Passing The Test
Enhanced diagnostic tools are allowing practitioners to properly and precisely diagnose individual treatment protocols for their patients.
Life is, without a doubt, absolutely miraculous in all its forms. The six-billion-plus individual Homo sapiens currently alive are physiologically, mentally and emotionally individualized— and when health issues arise, it makes sense that the tools available for practitioners allow for proper and precise individual diagnosis and treatment protocols.
This leads to a sobering reality, according to Laurie Barclay, MD, who wrote in her article, Infectious Disease Diagnosis: New Guideline on Lab Tests1, “Because laboratory testing underlies approximately 60 to 70 percent of diagnoses and treatment decisions, inappropriate or poorly performed tests may result in wrong diagnoses, unnecessary treatment and higher costs.”Innovation in diagnostic tools continues, allowing for much more precise understanding and discernment of what exactly may be awry in a patient’s body. And with the use of these technologies, the results are patients whose quality of life and overall health are restored—as well as lessening the risk of a wrong diagnosis and treatment protocol, a common fear of anyone who needs to figure out what is wrong with his/her health.
Adam Killpartrick, DC. CNS, Suncook Valley Chiropractic and Functional Medicine, Pittsfield, NH, a clinician who blends upper cervical chiropractic and cranial work with functional medicine, believes it is imperative to continue to research and work with the newer panels and tests that allow the clinician to reveal original causation of illness. He noted that the reason he relies heavily on more specific testing methods is because most diagnostic testing in mainstream medicine is geared toward identifying pathology and/or disease. And while being able to accurately and confidently identify a condition in a patient, these testing methods typically do not uncover the underlying cause for the dysfunction, he maintained.
“Ultimately, as a clinician I need to not only be able to identify but also develop a plan of action and lay out a treatment strategy for my patient,” Dr. Killpartrick said. “And while addressing symptoms is an important part of patient care I think it’s half the battle. The other half is addressing the underlying functional cause of the condition.”
For those patients who do not receive relief from chiropractic alone, he noted that the problem may be physiologic imbalance and dysfunction as the underlying causes. Dr. Killpartrick cited the following two case studies:
• One woman suffered from debilitating headaches for three days at a time, occurring every 21 days in a cyclical manner. This signified a hormone component to her flare-ups and she had been told by another physician it “was only her menopause kicking in.”After Dr. Killpartrick adjusted her atlas (top bone in the spine) the headaches subsided and the 21-day cycle was broken, however, her headaches would vary, signifying a structural component.Further, when she had a headache she reported that there was an accompanying temperature change and digestive upset, classic symptoms of thyroid dysfunction. Dr. Killpartrick then looked at the previous tests that were run on this patient and her TSH was normal. “This is where more advanced testing comes into play,” he asserted. “I ordered an expanded thyroid panel with a cytokine panel to assess whether there was a Th1/Th2 imbalance. Sure enough, this patient’s thyroid antibodies were off the charts, conversion of T4 to T3 was depressed, and there was Th1 dominance. Once these areas were addressed and the structural imbalance was corrected and maintained, her headaches were nearly eliminated.”
• Another male patient suffering from generalized fatigue and aggressive behavior toward co-workers and family members was assessed and found to have high cholesterol and slightly elevated glucose. In order to determine the underlying cause for the cholesterol, Dr. Killpartrick ran an expanded male hormone profile and found his dihydrotestosterone was elevated, which has been implicated in aggressive behavior.His test exhibited a significant imbalance between estrogen, progesterone and testosterone.These hormone imbalances were also drivers for the elevated cholesterol.”Without the hormone panel this patient’s specific clinical needs would be impossible to meet,” he said.
Testing Methods
Oregon-based ZRT Laboratory, founded by Dr. David Zava, is at the forefront of testing methods to expand the scope of endocrinological studies to previously unreachable subjects and study sites.According to the company website, “Simplified methods of sample collection also provide viable options for carrying out large-scale research and clinical studies.ZRT Laboratory has applied an innovative approach to medical research in a number of key areas including hormonal imbalances and quality of life; cardiovascular disease and breast cancer; vitamin D deficiency; reproductive endocrinology; botanical and herbal medicines; diabetes and osteoporosis.”
ZRT’s areas of special interest include breast cancer, endocrinology, diabetes, cardiovascular disease, insulin resistance and metabolic syndrome. Some of its latest research projects utilize its salive and dried blood spot testing biomarkers, and have tremendous opportunities for women’s health. Some examples:
1. PCOS Gymnema (with Ashley Hawyood, NCNM)—Study feasibility of natural treatment for PCOS, in particular, Gymnema Sylvestra and its effects on menstrual cycle regularity. Testing testosterone, LH, FSH, SHBG, glucose, insulin, HbA1c, estradiol, progesterone, cortisol.
2. The Relationship Between Hormones Across the Menstrual Cycle and Functions of Mood and Cognition (with Chisalbeth Guillermo, Psychology Department, UNLV) —Examine the relationship between Pg, DHEA, DHEAS, T, E2, E3 along with mood and cognition at different points during the female menstrual cycle.Also, to determine what role oral contraceptives have on the above mentioned hormones and on mood and cognition.
3. Breast Cancer Research Project (with Rebecca Glaser, MD, Alliance Cancer Center)—To study salivary hormone profiles in women newly diagnosed with breast cancer. Preliminary data: Distinct and unique steroid hormone profile seen in breast cancer patients associated with high estrogens, low progesterone, high testosterone, low DHEAS and high night cortisol.
