All Blood Tests

A wheat allergy is an immune system response to one or several of the proteins contained in wheat (albumin, globulin, gliadin and gluten) while a wheat intolerance is the failure of the body’s digestive system to properly break down the proteins in wheat. An allergy can cause sudden, life-threatening reactions, called anaphylaxis but it is much less common than an intolerance. An intolerance is believed to affect 15% of the U.S. population and in general, causes a variety of symptoms that are less severe than a true allergy. These symptoms can still undermine a person’s health and lifestyle.

Recognizing the Symptoms

The symptoms of a wheat allergy and an intolerance can easily be confused. Both can be gastrointestinal, like nausea, vomiting, diarrhea, bloating, cramps, abdominal pain and constipation. Some intolerance symptoms can masquerade as histamine responses, like rashes, eczema flare-ups, headaches, and congestion. Generally, an intolerance has a wider array of possible symptoms, including fatigue/lethargy, stiff, aching joints, depression, mood swings, and a variety of other ailments. Intolerance symptoms can also occur anywhere from immediately after eating a wheat product to a few days afterward, making it even more difficult to accurately diagnose. Because it is such a common substance, someone with an intolerance adapts to wheat or may become somewhat desensitized to “not feeling well.”

Wheat intolerance symptoms are also easily confused with Celiac Disease, also known as Celiac Sprue. This is an inherited autoimmune condition in which gluten (on of the wheat proteins) causes the body’s immune system to damage the lining of the small intestines, resulting in an inability to absorb nutrients.

Is It an Allergy or an Intolerance?

“I knew I had a wheat intolerance when, after years of feeling bloated and constipated and finally being put on a laxative by my doctor to take for the rest of my life, my acupuncturist suggested that I might have a food allergy and recommended an elimination diet. I really wanted to know what was wrong with me. It was tricky at first because I had to really think about what had wheat in it (beer for example caught me off guard). However, after just three or four days of successfully avoiding wheat, I literally felt like a new woman. My tummy wasn’t bloated after every meal and overall, I just felt better.”

If you suffer from chronic symptoms like the woman described and suspect that you have a wheat allergy or intolerance, a board certified allergist can perform a blood test that can confirm or rule out an allergy. The test measures the levels of IgE protein (which triggers allergic reactions) in a blood sample when exposed to wheat proteins. If the test results are negative, the most effective way to rule out a wheat intolerance is an elimination diet under the supervision of a licensed physician. The tests for Celiac Disease are more extensive, involving a number of blood tests called the Celiac Blood Panel (CBP). They test for IgA and IgG proteins in the blood. If these are positive, a doctor will likely recommend a biopsy of the small intestine.

Living with Wheat Intolerance

Although it may seem daunting at first, avoiding wheat proteins does not sentence you to a life of deprivation. Whether you have a wheat allergy or an intolerance, the greater number of companies and organizations that are devoted to the wheat-free/gluten-free population makes gluten-free living very manageable. There are rice, corn, and bean flour-based products available at many mainstream grocers or health food stores. There are support groups, magazines, cookbooks, and recipe websites. Even restaurants are now catering to the growing wheat-sensitive population. As a wheat-intolerant friend once told me, “What I like about having an intolerance to wheat, quite honestly, is that I can’t just eat whatever I want. It keeps me on my toes! I don’t feel deprived of anything. And yet, I feel so much better.”

One of the necessary evils of diabetes is monitoring and controlling your blood sugar levels. By continually keeping a close eye on your levels of glucose or blood sugar, you will come to understand just how not only your medication affects your levels, but also stress, activity, and foods. Monitoring your levels of sugar within the blood is necessary and could help in prevention or delay of severe complications commonly associated with diabetes such as kidney failure or blindness.

To accurately and properly monitor your blood sugar levels you will have to obtain some supplies. Supplies needed will include test strips, sterile lancets, alcohol pads, and a glucose meter. These are typically prescribed by your physician, obtain from your local drug store, and most often covered by your medical insurance. Your doctor will educate you on the proper use of this equipment. However, in general circumstances the following steps are taken to measure the levels of sugar within the blood.

First, you should make sure your hands are clean and completely dry before performing the tests. Then you will want to clean the area to be tested with the alcohol pad. In most cases this will be your fingertip; however, some meters will allow you to use other areas of the hand, thigh, or even the forearm. You will then take the sterile lancet and prick the area to be tested. A drop of blood will form and should be carefully placed on the testing strip. You will then place the strip into your glucose meter, following the instruction provided by the manufacture or your doctor. After the meter has completed its course, you will be provided with a number, which indicates your blood sugar level.

It is necessary to document your test results, as well as medications taken, times taken, and foods that have been eaten that day. In the beginning of your treatment your doctor will likely ask you to test and record your blood sugar levels two to three times each day. Do not forget to document foods eaten and activity as well. This will allow both of you to get a general idea of what affects your levels and why. After this initial period, you may only be required to perform tests two to three times weekly.

