Podcast 2 – Your Lab Results: Are They Normal?

your labs may be normal yet still be less than ideal



Dr. Chad: This is Dr. Chad Edwards, and you are listening to Podcast number two of Against the Grain.


Marshall: Welcome to Against the Grain Podcast with Dr. Chad Edwards. Where he challenges the status quo when it comes to medicine. We get into hot topics in the medical field, with real stories from real patients, to help you on your way to a healthy lifestyle. Get ready because we’re about to go Against the Grain.


Bryan: This is Bryan Wilkes here with my good friend and real doctor, since it said real at least five times in that intro. You are a real doctor right?


Dr. Chad: That is correct.


Bryan: That’s awesome. That’s awesome. That helps. I think that helps the whole situation here.


Dr. Chad: I think it adds a little bit of credibility.


Bryan: I agree. Hey, Chad I got a question for you. I’ve been thinking about it. It’s a pretty deep question. Have you been thinking about what you’re getting me for Christmas? Christmas is coming up. No?


Dr. Chad: No, I’m not going to discuss that.


Bryan: Okay, well, I’ll give you a hint. No, I’m not giving you a hint. I’m going to be really direct with you. I’ve got a cold and I need a Z-Pak. Okay. How does that work?


Dr. Chad: You just know my hot buttons.


Bryan: Is that bad?


Dr. Chad: No.


Bryan: Listen, I don’t need a long explanation because we got plenty of stuff on the show. Just give me the 10 second reason why you’re not going to give me a Z-Pak right now.


Dr. Chad: Because 99% of the time it’s not a bacteria number one. Number two, common use of antibiotics when they’re not medically indicated, and upper respiratory infections, acute sinusitis, acute bronchitis, there is no medical scientific evidence to support the use of antibiotics in those situations. Where there’s very limited evidence they actually have some warnings about it.


Bryan: Okay, here’s what I’ll say, Dr. Chad Edwards. Okay. Will it make me feel better, yes or no?


Dr. Chad: Most of the time.


Bryan: Yes, now.


Dr. Chad: No.


Bryan: We have a tie, so we’ve got Marshall here. He does something on the show. He’s got a big keyboard in front of him. A lot of buttons, a lot of stuff. You have to decide, does he give me a Z-Pak for Christmas, or just a normal gift like a car.


Marshall: I have to say that for the credibility, I got to give the win to him. It sounds like just a regular Christmas gift like a car.


Bryan: Yes, okay.


Marshal: Yes, you lost that one.


Bryan: Okay. Okay, that’s great. Be sick for another week or so, and then I got myself a Christmas present. That’s great. I appreciate that Chad.


Dr. Chad: It’s because I care.


Bryan: Let’s get to the important stuff, our sponsors. Revolution Health and Wellness Clinic. You know a little bit about those people, right Chad.


Dr. Chad: Yes. My clinic. If you’re tired and fatigued, feel frustrated with doctors because they don’t listen to you, want to fix your pain without surgery. If you answered yes to any of those, give us a call 918-935-3636. Or visit our website at revolutionhealth.org to schedule your appointment.


Bryan: Awesome. I get the good one. The Upper Cervical Health Centers. You know these people; great people. Their patients report an improvement of over 75% in their overall health. The interesting thing about these guys is they’re not your typical chiropractic office. Where they go and they basically break your back to fix your back.


Dr. Chad: Snap, crackle, and pop.


Bryan: Their number is 918-742-2300. Again, that’s 918-742-2300. Or you can visit their website at uppercervicaltotalset.com/newyou. We’ve got a pretty cool topic today, Chad.


Marshall: This episode’s hot topic.


Bryan:  Your lab results are they normal? Are they?


Dr. Chad: Yes.


Bryan: That was written here, so it makes it very awkward.


Dr. Chad: It sounds like we’re talking about labs.


Bryan: Right.


Dr. Chad: That sounds pretty darn boring. Your challenge is to make this interesting.


Bryan: I’m happy to do that for a Z-Pak. How about that?


Dr. Chad: Okay, we’ll talk about that after the show.


Bryan: Okay, okay. That’s another show. That’s a whole other show right?


Dr. Chad: That’s right.


Bryan: Okay. Tell me about lab results. I will say lab results for me the average guy, it’s going to be a challenge for you to keep me interested, because they seem like some sort of algorithm written on a sheet of paper. I don’t really understand them.