A recently presented poster by Dr. Zava focused on convenience of collecting urine samples, saving the patient and the practitioner time. This paper describes ZRT Laboratory’s novel test in dried urine for iodine and creatinine. This test makes urine collection for iodine testing simple and convenient, unlike typical liquid urine collections over 24 hours.2
Utah-based Systemic Formulas is also on the same convenience track. The company has innovated an intestinal dysbiosis test that reveals the amount of hydrogen sulfide in the urine. This is a marker of elevated pathogenic bacteria in the intestines and a condition known as SIBO (small intestinal bacterial overgrowth). The test takes only three minutes to conduct. This means that it can easily provide real-time, immediate test results that the clinician can use for immediate remedial support.
Additionally, its Meta-Oxy test is a realtime urine test of lipid peroxidase in the urine. It’s inexpensive—$4 per test—and requires only a few minutes for real-time results. “Patients who have elevated test scores can then immediately address issues such as chronic cell membrane inflammation and free radical damaging cellular processes,” said Jack Tips, PhD, CCN, senior clinical advisor to Systemic Formulas.”It’s as simple as the patient collecting some urine and placing it in a vial before visiting with the doctor minutes later.”
Meanwhile, Parkway Clinical Laboratories in Pennsylvania specializes in comprehensive panels to help practitioners alight upon a more complex chronic condition diagnosis. Its comprehensive integrative diagnostic panels include: advanced cardiovascular, allergy screening, anemia, anti-aging, chronic fatigue, chronic inflammation, comprehensive hormone, comprehensive wellness, musculoskeletal, nutritional assessment, thyroid function and tick-borne/Lyme disease. According to the company’s website, “More than 100 million Americans suffer from complex chronic conditions that remain untreated and undiagnosed.” Ordering what you deem may be the right panels will not only help contain rising healthcare costs, but help you achieve better treatment outcomes for your patients.
The increasing precision and ease-of-use now afforded by the diagnostic technologies available to clinicians today provide other benefits for the practitioner and his/her patients. “In an age of expensive lab tests that take a long time to receive, it’s a tremendous blessing to clinicians to have in-office, immediate results via test that patients can easily afford,” Tips explained.“Further, many traditional lab tests are simply looking at effects and don’t investigate the individual’s actual body function or cause of symptom-expressions. Systemic Formulas, via Dr. Shayne Morris, investigate the core cellular metabolic processes associated with symptoms and seek out tests that reveal the deeper causes.”
For example, he offered, it is one thing to know that the immune system is engaging inflammatory responses, but it’s even more empowering to know if the cause is an altered intestinal microbiome that’s goading the immune system toward hyperexpression.”The motivation is the same as what motivates functional medicine clinicians— to know the causes of symptoms so that remedial programs genuinely help the body correct itself,” Tips stressed.
Dr. Killpartrick agreed. In his practice, typical symptoms range from generalized (fatigue, malaise, brain fog, just feeling off ), to more specific (thyroid symptoms, cardiovascular concerns, pain, autoimmune and inflammatory conditions). “And this idea that there is an underlying cause is beginning to gain ground among patients,” he said. “More than ever I’m hearing people ask me ‘Why is this happening?’ And that is something that functional and integrative practitioners have a responsibility to answer.
In his view, there are two aspects to advanced functional testing that need to be considered: Clinical and practical.When you whittle down the possible tests to the most appropriate for that individual patient and present that recommendation from a clinical perspective while maintaining the financial and logistical considerations, the level of appreciation and compliance on the part of the patient increases significantly.
“I think we currently have some really great diagnostic options available in clinical practice,” Dr. Killpatrick said. Whatever advances are developed and launched, he believes there will be a more widespread hyper-focus on two areas: ease of testing and customization of testing. “It appears that diagnostic companies are going to aim to make testing more accessible,” he continued.”There have been great advances in sample collection for food sensitivities wherein you can use blood from a finger prick as opposed to getting blood drawn.And there is an amazing omega 3:6 test that is performed from a finger prick. I’ve also begun looking at genetic testing that helps identify optimal foods and dietary recommendations based on DNA results.”
A market research report, Lab Industry Strategic Outlook: Market Trends & Analysis 2009, from Washington G-2 Reports indicates that the clinical diagnostic lab testing market will reach $98.4 billion in revenue by 2017. Key growth contributors include an increase in genetic testing, esoteric testing, consumer driven healthcare, aging demographics and expanded access to healthcare.
As research into disease and disease etiology continues, so too shall innovation of the specific testing tools and methodologies used to unmask what exactly is ailing your patients
References:
1 Laurie Barclay, MD, Infectious Disease Diagnosis: New Guideline on Lab Tests. July 15, 2013, www.medscape.com.
2 Zava TT, et al. “Iodine and creatinine testing in urine dried on filter paper.”Anal Chim Acta 2013;764:64-69.
Healthy Take Aways
More than 100 million Americans suffer from complex chronic conditions that remain untreated and undiagnosed.
Most diagnostic testing in mainstream medicine is geared toward identifying pathology and/or disease and do not typically uncover the underlying cause.
Innovation in diagnostic tools allows for more precise understanding and discernment of what may be wrong in the patient’s body.
FOR MORE INFORMATION
Dr. Adam Killpartrick, (603) 435-6600
Parkway Clinical Laboratories, (800) 327-2764, www.parkwayclinical.com
Systemic Formulas, (800) 445-4647, www.systemicformulasmedia.com
ZRT Laboratory, (866) 600-1636, www.zrtlab.com
