Valley View Hospital recently held its three health fairs (Coal Ridge High School, Glenwood and Carbondale), and Aspen Valley Hospital will be holding its health fairs in Aspen and mid-valley in June. This column answers the most common questions people have about their results.
CBC (complete blood count): If your white blood count (WBC) is high, we worry about infection, or if very high, leukemia. If it is on the low side, that’s a good thing and usually means you don’t have inflammation — unless it is under 3.5, in which case you should see your PCP because that could mean bone marrow suppression. Hematocrit and hemoglobin are your red blood count — if low you have anemia, which should be investigated. Higher than normal levels often mean low oxygen levels from lung disease or sleep apnea (your body compensates for low oxygen by making more red blood cells to carry oxygen to organs and tissues). The MCV refers to the size of your red blood cells — large size occurs in B12 deficiency and with alcohol abuse. Platelets are small cells that help with clotting due to trauma — high and low levels should be investigated.
Chemistry panel: In spite of normal levels listed on your report, heart attack prevention doctors, who are always looking for diabetes and pre-diabetes, feel that the fasting glucose (blood sugar) should be in the 70 and 80s — at most the low 90s. If yours is above 95 you should request a two-hour glucose tolerance test (normal is one hour less than 125 and two hour less than 120 — higher values mean insulin resistance/pre-diabetes). BUN for kidney function is often elevated on chemistry panels — it goes up with dehydration due to overnight fasting, and it probably shouldn’t be included in health fair labs. A more important indication of abnormal kidney function is the creatinine and GFR. If your creatinine is elevated and/or your GFR is less than 60, you have chronic kidney disease. ALT and AST are measures of liver health — if you’re overweight with even mild elevation one or both of these two tests, you most likely have fatty liver, although chronic hepatitis, tumors and alcohol abuse need to be ruled out. Bilirubin is another marker of liver health, although many normal people have mild elevation — which is not a concern if the other liver tests are normal. Alkaline phosphatase is another liver test — if elevated, further investigation is warranted. Elevated uric acid means greater likelihood of gout and kidney stones. If calcium level is low or high, a parathyroid problem is likely (small glands in the thyroid that regulate calcium metabolism).
Lipid panel: Guidelines say total cholesterol should be less than 200; HDL (good cholesterol) greater than 40 in a man or post-menopausal woman; greater than 50 in a pre-menopausal female; triglycerides less than 150. However, half of people who have heart attacks have normal lipids based on these guidelines. Heart attack-proof levels are total cholesterol less than 150, LDL in the 30s and 40s, and triglycerides less than 70. If triglycerides are greater than 150 and HDL low, insulin resistance/pre-diabetes is present.
A1C tells us what your average blood sugar levels have been over the preceding three months. Normal is less than 5.7, and 6.5 or greater indicates diabetes. A1C is most useful for monitoring people with diabetes, but not as good as the two-hour glucose tolerance test for diagnosis if diabetes.
TSH (thyroid stimulating hormone): This hormone is made by the pituitary gland in the base of the brain. If your thyroid gland isn’t producing enough thyroid hormone (which regulates your metabolism), the pituitary gland puts out more TSH, so high TSH means low thyroid. Low TSH correlates with an overactive thyroid. If the TSH is abnormal, see your PCP for further evaluation.
PSA (prostate specific antigen): If the level is greater than 4.0, or if there is an increase of 1.0 or more over a year, we worry about prostate cancer, although infection of the prostate can also cause elevation.
Retired physician Greg Feinsinger, M.D., is author of new book “Enjoy Optimal Health, 98 Health Tips From a Family Doctor,” available on Amazon and in local bookstores. Profits go towards an endowment to the University of Colorado School of Medicine to add prevention and nutrition to the curriculum. He is available for free consultations about heart attack prevention, diabetes reversal, nutrition, and other health issues. Call 379-5718 for an appointment. For questions about his column, email gfeinsinger@comcast.net.