DrBaboon
11-10-05, 19:25
In another thread (pH - will anyone be the first penguin in the water?), WolfBrother and I were discussing lab planning:
DrBaboon,
You're correct about lab studies not being an isolated item but part of a continium.
*snip*
The year or two is not completely far fetched. The New Madid fault line in Southern Illinois and the Yellowstone super-volcano are two areas that could cause 1 to 2 year disruptions on a wide scale.
*snip*
This shows organization and the requirement to NOT have to do everything - like you mentioned.
You wrote:
My own first line of planning would be to evaluate the needs of my family or any other people I set out to care for. That's where I'd look to match some testing capability with treatments. And then build from there.
My wife is a Type2 diabetic, diet controlled. She also had the radiation treatment for Graves. So she has to take thyroid medications. Over the years, I've gotten pretty good at telling when she needs to go back to her Dr and get a TSH done. And pretty good at telling whether the meds will be increased/decreased. In a long term situation, we will be facing some problems due to non-availability of thyroid meds.
I have periodically thought about his situation, and it seems like as good a time as any to resume the discussion.
Using the approach of analyzing the family needs...
Mrs. WolfBrother is a Type II diabetic who is diet controlled, and has been given radiation therapy for Grave's disease. He seems to recognize when to have her get her TSH checked, etc.
On the whole, I am erring on the side of using more medical terminology in many of my posts. My reasons for that choice include: 1) economy of explanation and ease of use for me - my posts are long enough as it is; 2) I see the discussions on this board as helping any of us improve our capabilities, and to that end, a lay person who reads medical texts looking for information is in need of learning terminology. IOW - I hope to encourage pursuit of knowing terminology. That's part of how I see teaching - immersion in the subject.
The Austere Medicine book suggests basal temperatures for following thyroid replacement medication. That's a reasonable approach. It's also possible to do many of the bedside medical exams for signs of hypothyroidism or hyperthyroidism. Honestly, those signs are not that helpful because they are mostly going to be seen when people are further outside their goals than you want them to be. If it's all you have, well, OK - it's what you have. Relaxation phase of deep tendon reflexes, lid lag, tremor, skin, hair, etc. Note - I'm not mentioning thyroid auscultation for bruit or assessing/grading proptosis -- those would be more appropriate for un-treated Grave's or possibly for endogenous hyperthyroidism, rather than the possibility of excess thryoid replacement (exogenous hyperthyroidism).
There are home laboratory test, or CLIA waivered tests (in the US anyhow). There are tests considered to be more sophisticated than what are approved as home tests or CLIA waivered tests.
If this were a perfect world... Yeah - right. You'd be able to get TSH testing done as you have been doing, and perhaps glycohemoglobin (hemoglobin A-1-C and variations on the theme). There are "home tests" on the market for glycohemoglobin, but they really aren't tests AFAIK. They are actually kits to collect blood at home and send it in to a lab, so that won't help us in austere circumstances.
You're left with the choice of not pursuing either of these tests, or finding a way to have them available if you think it's important enough to your wife's health to do so. In all likelyhood, that means the assistance of your physician in ordering supplies for you, and learning how to perform the tests, even if they are easy to do.
For now - I'll simply point out a TSH testing product (I haven't used it, so I can't give you a recommendation on it). It is a CLIA waivered test, so an office laboratory doesn't need to have an actual laboratory license to use it - "merely" a CLIA Waiver (yeah - I know - a license by any other name...).
http://www.wampolelabs.com/poc/gh_thyro_features.asp
http://www.wampolelabs.com/poc/gh_thyro_use.asp
As you can see, it's pretty easy for use - more or less like a pregnancy test cassette. It does not give conventional results for TSH - as in an actual number - rather it gives you something like "high or medium." It won't give you a "low" on TSH, so excess thyroid replacement is not going to be spotted this way. At least it doesn't require a big machine to use the cassette. I wouldn't be surprised if it needs refrigeration. Given your parameters, do you envision enough electricity often enough to run a small refrigerator, or do you have an alternate means of refrigeration?
http://www.thyrotest.com/FAQ.html
Your wife is probably not getting TSH measurements more than a few times per year. They come in boxes of 20 tests, and it's around $300 for the box. I don't know the shelf-life.
Would it be work to collaborate with your physician and another couple or 2 who have an interest in TSH testing to split 20 tests between you? 4-6-8 tests would get an average person through a 2 year period - which is what you have stipulated. Would you potentially do your TSH testing at home and call the physician with your results, and use that as a means to maintain your skills and also use up the supplies so that stock ends up being rotated?
I can't answer those questions. I'm merely posing questions to illustrate the process you might go through in deciding what to do.
I'll try to post more later - and perhaps discuss glycohemoglobin. If nothing else, I'll aim to post more on whole blood glucose (which you probably already are capable of performing), and perhaps urine testing.
