Bloodwork: Four lab visits, the kindness of strangers, seeing everything and knowing nothing
I've always enjoyed getting blood drawn. First, tie on the tourniquet. Then a quick stick from the phlebotomist. Out pumps my lifeblood, ruby red and captured in tiny glass vials.
My first trip to the laboratory for blood work was three weeks ago. The appointment was set for 9:00 in the morning. It was my first day back from vacation and, since it was also the first day of school, I was running late. Of course.
Carrying a printed stack of orders from my doctor, I followed the phlebotomist into a tiny, windowless room. It smelled of disinfectant and settled myself into a slick brown armchair. She took the sheaf of papers, my drivers license and insurance and began pecking at the keyboard. Suddenly, I panicked.
Yanking the papers out of her hand, I ran my eyes down each line. Which of these did my insurance cover? Two of them were not covered, I was pretty sure. Aetna considered them "experimental". Was it hs-CRP and TNF alpha? Maybe. What about the ANA...that one had a line through it. Damn, why didn't I bring my laptop with me?
Apologizing profusely, I grabbed the orders and left. Considering the potential cost of these tests, accuracy was paramount. I drove home, hungry and suffering from not yet having had my morning coffee. Once there, I grabbed my laptop and drove back to the lab, once again signing in and waiting for a lab tech to call me back.
Insurance coverage verified, I again went into a tiny, windowless room that smelled of disinfectant and settled into a slick brown armchair to wait while the phlebotomist pecked at the keyboard. A baby screamed in the room next door and kept on screaming time and time again until, finally, it stopped. I thought about the mother and felt empathy for her. Lost in my thoughts of babies and food and English breakfast tea, I scarcely noticed when the clicking of the keyboard stopped and she swung around to ask me where I had gotten the orders. Ummm, from the doctor. I pointed at the front page and looked at her expectantly.
She gave me a smattering of reasons why I had to go somewhere else to get these tests done. They didn't have the correct kind of centrifuges. One test has to be performed at two separate times and they don't do that. The orders were electronically signed with an accession number and so they had to be done by Memorial Hermann, since my doctor is in that system. I got the impression that I was going to require too much effort on this Tuesday morning and she just wanted me to leave. To be honest, I felt the same way. This lab didn't appear organized enough to handle this battery of testing and when she asked me at one point to come look at the computer screen and tell her which test the doctor wanted me to take (there were several similar) I was none too impressed. So, I thanked her (for what, I don't know...just Southern politeness I suppose), grabbed my papers and my bag and headed to the closest brunch place to down coffee and food. By that point I had been fasting for 16 hours and was feeling a bit hangry.
Fast forward one week. I've spent a couple of days emailing with my doctor to request that she add some additional tests to the orders; based on discussions with my personal trainer we included estrogen and sex hormone binding globulin, or SHBG, so that with this one fell swoop of blood work I could kill two birds with one stone. Our trainer works with a lab and a physician to provide (primarily) hormonal testing with the goal of optimizing weight loss efforts in the gym; this typically costs a couple thousand dollars and so we have basically avoided it like the plague...but by including the tests they want me to take with the tests my doctor wants me to take, Voila! Covered by insurance.
For my third attempt at getting bloodwork, I decided to skip the low-cost Quest laboratory (see reasons above) and went straight to Memorial Hermann. They have recently built a standalone diagnostic center about three miles down the road from our house and so I went there, rather than trekking to the hospital main campus during morning rush hour. Remember, I have had no coffee or tea (headache) and have not eaten. Time is of the essence.
I signed in, grabbed a National Geographic and had literally just opened the cover when I heard my name called. Following the woman through an abbreviated maze of corridors, I once again arrived in a tiny, windowless room and plopped my posterior into a shiny, pleather armchair. All attempts at small chat fell flat and so I just sat, waiting, while she pulled up my name and the orders in her system. Since her computer was on the same system as my physician, she didn't have to do much legwork and within a couple of minutes she was printing out labels for my vials. And printing. And printing. Once printed, the labels stretched across the length of her desk and back. To me, it looked like a million.
We briefly chatted while she gathered collection vials; she left the room for a while and returned with a sheepish expression on her face: they didn't have enough blue vials to collect my samples at this location. I could either go to the main location near the hospital or wait while the main location sent some over with a courier. Panicked at the thought of no food and no coffee for at least another hour, I waffled back and forth unsure of which course would be quicker and least painful. In the end, I decided to go to the lab at the hospital based on my pronounced feelings of guilt-ridden entitlement that I felt at the thought of waiting around like a princess while an employee from the lab delivered supplies.
The plebotomist got on the phone and called the main lab and let them know I was coming with all my paperwork and labels ready to go and she sent me on my way with a wink and a smile. "Don't worry, my girl will take care of you. Just ask for Felicia."
Felicia did, indeed, take care of me. She was standing at the check-in desk when I arrived and she took me back immediately. I felt like a celebrity patient who was too important to wait with the common people and then again, a stab of guilt at my vainglorious thinking. There were sick people sitting in that waiting room. Shame on me.
She prepared all of the collection vials, labelling them and asking me to verify that my name was on each applied label and then it was time to rock and roll. After the tourniquet was on I squeezed my hand into a fist, plumping up my veins until the target was easy to see and to stick. She got it on the first try and I watched as vial after vial of blood was filled and carefully set aside, incredulous as always about the amazing maching that is my body and how damn fast that blood was pumping out. No thick sludge here, thank you very much!
Ten minutes and two cups of grape juice later, I was on my way to the closest coffee and breakfast spot I could find.
