LONG COVID FULL LABORATORY ANALYSIS (Blood Work) | Dr. Anderson

So here in part 2, what we want to look at is what would be the beginning of the laboratory and investigations we want to do that would then lead us to some treatment that might help when you're still feeling sick. Hey, I'm Dr. A. Welcome to my YouTube channel. I use this channel to answer questions, and I've been working in research and teaching in the integrative and naturopathic communities in medicine for 30 years now, and I've been seeing patients for a long, long time. So the first thing is you probably, But maybe not if you've been screened, would have the basics done. So they might have done a complete blood count and a differential. That's going to look at how many white blood cells you have, what families they are, how many red blood cells, going to look at your hemoglobin and hematocrit and your platelets and all of that business. And that may have been done, and that's great. You could maybe use that to start out with. The next would be a metabolic panel, or what you might know as a chemistry panel. And depending on who ordered it and why they ordered it, those can be fewer things or a greater number of things. Sometimes if there are a fewer number of things, we might look at that and say, well, let's update the chemistry panel to have more things in it. And chemistry panel tends to look at kidney function, liver function, electrolyte levels, and then a few other laboratory markers. So depending on how long it is, it might look at your liver function testing and maybe something like LDH, looking at your anoxic metabolism and stuff like that. But maybe if they did a short metabolic panel, like say a chemistry 6 or 7, some of those Wouldn't be in there. So might need to expand on that. The other one they probably would've done in the screening, but maybe not, and there's lots of iterations of it, would be iron studies. And so that might be something like a TIBC, the panel looking at your iron binding capacities. Ferritin is very important. That's your stored iron. And there may be other things there, but if that hasn't been done, that certainly should be looked at. Then there are things that are in the, what we would generally classify as the endocrine world, the hormonal world. And you might say, well, why would we look at these things if before I had long COVID, I didn't have any endocrine problems? You know, you never had any problem with blood sugar or thyroid or whatever, right? Well, the reason is that we see a lot of what we call de novo or brand new endocrine problems that are either low, medium, or high grade after long COVID or in long COVID. So that would include things like double-checking your blood sugar and insulin. That might be your hemoglobin A1C, maybe a fasting insulin C-peptide, things like that, we normally do a screening with your morning cortisol. So cortisol is your primary output from your adrenal glands for the middle part, the steroid-producing part in the middle. And the reason we do that is, is that if you got sick enough to develop long COVID symptoms, your cortisol can do one of 3 things. One is it's right in the middle of normal and it's happy. One is it actually goes too high because of all the stress, or the other is you maybe burn it out and you might not have the disease called Addison's disease where you don't have any cortisol output, but it might be really low. So it's sort of a Functional problem, but it's good to check that. Now there's other tests for cortisol too, but that's just screening. Then we normally take a step back, and even if your thyroid was totally normal before, we'll recheck it in a more broad way. That means you're going to do TSH, you're going to do free T3 and free T4. Those are your two main circulating thyroid hormones. You're going to do something called reverse T3, which is really only necessary in sick people, but you're sick, so we're going to check it. And then we're going to look at your thyroid antibodies. And the reason for that is is that autoimmunity, one of the most common is thyroid autoimmunity. And autoimmunity after COVID and in long COVID is a known phenomenon. So that's why we add the antibodies in. Now, if you had Hashimoto's or some thyroid autoimmune issue before, we need to recheck them because they could have got worse too. The other ones which people will sometimes, when we're writing up these things and we're sending to the lab, they'll say, why are we checking this? Men or women, doesn't matter. We will check estrogen, progesterone, and testosterone and look at the balance. Now, obviously in a male phenotype or a female phenotype, There are going to be different levels of these things, so you have to order correctly. But the bottom line is there are patterns that we see there. One of many examples we could give, if a male or a female, although the numbers will be different, the same pattern, because of all the inflammation, you can have an elevation in your estrogens and your androgens like testosterone, DHEA start to go down. You will not only have fatigue, you'll have inflammation you can't get to go away, and you'll have very slow healing because the androgens help you with healing. So we just look at balance. They're mostly nutrients. You can get specialty labs, do all sorts of nutrients, but the bottom line ones that we would want to look at would be your vitamin D levels, D like dog, vitamin B12. We will usually do some minerals like red blood cell magnesium and zinc, copper, depending on what you've been supplementing to. A lot of people during COVID took like lots of zinc and no copper. And so that ratio may be off. Now, are those tests perfect? No, there's no blood test that's perfect, but they can give you an idea if you're really overshooting or undershooting and things Things like zinc and magnesium levels and copper levels have a lot to do with your function, both for inflammation, but also for immune purposes. And again, you can do other lab testing from outside labs, we call it, where they might do a whole panel on your minerals or something like that. So looking at nutrients. The next thing that is super critical to follow is in the world of COVID that we've been in, we've seen elevations in people's clotting