If you want to know the level of cholesterol in your blood, you have to go through cholesterol blood test. This test would give you a good estimate of how much cholesterol is present in your system. It is also the test that doctors use as a guide so that they can provide the right type of medications for you. Cholesterol blood test can be performed in most clinics that have the necessary equipments. With the many health centers in operation today, getting your cholesterol tested becomes as easy as buying fruits from a grocer.

And it gets even better still. Right now, there are cholesterol blood test kits that can be bought from pharmacies. These tests can reveal your cholesterol count in a matter of minutes. These at-home tests allow patients to test their cholesterol level whenever they want and where they want, even at the comforts of their own homes. Aside from these kits, there are also devices that can read your cholesterol level, including other information relevant to your condition.

With more and more people getting concerned with their cholesterol count, many are getting alarmed about the increasing instances of heart problems. Heart diseases can strike anybody. It is a disease that is very common to people 50 years old and above. This is because of the fact that at such point in their life, their heart had worked long enough to show signs of wear and tear. The people who failed to take care of their hearts and check their cholesterol levels are the ones who are more likely to develop heart concerns.

Cholesterol is one of the unwanted substances present in the bloodstream. It finds its way inside the body through the foods that you eat. Cholesterol is contained in your meals. And there are foods that are unmistakably rich with cholesterol that when eaten, could elevate your count drastically. It is quite easy to tell yourself not to eat foods high in cholesterol. But actually doing it is the hardest thing. Changing your lifestyle and your diet can’t happen overnight. It even takes a lifetime for some people to change a single detail about their life, even if it is as simple as neglecting the food they love eating.

This is where cholesterol blood test comes into play. As these tests are getting more and more accessible, people are slowly getting aware of their condition, enough to leave them alarmed at a certain point. Knowledge of your condition and its implication is very important to motivate yourself to initiate some major changes. This is one of the reasons why taking a cholesterol blood test on a regular basis can help a lot.

When your cholesterol level is checked, the total number of cholesterol shows up. Generally, the ideal number is below 200 mg/dL. That’s for people who don’t possess any risk of developing heart problems. You might want your number lower if you have history of heart diseases or if any member of your family had suffered from it. The number of LDL or bad cholesterol should be kept below 100 mg/dL. Your HDL level or your level of good cholesterol should be at 40 to 60 mg/dL.

All individuals aged 20 years old and above should regularly go through cholesterol blood test. Checking your cholesterol level once every five years is good enough if you are not diagnosed with any type of heart disease. Of course, it gets more frequent if you are under the direct care of a physician due to heart problems. This test is medically referred to as the lipoprotein profile test. Your doctor should know how to interpret the results and provide you with the right medications, including lifestyle and dietary changes when needed.

Don’t go through life with high levels of cholesterol in your blood. Not only that condition can be very risky for you – it can also stop you from living a life like you want it. Eventually, you will feel that you have less tolerance for extraneous activities. And so your movements and your actions get restricted over time. If you have your cholesterol blood test now, heart problems can be diagnosed early on. And at its initial stages, any problem with the functions of the heart can be very treatable. You may not realize it, but this simple test can actually save your life.

Your body is protecting you.

You have two small pyramid shaped glands that sit on top of your kidneys called the adrenals. Your adrenals are nicknamed your stress glands or your stress organs. The hormones they release can be triggered by emotional stress, chemical stress, or even physical trauma. The adrenals are a part of a feedback loop that helps control and respond to various functions of your body’s hormonal and nervous systems.

These tiny adrenal glands are responsible for the funny feeling you get when you are scared by something. Just imagine the last time you were driving or riding in the car, when suddenly another car cuts in front of you. The brakes are slammed to avoid an accident and hopefully the near accident was avoided. That “wave” of fear and funny adrenaline rush you get is called your “fight or flight response”. This is an instinctive reaction by your body for your protection. This reaction is designed to either get you out of a dangerous situation or allow you to deal with a dangerous situation for your ultimate survival.

There are an amazing number of hormones being released to prepare you for stressful scenarios whenever the body deems it necessary. The problem occurs when this protective mechanism that is designed for promoting survival is fooled into being active when no true stressful event is present. When you get scared by something there are certain physiological functions that occur such as an increased heart rate to pump more blood to your extremities in case you need to flee, your digestive system stops breaking down food to allow more energy for other areas of the body and you become more focused. All of these responses occur during the excited state of the nervous system.

Stress and belly fat explained…stay with me I’m going somewhere with this.

The true problem occurs when your nervous system is functioning in the excited state during a relaxed scenario. Here’s a brief example. If you are like millions of people in this country and enjoy a hot cup of coffee or tea to start your day or get you through a mid afternoon meeting, to battle your chronic fatigue, you are causing this false scenario to occur. Caffeine is a researched and known stimulant that triggers the same functions that are triggered when you are scared. The problem is after you ingest the caffeine your body is left in the excited state during a relaxed scenario.

