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In addition to CD 57, what are the inflammation biomarker tests that you would recommend a chronic Lyme patient request of his /her physician to better understand their situation?
Well, there are several you can use. I usually do CD 57, I usually do a C 4A A. I oftentimes do Myeloperoxidase or MPO. IL6ix is an important one. Both Lyme and the COVID infections. Fibrinogen, CRP, HSCRP, those are basically the main ones. I tend not to do any of the fancier NFcappa and some of these other VGF and things like that. I don't find them overly useful.
I think, by the time I get a good history and physical on the patient and have a clear idea of what's going on, based on their history, 80% of their history, and maybe 10% more on the physical exam, I'm ready to make a clinical diagnosis and start therapy.
I think really the clinician who is very sure of themselves and very well experienced, if they've been doing this for 20-30 years, their reliance on biomarker testing and laboratory testing is not as heavy as a newer clinician with less experience.
If you go into the ER and you have abdominal pain, the emergency room resident, who's got maybe less than a year of experience, is going to order all these blood tests and a CT scan and ultrasound and all that to make a diagnosis. Whereas, the doctor with the gray hair, who's been at it for 40 years, can lay hands on you and take a good history and probably make the correct diagnosis 90% of the time. So, it's really clinician dependent on how many tests need to be ordered or should be ordered.
I think, some of the teaching institutions like the IFM and A4M, tend to teach the novices to over-test. I am training nurse practitioners all the time. I try to teach them to use their noggin, their ears, and all the gray and white matter in between, to come up with a clinical diagnosis, and only if they get into a quandary to do a test. That's everything from functional medicine testing, stool CDSAs, Lyme testing, et cetera.