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Can You Trust Your Lab Test?

lab test

Can You Trust Your Lab Test?

Do you expect your lab test to be reliable?  Is it your belief that the results are a vital tool for the diagnosis of medical problems. Do you think that the FDA regulates all lab tests? If so, you need to know about lab-developed tests, or LDTs.

LDTs are diagnostic tests that are designed, manufactured and used solely within a single laboratory. They are not distributed or sold to any other labs or healthcare facilities to perform on their own. LDTs are often developed because a commercial test is not currently available. Some examples are certain cholesterol tests and genetic tests looking for Alzheimer’s risk or Huntington’s disease.

LDTs are not subject to strict FDA regulations the way other lab tests are.  The FDA found that some of these tests failed to perform adequately, or worse, they caused harm. In an FDA report (November 2015), the FDA found, “We examined events involving 20 LDTs that illustrate, in the absence of compliance with FDA requirements, that these products may have caused or have caused actual harm to patients. In some cases, due to false-positive tests, patients were told they have conditions they do not really have, causing unnecessary distress and resulting in unneeded treatment. In other cases, the LDTs were prone to false-negative results, in which patients’ life-threatening diseases went undetected. As a result, patients failed to receive effective treatments.” These findings were sufficient to cause the FDA to consider regulation of LDTs.

In January 2017, the FDA put further regulation of LDTs on hold. They concluded, “Many stakeholders, in addition to FDA, have indicated that there is a public health need for greater oversight of LDTs…Extensive stakeholder feedback further confirmed the importance of balancing the unique qualities of LDTs, while still providing a reasonable assurance that such tests are analytically and clinically valid…”

 In short, the FDA found the need but LDTs are still largely unregulated. If your doctor orders an LDT, discuss the pros and cons of this.


Dancing in the Rain for Exercise

Dancing in the rain

When it is raining, play in the puddles

I live in northern California. After years of drought, no one dares to complain about the rain. However, it is interfering with my daily walks, which is my primary exercise. Fortunately, I also do Jazzercise, where a 30-day challenge is motivating me to lace up and drive through wind, rain, mud slides, and mild flooding. I’ll do anything for a free t-shirt.

Actually, the t-shirt is only part of the motivation. It feels good. I am also exercising for my heart, brain, liver, cancer prevention, diabetes prevention, and so on. The benefits of staying fit are endless.  In short, I move to feel good and to stay alive.

According to the Centers for Disease Control and Prevention (CDC), the minimum amount of daily exercise that adults need is:

  • 2 hours and 30 minutes of moderate-intensity aerobic activity (i.e., brisk walking) every week and muscle-strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms).


  • 1 hour and 15 minutes of vigorous-intensity aerobic activity (i.e., jogging or running) every week and muscle-strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms).


  • An equivalent mix of moderate- and vigorous-intensity aerobic activity and muscle-strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms).

If you want more health benefits, strive for:

  • 5 hours each week of moderate-intensity aerobic activity and strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms).


  • 2 hours and 30 minutes each week of vigrous-intensity aerobic activity and strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms).


  • An equivalent mix of moderate- and vigorous-intensity aerobic activity and muscle-strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms).

Be sensible. If you are new to exercise, check with your healthcare provider before starting a new fitness routine. Remember to drink water, apply sunscreen and avoid injuries. Pain is NOT gain. However, sore muscles may occur. Heat, cold packs, and stretching may be beneficial. Remember to consult a doctor for injuries and discuss a back-up fitness plan for common injuries. Avoid exercise when ill.

Start small. A physical fitness plan should be safe and fit your needs. A reasonable beginning regimen might be to walk a few minutes, stretch, and stop for the day. Always allow a day of rest between weight training workouts.

Set a goal. Gradually work up to a goal. If the long-term goal is to walk 30 minutes five days a week, then start with 5 minute walks 3 days a week until you can do this effortlessly. Do not overdo it as this may sabotage your chances of reaching your goal.

Find your passion. If you find something you enjoy, you are more likely to be successful at it. Fortunately, there are many types of activities from which to choose. Walking, hiking, swimming, dancing, bicycling and weightlifting are some common recreational activities. Yoga, Tai Chi, Pilates, gardening and playing with children are forms of exercise.