Some of the physiological effects are an increased heart rate, changes to the digestive system and better mental focus. This is great to avoid being caught sleeping in a boring meeting but not so great for your body. You have just sent the signals to your adrenals and nervous system that some dangerous scenario is occurring. The body is very smart but also very dumb. It will do what it’s told just like a computer. When the user tells a computer to delete something, that’s exactly what the computer will do. The body can’t differentiate between right and wrong when it comes to releasing hormones and reactions to stress. Physiologically the body cannot tell whether you were almost in a car accident or sitting in the weekly board room meeting.

I’m often asked, what is the best way to lose belly fat?

While you will increase abdominal strength doing exercises, doing them is not the best way to lose fat. The quickest way to lose is through stress management. Stress and belly fat have a very intimate relationship that you can easily abolish. You must eliminate or decrease the stressful influences on the body so the adrenals don’t release stress related hormones on a continual basis. When these hormones are released they travel through the blood stream in search of problems to fix. When no true problem is discovered your body will begin to prepare itself for some impending stressful scenario that the body assumes must be on the way. After all why would there be a stress response if no stress were coming?

A hormone that you may be familiar with is called cortisol. Cortisol is released when the body gets information that it is in danger. Cortisol is responsible for controlling inflammation and swelling when there is a physical stress on the body. Once the adrenals release the cortisol because of increased stress, the hormone does not just disappear if no trauma is discovered.

When there is no dangerous situation the one protective mechanism is to use the cortisol to store fat around internal organs to protect them from a future risk. This is where the unwanted belly fat comes from. When this hormone is triggered with other protective hormones it will appear that the exercise and dieting you have so intensely committed yourself to are in vain. The problem stems from another source and that is the reason for the poor results with your weight loss protocol.

How can you decrease the emotional, chemical and environmental stress?

Obviously we all have things that concern us. The best way to deal with emotional stress is by using avenues like prayer or meditation to help balance your mental well being. Exercising is a great way to promote adrenal health. This can be doing something as simple as walking, yoga, swimming or more intense types of exercise. The emotional component of stress is extremely common in our society and can be the most damaging. This is because we can potentially think “bad” thoughts constantly and constantly keep our system in a position to release fat storing hormones.

The chemical and environmental stressors are somewhat easier to handle because we can all make better choices of the products we consume and use. Are you on a diet? I recommend avoiding diets and just adopt better habits and lifestyle changes over a period of time. You have higher chance of sticking with it if you’re not overwhelmed by the sudden changes in your routine.

The easiest changes to make are centered at the foods you eat. Avoid foods made with preservatives, additives and other synthetic chemicals that trigger stress responses. Substances like alcohol, nicotine and caffeine all cause the adrenals to become active. Sugars and artificial sweeteners also contribute to causing elevated adrenal stress. Weight loss pills will only make your problem worse when the bottle is finished and should be avoided at all cost. A great and simple way to start is to decrease the amount of liquids you consume that contain caffeine and excess sugars. Then choose a time frame to start reducing certain foods from your diet that lead to adrenal stress.

Environmental stress can be reduced by making better choices around the home and using more “green” products. Using more organic friendly cleaning products and personal hygiene products is not only better for your body but may also help you with your weight loss protocol. It has been researched for over half a century that certain types of chemicals will cause your hormonal system to function less than optimum. Research has been performed by the FDA, EPA, CDC, major pharmaceutical companies and medical universities showing the effects of certain chemicals on your body. The fancy name for these problems is “endocrine disruptors”. I suggest you just search the term on Google and read the information for yourself.

Belly fat is only one of the symptoms that you will experience when the adrenals are compromised or fatigued. The adrenals are also responsible for a few other key functions in your body. The adrenals do not only control inflammation and swelling.

You may have adrenal fatigue if you notice any of the following symptoms:

chronic fatigue, osteoporosis, trouble falling asleep or difficulty sleeping through the entire night, anxiety, constant worrying, high blood pressure, cravings, arthritis, difficult menstrual cycles, low sex drive, allergies and asthma.

One of the best ways to know if your adrenals are compromised is to have an Adrenal Stress Index performed. This is a saliva test that will measure your hormonal levels over a period of time. The test is non-invasive & can be performed wherever you are. Saliva is collected under real life conditions and there are no stressful blood draws and no gallon sized urine containers to carry around for 24 hours. With blood and urine testing, a number of borderline adrenal conditions are missed due to lack of sensitivity.

This is not the case with the Adrenal Stress Index because samples are taken within one circadian cycle and the more definitive free fraction is measured. Treatment options are expanded by 400-500% over blood test and urine test results.

Once you understand the mechanisms for many of the symptoms that are causing your difficulty, it becomes much easier to handle the battle of the bulge. Good luck to you and I trust this information will serve you well.

If you have been diagnosed with diabetes then you should be aware of the importance of diabetes testing. Keeping your blood sugar under control is critical in preventing organ damage and other complications. Read on to discover more about the many different products on the market used in testing your diabetes.

Ideally, if you are insulin dependent, you should test your blood sugar four times a day. Monitoring your blood sugar before meals can help you maintain a healthy blood sugar level. So what is the best way to monitor your blood sugar levels?

