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Posted: Mon Aug 1st, 2005 02:00 |
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Which diagnostic tests do I need?
Neither a specific diagnostic label or identification of specific pathogens is needed to begin the Marshall Protocol. The simplicity of the MP is that it can identify Th1 inflammation with simple blood tests and then act as a therapeutic probe to provide proof positive of occult microbes. As treatment continues, the presence of the immune system reactions confirms the continuing efficacy of treatment. And finally, symptom resolution, absence of immune system reactions and normal blood work indicate recovery.
"Absolute certainty in diagnosis is unattainable"
Kassirer's dictum: "Absolute certainty in diagnosis is unattainable, no matter how much information we gather, how many observations we make, or how many tests we perform.
Our task is not to attain certainty, but rather to reduce the level of diagnostic uncertainty enough to make optimal therapeutic decisions."
Kassirer JP. Our stubborn quest for diagnostic certainty: a cause of excessive testing [editorial]. N Engl J Med 1989;320:1489-1491
Diagnosing illness
"Rather than trying to understand the way the body works, modern medicine has created a set of rules to diagnosis, and then a number of rules as how to treat each diagnosis. We are slowly changing that paradigm." ..Trevor..
Patients ill for years with Th1 inflammatory symptoms collect a wide range of diagnostic labels in their quest for answers. Some doctors order specialized testing to try to verify all possible diagnoses because they are thinking of them as separate diseases and do not understand the common etiology.
However, we now know that all these so-called autoimmune diseases and chronic infections are a variation of the Th1 inflammatory process.The obsession with diagnosis is based on the old premise that symptoms can then be managed or individualized treatment can be determined.
"Diagnosis is an imprecise art, and it involves making logical sense of the patchwork of symptoms presenting before you. When somebody has so many apparently diverse symptoms, it becomes very hard indeed to hang tags onto symptoms, yet patients usually prefer a name, so that they have something they can juggle in their mind. We have focused on the commonalities, rather than the differences, between immune disease syndromes, and this tends to make it easier to distinguish the forest from the trees."
..Trevor..
-I have several diagnoses that I believe are all due to Th1 inflammation. These labels refer to the damage that the inflammation has done to my body but do not explain why. I much prefer the following diagnostic label because it explains the root cause of the clinical picture.
Hyervitaminosis-D (proven by bloodwork) resulting in symptoms of Th1 inflammation due to systemic chronic intracelluar infection (as evidenced by Herxheimer reaction) and also evidenced by resolution of abnormal bloodwork and inflammatory symptoms with the Marshall Protocol. Not very catchy but it points to the correct treatment which will eliminate the cause and thus the disease/s. ~Meg
The only tests needed for diagnosis
If you already have a Th1 inflammatory disease diagnosis, the only tests required for confirmation of systemic Th1 inflammation are the D-metabolites tests. If you have financial constraints, you only need to measure the, relatively inexpensive, 25-D.
If your D metabolites tests are abnormal, you can stop your quest for an accurate diagnosis. You have hypervitaminosis-D which is indicative of systemic Th1 inflammation as suggested by your symptoms. The logical etiology is intracellular bacteria. A therapeutic probe with the Marshall Protocol should provide proof positive, in the immune system reaction, of the presence of occult microbes.
-At present, the only readily accepted causation of non renal up-regulation of Vit D, is an intracellular bacterial infection. So measuring 25 OH and 1,25 OH Vit D is a reasonable screening test and at least in Canada, not that expensive. ~Greg Blaney, MD
Naming a disease
-Naming a disease is sort of like "matching colors." Doctors try to get as close as they can to describe what they see, but (just like with colors) there can be disagreement about what the name is. Sometimes two names can describe the same or similar colors (or diseases). It's easy to differentiate shades from opposite sides of the color wheel. Only the color-blind would get confused there. On the other hand, people argue over similar color-names all the time. What my mother calls teal I call blue-green, and what I call a purple, my daughter insists is a shade of blue. ~Belinda Fenter
Testing for infections
Trying to pinpoint a specific organism and testing for antibodies is futile and unnecessary. "There are actually hundreds of proteins, probably thousands, which are mutated in the acute phase of Th1 disease.
-Where the MP is unique is that I set out to kill pathogens which have never been fully identified, whose exact nature is still largely unknown. I did this based on an understanding of the pathogens' biochemical effects on the body, and the consequent understanding of how they must therefore be exerting that effect.
Just trying to understand one or other effect of a lifetime accumulation of pathogens is like looking for a needle in a haystack. And even if scientists stumble over that needle it is unlikely they will recognize it for what it is.
