Download YOUR Executive Physical-With Results

David Carfagno, D.O., C.A.Q.S.M.
Welcome To Your
Executive Physical
Index:
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Cardiology
Pulmonary
Gastrointestinal
Renal/Nephrology
Endocrinology-Hormone-Reproductive
Hematology/Oncology
Neurology
Muscular
Dermatology
Metabolic/Fitness
Genetic/Spectracell
Cardiovascular System
The Cardiovascular System is one of the most important systems in your body. It is your body's
delivery system for the circulation of blood. It is made up of blood, blood vessels and the heart.
Blood moving away from the heart delivers oxygen and nutrients to every part of your body
through arteries. You can remember the function of arteries by recalling that "A" stands for
"away from the heart." Arteries will carry blood away from your heart to smaller and smaller
blood vessels called capillaries. Your heart needs to have enough pressure to deliver that blood
down to your fingertips and to the tip of your toes. On the other hand, 'veins' carry blood back to
the heart. Blood moving back to heart picks up waste products like a trash truck so that your
body can get rid of them. So arteries carry blood away from the heart and veins carry blood back
to the heart. Interestingly enough, veins have to carry blood back UP to the heart, against gravity,
while you are standing up, running or walking up the stairs. So you can visualize how important
proper blood pressure is to get blood circulating down and back up to the heart. Too much or too
little pressure can be detrimental to your health. It's one big ol' circle.
Your heart is only about the size of your clenched fist; yet it is indeed a very strong muscle. The
muscle fibers in the heart are different than the muscle fibers in your legs or those that line your
organs and blood vessels. This type of muscle fiber is called "cardiac muscle." These muscle
fibers branch out and form a continuous network (anastomose). At intervals, there are prominent
bands or intercalated disks that cross the fibers. The special fibers in the heart are called Purkinje
fibers. The Purkinje Fibers form the impulse-conducting system of the heart.
Your heart contracts and relaxes approximately 70 or so times a minute at rest. And of course it
will contract more when you are exercising. The heart muscle squeezes and pumps blood
through its four chambers to all parts of your body. And it pumps blood through a large
collection of blood vessels.
When you inhale, you breathe in air that reaches your lungs. Blood is pumped from the heart to
your lungs. This is where oxygen from the air that you've breathed in gets mixed with the blood.
The oxygen-rich blood travels back to the heart where it is pumped through your arteries, to the
capillaries and to the rest of the whole body. This system delivers oxygen to all the cells in your
body. This includes your skin, bones and other organs. Yep! Even your bones need blood. Your
veins will then carry the oxygen-depleted blood back to the heart for another ride in this huge
circulatory system.
Heart Disease and Stroke Statistics
These are a few key statistics about heart disease, stroke, other cardiovascular diseases and their
risk factors*:
• Cardiovascular disease is the leading global cause of death, accounting for 17.3 million deaths
per year, a number that is expected to grow to more than 23.6 million by 2030
• In 2008, cardiovascular deaths represented 30 percent of all global deaths, with 80 percent of
those deaths taking place in low and middle-income countries
• Nearly 787,000 people in the U.S. died from heart disease, stroke and other cardiovascular
diseases in 2011. That’s about one out of every three deaths in America
• About 2,150 Americans die each day from these diseases, one every 40 seconds
• Cardiovascular diseases claim more lives than all forms of cancer combined
• About 85.6 million Americans are living with some form of cardiovascular disease or the aftereffects of stroke
• Direct and indirect costs of cardiovascular diseases and stroke total more than $320.1 billion.
That includes health expenditures and lost productivity
• Nearly half of all African-American adults have some form of cardiovascular disease, 48
percent of women and 46 percent of men
• Over 39,000 African-Americans died from heart disease in 2011
• Heart disease is the number one cause of death in the world and the leading cause of death in
the United States, killing over 375,000 Americans a year
• Heart disease alone strikes someone in the U.S. about once every 43 seconds
• Someone in the U.S. dies from heart disease alone about once every 90 seconds
• From 2001 to 2011, the death rate from heart disease has fallen about 39 percent – but the
burden and risk factors remain alarmingly high
* (The source for these health statistics is the 2015 Heart Disease and Stroke Statistics Update, which is compiled annually by the
American Heart Association, the Centers for Disease Control and Prevention, the National Institutes of Health and other
government sources)
Reference: American Heart Association
Blood Pressure
Date: 01/01/15
Result: 124/82
Normal Range: See JNC updated Guidelines
Compared with previous hypertension treatment guidelines, the JNC 8 guidelines advise higher blood
pressure goals and less use of several types of antihypertensive medications.
Patients will be asking about the new Joint National Committee (JNC 8) hypertension guidelines, which
were published in the Journal of the American Medical Association on December 18.
The new guidelines emphasize control of systolic blood pressure (SBP) and diastolic blood pressure
(DBP) with age- and comorbidity-specific treatment cutoffs. The new guidelines also introduce new
recommendations designed to promote safer use of angiotensin converting enzyme inhibitors (ACEIs)
and angiotensin receptor blockers (ARBs).
Important changes from the JNC 7 guidelines include the following:
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In patients 60 years of age or older who do not have diabetes or chronic kidney disease, the goal
blood pressure level is now <150/90 mmHg
In patients 18 to 59 years of age without major comorbidities, and in patients 60 years of age or
older who have diabetes, chronic kidney disease, or both conditions, the new goal blood
pressure level is <140/90 mmHg
First-line and later-line treatments should now be limited to 4 classes of medications: thiazidetype diuretics, calcium channel blockers (CCBs), ACEIs, and ARBs
Second- and third-line alternatives included higher doses or combinations of ACEIs, ARBs,
thiazide-type diuretics, and CCBs
Several medications are now designated as later-line alternatives, including the following:
o Beta-blockers
o Alpha-blockers
o Alpha1/beta-blockers (eg, carvedilol)
o Vasodilating beta-blockers (eg, nebivolol)
o Central alpha2-adrenergic agonists (eg, clonidine)
o Direct vasodilators (eg, hydralazine)
o Loop diuretics (eg, furosemide)
o Aldosterone antagonists (eg, spironolactone)
o Peripherally acting adrenergic antagonists (eg, reserpine)
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When initiating therapy, patients of African descent without chronic kidney disease should use
CCBs and thiazides instead of ACEIs
Use of ACEIs and ARBs is recommended in all patients with chronic kidney disease regardless of
ethnic background, either as first-line therapy or in addition to first-line therapy
ACEIs and ARBs should not be used in the same patient simultaneously
CCBs and thiazide-type diuretics should be used instead of ACEIs and ARBs in patients over the
age of 75 with impaired kidney function due to the risk of hyperkalemia, increased creatinine,
and further renal impairment
The change to a more lenient systolic blood pressure goal may be confusing to many patients who are
accustomed to the lower goals of JNC 7, including the <140/90 mmHg goal for most patients and
<130/80 mmHg goal for patients with hypertension and major comorbidities.
Results of 5 key trials--HDFP, Hypertension-Stroke Cooperative, MRC, ANBP, and VA Cooperative-informed the changes in the new guidelines. In these trials, patients between the ages of 30 and 69
received medication to lower DBP to a level <90 mmHg. Results showed a reduction in cerebrovascular
events, heart failure, and overall mortality in patients treated to the DBP target level.
The data were so compelling that some members of the JNC 8 panel wanted to keep DBP <90 mmHg as
the only goal among younger patients, citing insufficient evidence for benefits of an SBP goal lower than
140 mmHg in patients under the age of 60. However, more conservative panelists pushed to keep the
target SBP goal as well as the DBP goal.
In younger patients without major comorbidities, elevated DBP is a more important cardiovascular risk
factor than is elevated SBP. The JNC 8 panelists are not the first guideline authors to recognize this
relationship. The JNC 7 guideline authors also acknowledged that DBP control was more important than
SBP control for reducing cardiovascular risk in patients <60 years of age. However, in patients 60 years
of age and older SBP control remains the most important factor.
Other recent evidence suggests that the SBP goal <140 mmHg recommended by the JNC 7 guidelines for
most patients may have been unnecessarily low. The JNC 8 guideline authors cite 2 trials that found no
improvement in cardiovascular outcomes with an SBP target <140 mmHg compared with a target SBP
level <160 mmHg or <150 mmHg. Despite this finding, the new guidelines do not disallow treatment to a
target SBP <140 mmHg, but recommend caution to ensure that low SBP levels do not affect quality of
life or lead to adverse events.
The shift to a DBP-based goal may lead to use of fewer medications in younger patients with a new
diagnosis of hypertension and may improve adherence and minimize adverse events associated with
low SBP, such as sexual dysfunction.
- See more at: http://www.pharmacytimes.com/news/the-jnc-8-hypertension-guidelines-an-in-depthguide#sthash.GKzB5ReP.dpuf
Abdominal Aortic Aneurysm (AAA)
Date of Service: 01/01/15
Your Results: Negative for abdominal aortic aneurysm
AAA Diameter (cm) Rupture Risk (%/y)
<4
0
4-5
0.5-5
5-6
3-15
6-7
10-20
7-8
20-40
>8
30-50
AAA—abdominal aortic aneurysm.
An abdominal aortic aneurysm (AAA) is a localized dilation (ballooning or enlargement) of the
abdominal aorta exceeding the normal diameter by more than 50 percent, and is the most
common form of aortic aneurysms. Approximately 90 percent of abdominal aortic aneurysms
occur infrarenally (below the kidneys), but they can also occur pararenally (at the level of the
kidneys) or suprarenally (above the kidneys). Such aneurysms can extend to include one or both
of the iliac arteries in the pelvis.
Abdominal aortic aneurysms occur most commonly in individuals between 65 and 75 years old
and are more common among men and smokers. They tend to cause no symptoms, although
occasionally they can cause pain in the abdomen and back (due to pressure on surrounding
tissues) or in the legs (due to disturbed blood flow). The major complication of abdominal aortic
aneurysms is rupture, which is life-threatening, as large amounts of blood spill into the
abdominal cavity. The mortality rate of those with a ruptured AAA even with repair of the
rupture in the hospital is 60% to 90%. Treatment is usually recommended when an AAA grows
to greater than 5.5 cm in diameter. While in the past the only option for the treatment of AAA
was open surgery, today most are treated with endovascular aneurysm repair (EVAR). EVAR
has been widely adopted, as EVAR possesses a lower risk of death associated with surgery.
Open surgery is sometimes still preferred to EVAR, as EVAR requires long-term surveillance
with CT Scans.
Current recommendations for AAA screening:
The USPSTF recommends a one-time screening for abdominal aortic aneurysm (AAA) with
ultrasonography in men aged 65-75 who have ever smoked
- U.S. Preventative Services Task Force release date June 2014
Echocardiogram (Echo)
Date of Service: 01/01/15
Your Results: Mild Tricuspid Regurgitation
Remaining results are normal
An echocardiogram (echo) is a type of ultrasound test that uses high-pitched sound waves that
are sent through a device called a transducer. The device picks up echoes of the sound waves as
they bounce off the different parts of your heart. These echoes are turned into moving pictures of
your heart that can be seen on a video screen
This test is performed to look for the cause of abnormal heart sounds (murmurs or clicks), an
enlarged heart, unexplained chest pains, shortness of breath, or irregular heartbeats. It will also
check the thickness and movement of the heart wall, look at the heart valves and check how well
they work, measure the size and shape of the heart's chambers, check the ability of your heart
chambers to pump blood (cardiac performance). During an echocardiogram the doctor can
calculate how much blood your heart is pumping during each heartbeat. This is called an ejection
fraction. An echo can see how well an artificial heart valve is working. It can check for clots or
tumors in the heart, and can also detect a disease that affects the heart muscle and the way it
pumps, known as a cardiomyopathy.
Carotid Ultrasound
Date of Service: 01/01/15
Your Results: Normal/Negative, no atherosclerotic narrowing
A carotid ultrasound is a test that uses high-frequency sound waves to create pictures of the
insides of your carotid arteries. A standard carotid ultrasound shows the structure of your carotid
arteries. You have two common carotid arteries, one on each side of your neck. They each divide
into internal and external carotid arteries. The internal carotid arteries supply oxygen-rich blood
to your brain. The external carotid arteries supply oxygen-rich blood to your face, scalp, and
neck.
A carotid ultrasound can show whether a waxy substance called plaque has built up in your
carotid arteries. The buildup of plaque in the carotid arteries is called carotid artery disease.
Over time, plaque can harden or rupture (break open). Hardened plaque narrows the carotid
arteries and reduces the flow of oxygen-rich blood to the brain.
If the plaque ruptures, a blood clot can form on its surface. A clot can partially or completely
block blood flow through a carotid artery, which can cause a stroke.
A piece of plaque or a blood clot also can break away from the wall of the carotid artery. The
plaque or clot can travel through the bloodstream and get stuck in one of the brain's smaller
arteries. This can block blood flow in the artery and cause a stroke.
Electrocardiogram (EKG/ECG)
Date of Service: 01/01/15
Your Results: Normal Sinus Rhythm
An electrocardiogram (EKG or ECG) is a test that checks for problems with the electrical
activity of your heart. An EKG translates the heart's electrical activity into line tracings on paper.
The spikes and dips in the line tracings are called waves
Current recommendations for screening of coronary heart disease with
electrocardiography:
The USPSTF recommends against screening with resting or exercise electrocardiography (ECG)
for the prediction of coronary heart disease (CHD) events in asymptomatic adults at low risk for
CHD events.
-USPSTF release date July 2012
CT Cardiac Score (Done at Simon Med)
Date of Service: 01/01/15
Your Results: Agatston score 27, mild atherosclerotic plaque
Coronary calcium scans use a special X-ray test called computed tomography (CT) to check for
the buildup of calcium in plaque on the walls of the arteries of the heart (coronary arteries). This
test is used to check for heart disease in an early stage and to determine how severe it is.
Coronary calcium scans are also called cardiac calcium scoring.
The coronary arteries supply blood to the heart. Normally, the coronary arteries do not contain
calcium. Calcium in the coronary arteries may be a sign of coronary artery disease (CAD).
A CT scan takes pictures of the heart in thin sections. The coronary calcium scan can help Dr.
Carfagno to make decisions about how to lower your risk for heart disease, heart attack and
stroke.
VO2
Date of Service: 01/01/15
Your Results: VO2 max: 29 ml/kg/min
Anaerobic Threshold heart rate: 152 bpm
A VO2 max is the gold standard, maximal exercise test to determine your aerobic capacity. With
Scottsdale Sports Medicine Institute’s on-site and portable off-site testing capabilities, the test
can be performed in virtually any exercise environment, whether it be here at the fitness lab,
around your local track, in a health club or even climbing a mountain. For the test, the subject
will breathe through a mouthpiece connected to a metabolic analyzer, and he/she will wear a
