An important part of assessing your current state of health and healing progress is getting labs done on a regular basis. Labs serve as a very important tool for doctors to determine what is going on under the surface, beyond your physical symptoms. For some, there may be a lot of action going on at the cellular level, without making it’s way to the surface. Without getting frequent labs done, both you and your doctor have no way of knowing what is happening within your blood, organs, tissues, muscles and cells.
It is not just as simple as going to the doctor, getting labs done, checking that off your to-do list and moving on with your life. Our doctors are huge proponents of being proactive about your health and healing journey. What does that look like?
- Visiting your physician
- Getting labs done every 6-8 months
- Staying on top of new symptoms that crop up
- Keeping up to date with yearly exams (Well Women Exams, Men’s Health Exams, Mammograms etc.)
Here are three ways that your current doctor might be misdiagnosing “normal” lab values:
1) Statistics vs. Real Life
There are many variables that go into interpreting laboratory values as “normal” or “abnormal.” To determine what is normal, samples are obtained from a group of healthy individuals, usually adults, and divided between males and females.
A common measurement is called a 95% confidence interval. A 95% confidence interval covers 95% of the normal curve – ie. The probability of finding a value outside of this curve is less than 5%.
Another test is often used to calculate the mean (the average) and the standard deviation of the mean. One standard deviation above and below the mean includes 65% of the values and 2 standard deviations encompasses 95% of the values.
It is important to note that a “normal range” is set as a 95% confidence interval. The 5% falls outside the normal range, in the “abnormal range.” This is one of the challenges with using statistical methods to define a normal range, and must be kept top of mind by both the physician and patient when interpreting lab values.
Let’s use “height” as an example. Normal individuals can be just above or just below a normal range (or 95% confidence interval) and can still considered of “normal” height. This is commonly used with children as they are growing and attending their yearly check-ups.
Someone who is 1 inch taller than the 95% confidence interval is not necessarily a giant, while and someone who is 1 inch shorter is not necessarily a little person. In fact, by definition, 2.5% of normal individuals are usually below the 95% confidence limit and 2.5% are above.
The fact that 5% of otherwise normal, healthy individuals will fall outside the normal range is important when looking at laboratory results. As a physician, finding a value outside of the reference range does not automatically represent an abnormality. The clinical relevance of an abnormal laboratory finding must be based on the clinical history as well as the extent of deviation from the normal range.
All in all, as naturopathic physicians, we are trained to read and interpret values outside of the standard “normal lab ranges,” because we find that health (and disease) are more than just a number. A person can have a conventionally “normal” lab value and still represent symptoms of a disease, just as a person can have a conventionally “abnormal” lab value and might be within the 5% mentioned above.
2) Who is considered “normal”?
Another important issue is the group that was used to determine the normal range. This is crucial since the immune system undergoes substantial development during infancy and childhood. The range of test values that are normal in infancy will probably be quite different when the child is 5 or 20 years old.
As a result, all studies in children must be compared with ‘age-matched controls.’ If the laboratory reporting test results does not provide age specific information, it is important to consult with a specialist who knows the age-specific reference ranges. In an ideal situation, the laboratory doing the test should provide this, but if it’s unavailable, your physician should consult published, age-specific reference ranges. This means that what’s considered “normal” for one person or child, might not be comfortable and appropriate for your body.
3) Some docs diagnose a patient as “normal” without having ALL of the appropriate tests done first
In the case of hypothyroidism, many females are misdiagnosed as “normal” because their primary care doctors aren’t ordering the full thyroid panel, to include:
- Free T4
- Free T3
- Reverse T3
- Thyroid Peroxidase Antibodies (TPO)
- Thyroglobulin Antibodies (TGAB)
If TSH, Free T4 and Free T3 come back “normal,” but the physician fails to order TPO and TGAB labs, the doctor and patient are missing out on vital information that would seriously impact the health and diagnosis of the patient. This can be the case with a variety of different conditions in both men and women, not just hypothyroidism. When in doubt, ordering more labs is usually better than less, to ensure you and your doctor are not missing any vital indicators of a suppressed immune system.
As always, it’s important to take charge of your own health and stand up for yourself. Are there a few specific labs that you want to check, that your physician didn’t order, like Vitamin D or HBA1C? If so, ask you physician to add them to your lab order. Most will be wiling to add more, if you are insistent.
Remember: You are the only person living in your body, so it’s important to respect and honor how you are feeling and your intuition when it comes to your healing journey. The doctor and patient are working together, as a team, to provide care and relief, but in the end, the patient is the one living inside the body (and feeling the symptoms), so it’s important to be your own advocate.
If you are curious about recent labs or looking to get labs done to check in on a health concern, feel free to call our office and schedule a new patient appointment (or follow-up) with one of our doctors.