The traditional home diabetes test involves pricking your finger with a small needle-like device called a lancet. A small drop of blood is then applied to a test strip that is inserted into a small meter that will read the result. These meters come in different sizes and features. Some will have larger displays or will have spoken instructions for the visually impaired.

There are meters that come with special software to upload to your computer and it will allow you to retrieve information from the meter to graph your blood glucose results over time. This can be very helpful when you visit your doctor. It can easily be determined if your diabetes medicines need to be altered in any way.

There are newer meters on the market that allow you to draw blood from alternative sites. Any diabetic can tell you how sore their fingertips become from the frequent diabetes testing. These newer meters allow you to test from places such as the forearm, base of the thumb and the upper thigh. But a word of warning; blood glucose results from these alternative sites may be different than the results you receive from the fingertip site.

The reason is that blood glucose levels show changes more rapidly than any other site on the body. So keep in mind that if you are experiencing any symptoms that may be related to low blood sugar or high blood sugar, you should conduct a traditional fingertip diabetes test to get an accurate result.

Two other new diabetes testing devices to hit the market recently are a laser that draws blood and a GlucoWatch. The laser produces a beam of light that will penetrate the skin of the finger. The purpose of this is to reduce the discomfort of a traditional needle prick.

The GlucoWatch will draw tiny amounts of fluid by emitting small electric currents. This watch has the ability to measure your blood glucose level three times an hour for up to 12 hours. Although it has been approved by the FDA, it should not be used to replace the traditional finger tip diabetes testing.

These are the basic diabetes testing products on the market today. Talk with your doctor to get his recommendation and take good care of yourself by maintaining a healthy blood sugar level.

Glucose, the primary energy source for human and animal cells, is a type of sugar that travels through the bloodstream. Glucose enters your body whenever you eat carbohydrate foods. Glucose levels are regulated by insulin and glucagon. Insulin is a hormone that is produced by the pancreas and released into the bloodstream when glucose levels rise.

Normal glucose levels fall between 70 and 150 mg. Levels typically are lower in the morning, and rise after meals. Blood sugar levels falling consistently above 150 are indicative of hyperglycemia, or high blood sugar. Chronic low levels, falling below 70, characterize hypoglycemia, or low blood sugar. Hypoglycemia is a potentially fatal condition. Symptoms of this condition are lethargy, impaired mental functioning, irritability and loss of consciousness. Persistent hyperglycemia results in diabetes mellitus, which is the most common disease related to blood sugar regulation failure. Diabetes can cause eye, kidney and nerve damage.

A blood glucose test measures the amount of glucose in the bloodstream. Reasons for testing glucose levels are to check for diabetes, to monitor treatment of diabetes, and to check for hypoglycemia. There are several different types of glucose tests. The ‘fasting blood sugar’ test checks glucose levels after an eight-hour fast and is often the first test performed when checking for diabetes. For this test, levels have to fall between 70 and 99 in order to be considered normal. The ‘two-hour postprandial blood sugar’ test measures glucose levels two hours after eating a meal.

Normal glucose levels for this test fall between 70 and 145. Random blood sugar testing checks glucose levels randomly throughout the day, regardless of meal times. If levels vary widely, there could be a problem. Blood sugar levels should be between 70 and 125 in order to be considered normal for random testing. The ‘oral glucose tolerance test’ diagnoses diabetes and predicaments. This tests your blood after drinking a glucose drink. If you think you may have a blood sugar disorder, contact your primary care physician for testing. There are many conditions that can cause a change in your blood glucose levels. Normal results may vary depending on the lab.

Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis and affects more than 2 million Americans. The diagnosis is not easy to make in many instances. There are more than 100 different kinds of arthritis. Most of them involve inflammation. When a patient goes to a rheumatologist to get a diagnosis, there is a process of elimination in order to arrive at the proper diagnosis. This process of elimination is called “differential diagnosis.”

Differential diagnosis can be a difficult undertaking because so many forms of arthritis, particularly inflammatory forms of arthritis look alike. Generally it is helpful to divide the differential diagnosis of rheumatoid arthritis into two groups. The first group are the non-infectious diseases to consider and the second group are the infection-related conditions.

Since the discussion is rather long I have chosen to divide the article into two parts.

The following is a partial list of forms of inflammatory arthritis that can be seen and must be considered when evaluating a patient with inflammatory symptoms of arthritis and are not infection related.

RA is an autoimmune chronic inflammatory disease, primarily involving the peripheral joints (hands, wrists, elbows, shoulders, hips, knees, ankles, and feet). It can also affect non joint structures such as the lung, eye, skin, and cardiovascular system.

RA may start slowly with nonspecific symptoms, including fatigue, malaise (feeling “blah”), appetite loss, low-grade fever, weight loss, and vague joint pains, or it may have an explosive onset with inflammation involving multiple joints. The joint symptoms usually occur bilaterally- both sides of the body equally involved- and symmetric. Erosions- damage to the joint- can be seen with x-ray. In about 80% of cases, elevated levels of rheumatoid factor (RF) or anti-cyclic citrullinated antibodies (anti-CCP) are present in the blood. There appears to be a correlation between the presence of anti-CCP antibodies and erosions.

