When “everything is normal,” but you don’t feel right…
There is a phrase I hear a lot from new patients, “my doctor said everything is normal, but I just don’t feel right.” You feel off, less energetic, bloating, headaches or other symptoms – eventually it’s bad enough that you see your doctor. After the visit and lab work, you are told everything is normal and no follow up is needed. But your symptoms remain. What do you do?
Many patients with this familiar story end up in my office or the office of a fellow naturopathic doctor (ND). The first difference you might notice when you see an ND is that our visits are longer. I use this time to gather a thorough health history including social and environmental factors that can influence disease and treatment. I perform a relevant physical exam and order appropriate lab and imaging studies. These may be very similar to what are ordered by your conventional provider, but my interpretation may look a bit different.
Labs are intended to rule in or rule out possible explanations for symptoms. But normal lab results don’t supercede a patient’s symptoms. In fact, many symptoms and conditions cannot be explained by lab results. For example, we might run a complete metabolic panel (CMP) for a patient with headaches. A normal CMP would rule out electrolyte imbalance, liver disease or kidney dysfunction as a cause for headaches, but there are many other causes for headaches.
I often explain to patients that the normal range isn’t the whole story when it comes to lab results. When I interpret lab results, I often have an “optimal range” in mind within the normal range. Vitamin D is a great example of this – the normal range is 30-100, but I recommend an optimal range of 50-80.
Additionally, abnormal results that do not meet the criteria for a disease are sometimes ignored. Addressing minor abnormalities may help prevent or delay the development of disease. Diabetes screening is a great example of this. Hemoglobin A1c (Hgb A1c), a marker used in diabetes screening, has a normal range, a “prediabetic” range and an abnormal range which indicates diabetes. Addressing blood sugar when Hgb A1c is in the prediabetic range is much more effective than waiting until the labs are in the diabetic range and can prevent or delay the development of diabetes.
And finally, after the history, physical exam and lab or imaging studies, we come to treatment. As a naturopathic physician and licensed acupuncturist, I have many tools in my toolbelt – lots of treatment options. It is very satisfying in my work that I rarely have to tell a patient that there is nothing I can do to help them. I use diet, lifestyle advice, botanical medicines, targeted nutritional supplementation, prescription medications and acupuncture to help normalize function, ease symptoms and optimize health. If you’ve been told “everything is normal,” and you’re still suffering, consider scheduling an appointment with a naturopathic physician.