Optimizing your medical care: what you ask your doctor matters!
Navigating health and wellness in today's climate is super tricky.
Whenever I make an appointment with my doctor, I like to have a game plan: what concerns do I want to address? What labs do I want to request? What questions do I have for them?
Being proactive in your own healthcare is so important. Advocate for yourself if you feel like something is wrong inside of your body. Sometimes the first doctor we see might not be able to help, and you need to get a second opinion or seek out a specialist who can understand and target their guidance to your specific issue.
You are allowed to question your doctor and even seek out second opinions.
Whenever I meet a doctor I treat it like an interview. How do I feel about this person? Do they have my wellness and quality of life as a main consideration? Do they know when something is in their expertise and when to refer out?
You are the one living in your body and ultimately the one most invested in your health. No one will fight for you like you.
Our bodies can feel like a lot of work, but they are also SO worth the effort. After all, we only get one beautiful body in our lifetimes! It's up to us to care for it.
How should I prepare for my doctors appointment?
Look up your doctor - what is their area of expertise? You can also ask them directly what their typical clientele are? What experience do they have working with someone with your condition / illness(es)?
Get really specific with what you're seeking. If you're dealing with a health issue, pay close attention to the problem before you go in for your appointment so you can speak specifically to it. For example:
If you have pain - is it a sharp pain? a dull pain? Where in your body does it hurt? Is there a specific time of onset (throughout the day? week? stress induced? Related to sleep?)
If you have digestive issues - Is it in a specific part of your gut (i.e. upper? lower?)? Do you have specific symptoms to go with it (ex: diarrhea? constipation? heartburn?) Is there a particular time of day or week that the issue comes up?
Know your family history! If you have a chronic illness that runs in your family, it is never too early to start caring for your body. If you know your risks you can start getting screened early. Lifestyle and wellness tools like changing your diet can be a profound way to get proactive and care for your body before the onset of any problems.
What questions should I ask my doctor if they are recommending medication?
Why are they recommending this particular medication? Is there an alternative to medication? What are the side effects? How long do they expect you to be on it? Are there alternative modalities, nutritional therapies, vitamins or supplement regimens that you can seek before starting medication?
Note: I am an advocate for medication when it is needed, but many times doctors use it as their primary therapy when there may be equally effective natural modalities that you can try before starting pharmaceuticals. I think it's just important to know that there are alternative modalities to be aware of!
What blood work / labs should I request from my doctor?
This is by no means an exhaustive list of labs, however your doctor can run the following labs that can be particularly helpful when it comes to certain conditions and optimizing your health.
Most doctors will run a basic metabolic profile, which can provide some helpful information. For example, below you will find some markers that are routinely run, whereas other markers are helpful for specific individuals, conditions and scenarios.
Here are the most common tests I request and why you would ask your doctor to run them:
Hemoglobin A1C -Hemoglobin is the way your body transports oxygen to all your cells and tissues. Hemoglobin A1C is a marker for long term blood sugar control. If blood sugar is elevated over an extended period of time, it will begin to bind hemoglobin. This is especially helpful for those who are at high risk for metabolic syndrome, or either have or are at high risk of diabetes.
Vitamin D - In my opinion, Vitamin D should be on all routine blood work. Vitamin D is required for bone health, immunity, mood balance, and low levels have been associated with depression, osteoporosis, autoimmune conditions and more. Deficient vitamin D levels are below 30 ng/mL but optimal vitamin D levels are much higher at 60-80 ng/mL
Thyroid labs - most doctors will just run TSH levels, but it can be really helpful to also run TPO, Free T3, Free T4, Reverse T3. If your TSH is slightly elevated, these other markers can give a good sense of where to provide your body with additional support. If you suffer from fatigue, cold intolerance, constipation, hair loss, extreme stress, unexplained weight gain, mood swings, nervousness, anxiety and irritability - you may benefit from testing your thyroid.
Cholesterol Labs. VAP or NMR Profiles - these detailed cholesterol tests give a better idea of your overall cardiovascular risk than just cholesterol and triglycerides alone. Standard cholesterol tests run are normally total cholesterol, HDL-C, LDL-C and triglycerides.
HDL-C is the type of cholesterol that transports cholesterol away from your tissues and arteries and delivers it back to your liver (this is the "good" form of cholesterol)
LDL-C is the type of cholesterol that delivers cholesterol to your tissues and arteries and is generally considered "bad".
