Friday, 12 March 2010

Doctors and their Good Intentions: The Blood Test Fiasco Continues

"I suggest you stop taking vitamin D."

Such was the well-intentioned advice of my consultant haematologist recently. He was concerned about my kidney function.

It all started when I turned up for my regular blood test about an hour after a savage workout in the gym. These tests are to monitor a condition called 'aplastic anaemia'. My view is that there is nothing wrong with me – but that’s another story.

On the day of the blood test, my haematologist was upbeat. For several years I've had very stable blood counts, albeit that they are at the 'lower end of normal'. Not low enough to require action, not high enough for me to be left alone. Hence, I’ve been on the blood test merry-go-round since about 2004.

This time I took a photo of the blood being taken:


Every 6 months, this is is the conversation:

"How are you feeling?"
"Fine"
"No symptoms?"
"No."
"Okay, see you in 6 months."

I have always been deeply suspicious of these 'normal' ranges, given the things 'normal' people do, diet and exercise-wise. Yet all kinds of changes have taken place in my life since 2004, not least turning Paleo and starting vitamin D supplementation. I have even deliberately eaten wheat to see whether that would change the numbers. Yet they have scarcely changed. Until now.

My suspicion is that some people simply have lower blood counts that others, yet function fine. I think low counts can be caused by many factors - and depending on the cause, health may or may not be affected.

This time, two of the key numbers had rocketed. The white cell count had gone from 3.0 to 7.7 and the neutrophil count from 1.3 to 6.7. The other numbers had not really changed.

As far as the consultant was concerned, this was great news. He even wondered whether they had mixed up my sample with someone else, before quickly waving the idea away with his hand in case I thought he was being serious.

Should I be pleased? I am not sure – forgive me if I don’t start arranging a party. After all, I feel just as healthy as I always have and, no, I do not have any symptoms. Whilst I accept it's possible to feel fine but not be well, one has to assume some significance from 6 unbroken years of feeling fine, during which the sum total of my illness has been two, short, mild colds.

If anything, I ought to worried. It will not be possible to untangle the multiple and no doubt interdependent factors behind my blood counts - but surely common sense should raise alarm bells when there are changes to a system that aint broke.

Have I pummelled my body into having normal counts by my too-frequent forays into a ‘normal’ lifestyle? A look at the flagged points and associated posts on my body composition graph are enough to give you an idea of what I’ve been up to since the start of 2009.

On the other hand, perhaps there really was a problem, and either the vitamin D, the Paleo diet or both have helped cure it – but it just took a year or more for the benefits to filter through to the blood counts.

We will never know.

Three days later, I got a call from my haematologist. He wanted to talk about creatinine. I had forgotten they were even testing my creatinine levels. The creatinine tests take a few days to come through, which was why he had not mentioned them on the day.

Creatinine is one of the by products of muscle activity. Since the kidneys are responsible for removing the creatinine from the blood, high levels are taken as a sign of poor kidney function. Of course it rather depends on how long the kidneys have had to do their job. If you’ve recently generated a lot of creatinine then even a fine pair of kidneys may not have got rid of it all when the test is done.

“I can probably clear this up straight away”, I told him.

Pleased with myself for having worked hard enough at the gym to affect a blood test, I recounted my activities with relish.

“Yes I suppose that could have had some effect”, he conceded.

I was also pleased with myself for knowing also that vitamin D toxicity can effect kidney function, so I mentioned my daily winter dose of 4000 IU, swelling even further with pride at my savvy decision to supplement.

This, on reflection, was a bad idea. First, because I was expecting a member of the medical profession to be impressed by my decision to supplement something which based on official guidelines, I do not need to. Second, because I was bringing into the discussion something about which I probably know more than he does.

Was I prepared to explain the research that had convinced me that the official healthy range is wrong? Would I try to convince him of the credentials of the organisation I get the test kit from? He’s a nice guy, but he’d have to be a lot nicer to let some upstart armchair pseudo-medic tell him what’s what.

When he had finished politely listening, he suggested the following:

1. Stop taking vitamin D
2. Avoid intense exercise for a few days before my next blood test
3. A visit to the kidney specialist

A week later, I found myself once again amongst the unwell, as I sat in the ultrasound department waiting to have my kidney function checked. I had mixed feelings about this. On the one hand, I applauded his caution and was glad to be the subject of such careful scrutiny. I can see why people develop Münchausen syndrome.