As the body becomes more sick then more co-infections take hold, and more toxins are created. But what is making the body ill in the first place is not necessarily what is observable. It is not the opportunistic co-infections, it is not the plethora of toxins or mutated proteins. These are the result of the Th1 infection, not the cause. ..Trevor..
See Why can't CWD bacteria be detected with tests?
Response to therapy provides a diagnosis
The bottom line, like in all medical diagnosis, the ultimate confirmation is response to a trial of therapy. With the MP, the reactions to low dose minocycline if you have Th1 disease, are obvious and easily discerned from side effects. This will confirm the diagnosis and after a time with therapy, a number of weeks, the improvements are also very apparent. The lifestyle restrictions are not that severe and limited in time and well worth it if you truly are that dysfunctional. ~Greg Blaney, MD See What is a therapeutic probe?
Lung biopsy
It isn't necessary to undergo an invasive and risky lung biopsy for a proven diagnosis of sarcoidosis or expensive tests to locate inflamed tissues in order to prescribe the MP. See Diagnosis
Testing to monitor general health
It is expected and encouraged that patients on the MP will be monitored by their primary care provider who will order tests appropriate to monitor general health. Please see Suggested tests to monitor your progress on the MP.
Unnecessary testing
The use of repeat invasive and/or expensive procedures/imaging and testing are rarely needed and can be dangerous. Ask your doctor if the results of the proposed testing will change the treatment plan. See Radiation Exposure in this FAQ
Some doctors are accustomed to repeat testing to monitor disease progression and they fail to inform their patients that the tests do nothing to change the course of treatment.
See What is the best way to assess lung function?
Members' experiences
-almost 1 year ago i had a lumbar puncture. unfortunately a nerve was hit during it. this has caused me many problems including back pain and stiffness, radicular symptoms in legs, weakness, diff. walking, heaviness in legs, etc. i have also developed a massive vascular type headache now that particularly comes on with activity/ increased cardio. exercise that i never had prior to the LP. ~DWD
See also:
Diagnostic imaging
What do my lab tests mean?
How often should I test D levels?
Why doctors order tests
Borreliosis
Sarcoidosis diagnosis
Suggested tests to monitor your progress on the MP.
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Posted: Thu Sep 14th, 2006 05:35 |
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Diagnostic imaging
MRI and CT scans
Please understand that there is little or no correlation between symptoms such as headaches, and lesions on MRI. Don't fall into the trap of supposing "there must be," because the studies (often) show otherwise.
If you are going to let this MRI report upset your trajectory to recovery you need to borrow those films and the reports from Doc. Doc's staff will help you do this. Sit down and think long and hard about them, and the moderators will help you understand the language being used. It is your life at risk here. You need to be happy with the course of action being followed.
On a personal note, I had a CT scan of my head taken at age 30. The radiologist said I had a brain-age of 70, with so many abnormal regions that they didn't bother to call them out one by one. I was given 18 months to live. I took up the study of Biomedicine instead of "setting my affairs in order" as Doc had advised me to do. This is just one of the reasons I suggest you need to do some footwork, and homework, yourself. Neurology is far from an exact science.
..Trevor..
ps: I guess my brain age must now be (58-30)+70 = 98. I'm not doing bad for such an old codger 
CT with contrast
When a CT with contrast is done, the contrast material usually contains iodine. This may be pose a risk to patients who have renal insufficiency. Usual precautions are to drink plenty of water before and after the CT.
Radiation from CT scans
It's a good idea to not do CTs any more often than absolutely necessary because the radiation involved in a CT is much more than what you get from a chest x-ray.
Dec 07 The New England Journal of Medicine recently reported the average American's radiation exposure has doubled since 1980, largely because of the booming use of CT scans. A person who receives two scans is bathed in as much radiations as if he stood two miles from greound zero at Hiroshima.
Volume CT system
-The volume CF system is a relatively new (couple years or so) high resolution multi-slice CT scanner. In a single rotation it creates 64 high-resolution anatomical images as thin as a credit card, just as if a slice was being taken. These images are combined to form a three dimensional view of your anatomy for analysis. From these images physicians can view such things as the condition and patency of your coronary artery ie, blockages etc., as well as the motion and pumping action of the heart. Pretty extensive cardiac information can be captured in about 5 heart beats.
It also allows for enhanced imaging of the lungs in much the same way enabling more accurate assessment of lung structures including hilar nodes, vessels etc. Most health insurance will not cover cost of this test.
From a diagnostic point of view this is a great piece of equipment, it is many times referred to as almost as accurate as a cardiac catherization (a very invasive procedure). If you have the financial ability to have this it will in fact give you some accurate info about the condition of your coronary arteries and lungs.