Typically, I’m not getting lab results unless I’m sick. I’m from Oklahoma and somewhat of a redneck. We don’t go to the doctor unless we’re sick. And even when we do go to the doctor we’re not feeling well, we get our labs drawn. The doctor comes in and explains it, but I have no idea who he’s measuring them against. I have no idea what normal means.

Explain to us kind of the general, if I go to just an average doctor, how he’s basing all these results. Against who’s the population and give us some insight to that.


Dr. Chad: Sure. Basically, this started because when I started looking at medicine differently and started doing Prolotherapy, and just a lot of the things that I was looking at. Patients would come in and they would say “I feel bad”. And they’d get labs. And they would say “Everything’s normal”; normal on your labs.


And I was like, well what is normal? We’ve got this range. Like on thyroid, it’s .5 to 5 for a lot of labs. And we’ll say that, okay, that range is normal. If you fall within that range that’s normal, but what does that mean?


Bryan: Yes, that’s the big question is what does normal mean? Yes.


Dr. Chad: Where did that come from? That’s kind of what we’re going to talk about. And the reason that I wanted to discuss this is because I think it explains a lot of why people feel bad. They get labs, their doctor say this is normal, yet it may not be. Or you may be normal and you’re actually abnormal, but you may be abnormal and you’re within the normal. So it can go both. Or you can be abnormal and your labs are– yes, it can go both ways.


Bryan: I always thought, what’s normal for me?


Dr. Chad: Exactly. Well, there’s normal and then one of the things that we focus on at Revolution Health, is are you normal or are you optimal? I don’t know a single person that says, no, I’ll just be normal. You’re coming to us, let’s get you optimal.


Bryan: People shoot for average all the time.


Dr. Chad: Exactly. And the sad thing is that-


Bryan: There’s a lot of movies about that.


Dr. Chad: The sad thing is that many of them miss.


Bryan: Yes, exactly. They set their bar low and they miss.


Dr. Chad: That’s right.


Bryan: There’s a big problem.


Dr. Chad: That’s right. I want to go ahead and start. We’re going to go a little bit out of sequence on this thing, but I’m going to go ahead and start with a story.


Marshall: It’s story time.

Dr. Chad: And we’re going to start with a patient, we’ll call her Sally. Sally comes into us, feels awful. She’s very tired, she’s very athletic. Runs long distances. She does marathons and half marathons, and all kinds of crazy running distances. And she feels horrible.

We’re like, okay we do this all the time. Come on in we’ll get your labs. Well, this story really underscores why we have to consider labs and where this stuff comes from. One of the things that can cause fatigue is thyroids. Obviously, we get a full thyroid panel. And our thyroid panels is a little bit more extensive than the way I was trained.


Bryan: Tell me about it. I’m not so sure that I understand typically what a thyroid does for a person.


Dr. Chad: Yes. You have the thyroid gland.


Bryan: Sure.


Dr. Chad: Which makes them thyroid hormones T4 and T3. We’ll talk more about that in a future podcast. But T3 is the active form of the hormone, and basically, it is the gas pedal for your metabolism. There’s a thyroid receptor on almost every cell in your body. That hormone goes inside the cell, binds the nucleus, causes a number of changes that revs up your metabolism, basically.

T3 is what you really want, but it’s converted from T4. Again, it’s just biochemistry mumbo jumbo that I care about, most people don’t. But T4 becomes T3. All that stuff goes to the brain. Your brain sees how much you have and starts kicking out this stimulator hormone, from the brain called THS, Thyroid Stimulating Hormone. If you don’t have enough, the brain says, thyroid gland makes more. It kicks out this TSH.

When your TSH is low, usually that means your thyroid hormones are high, and vice versa. When your TSH is high, it usually means you don’t have enough. I was taught in medical school that all you need to evaluate the thyroids is a TSH. And the interesting thing is I was taught that by a non-clinician. In other words, he’s a scientist, he’s a doctor, but he doesn’t see patients. He was a pathologist. Brilliant, brilliant man.

You know, Sir William Osler said, a physician in the early 1900s, said “Listen to your patient, he’s telling you the diagnosis”. When your patient says they’re tired and fatigued and you get these labs that are normal, are you listening to the labs or are you listening to the patients?