heart-rate monitor. The analyzer measures the volume as well as the percentage of carbon
dioxide and oxygen in the expired gas. From this data, we are able to calculate:
AEROBIC THRESHOLD: Aerobic threshold is the intensity or heart-rate at which an
individual burns the most fat. Using fat for fuel, more oxygen is required to release a given
amount of energy than when carbohydrate is the main fuel. This means that at low intensities,
when plenty of oxygen is available to the muscle, fat is the preferred fuel. As intensity increases,
at some point the cardiovascular system will not be able to transport proportionally more oxygen
to the muscles. This is the aerobic threshold. Above this point, increased intensity will reduce fat
burning.
ANAEROBIC THRESHOLD: Known as the red-line to endurance athletes, this threshold is
the highest intensity, as measured by heart rate, at which the body can remove lactic acid as
quickly as it is produced. Just below anaerobic threshold (AT), an athlete is working hard, but
feels no burning in the muscles and is breathing heavily, but in a controlled fashion. Above AT,
lactic acid is building up in the muscles and will cause premature fatigue. Knowing one’s
threshold allows one to achieve a very high level of cardiovascular conditioning without the
discomfort and muscle damage of lactic acid buildup.
VO2 MAX: For those who take the test to completion (so that we are able to determine VO2 Max),
VO2 max is the volume of oxygen the body uses during one minute of maximal exercise.
Expressed as liters of oxygen per minute or milliliters of oxygen per kilogram of bodyweight per
minute; this data determines your potential for endurance athletics. While anaerobic threshold is
the best predictor of current endurance performance, VO2 max indicates the potential of an athlete
after several years of systematic, structured training.
Stress Test (GXT)
Date of Service: 01/01/15
Your Results:
Graded Exercise Test w/ EKG Eval
Stage
BP
HR
RPE
Comments
Rest
107/22
70
0
Normal ST, no ectopy,
NSR 1
122/65
98
2
Normal ST, no ectopy,
NSR 2
133/80
117
5
Normal ST, no ectopy,
NSR 3
155/92
149
5
Nonspecific ST changes, no ectopy,
NSR Rec 133/93
115
2
Normal ST, no ectopy, NSR
A treadmill stress test is normally the first stress test performed, as long as you can walk and
have a normal ECG. You walk on a treadmill while being monitored to see how far you walk and
if you develop chest pain or changes in your ECG that suggest that your heart is not getting
enough blood. The stress test can determine if there is adequate blood flow to your heart during
increasing levels of activity, evaluate the effectiveness of your heart medications to control
angina and ischemia, determine the likelihood of having coronary heart disease and the need for
further evaluation. The stress test can also check the effectiveness of procedures performed to
improve blood flow within the heart vessels in people with coronary heart disease. The GXT can
identify abnormal heart rhythms, assess the function of heart valves if they are not functioning
properly, and help you and Dr. Carfagno develop a safe exercise program.
Lipid Panel
Date of Service: 01/01/15
Your Results: Total: 206
LDL: 119
HDL: 79
Triglycerides: 62
Lipids are a group of fats and fat-like substances that are important constituents of cells and
sources of energy. A lipid profile measures the level of specific lipids in the blood.
Two types of lipids, cholesterol and triglycerides, are transported in the blood by lipoprotein
particles. Each particle contains a combination of protein, cholesterol, triglyceride, and
phospholipid molecules. The particles measured with a lipid profile are classified by their density
into high-density lipoproteins (HDL), low-density lipoproteins (LDL), and very low-density
lipoproteins (VLDL).
Monitoring and maintaining healthy levels of these lipids is important in staying healthy. While
the body produces the cholesterol needed to function properly, the source for some cholesterol is
the diet. Eating too much of foods that are high in cholesterol, saturated fats, and trans
unsaturated fats (trans fats) or having an inherited predisposition can result in a high level of
cholesterol in the blood. The extra cholesterol may be deposited in plaques on the walls of blood
vessels. Plaques can narrow or eventually block the opening of blood vessels, leading to
hardening of the arteries (atherosclerosis) and increasing the risk of numerous health problems,
including heart disease and stroke. A high level of triglycerides in the blood is also associated
with an increased risk of developing cardiovascular disease (CVD), although the reason for this
is not well understood.
A lipid profile includes:
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Total cholesterol – this test measures all of the cholesterol in all the lipoprotein particles
High-density lipoprotein cholesterol (HDL-C) – measures the cholesterol in HDL
particles; often called ‘good cholesterol’ because it removes excess cholesterol and carries it
to the liver for removal
Low-density lipoprotein cholesterol (LDL-C) – calculates the cholesterol in LDL
particles; often called ‘bad cholesterol’ because it deposits excess cholesterol in walls of
blood vessels, which can contribute to atherosclerosis. Usually, the amount of LDL
cholesterol (LDL-C) is calculated using the results of total cholesterol, HDL-C, and
triglycerides
Triglycerides – measures all the triglycerides in all the lipoprotein particles; most is in the
very low-density lipoproteins (VLDL)
Some other information may be reported as part of the lipid profile. These parameters are
calculated from the results of the tests identified above.
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Very-low density lipoprotein cholesterol (VLDL-C) – calculated from triglycerides/5;
this formula is based on the typical composition of VLDL particles
Non-HDL-C – calculated from total cholesterol minus HDL-C
Cholesterol/HDL ratio – calculated ratio of total cholesterol to HDL-C
Current lipid panel screening guidelines:
USPSTF strongly recommends screening men aged 35 and older for lipid disorders.
Screening men 20-35 if they are at increased risk for CHD
Screening women 45 and older for lipid disorders if they are at increased risk for CHD
Screening women 20-45 if they are at increased risk for CHD
(USPSTF release date June 2008)
Atherosclerotic Cardiovascular Disease (ASCVD) Risk Calculator:
Date of Service:
Your results:
10 year:
Lifetime:
Enables Dr. Carfagno to estimate your 10-year and lifetime risk of atherosclerotic cardiovascular
disease, including heart attack and stroke. The calculator also suggests whether you will need to
be placed on statin, or lipid-lowering, therapy based on your risk.
Assessment of Cardiovascular Risk. The spreadsheet enables health care providers and patients
to estimate 10-year and lifetime risks for atherosclerotic cardiovascular disease (ASCVD),
defined as coronary death or nonfatal myocardial infarction, or fatal or nonfatal stroke, based on
the Pooled Cohort Equations and the work of Lloyd-Jones, et al., respectively. The information
required to estimate ASCVD risk includes age, sex, race, total cholesterol, HDL cholesterol,
systolic blood pressure, blood pressure lowering medication use, diabetes status, and smoking
status.
Estimates of 10-year risk for ASCVD are based on data from multiple community-based
populations and are applicable to African-American and non-Hispanic white men and women 40
through 79 years of age. For other ethnic groups, we recommend use of the equations for nonHispanic whites, though these estimates may underestimate the risk for persons from some
race/ethnic groups, especially American Indians, some Asian Americans (e.g., of south Asian
ancestry), and some Hispanics (e.g., Puerto Ricans), and may overestimate the risk for others,
including some Asian Americans (e.g., of east Asian ancestry) and some Hispanics (e.g.,
Mexican Americans).
Estimates of lifetime risk for ASCVD are provided for adults 20 through 59 years of age and are
shown as the lifetime risk for ASCVD for a 50-year old without ASCVD who has the risk factor
values entered into the spreadsheet. The estimates of lifetime risk are most directly applicable to
non-Hispanic whites. We recommend the use of these values for other race/ethnic groups, though
as mentioned above, these estimates may represent under- and overestimates for persons of
various ethnic groups. Because the primary use of these lifetime risk estimates is to facilitate the
very important discussion regarding risk reduction through lifestyle change, the imprecision
introduced is small enough to justify proceeding with lifestyle change counseling informed by
these results.
The figure to the right represents the recommendations of the Risk Assessment Work Group.
Further details regarding the derivation and validation, and strategies for implementation, of the
risk assessment algorithm are available in the 2013 ACC/AHA Guideline on the Assessment of
Cardiovascular Risk and the Full Report of the Risk Assessment Work Group. These reports also
contain the information necessary for programming the risk assessment algorithm into an
electronic health record to allow for automatic calculation of 10-year and lifetime risk estimates
in clinical practice settings.
- American College of Cardiology and the American Heart Association 2014
Apolipoprotein B (APO-B)
Date of Service: 01/01/15
Your Results: 94
Normal Range: 40-100
Apolipoprotein B is a protein that is involved in the metabolism of lipids and is the main protein
constituent of lipoproteins such as very low-density lipoprotein (VLDL) and low-density
lipoprotein (LDL) Apolipoproteins combine with lipids to transport them throughout the
bloodstream. Apolipoproteins provide structural integrity to lipoproteins and shield the waterrepellent (hydrophobic) lipids at their center. Most lipoproteins are cholesterol- or triglyceriderich and carry lipids through the body for uptake by cells.
Chylomicrons are the lipoprotein particles that carry dietary lipids from the digestive tract, via
the bloodstream, to tissue – mainly the liver. In the liver, the body repackages these dietary lipids
and combines them with apo B-100 to form triglyceride-rich VLDL.
The cholesterol that LDL and apo B-100 transport is vital for cell membrane integrity, sex
hormone production, and steroid production. In excess, however, LDL can lead to fatty deposits
(plaques) in artery walls and lead to hardening and scarring of the blood vessels. These fatty
depositions narrow the vessels in a process termed atherosclerosis. The atherosclerotic process
increases the risk of heart attack.
High Sensitivity C-Reactive Protein (CRP-HS)
Date of Service: 01/01/15
Your Results: 1.65
Normal Range: <3.00
CRP (C-Reactive Protein) is a protein produced in the liver that circulate in the blood. High
Sensitivity CRP is a blood test that is able to detect small amounts of CRP. Even low levels of
CRP can help indicate your risk for heart disease and help predict risk of a first heart attack up to
eight years in advance.
Low risk for developing heart disease: hs-CRP lower than 1.0mg/L
Average risk for developing heart disease: hs-CRP between 1.0mg/L and 3.0mg/L
High risk for developing heart disease: hs-CRP greater than 3.0mg/L
Pulmonary System
The pulmonary system brings oxygen into the body and expels metabolic wastes in the form of
gases.
The lungs bring life-giving oxygen into the body and remove toxic gaseous wastes from it. An
asymmetrical pair, these spongy structures rhythmically expand and compress about 15 to 20
times a minute. Expansion, or inhalation, draws air and oxygen into the lungs; compression, or
exhalation, expels carbon dioxide and other gases that are metabolic waste byproducts of cellular
activity. The structures of the nasal cavity and the upper airway (throat) bring air, containing
about 21 percent oxygen, into the body. The nose and sinuses warm and moisturize the air.
Carrying that air to the lungs are the trachea, bronchi, and bronchioles – a branching structure of
progressively smaller airways. The air’s destination is the alveoli, tiny membranous sacs that
cluster grapelike at the ends of the bronchioles. A webbing of capillaries (tiny blood vessels)
surrounds each alveolus, carrying erythrocytes (red blood cells) waiting to receive oxygen
molecules and releasing carbon dioxide molecules as waste. This process, the oxygen-carbon
dioxide exchange, gives the body life.
Bronchi: The two main air passages into the lungs
Diaphragm: The main muscle used for breathing; separates the chest cavity from the abdominal
cavity
Epiglottis: A flap of cartilage that prevents food from entering the trachea (or windpipe)
Esophagus: The tube through which food passes from the mouth down into the stomach
Heart: The muscular organ that pumps blood throughout the body
Intercostal muscles: Thin sheets of muscle between each rib that expand (when air is inhaled)
and contract (when air is exhaled)
Larynx: Voice box
Lungs: The two organs that extract oxygen from inhaled air and expel carbon dioxide in exhaled
air
Muscles attached to the diaphragm: These muscles help move the diaphragm up and down for
breathing
Nasal cavity: Interior area of the nose; lined with a sticky mucous membrane and contains tiny,
surface hairs called cilia
Nose hairs: Located at the entrance of the nose, these hairs trap large particles that are inhaled
Paranasal sinuses: Air spaces within the skull
Pharynx: The throat
Pleural membrane: Covering the lung and lining the chest cavity, this membrane has 2 thin
layers
Pulmonary vessels: Pulmonary arteries carry deoxygenated blood from the heart and lungs;
pulmonary veins carry oxygenated blood back to the heart
Respiratory center: Area of the brain that controls breathing
Ribs: Bones attached to the spine and central portion of the breastbone, which support the chest
wall and protect the heart, lungs, and other organs in the chest
Trachea: Tube through which air passes from the nose to the lungs (also known as the
windpipe)
Reference: American medical association
Pulmonary Function Tests (PFTs)
Date of Service: 01/01/15
Your Results: Baseline PFT reveals:
FEV1: 2.71, 95.74% predicted
FVC: 3.51, 99.66% predicted
FEV1/FVC ratio: 77.34, 95.75% predicted.
Pulmonary function tests (PFTs) are noninvasive diagnostic tests that provide measurable
feedback about the function of the lungs. By assessing lung volumes, capacities, rates of flow,
and gas exchange, PFTs provide information that, when evaluated by your doctor, can help
diagnosis certain lung disorders.
A normally-functioning pulmonary system operates on many different levels to ensure adequate
balance. One of the primary functions of the pulmonary system is ventilation, the movement of
air into and out of the lungs.
Some medical conditions may interfere with ventilation. These conditions may lead to chronic
lung disease. Conditions that interfere with normal ventilation are categorized as restrictive or
obstructive. An obstructive condition occurs when air has difficulty flowing out of the lungs due
to resistance, causing a decreased flow of air. A restrictive condition occurs when the chest
muscles are unable to expand adequately, creating a disruption in air flow.
Pulmonary function tests may be indicated to determine the presence, location, cause, and
characteristics of the problem, and to guide treatment.
Some of the more common values that may be measured during pulmonary function testing
include:
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Tidal volume (VT) – This is the amount of air inhaled or exhaled during normal
breathing
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Minute volume (MV) – This is the total amount of air exhaled per minute
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Vital capacity (VC) – This is the total volume of air that can be exhaled after maximum
inspiration
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Functional residual capacity (FRC) – This is the amount of air remaining in lungs after
normal expiration
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Total lung capacity – This is the total volume of lungs when maximally inflated
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Forced vital capacity (FVC) – This is the amount of air exhaled forcefully and quickly
after maximum inspiration
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Forced expiratory volume (FEV) – This is the volume of air expired during the first,
second, and third seconds of the FVC test
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Forced expiratory flow (FEF) – This is the average rate of flow during the middle half
of the FVC test

