Advice on health check up menu

[ant]

Hi everyone,

I am having a general health check up in two days time and am wondering if anyone knows from previous experience with MC if there are any specific additional things from their standard list that I should ask them to cover? (I am 55 yr old male).

The hospital list says it covers the following:
Complete blood count.
Fasting blood sugar.
Lipid (fats) profile - Cholesterol, DHL and Triglyceride; Cholesterol / HDL ratio, LDL Cholesterol.
Gout - Uric acid.
Kidney function panel - Creatinine, BUN.
Liver function panel - SGOT (AST) and SGPT (ALT); Alkaline Phospatase (ALP); Total Bilirubin. Almumin, Globulin; Gamma GT (GGT).
Thyroid Panel - TSH and Free T4.
Hepatitis Screening - HBsAg and HBsAb, Anti-HCV.
Tumor Markers - CEA for GI Cancer; AFP for Liver Cancer; PSA for Prostate Cancer.
Urine Examination.
Stool Examination with Occult blood.
Electrocardiogram.
Exercise stress test.
Chest X ray.
Ultrasound whole abdomen.
Eye exam (Acuity and Tonometry).

I am also considering having an ultrasonic probe prostate exam and a DEXA scan (bone density test).

Please let me know if you have any comments. Since my insurance does not cover check-ups I do not want to inadvertently miss something while paying for these screening programs. Thanks , Ant

[JLH]

Sorry, I can't answer your question. I've been trying to get DH to get a DEXA test but it's just like the sleep apnea test, he's not interested.

He was going to make an appointment with a DO to get the SpectraCell test but she only wanted $1200 for it and the privilege of being her patient. She doesn't take MediCare. I may have written this previously. Hopefully, he'll go to the doctor who did my SpectraCell testing.

[tex]

Ant,

That appears to me to be pretty thorough. If you do too many tests, they're bound to find something wrong, (whether there's actually anything wrong or not. ).

Good luck,
Tex

[ant]

Thanks for your responses. I take the point that if you look too hard for something you might "find" it. I will try and keep that wise perspective in mind!

Best ant.

[Rosie]

Ant, I didn't see a Vitamin D3 blood level test on your list. It would be good to know, because even if you are taking extra, who knows how much you are actually absorbing with MC issues. And Vit D is so important to general health.......


Rosie

[ant]

Hi all,

I am posting this in case it sparks some thoughts or useful debate….

The check-up was last week and have had some, but not all, the results. I am waiting for the GP doctor’s full report. He had a knee operation last week so I am not pressing him (must be Polly’s twin!).

The good news is my heart stress test and PSA count were both good, but I have osteoporosis in the spine (just into the danger level – do not have the numbers yet). Wrists and hips in the safe zone - just.

My vitamin levels were low (referring mainly to vitamins C, B12, Folic Acid and D). My lymphocytes (as counted from the blood sample) were also a little low.

I saw an immunologist Doctor as part of the review, which was an interesting discussion…..

He took one look at the MC diagnoses;

there is diffuse intraepithelial infiltration by some lymphocytes in the surface epithelium. The subepithelial collagenous plate is not thickened. Lamina propria is slightly oedematous and congested with slight increase in mononuclear cell content. A few lymphoid follicles are seen. The crypt architecture is preserved and there is no goblet cell depletion. No cryptitis, giant cells, granulomas, specific infection or malignancy seen.

and agreed that gluten intolerance was likely “just like celiac because of the lymphocytes evidence”. He thought I was very sensible to cut out gluten, dairy and soy. (wow… maybe GI Docs need to speak to Immunologist Docs!). However, this immunologist poo pooed the Enterolab tests because it was not a blood test - which almost made me get up and leave

Once I had calmed down, I asked how come I had an over active lot of lymphocytes in my colon, but a deficiency in the blood sample. He said that perhaps they were being diverted to the gut. He said that my low lymphocytes generally make me more susceptible to malignancies. However, if I tried to boost the immune system with more vitamin D and C this could increase the overactive immune response in the gut – a difficult dilemma. The other explanation of low lymphocytes was the effect of Entocort, yet another part of the dilemma.