On the other hand, the evident poor health of the people who invariably surround me when I am waiting for these tests leaves me with an abiding sense of misplaced attention.

While the ultra scan doctor glided her device around my gel-lubed abdomen and I dutifully breathed in and out when bidden, I noticed the nurse at the end of the bed eying my Vibram Five Fingers curiously.

"What are they?!" she half asked, half laughed.

"Vibram Five Fingers," I said. They allow you to go barefoot without being barefoot."

She pondered this information, then appeared to come to a conclusion. "Very cool," she declared. End of conversation.

When the scan was over, the expected news was delivered. "Your kidneys are working fine."

Nevertheless, procedure dictates that I must pay a separate visit to the kidney specialist, with whom I will discuss this and the creatinine readings. By then it will be less than a month before my next regular blood test. The merry-go-round continues.

In case you were wondering, I will not stop taking vitamin D. I will, however, avoid intense exercise on the morning of the next blood test.

-------------

Meanwhile, elsewhere, the medical establishment was potentially threatening the vitamin D levels of someone else.

One of my relatives was recently prescribed drugs to treat high blood pressure. Not particularly high, you understand - but high enough, in the opinion of the doctor, to merit treatment.

A few weeks later, she noticed her asthma was a little worse than usual, but paid no attention. By chance, she later came across information on the Internet suggesting the drug she was taking could cause coughing symptoms.

Back at the doctor’s, she was told this is a common symptom of the drug she was taking, and she was duly put on different drug instead. Two things bugged me about this. First, that she was not warned about the potential side effect. Should thing like that be left up to the patient to notice? Second, what are the potential side-effects of the new drug? And could there be side effects that don't make themselves known so conspicuously?

So I did a little digging of my own. The new drug is what’s called a calcium blocker. This family of drugs acts by blocking the calcium channels, which apparently has a blood pressure-lowering effect. But guess what? It also affects the ability of the body to produce vitamin D. The fact that calcium blockers are said to have 'interactions' with vitamin D, means doctors may recommend against vitamin D supplementation for people taking them.

Ironically, my relative has reduced the vitamin D dose she takes based on the information I drew her attention to, not on the advice the doctor, who is not aware of the vitamin D.

I have not read enough about this to be sure - but instinctively I am not comfortable. If calcium blockers inhibit the body's production of vitamin D then presumably sunlight becomes a less potent source and so more, not less supplementation is needed in our sun-starved UK climate. If any readers have knowledge in this area, your thoughts would be appreciated.

I don’t wish to paint an unduly bleak picture, nor to denigrate the efforts or intentions of doctors. I know one or two personally and they are amongst the most genuinely caring people I know.

One of them sent me an article recently, featured on the front page of a prominent medical publication, covering the potential importance of vitamin D. So things are changing. I just hope they change quickly enough so that my relative and others I care about can avoid being sucked into the downward vortex of prescription drugs.

See Also:

My Yellow Skin Mystery
My Wheat Experiment
My Wheat Experiment Blood Test Update

[Blood Test Update in Post on Weight Loss]
My Vitamin D Defficiency
How I Got My Vitamin D into the Sweet Spot

15 comments:

Grok said...

Congrats!

With all that blood testing, you've probably managed to fill about half of some pharma exec's yacht fuel tank by now. Ha-ha :)

Methuselah said...

I hadn't thought about it that way. Since I am not taking any meds I had assumed the pharmas were not getting anything out of it... but of course they supply the needles, vials, swabs etc. Oh well - at least these are the things which are not ethically dubious!

Grok said...

Of course you know I'm just giving you crap.

You're healthier than 100% of the people I see every day.

Methuselah said...

:-) Most of the time anyway!

Drs. Cynthia and David said...

The high creatinine result was predictable. I worked in a cancer biology lab for a year once, and we would occasionally give a vial of blood for harvesting white blood cells. The researchers there would joke that I should go run first before donating so I would have higher counts- they speculated it had something to do with stirring up the blood. Anyway, it will be interesting to see if your white counts are higher when you haven't exercised beforehand.

I did see a report talking about plasma volume expansion due to training, and that this results in a "dilutional pseudoanemia" that is not a pathological state. The lower blood cell counts actually provide lower viscosity that helps with perfusion and performance (one of the reasons why dehydration hampers performance -the blood gets thicker - and why blood doping can be problematic).