factors that, you know, aren't necessarily due to all of the normal reasons, but things like the D-dimer and fibrinogen. There's different tests in around fibrinogen that you can look at, but those should be looked at in the beginning and certainly followed if they're elevated because you might be more at risk for clotting or you might be one of these people getting microclots in the lungs, for example, or the brain or something. So that's something to look at early on. Global inflammatory markers like either sedimentation rate or CRP, and then if it wasn't included in the metabolic panel, the chemistry panel, normally there is alkaline phosphatase included in there, but also L. LDH. If it wasn't, we make sure both of those are in. So the LDH is looking more at hypoxic metabolism, potentially mitochondrial damage, etc. And alkaline phosphatase can be a marker for a number of things that are beyond the scope of what we're talking about. And then, at least in the beginning, so all of these would be done if, if you come in with resistant symptoms of long COVID. These are all things that would be done. You don't do them in steps. It'd just be look at all of it at once. The last area would be infectious disease. And we know from research, for example, very common to have co-infections with COVID Well, those co-infections with COVID often fly under the radar and then they cause long COVID. Now, they're not the only cause, but they're a big cause. Epstein-Barr has been identified. Treatment-resistant Candida, a fungal organism, can be there. So that's another thing that you might check. So viruses like Epstein-Barr and its family, Candida certainly on the fungal end of things. We often will look at chronic streptococcal markers like the ASO titer and the anti-DNA B, because sometimes those are resident and they go up in people with long COVID. And then there's a whole host of other chronic infections that can be looked for. I tend to also include your atypical pneumonia organisms, Mycoplasma pneumoniae and Chlamydia pneumoniae, maybe Anaplasma, et cetera, because those are associated with COVID infection. And then there's other things that can be tested too. So something in the infectious world. And then I brought this up under thyroid where I said, you know, thyroid autoimmunity is one of the most common reasons for autoimmunity, but there's other reasons for autoimmunity. And definitely something that we see in people that is in the literature as well, that is triggered by, you know, COVID, et cetera, and can drag you into long COVID is you never had an autoimmune condition and now you do. And autoimmunity, if it is brewing, can look like other problems. So it can give you chronic fatigue, chronic pain, other things. So we will do at the very least a screening Antinuclear antibody, ANA. Now the ANA has a bunch of subtests that can be done, and normally the way the doctors order it is they get the ANA, and if it's positive, it reflexes to do all the subtesting. But then there's other autoimmune things. So we got the thyroid antibodies, we got the ANA, and maybe the reflexes there. But because you get new autoimmunity, if you're having a lot of joint problems, we may do rheumatoid factor and some of the HLA series of studies. And then there's some other autoimmune things that we might look at as well. So in this part 2, I I really wanted to take more time to break that down as far as what is it that we'd be looking for beyond your major pathology things of cardiac disease, lung disease, kidney disease, you know, neurological disorders, et cetera. And those labs there that I just went through are what we would use with people as they're looking at trying to get to the bottom of, even if they did have, say, some kidney function problem or lung function problem, if they're still sick, there's other reasons for this stuff. And so this lab mix that I just showed you gives you, casts a wide net. It allows you to look at all the the main areas, not all of them, but all the main areas that trigger, whether it's fatigue, brain fog, chronic pain of either the central or peripheral type, neurological conditions, any other stuff. And it allows you then to follow what's out of range. And then the follow-up with that, of course, when you rule out pathology, if you find a pathology, you treat what you see. Well, when you do these labs, if you find that, then you treat what you find. Now that might be very functional. It might be very, you know, kind of gentle things that you need, such as, you know, natural supports for things and other stuff like that. It might be certain drug therapies that you need or hormonal therapies that you need, and it could be a mixture of all of the above. There's not one group of things that fits everybody. You have to really assess where the person's at. You assess how bad the symptoms are, what's not going away, and then you look at these objective markers from your laboratory testing, etc., and try and work on the ones that are there. If you're hypercoagulable, so have, you know, these high thick, thick blood markers, or if you're anemic, or if you're having insulin sensitivity problems, or if you have infections or you have any other thing, you work on those things as you go. Now, do they go away quickly? Usually not. It takes some time. And the longer you've had long COVID or long hauler syndrome, the longer these things take to get there. But the other side of it is if you don't look, you don't find these things. And you, you know, you can empirically, meaning sort of just because it's there, treat it, treat some things. But for some things like autoimmune conditions, Or hormones that are out of balance, or chemistry things that are out of balance, etc. You really want data. You want to know like what is in these labs and what what are my targets, so that then in two months or three months or four months or six months whenever you do your follow-ups, you do the labs again that were abnormal and see if you are making headway there. All right, this is part two. I'm Dr. A. It's been a lot of fun for me answering your questions. Thank you guys so much for adding new subscribers every day. This is a patient education channel. I'll see you all on the next video. Thank you.