In office assessment and functional lab tests
The following is a basic outline for the initial intake and assessment of someone with a condition related to fatigue. This can apply to Chronic Fatigue Syndrome, fibromyalgia, or any other case of fatigue with unknown cause. It is possible for case history to lead to factors not in the summary. This is only intended as a basic outline, to be modified as needed - not a rigid protocol.
Subjective - Review of Symptoms
The following is a brief outline - much more can be covered in a visit - depending upon what direction the case points to.
- Energy level throughout the day. Any time feel better or worse?
- Sleep. Need to sleep/nap in the middle of the day? Insomnia? If so can't fall asleep insomnia or waking up in the middle of the night?
- Review of systems
- Digestive system: gas, bloating, pain, tenderness on palpation
- Immune system. Often get sick? Frequent use of antibiotics? Never get sick (can be a sign of depressed immune system)
- Musculoskeletal: any aches or pains? In joints? Muscles? tender point Vs trigger point
- Cardiovascular symptoms?
- G/U symptoms. UTI's infections?, kidney pain? Frequent urination?
- Women: PMS or other illness associated with reproductive system, or any symptoms with cycle (if not current, then past?)
- Respiratory system. Coughs, bronchitis, swollen lymph nodes?
- Nervous system
- Emotional stress - emotional trauma, losses, grief, anger, worry, fear?
- Lifestyle and diet. Any special diet? Any foods currently avoiding and why? Review diet for common allergens (wheat, dairy, corn, soy are at top of list - although more). Lifestyle - especially stress or long work hours? Stress at home? Healthy environment at home?
- Current medications or supplements
- Constitutional signs: Hot/Cold, stagnation, constriction, dampness. See page on herbal medicine for more information. This assessment is very important to determine what herbs are best for the individuals, as part of treating the person rather than the disease.
Past medical history
- Childhood illness or infections
- Dental work, infections?
- History of antibiotic use
- Reoccurring past infections - even if doesn't have it anymore (may be a sign that the body is not longer producing that symptoms, as the "disease" has moving deeper inside the body).
- Emotionally traumatic events
- Any past surgeries including tonsillectomy, appendectomy, gallbladder?
- Potential toxic exposures?
- Health history time line: Taking note of all symptoms past and present and charting it out in order to progression. Often people seem to have different diseases at different times, when in fact it's the same disease process that never goes away, but rather just presents as different symptoms. Symptoms may be very different, effecting various systems, so this may not be obvious at first
All blood work should be reviewed carefully. Official reference ranges are often very large and have more to do with establishing norms for official diagnosis categories, then determining overall health.
Very sick people may have "normal" blood work. However on closer inspection labs are often not in optimal range. For example, the official reference range for monocytes may go up to 13%, but optimally it should be less than 7%. Anything higher can indicate a chronic infection.
Typically the most relevant blood work includes:
- CBC and differential: White Blood Cell count (WBC) and differential may be very important, as infections (acute or hidden chronic ones) can be a major cause of fatigue
- Thyroid hormone: TSH, T3, T4, thyroid antibodies
- Anemia? Iron, TIBC, Ferritin in addition to CBC (RBC, hemoglobin, hematocrit)
- Blood sugar: glucose, HgA1c
Applied Kinesiology is a system which uses manual muscle tests to assess and treat underlining dysfunctions in the body. This technique - originally started by chiropractor George Goodheart in the 1960's has since spread around the world. There are many systems that use manual muscle testing which have branched off of Applied Kinesiology.
A simple way to understand how muscle testing works is to think of the brain as a computer.
This "computer" is constantly sending electrical signals - through the nervous system - to all 639 muscles in the body. Even you're not doing anything to move the muscle at the moment, this communication still goes on every second. The brain sends a signal to muscles, and the muscles then send a signal back to the brain.
When there is some stress going on, this signal can become overloaded and the muscle then goes weak on a manual muscle test. Since the brain is not just in communication with muscle, but organ systems - and those organs are in communication with muscles, a weakness in one area can effect the other.
In systems that use manual muscle testing - such as Applied Kinesiology, or Touch for Health - there are known associations between various muscle groups and organ systems.
For example, the anterior deltoid is associated with the gallbladder. Therefore if the anterior deltoid is weak, that may indicated a problem with the gallbladder.
Another way muscle testing can be used it to search for food allergies. If exposed to a substance that the body has lack of tolerance for, it can momentary cause a weakness in this communication between brain and muscles. A weakness then may be found on manual muscle test.
There are numerous techniques which have been developed using manual muscle testing. Some examples are:
- Uncover areas of weakness - such as organ systems which are struggling
- Challenge body to see what it needs to fix the problem
- Uncover possible allergies or substances body has lack of tolerance against
- Uncover emotional blocks: NET - neuroemotional technique - https://www.netmindbody.com
Dr. Marcus has been trained in numerous systems that use manual muscle testing. These are powerful tools which can be used to help people, when of course combined with a good intake, review of lab work, and other assessment techniques.
Disclaimer - muscle testing can not be used to diagnose a disease. For example a weak anterior deltoid muscle may indicated a weakness in the gallbladder. Based upon this, further muscle testing and symptoms gallstones may be suspected. However the specific diagnosis of gallstones (cholelithiasis) is made by ultrasound.
Numerous other in person techniques such as looking at finger nails, tongue analysis, pain on specific reflux points and visual assessment.
In term of working with someone in the natural health field, lab work can be roughly divided into two categories.
- Conventional lab work: tests that just about all MD's will run, and generally covered by insurance
- Functional lab tests. These are specialty tests that conventional MD's generally are not trained in. However, many more holistically minded MD's and other people in natural health often use.
Conventional Blood Tests
In conventional medicine lab are used to diagnose specific disease.
This is not the same as diagnosing the cause of a disease. For example, it can take years for an autoimmune disease to develop. During this time there may be some skewing on conventional labs. However everything will still technically be in the "reference range." There is no diagnosis until a threshold point is hit. All of a sudden the patient who was perfectly "healthy" the day before now has a "disease," and can be treated with drugs or surgery.
Labs tests and established reference ranges are designed only to determine threshold point in which a "disease" officially starts.
Prior to this there may be clues to poor health, even if the results are still in the "reference range." However, this will typically be ignored because things are not yet bad enough. Often established reference ranges are far to large, so labs which indicate a problem are called "normal."
For this reason, it's important to go over labs work (even if it's all "normal") for underlining functional problems.
- On a complete blood cell count - a MCH of 100 or more indicates macrocytic anemia. This is an problem of too many immature red blood cells cause by a deficiency of vitamin B12, or folate.
- However, functionally speaking, when MCV is over 90, it may be recommended to take B12 and folate. This is because the labs are at this point showing a problem with those two vitamins. However, this is not a diagnosis of "macrocytic anemia," as that by definition is not present until MCV is over 100.
Functional Lab Tests
"Functional labs" is a blanket term for numerous labs tests not generally run in conventional medicine, but often run by more "alternative" practitioners such as; naturopathic doctors, chiropractors, holistic MDs and other people in the field.
Functional lab tests are typically designed to find underlining causes of poor health, whereas conventional labs are better at diagnosing specific diseases.
There are many different types of functional lab tests. These include:
- Saliva hormone tests
- Stool tests (typically tests for many more markers, then conventional parasitology tests)
- Allergy tests
- Various lab tests for toxicity
Although at times functional labs may be useful, it's also important to carefully consider need. Extensive functional lab testing can be expensive, and is not necessarily going to show the real problem. If sufficient information can be gathered from history, a more functional review of prior lab work, and simple in office assessment, then there may not be a need to run lots of special functional lab tests.