. Now it's down here,” she said pointing to a recent bar, “but it still should be lower according to new standards. So I'm going to recommend that we increase your statin from 40mg. daily to 80 mg.”

“Doubling it?”

“Yes.”

Seeing the none too happy look on my face, she said, “I know you have a problem with statins – I read your blog about it -- but I have to do what I think is best for you based on all the information that I have and to do everything I can not to harm you. But it's not easy.”

“Of course. I understand completely. Those graphs are amazing.”

“Yes, they are. The whole history is there.” She clicked the mouse and another bar graph popped up. “This is your blood pressure history. Your latest is 116 over 60, the lowest it has ever been.”

“Tennis,” I said. “Singles tennis, in my unprofessional opinion.”

She smiled and then reminded me that last year's colonoscopy had been “cloudy” in places. Three polyps had been found and excised. The doctor who performed the colonoscopy had recommended that it be redone in a year just to be sure there were no other growths. I agreed to make the appointment with the outside doctor.

With a stethoscope, she had me take deep breaths. She felt the sides of my neck for blood flow to the brain. “Good, very good,” she said. That was it. Fast, about 20 minutes. High tech. Efficient. Thorough, with my entire health history referenced at a tap of the computer.

She entered the latest datum, her new statin prescription. She gave me a sheet for an appointment in six months, and sent me on my way. Within a week, a new bottle of 80 mg statin tablets arrived in the mail from the VA. I have been doing a lot of staring at the bottle.

So far, I have not taken the doubled dose.

I also asked Marion to review my blood test and tell me what my blood is telling her about the state of my health. Here, in her professional opinion, is what my blood is telling her about this 70-year-old caucasian male, who is also her older brother:

“Your body isn't fighting any significant infection because your white blood count is not elevated. You have good blood volume with adequate red blood cells and hemoglobin. You have normal range of platelets so you are not in danger of of bleeding because your platelets help to clot blood – eg. If you cut yourself. Your liver function is normal. You are not at risk for cardiac disease based on your cholesterol results, including HDL and LDL. Results show normal kidney function. Your blood sugar is borderline high for a fasting blood sugar. With your family history of diabetes – ie.mother and sister both diabetic – this requires monitoring. You may want to consider watching your CHO's. You are not overweight and certainly get enough exercise, so the only option is to watch CHO's and see if it changes. Overall, I think you should be really pleased with the story your blood told. I see no signs of any major disease.”

I'll take it. I'll take it. Thank you Marion!

On the issue of doubling my statin dose, I cannot shake reservations about doing so. My cholesterol is only marginally high by new, stricter guidelines. I do not have heart disease. Aside from cholesterol, I have no other risk factors for a heart attack except that three years ago I did have a TIA while out walking in Seattle. This could have been a “mini-stroke” which, if it was, could be a precursor to a bigger one.

Though I have experienced no side effects, no muscle pain or kidney problems – and my cholesterol count is down since going on a statin– I find it hard to entirely discount responsible criticism of statin use.

In his newsletter, drmcdougall.com, John McDougall, MD, one of many such critics of statin use, wrote:

“During my forty years of medical practice, I have never seen anyone die of high cholesterol (and neither has any other doctor). Cholesterol is a risk factor – this means it is a sign that reflects: the richness of the person's diet, his or her ability to metabolize the rich foods, and most importantly, the overall health of the body. The cholesterol molecules, themselves, in the bloodstream are relatively non-toxic.

“If cholesterol, itself, were the problem, then their predictive value for heart attacks and strokes would be close to 100% -- high cholesterol would always mean sick arteries. However, I know many people with cholesterol levels over 300mg/dl, with perfectly clean arteries – and just the opposite, people with levels below 170 mg/dl who have suffered a major heart attack.

“Furthermore, when the arteries of patients taking statins are studied over time, regression of the underlyhing artery disease, atherosclerosis, occurs in only a minority of patients, even if cholesterol drops profoundly under the influence of powerful medications.

“The underlying truth is: there is a strong correlation between the richness of a person's diet (reflected by cholesterol and saturated fat content of the food choices) and the level of cholesterol found in that person's blood. The richer the diet, the higher the blood cholesterol. The association continues: the higher the choleterol in the diet and in the blood, the more likely disease will happen – such as heart attacks, strokes, and a variety of cancers. The real culprit is the rich diet; the elevated cholesterol is, more or less, a secondary finding.

“Because of the enthusiastic and dishonest promotion of these high-profit drugs, many patients actually believe they are “cured” of their health problems. As a result, they may see no more need to make beneficial diet and lifestyle changes, which in truth make a far greater difference than any medications.”

Dr. Nan Fuchs, who has a Ph.D in nutrition and writes the Womens Health Letter, writes that "all statins reduce your body's stores of coenzyme Q10, a nutrient essential to heart and brain health. In fact, if you're taking any statin you should be taking at least 100 mg of CoQ10 a day. Many doctors of integrative medicine believe that 200 mg or more a day is necessary to protect the heart and brain."