We then discussed TH1 and TH2 cells. He said that too much TH1 (too little TH2) was linked to intolerances, while too much TH2 (too little TH1) was linked to allergies. Symptoms would suggest I am in the former camp. However, it is not just a matter of me increasing TH2, since another T cell regulates the balance between the two. Looks like I need to get more of that T cell regulator, but at this point I think we hit the boundaries of what is really known…. Also, what happens for people with both allergies and intolerances?

Net: helping TH1 and TH2 return to balance was important, but researchers do not knows (yet) how to do this.

All the best, Ant


PS. My vitamin test details:

CoEnzyme Q10 = 0.67 – moderate (normal range 0.18 – 2.70)
a – Tocopherol (Vit E) = 21.1 – low (normal range 17.61 – 71.36)
y – Tocopheral = 0.74 – low (normal range 0.51 – 8.23)
Lycopene = 0.16 – low (normal range 0.11-1.37)
b-Carotene = 0.38 – low (normal range 0.12-3.78)
a–Cartotene = 0.03 – low (normal range 0.02-0.58)
Vitamin A (Retinol) = 2- excellent (normal range 1.06-3.09)
Ascorbate (vitamin C) = 17.63 – very low (normal range 19.25-130.25)
Vitamin B12 = 118 pg/ml – low (reference range 180-914)
Folic Acid = 2.2 ng/ml– low (reference range 3.6-20.0)

[tex]

Ant,

Well, I don't know if this could be considered to be useful debate, but here are my thoughts, for what they're worth:

It will be interesting to see what your GP says, because as far as I can tell, (from what you said), your immunologist missed the point. For a second there, when you said that he recognized the likelihood of gluten-sensitivity, I thought that you had found a doctor who had all his ducks in a row, but that image was quickly shattered, when I read his assessment of the relationship between your lymphocyte levels in your blood, and the epithelia of your colon.

Once I had calmed down, I asked how come I had an over active lot of lymphocytes in my colon, but a deficiency in the blood sample. He said that perhaps they were being diverted to the gut.

Well duh! Perhaps they are - what a revolutionary thought. Has it never occurred to him that they are diverted to the epithelia of the intestines, because that is were the reaction is taking place? Why should they be concentrated in the blood? The blood is only used to convey the T-cells to the thymus, where they mature, and then to the spleen and lymph nodes, (for storage), or to where they are needed, (in the gut, in this case). This is a continuous process, (to storage, at least), regardless of whether or not they are needed anywhere. Consequently, blood levels are not likely to be significantly elevated, (unless certain extraordinary conditions exist, such as leukemia).

Entocort EC works, by suppressing the immune system, so at first glance, that would appear to be the most likely reason why your lymphocyte blood levels were low. However, the doses of Entocort typically prescribed to treat IBDs, are not normally high enough to significantly suppress the immune system, according to Dr. Fine, (see the 4th post in this thread), except possibly with long-term use:

http://www.perskyfarms.com/phpBB2/viewt ... tool+tests

I doubt that you have been using it long enough for it to significantly suppress your immune system, but that's just a guess, obviously. With MC, sometimes lymphocytes are significantly elevated in the blood, and sometimes they are not. There is obviously a reason why T-cell presence should be elevated in the gut, though, and it's the same reason why antibody levels are much higher there, than in the blood - that's where the reaction is taking place.

I'm not familiar with vitamin C's effects on the immune system, and/or autoimmune issues, but while it's true that vitamin D3 strengthens the immune system, I'm not aware of any research that indicates that D3 leads to worsened autoimmune responses. In fact, the anecdotal evidence seems to point to the opposite effect - autoimmune problems appear to be significantly reduced, with increasing 25(OH)D blood levels.

OK, here's the bottom line, as I see it, (and this is the main point that the immunologist seems to have completely overlooked) - regardless of the fact that your fecal fat score was within the normal range, you obviously have a significant malabsorption problem, (that's pretty clear from your test scores). If you aren't already doing so, you need to start using a sublingual lozenge that combines B-12 and folic acid, (in the proper proportions). You should also be taking a good multivitamin. In the event that you are already doing this, then you obviously need to increase your dosages. What was your 25(OH)D level, (vitamin D)?