Bryan: That’s interesting. Prior to drawing labs she’s saying that I’m lacking energy, right?


Dr. Chad: Right.


Bryan: And this is a high functioning visual, an athlete, if you will.


Dr. Chad: Correct. She eats clean, she exercises, why does she feel bad?


Bryan: Yes.


Dr. Chad: That’s her job.


Bryan: Let me ask you kind of a side note here. Would most doctors even test for the thyroid right off?


Dr. Chad: Yes, I think that’s a pretty common. If you come in and you say, I’m fatigued, especially for women thyroid is a common issue. But many times they’ll get a TSH, Thyroid Stimulating Hormone, and they’ll stop right there. And that’s where this patient’s story is very interesting, because her TSH was 2.02. Normal reference range on our lab is roughly .5 to 5.

That’s well within what we define as normal. That didn’t answer the question on is it thyroid? And if all I got was a TSH, it would end there. And we would say, there’s nothing wrong with your thyroid, there’s nothing “Wrong with you”. You’re just tired, depressed, here’s your antidepressant. Maybe it’s your hormones. Maybe you don’t get enough sleep. You’ve got stress in your life, whatever. But, you remember we mentioned, T4 and T3?


Bryan: Right.


Dr. Chad: We measured her T4, which many doctors won’t do. Sometimes under a little bit of direst the patient says, I want this checked, they’ll go ahead and measure it. Some endocrinologists will go ahead and measure it. Some primary care doctors will go ahead and measure it. Hers was 2.16, which is actually elevated. That’s outside the normal range. If all I got was a TSH, it wouldn’t show me that elevated T4.


Bryan: Let’s stop here.


Dr. Chad: Okay.

Bryan: Again, define normal. In this instance is, compared to the thousands of other people that have gotten this same test. Not compared to her previous labs.


Dr. Chad: Correct. On the upper limit of normal, depending on the lab, you’re looking it around 2, something like that,the 1.8. Hers was outside that normal range. It was “Too high.” if she were on thyroid medicine I would say, “Oh, you got too much.” Well, actually the way I was trained I would say, “No you’ve got enough because your TSH is normal.” Everything is based on TSH.


Her free T4 was a little bit elevated. T4 has to be converted to T3, and so we checked her T3 also. Again, T3 is that active form of the hormone. Hers were 1.9, which is actually pretty darn low. So, got enough T4, If all I checked wasT4 we’d say you got enough thyroid hormones, but the one that really matters, the T3 is low. She is not making enough T3 from that T4.


The really interesting thing for her is her reverse T3. Again, topic of another podcast, but it’s kind of the anti-T3, it comes from T4, and it works against T3. She had reverse T3, which is kind of blocking the T3, and hers was off the charts elevated. Her problem was a thyroid hormone problem. It was not a thyroid problem because her thyroid gland is functioning normally. She is making the T4, she is making the hormones, but she is converting into a different hormone that’s not appropriate, and therein was her problem.


Now we had to dig into “Why?” That’s another topic. If all I got was the TSH it wouldn’t answer the question. There’s two important things I would say that we need to understand about our labs. Number one, you got to ask the right question. If you don’t ask the right question you’ll never get the right answer. That’s the first piece on labs, and not really the major topic of this podcast, but you got to ask the right question. If you don’t, you get a bunch of labs and they say you’re normal, they haven’t completed their work.


Bryan: But I would challenge you on this only because for me, I go in — I’m a business guy, I’ve said this couple times in the first podcast, I knew nothing about the right questions to ask. How does a person go into their doctor’s office and even begin to lead them down?

Is it more the doctor asking the right question, or the patient asking the right question? I think goes back to our first podcast, maybe there is no– doctor certainly doesn’t have any traditional medicine, these days he doesn’t have time to ask a lot of the right question.


Dr. Chad: That’s exactly right. The issue, for me, is that patient’s– my job as the physician, as this patient’s doctor is to ask these questions, and to answer them with the work-up. The patient comes in with the complaint, they’ll say I’m tired, I’m fatigued, whatever it is, and my job is to ask the questions so that I can get to the right answer.


Bryan: The leading questions to get to it, yes.