Juvenile rheumatoid arthritis (JRA) occurs in children under the age of 16. Three forms of JRA exist, including oligoarticular (1-4 joints), polyarticular (more than 4 joints), and systemic-onset or Still’s disease. The latter condition is associated with systemic symptoms — including fever and rash in addition to joint disease.

Polyarticular JRA has similar characteristics to adult RA. It causes about 30% of cases of JRA. Most children with polyarticular JRA are negative for RF and their prognosis is usually good.

Approximately 20% of polyarticular JRA patients have elevated RF, and these patients are at risk for chronic, progressive joint damage.

Eye involvement in the form of inflammation- called uveitis- is a common finding in oligoarticular JRA, especially in patients who are positive for anti-nuclear antibody (ANA), a blood test that is often used to screen for autoimmune disease. Uveitis may not cause symptoms so careful screening should be performed in these patients.

SLE is an inflammatory, chronic, autoimmune disorder that can involve the skin, joints, kidneys, central nervous system, and blood vessel walls. Patients may present with 1 or more of the following: butterfly-shaped rash on the face, affecting the cheeks; rash on other parts of the body; sensitivity to sunlight; mouth sores; joint inflammation; fluid around the lungs, heart, or other organs; kidney abnormalities; low white blood cell count, low red blood cell count, or low platelet count; nerve or brain inflammation; positive results of a blood test for ANA; positive results of a blood test for antibodies to double-stranded DNA or other antibodies.

Patients with lupus can have significant inflammatory arthritis. As a result, lupus can be difficult to distinguish from RA, especially if other features of lupus are not present. Clues that favor a diagnosis of RA over lupus in a patient presenting with arthritis affecting multiple joints include lack of lupus features, erosions (joint damage) seen on x-rays, and elevations of RF and anti-CCP antibodies.

Polymyositis (PM) and dermatomyositis (DM) are types of inflammatory muscle disease. These conditions typically present with bilateral (both sides involved) large muscle weakness. In the case of DM, rash is present. Diagnosis consists of finding the following: elevation of muscle enzyme levels in the blood [the two enzymes that are measured are creatine kinase (CPK) and aldolase], signs and symptoms, electromyograph (EMG)- an electrical test- alteration, and a positive muscle biopsy.

In addition, in many cases abnormal antibodies specific for inflammatory muscle disease can be elevated.

In both PM and DM, inflammatory arthritis can be present and can look like RA. Both inflammatory muscle disease and RA can affect the lungs. In RA, muscle function will usually be normal. Also, in PM and DM, erosive joint disease is unlikely. RF and anti-CCP antibodies are typically elevated in RA but not PM or DM.

SAs — psoriatic arthritis, reactive arthritis, ankylosing spondylitis, and enteropathic arthritis — are a category of diseases that cause systemic inflammation, and preferentially attack parts of the spine and other joints where tendons attach to bones. They also can cause pain and stiffness in the neck, upper and lower back, tendonitis, bursitis, heel pain, and fatigue. They are termed “seronegative” types of arthritis. The term ‘seronegative’ means that testing for rheumatoid factor is negative. Symptoms of adult SAs include:

• Back and/or joint pain;

• Morning stiffness;

• Tenderness near bones;

• Sores on the skin;

• Inflammation of the joints on both sides of the body;

• Skin or mouth ulcers;

• Rash on the bottom of the feet; and

• Eye inflammation.

Occasionally, arthritis similar to that seen in RA can be present. Careful history and physical examination can often distinguish between these conditions, especially if an obvious disease that is promoting inflammation is present (psoriasis, inflammatory bowel disease, etc.). In addition, RA rarely affects the DIP joints- the last row of finger joints. If these joints are involved with inflammatory arthritis, the diagnosis of an SA is possible. (Note of caution: a condition known as inflammatory erosive nodal osteoarthritis can also affect the DIP joints). RF and anti-CCP antibodies are negative in SAs, although, rarely, in cases of psoriatic arthritis there may be elevations of RF and anti-CCP antibodies.

Gout is caused by deposits of monosodium urate (uric acid) crystals into a joint. Gouty arthritis is acute in onset, very painful, with signs of significant inflammation on exam (red, warm, swollen joints). Gout can affect almost any joint in the body, but typically affects cooler areas including the toes, feet, ankles, knees, and hands. Diagnosis is made by drawing fluid from an inflamed joint and analyzing the fluid. Demonstrating monosodium urate crystals in the joint fluid is diagnostic, although finding elevated serum levels of uric acid can also be helpful.

In most cases, gout is an acute single joint disease that is easy to distinguish from RA. However, in some cases, chronic erosive joint inflammation where multiple joints are involved can develop. And, in cases where tophi (deposits of uric acid) are present, it can be difficult to distinguish from erosive RA. However, crystal analysis of joints or tophi and blood tests should be helpful in distinguishing gout from RA.

