Wednesday, December 16, 2015

Tests Pending for February 2016 Assessment

Seeing my new endocrinologist has led to a variety of tests and consultations to establish diagnoses that my previous doctors suspected and prescribed for without necessarily testing for. For example, my excellent Kaiser doctor suspected that I might have "fatty liver syndrome" (NASH) but didn't test specifically for it, or made his judgment on the more standard tests. He also suspected some "insulin resistance" and talked of my being "pre-diabetic".  But my A1c test was typically normal, so those diagnoses were put on the back burner after attaining and holding a good lipid profile.

Often heard, "Yes it would be nice to have additional tests results, but because they would not change your treatment regime, there is no need to do them." A follow-up heart scan was not indicated because it wouldn't tell us anything we don't already know - and are treating for. (In addition, it would introduce additional radiation, something I did not need after the IMRT treatments at RCOG in Georgia for my prostate cancer.) The VAP test is expensive, and the results would be interesting, but they would not affect what we are already doing for treatment.And so on. I've continued to take my medications, exercise, and eat reasonably well.

Yet ferritin levels continue to be high. A younger family member has had two strokes. A cousin died in her forties from atherosclerosis. My Dad had this disease as well and suffered at least one very bad stroke. So it is perhaps not surprising that my new endocrinologist is specifically testing for these assumed diagnoses.

I've consulted a second specialist for the NASH - "fatty liver syndrome." There are a set of labs which are grouped under this heading "NASH". I've taken the test and will get the results back when the specialists reports back to my endocrinologist.

In January, I'll take the "VAP" lipid profile (equivalent to the Berkeley Labs lipid panel), then meet with my new endocrinologist. The VAP panel will help diagnose the "small-LDL-trait" - where one's LDL is small and gritty rather than large and buoyant. It is perhaps the best predictor of stroke. The smaller and grittier, the greater is the likelihood of a stroke or some other heart incident.

In the meantime, I've started shifting to the foods recommended by the dietitian in my endocrinologist's office. I'm intrigued with the possibilities. The idea is not to eat less food, but to eat different food. The result should be weight loss, the last piece of the puzzle. I am enthusiastic because this has worked for me in China where I lose 5 pounds/month eating all I want. More about this in a separate posting.

I'm taking milk-thistle, a supplement which is supposed to detoxify my liver. We will see from the VAP and liver tests in late January where this helps ferritin levels, or the slightly high/low scores of my liver enzymes.(See this earlier post.)  I'll have an ultrasound of my liver before Christmas to see whether there are any anomalies there. More about these tests later.

Nor have my kidneys escaped notice, though I haven't identified any tests specifically directed at them.

It is likely that the ferritin, NASH, insulin resistance, small-LDL-trait (and throw in Hyperlipoproteinemia Type IIb see this) are all part of the same syndrome that can be addressed by essentially the same medications, loss of 15 pounds, and a shift of diet.

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