Some day, the immune system may be well-enough understood that we will be able to control disease simply by tweaking genes - (yep, the much maligned, and "much-feared-by-the-general-public", concept of gene manipulation). In view of the current level of understanding, though, that goal seems to be light years away.

Remember, this is just my opinion, and I'm not a you-know-what.

Tex

[ant]

Tex,

Thanks for your reply.

Consequently, blood levels are not likely to be significantly elevated, (unless certain extraordinary conditions exist, such as leukemia).

Interesting, I had thought that an inflammation anywhere in the body would normally increase the levels of lymphocytes being produced and this could be detected in the blood (on their way to the 'battlefield'), and that a normal or lower than normal level would suggest no inflammation (no battles). But obviously, that hypothesis does not fit with an inflamed gut and low levels of lymphocytes in the blood. As you say, lets see what the GP has to say.....

In fact, the anecdotal evidence seems to point to the opposite effect - autoimmune problems appear to be significantly reduced, with increasing 25(OH)D blood levels.

I seem to remember reading about correlations between autoimmune problems and low vitamin D (leading, of course, to osteoporosis and other problems). But, is it the autoimmune reaction that reduces the vitamin D, or the lack of vitamin D that causes the autoimmune problems? I.E, which is cause and which is effect? If lack of vitamin D causes (or helps to cause) autoimmune disorders then upping vitamin D should be the cure (or be part of the cure). But, if it is the effect of the autoimmune disease, then feeding the body more vitamin D could feed whatever is causing the immune system overreaction - i.e. make the immune system stronger to go on attacking the wrong "enemy". I am open to all thinking on this.....since I just want to get better. Are there any scientific answers to these questions?

you obviously have a significant malabsorption problem, (that's pretty clear from your test scores). If you aren't already doing so, you need to start using a sublingual lozenge that combines B-12 and folic acid, (in the proper proportions). You should also be taking a good multivitamin. In the event that you are already doing this, then you obviously need to increase your dosages. What was your 25(OH)D level, (vitamin D)?

Agree 100%. I stopped taking vitamin B and C pills about 6 months ago since I thought they might be one of the contributors to my symptoms. I have just gone shopping in Hong Kong and tried to find sublingual B-12 and folic acid in the chemists - but no luck yet. Just normal pills or "go to the doctor and get an injection" from the pharmacists. I do not know my vitamin D level yet - should get it in the GP report.

Tex, once again thanks for your experience and input on all this, albeit that you are not a "you-know-what". I wonder if architects claimed that ordinary mortals have no business talking about buildings in the same way that some in the medical profession try and protect themselves from a healthy public debate. (Actually, of course, some architects do and build socially inappropriate monstrosities - but that is for another forum ).

All the best, Ant

PS. I found the discussion on TH1 and TH2 interesting. Any views?

[tex]

Ant,

Your immunologist doesn't seem to be keeping up with current research. As I mentioned above, vitamin D definitely helps to reduce autoimmune problems.

http://ard.bmj.com/cgi/content/short/66/9/1137

From an MS, (Multiple Sclerosis), article:

Suppressing Autoimmune Reactions- Notably there are two nutrients which are effective in suppressing the immune system in the central nervous system. These are vitamin D and omega three essential fatty acids. Not surprisingly these nutrients are in very short supply in our society and persons with MS are very deficient in them. By greatly increasing their intake, persons with MS can help the body suppress autoimmune reactions.