It is sad that physicians know so little about the affects of diet and exercise on the physiology and health of their patients.

Just out of curiousity- how much does all this testing cost you?

Cynthia

Methuselah said...

Cynthia - that's fascinating. So are you saying that my high results this time could be exercise-related? Or that previous lows were due to my fairly consistent exercise regime?

The tests cost me nothing thanks to the UK's national health service. As it happens I have private medical insurance as a benefit from work but have never called upon it because the tests started before I joined my company. In practice, private medical merely speeds up the process and since I am already in the process there's no benefit to switching to private. It's because I am using national resources that I feel guilty about taking up space. I suppose I ought to switch to private out of principle.

Isaac said...

Protein Power Life Plan talks about calcium channel blockers in the Magnesium Miracle chapter. "Magnesium is nature's calcium blocker, acting as a natural retardant to the flow of calcium ions into the cells." Has your relative tried magnesium supplementation? If it worked to lower her BP, that would resolve the Vitamin D/BP med conundrum.

Dexter said...

High Neutrophils is probably a good thing. See this
http://vonpurdy-cancerpage.typepad.com/weblog/2008/01/intriguing-canc.html
regarding Vit D and Neutrophils.

Drs. Cynthia and David said...

I'm just suggesting it's possible that your hydration and training status may have an affect. You would be in a better position to judge your condition prior to giving blood each time. Here is the article I referred to:
http://www.ncbi.nlm.nih.gov/pubmed/10688281

I'd love to read the full text,but it's a pay-for read.

Here's another: http://www.ncbi.nlm.nih.gov/pubmed/9610226

Sometimes I suspect my weight fluctuations are partially due to this phenomenon (changes in training).

Also, I was going to mention, Drs may not warn patients of side effects because of the placebo effect- if they suggest the possibility, certain patients will experience it by suggestion, so the Dr won't know if it was a real side effect.

Cynthia

Asclepius said...

Reactive medicine at its best. This is a good example of treating numbers, not patients.

Anonymous said...

I recently had 2 blood tests 3 weeks apart at different clinics. The first showed me having "medium risk" due to high ldl and also that I was aneamic. The second was done due to the aneamic ersult and showed that I was no where near aneamic. Iron and b12 were normal but this one showed I had low folic acid .

aurelia.donka said...

I don't understand why you continue to comply with the blood monitoring. If you don't think anything is wrong and you feel guilty using scarce resources then why monitor this?

Methuselah said...

Isaac - thanks for the tip on Mg supplementation - my relative in fact has a copy of PPLP and is re-reading the chapter as you suggested.

Dexter - thanks for the link. Interesting article. Not sure whether we can conclude from the success of the infusion therapy that higher or lower baseline levels affect resistance to cancer. I will re-read when I have digested.

Cynthia - thanks for the links. It's a good point about side effects and the placebo effect. I suppose doctors can't win in that regard.

Aurelia - that's a fair question; and I guess there are three answers.

1) Because deep down I am a conformist and do as I am told - they tell me to come back in 6 months, so I do.

2) Because in spite of the flaws I talk about in the medical profession, I would be the first to concede that overall, they know a lot and I know very little. In case it turns out that I'm wrong there is a serious problem, I'd rather be in their hands than no hands at all

3) Because I am fascinated by how the whole thing is playing out, and I suspect that my consultant is quite interested too.

Michael said...

Its funny about doctors...at least to me. I have a team of doctors now. (Check my small blog Free The Wolf). I am feeling really good now. My blood tests two years ago were horrible. Now, my blood tests are better than a few years ago, but still not good. But..I usually feel great. Great that is until I go to my next doctors appointment. Then the ask all sorts of questions, ask if I am tired, achy, look at me like I have three heads when I discuss Paleo. Then, (it must be the power of suggestion) I start thinking of all the aches and pains I have which up until the time they ask, I don't give much attention to. Actually, I think everyone seems to have aches and pains...especially at 51 years old. And doctors......some would have me on three kinds of medication, and follow a completely different diet. I wonder why, because what I am doing is making me feel really great! Great that is until I see the doctor again. I just found your blog and really enjoy it. Sorry to ramble on.

Methuselah said...

Hi Michael - nice to know I'm not the only one who feels fine when the doctors think I shouldn't. It's a difficult balance to strike - I dare not stop seeing them just in case they are partly right. It's sometimes difficult to remember how much doctors know when faced with their ignorance about diet. Stay healthy!

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