The Measure of Success
They say you can't manage what you can't measure. Measuring our health is an important skill.
I like tests. All kinds of tests. The challenge of being tested is exciting, bringing out my competitive nature. I’ve known the thrill of victory and the agony of defeat. The results are not always as satisfying as I hoped, but they always give me the satisfaction of knowing where I stand, and what I need to do.
Testing our health doesn’t always provide certainty of our diagnosis or our prognosis. We are complex creatures, and our tests are also complicated. At best, tests zero in on a specific problem and indicate a course of action to correct it. At least, they give us important clues, and can indicate a need for additional tests or professional support. Skills in testing are important tools for managing our health.
The simplest test is self awareness. In the movie Star Trek IV, the character Spock, a precise and analytical alien from the planet Vulcan, was being tested to determine his recovery from a bizarre incident. He was asked, “How do you feel?” and was unable to answer that imprecise question. We Earth people are more accustomed to imprecision, sometimes habitually so. Our feelings can tell us a lot. But imprecision creates the risk of misunderstanding. Is that pain in my arm a result of a hard workout, or a heart attack?
We need to understand something about our body to properly understand our observations. In Spock's case, he might use a “medical tricorder” to quickly scan himself and receive a complete analysis. We don’t have tricorders yet, so we use other tests. First, we need knowledge of possible causes of our symptoms so we can identify which tests we should use. Muscle or joint pain are possible in this case. A heart attack would be more urgent. Cancer, arthritis, snake bite? No visible punctures, so the greatest urgency would be the heart. A stethoscope can tell us whether the heart is operating correctly, or needs further tests. The next step might be an electrocardiogram to test the electrical performance. That might be used to decide whether a trip to the emergency room is in order, or just take a pill for the arm pain.
Doctors receive years of training to perform and evaluate tests. We can learn them, too. Doctors have access to state-of-the-art equipment to perform these tests. Technology has produced less sophisticated but perfectly adequate versions at low cost. Knowing what tests to use and how to interpret them requires the same knowledge that doctors use. That knowledge is freely available to all of us, without obtaining medical doctor training and certification, if we choose to expend a little effort in web searches. The difference between our skills as a successful patient, and the doctors’ years of intense training is that we can focus on specific conditions, while doctors need to know about many other conditions entirely unrelated to our complaint. We have the advantages of focus, and of first-hand awareness of our body. And we are more motivated for our success than anyone else in the world.
Our blood carries all the nutrients that every one of our 30 trillion cells needs to survive, and removes the waste products from their activities. The contents of our blood tells a great deal about how most of our systems are working.
We have a huge array of sophisticated blood tests available which can tell us a great deal about our health. They’re not all useful all the time, so knowing which tests are useful for which purposes is useful to focus our efforts. Doctors often use a few standardized sets of tests for routine monitoring. Physical exams at a regular interval, often done annually, include drawing a few vials of blood from a vein to test our chemistry and metabolism. These can be evaluated to spot emerging problems.
One good step is to look at your lab report and learn what each entry means for your health.
As I discussed in a recent article on magnesium, there are services available which allow us to obtain sophisticated lab tests without a doctor visit. requestatest.com is one that I have used. I love doctors, but the problem with doctors is their expense, to ourselves or our insurance, and that the insured medical industry is organized on specific (approvable) tests for specific (recognized) diagnoses. Sick care, not health care.
Those of us who want to more precisely monitor our health need to learn to identify, obtain, and interpret our own tests.
My purpose for this article is to address testing we can do ourselves. I routinely check my blood pressure and heart electrical performance. I have blood test equipment to monitor my blood glucose and ketones. I wear a watch that monitors my steps, pulse, and sleep quality. And I’ve learned to request lab tests my doctor hasn’t seen fit to order. These give me a quick look at whether I’m on track for my health goals.
A key consideration is that all tests, even high end lab and diagnostic tests, have some errors. If we send blood samples to two different labs, we’d likely get two different readings. How carefully do they calibrate and maintain their equipment? How careful is the staff? What’s the temperature? So, don’t get too excited about specific numbers. Even if they happen to be exact, they’ll be different in a few hours. Or minutes. Tests are evaluated in ranges to account for typical variations between individuals, as well as accounting for the inherent errors in all test equipment. Inexpensive retail test equipment may have greater variations than higher quality clinic equipment, though the available technology makes them very good.
