"Functional Medicine Testing" - What is it?

OUTLINE OF THIS PAGE:

1. Introduction

2. Brief review of methodology and selection of CWI clinicians.

3. Conventional laboratory testing - usually omitted by other physicians - that reveals disorders of FUNCTION

4. More esoteric functional medicine testing

5. The "ultimate functional medicine test" - SPECT evaluation of the living brain


INTRODUCTION

"Functional medicine testing" is what the name implies - a laboratory analysis which attempts to understand an underlying biological FUNCTION of the patient. The reason that we use it in some cases is, quite simply, that conventional laboratory testing - typical of what most doctors order as standard practice - is not always sufficiently revealing to tell the whole story.

The current peer reviewed literature is replete with absolutely unmistakable evidence that disorders of essential fatty acids, low levels of antioxidants, delayed food sensitivity with IgG reactions, and heavy metal toxicity may play a role in what appear to be "psychiatric" disorders of children, teens, and adults. They may have actual physiological disorders of functioning and be unwitting and hapless victim.

Furthermore, there are conventional laboratory tests that many physicians frequently overlook with shocking and tragic results. Indeed, it was women patients, identified in referral as "antidepressant failures" and sent to Dr. Cady for "psychiatric consultation" who were the impetus for the establishment of Cady Wellness Institute. What we found were women with low thyroid, burned out adrenals, yeast growing in the intestines, and hormonal disruption.

Orientation/Methodology of Testing for CWI Clinicians:

We favor a "rifle shot" approach, rather than a "shotgun blast" of testing. While our initial workup may be comprehensive and rather inclusive, we order absolutely no laboratory evaluation - conventional or otherwise - unless it is medically justified. On all laboratory "draw" orders, we place the medical diagnostic codes ("ICD - 9 codes") such that your insurance company (if laboratory services are covered) should pay for it. Naturally, we absolutely cannot guarantee that your insurance will pay one dime on anything - nor can any other physician. Typically, however, conventional laboratory testing which is done in doctors' offices or hospital labs is covered.

After the original laboratory workup is done, we may come back for second and third helpings in the future to monitor response for treatment. Particularly if the endocrine system or neurotransmitters are being adjusted, it is imperative to have follow-up testing to insure that the patient remains solidly in the physiological normal ranges, and that our treatment conforms to the expectations and intellectual rigor of the peer-reviewed medical literature.

Conventional laboratory testing - here are some of the conventional labs that we typically see omitted (and all of these tests are paid for by most insurance companies):

- DHEA-S in both sexes. This critical hormone is associated specifically with energy in both men and women, as well as the ability to hang on to bone bass in menstruating females as well as post-menopausal women with or without hormone replacement therapy. It is also associated with control of blood sugar and insulin. We rarely see it checked on previous workups.

- Homocysteine and c-reactive protein - the "other two" labs (besides fasting lipids) that can reveal a tendency to heart disease. The coronary artery disease risk factors of elevated homocysteine and c-reactive protein (a measurement of inflammation) are now well established in the peer-reviewed medical literature, and lay people can even read about them in USA TODAY in a 2007 article on a sitting US President's health status.

Yet. ... they are rarely checked by conventional MD's. We may also do a "super-duper" lipid panel, known as a "VAP" or vertical array profile. Many enlightened lay people known that the LDL cholesterol is the "bad one" and the HDL cholesterol is the "good one" that goes up with exercise. What almost all lay people do not know - including many physicians - is that those numbers are frequently not adequate. There is a really, really, really bad kind of LDL and a "not so bad kind" - and the percentages can be determined on the VAP. There is also a really, really, really good and healthful kind of HDL, and a "not so good" HDL. Thus, you could have a "low LDL and high HDL" and be feeling pretty good about your self.... but if your percentage of LDL is much higher on the BAD kind, and your percentage of HDL is low on the GOOD kind - you are still at risk. I have almost never seen any patient come in with this lab having been done.

- COMPLETE thyroid panels. We usually see a solitary "TSH" test as a pitiful and woefully inadequate assessment of the thyroid axis. This is much like looking only at whether or not the Federal Reserve is increasing the money supply to get a "definitive" read on the U.S. economy. It doesn't work that way. The downstream effects (how much people are spending, how the housing market is, what the worker productivity is, etc.) are critical in understanding the economy. There are at least three more thyroid function tests we obtain, and sometimes five, in order to fully understand the issues.

- Viral "titers" (levels). Frequently when people come in with their energy sucked out of them, it's not because they are "depressed" or "not trying hard enough" or need to get "shrunk" to see "why they're not motivated" - but because they are filled with the unholy trio of viruses most commonly associated with post-viral fatigue syndrome: HHV-6, CMV, and Epstein-Barr virus ("mono" or "the kissing virus.") We will typically intervene - once the diagnosis is made, with holistic therapies to increase immune system function and balancing the thyroid and adrenal axes, if necessary. Usually only after that would we consider anti-viral therapy.

- the Cady Wellness Institute protocol for the "3 hour glucose tolerance test". Usually, this test - ordered by well meaning and dutiful physicians - is devoid of about HALF the data required to adequately interpret it. We order all of it, and will be happy to explain it to you and your physician, with whom we focus on helpful and collegial collaboration and amplification of their efforts. The development of this protocol is the brainchild of our naturopathic physician/educational consultant - Dr. Whitney Gabhart, ND.

- testosterone levels for men and women. It's not just the days of the "East German swim team" in past Olympics who were accused of "doping" and using "anabolic steroids." Both men and women need adequate levels of testosterone. While women have a more obvious "menopause," men have a similar, but more insidiously declining loss of this hormone: andropause. Interestingly, women do not get a free pass on this issue, because quite a bit of their testosterone is made in their ovaries. Loss of testosterone following menopause or a "total hysterectomy" causes their testosterone levels to plummet, with predictable and unfortunate results. In women, "brain fog," feelings of sloth, and self-condemnation about "why can't I get everything done" frequently accompany low levels of testosterone... not to mention no excitement in the bedroom. In men, there has not yet been identified a symptom of "acute Viagra deficiency." Erectile dysfunction is an inescapable downstream effect of flagging levels of testosterone, as well as loss of drive for career, mental clarity, and muscles turning into sagging fat - resistant to the most extreme and "motivated" gym workouts possible. In both sexes - once the problem is identified and precisely quantified - intervention is usually possible with spectacular results.

More esoteric labs

"Functional" labs of a more esoteric nature (these will be described in a later revision of this page. For now, we list for your review, some of the labs that we use and for what purposes):

SPECT Neuroimaging examination of the living brain:

(To be completed. In the meantime, visit the BRAINPLACE SPECT Atlas of Dr. Cady's friend and colleague, Dr. Daniel Amen,MD for an amazing tour through the living brain.)