Dr. Chad: My Traditional medical education did not give me the tools that I needed to be able to answer this question adequately. I was actually taught in medical school that this reverse T3 thing was hogwash, it wasn’t true. Again, I was taught that by a non-clinician. I will tell you with one hundred percent certainty that it absolutely does matter, because when you fix it they get better.


Bryan: Well, this story, this particular story, did she get better, Sally?


Dr. Chad: Yes. We actually gave her a little bit of T3, so T3 only medication, and then we started looking into the underlying problems of nutrition, why does it convert. A couple of months later she felt fantastic. We got her off of those thyroid, the T3 only medications. We just did that to help her feel better in the interim. We watched for all side effects, and these are things that may be managed because there is risks associated with that. But, they’re small, especially if you manage those. She felt amazing. Today she is out doing her thing, running her marathons, and eating clean like she was before. She is really working on the stress, because that was a major contributor, but she feels fantastic. We had to ask the right questions.


Bryan: Yes. Well, I’m still kind a ticked off that you won’t give me my Z-Pak, because I’m a hundred percent sure that I feel better two days from now. Good for Sally, right? Good for Sally. Sounds like you got to go in, and pay the money, and get the product.


Dr. Chad: Well, I’ll just give you some Prozac to deal with your depression from not getting Z-Pak.


Bryan: [laughs] We’re going to do a podcast on that, but that’s going to be a month long podcast right?




Bryan: The use of Prozac.


Dr. Chad: Yes, it’s going to be really depressing.


Bryan: Yes, yes. Let’s go right to– I’m looking at some of these notes here. Again, I don’t understand all the medical jargon, but there is a difference between functional medical testing that we– lab results that we’ve kind a talked about and traditional medicine, how they interpreted differently? I want to go back through that one more time, something that’s important?


Dr. Chad: Yes, absolutely. The question that we need to keep in our brain is “Why?” Somebody comes in, they say I feel bad, I’m tired, this is going on, the real question is “Why?” We’ll be talking– In the next couple of podcasts we’ll be talking about testosterone. I’ve got these young guys, I had a guy that was 22 years old come in, and his testosterone was just over 100. I literally have some female patients that have higher levels of testosterone than what he have.


Bryan: Wow, 25-years-old.


Dr. Chad: 22.


Bryan: He’s Marshall’s age.


Dr. Chad: [laughs] I didn’t believe it. I rechecked. It actually came back at 75. When you have a 22-year-old male patient confirmed on two labs to have low testosterone, you have to ask the question “Why? Why is this?” You’ve got the problem, and you can “Manage the problem.” But why did this happen to begin with? You can either just prescribe a medication, the pill, or whatever to fix– to correct his testosterone, make his labs look normal, or you can address the underlying problem, “Why did this happen to begin with?”


We look at functional medicine we’re at constantly asking that question “Why?” You have high blood pressure, “Why you have high blood pressure?” Let’s fix the “Why” and then we don’t have to worry about managing this abnormal blood pressure. That’s our whole focus with functional medicine, let’s get to the basics, let’s get to the basis of this, the foundation, fix the foundation, make it where you don’t need all of these other medications. The other medications, I’m not anti-medication I use them almost every day, as I prescribed them almost every day.


Bryan: But it’s not getting to the foundational problems of your makeup, of your chemistry?


Dr. Chad: That’s exactly right.


Bryan: If you’re a person that’s overweight and have diabetes, and there is a direct correlation. I think people can understand that, you lose weight your diabetes can be improved, heart conditions, all that good stuff. It is very common that people obviously– I think anyone would agree that the model for today’s medicine is you take a pill, right?


Dr. Chad: Yes, absolutely. You go in with your problem-


Bryan: And you’re against that?


Dr. Chad: Absolutely. Again, it has its place, but you can’t just fill in the gaps without asking “Why?” I think it’s very important to ask that “Why” question.


Bryan: That’s interesting. In business we have matrix, right, we have matrix where we say as a business, we want to have this much profitability or we want to produce this much product. In order to do that we have to back up and start asking ourselves what can we change fundamentally in our process and business to get to those results. I got to see medicine the same way, you don’t start with the lab, it can be a conversational piece, it can be a goal to get to, right?


Dr. Chad: Correct.


Bryan: But you have to put in the work to make the chemistry, right?


