But What Does That Mean?

11164740_10206320086664607_5860553690846776933_oI have to start off with gratitude to Team SlowItDownCKD for their willing participation in yesterday’s National Kidney Foundation of Arizona Kidney Walk. Abby Wegerski, Lara Garwood (and their ‘others’), Keith Harris, Patti DuBois, and Amy Vlasity with her children – Olivia, Willie, and Adam – all showed up bright and early.  I was so busy passing out book cards, speaking to others, and enjoying the dancing my team did that I neglected to notice which radio and TV stations were there.  Let me know if you can help out here.

Funny anecdote: when I presented Dr. Ivie of NKF of Az. with a copy of The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1, he looked at it quizzically and said something to the effect that it looked thicker than the other one I’d given him.  He was actually referring to What Is It and How Did I Get It? Early Stage Chronic Kidney Disease.  Thank you, Dr. Ivie, for proving to me that I got the cover just right for everyone to know this is a series.Book Cover

I’m glad to report there are loads of questions about last week’s blog.  These are questions I was going to answer when I got the results, hopefully for next week’s blog.  However, I’ll happily yield to public demand.

To refresh your memory, the test in question is NutrEval (FMV Amino Acids) with Nutrient & Toxic Elements. Below is a scan of the orders.  Lots of different elements being tested here.  I could think of several ways to explain them, but turned to the CPT codes as what seemed to be the easiest way of doing so.

Notice there are CPT codes to the right of the profile components.  CPT means ‘Current Procedural Terminology” according to The American Medical Association (AMA) at http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page

I attempted to use the AMA code manager at https://ocm.ama-assn.org/OCM/CPTRelativeValueSearch.do?submitbutton=accept  where you can enter any CPT code. No go, it turned out the site required registration and payment. I also wonder if this is not a billing site.

Back to figuring this out.  Next I did a simple Google search. I did come up with a few sites, but they all seemed to be for billing purposes. Well, maybe I shouldn’t be using those codes.  Maybe they were codes used solely for billing.

Oh! Mental head slap!  That’s exactly why CPT coding was developed and what it’s used for. (Do you think I can get away with saying I’m still tired from yesterday’s walk as my excuse for not catching that immediately?)

IMG_0070Think!  What else could I do? I could do a simple search for the name of the test, couldn’t I?  I decided to find out. I looked for the most esoteric name I could find and settled upon 8-OHdG.  Anyone ever hear of it?  Me, neither. But Farley’s Free Medical Dictionary has.  This is at http://medical-dictionary.thefreedictionary.com/8-OHdG 8-OHdG 8-hydroxy-2’-deoxyguanosine.

A modified DNA nucleoside product generated by reactive oxygen species (ROS), which is elevated in colorectal carcinoma, but not in adenomas. 8-OHdG is also elevated in ulcerative colitis (UC) and increases with disease duration and dysplasia. MUTYH, the human mutY homologue, is responsible for excising misincorporated adenine and for suppressing mutations caused by ROS. Nuclear expression of MUTYH is attenuated in UC.

We have a choice here: wait for the nutrition counselor prescribing the test to explain this in detail IF the value is unacceptable upon testing or define each unknown separately.  I’m willing to wait until the test results are in.  Do tell me if you’re not and we’ll explore these terms together.

Maybe we’ll have more luck with another term.  Which one, though?  Ummmm, okay, let’s take a look at Pyruvic Acid. The same dictionary tell us this is

CH3COCOOH, an intermediate in carbohydrate, lipid, and protein metabolism.

Now we could look up CH3COCOOH but what good would it do?  We have what we need. We know carbohydrates, lipids (fats), and protein have to be metabolized in order to be of any use to us.  This acid helps to do that.  We can understand how a lack of or surplus of this could affect us. I’d pay special attention to this component since it’s the metabolism of these components that give us energy… or in my case, seemingly not enough energy.

Let’s try another one.  How about Behenic Acid this time?  I found this definition at Dictionary.com (http://dictionary.reference.com/browse/behenic+acid?s=ts).

a crystalline, saturated fatty acid, C 22 H 44 O 2, obtained from plant sources, used chiefly in the manufacture of cosmetics, waxes, and plasticizers.

Frankly, the definition left me scratching my head and wondering why I would be tested for that.  Wait! I’ve got it, but it’s supposition. Maybe too coxemeticsmuch of that seeping into my system would cause a problem.  Clogging?  If so, clogging what?

Drugs.com at http://www.drugs.com/dict/behenic-acid.html told me it’s

A constituent of most fats and fish oils; large amounts are found in jamba, mustard seed, rapeseed oils, and cerebrosides.

And that it has a synonym:  N-docosanoic acid. This is getting frustrating.  It’s at times like these that I wish I did have all the answers, but – as I keep saying – I’m not a doctor.

Okay, one more shot – this time at the synonym. Oh boy, the information about this is written in deep chemistry terms.  That’s a foreign language to me.  I will have the same questions for my nutrition counselor when the test results are in as you probably have reading this blog.

Hey, maybe I could work with a word I know – like manganese. Oh, sorry, that means

manganesea mineral that is found in several foods including nuts, legumes, seeds, tea, whole grains, and leafy green vegetables. It is considered an essential nutrient, because the body requires it to function properly.

Thank you to WebMD at http://www.webmd.com/vitamins-supplements/ingredientmono-182-manganese.aspx?activeingredientid=182&activeingredientname=manganese for information we could all finally understand.  It doesn’t help to have loads of information about a component if the information doesn’t make sense to you.  I’m the one who’s meant to simplify explanations and I couldn’t understand enough to explain to you.

On a happy note, I am more than willing to share both my results and the explanations the nutritional counselor offers me when they arrive.  You know that saying about sometimes it just doesn’t pay to even get out of bed….Part 2Digital Cover Part 1


Until next week,

Keep living your life!


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