I disagree with the claim that vitamin D and omega-3 fatty acids suppress the immune system. IMO, they only suppress autoimmune reactions, not the immune system in general. Anyway, that quote is from this link:

http://chetday.com/msnutrition.htm

On RA, (Rheumatoid Arthritis):

http://www.nutraingredients.com/Researc ... e-diseases

On autoimmune diabetes:

http://www3.interscience.wiley.com/jour ... 1&SRETRY=0

On the other hand, autoimmune reactions also adversely affect vitamin D utilization, which probably plays a large part in why autoimmune reactions are so effective at perpetuating themselves. For example:

Another food introduced into the human diet by agriculture is milk. Milk may also have an adverse effect on vitamin D by affecting the vitamin D receptor on cells. Part of the bovine albumin protein of milk is a molecular mimic of the vitamin D receptor. Thus an immune reaction against that milk protein can potentially result in an autoimmune reaction against the vitamin D receptor. This would significantly lower the effectiveness of vitamin D hormone to bind with a variety of cells (including immune cells) and carry out its important functions.

http://www.sunarc.org/embryms1.htm

That's a very excellent article, BTW, about vitamin D in general, even though it's primarily directed at the treatment of MS.

I'm afraid I don't know much about TH1 and TH2 balances. I do know, however, that all autoimmune issues are generally considered to be TH1 type responses, and that this relationship is probably much more complex than can be described by a simple TH1/TH2 concept. There's much more to it than that. If you want to look at it as a simple TH1/TH2 balance, though, then consider this:

Because a strong TH2 response is necessary in pregnancy, (to reduce the risk of miscarriage), we are typically born with TH2-biased immune responses. Early exposure to microbes and/or allergens, tends to change the balance, of course. It's also hypothesised that those who go on to develop full blown allergies, may be those who are born with a generally weaker TH1 response. That's probably why your immunologist suggested that you had a balance that was shifted too far in favor of TH1 responses.

Does this imply that we all have immune responses tilted too far in the TH1 direction. We all have both intolerances and allergies, don't we? I know that I do, with asthma early in life, which was later exchanged for hay fever, and skin sensitivities. IOW, I'm not totally convinced that the study of this TH1/TH2 balance thing, will ever lead to knowledge directly beneficial for people with MC, at least not in our lifetimes. As I mentioned above, I think that this issue is far too complex to be unraveled by our current state of scientific knowledge. I guess we'll see, but if anything ever does come out of this, it's probably still a long way down the pike.

If you want to read an interesting abstract about a research project on TH1 responses, read this:

http://www.ncbi.nlm.nih.gov/pubmed/15240661

That article suggests that cholera toxin, could stop autoimmune reactions.

Tex

[ant]

Dear Tex

Thank you for your enlightening response. and, as you indicated, the Sunarc document is especially good. Whether of not the TH1 and TH2 balance is finally understood, it seems clear that vitamin D should help calm down the over enthusiastic immune system (and, of course, help the osteoporosis). I am now waiting for the numbers on my 25(OH)D level with extreme interest.

If they are low I wonder if I could get a prescription for a life of sun, sand and grilled fish on the beach!!

All the best, Ant

[ant]

Update on my vitamin hunt...

I finally found Vitamin B-12 and Folic Acid sub-lingual lozenges in Hong Kong (at a specialty health shop not a mainstream pharmacy). They are made by Swanson. B-12 1 mg (% daily value 16,667%) USP (as cyanocobalamin). Folic Acid 400 mcg (% daily value 100%). No idea if these are the right amounts when taken sub-lingualy, nor what the % means.

The other ingredients are: Sorbitol, mannitol, microcrystalline cellulose (plant fiber), natural strawberry flavour, magnesium stearate, silica. I am hoping that I do not react to any of these. I know that Sorbitol is a problem for many on this board.....

Also found some Vitamin D-3 softgels, (made by Now Foods), but did not buy them when I saw the ingredients included soybean oil. So will keep looking.

Best, Ant

[tex]

Ant,

Yes, that's a good combination of B-12 and folic acid. The mannitol is also a sugar alcohol, (as is sorbitol). Those two ingredients are in there just to add sweetness, so that the lozenge is more palatable, of course. Maybe the amounts won't be enough to bother you. The one that I used to take also included sorbitol, and even though sorbitol in significant quantities bothered me, (still does, for that matter), I never noticed an adverse reaction to those lozenges, fortunately.

Tex