Dr. Chad: Again, going back to what Dr. Osler said is that “listen to the patient, they’re telling you the diagnosis.” When you actually listen to the patient, ask the right questions, work through so we develop what’s called the differential diagnosis. You come in you say I’m tired, we’ll say, “Okay, it could be testosterone, it could be adrenal, it could be nutrition, it could be stress, it could be sleep,” all these kinds of things. We start working through those and checking them off of our list, that’s a normal medical paradigm.


It’s when things don’t fit that mold that we have to dig a little bit deeper, we have to figure out “Why?” First, we have to find the right category, is it the testosterone, then we have to ask the “Why?” Again it’s not just a simple matter of, where is your testosterone?


Bryan: Chad, I hate to give you complements to your face, especially, right?


Dr. Chad: I can turn around if you want.


Bryan:  For people listening, Chad and I went to college together, so I’ve known this guy a long time. He pays me zero to be on this show by the way. I believe in Chad, he is a great guy, I can say personally. He’s done a lot for my family. I’m  disappointed he won’t give me a Z-Pak, but that’s probably continue on in the next couple of shows asking.


Dr. Chad: Sometimes patients have to be protected from themselves.


Bryan: [laughs] Yes, well, so do doctors. More so than any category I would say. On that note, one of the things I really, really liked about you, Chad, that I have seen, and it’s who you are. Having known your college, I think you, my perception is you went to medical school for all the right reason, because you were making a contribution to, an impact to, whether be your town, your city, the place that you lived in, contributing to over wellbeing of a person. You’ve always been interested in health, right?


My perception toward some doctors is they go to medical school for [laughs] probably a lot of the wrong reasons, right. Tell me a little bit about when you being to see the traditional medicine model. We talked about a little bit in our first podcast of you draw lab results, you prescribe a pill to somebody, and it’s burn and churn. It’s how many people you can get through the door. I think that all leads back. This lab work conversation leads to the average doctor is not setup to win for their patient.


Dr. Chad: Correct.


Bryan:  And they’re really– all that concerned about the overall health of the patient. They’re not really concerned about that.


Dr. Chad: Well, but let’s look at how they get to that point. Because patients ask me this kind of stuff a lot. They’ll think, do doctors not care. I think the vast majority of physicians out there very much do care. It’s why they go into medicine they want to help people.


Bryan: Interesting.


Dr. Chad: And all those kind of things.


Bryan: Yes, because for me my perception is they don’t. I’m with all the other people that say that, but you have insight on that. I get it.


Dr. Chad: Right.


Bryan: They start out caring.


Dr. Chad: My medical school class we had 88 people there. They are all wonderful, fantastic people. I have nothing but respect for them. And that was just my class. I’ve worked at a major clinic here in Tulsa Prolotherapy, I’ve worked in the military, and most of them very traditionally trained. These people care. They’re good people. But when you look at the system, Number 1 in medical school, we were taught biochemistry, anatomy, all of those things that help us understand what went wrong, what got disrupted.

Then you get out into clinical rotations and it shifts from understanding biochemistry, and understanding anatomy, and understanding, pathophysiology, and what’s going wrong with this? It shifts away from that toward your medical mentor. Your medical mentor says, when the patient comes in, they’ve got this, and what drug are you going to treat them with? What studies shows that you need to do this? And my-


Bryan:  They get involved, maybe this was land before time, but they’re involved with drug reps. They’re hearing different features and benefits about like more of a business situation eventually.


Dr. Chad: Well, I don’t think many of them think about it as business, it’s just kind of what happens. And so the physicians that I looked up to for the most part knew the studies. And they would say, well we’re going to put you on this drug because this study showed that blah, blah, blah, blah.  And the ones that can quote those studies I was like, my gosh that guy’s brilliant. I want to be that guy. They were just amazing.

But what ends up happening is they’re practicing by guidelines because those guidelines are formulated from the research studies. When I was in residency I had a physician mentor, Sammy Choi, that was just absolutely brilliant. He was the guy that on the cover of the American Heart Association, the BLS, Basic Life Support, CPR manual.

At the time, there were pictures of a hundred people, a 100 physicians. They’re in scrubs and their white coats, and all those things. He was the one that would say, this guy right here is Billy Bob Smith and he wrote a paper in 1972. It was ridiculous what this guy knew. And he spent all of his time reading.

