One of the first lessons I distinctly recall from medical school:
“𝐓𝐫𝐞𝐚𝐭 𝐭𝐡𝐞 𝐩𝐚𝐭𝐢𝐞𝐧𝐭. 𝐍𝐨𝐭 𝐭𝐡𝐞 𝐧𝐮𝐦𝐛𝐞𝐫𝐬.”
We were learning about interpreting lab values in the context of the patient’s clinical course.
𝐃𝐨𝐧’𝐭 𝐫𝐞𝐟𝐥𝐞𝐱𝐢𝐯𝐞𝐥𝐲 𝐝𝐨 𝐬𝐨𝐦𝐞𝐭𝐡𝐢𝐧𝐠 𝐛𝐞𝐜𝐚𝐮𝐬𝐞 𝐨𝐟 𝐚 𝐥𝐚𝐛.
Don’t just use an algorithm.
Consider the whole picture. The context.
Consider the physiology.
𝐀 𝐧𝐨𝐫𝐦𝐚𝐥 𝐥𝐚𝐛 𝐢𝐬 𝐧𝐨𝐭 𝐧𝐞𝐜𝐞𝐬𝐬𝐚𝐫𝐢𝐥𝐲 𝐧𝐨𝐫𝐦𝐚𝐥.
Example: A normal white blood cell count is not normal for many of my patients with primary immune deficiencies.
𝘋𝘰 𝘵𝘩𝘦𝘺 𝘩𝘢𝘷𝘦 𝘢𝘯 𝘪𝘯𝘧𝘦𝘤𝘵𝘪𝘰𝘯? 𝘓𝘦𝘶𝘬𝘦𝘮𝘪𝘢?
Sadly, I think with inflammatory conditions this is the first lesson that is forgotten.
Labs that we routinely run may be normal.
Pain, stiffness, fatigue, rashes, headaches, brain fog, food sensitivities, chronic hives.
We may not have all the answers.
𝐒𝐭𝐢𝐥𝐥 𝐍𝐎𝐓 𝐧𝐨𝐫𝐦𝐚𝐥.
Through recent history we have seen a huge upswing in the development of allergic and auto-inflammatory conditions.
First it was hay fever, then asthma.
More recently food allergies, eosinophilic esophagitis, FPIES, inflammatory bowel, Celiac disease, type 1 diabetes, rheumatoid arthritis, Sjogren’s syndrome.
The list goes on and on.
In my own field I wonder, are we seeing more systemic mast cell/histamine related disorders?
Most weeks it seems like it.
Time will tell but we won’t know if we don’t listen to our patients.
If we don’t think about the physiology.
If we don’t think about how our species maybe reacting in context to our environment.
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.
How has the rapid change in the make up of “the other” changed us?
How is this changing our physiology?