If you have high cholesterol levels, running a VAP or NMR profile can be helpful. These specialized tests look at cholesterol particle size that can determine your overall heart disease risk. For example, while LDL cholesterol is normally considered "bad", but it depends on the size of the individual particles. Those that are small and dense are more likely to get caught in the damaged arteries versus LDL particles that are big and fluffy. These tests can help differentiate the two.
You may discuss these specific tests if you are at high risk for heart disease, high cholesterol or have a family history.
Apoprotein A-1 and Apoprotein B are additional markers that can give more information about your specific arterial health risk.
Anemia markers.
Typical metabolic panels run by doctors usually include hemoglobin, hematocrit, MCV, MCH and MCHC - all which give some information to your anemia risk.
Serum iron can be helpful to assess iron deficiency, but it is only one helpful marker in assessing iron deficiency. If you are at risk for iron deficiency, your physician may run a ferritin along with "total iron binding capacity" (TIBC) to get a bigger picture of your body's overall iron status. There is virtually no iron floating around freely in your bloodstream, which is why it's helpful to run these other labs that can see how low your actual iron stores are. Individuals at particular risk for anemia include those with a heavy menstrual flow or increased risk of bleed (ex: hemophilia) along with vegans and those exhibiting chronic fatigue.
If MCV, MCH and MCHC are increased, you may be at increased risk for deficiencies of vitamin B9 (folate) and vitamin B12. If this is the case your practitioner may run a marker called "MMA" along with homocysteine, which differentiates between a folate or B12 deficiency. Anemia is not just a result of iron deficiency - many vitamins and minerals are involved in iron metabolism and utilization, including these two B complex vitamins. Vegans, individuals over the age of 50, those with digestive pain and those on stomach acid inhibitors have a particularly high risk for these types of anemia. In addition, those with neuropathy should always be screened for B12 deficiency.
B12 - Vitamin B12 is one of the most difficult vitamins to digest and absorb. As a result, it is one of the most common nutrient deficiencies, especially among the aging population. Low B12 can cause irreversible nerve damage and anemia. Those who are particularly higher risk for low B12 are vegans, individuals over 50 and those who have digestive issues
Overall inflammation status - CRP + Homocysteine are both markers of inflammation. This is helpful if you are at high risk of heart disease, autoimmune conditions or are experiencing increased pain and inflammation in your body.
Can integrative holistic modalities help me?
I have found so many allies and advocates in the integrative health world. While some of these methods of care can be pricey, some may be covered by your insurance plan, while you can pay with some services with your health spending account (HSA). Coverage usually depends on your individual plan.
Integrative medicine is the blend of different holistic modalities. Many folks believe that we either need to choose western medical care OR holistic modalities, but I have found so much value in using both. Western medical doctors save lives, but they don't always promote wellness, which is when I usually seek help and guidance from specialists.
Here are some that may provide you with value depending on what you are seeking:
Dietitian / Nutritionist - can help manage and even resolve certain health conditions through food and nutrition (for ex: digestive issues, high blood pressure, cholesterol, diabetes). A dietitian can also help you eat more intuitively and feel more empowered and confident around food. Nutrition is highly unregulated, so I recommend finding a RD, RDN, CCN or CNS.
Acupuncture - is a 3000 year old Traditional Chinese Medicine technique that is covered by some health insurance plans. Acupuncture promotes self healing process through the stimulation of acupuncture and acupressure points. Acupuncture can be especially helpful for headaches/migraines, pain, stress, blood pressure imbalances, among so many others.
Naturopathic medicine -uses natural remedies to help the body heal itself. Like functional medicine, the goal of naturopathic medicine is to treat the whole person.
Chiropractic care is helpful for structural imbalances that are causing pain. They rely on adjustments to help your spine into alignment.
Therapy - depending on the guidance you are seeking, you may look for a licensed therapist, family therapist and even a social worker. Those individuals may have particular experience with cognitive behavioral therapy or specific trauma therapies such as somatic experiencing work and EMDR therapy.
Other helpful modalities include:
Soft tissue massage
Lymphatic drainage
Myo-fascial release
You deserve the absolute BEST care possible. I truly hope this list helps.