Calcium pyrophosphate deposition disease (CPPD), also known as pseudogout, is a disease is caused by deposits of calcium pyrophosphate dihydrate crystals in a joint. The presence of these crystals in the joints leads to significant inflammation. Establishing the diagnosis includes using:

• Detailed medical history;

• Withdrawing fluid from a joint to check for crystals;

• Joint x-rays to show crystals deposition in the cartilage (chondrocalcinosis); and

• Blood tests to rule out other diseases (e.g., RA or osteoarthritis).

In most cases, CPPD arthritis presents with single joint inflammation. In some cases, CPPD disease can present with chronic symmetric multiple joint erosive arthritis similar to RA. RA and CPPD disease can usually be told apart by joint aspiration demonstrating calcium pyrophosphate crystals, and by blood tests, including RF and anti-CCP antibodies, which are usually negative in CCPD arthritis. A complicating feature is that RA and CPPD can coexist!

Sarcoidosis is an inflammatory joint disorder. The majority of patients with this disease have lung disease, with eye and skin disease being the next most frequent signs of disease. Although the diagnosis of sarcoidosis can be made on clinical and x-ray presentation alone, sometimes the use of tissue biopsy with the demonstration of “noncaseating granulomas” is necessary for diagnosis.

Arthritis is present in 15% of patients with sarcoidosis, and in rare cases can be the only sign of disease. In acute sarcoid arthritis, joint disease is usually of rapid onset. It is symmetric involving the ankles, although knees, wrists, and hands can be involved. In most cases of acute disease, lung and skin disease are also present. Chronic sarcoid arthritis can be difficult to distinguish from RA. Although RA-specific blood tests, such as RF and anti-CCP antibodies, can be helpful in distinguishing RA from sarcoidosis, in some cases a biopsy of joint tissue may be required for diagnosis.

Polymyalgia Rheumatica (PMR) is a disease that leads to inflammation of tendons, muscles, ligaments, and tissues around the joints. It presents with large muscle pain, aching, morning stiffness, fatigue, and in some cases, fever. It can be associated with temporal arteritis (TA), also known as giant-cell arteritis, which is a related but more serious condition in which inflammation of large blood vessels can lead to blindness and aneurysms. Also, a peculiar syndrome where use of the arms and legs leads to cramping because of insufficient blood flow (limb claudication) can occur. PMR is diagnosed when the clinical picture is present along with elevated markers of inflammation (ESR and/or CRP). If temporal arteritis is suspected (headache, vision changes, limb claudication), biopsy of a temporal artery may be necessary to demonstrate inflammation of blood vessels.

PMR and TA can present with symmetric inflammatory arthritis similar to RA. These diseases can usually be distinguished by blood testing. In addition, headaches, vision changes, and large muscle pain are uncommon in RA, and if these are present, PMR and/or TA should be considered.

In part 2 of this article, I will discuss infectious diseases that need to be considered in the differential diagnosis of rheumatoid arthritis. When RA is suspected, it is critical to consult with an expert rheumatologist.

Celiac disease, also known as gluten sensitive enteropathy is very common but frequently missed. It is an autoimmune disease of intestinal damage due to gluten in people who are genetically predisposed. Classic Celiac disease is diagnosed by abnormal blood tests and an abnormal
appearing intestine on biopsy and symptoms that resolve with a gluten free diet.

Several blood tests exist for Celiac disease. They have varying degrees of accuracy. Some are more sensitive, meaning they will be positive in milder forms of the disease but are not specific, meaning a positive test may not indicate Celiac disease. Others are felt to be very specific, meaning that when they are positive, it is almost certain you have the disease.

The most specific tests are tests for Celiac disease endomysial antibodies (EMA) and
tissue transglutaminase antibody (tTG) tests. These two tests are IgA based tests and can be negative if you are deficient in the immunoglobin IgA, which occurs in 10-20% of people with Celiac. When either EMA or tTG are positive Celiac disease is very likely and usually the intestine biopsy is positive. Recent studies indicate that the tTG may only be positive in 40% of true Celiacs when mild degrees of intestine damage are present on biopsy. Seronegative Celiac, meaning the blood tests are negative but the biopsy is positive, may occur in up to 20% of Celiacs.

Antibodies for gliadin (AGA), the toxic fraction of gluten are considered very sensitive but not specific for Celiac disease. Newer assays for AGA antibodies for gluten that has undergone a chemical change
called deamidation appear to be more specific for Celiac disease (Gliadin II,
Inova) than the older gliadin tests. They also may be as or more accurate than EMA and tTG
antibody tests but are not yet widely available.