Peak expiratory flow rate (PEFR) – This is the maximum volume during forced
expiration
Normal Values of Pulmonary Function Tests
PULMONARY FUNCTION
NORMAL VALUE (95 PERCENT CONFIDENCE
TEST
INTERVAL)
FEV1
80% to 120%
FVC
80% to 120%
Absolute FEV1 /FVC ratio
Within 5% of the predicted ratio
TLC
80% to 120%
FRC
75% to 120%
RV
75% to 120%
DLCO
> 60% to < 120%
American Family Physician: “An Approach to Interpreting Spirometry” 2004
FEV1/FVC < 70% is indicative of obstructive lung disease, including COPD and asthma
CT of Lungs/Lung Screening (Ordered at Simon Med)
Date of Service: 01/01/15
Your Results: Negative CT of the chest, no pulmonary nodules or infliltrates
A chest CT scan is frequently ordered to look at the lungs, heart and nearby tissues.
Lungs
A chest CT scan will detect pneumonia, emphysema, lung scarring, pleural effusion (fluid on the
lungs), pneumothorax (air leak), and lung cancer.
Mediastinum
The mediastinum refers to the part of the chest that contains your heart, vessels and the
esophagus. The chest CT will detect lymph nodes, tumors in the chest, heart disease, pericardial
effusion (fluid around the heart), aneurysms of the aorta and pulmonary emboli (these cause
sudden shortness of breath). It can also detect tumors or inflammation of the esophagus.
Bones
Your chest is protected by your ribs, sternum and the spine. A chest CT scan can detect fractures
of these bones, tumors, infection or degenerative changes.
Other structures
A chest CT scan also includes parts of the upper abdomen and can pick up abnormalities of the
liver, spleen and stomach.
Current lung cancer screening guidelines:
The USPSTF recommends annual screening for lung cancer with low-dose computed
tomography (LDCT) in adults aged 55-80 years who have a 30 pack-year smoking history and
currently smoke or have quit within the past 15 years. Screening should be discontinued once a
person has not smoked for 15 years or develops a health problem that substantially limits life
expectancy or the ability or willingness to have curative lung surgery.
(USPSTF release date Dec 2013)
Gastrointestinal Tract (GI System)
Your digestive system is uniquely designed to turn the food you eat into nutrients, which the
body uses for energy, growth and cell repair. Here's how it works.
Mouth
The mouth is the beginning of the digestive tract. In fact, digestion starts here as soon as you take
the first bite of a meal. Chewing breaks the food into pieces that are more easily digested, while
saliva mixes with food to begin the process of breaking it down into a form your body can absorb
and use.
Throat
Also called the pharynx, the throat is the next destination for food you've eaten. From here, food
travels to the esophagus or swallowing tube.
Esophagus
The esophagus is a muscular tube extending from the pharynx to the stomach. By means of a
series of contractions, called peristalsis, the esophagus delivers food to the stomach. Just before
the connection to the stomach there is a ‘zone of high pressure’ called the lower esophageal
sphincter; this is a valve meant to keep food from passing backward into the esophagus.
Stomach
The stomach is a sac-like organ with strong muscular walls. In addition to holding the food, it's
also a mixer and grinder. The stomach secretes acid and powerful enzymes that continue the
process of breaking down the food. When it leaves the stomach, food is the consistency of a
liquid or paste. From there the food moves to the small intestine.
Small Intestine
Made up of three segments, the duodenum, jejunum, and ileum, the small intestine is a long tube
loosely coiled in the abdomen (spread out, it would be more than 20 feet long). The small
intestine continues the process of breaking down food by using enzymes released by the pancreas
and bile from the liver. Bile is a compound that aids in the digestion of fat and eliminates waste
products from the blood. Peristalsis (contractions) is also at work in this organ, moving food
through and mixing it up with digestive secretions. The duodenum is largely responsible for
continuing the process of breaking down food, with the jejunum and ileum being mainly
responsible for the absorption of nutrients into the bloodstream. Three organs play a pivotal role
in helping the stomach and small intestine digest food: the pancreas, liver, and gallbladder.
Pancreas
Among other functions, the oblong pancreas secretes enzymes into the small intestine. These
enzymes break down protein, fat, and carbohydrates from the food we eat.
Liver
The liver has many functions, but two of its main functions within the digestive system are to
make and secrete bile, and to cleanse and purify the blood coming from the small intestine
containing the nutrients just absorbed.
Gallbladder
The gallbladder is a pear-shaped reservoir that sits just under the liver and stores bile. Bile is
made in the liver then travels to the gallbladder through a channel called the cystic duct. During a
meal, the gallbladder contracts, sending bile to the small intestine.
Once the nutrients have been absorbed and the leftover liquid has passed through the small
intestine, what is left of the food you ate is handed over to the large intestine, or colon.
Colon (Large Intestine)
The colon is a 5- to 6-foot-long muscular tube that connects the cecum (the first part of the large
intestine to the rectum (the last part of the large intestine). It is made up of the cecum, the
ascending (right) colon, the transverse (across) colon, the descending (left) colon, and the
sigmoid colon, which connects to the rectum.
Stool, or waste left over from the digestive process, is passed through the colon by means of
peristalsis (contractions), first in a liquid state and ultimately in solid form as the water is
removed from the stool. A stool is stored in the sigmoid colon until a ‘mass movement’ empties
it into the rectum once or twice a day. It normally takes about 36 hours for stool to get through
the colon. The stool itself is mostly food debris and bacteria. These bacteria perform several
useful functions, such as synthesizing various vitamins, processing waste products and food
particles, and protecting against harmful bacteria. When the descending colon becomes full of
stool, or feces, it empties its contents into the rectum to begin the process of elimination.
Rectum
The rectum is an 8-inch chamber that connects the colon to the anus. It is the rectum's job to
receive stool from the colon, to let you know there is stool to be evacuated, and to hold the stool
until evacuation happens. When anything (gas or stool) comes into the rectum, sensors send a
message to the brain. The brain then decides if the rectal contents can be released or not. If they
can, the sphincters (muscles) relax and the rectum contracts, expelling its contents. If the
contents cannot be expelled, the sphincters contract and the rectum accommodates, so that the
sensation temporarily goes away.
Anus
The anus is the last part of the digestive tract. It consists of the pelvic floor muscles and the two
anal sphincters (internal and external muscles). The lining of the upper anus is specialized to
detect rectal contents. It lets us know whether the contents are liquid, gas, or solid. The pelvic
floor muscle creates an angle between the rectum and the anus that stops stool from coming out
when it is not supposed to. The anal sphincters provide fine control of stool. The internal
sphincter keeps us from going to the bathroom when we are asleep, or otherwise unaware of the
presence of stool. When we get an urge to go to the bathroom, we rely on our external sphincter
to keep the stool in until we can get to the toilet.
Facts on Colon Screening
Colorectal Cancer Basics:
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Colorectal cancer is the second-leading cause of cancer deaths in the U.S
Men and women are at equal risk of developing colorectal cancer
Early detection of colorectal cancer leads to easier treatments and higher survival rates
More than one-third of colorectal cancer deaths could be avoided if all eligible
individuals participated in regular screening
Colorectal cancer screening is safe and effective
Colorectal Cancer:
Cancer of the colon and rectum, called colorectal cancer, occurs when a growth in the lining of
the colon or rectum becomes malignant, or cancerous. It is the second-leading cause of cancer
deaths in the U.S. However, if caught early, colorectal cancer can be effectively treated. It’s
important for you to understand your risks for colorectal cancer, the symptoms of colorectal
cancer and screening tests that can detect cancerous growths. With simple preventive steps, you
can also reduce your risk of developing the disease.
Polyps:
Colorectal cancer usually develops from pre-cancerous polyps called adenomatous polyps or
serrated polyps. A polyp is a grape-like growth on the inside wall of the colon or rectum. Polyps
grow slowly over many years. Most people do not develop polyps until after the age of 50 if they
have an average risk for colorectal cancer (see below).
Some polyps become cancerous, others do not. In order to reduce the likelihood of colorectal
cancer, it is important to get screened to find out if you have polyps and to have them removed if
you do.
With regular colorectal cancer screening, more than one-third of colorectal cancer deaths could
be avoided.
Prevention:
Along with regular screening, healthy lifestyle choices are the best current preventive measures
against colorectal cancer. Here’s how you can help reduce your risk:
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Eat more foods that are high in fiber, including whole grains, fruits, and vegetables
Eat more cruciferous vegetables, such as cabbage, broccoli, cauliflower, and brussels
sprouts
Increase calcium intake with low-fat milk, shellfish, salmon, and calcium supplements
with vitamin D
Decrease fats, oils, butter, and red meats
Limit your intake of charcoal broiled foods and avoid salt-cured foods
Exercise regularly
Do not smoke
Keep your body mass index in the normal range
Symptoms of colorectal cancer:
Colorectal cancer usually begins with no symptoms at all. However, over time, there are a
number of warning signs that can occur such as:
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Rectal bleeding
Blood in your stool (bright red, black or very dark)
A temporary change in your bowel movements, especially in the shape of the stool (e.g.,
narrow like a pencil)
Discomfort in having a bowel movement or the urge to move your bowels without having
a bowel movement (tenesmus)
Frequent cramping pain in your lower abdomen
Frequent gas pains
Weight loss without dieting
Constant fatigue
You are at increased risk for colorectal cancer if you have:

