Happy spring to all of you!
Hopefully you have enjoyed, as I have, the pear blossoms and then the apple blossoms that are all over the county. It’s a time of year when we see the potential of new life and renewal all around us. It reminds me of the spring lambs that had so much fun gambling (a form of running and jumping) through the pasture just outside my window when I was growing up!
This month, I want to share with you my views on follow up labs so that we have a better mutual understanding of what needs to be accomplished to meet your health goals. Any personal needs beyond that we can discuss at your next visit.
Labs are needed to determine whether there is an imbalance in your body system(s) that we are evaluating, and if so what the exact nature and extent of that imbalance is.
These lab results provide critical information to determine where to start treatment, how rigorous the treatment protocol needs to be, and what sequencing of treatment will give the best outcome for you.
The only exception is when you are significantly past menopause and wish to start using bio-identical hormones. Under those circumstances, we can be sure just by your symptoms whether your levels of estradiol and progesterone are low. However, we still would not know your testosterone level, so it is always necessary to check that before starting any therapy for testosterone deficiency in women. Men usually need all their levels checked before beginning any hormone treatment since their process of hormonal decline is longer and more gradual.
Symptoms of decline for each of the different hormones, estrogen, progesterone, testosterone, DHEA, thyroid, and cortisol, can be the same or partially overlap, which adds to the case for testing so that we really know what we are dealing with. So, to be confident we are treating appropriately and achieving safe levels of hormones, we must do testing at regular intervals.
Sometimes people say that their doctor is of the view that you can’t test hormones because they are always changing. While there is some truth to that, especially before menopause, we can do testing at specific times of the monthly cycle even for peri-menopausal or pre-peri-menopausal women and get very accurate and useful information. The results do need to be ordered and interpreted by a clinician who is trained in Integrative Medicine Hormonal Therapy. No clinician can be 100% right in guessing hormonal levels of their patients. Many, including myself, develop a lot of expertise over time and can come close to predicting these levels, but the bottom line is that we have to do periodic testing to KNOW where you are.
How often we need to test depends on what is happening for you.
If you have multiple hormonal systems that we are balancing, there usually is a more frequent need for test. If you are in peri-menopause, things are often changing so rapidly that we need to re-evaluate every 3 months or so. By contrast, if you are a woman who is years post menopause and who has low stress (a big variable!) and a healthy lifestyle, a yearly evaluation may be sufficient. Men will usually be able to go to a 6 months regime fairly soon after initiating treatment, and then switch to yearly when their dosage has been stabilized and their response to the treatment has been documented.
Whenever I change doses for your hormones, whether that is thyroid, estrogens, testosterone, or progesterone, after sufficient time to establish a therapeutic level in your body, we need to do testing to determine that you have reached an optimal level for good health. The same applies for yearly mammograms and pelvic exams for women and prostate exams for men. Those tests are done to be sure that nothing is developing that threatens your health and requires prompt action.
The types of test that we use may vary depending on your circumstances and how your therapy is progressing. These may include blood tests, urine tests, saliva tests and stool tests as needed to determine the state of your health most accurately.
All the testing is focused on your optimal health and vitality.
So many of you are right on the mark when you make sure that you follow up and ask to discuss the results with me, and I very much appreciate your proactive approach. Know that my staff and I are always looking to make it as easy as possible for you to be assured that your hormonal care is receiving the attention you deserve.
We’ll call you or email you if we find that your re-evaluation is overdue. Then, please let us know the lab you prefer to use and we will get you cared for quickly with providing lab orders and then a return appointment. There will be some changes coming soon, with LabCorp first and then other labs, that will permit us to implement lab orders electronically. We are excited about this development, and we will do everything in our power to make the whole process as efficient for you as possible.
Other capabilities of the electronic medical record will be introduced to you within the next 6 months, and they should help to increase the ease and efficiency of your care. Stay tuned!
As I’ve spent more time outdoors in this wonderful weather and getting my body back into the rhythm of good exercise, I realize there is a lot to be grateful for! Good health is a big one.
And I feel honored to be working with you to create your BEST HEALTH!
Jane Kennedy, CFNP, MN, MPH