Develop an excuse-proof plan. Physical fitness is more likely to be successful if it is portable, and not dependent on the weather, and fits any budget. Put the radio on your favorite oldies station and dance to your heart’s content. Take a walk in a park, even if it is drizzling.  Jump in some puddles like you did when you were a kid.

Exercise can be fun. The benefits are unquestionable. I am living proof. It was hard at first, but now I can’t imagine my life without it.

hand washing

Your health is in your hands

It’s flu season in Grass Valley. People who had this year’s flu shot are getting sick. I am washing my hands as if my life depended on it. Despite a flu shot, I had the flu last year. It was horrible, and the reality is, that my life does depend on good hand washing.

The benefits of hand washing are well-documented. Done properly, hand washing reduces the transmission of microscopic pathogens (disease-producing particles, such as viruses and bacteria). This is particularly true for pathogens which may be passed by direct contact or by a fecal-oral route. Hand washing does not completely protect us from catching colds and some other viruses because cold viruses are airborne. Sneezing, coughing, and spitting will propel the virus into the air and if we are in harm’s way, then we are at risk. However, hand washing provides some protection, because there are many opportunities to come into contact with viruses. For instance, using the ATM key pad or shaking hands with someone who just coughed may put you in contact with a pathogen.

Hand washing is much like flossing our teeth; we know it is good for us, but many of us don’t practice it as diligently as we should—or at all. I can tell you how to do it, but I think the experts are better resources than I am. Let’s start with the Centers for Disease Control and Prevention (CDC). Want the simple graphics version? Here is what the World Health Organization (WHO) has to say on hand washing.

At the risk of sounding like the obsessive-compulsive private investigator on Monk, when I am around children I increase my hand washing, particularly if they are showing symptoms of an illness. I also wash my hands more when travelling, before putting in contact lens, after handling money, visiting people in hospitals, going to the doctor’s, or if I’ve done a lot of hand shaking.

One issue that bothers people about hand washing is that it dries out the skin. Keep hand cream near your sink so you can apply this immediately after washing your hands. A scent-free cream or lotion is more suitable for both men and women or those bothered by perfumes.

In these high-tech times, it is reassuring to know that we have power over our health. That power is in our own hands. Hand washing is cheap, simple and easy to practice—all we have to do is do it.

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health Information

Important Information That Everyone Needs

Lately we hear a lot about fake news and alternative facts. Leading news organizations bypass reporting the news and publish opinion pieces about what is truth and what is a lie. It can all get quite fuzzy.

I want reliable facts. The only thing I dislike more than phony news is when I accidentally pass along something false. It’s usually because I failed to verify the source. For instance, a chain email was sent to me recently about how much the president and other elected officials make. It was fraught with errors. I almost believed it, except I knew one of the figures was wrong. Turns out, much of it was incorrect.

Most of us are bombarded with information. From print, radio, TV and social media, we are inundated with more than ever before. According to a report from the University of California, San Diego, “How Much Information?” the average American consumed 3.6 zettabytes in 2008. They wrote, “One zettabyte is 1,000,000,000 trillion bytes, and total bytes consumed last year were the equivalent of the information in thick paperback novels stacked seven feet high over the entire United States, including Alaska.”

This data is already old. Can you imagine what it is for 2017? No wonder I don’t finish as many novels as I used to – there is no room in my head for one more byte. I’m probably consuming a gigazettabytes, which is something I made up. (Note: This is not a fact. It’s not an alternative fact. It’s disinformation; something we used to call a lie. )

Back to my point. (Yes, I have a point.) There is a lot of bad information out there. My Hep blog, “Hepatitis C in the News,” gives an example of this.  And because of this, here’s what I need to remember: Everyone, including me, is clamoring for your attention. Writers will write alluring titles and headlines, such as, “Important Information That Everyone Needs.” We will include meaningless images with our work, such as the one I used in this blog today. Journalists will take short cuts in order to make a deadline or a story fit the space limit. We are competing for your time, so we make short statements to grab your attention (something I am too long-winded to even attempt). And the facts can get lost.

Your health, my health, cannot fit into a byte of information. I need trustworthy experts to give me sound advice. If I hear something on the news, I check out the sources. If I am short on time, I ask the experts in my life.

And, I try never to repeat something that I haven’t verified.