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Personal history of colorectal cancer or polyps (adenomatous or serrated)
Family history of one or more parents, siblings, or children with colorectal cancer or
polyps (adenomatous or serrated)
Family history of multiple cancers, including colorectal cancer, and those involving the
uterus, ovary and other organs
Personal history of inflammatory bowel disease, such as ulcerative colitis or Crohn’s
disease
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
Inherited syndrome such as Familial Adenomatous Polyposis (FAP), which leads to
hundreds of polyps in the colon or rectum during the teen years; generally one of these
develops into cancer by age 30
Lynch Syndrome (Hereditary Non-Polyposis Colon Cancer), which is not characterized
by a large number of polyps as a warning sign, but often includes a family history of colorectal
cancer among multiple family members in multiple generations.
Reference: American Gastroenterological Association
**Colorectal cancer screening guidelines
Screening via colonoscopy, fecal occult blood testing, or sigmoidoscopy in adults beginning at
age 50 years and continuing until age 75 years.
-
Fecal occult blood test – annual
Sigmoidoscopy – every 5 years
Colonoscopy – every 10 years, depending on results
Earlier start to screening is recommended for those with a first degree relative with colon cancer,
usually ten years before the relative was diagnosed.
USPSTF recommends against routine screening for adults 76-85 years of age. Considerations for
screening may be made for the individual patient.
USPSTF recommends against any screening for adults over the age of 85.
- USPSTF release date October 2008
Comprehensive Metabolic Panel (CMP)
Date of Service: 01/01/15
Your Results:
Glucose: 106
Urea Nitrogen (BUN): 18
GFR Estimated: 78
BUN/Creatinine Ratio: 20.9
Sodium: 143
Potassium: 3.8
Chloride: 104
Carbon Dioxide (CO2): 25
Anion Gap: 14
Total Protein: 6.8
Albumin: 4.9
Globulin: 1.9
Calcium: 9.9
Alkaline Phosphatase: 75
Alanine Aminotransferase: 27
Aspartate Aminotransferase: 23
Total Bilirubin: 0.2
Normal CMP lab values:
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Albumin: 3.9 to 5.0 g/dL
Alkaline phosphatase: 44 to 147 IU/L
ALT (alanine aminotransferase): 8 to 37 IU/L
AST (aspartate aminotransferase): 10 to 34 IU/L
BUN (blood urea nitrogen): 7 to 20 mg/dL
Calcium: 8.5 to 10.9 mg/dL
Chloride: 96 - 106 mmol/L
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CO2 (carbon dioxide): 20 to 29 mmol/L
Creatinine: 0.8 to 1.4 mg/dL
Glucose test: 70 to 100 mg/dL
Potassium test: 3.7 to 5.2 mEq/L
Sodium: 136 to 144 mEq/L
Total bilirubin: 0.2 to 1.9 mg/dL
Total protein: 6.3 to 7.9 g/dL
Glucose
Glucose is the chief source of energy for all living organisms; however, abnormally high or low
blood glucose levels may be a sign of disease. For example, high glucose levels after 12 hours of
fasting may suggest diabetes. Low blood glucose, on the other hand, may be seen with certain
tumors or with liver disease.
Calcium
Calcium is one of the most important elements in the body. Ninety-nine percent of the calcium in
the body is in the bones. The remaining one-percent is in body fluids, such as blood, and is very
important for the proper function of nerves, enzymes, muscles, and blood clotting.
PROTEINS
Albumin
Approximately two-thirds of the total protein circulating in your blood is albumin. This
important protein keeps water inside your blood vessels. When your albumin level is too low,
water can leak out of your blood vessels into other parts of your body and cause swelling. A low
level of albumin in the blood can be caused by malnutrition, too much water in the body, liver
disease, kidney disease, severe injury such as burns or major bone fractures, and slow bleeding
over a long period of time.
Total Protein
This is a measure of the total amount of protein in your blood. A low or high total protein does
not indicate a specific disease, but it does indicate that some additional tests may be required to
determine if there is a problem.
ELECTROLYTES
Sodium
This element plays an important role in salt and water balance in your body. The adrenal
hormone, aldosterone, and the rate of excretion in urine, regulate the blood sodium level.
Potassium
This element is found inside all cells. Its role is to maintain water balance inside the cells and
help in the transmission of nerve impulses. The level of potassium in blood is of critical
significance.
CO2 (carbon dioxide, bicarbonate)
When bicarbonate levels are higher or lower than normal, it is a sign that the body is having
trouble maintaining its acid-base balance or that something has upset the electrolyte balance,
perhaps by losing or retaining fluid. Both of these imbalances may be due to a wide range of
dysfunctions.
Chloride
Chloride is another element that plays a role in salt and water balance. It is almost never the only
element that is low or high. Changes in the chloride level are usually associated with changes in
sodium or potassium. Borderline low or high levels of chloride usually have very little
significance. When there is too much or too little acid in the blood, chloride is an important clue
to the cause of the acid abnormality.
KIDNEY
BUN (Blood Urea Nitrogen)
BUN is a waste product derived from protein breakdown in the liver and excreted by the
kidneys. When your kidneys are not working well, the level of BUN in the blood will rise.
Dehydration and blood loss can also cause a high BUN level. Liver disease, a low protein diet, or
too much water intake may cause a low BUN level.
Creatinine
The blood concentration of creatinine depends upon two things – the amount of muscle you have
and the ability of your kidneys to excrete the creatinine. A high level of creatinine in the blood
usually indicates deterioration in kidney function.
LIVER
ALP (alkaline phosphatase)
Alkaline Phosphatase is found in all body tissues, but the most important sites are bone and liver.
Blood levels increase when bones are growing; thus children have higher levels than adults do.
High levels may also be seen in bone and liver disease. Certain drugs may cause high levels as
well.
ALT (alanine amino transferase) and AST (aspartate amino transferase)
AST and ALT are considered to be two of the most important tests to detect liver injury,
although ALT is more specific to the liver than is AST. Sometimes AST is compared directly to
ALT and an AST/ALT ratio is calculated. This ratio may be used to distinguish between
different causes of liver damage and to help recognize heart or muscle injury.
AST is found mainly in the heart, liver, and muscles.
Bilirubin
Bilirubin is the pigment in the blood that makes your blood plasma or serum yellow. Bilirubin
comes from the breakdown of old red cells in the blood. A high bilirubin level in the blood can
be caused by too many red cells being destroyed (hemolysis), by liver disease, or by a blockage
of the bile ducts. Fasting can also cause a slight increase in total bilirubin.
Renal System/Nephrology
The renal system is a group of organs that work together to produce, store, and release urine.
Urine is the liquid waste material excreted from the body. The organs that work together in this
system include the kidneys, bladder, ureters, and urethra. It is also known as the urinary or the
excretory system.
The kidneys are a vital part of the renal system. They are located in the back portion of the
abdominal cavity, with one on either side. Perhaps the most well-known function of the kidneys
is to transport urine into the tubes known as ureters before it exits the body. These organs also
have several other important functions, however, such as helping to regulate blood pressure.
They also work to regulate the pH balance in the human body, as well as the balance of
electrolytes such sodium and potassium.
The ureters are small tubes made of muscle. These structures are attached at one end to the
kidneys, and to the bladder at the other. They use a small amount of pressure to gently force or
push urine from the kidneys to the bladder and then from the bladder to the urethra on its way
out of the body. The ureters also prevent urine from backing up and going back into the kidneys
once it has passed into the bladder, a disorder which would be known as reflux.
The next part of the system is the bladder, sometimes referred to as the urinary bladder. The
bladder is shaped much like a muscular, hollow balloon and sits in the pelvic area of the body. Its
primary function is to collect and store the urine that has left the kidneys. Once the bladder starts
to become full, the urine begins to leave the bladder and pass into the urethra.
The urethra is the final portion of the renal system. This structure is a hollow tube connected to
the bladder and passes through the genitals, exiting the body. The urethra passes through the
penis in males and is responsible for transporting both urine and semen. This tube is significantly
shorter in females and stops just above the opening to the vagina. An external muscle known as
the urethral sphincter helps to control the action of voluntary urination.
What Is Kidney Disease?
Kidney disease occurs when your kidneys are damaged and not functioning as they should.
When kidney disease persists, it is known as chronic kidney disease or CKD. When the kidney is
suddenly injured acute kidney injury or AKI results.
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Waste is not removed and it builds up. When you have chronic kidney disease waste
products and salts and water are not cleared from your body the way they should be
Chronic kidney disease usually progresses slowly over time but how fast it progresses
may be different from person to person
Signs or symptoms may not be obvious. The build-up of waste products usually does not
result in any specific signs or symptoms at the early stages of kidney disease. Often, few
symptoms appear until kidney function is reduced to less than 15% of normal
Other organs. The kidneys talk to many other body systems, including the heart, lungs,
brain, blood, and skin. These too may be affected when there is kidney disease
Risk Factors for Kidney Disease
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Diabetes and high blood pressure
Family history. If someone in your family has kidney disease, has been on dialysis or
received a kidney transplant, you may have a greater chance of developing kidney disease
than someone without this family history
Medicines. Some medications, such as over-the-counter pain medications (NSAIDS),
may cause or worsen kidney disease
Age and race. Older people and some racial groups may be more likely to develop kidney
disease
Reference: American Society of Nephrology
Comprehensive Metabolic Panel (CMP)
Date of Service: 01/01/15
Your Results:
Glucose: 106
Urea Nitrogen (BUN): 18
GFR Estimated: 78
BUN/Creatinine Ratio: 20.9
Sodium: 143
Potassium: 3.8
Chloride: 104
Carbon Dioxide (CO2): 25
Anion Gap: 14
Total Protein: 6.8
Albumin: 4.9
Globulin: 1.9
Calcium: 9.9
Alkaline Phosphatase: 75
Alanine Aminotransferase: 27
Aspartate Aminotransferase: 23
Total Bilirubin: 0.2
Normal CMP lab values:
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Albumin: 3.9 to 5.0 g/dL
Alkaline phosphatase: 44 to 147 IU/L
ALT (alanine aminotransferase): 8 to 37 IU/L
AST (aspartate aminotransferase): 10 to 34 IU/L
BUN (blood urea nitrogen): 7 to 20 mg/dL
Calcium: 8.5 to 10.9 mg/dL
Chloride: 96 - 106 mmol/L
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CO2 (carbon dioxide): 20 to 29 mmol/L
Creatinine: 0.8 to 1.4 mg/dL
Glucose test: 70 to 100 mg/dL
Potassium test: 3.7 to 5.2 mEq/L
Sodium: 136 to 144 mEq/L
Total bilirubin: 0.2 to 1.9 mg/dL
Total protein: 6.3 to 7.9 g/dL
Glucose
Glucose is the chief source of energy for all living organisms; however, abnormally high or low
blood glucose levels may be a sign of disease. For example, high glucose levels after 12 hours of
fasting may suggest diabetes. Low blood glucose, on the other hand, may be seen with certain
tumors or with liver disease.
Calcium
Calcium is one of the most important elements in the body. Ninety-nine percent of the calcium in
the body is in the bones. The remaining one-percent is in body fluids, such as blood, and is very
important for the proper function of nerves, enzymes, muscles, and blood clotting.
PROTEINS
Albumin
Approximately two-thirds of the total protein circulating in your blood is albumin. This
important protein keeps water inside your blood vessels. When your albumin level is too low,
water can leak out of your blood vessels into other parts of your body and cause swelling. A low
level of albumin in the blood can be caused by malnutrition, too much water in the body, liver
disease, kidney disease, severe injury such as burns or major bone fractures, and slow bleeding
over a long period of time.
Total Protein
This is a measure of the total amount of protein in your blood. A low or high total protein does
not indicate a specific disease, but it does indicate that some additional tests may be required to
determine if there is a problem.
ELECTROLYTES
Sodium
This element plays an important role in salt and water balance in your body. The adrenal
hormone, aldosterone, and the rate of excretion in urine, regulate the blood sodium level.
Potassium
This element is found inside all cells. Its role is to maintain water balance inside the cells and
help in the transmission of nerve impulses. The level of potassium in blood is of critical
significance.
CO2 (carbon dioxide, bicarbonate)
When bicarbonate levels are higher or lower than normal, it is a sign that the body is having
trouble maintaining its acid-base balance or that something has upset the electrolyte balance,
perhaps by losing or retaining fluid. Both of these imbalances may be due to a wide range of
dysfunctions.
Chloride
Chloride is another element that plays a role in salt and water balance. It is almost never the only
element that is low or high. Changes in the chloride level are usually associated with changes in
sodium or potassium. Borderline low or high levels of chloride usually have very little
significance. When there is too much or too little acid in the blood, chloride is an important clue
to the cause of the acid abnormality.
KIDNEY
BUN (Blood Urea Nitrogen)
BUN is a waste product derived from protein breakdown in the liver and excreted by the
kidneys. When your kidneys are not working well, the level of BUN in the blood will rise.
Dehydration and blood loss can also cause a high BUN level. Liver disease, a low protein diet, or
too much water intake may cause a low BUN level.
Creatinine
The blood concentration of creatinine depends upon two things – the amount of muscle you have
and the ability of your kidneys to excrete the creatinine. A high level of creatinine in the blood
usually indicates deterioration in kidney function.
LIVER
ALP (alkaline phosphatase)
Alkaline Phosphatase is found in all body tissues, but the most important sites are bone and liver.
Blood levels increase when bones are growing; thus children have higher levels than adults do.
High levels may also be seen in bone and liver disease. Certain drugs may cause high levels as
well.
ALT (alanine amino transferase) and AST (aspartate amino transferase)
AST and ALT are considered to be two of the most important tests to detect liver injury,
although ALT is more specific to the liver than is AST. Sometimes AST is compared directly to
ALT and an AST/ALT ratio is calculated. This ratio may be used to distinguish between
different causes of liver damage and to help recognize heart or muscle injury.
AST is found mainly in the heart, liver, and muscles.
Bilirubin
Bilirubin is the pigment in the blood that makes your blood plasma or serum yellow. Bilirubin
comes from the breakdown of old red cells in the blood. A high bilirubin level in the blood can
be caused by too many red cells being destroyed (hemolysis), by liver disease, or by a blockage
of the bile ducts. Fasting can also cause a slight increase in total bilirubin.
Endocrinology-Hormone-Reproductive
Your endocrine system is a collection of glands that produce hormones that regulate your body's
growth, metabolism, and sexual development and function. The hormones are released into the
bloodstream and transported to tissues and organs throughout your body.
Adrenal glands
Divided into 2 regions, the adrenals secrete hormones that influence the body's metabolism,
blood chemicals, and body characteristics, as well as influence the part of the nervous system
that is involved in the response and defense against stress
Hypothalamus
Activates and controls the part of the nervous system that controls involuntary body functions,
the hormonal system, and many body functions, such as regulating sleep and stimulating appetite
Ovaries and testicles
Secrete hormones that influence female and male characteristics, respectively
Pancreas
Secretes the hormones insulin and glucagon that control the use of glucose by the body
Parathyroid glands
Secretes a hormone called parathyroid hormone that maintains the calcium level in the blood
Pineal body
Involved with daily biological cycles and produces melatonin, which modulates sleep patterns
Pituitary gland
Produces a number of different hormones that influence various other endocrine glands
Thymus gland
Plays a role in the body's immune system
Thyroid gland
Produces hormones that stimulate body heat production, bone growth, and the body's metabolism
The Reproductive System
The reproductive system is a collection of organs that work together for the purpose of producing
a new life.
The major organs of the reproductive system include the external genitalia and internal organs,
including gonads that produce gametes, which are cells that fuse with another cell during
conception in organisms that reproduce sexually. Substances such as fluids, hormones, and
pheromones are also important to the effective functioning of the reproductive system.
The male reproductive system consists of two major parts – the testes, where sperm are
produced, and the penis. Having the testes outside the abdomen facilitates temperature regulation
of the sperm, which require specific temperatures to survive. If the testicles remain too close to
the body, the higher temperature will likely harm the spermatozoa, the mature sperm, making
conception more difficult or impossible. The testes are carried in an external pouch known as the
scrotum, where they normally remain slightly cooler than body temperature to facilitate sperm
production.
The two major parts of the female reproductive system are the vagina and uterus, which act as
the receptacle for semen, and the ovaries, which produce the female's ova. The vagina is attached
to the uterus through the cervix, while the fallopian tubes connect the uterus to the ovaries. In
response to hormonal changes, one ovum, or egg (more in the case of multiple births) is released
and sent down the fallopian tube during ovulation. If not fertilized, this egg is eliminated as a
result of menstruation. (Reference: American Medical Association)
AM- Cortisol
Date of Service: 01/01/15
Your Results: 9.6
Normal morning cortisol: 6-23g/dL
Cortisol is a hormone that plays a role in the metabolism of proteins, lipids, and carbohydrates. It
affects blood glucose levels, helps maintain blood pressure, and helps regulate the immune
system. Most cortisol in the blood is bound to a protein; only a small percentage is ‘free’ and
biologically active. Free cortisol is excreted into the urine and is present in the saliva.
The level of cortisol in the blood normally rises and falls in a ‘diurnal variation’ pattern. It peaks
early in the morning, then declines throughout the day, reaching its lowest level about midnight.
This pattern can change when a person works irregular shifts (such as the night shift) and sleeps
at different times of the day, and it can become disrupted when a disease or condition either
limits or stimulates cortisol production.
Cortisol is produced and secreted by the adrenal glands, two triangular organs that sit on top of
the kidneys. Production of the hormone is regulated by the hypothalamus in the brain and by the
pituitary gland, a tiny organ located below the brain. When the blood cortisol level falls, the
hypothalamus releases corticotropin-releasing hormone (CRH), which directs the pituitary gland
to produce ACTH (adrenocorticotropic hormone). ACTH stimulates the adrenal glands to
produce and release cortisol. In order for appropriate amounts of cortisol to be made, the
hypothalamus and both the pituitary and adrenal glands must be functioning properly.
Prostate Specific Antigen (PSA)
Date of Service:
Your Results:
Normal Range:
PSA is a protein produced primarily by cells in the prostate, a small gland that encircles the
urethra in males. The prostate produces a fluid that makes up a part of semen. Most of the PSA
that the prostate produces is released into this fluid, but small amounts of it are also released into
the bloodstream. PSA exists in two forms in the blood – free (not bound) and complexed (cPSA,
bound to a protein). The most frequently used PSA test is the total PSA, which measures the sum
of the free PSA and the cPSA in the blood. This test is used as a tumor marker to screen for and
to monitor the progression of prostate cancer. It is a useful tool but not a perfect one. Elevated
levels of PSA are associated with prostate cancer, but they may also be seen with prostatitis and
benign prostatic hyperplasia (BPH). Mild to moderately increased concentrations of PSA may be
seen in those of African American heritage, and levels tend to increase in all men as they age.
Current prostate cancer screening guidelines:






The American Urological Association (AUA) recommends against PSA screening in men
under 40 years of age
AUA does not recommend routine PSA screening in men between the ages 40 to 54 years
at average risk
For men under the age of 55 with higher risk (e.g. positive family history or African
American race) decisions regarding screening should be individualized
For men ages 55 to 69 years the Panel recognizes that the decision to undergo PSA
screening involves weighing the benefits of preventing prostate cancer mortality in 1 man
for every 1,000 men screened over a decade against the known potential harms associated
with screening and treatment. For this reason, the Panel strongly recommends shared
decision-making for men age 55 to 69 years that are considering PSA screening, and
proceeding based on a man's values and preferences
A routine screening interval of two years or more may be preferred over annual screening
in those men who have decided on screening. As compared to annual screening, it is
expected that screening intervals of two years reduce over-diagnosis and false positives
The Panel does not recommend routine PSA screening in men age 70+ years or any man
with less than a 10 to 15 year life expectancy (American Urological Association)
Total and Free Testosterone
Date of Service: 01/01/15
Your Results: Total: <20
Free: <0.3
Normal testosterone levels:


Male: 300 -1,000 ng/dL
Female: 15 - 70 ng/dL
Testosterone is a steroid hormone (androgen) produced by special endocrine tissue (the Leydig
cells) in the male testicles. It is also produced by the adrenal glands in both males and females
and, in small amounts, by the ovaries in females. This test measures the level of testosterone in
the blood.
In males, testosterone stimulates development of secondary sex characteristics, including
Enlargement of the penis, growth of body hair, muscle development, and a deepening voice. It is
present in large amounts in males during puberty and in adult males to regulate the sex drive and
maintain muscle mass.
In women, testosterone is converted to estradiol, the main sex hormone in females. Women’s
bodies produce testosterone but in small amounts. It is needed for hormonal balance and to help
women’s bodies to function normally.
We recommend making a diagnosis of androgen deficiency only in men with consistent
symptoms and signs and unequivocally low serum testosterone levels. We suggest the
measurement of morning total testosterone level by a reliable assay as the initial diagnostic test.
We recommend confirmation of the diagnosis by repeating the measurement of morning total
testosterone and in some men in whom total testosterone is near the lower limit of normal or in
whom sex hormone binding globulin (SHBG) abnormality is suspected by measurement of free
or bioavailable testosterone level, using validated assays. We recommend testosterone therapy
for men with symptomatic androgen deficiency to induce and maintain secondary sex
characteristics and to improve their sexual function, sense of well-being, muscle mass and
strength, and bone mineral density. We recommend against starting testosterone therapy in
patients with breast or prostate cancer, a palpable prostate nodule or induration or prostatespecific antigen greater than 4 ng/ml or greater than 3 ng/ml in men at high risk for prostate
cancer such as African Americans or men with first-degree relatives with prostate cancer without
further urological evaluation, hematocrit >50%, untreated severe obstructive sleep apnea, severe
lower urinary tract symptoms with International Prostate Symptom Score (IPSS) > 19, or
uncontrolled or poorly controlled heart failure. When testosterone therapy is instituted, we
suggest aiming at achieving testosterone levels during treatment in the mid-normal range with
any of the approved formulations, chosen on the basis of the patient’s preference, consideration
of pharmacokinetics, treatment burden, and cost. Men receiving testosterone therapy should be
monitored using a standardized plan.
J Clin Endocrinol Metab, June 2010, 95(6):2536–2559
Follicle-stimulating hormone (FSH)
Date of Service: 01/01/15
Your Results: 72.4
Normal FSH levels:

Male
o
o
o

Before puberty: 0 - 5.0 mIU/ml
During puberty: 0.3 - 10.0 mIU/ml
Adult: 1.5 - 12.4 mIU/ml
Female:
o Before puberty: 0 - 4.0 mIU/ml
o During puberty: 0.3 - 10.0 mIU/ml
o Women who are still menstruating: 4.7 - 21.5 mIU/ml
o After menopause: 25.8 - 134.8 mIU/ml
Follicle-stimulating hormone (FSH) is a hormone associated with reproduction and the
development of eggs in women and sperm in men. FSH is made by the pituitary gland, a grapesized organ located at the base of the brain. Control of FSH production is a complex system
involving the hypothalamus in the brain, the pituitary gland, and the hormones produced by the
ovaries or testicles. The hypothalamus releases gonadotropin-releasing hormone (GnRH), which
stimulates the pituitary to release FSH and luteinizing hormone (LH), a closely related hormone
also involved in reproduction.
In women, FSH stimulates the growth and maturation of eggs (follicles) in the ovaries during the
follicular phase of the menstrual cycle. The menstrual cycle is divided into the follicular and the
luteal phases, with each phase lasting about 14 days. During this follicular phase, FSH initiates
the production of estradiol by the follicle, and the two hormones work together in the further
development of the egg follicle. Near the end of the follicular phase, there is a surge of FSH and
luteinizing hormone. Release of the egg from the ovary (ovulation) occurs shortly after this surge
of hormones. Estradiol and progesterone help control the amount of FSH released by the
pituitary gland. FSH also facilitates the ability of the ovary to respond to LH.
As a woman ages and menopause approaches, ovarian function wanes and eventually ceases. As
this occurs, FSH and LH levels rise.
In men, FSH stimulates the testicles to produce mature sperm and also promotes the production
of androgen binding proteins. FSH levels are relatively constant in men after puberty.
Luteinizing hormone (LH)
Date of Service: 01/01/15
Your Results: 23.0
Normal results for adult women are:



Before menopause: 5 to 25 IU/L
Level peaks even higher around the middle of the menstrual cycle
Level then becomes higher in women after menopause: 14.2 to 52.3 IU/L
Normal result for men over 18 years of age is around 1.8 to 8.6 IU/L.
Luteinizing hormone (LH) is a hormone associated with reproduction and the stimulation of the
release of an egg from the ovary (ovulation) in women and testosterone production in men. LH is
produced by the pituitary gland. Control of LH production is a complex system involving the
hypothalamus in the brain, the pituitary gland, and the hormones produced by the ovaries and
testicles.
In premenopausal women, several hormones rise and fall in a specific sequence during each
menstrual cycle. During the cycle, LH stimulates ovulation and the production of other
hormones, estradiol and progesterone.
In men, LH stimulates Leydig cells in the testicles to produce testosterone. LH levels are
relatively constant in men after puberty. A high testosterone level provides negative feedback to
the pituitary gland and the hypothalamus, thus decreasing the amount of LH secreted.
Prolactin
Date of Service: 01/01/15
Your Results: 7.5
Normal values for prolactin:



Males: 2 - 18 ng/mL
Nonpregnant females: 2 - 29 ng/mL
Pregnant women: 10 - 209 ng/mL
Prolactin is a hormone produced by the anterior portion of the pituitary gland. Normally present
in low amounts in men and non-pregnant women, prolactin's primary role is to promote lactation
(breast milk production).
Prolactin secretion is regulated and inhibited by the brain chemical dopamine. A common cause
of an abnormally elevated prolactin level is a prolactinoma, a tumor of the pituitary gland that
causes excess production of prolactin. Prolactinomas are the most common type of pituitary
tumors and are usually benign. They develop more frequently in women but are also found in
men. Problems resulting from them can arise both from the unintended effects of excess
prolactin, (such as milk production in a woman who is not pregnant or nursing and, rarely, in a
man – galactorrhea) and from the size and location of the tumor. These tumors, if large enough,
can put pressure on the optic chiasm, leading to partial blindness.
Estradiol
Date of Service: 01/01/15
Your Results: Estradiol ( E2) 39
Estrone (E1)
20.6
Estriol (UE3) <0.07
Normal estradiol levels:



Male: 10 to 50 picograms per milliliter (pg/mL)
Female (premenopausal): 30 to 400 pg/mL
Female (postmenopausal): 0 to 30 pg/mL
Estrogens are a group of steroids that are responsible for the development and function of
reproductive organs and the formation of secondary sex characteristics in women. Along with
another hormone, progesterone, they help regulate the menstrual cycle, are involved in the
growth of breasts and the uterus, and help maintain a healthy pregnancy. Though considered the
main sex hormones for women, they are also found in men and play a role in bone metabolism
and growth in both sexes. Estrogen tests measure one of three components: estrone (E1),
estradiol (E2), or estriol (E3) in the blood or urine.



Estrone (E1) is directly converted from androstenedione (from the adrenal gland) or
indirectly from other androgens. E1 can also be produced by the ovaries and placenta,
testicles, and adipose (fat) tissues. E2 and E1 can be converted into each other as needed. E1
is the primary estrogen in men and in post-menopausal women.
Estradiol (E2) is primarily produced in the ovaries in pre-menopausal women and in the
testicles in men. E2 is converted from E1 in post-menopausal women. It is the most potent
estrogen and the one that is present in the highest concentration in non-pregnant, premenopausal women. E2 levels vary depending on a woman's age and reproductive status.
They are a good marker of ovarian function.
Estriol (E3) is produced by the placenta, with concentrations rising throughout a woman's
pregnancy. Increasing levels are an indication of the health of the pregnancy and developing
baby. Estriol is part of the second trimester maternal serum screen, a test performed to
evaluate fetal risk due to certain chromosomal abnormalities. Very low levels of E3 are
present in non-pregnant women or men.
Estrogen in Girls and Women
The types and amounts of estrogen normally present in a woman's blood will vary throughout her
lifetime. Levels vary during each menstrual cycle, during pregnancy, and on a daily basis.

