Treat the patient.

One of the first lessons I distinctly recall from medical school:

โ€œ๐“๐ซ๐ž๐š๐ญ ๐ญ๐ก๐ž ๐ฉ๐š๐ญ๐ข๐ž๐ง๐ญ. ๐๐จ๐ญ ๐ญ๐ก๐ž ๐ง๐ฎ๐ฆ๐›๐ž๐ซ๐ฌ.โ€โฃ
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We were learning about interpreting lab values in the context of the patientโ€™s clinical course. โฃ
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๐ƒ๐จ๐งโ€™๐ญ ๐ซ๐ž๐Ÿ๐ฅ๐ž๐ฑ๐ข๐ฏ๐ž๐ฅ๐ฒ ๐๐จ ๐ฌ๐จ๐ฆ๐ž๐ญ๐ก๐ข๐ง๐  ๐›๐ž๐œ๐š๐ฎ๐ฌ๐ž ๐จ๐Ÿ ๐š ๐ฅ๐š๐›. โฃ
Stop. โฃ
Think. โฃ
Donโ€™t just use an algorithm. โฃ
Consider the whole picture. The context. โฃ
Consider the physiology. โฃ
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Part 2:โฃ
๐€ ๐ง๐จ๐ซ๐ฆ๐š๐ฅ ๐ฅ๐š๐› ๐ข๐ฌ ๐ง๐จ๐ญ ๐ง๐ž๐œ๐ž๐ฌ๐ฌ๐š๐ซ๐ข๐ฅ๐ฒ ๐ง๐จ๐ซ๐ฆ๐š๐ฅ. โฃ
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Example: A normal white blood cell count is not normal for many of my patients with primary immune deficiencies. โฃ
๐˜‹๐˜ฐ ๐˜ต๐˜ฉ๐˜ฆ๐˜บ ๐˜ฉ๐˜ข๐˜ท๐˜ฆ ๐˜ข๐˜ฏ ๐˜ช๐˜ฏ๐˜ง๐˜ฆ๐˜ค๐˜ต๐˜ช๐˜ฐ๐˜ฏ? ๐˜“๐˜ฆ๐˜ถ๐˜ฌ๐˜ฆ๐˜ฎ๐˜ช๐˜ข? โฃ
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Sadly, I think with inflammatory conditions this is the first lesson that is forgotten. โฃ
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Labs that we routinely run may be normal. โฃ
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Pain, stiffness, fatigue, rashes, headaches, brain fog, food sensitivities, chronic hives. โฃ
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๐๐จ๐ญ ๐ง๐จ๐ซ๐ฆ๐š๐ฅ. โฃ
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We may not have all the answers. โฃ
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๐’๐ญ๐ข๐ฅ๐ฅ ๐๐Ž๐“ ๐ง๐จ๐ซ๐ฆ๐š๐ฅ. โฃ
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Through recent history we have seen a huge upswing in the development of allergic and auto-inflammatory conditions. โฃ
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First it was hay fever, then asthma. โฃ
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More recently food allergies, eosinophilic esophagitis, FPIES, inflammatory bowel, Celiac disease, type 1 diabetes, rheumatoid arthritis, Sjogrenโ€™s syndrome. โฃ
The list goes on and on. โฃ
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In my own field I wonder, are we seeing more systemic mast cell/histamine related disorders? โฃ
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Most weeks it seems like it. โฃ
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Time will tell but we wonโ€™t know if we donโ€™t listen to our patients. โฃ
If we donโ€™t think about the physiology.โฃ
If we donโ€™t think about how our species maybe reacting in context to our environment.โฃ
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Increasingly the evidence supports that we NEED to study our own evolution as a super-organism: our bodies and all of the other organisms living on and in us. โฃ
How has the rapid change in the make up of โ€œthe otherโ€ changed us?โฃ
How is this changing our physiology? โฃ
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