a picture my son drew of a wave on a beach

Old Man ­Juices

tagged with: #blood #nursing #health

I visited a doctor about my susceptibility to surfers ear. I had been idly wondering if grommets would improve them and perhaps the GP or an ear specialist would be able to offer some suggestions. The GP had nothing to say on the matter but her eyes lit up when she noticed that I was now over 50. “It is time for you to have some tests” she told me. As a health professional I was well aware that my old man excretions were now due for examination. She gave me the requisite pathology paperwork and I was on what we in the trade irritatingly call the Health Journey.

💩💩💩 🩸🩸🩸 😧😧😧

Every fairy tale is told in threes. Not wanting to dissapoint I collected three of my finest turds for inspection. I also gave three vials of my blood away. The Australian health system deems the results of the tests are not mine. This is no doubt because most of us have no idea what to make of the results but also I suspect so that doctors can maintain control. I think it would be a smart move for everyone to have access to all their results via some kind of central system. Here in Australia the government has set up a thing called My Health Record. It doesn’t have any of my results available when I log in to see which leaves me wondering what is the point of it. Before going back to visit my GP for the results I decided to join my partner at one of her gym classes, alas I would only get as far as the third set of exercises.

I dislike gyms at the best of times. I went along deciding to put aside my dislike and just have a go. I used the running machine to warm up. the class started with some push ups and some jumping around then we moved onto burpees. A ridiculous exercise. I pulled a lower back muscle in the first set and that was it for me. In agony I left and spent the day in bed popping ibruprofen and paracetamol as fast as my kidneys could handle it (TDS and QID respectively). Still recovering and feeling old I visited the GP.

My GP plugged my results into the Australian absolute cardiovascular disease risk calculator (a catchy title no?). I remembered using this same tool as a student nurse. I saw a large 3% appear on the GPs screen. She told me that I had a 10% chance of having a cardiac event in the next five years. Not wanting to question her arithmetical rounding skills I asked for a copy of my results. This involved her laboriously printing off a single page for each result, not de rigeur apparently. Whilst undertaking this endeavour she went on to say I would need more blood tests and an ultrasound on my liver but at least my poop was fine. No need for a colonoscopy just yet. I thanked her, took my stack of print outs, more pathology forms, a medical imaging form and left. She did not ask about my orginal complaint.

As someone who works in the industry it is very useful to be a consumer instead of practitioner. To understand how it feels to have your health judged by another. To be questioned on your life decisions. You drink? You smoke? What sort of foods and drinks do you consume? How much exercise do you get? How much? How often? It is impossible to be asked these questions without feeling judged. Yet, I know they are questions which need to be asked if I want to stay on the path of good health.

As I crossed the road I scanned through my blood results. They did not seem to be at all concerning to me. Yes, my ALT was slightly elevated at 65U/L between about 10-55U/L is generally considered normal. It hardly warranted an ultrasound of my liver. Although, a doubt crept in, it is my liver and I need it. Maybe I should avoid alcohol for a bit, maybe I have picked up hepatitis from cannulating patents… maybe I have a virus … maybe… This is the problem with tests they open up doubt and worry and lead to more tests. Then before you know it they are recommending surgery or chemo and your very life is in peril. I told myself I would just go through this round of tests and make an effort to drink less and exercise more and forgetaboutit.

Flipping through the pages my I found the GP had underlined my neutrophils, they were 1.9x10^9/L. To be normal is between 2-8x10^9/L. A measly 0.1 does not seem much of a concern. In fact looking at the white cell ratio I could see the lymphocytes were within a normal range but the overal ratio was out. The expected ratio is:

  • 60% (Neutrophils)
  • 30% (Lymphocytes)
  • 6% (Monocytes)
  • 3% (Eosinophils)
  • 1% (Basophils)

however my ratio is:

  • 42% (Neutrophils)
  • 47% (Lymphocytes)
  • 9% (Monocytes)
  • 2% (Eosinophils)
  • 0% (Basophils).

Here is a quick and dirty spreadsheet graph just for the hell of it.

my wbc ratio

What could that mean? I see suppressed neutrophils in the results of my patients recieving chemotherapy but I am pretty sure I have not spilt any of that stuff on me. I like my PPE. It can be an early indicator of cancer, an autoimmune disorder or just a virus. Ostensibly normal the lymphocytes are relatively high which can indicate a number of things (like chickenpox or rubella) all of which I can discount except viruses, hepatitis, CMV and of course cancer. It’s a bloody rabbit hole isn’t it? I can totally understand patients who tell me they wish they just didn’t know. I will just assume I’ve had a bit of a virus.

By this time I was walking up the stairs back to my office. My new job entails a lot of sitting at a desk so I relish my little excursions. I wrangle the phone and computer for much of the day. I am not on my feet in the ward as much as I used to be. To be honest I don’t mind as the work is interesting and helpful to people who are in the midst of hard times.

The rest of my blood results were OK except the last page which indicated high cholesterol:

Lipids Result Normal range
Cholesterol 6.8mmol/L <= 5.5mmol/L
Triglycerides 1.5mmol/L <= 2.0mmol/L
Cholesterol/HDL ratio 4.9
HDL Cholesterol 1.4mmol/L >= 1.0mmol/L
LDL Cholesterol 4.7mmol/L <= 3.0mmol/L
Non HDL Cholesterol 5.4mmol/L <= 4.0mmol/L

My total cholesterol had gone up from 5.7mmol/L in 2018 to 6.8mmol/L. It really should be below 5.5mmol/L. “That’d be bloody well right” I thought, I have stopped running and reduced my walking. I eat too much and have gone from 83kg in 2018 to 87kg today. Middle age you see, it creeps up on us.

I gave up some more vials of blood to test for hepatitis and had an ultrasound. The sonographer told me I was a ‘toffee’. A term I have also used in the past, not on myself though. It refers to people who look Thin on the Outside but are Fat on the Inside (TOFI). It generally means I have more risk of having clagged up arteries causing a surprise heart attack. Whoop-de-fucking-doo. If that’s not a judgement nothing is. There is plenty of controversy about using cholesterol to guess our cardiac future. Like all of my blood results what the numbers indicate is debatable. I know my exercise regime and diet has changed for the worse in the past 5 years. I also know that once we reach middle age we increasingly lose muscle mass leaving nowhere for unspent calories to be used except in fat storage. As we get older we have to work harder than we used to if we want to remain healthy. Damn it.

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