Take with a Grain of Salt

Take with a grain of salt

Take with a grain of salt

Last year, I had a lot of medical problems. Nothing life-threatening, all of them treatable. I don’t want to write a litany of woes, but I will discuss one of my issues in this post – Meniere’s Disease. If you’ve never heard of it, and want to know more, look it up. Vertigo, loss of balance, and hearing loss are the common symptoms. Tinnitus is a constant companion.

I’ve had Meniere’s for years, and it’s been well-managed. My doctor told me to go on a low sodium diet, which I assumed meant 1500 mgs. a day, the limit set for anyone over 50, African Americans, and those with high blood pressure, diabetes or chronic kidney disease. I followed that for years, likely going overboard now and then, but not so much that it triggered another attack.

Then I spent a couple of weeks with my parents who run a witness protection program for hidden sodium. Everything comes out of a container. Food that one would think had no sodium, in fact had sodium – a lot of it. I came home barely able to walk because of intense vertigo.

Then I got a new doctor who told me I need to aim for 1000 mgs. a day of sodium. I was desperate enough to do this, but I needed a way to be accountable. So, I used a nutrition app and found out how much sodium I was eating. Plus I figured out that I had been fooling myself if I thought my previous diet was low sodium. I am just guessing, but I am pretty sure I ate more like a person who was under 50 (2300 mgs per day). I “got away with it” until I went to the great sodium haven at my parents.

Now I am back on track, and walking in straight lines. But something about this is bothering me, which is why I am talking about this: When I mention my sodium restriction to people, they all say, “I don’t eat salt.” Well, neither did I. But look at the label on capers, olives, salsa, hot sauce, catsup, mustard, pickles, canned beans, yogurt, cheese, salad dressing, milk, matzo balls, crackers, bread, soup, broth, soy sauce, seasoned vinegar, and so on, and you will find out what I found out – you are eating salt.

You can wait until you have high blood pressure or chronic kidney disease or any of the other sodium-related medical conditions. Or you can join me on the road to wellness. That’s a big reward for such a small sacrifice.


When Illness Is Invisible


Is your illness invisible?

Last week in Words that Wound, Words that Heal, I wrote about how we sometimes pay a compliment to people who are sick by remarking on how well they look, and it backfires. This week I want to talk more about the invisibility of illness, specifically on our tendency to conceal how we feel.

Susan Milstrey Wells, author of A Delicate Balance: Living Successfully with Chronic Illness, examines some of the complexities of living with a chronic illness.  She points out that society values beauty, strength, and productivity. When we can’t live up to those standards we may blame or shame ourselves.  When asked, “How are you?” Milstrey observes that we’ll often reply that we are fine—even if we aren’t.

We may have good reasons for not wanting to admit that we don’t feel well. It may be inappropriate in social or professional situations to be overly honest. President George H.W. Bush probably didn’t tell the Prime Minister of Japan that he wasn’t feeling well before vomiting on Miyazawa. We expect our president to be invincible; we don’t want to see him sick, and he is unlikely to admit as such.

Although we aren’t heads of state, we may not want our bosses, neighbors, or casual acquaintances to know that we aren’t in tiptop shape. We are vulnerable when we are ill and admitting we are sick makes us feel more vulnerable. Acting like we are fine is a way to exert control in a situation over which we feel powerless.

Milstrey believes that it takes courage to admit being unwell, but we don’t need to tell the world. She writes, “When we accept the fact that we’re sick, it’s less important that everyone else does, too.”

Admitting we are sick is one thing, but sick with an infectious disease is another. Some viruses, such as hepatitis C and HIV are stigmatized.  It’s best to think about it before disclosing one’s status. If you do disclose, start with trustworthy family and friends, and not someone who will announce it on Facebook.

I was comfortable telling people that I had hepatitis C, but when I went public with it there was no turning back. However, I rarely told people when I didn’t feel well, unless they were close to me. I don’t like the fuss that comes when people know I feel poorly. When I am under the weather and people ask me how I am, I say, “Hanging in there,” a response that Milstrey endorses.

If someone says you look great when you’ve admitted feeling awful, Milstrey says, “Looking good while feeling bad takes talent!” and she proposes simply saying thank you. If they express that you look far too good to be feeling sick, then Milstrey suggests, “Yes, it’s even hard for me to understand how I can feel so bad when I look so good.”