At Birth
Estradiol (E2) and estrone (E1) are high but fall within a few days. Concentration levels
are minimal during early childhood

At Puberty
Concentrations of E2 and E1 begin to rise as puberty approaches. These estrogens are
responsible for the development of breasts, uterine growth, and (with other hormones) the
onset and regulation of menstruation. A moderate amount of E1 is present from puberty
to menopause. This concentration will vary during the day but is otherwise relatively
stable
During Menstruation
The menstrual cycle is approximately 28 days long and consists of two phases, follicular
phase and luteal phase. During each cycle, estradiol (E2) and several other hormones
normally rise and then fall in a specific sequence


During Menopause
Estrone (E1) is the primary estrogen present during menopause. E2 concentrations
significantly decrease as ovarian production wanes and eventually stabilize at a low level.
Estrogen in Boys and Men
The types and amounts of estrogen normally present in a man's blood change, but they vary
much less over time than a woman's and they are much lower overall. Estrogen levels are
monitored regularly in men on hormone replacement therapy (HRT) as higher levels of
testosterone can convert into estrogen.
Dehydroepiandrosterone Sulfate (DHEAS)
Date of Service: 01/01/15
Your Results: 61
Typical normal ranges for females are:
 Ages 18 - 19: 145 - 395 micrograms per
deciliter (ug/dL)
 Ages 20 - 29: 65 - 380 ug/dL
 Ages 30 - 39: 45 - 270 ug/dL
 Ages 40 - 49: 32 - 240 ug/dL
 Ages 50 - 59: 26 - 200 ug/dL
 Ages 60 - 69: 13 - 130 ug/dL
 Ages 69 and older: 17 - 90 ug/dL
Typical normal ranges for males are:
 Ages 18 - 19: 108 - 441 ug/dL
 Ages 20 - 29: 280 - 640 ug/dL
 Ages 30 - 39: 120 - 520 ug/dL
 Ages 40 - 49: 95 - 530 ug/dL
 Ages 50 - 59: 70 - 310 ug/dL
 Ages 60 - 69: 42 - 290 ug/dL
 Ages 69 and older: 28 - 175 ug/dL
Dehydroepiandrosterone sulfate (DHEAS) is a male sex hormone (androgen) that is present in
both men and women. DHEAS plays a role in developing male secondary sexual characteristics
at puberty. It can be converted by the body into more potent androgens, such as testosterone and
androstenedione. It can also be converted into the female hormone estrogen. DHEAS is produced
almost exclusively by the adrenal glands, with smaller amounts being produced by a woman's
ovaries and a man's testicles. This test can be a useful as a marker for adrenal gland function.
Progesterone
Date of Service: 01/01/15
Your Results: 0.3
Normal progesterone levels:







Female (pre-ovulation): less than 1 ng/mL
Female (mid-cycle): 5 to 20 ng/mL
Male: less than 1 ng/mL
Postmenopausal: less than 1 ng/mL
Pregnancy 1st trimester: 11.2-90.0 ng/mL
Pregnancy 2nd trimester: 25.6-89.4 ng/mL
Pregnancy 3rd trimester: 48-150 to 300 or more ng/mL
Progesterone is a steroid hormone whose main role is to help prepare a woman's body for
pregnancy. It works in conjunction with several other female hormones. On a monthly basis, the
hormone estrogen causes the lining of the uterus, the endometrium, to grow and replenish itself,
while a surge in luteinizing hormone (LH) leads to the release of an egg from one of two ovaries.
A corpus luteum then forms in the ovary at the site where the egg was released and begins to
produce progesterone. This progesterone, supplemented by small amounts produced by the
adrenal glands, stops endometrial growth and readies the uterus for the possible implantation of a
fertilized egg.
If fertilization does not occur, the corpus luteum degenerates, progesterone levels drop, and
menstrual bleeding begins. If a fertilized egg is implanted in the uterus, the corpus luteum
continues to produce progesterone, with the egg forming a trophoblast that produces human
chorionic gonadotropin (hCG). After several weeks, the placenta replaces the corpus luteum as
the main source of progesterone, producing relatively large amounts of the hormone throughout
the rest of a normal pregnancy.
Progesterone is also produced in males but at a much lower level. Its function involves the
development of sperm.
Thyroid Stimulating Hormone
(TSH w/ reflx to Free T4)
Date of Service: 01/01/15
Your Results: TSH: 0.005
Total T4: 5.9
Free T3: 3.5
Free T4: 0.97
Normal TSH levels: 0.4 - 4.0mIU/L
Normal T4 levels: 4.5 – 11.2mcg/dL
Thyroid-stimulating hormone (TSH) is produced by the pituitary gland, a tiny organ located
below the brain and behind the sinus cavities. TSH stimulates the thyroid gland to release the
hormones thyroxine (T4) and triiodothyronine (T3) into the blood. These thyroid hormones help
control the rate at which the body uses energy. TSH, along with its regulatory hormone
thyrotropin releasing hormone (TRH), which comes from the hypothalamus, is part of the
feedback system that the body uses to maintain stable amounts of thyroid hormones in the blood.
When thyroid hormone concentrations decrease, the production of TSH by the pituitary gland is
increased. TSH in turn stimulates the production and release of T4 and T3 by the thyroid gland, a
small butterfly-shaped gland that lies at the base of the throat flat against the windpipe. When all
three organs are functioning normally, thyroid production turns on and off to maintain relatively
stable levels of thyroid hormones in the blood.
Hematology/Oncology
A hematologist is an expert in the investigation, diagnosis, and management of disorders of the
aforementioned organ systems through the use of the medical history, physical findings,
specialized clinical laboratory tests, and evaluation of tissue or cytological specimens. Clinical
entities considered specific to the specialty of hematology include disorders of the structure,
function, and physiology of red and white blood cells and platelets, disorders of hemostatic
system regulation or function, and benign and malignant disorders of the bone marrow and
lymphoreticular system. Hematologists also evaluate and manage systemic disorders and other
poorly understood diseases that clinically present as abnormalities of the aforementioned organ
systems.
In addition to therapeutic measures common to all medical specialists, therapies in the following
areas are considered specific to the expertise of a hematologist:

Blood products and derivatives

Blood processing

Hematinics

Immunosuppressives

Chemotherapy and other anti-tumor agents

Supportive care (including pain management)

Anticoagulants and antithrombotic agents

Progenitor cell therapies (including stem cell therapies)
Obesity and Cancer
Obesity is quickly overtaking tobacco as the leading preventable cause of cancer, and although
data are still emerging, research suggests that the risk of developing and dying from many
common cancers is increased in obese individuals. Obesity is also linked to poorer cancer
outcomes, including increased risk of recurrence and of both cancer-specific and overall
mortality.
Oncologists play a critical role in patient education, as well as in education of caregivers and
families, regarding the importance of weight management. Oncologists are also often the main
source of referrals to appropriate sources where patients and their families can receive sound
guidance. ASCO is committed to informing oncology providers regarding the existing data
linking obesity, inactivity and poor diet to poor outcomes in patients with cancer and to provide
educational materials for patients regarding the role of weight management and healthy lifestyle
behaviors in cancer.
Reference: American Society of Hematology & American Society of Oncology
Complete Blood Count (CBC)
Date of Service: 01/01/15
Your Results: WBC:
7.5
RBC: 4.46
Hemoglobin: 13.8
Hematocrit: 42.8
MCV: 96
MCH: 30.9
Platelet Count: 368
RDW (sd): 47.8
RDW (cv): 13.4
MPV: 10.3
Segmented Neutrophils: 50
Lymphocytes: 41
Monocytes: 7
Eosinophils: 1
Basophils: 0
Absolute Neutrophil: 3.8
Absolute Lymphocyte: 3.1
Absolute Monocyte: 0.5
Absolute Eosinophil: 0.1
Absolute Basophil: 0.0
Immature Granulocytes: 0
Absolute Immature Granulocytes: 0.0
Normal Range:
The complete blood count (CBC) is often used as a broad screening test to determine an
individual's general health status. It can be used to screen a wide range of conditions such as
anemia, infection, inflammation, bleeding disorders and others. It can also monitor the condition
and/or effectiveness of treatment after a diagnosis is established
Red Blood Cells (RBCs) – transporting oxygen throughout the body
RBCs play a vital role in transporting oxygen from the lungs to the rest of the body. These ovalshaped cells contain hemoglobin, the protein that binds oxygen while it is being carried to all the
stationary cells in the body (cells in the skin, muscle, bone and organs). The chemical process
that converts the nutrients found in food into energy requires oxygen. All the stationary cells
require energy to function; thus, they need oxygen and are dependent on the RBCs to transport it.
More about hemoglobin
Hemoglobin (Hb or Hgb) is an iron-rich protein that carries oxygen and makes the blood red.
Since hemoglobin is contained only in the RBCs, a low number of RBCs leads to low levels of
hemoglobin. However, if there is something wrong with the RBCs, hemoglobin levels can be
low even when the RBC count (i.e. number of RBCs) is within the reference range. So a CBC
test report includes the number of RBCs, the amount of hemoglobin, and other measurements
related to the RBCs.
Other RBC measurements
The hematocrit reflects the amount of space in the blood that is occupied by RBCs. Hematocrit
measurements are affected by the number of RBCs and by the size of the RBCs.
The mean corpuscle (cell) volume (MCV) is a measurement of the average size of the RBCs.
Small-sized RBCs result in a lower MCV, while larger RBCs result in a higher MCV.
The mean corpuscular hemoglobin (MCH) reflects the average amount of hemoglobin in a
person’s RBCs. RBCs with more hemoglobin result in a higher MCH and vice versa.
The mean corpuscular hemoglobin concentration (MCHC) is a measurement of the average
amount of hemoglobin in the RBCs compared to the average size of the RBCs. Put another way,
the MCHC is the ratio of the MCH to the MCV.
The red cell distribution width (RDW) reflects the degree of variation in size of the RBCs. Not
all the RBCs are the same size; some are larger and some are smaller. The RDW measurement is
affected by the size of the smallest RBC and the size of the largest RBC.
White Blood Cells (WBCs) – defending your body
WBCs help the body fight illness or infection. As part of the immune system, they recognize and
fight things that are foreign to (not part of) the body. The number of WBCs (WBC count) is
lower than the number of RBCs; however, the WBCs are larger in size RBCs. There are 5 types
of WBCs; each type plays a different role in protecting the body from invaders.
Types of WBCs





Neutrophils are cells that protect the body from bacterial infections. They move toward
bacteria and then ingest them so the bacteria cannot harm the body
Lymphocytes are cells that protect the body against viruses, bacteria, and fungi. One type
of lymphocyte (B-cell) produces antibodies that attack and destroy the bacteria and
viruses. Another type of lymphocyte (T-cell) can directly attack viruses and bacteria and
can stimulate the B-cells to produce antibodies
Monocytes are cells that consume dead or damaged cells. They are the ‘clean-up crew’
Eosinophils are cells that kill parasites and contribute to allergic reactions
Basophils are cells that release histamines during allergic reactions
The differential – visualizing the cells
When performing a differential, a medical technologist looks at the various cells under a
microscope. A differential provides information about the relative numbers (that is, the
percentage) of each type of WBC. Such information helps the doctor determine whether an
illness is caused by a bacteria, a virus, or leukemia. A differential can be used to monitor patients
with allergies and to determine how a patient is recovering from an illness or responding to
therapy.
In addition to the cell types listed previously, certain cell types that don’t normally appear in the
blood can be reported in the differential. These cells include promyelocytes, metamyelocytes,
blasts, etc. Finally, the differential can provide information about the appearance of RBCs, since
the cells are visualized under a microscope. Anisocytosis is the term used for abnormal RBC
shape and can occur in various anemias.
Platelets – helping to clot blood
Platelets are the smallest blood cells. They are an important part of blood clotting. These small
cells clump together and form a sticky mass that helps the blood to clot. Blood clots help your
body handle injury by stopping or preventing bleeding.
Neurology/Nervous System
The nervous system is a complex collection of nerves and specialized cells known as neurons
that transmit signals between different parts of the body. Vertebrate animals with backbones and
spinal columns have central and peripheral nervous systems.
The central nervous system is made up of the brain, spinal cord and retina. The peripheral
nervous system consists of sensory neurons, ganglia (clusters of neurons) and nerves that connect
to one another and to the central nervous system.
The nervous system is essentially the body’s electrical wiring. It is composed of nerves, which
are cylindrical bundles of fibers that start at the brain and central cord and branch out to every
other part of the body.
Neurons send signals to other cells through thin fibers called axons, which cause chemicals
known as neurotransmitters to be released at junctions called synapses. A synapse gives a
command to the cell and the entire communication process typically takes only a fraction of a
millisecond.
Sensory neurons react to physical stimuli such as light, sound and touch and send feedback to the
central nervous system about the body’s surrounding environment. Motor neurons, located in the
central nervous system or in peripheral ganglia, transmit signals to activate the muscles or
glands.
Glial cells, support the neurons and hold them in place. Glial cells also feed nutrients to neurons,
destroy pathogens, remove dead neurons and direct the axons of neurons to their targets. Specific
types of glial cells (oligodendrocytes in the central nervous system and Schwann cells in the
peripheral nervous system) generate layers of a fatty substance called myelin that wraps around
axons and provides electrical insulation to enable them to rapidly and efficiently transmit signals.
There are more than 600 neurologic diseases. A neurological disorder is any disorder of the
body’s nervous system. There are many recognized neurological disorders, some relatively
common, but many rare. Structural, biochemical or electrical abnormalities in the brain, spinal
cord or other nerves can result in a range of symptoms. They may be assessed by neurological
examination, and studied and treated within the specialties of neurology and clinical
neuropsychology.
Major types include




Diseases caused by faulty genes, such as Huntington’s disease and muscular dystrophy
Problems with the way the nervous system develops, such as spina bifida
Degenerative diseases, where nerve cells are damaged or die, such as Parkinsons’s
disease and Alzheimer’s disease
Diseases of the blood vessels that supply the brain, such as stroke




Injuries to the spinal cord and brain
Seizure disorders, such as epilepsy
Cancer, such as brain tumors
Infections, such as meningitis
Reference: American Academy of Neurology
Muscular System
This system is made up of:

Bones
A bone is a rigid organ that constitutes part of the vertebral skeleton. Bones support and protect
the various organs of the body, produce red and white blood cells, store minerals and also enable
mobility. Bone tissue is a type of dense connective tissue. Bones come in a variety of shapes and
sizes and have a complex internal and external structure. They are lightweight yet strong and
hard, and serve multiple functions. Mineralized osseous tissue, or bone tissue, is of two types –
cortical and cancellous, providing rigidity and a coral-like three-dimensional internal structure.
Other types of tissue found in bones include marrow, endosteum, periosteum, nerves, blood
vessels and cartilage.
In the human body at birth, there are over 270 bones, but many of these fuse together during
development, leaving a total of 206 separate bones in the adult, not counting numerous
small sesamoid bones. The largest bone in the body is the thigh-bone (femur) and the smallest is
the stapes in the middle ear

Joints
Joints are mainly classified structurally and functionally. Structural classification is determined
by how the bones connect to each other, while functional classification is determined by the
degree of movement between the articulating bones.