The most distressing problem for people with lesser forms of gluten intolerance who have blood tests and/or biopsies that are normal or borderline yet respond to a gluten free diet is either not being taken seriously or knowing for sure if they are sensitive to gluten. For these individuals stool
antibody testing for antigliadin and tTG have been helpful. Such stool testing has been performed in research labs and published in a few studies but are only recently available through the commercial lab, Enterolab. Founded by a former Baylor research gastroenterologist, Dr Ken Fine, the tests are available to people online without a doctors order but are not generally covered by insurance. Dr. Fine, who patented the test, has yet to publish the results of his findings in a peer reviewed journal so his tests are not widely accepted. However, his unpublished data and the clinical experience of some of us who have used his test have
indicated the tests are very sensitive for signs of gluten sensitivity. He reports that they are 100% sensitive for Celiac disease and highly sensitive
for gluten sensitivity of lesser degrees. In the presence of symptoms, that reverse on a gluten-free diet,
abnormal stool antibody levels can be found in most people before blood tests or biopsies become
abnormal.

Small intestine biopsies during upper gastrointestinal endoscopy
are considered the “gold standard” for the diagnosis of Celiac disease.
However, recent studies have demonstrated that some people with gluten sensitivity, especially relatives of Celiacs
with little or no symptoms, have changes from gluten injury to the intestine that can not be seen with normal microscope examination. They can only be seen with special stains not routinely done or with a research electron microscope. The special stains are known as immunohistochemistry stains. They stain specialized white
blood cells called lymphocytes in the intestinal lining tips or villi. When these lymphocytes are increased it is known as intraepithelial lymphocytosis or increased IELs and it is the earliest sign
of gluten induced injury or irritation. Electron microscopy also reveals very early ultrastructural changes in some individuals when blood tests and standard biopsy examination are normal. When people who have these changes are
offered the option of a gluten-free diet they usually responded favorably. In contrast, those who continue to eat gluten often later developed classic Celiac disease.

What these studies suggest is that a “normal small intestine biopsy” may exclude
Celiac disease as defined by strict criteria but it is not a gold standard for detecting gluten sensitivity. This fact is appreciated by many individuals who have respond to a gluten-free diet they start
based on their symptoms, family history, suggestive blood test or stool antibody
test(s).

Another source of confusion is in the genetics of Celiac and gluten sensitivity.
Testing for specific blood type patterns on white blood cells known as HLA
DQ2 and DQ8 is increasingly being employed to determine if a person carries either of the two gene
pattern present in 95-98% of Celiacs and predisposing them to the development of Celiac disease. Some use the absence of these two patterns
as a way of excluding the possibility of Celiac disease and the need for testing or
gluten-free diet. However, there are rare reports of documented Celiac disease in people who are DQ2 and
DQ8 negative. Moreover, recent studies indicate other DQ
patterns may be associated with gluten sensitivity though unlikely to
predispose to classic Celiac disease.

Testing for all the DQ patterns is advocated by Dr. Fine, based on his
experience with stool antibody test results. He reports that other DQ types are
associated with elevated levels of gliadin and tTG in the stool and symptoms that respond to a gluten-free diet.
According to his unpublished data, all the DQ types except DQ4 are associated with
a risk of intolerance to gluten. Therefore, testing for all the DQ types allows a person to
determine if they carry one of the two high risk gene types for Celiac disease or
any of the other “minor DQ” genes Fine has found associated with gluten sensitivity.

Enterolab’s stool testing for gliadin antibodies and tissue
transglutaminase antibodies, though not widely accepted, have gained favor in the lay
public’s opinion as an option for determining sensitivity to gluten either despite negative blood tests and/or biopsies or in place of the more invasive tests. Most doctors still recommend the accepted blood tests and small
bowel biopsy for confirmation of Celiac. Though the reports in the lay community
are overwhelmingly positive they have not been subjected to peer review in
the medical community pending Dr. Fine publishing his data or other researchers reproducing his results.

However, doctors open to
the broader problem of gluten
sensitivity are reporting these tests helpful in many patients suspected of gluten
intolerance. Especially when someone has symptoms consistent with gluten sensitivity but has negative or inconclusive blood tests and/or biopsies these tests may be very helpful though some are not certain
how to interpret the tests. The national Celiac organizations are uncertain about how to
comment on their application without published research though a recent article
in the British Medical Journal did show stool tests highly specific for Celiac. Dr.
Fine has publicly commented that his unpublished data demonstrates those with
abnormal stool tests indicating gluten sensitivity
overwhelmingly respond favorably to a gluten free diet with improvement of
symptoms and general quality of life.

Another problem is that there are not universally agreed upon definitions for gluten sensitivity or intolerance. This becomes especially difficult for those who do not meet strict criteria for Celiac disease yet may have abnormal tests and/or symptoms that respond to a gluten-free diet. Those individuals become confused when they try to find information but do not have a formal diagnosis of Celiac disease. Consensus in the medical community on definitions and more research in this area is greatly needed

To estimate of your blood alcohol concentration (BAC) a breath alcohol test is given. The breath alcohol test measures the amount of alcohol in the air that you breathe out or exhale. There is a simple hand held device that allows you to measure your own breath alcohol level. If the device is calibrated correctly and used according to the manufacturer’s directions, it will give you an accurate estimate of your blood alcohol level. This personal device is similar to, although not as precise as, the type of test given by police for suspected drunk drivers.