The experience of Martin Winn, 71, a retired machinist in Vancouver, B.C who reminds me of myself, reinforces my statin skepticism. With his cholesterol count inching up, his doctor put him on a statin as doctors do around the world. Statins are the best-selling drugs in history.

But it so happened that Winn's doctor, James M. Wright, was also a professor at the University of British Columbia and a director of government-funded Therapeutic Initiative, whose purpose is to evaluate how well particular drugs work. Just as Winn went on a statin, Dr. Wright's team began analyzing numerous statin trials over the years.

Soon, Dr. Wright began not liking what he was finding. Yes, he found that the statins can be life-saving for patients who have already suffered heart attacks. But when he looked at the data for the majority of patients without heart disease, like Winn (and like me), he found no benefit in people over the age of 65, no matter how much their cholesterol declined and no benefit in women of any age. Statin takers did not live any longer than non statin-takers.

Dr. Wright changed his mind about statins and advised Martin Winn to stop taking them, which he did. “Most people are taking something with no change of benefit and a risk of harm,” Dr. Wright said.

Other studies have found that for healthy men over 70 without heart disease, there is little evidence, if any, that statins make a meaninglful difference in longevity. Dr. Mark H. Ebell, a professor at the University of Georgia and deputy editor of the journal American Family Physician, said, “High-risk groups have a lot to gain. But patients at low risk benefit very little if at all. We end up overtreating a lot of patients.”

A 2006 study in the Archives of Internal Medicine looked at seven trials of statin use in nearly 43,000 patients, mostly middle-aged men without heart disease. In that review, statins didn't lower mortality. Nor did they in a study called Prosper, published in The Lancet in 2002, which studied statin use in people 70 and older.

Joge Tsang, a competitive singles tennis player in his sixties, took matters into his own hands when his doctor urged him to go on a statin to get his cholesterol down. He felt that there had to be a better way -- and he found one. Today his total cholesterol is a low 176. Here he describes how he did it:

“ I take daily dosages: flax-seed oil pills, 2000 mg, 3000 fish oil capsules, also began eating more soy base products: tofu (twice a week) New addition: 1 red rice yeast pill w/ COQ-10, 2 vitamin C tablets.

“My typical diet consists of (Breakfast)Oatmeal, granola(home made) cranberries dried, fresh fruit, yogurt. Lunch: leftovers from nite before. Dinner: organic chicken, lots of greens, brown rice, mostly whole grain stuff. Fish twice a week. No dessert. No carbs such as potatoes, or processed foods. Very little cheese & eggs.”

This diet is working for Joge. But I have a sweet tooth. Do I want to give up my desserts with coffee (black) while watching the evening news? Do I want to give up the occasional chocolate-covered ice cream bar? I enjoy potatoes once in a while. Do I want to give up carbs? I love fish and have it a couple of times a week, but do I want to start taking fish oil capsules?

I don't know.

Thanks, Joge, for making me feel so damned guilty. Thanks for coming between me and my chocolate-covered ice cream bars. Congratulations (grudged) on your discipline and success, though.

I must also decide whether to take the doubled statin dose. My VA provider is superb and has my deepest respect. She takes wonderful care of me. She has my blood tests and my medical history. She has professional qualifications that I don't. In her considered professional opinion, I should take the higher dose.

I'm wondering whether I should take a statin at all. After all, it is my body and my life. The final decision, as unqualified as I am to make it, must be mine – as it must be for all of us. In this holiday season, however, my thoughts will not be of statins and my blood test and corruptible corpus. My thoughts will be of all that I have to be thankful for, such as a loving family and good health at age 70, and the many who are less fortunate.

So long and keep moving.

NOTE: My novel, State Kid: Hero of Literacy is now available on Amazon and for the Nook.

Billy Stone was a foster child.

He ran away from abuse.

He went to juvenile prison.

He went up from there.

And he did it his way.

With the power of the written word. 

Amazon E-Books by George Pollock


 "State Kid: Hero of Literacy" is fiction based on his  real-life experiences  growing up in foster homes; "Last Laughs," is the true story of how five foster kids (he and four younger siblings) found their way in life and each other. "Killers: Surprises in a Maximum Security Prison," is the story of his being locked up for 23 hours with killers in a maximum security prison;  "I, Cadaver" is about his postmortem adventures and mischief in the anatomy lab at UMass Medical School. “A Beautiful Story” demonstrates the art and process of creative writing as a 16-year-old boy goes all out to write a story that literally saves his life;  "A Long, Happy, Healthy Life,"  is about how to live the title every day; and "Unlove Story," Writing anonymously as "Elvis," a husband, dumped after 38 years of marriage, lets it all out on love, marriage, life, everything. A guy doing this? It's unheard of.
   For the Nook:

A Beautiful Story
A Long, Happy, Healthy Life
I, Cadaver
Killers
State Kid
Unlove Story


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At January 19, 2009 1:30 AM, Blogger harry said...

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