I have been borderline diabetic for years, but always within the “normal“ range, so I never worried much about it. A year ago, I decided to change my diet from vegan to carnivore to deal with heart rhythm irregularities. My vegan diet had a lot of oxalates, a chemical which binds to my magnesium, leaving me deficient in magnesium, and causing electrical problems. These showed up as pulse arrhythmia, premature ventricular contractions, and occasional atrial fibrilation indications. My acupuncturist once diagnosed me with AFIB by holding my wrists. So I bought a home ECG device, a Kardia 6L, which also occasionally indicates AFIB. Visits to my cardiologist say I’m fine, so maybe it’s an occasional problem the doctors aren’t catching. But the indicators were stacking up so I began monitoring more carefully.
Eliminating oxalates with the shift to high protein diet resolved my arrhythmia problems. My Kardia consistently reports Normal.
I was especially curious about how shifting from a high carb diet to a high protein diet would affect blood sugar, so I began frequent blood glucose tests at home, using a 15 year old FreeStyle tester. Results were fairly dramatic, dropping from 70s to low 50s. That was said to be dangerous, but I felt fine, so I proceeded. Then the glucose steadily rose over several months, back to the 70s. I determined this is a normal reaction, a result of glucogenesis in my liver.
We need energy to survive, and our metabolism evolved to allow us to survive on protein or carbohydrate, depending on what is available. Ketones are an alternate energy source for the cells, produced in the absence of glucose. If you’re on a ketogenic diet, you should check ketone levels. My ketones rose so I was evidently creating energy from ketones, but apparently my cells still wanted glucose, so the liver constructs it from protein. I’m still eating a few carbs, about 30, mostly from a daily avocado from a tree in my yard that has a bumper crop right now. I’ll try to wean myself completely when that tree is cleared to see what no-carbs does to me.
Perfect accuracy is not necessary for these monitoring checks
Along the way, I noticed the test strips were expired (in 2012!) I ordered new ones and began getting readings about 10 points higher. So I bought a second device, a different brand (CareTouch), to validate the FreeStyle. It read 10 points higher than the FreeStyle! So I bought a third device (ReliOn) to break the tie, dirt cheap at Walmart, and found it was within a point or two of the second one. So I decided the old FreeStyle must have exceeded its life expectancy and now I stick with one of the new ones.
Calibrating our equipment occasionally helps to reassure us our data is reliable.
As President Reagan said, trust but verify. Fortunately, the difference of 70 or 90 for glucose readings isn’t important, they’re both “normal.” My lab likes 70-99. If I am close to the standard thresholds, I seek better advice. It’s usually sufficient for my purposes to track the trend. If it changes, I’ll investigate. I’m still curious why my liver still wants glucose with almost no carbs, but that sort of mystery motivates me to keep investigating, and keep learning. Several doctors I consulted didn’t have good answers either.
I have also calibrated my blood pressure testers the same way. Blood pressure varies widely, throughout the day and from moment to moment, so accuracy is harder to determine. I do have two testers, which I use to validate each other, and have found them to be fairly close.
I use a Kardia 6L which emulates a 6 lead clinic ECG machine. I have showed printouts to my cardiologists who are sad that I’m competing with them, but grudgingly agreed its a useful check.
I wear a FitBit Sense watch. It tells time, of course, and counts steps, which is why my physiologist ordered me to get it. He was a former Green Beret with a PhD and had high expectations for me. And he wanted to be sure I followed his orders. It also has several sensors including pulse, blood oxygen, temperature, even an ECG. It even tells me to get up and move around at least once an hour. Useful for writers and other couch potatoes. It uses algorithms to recognize sleep phases, breathing, and identify sleep apnea. Not as good as a tricorder, but we’re getting closer. Sensors like these are even packaged in rings from companies like Oura, which I haven’t tried yet.
The management slogan that you can’t manage what you can’t measure might be better stated as you can’t manage WELL what you can’t measure. Some managers prefer to hire subordinates to measure things for them. This reflects the relationship most of us have with our doctors. Good managers understand their employees’ jobs and supervise them to assure desired results. That’s really what management is all about.
Our bodies provide a lot of status information for our consideration. Some is perceptual, exhibited as sensations that we learn to interpret to gauge our health. Our systems emit electrical signals that can be read with ECG; kinetic information that can be read with a blood pressure cuff, stethoscope, or imaging with ultrasound or x-rays; and chemical signals that can be read with blood tests. Many of these signals can be read with simple and inexpensive retail equipment we can use at home. Understanding all of these tests is moderately complicated, but much easier than getting an MD degree. Learning to use these devices can provide convenient checks between doctor visits, and will make our discussions with them more productive.