Within minutes of drinking alcohol, your blood alcohol concentration starts to rise. Unlike food, alcohol is absorbed directly through the walls of the stomach, goes into the bloodstream, and travels throughout your body and to your brain. This allows blood alcohol levels to increase quickly.

The amount of alcohol in your blood reaches its highest level about 60 minutes after drinking. However, food in your stomach may increase the amount of time it takes for the blood alcohol to reach its highest level. Most of the alcohol is broken down in the liver. The rest of it is passed out of your body in urine and your exhaled breath. You can buy breath alcohol devices to measure your breath alcohol concentration at many pharmacies or through the Internet.

The manual appliance is a glass tube (or a balloon and a glass tube) that contains color changing crystals activated when exposed to alcohol from your breath. This device is easier and less expensive than electronic meters.

The electronic meter shows your blood alcohol concentration (BAC) percentage in a digital display window after you blow into a glass mouthpiece attached to the meter. This type of meter is more expensive than the manual type.

Many bars and restaurants provide their customers with free alcohol breath tests using one of these two methods. The devices are also used to monitor people in an alcohol rehabilitation center or hospital.

The breath alcohol self-test is used to estimate your blood alcohol concentration (BAC). The results can help you decide whether it is safe to drive. This estimate of blood alcohol is not intended to represent your actual driving abilities. Your driving may be impaired even with a low BAC level, such as below 0.05.

The breath alcohol test offers only one piece of information to help you make a safe decision about drinking and driving. The safest decision is always to not drive if you have been drinking.

Blood alcohol concentration (BAC) is commonly used by police and other legal authorities to determine whether a person is legally impaired and should not drive. A blood alcohol concentration in the range of 0.05 to 0.10 is considered legally impaired throughout most of the United States. However, legal BAC levels vary from state to state.

Driving under the influence of alcohol (DUI) can have fatal results. Alcohol is involved in almost half of all deadly highway accidents. All it takes is one drink to possibly impair your ability to drive safely. At 0.06 BAC, your judgment and physical coordination are impaired. At a BAC of 0.08, your muscle coordination and driving ability are significantly impaired.

Having any amount of alcohol in your blood can mean that judgment and reflexes will be impaired. You can purchase breath alcohol tests on the Internet, either directly from the manufacturer or from a company that sells this kind of product. To find a vendor simply do an internet search for the type of test or the name of the manufacturer.

When you feel the first symptoms of pregnancy, you naturally head to the drug store to find a good pregnancy test. Have you ever wondered how they work?

Over-the-counter pregnancy tests look for the presence of the “pregnancy hormone” in your urine. The test you receive later in your doctor’s office looks for the same hormone in your blood. The hormone is called human chorionic gonadotropin, or hCG for short. This hormone begins to build up just a few days after the fertilized egg is implanted in your uterine wall. The hCG will cause your placenta to produce progesterone after the implantation of the embryo, which is necessary to prevent the embryo’s rejection.

Because it takes time for the hormone to build up to detectable levels, most over-the-counter pregnancy tests work best when taken a few days or a week after your missed period. Some brands claim to be accurate sooner, but all women ovulate at different times of their cycles, so this may or may not be true for you.

The most accurate test is done in your doctor’s office. A blood test can detect much lower levels of the pregnancy hormone than urine tests. If you get a negative reading from your drug store pregnancy test, but you still “feel” pregnant, you’ll want to make an appointment with your doctor. Planned Parenthood offices also offer pregnancy tests and exams.

About 25 days after an egg is fertilized the fetus can be seen by transvaginal sonography.

What causes false negative test results?

A false positive result may occur if you take your test too early. The pregnancy hormone hCG does not begin to build up in your system until after the fertilized egg has attached to the uterine wall. This usually occurs within 14 days of fertilization, so a blood test is almost always accurate if it’s done after your next period was supposed to start. Some over-the-counter tests need higher levels of the hormone to be accurate, and so they say you’re not pregnant, even though you are. You can take another test a few days later to be sure.

Can you get a false positive result?

Yes, your test may say you’re pregnant even though you’re not. The most common cause is waiting too long to read the results of the test – the urine will evaporate from the test strip, and the color will change to show a positive result. If you get a positive result but you waited longer than suggested by the test’s instructions, you’ll want to take the test over.

If you’re taking fertility hormones, a home pregnancy test may show a false positive result. Ask your doctor if your injections include the hormone hCG. If so, the hormone will show up on the test, and the reading will be inaccurate.

In very rare instances, a false positive reading is caused by certain unusual forms of cancer.

What about the rabbit?

In your grandmother’s day, there were no over-the-counter pregnancy tests. The doctor would take a urine sample, and inject the urine into a female rabbit. If the rabbit was injected with humane urine that contained the pregnancy hormone, the rabbit’s ovaries would change. It usually took several days for the changes to take place, and the rabbit had to die before the lab technicians could look at her ovaries.

Fortunately, rabbits are no longer necessary for pregnancy tests.