I'd also like to get around to posting more considerations on using animal thyroid.
DrBaboon,
You're correct about lab studies not being an isolated item but part of a continium.
*snip*
The year or two is not completely far fetched. The New Madid fault line in Southern Illinois and the Yellowstone super-volcano are two areas that could cause 1 to 2 year disruptions on a wide scale.
*snip*
This shows organization and the requirement to NOT have to do everything - like you mentioned.
You wrote:
My own first line of planning would be to evaluate the needs of my family or any other people I set out to care for. That's where I'd look to match some testing capability with treatments. And then build from there.
My wife is a Type2 diabetic, diet controlled. She also had the radiation treatment for Graves. So she has to take thyroid medications. Over the years, I've gotten pretty good at telling when she needs to go back to her Dr and get a TSH done. And pretty good at telling whether the meds will be increased/decreased. In a long term situation, we will be facing some problems due to non-availability of thyroid meds.
I have periodically thought about his situation, and it seems like as good a time as any to resume the discussion.
Using the approach of analyzing the family needs...
Mrs. WolfBrother is a Type II diabetic who is diet controlled, and has been given radiation therapy for Grave's disease. He seems to recognize when to have her get her TSH checked, etc.
On the whole, I am erring on the side of using more medical terminology in many of my posts. My reasons for that choice include: 1) economy of explanation and ease of use for me - my posts are long enough as it is; 2) I see the discussions on this board as helping any of us improve our capabilities, and to that end, a lay person who reads medical texts looking for information is in need of learning terminology. IOW - I hope to encourage pursuit of knowing terminology. That's part of how I see teaching - immersion in the subject.
The Austere Medicine book suggests basal temperatures for following thyroid replacement medication. That's a reasonable approach. It's also possible to do many of the bedside medical exams for signs of hypothyroidism or hyperthyroidism. Honestly, those signs are not that helpful because they are mostly going to be seen when people are further outside their goals than you want them to be. If it's all you have, well, OK - it's what you have. Relaxation phase of deep tendon reflexes, lid lag, tremor, skin, hair, etc. Note - I'm not mentioning thyroid auscultation for bruit or assessing/grading proptosis -- those would be more appropriate for un-treated Grave's or possibly for endogenous hyperthyroidism, rather than the possibility of excess thryoid replacement (exogenous hyperthyroidism).
There are home laboratory test, or CLIA waivered tests (in the US anyhow). There are tests considered to be more sophisticated than what are approved as home tests or CLIA waivered tests.
If this were a perfect world... Yeah - right. You'd be able to get TSH testing done as you have been doing, and perhaps glycohemoglobin (hemoglobin A-1-C and variations on the theme). There are "home tests" on the market for glycohemoglobin, but they really aren't tests AFAIK. They are actually kits to collect blood at home and send it in to a lab, so that won't help us in austere circumstances.
You're left with the choice of not pursuing either of these tests, or finding a way to have them available if you think it's important enough to your wife's health to do so. In all likelyhood, that means the assistance of your physician in ordering supplies for you, and learning how to perform the tests, even if they are easy to do.
For now - I'll simply point out a TSH testing product (I haven't used it, so I can't give you a recommendation on it). It is a CLIA waivered test, so an office laboratory doesn't need to have an actual laboratory license to use it - "merely" a CLIA Waiver (yeah - I know - a license by any other name...).
http://www.wampolelabs.com/poc/gh_thyro_features.asp
http://www.wampolelabs.com/poc/gh_thyro_use.asp
As you can see, it's pretty easy for use - more or less like a pregnancy test cassette. It does not give conventional results for TSH - as in an actual number - rather it gives you something like "high or medium." It won't give you a "low" on TSH, so excess thyroid replacement is not going to be spotted this way. At least it doesn't require a big machine to use the cassette. I wouldn't be surprised if it needs refrigeration. Given your parameters, do you envision enough electricity often enough to run a small refrigerator, or do you have an alternate means of refrigeration?
http://www.thyrotest.com/FAQ.html
Your wife is probably not getting TSH measurements more than a few times per year. They come in boxes of 20 tests, and it's around $300 for the box. I don't know the shelf-life.
Would it be work to collaborate with your physician and another couple or 2 who have an interest in TSH testing to split 20 tests between you? 4-6-8 tests would get an average person through a 2 year period - which is what you have stipulated. Would you potentially do your TSH testing at home and call the physician with your results, and use that as a means to maintain your skills and also use up the supplies so that stock ends up being rotated?
I can't answer those questions. I'm merely posing questions to illustrate the process you might go through in deciding what to do.
I'll try to post more later - and perhaps discuss glycohemoglobin. If nothing else, I'll aim to post more on whole blood glucose (which you probably already are capable of performing), and perhaps urine testing.
I'd also like to get around to posting more considerations on using animal thyroid.