Within seven days, I had all test results back; they were available in the patient portal and I began combing through them while my husband and I were on a trip out in West Texas. There was so much to see!
First things first: I scanned through the results to see if there was anything flagged by the system as out of normal range (most lab values were accompanied by defined "normal" ranges). No significant markers of chronic inflammation were present. No concerning levels of heavy metals (except for arsenic, which my husband immediately denied poisoning me with). My hormones and other trophic factors (things that make the cells in our bodies work properly) were, however, a little funny looking to me. I had super high levels of some vitamins and super low levels of some hormones.
Once we got back home, I started transferring the online test results into a spreadsheet (thanks Mom, for teaching me the value of spreadsheets at a young age) and then I really nerded out. Line by line, I checked all results against the normal values as defined in my patient portal and against the optimal values as defined by Dr. Bredesen. Read more about this in my earlier blog post.
Here is an overview of the values that looked out of whack in my body, at least to my untrained eye:
Low potassium. Low potassium can be a sign that the kidneys or the adrenal glands aren't working well. It can be caused by drinking too much alcohol or having a folate deficiency. Symptoms may include weakness, fatigue, muscle cramps or twitching, constipation and heart arrhythmia.
High Vitamin B6. Very high, according to the patient portal range and slightly high, according to the Bredesen range. This can be because I'm getting too much B6 in my diet or because my liver and kidneys are not sufficiently filtering it out of my blood. This could also be caused by a genetic mutation (MTHFR); unfortunately, my 23andme genetic reports do not include this one but the raw data is available for analysis if needed.
Low cholesterol to HDL ratio. Like way low. Cholesterol is made by the liver and insufficient cholesterol levels can cause mental health problems.
Low triglycerides. Extremely, alarmingly low. This could be caused by hyperthyroidism, a low-fat diet, malabsorbtion or medications. While there are no "direct" symptoms of low triglyceride levels (just like we don't know that we have high triglycerides until we get a blood test) symptoms typically expected in cases of malnutrition, malabsorbtion and hyperthyroidism may present.
Low folate. Folate is a B vitamin that helps your body make red blood cells. We get folate in our diet from leafy green vegetables. Low levels can be caused by not eating enough of these vegetables or could be due to a malabsorbtion disorder, genetics, medication side effects or drinking too much alcohol. Symptoms may include fatigue, lethargy, feeling faint, heart palpitations, tinnitus, numbness and tingling in the feet and hands and depression.
Low zinc. Zinc is required to produce testosterone, a necessary sex hormone even for us ladies. Deficiencies can be caused by insufficient dietary intake, inadequate absorbtion, increased loss or increased body system utilization. This one is odd because I actually take zinc supplements and consume significant amounts in my diet. Symptoms of low zinc may include impaired congnitive functioning and psychological disorders, among others.
High Copper: Zinc ratio. Not surprising since I have suboptimal levels of zinc and optimal levels of copper.
Low cortisol. Cortisol is a steroid hormone that is important for the immune system, regulating blood pressure, the cardiovascular system, metabolism, and more. Symptoms of low cortisol levels may include lethargy, depression, heart palpitations, inability to cope with stress, emotional hypersensitivity, and more. Most people worry about having too much cortisol, the "stress hormone" but apparently low cortisol is just as concerning.
High SHBG (sex hormone binding globulin). SHBG helps regulate the concentrations of some sex hormones in our bodies by transporting the free-floating hormones in our blood to the target tissues. Symptoms may include fatigue, weight gain, depression and anxiety and others related to having too much estrogen and too little testosterone in the body.
Low pregnenelone. Very low. Pregnenlone is a hormone that is synthesized from cholesterol; it is a precursor to the body's other naturally occuring hormones like estrogen, progesterone and testosterone. Symptoms of low pregnenlone may include poor memory, irritability, anxiety and fatigue, amother others.
Low RBC (red blood cell count). Also known as anemia, this can be cause by a variety of factors from leukemia to vitamin deficiency. Since I've always been borderline anemic, this one isn't surprising or alarming since I am right at the bottom of the normal value range.
High MCH (mean corpuscular hemoglobin). This refers to the average amount of hemoglobin found in the body's red blood cells; MCH may be elevated due to liver disease or even drinking alcohol regularly. Weirdly enough, if anemia were present, MCH should be low. Symptoms of high MCH levels include tiredness, fast heartbeat, brain fog, poor concentration, confusion and memory loss.
High RDW (red blood cell distribution width). This means the red blood cells are bigger than they are supposed to be; they are released into the bloodstream before they are fully mature. Elevated RDW may indicate a nutrient deficiency such as iron, folate or B12 or chronic liver disease and is associated with higher mortality rates in middle-aged people. Yay.
So much information! As I read more and try to connect the dots, I notice some patterns which are alternately comforting and alarming. I'm kicking myself for writing off symptoms small and large such as anxiety, fatigue, poor memory, heart palpatations, numbness in my fingers, ringing in my ear and bouts with depression as normal. I'd never even mention these at my annual physical because they seem petty and small and inconsequential. I would rather drink coffee, take my ADHD medications, exercise and meditate the symptoms away.
I know this is a lot of very personal information to share with the world but my goal is to help inspire each and every one of you to live life well and to approach aging with purpose. I may look and feel pretty good, but my body is telling me something's not right. I don't yet know what the root cause is but I am going to find out...and I'm going to fix it.
In my next blog post, I will tell you all about the feedback on my bloodwork from my a doctor, personal trainer and nutrition coach. The plan, as always, is to make lifestyle adjustments first (nutrition, exercise, alcohol consumption) and then consider pharmaceutical interventions. I can't wait to share this journey with you!