But it probably will not change your treatment unless of course a large obstruction is found in your coronary arteries. Most folks have some prior symptoms of chest pain etc. when that is the case I might add.
So the decision is yours as to whether you want to spend the money ($1000). Some insurances will cover if you have had an episode of atrial fib, unexplained or another unexplained cardiac event. ~VEZ R,N.
-As with any test or procedure, one has to weigh the benefits versus the cost and risk. Cardiac Cat scans can be expensive and give you a much larger dose of radiation than a simple x-ray that would probably be adequate just to look at your lung status. The cardiac CAT scans can find coronary artery disease in a great many cases, but do not totally replace cardiac catheterizations (that are more invasive).
Given the fact that I would not usually advise anyone to have a C.A.B.G. or stents placed for CAD unless cardiac symptoms are intolerable even with medication, the greater information you would receive from this test might be mostly for your peace of mind. I personally would not be too concerned about your levels on your lipid panels, but I would let you know that this is still probably a minority type of opinion among cardiologists; who generally seem to think that statins are a good idea.
If you are willing to spring for the extra bucks for extra information that is your choice. ~PB R.N.
Bio-resonance scanning and electrodermal testing
-Bio-resonance scanning appears to be a form of muscle testing. It and electrodermal testing are commonly used by naturopaths, chiropractors etc. to diagnose conditions and evaluate treatments.
I have trained in these methods and have found them to be inaccurate and often at times misleading. Why? We know that Bb can evade the immune system and alter basic physiologic functions. These tests rely on autonomic changes to indicate either the presence of an organism or toxin. This is done by introducing the suspected organism or toxin either via a sample or an energetic pattern of said sample and seeing if there is a weakening of response to a provocation muscle strength or increased dermal electrical resistance. Any weakening is diagnostic of a problem.
Well, how do they get the myriad of different phenotypes of Bb to test with. What is the energetic pattern of a healthy organ? Why do they interpret weakening as a negative, knowing the reality of immune system reactions?
I attempted for many years to use these diagnostic techniques and associated remedies. For simple problems and when used by experienced practitioners, good results could be obtained. However, they proved to be inadequate for our truly ill patients. We must combine what we know about the basics of physiology with clinical acumen to truly help these patients. ~Greg Blaney MD
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Posted: Mon Sep 18th, 2006 05:43 |
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Why doctors order tests
Dallas Morning News online
Monday, December 17, 2007
Steve Cole:
The biggest factor in rising health costs are the doctors themselves
There are myriad factors involved in the rising costs of delivering quality care to the population, but the primary factor is with the health care providers themselves.
One of the reasons costs have continued to rise is that physicians and other health care providers are ordering more tests, prescribing more medications and requesting more consultations with specialists. The consultants will then order more tests, prescribe different medications and often request additional assistance from other consultants.
This vicious cycle is compounded by the fact that many of these tests and prescribed medications lead to complications (surgical complications, adverse effects from medications, etc.) that also contribute to rising costs.
Why do we order so many tests? The simple answers are that we "don't want to miss anything" and "because we can." We don't want to miss anything because it would mean that our patients may unnecessarily suffer from an illness by our inability to quickly diagnose the problem. The vast majority of physicians feel the need to help their patients by doing – and ordering more tests fulfills the physician's needs but is not what is necessarily best for the patient. Because we have this desire to help by doing, we frequently do our patients a disservice.
Physicians are accustomed to performing well and answering correctly, as these are the traits necessary to become a physician in the first place. Many feel that if they surround themselves with more data, they will be able to arrive at the correct diagnosis. The problem inherent with this line of reasoning is that the solution to the problem is often buried in a massive, meaningless mesh of data, making it more difficult to arrive at the appropriate conclusion. We as a profession should strive for better data, not just more of it.
The third, often lamented, reason we "don't want to miss anything" is because of an intense fear of litigation. The medical student is frequently reminded by mentors of the likelihood for lawsuits brought about by a missed diagnosis. As a consequence, the practicing physician has a tendency to practice defensive medicine, ordering as many tests and requesting a multitude of additional consultations in an attempt to stave off potential legal action. It is an unfortunate truth that the phrase "first do no harm" has taken new meaning when finished by "...to your attorney's case."
The final reason we don't want to miss anything has to do with the way we educate new physicians. Prior to the advent of easily obtainable diagnostic tests, physicians primarily used the now ancient art of history and physical examination, whereas today's generation of newly trained physicians (my generation, incidentally) relies more heavily upon the laboratory result as opposed to listening to what the patient has to say. This shotgun approach to ordering a multitude of diagnostic testing has become reflexive in our training institutions and has changed the way physicians practice medicine.