Ligaments
Articular Ligaments
‘Ligament’ most commonly refers to a band of dense regular connective tissue bundles made
of collagenous fibers, with bundles protected by dense irregular connective tissue sheaths.
Ligaments connect bones to other bones to form joints. Some ligaments limit the mobility of
articulations, or prevent certain movements altogether.
Ligaments are viscoelastic. They gradually strain when under tension, and return to their original
shape when the tension is removed. However, they cannot retain their original shape when
extended past a certain point or for a prolonged period of time. This is one reason
why dislocated joints must be set as quickly as possible: if the ligaments lengthen too much, then
the joint will be weakened, becoming prone to future dislocations. Athletes, gymnasts, dancers,
and martial artists perform stretching exercises to lengthen their ligaments, making their joints
more supple.
The term hypermobility refers to people with more-elastic ligaments, allowing their joints to
stretch and contort further; this is sometimes still called double-jointedness.

Muscles
The Human muscular system is made up of a complex network of soft tissues, which are called
muscles. Muscle tissue is found throughout the human body and it has the following functions:
1. Movement. Skeletal muscles attached to the skeleton move the body by moving bones.
The muscles in the walls of some of our visceral organs squeeze to produce movement of
fluids and other substances through the hollow passageways as well as regulating organ
volume
2. Maintenance of Posture. Some skeletal muscles contract continuously to maintain
posture, enabling the body to remain in standing or sitting positions
3. Joint stabilization. The role of muscle tone in stabilizing and strengthening joints
4. Heat generation. Muscle contractions produce heat that plays a vital role in maintaining
normal body temperature at 37°C (98.6°F)
Muscle tissue possesses some unique characteristics that help to differentiate it from other bodily
tissue such as the following:
1. Contractility. A notable characteristic of muscles are that they can contract forcefully.
Muscle cells shorten and generate a strong pulling force as they contract
2. Excitability. Nerve signals or other factors excite muscle cells, causing electrical
impulses to travel along the cells’ plasma membrane. These impulses then stimulate the
cells to contract
3. Extensibility. Muscle tissue can be stretched by the contraction of an opposing muscle
4. Elasticity. After being stretched, muscle tissue can recoil passively and resume its usual
resting length
Several sheaths of connective tissue hold the fibers of a skeletal muscle together. These sheaths,
from external to internal, are as follows:
1. Epimysium. An “overcoat” of dense, irregular connective tissue surrounds the whole
skeletal muscle. This coat is the epimysium, a name that means “outside the muscle.”
Sometimes the epimysium blends with the deep fascia that lies between neighboring
muscles
2. Perimysium. Within each skeletal muscle, the muscle fibers are separated into groups.
Each group, which resembles a bundle of sticks tied together, is called a fascicle
(bundle). Surrounding each fascicle is a layer of fibrous connective tissue called
perimysium
3. Endomysium. Within a fascicle, each muscle fiber is surrounded by a fine sheath of
loose connective tissue consisting mostly of reticular fibers. This layer is the
endomysium (within the muscle)
These fibrous connective tissues bind muscle fibers together and hold them in parallel alignment
so they can work together to produce force. These muscle fibers are made up of millions of tiny
protein filaments known as myocytes that slide past each other to either contract (shorten) or
relax (lengthen) the muscle, resulting in changing the length and size of the fiber. As a result of
this contraction force is produced to create motion. This force exerted by the muscle is a result of
converting chemical energy in complex chemical reactions inside the muscle which causes the
muscles into tension and contraction. When muscle fibers contract, they pull on the surrounding
endomysium. Because of the continuity between sheaths, this pull is then exerted on the
perimysium, epimysium, and tendon, a sequence that transmits the force of contraction to the
bone being moved. The sheaths also provide a muscle with much of its natural elasticity and
carry the blood vessels and nerves that serve the muscle fibers. Muscles are used throughout the
human body to assist in nearly all of our day to day functions such as walking, running, lifting,
standing, squatting, driving, riding as well as looking in different directions, breathing, digestion
of our food and most importantly the beating of our hearts.
How many muscles does the human body have? This is a difficult question to answer. Each
human body possesses between 600 and 700 different muscles throughout the body. The exact
number is not actually known due mainly to the many differing types of muscles found in the
body. Opinions vary as to what should or should not be included in the muscle count. For
example, each hair follicle has a tiny muscle surrounding it at the base and these muscles
contract to make the hair stand on edge (goose bumps). There are five million of these tiny
muscles.

Nerves
A nerve is an enclosed, cable-like bundle of axons (the long, slender projections of neurons) in
the peripheral nervous system. A nerve provides a common pathway for the electrochemical
nerve impulses that are transmitted along each of the axons to peripheral organs.

In the central nervous system, the analogous structures are known as tracts. Neurons are
sometimes called nerve cells, nerves also include non-neuronal schwann cells that coat the
axons in myelin.

Each nerve is a cordlike structure that contains many axons, also called nerve fibers.
Within a nerve, each axon is surrounded by a layer of connective tissue called the
endoneurium. The axons are bundled together into groups called fascicles, and each
fascicle is wrapped in a layer of connective tissue called the perineurium. Finally, the
entire nerve is wrapped in a layer of connective tissue called the epineurium.
Nerves are categorized into three groups based on the direction that signals are conducted:



Afferent nerves conduct signals from sensory neurons to the central nervous system
Efferent nerves conduct signals from the central nervous system along motor neurons to
their target muscles and glands.
Mixed nerves contain both afferent and efferent axons, and thus conduct both incoming
sensory information and outgoing muscle commands in the same bundle.
Nerves can be categorized into two groups based on where they connect to the central nervous
system:


Spinal nerves innervate much of the body, and connect through the spinal column to
the spinal cord. They are given letter-number designations according to the vertebra through
which they connect to the spinal column.
Cranial nerves innervate parts of the head, and connect directly to the brain (especially to
the brainstem).
Bone Mineral Density Test (BMD)
Date of Service: 01/01/15
Your Results: T-score AP L-spine: 0.2
T-score Right femur: -1.3
T-score Left femur: -1.8
WHO classification: Osteopenia
A bone mineral density (BMD) test is the best way to determine your bone health. The test
can identify osteoporosis, determine your risk for fractures (broken bones), and measure your
response to osteoporosis treatment. The most widely recognized BMD test is called a dualenergy x-ray absorptiometry, or DXA test, which is what is used in Dr. Carfagno’s office.
There are a variety of factors – both controllable and uncontrollable – that put you at risk for
developing osteoporosis:
Uncontrollable Risk Factors
•Being over age 50.
•Being female.
•Menopause.
•Family history of osteoporosis.
•Low body weight/being small and thin.
•Broken bones or height loss.
Controllable Risk Factors
•Not getting enough calcium and vitamin D.
•Not eating enough fruits and vegetables.
•Getting too much protein, sodium and caffeine.
•Having an inactive lifestyle.
•Smoking.
•Drinking too much alcohol.
•Losing weight.
A woman’s risk of breaking a hip due to osteoporosis is equal to her risk of breast, ovarian
and uterine cancer combined. And a man age 50 or older is more likely to break a bone due
to osteoporosis than he is to get prostate cancer.
There are also medications and diseases that can cause bone loss and increase your risk of
osteoporosis.
Dermatology/Skin
Body organs are not all internal like the brain or the heart. There's one we wear on the outside.
The skin is our largest organ – adults carry some 8 pounds (3.6 kilograms) and 22 square feet (2
square meters) of it. This fleshy covering does a lot more than make us look presentable. In fact,
without it, we'd literally evaporate.
Skin acts as a waterproof, insulating shield, guarding the body against extremes of temperature,
damaging sunlight, and harmful chemicals. It also exudes antibacterial substances that prevent
infection and manufactures vitamin D for converting calcium into healthy bones. Skin
additionally is a huge sensor packed with nerves for keeping the brain in touch with the outside
world.
Skin is made up of three layers. The outermost is the epidermis. This consists mainly of cells
called keratinocytes, made from the tough protein keratin (also the material in hair and nails).
Keratinocytes form several layers that constantly grow outwards as the exterior cells die and
flake off. It takes roughly five weeks for newly created cells to work their way to the surface.
This covering of dead skin is known as the stratum corneum, or horny layer, and its thickness
varies considerably, being more than ten times thicker on the soles of the feet than around the
eyes. The epidermis harbors defensive Langerhans cells, which alert the body's immune system
to viruses and other infectious agents.
The epidermis is bonded to a deeper skin layer below known as the dermis, which gives the
organ its strength and elasticity thanks to fibers of collagen and elastin. Blood vessels here help
regulate body temperature by increasing blood flow to the skin to allow heat to escape, or by
restricting the flow when it's cold. A network of nerve fibers and receptors pick up feelings such
as touch, temperature, and pain, relaying them to the brain.
The dermis houses hair follicles and glands with ducts that pass up through the skin. Sweat
glands bring down internal temperature through perspiration while ridding the body of the waste
fluids urea and lactate. Apocrine glands, which develop during puberty, produce a scented sweat
linked to sexual attraction that can also cause body odor, especially around the armpits.
Sebaceous glands secrete oil-like sebum for lubricating the hair and skin.
The skin's base layer is the subcutis, which includes a seam of fat laid down as a fuel reserve in
case of food shortage. It also works as insulation and cushions us from knocks and falls.
Skin Color
Skin color is due to melanin, a pigment produced in the epidermis to protect us from the sun's
potentially cancer-causing ultraviolet (UV) rays.
It is currently estimated that one in five Americans will develop skin cancer in their lifetime.
Exposure to ultraviolet light is the most preventable risk factor for skin cancer. If you could
reduce your risk of skin cancer by seeking shade, wearing sunscreen and protective clothing, and
avoiding tanning beds, wouldn’t you?
Not only is skin cancer preventable, it is highly treatable when caught early. Because the signs
of skin cancer are visible on the surface, call your dermatologist when you see something
unusual, growing or changing on your skin. The five-year survival rate for people whose
melanoma is detected and treated before it spreads is 98%. Yet, one American dies from
melanoma, the deadliest form of skin cancer, almost every hour
ABCDE’s of skin cancer
A-asymmetry
If you draw a line through this mole, the two halves will not match.
B-borders
The borders of an early melanoma tend to be uneven. The edges may be scalloped or notched.
C-color
Having a variety of colors is another warning signal. A number of different shades of brown, tan
or black could appear. A melanoma may also become red, blue or some other color.
D-Diameter
Melanomas usually are larger in diameter than the size of the eraser on your pencil (1/4 inch or 6
mm)
E-Evolving
Reference: American Academy of Dermatology
Metabolic and Fitness
Similar to reading a road map, your journey to higher, healthier fitness begins with first knowing
where you are and then making a plan to get where you want to go. Fitness testing is used to
establish your baselines in basic markers of fitness – daily calories needed for normal function,
body fat percentage, muscle mass, maximal aerobic capacity, and current aerobic and anaerobic
training zones. A review of your 24-48 food diary will also be discussed with you.
Your fitness testing will include a resting metabolic rate (RMR), body composition, and aerobic
capacity (VO2 max).
An exercise physiologist/strength and conditioning specialist will then review your body
composition, RMR, and VO2 max results and will apply these results to help you achieve your
individual goals.
Body Composition (Body fat % and Lean Mass)
Body composition is a vital component of health and wellness in the general population as well
as impacting athletic performance in active populations. Most people understand the concept of
achieving and maintaining an appropriate body fat level. However, not everyone realizes the
importance of maintaining or increasing lean mass levels as we age.
According to the American College of Sports Medicine (ACSM), sarcopenia is the most
common age-related change in our bodies. Sarcopenia is the loss of muscle mass, specifically,
the fibers that produce the most force. What this means is that as we age our muscles get weaker
and we are not able to move as efficiently, protect ourselves from falls as effectively, or burn as
many calories as when we were younger. Thus, it is important to not only track changes to your
fat percentage, but also make sure your muscle mass doesn’t drop.
The DEXA machine, which is considered the industry gold standard, will determine body fat
percentage. The entire scan takes 6 to 12minutes. The computer software reconstructs the x-ray
beams to produce an image of the underlying tissues and quantify bone mineral content, total fat
mass, and fat-free mass.
Date of Service: 01/01/15
Your body fat percentage: 35.6 %
Fat Mass (lbs): 51.8
Muscle Mass (lbs): 93.8
Bodyfat % Norms
Athletic
Healthy
Overfat
Obese
Men
5-12%
13-22%
23-29%
>30%
Women
15-23%
24-34%
35-40%
>41%
Resting Metabolic Rate (RMR)
Your BASE calories per day: 1357 kcal/d
Date of Service: 01/01/15
In the past, a metabolic test was only been available at universities and hospitals.
This test shows precisely how much energy (calories) you burn in a day. Metabolic Testing is a
simple 10-20 minute breath test. You simply sit back, relax and breathe!
During the test, the air you breathe out is analyzed to determine exactly how much oxygen is
used by your body and therefore how many calories your body is consuming.
Once completed, your metabolic rate will be used to calculate your daily caloric intake goals.
This is powerful information to help you lose weight effectively.
VO2
A VO2 max is the gold standard, maximal exercise test to determine your aerobic capacity. With
Scottsdale Sports Medicine Institute’s on-site and portable off-site testing capabilities, the test
can be performed in virtually any exercise environment, whether it be here at the fitness lab,
around your local track, in a health club, or even climbing a mountain. For the test, the subject
will breathe through a mouthpiece connected to a metabolic analyzer, and he/she will wear a
heart-rate monitor. The analyzer measures the volume, as well as the percentage of carbon
dioxide and oxygen, in the expired gas.
VO2 MAX: For those who take the test to completion (so that we are able to determine VO2 Max),
VO2 max is the volume of oxygen the body uses during one minute of maximal exercise.
Expressed as liters of oxygen per minute, or milliliters of oxygen per kilogram of bodyweight per
minute, this data tells your potential for endurance athletics. While anaerobic threshold is the
best predictor of current endurance performance, VO2 max indicates the ultimate genetic potential
of an athlete after several years of systematic, structured training. On average, an individual may
improve VO2 max 15-25% in the first year of structured training, with a significantly slower rate
of improvement after that.
Date of Service: 7/10/15
Your Results: VO2 max: 29 ml/kg/min
Anaerobic Threshold heart rate: 152 bpm
Peak VO2 Ratings for Executives
Fitness Score
<20 years
21-29 years
30-39 years
40-49 years
50-99 years
Poor
0-23
0-19
0-16
0-14
0-12
Below Avg.
24-30
20-27
17-23
15-20
13-14
Average
31-37
28-33
24-30
21-27
18-23
Good
38-48
34-44
31-41
28-37
23-34
Excellent
>48
>44
>41
>37
>34
Peak VO2 Ratings for MALE Athletes
Rating
18-25
26-35
36-45
46-55
56-65
65+
Excellent
>60
>56
>51
>45
>41
>37
Good
52-60
49-56
43-51
39-45
36-41
33-37
Above Avg
47-51
43-48
39-42
36-38
32-35
29-32
Average
42-46
40-42
35-38
32-35
30-31
26-28
Below Avg
37-41
35-39
31-34
29-31
26-29
22-25
Poor
30-36
30-34
26-30
25-28
22-25
20-21
Very Poor
<30
<30
<26
<25
<22
<20
Peak VO2 Ratings for FEMALE Athletes
Rating
18-25
26-35
36-45
46-55
56-65
65+
Excellent
>56
>52
>45
>40
>37
>32
Good
47-56
45-52
38-45
34-40
32-37
28-32
Above Avg
42-46
39-44
34-37
31-33
28-31
25-27
Average
38-41
35-38
31-33
28-30
25-27
22-24
Below Avg
33-37
31-34
27-30
25-27
22-24
19-21
Poor
28-32
26-30
22-26
20-24
18-21
17-18
Very Poor
<28
<26
<22
<20
<18
<17
ANAEROBIC THRESHOLD: Also known as the “race pace” intensity, the anaerobic
threshold (AT) is the intensity, as measured by heart rate, at which the body starts to accumulate
lactate in the blood. Blood lactate is the accumulation of metabolic byproducts (lactic acid in the
muscles) when your muscles work without oxygen. As you work harder and harder,
progressively less oxygen is available to the muscles thereby increasing lactic acid production as
a result.
Practically speaking, working at an intensity just at anaerobic threshold (AT), an athlete is
working hard, but feels no burning in the muscles and breathes heavy, controlled breaths. Above
AT, lactic acid builds up in the muscles causing burning and aching and then accumulates in the
bloodstream, triggering overall fatigue. Knowing your AT allows you to precisely program your
aerobic and anaerobic training zones to maximize your desired results for your time and effort.
Unlike the VO2 max, the AT is a constantly changing value which is dependent on your current
fitness and training plan. It represents a ‘snapshot’ of your current conditioning level rather than
a relatively static (after the first year) predictive value.
Your Training Zones:
Lower Limit
Zone I
Zone II
Zone III
Zone IV
Zone V
Long, Slow, Distance
Aerobic Power
AT/Race Pace
Long Interval
Short Interval
Upper Limit
Genetics/Spectracell Testing
SpectraCell offers a variety of testing that is recommended.
1. Micronutrient Testing
Micronutrient testing measures how micronutrients are actually functioning within your white
blood cells. SpectraCell’s patented, chemically-defined control media contains the minimal
amount of each essential micronutrient that is needed to support optimal lymphocyte growth or
mitogenic response. The functional intracellular status of micronutrients involved in cell
metabolism is evaluated by manipulation of the individual micronutrients in the media followed
by mitogenic stimulation and measurement of DNA synthesis. The same technology also
provides a total antioxidant function test (SPECTROX™) which assesses the ability of cells to
resist damage caused by free radicals and other forms of oxidative stress. Due to the considerable
number of cellular antioxidants with extensive interactions, redundancies, repair and recharging
capabilities, measuring total function is the most accurate and clinically useful way to assess
your patients’ capacity to resist oxidative damage. Since lymphocytes are produced in the bone
marrow and stored in the peripheral locations for long periods of time (the average life span of a
lymphocyte is approximately four to six months), SpectraCell’s measurements provide a
powerful portrait of each patients’ long-term nutrient status. This is analogous to the use of a
glycosylated hemoglobin test to evaluate blood glucose levels over a one to three month period.
Vitamins tested include: Biotin, Folate, Pantothenate, Vitamin A, VitaminB1, Vitamin B2,
Vitamin B3, Vitamin B6, Vitamin B12, Vitamin C, Vitamin D, Vitamin K2,
Minerals tested include: Calcium, Copper, Magnesium, Manganese, Zince
Amino acids tested include: Asparagine, Glutamine, Serine
Antioxidants tested include: Lipoic Acid, Coenzyme Q10, Cysteine, Glutathione, Selenium,
Vitamin E, Spectrox (Total Antioxidant Function.)
Carbohydrate metabolism, fatty acids and metabolites tested include: Carnitine, Choline,
Chromium, Fructose Sensitivity, Glucose/Insulin Metabolism, Inositol, Oleic Acid
2. Genetic Testing

Apolipoprotein E Genotyping
This test determines an individual’s genetic risk associated with the Apolipoprotein E gene.
ApoE is involved in the metabolism of cholesterol and triglycerides, and variants in this gene can
have clinically relevant implications for disease risk as well as one’s response to statin therapy,
dietary fat, and other risk factors (e.g. smoking and alcohol consumption). Approximately 45%
of individuals carry one or more of the high risk variants within the ApoE gene. The results of
the genotyping of Apolipoprotein E have important implications in the treatment strategies for
individual patients in reducing cardiovascular disease risk.

Methylenetetrahydrofolate Reductase Mutations (MTHFR) Genotyping
MTHFR is an enzyme responsible for converting 5,10-methylenetetrahydrofolate to the product
5-methyltetrahydrofolate – it is involved in the metabolism of folate and homocysteine. The
product of the reaction catalyzed by MTHFR converts homocysteine (a potentially toxic amino
acid) to methionine (a useful and necessary amino acid).
Why is MTHFR Genotyping Important?
•
Certain mutations in the gene coding for MTHFR produce an enzyme that has reduced
activity.
•
Reduced activity can lead to elevated levels of homocysteine (a.k.a.
hyperhomocysteinemia), especially when folate levels are low.
•
High homocysteine (>13umol/L) may double the risk of developing illness or
complications.
•
MTHFR genotyping can provide information about potential causes of elevated
homocysteine and approaches for addressing it.
•
Based on MTHFR and homocysteine results, physicians can develop dietary and medical
recommendations - increased intake of folate alone or in combination with vitamins B6
and B12 are recommended.
•
Based on results, recommendations for methotrexate dosage can be adjusted.
Risks Associated with MTHFR Variants/High Homocysteine:
•
Cardiovascular Disease
•
Cerebral Vascular Disease (Stroke)
•
Venous and Arterial Thrombosis
Factor V Leiden and Prothrombin
Factor V Leiden refers to a mutation in the gene that manufactures a protein called factor V,
which is involved in the process of blood coagulation. The factor V protein is also called
coagulation factor V, and sometimes proaccelerin or labile factor. People with factor V Leiden
gene have an increased risk of developing a type of blood clot called a deep venous thrombosis
(DVT).
Prothrombin is a protein that causes blood to coagulate and form blood clots. A genetic mutation
(called G20210A) in the production of this protein is a risk factor for thrombosis (blood clots),
including deep venous thrombosis (DVT). This mutation in the gene encoding the clotting factor
prothrombin is found in about 1 in 50 persons in the US. It raises the risk of thrombosis
significantly for both males and females in all age groups by creating a hypercoagulable state
through increased circulating prothrombin levels.

Telomere Testing
Telomeres are sections of genetic material at the end of each chromosome whose primary
function is to prevent chromosomal ‘fraying’ when a cell replicates. As a cell ages, its telomeres
become shorter. Eventually, the telomeres become too short to allow cell replication, the cell
stops dividing and will ultimately die - a normal biological process. SpectraCell’s Telomere Test
can determine the length of a patient’s telomeres in relation to the patient’s age.
How are the results reported?
The Patient Telomere Score is calculated based on the patient’s average telomere length in
peripheral whole blood cells. This average is then compared to telomere lengths from a
population sample in the same age range as the patient to determine the patient’s percentile
score.
What are the nutritional implications on telomere length and repair?
An inflammatory diet, or one that increases oxidative stress, will shorten telomeres faster. This
includes refined carbohydrates, fast foods, processed foods, sodas, artificial sweeteners, trans fats
and saturated fats. A diet with a large amount and variety of antioxidants that improves oxidative
defense and reduces oxidative stress will slow telomere shortening. Consumption of 10 servings
of fresh and relatively uncooked fruits and vegetables, mixed fiber, monounsaturated fats,
omega-3 fatty acids, cold water fish, and high quality vegetable proteins will help preserve
telomere length. In addition, it is advised to reduce total daily caloric intake and implement an
exercise program. Fasting for 12 hours each night at least 4 days per week is recommended.
What lifestyle modifications are likely to be helpful?
One should achieve ideal body weight and body composition with low body fat (less than 22 %
for women and less than 16 % for men). Decreasing visceral fat is very important. Regular
aerobic and resistance exercise for at least one hour per day, sleeping for at least 8 hours per
night, stress reduction, and discontinuation of all tobacco products are strongly recommended.
Bioidentical hormone replacement therapy may decrease the rate of telomere loss.
When should retesting be considered?
Testing should be done once per year to evaluate the rate and direction of telomere changes and
make adjustments in nutrition, nutritional supplements, weight management, exercise and other
lifestyle modifications known to influence telomere length.
What role will nutritional supplements play in slowing telomere shortening?
Oxidative stress may shorten telomere length and cause aging in cellular tissue. Antioxidant
supplements can potentially reduce oxidative stress very effectively, which will ultimately
improve oxidative defenses, mitochondrial function, reduce inflammation and slow vascular
aging. Targeted supplementation is key, as antioxidants work synergistically and must be
balanced to work most effectively and avoid inducing a pro-oxidant effect. Increasing
antioxidant capacity at the cellular level is critical to maintaining telomere length. Recent
evidence suggests that a high quality and balanced multivitamin will also help maintain telomere
length. Specifically, studies have linked longer telomeres with levels of vitamin E, vitamin C,
vitamin D, omega-3 fatty acids and the antioxidant resveratrol. In addition, homocysteine levels
have been inversely associated with telomere length, suggesting that reducing homocysteine
levels via folate and vitamin B supplementation may decrease the rate of telomere loss.
Similarly, conditions such as cardiovascular disease, insulin resistance, diabetes, hypertension,
atherosclerosis and even dementia affect telomere length. Correcting subclinical nutritional
deficiencies that may contribute to such diseases is crucial for telomere maintenance.
Overall recommendations to maintain telomere length
Some clinicians have recommended reducing all known coronary risk factors, inflammation,
oxidative stress, ADMA levels and angiotensin II levels or its action. At the same time, therapy
should increase nitric oxide levels and nitric oxide bioavailability, increase arginine, increase
endothelial progenitor cells, improve mitochondrial function and increase oxidative defenses. In
addition, one should optimize hormone levels, exercise, sleep, nutrition and nutritional
supplements. Fasting and caloric restriction should be part of the regimen as well.
Reference: Spectracell Laboratories