The second part of the initial response to the question of why we order so many tests is much more troubling – "because we can." We can order all of these tests because there is no cost to the ordering physician; in fact, there is often a financial incentive to do so.
The physician is awarded a higher level of complexity when reimbursed if he or she prescribes medications, orders diagnostic testing or requests a consultation with another physician. Requesting consultations can positively affect the physician's business as well. By sending patients to multiple physicians in various specialties, the physician becomes a part of a referral circle, a kind of network that ultimately leads to more patients walking through the door of each physician involved.
To be fair, there are often times when these consultations are not only appropriate, but are necessary as part of a balanced plan of care.
All of the above mentioned problems lead to unnecessary testing, patient angst and a decreased quality of care. We should take into account the degree of complexity in reducing or discontinuing a medication and reward those physicians with the courage and common sense to do so.
The overwhelming majority of physicians want to do the best thing for their patients, but not all of them have been taught the best way to do that.
As such, we should change the way we educate physicians and decrease the amount of financial exposure to litigation that physicians face.
I don't know the best way to remedy these problems, but as a physician, I have become a part of the problem and I know we can do better.
Dr. Steve Cole is a staff physician at Baylor University Medical Center, and works as an allergist/immunologist at Park Lane Allergy and Asthma Center in Dallas. E-mail him at SteveCo@ BaylorHealth.edu.
Doctors Work the System to Increase Income-at the Patient's Expense
Found an interesting op-ed from the Dallas News online yesterday, written by Dr. Steve Cole entitled, “Biggest factor in rising health costs are the doctors themselves." Unfortunately, the title doesn’t even begin to touch the content, so many folks will miss this enlightening piece — a piece that should be read by everyone who has an interest in the costs of healthcare.
The article explains many of the reasons healthcare costs go up based on a doctor’s wants and needs and not necessarily on the best interests of the patient. There are a few statements that should make all of us pause — because they speak to the real problems of increased costs. I give Dr. Cole plenty of credit for citing these points — and no doubt he’s taking plenty of flak from his physician-colleagues for raising them.
Doctors don’t order tests, or refer their patients to other specialists because they are necessarily best for the patient. They do so because there is a financial incentive to do so. Such as:
- A doctor orders a medication for his patient because he gets a higher reimbursement for that patient’s visit. The patient is considered to have a “more complex” ailment.
The same is true for ordering a diagnostic test. Diagnostic test = higher reimbursement for that particular visit.
-A doctor will refer his patient to an additional consultant / specialist for the same reason. Only this time there is an additional financial incentive. By making the referral, he becomes part of an inner circle of sorts — and eventually may be rewarded by those specialists for sending patients their way. Sort of a medical referral commission, in effect.
-Dr. Cole suggests that much of the test ordering is about staving off litigation, too. Honestly, however, I’m not so sure it’s a fear of litigation. Instead I think it’s CYA (cover your a**) — because, if a medical error or misdiagnosis results, then all the tests in the world won’t avoid litigation. Instead, I think it’s just about having all that data and evidence amassed just in case there IS litigation. (As in, “But your honor. I tried to do it right! Look! I ordered all these tests!”) What’s the bottom line for us savvy patients? When we think as patients — people with symptoms who need a diagnosis — we want to be sure we are getting the RIGHT tests and visiting the RIGHT specialists. We can determine that, at least fairly closely, by asking our doctor some questions. Why are you ordering this test? What do you expect it will tell us? What if it doesn’t tell us that? Is there another test that will be required? — or — Why do you want me to visit that specialist? Is there any other specialty that might might address the symptoms I’m having? And why are you sending me to this particular doctor? (if you determine it’s because they are friends, or are in the same practice, or even down the hall, then you’ll want to assess whether that doctor truly is the best one for you to see.)
When we think as consumers, then we want to be sure we aren’t getting any more tests than necessary, and that the cost of the test is fair. The literature is rife with doctors ordering tests only because they own the testing equipment and can bill insurance for it! That doesn’t necessarily help the patient, but it most definitely helps the doctor’s bottom line.
Truth is — doctors deserve to make a living and they deserve to max it for themselves, too. I don’t think it’s the doctors who are at fault for taking advantage of this system that is set up, like so many others, to fail patients. It’s more a question of looking at how reimbursements are made, and whether they support a patient-centered model of care.
Tisha Torrey from Every Patient's Advocate blog
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Posted: Sat Dec 9th, 2006 04:10 |
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Tests to detect cancer
Colonoscopy and PSA
If either of these cancer tests gave a precise answer, a definite prognosis, and a clear treatment path for every possible outcome, then they would be very worthwhile indeed. You can find studies both supporting and denigrating every pathway. Medicine just doesn't have the answers yet, unfortunately. ..Trevor..
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