Absolutely brilliant. But he taught me that you need to know the guidelines for how to practice medicine. And the great physicians will break the guidelines and they won’t practice by them. But you have to know them and know why you’re deviating from them. Tulsa Prolotherapy


Bryan: Yes. It all comes back to labs are a very personalized experience, is what I’m hearing you saying.


Dr. Chad: Yes. And going back to my original point, you make that differential diagnosis, but then you use the labs to confirm-


Bryan:  The guidelines.


Dr. Chad: -what you’re suspecting.


Bryan: Absolutely.


Dr. Chad: I think it’s this. You come into the emergency, you’ve got right lower quadrant abdominal pain in the bottom of your belly on the right side. And we think that’s appendicitis, so let’s get an ultrasound or a cat scan and confirm that test. We’ll get a blood count and confirm that diagnosis. Tulsa Prolotherapy

Bryan:  You’re playing within the boundaries of some pretty well documented lab type situation. I don’t even know the terms. But last night I was watching when I was sick, you know I’m sick.


Dr. Chad: Yes, because you need a Z-Pak.


Bryan: Right.


Dr. Chad: Quote/unquote.


Bryan:  I hear what you’re saying on the show, I’m still not there though. I need a Z-Pak. I’m a business guy I’ve got to get back to work. But last night I watched a PBS special when I was up late sick on Edison. And the interesting thing about Edison he was an inventor, but he’s a scientist. And that’s how I view doctors is they’re scientist. They love data or they should love data. They should love data.

They should love taking this individual and try to make it better. And Edison was the same, he’d take an individual problem and he wanted to fix it. And he actually had a state-of-the-art laboratory by the time he was I think 25. He invents the lightbulb and then he has to setup this whole network topology grid, if you will, to get electricity to the lightbulb.

He comes out of the laboratory in order to provide literally electricity to his lightbulb everywhere. He was miserable. That’s why I think of doctors. You take a scientist that invents something great for countless people. You take him out of his element. You throw him into this mass production environment and he literally is miserable. He stops inventing. His passion is lost. Tulsa Prolotherapy

And I got to tell you as I watched that and I thought about this podcast, it all goes back to the lab results. Because I think doctors, I think you’re probably right, they’re scientists at the end of the day. They’re getting into the science of the body. And they’re fascinated by it.

I’ve never met a doctor that’s not fascinated by the chemistry of the body. But you take them out of that passion, and you put them into a system of a burn and churn, someone like Edison. It’s no longer about inventing liable you’re trying to pump as much electricity as you possibly can to make a profit for a large amount of investors.

Now, the system as I see it the hospitals are owned by businessmen like me, they demand a return from the physician’s group, or whatever, they hire physicians, and it literally is a burn and churn position. They don’t get to do a lot of science. Tulsa Prolotherapy


Dr. Chad: Well, if you look at the way insurance reimburses and just the way the whole thing is setup, the physician has no control over the revenue that’s brought in. If you think about you, if you have a factory and you manufacture widgets, and it costs you $100 dollars to manufacture one of the widgets but you have no control over the sale of that widget.

Bryan:  What’s the incentive? It’s out of your hands, yes.


Dr. Chad: And I don’t mean to say that medicine, the delivery of medical care to patients, is a business. But the reality is that there’s a business transaction and you have to be able to turn the lights on.


Bryan:  This is really the underlining passion behind you starting Revolution Health, because in a way I see you taking full responsibility, along with the profit, which is a great thing. You fought for our country, which is a free country and you should be able to come back and be a businessman and a doctor at the same time. But in my opinion, you started this clinic so you could invest in people. That you would see a long term recurrent. Tulsa Prolotherapy


Dr. Chad: Correct.


Bryan:  Yes.


Dr. Chad: And you know my thing is, if I take insurance I become a slave to the insurance company. And that’s just the truth. Whether we agree with that or not, that’s really the reality of it. And I don’t think the insurance company has a role inside that office exam room between the patient and the doctor.


Bryan:  I agree.


Dr. Chad: They have to be removed from that. And it’s between the patient and the doctor. At this point, the only way to do that is for the patient to pay us. Now, there are things that we can do to save them money. We do everything we can to save them money at every step, and still be able to keep the lights on. And there’s a lot of things that go on that patients don’t get to see behind the scenes. How much time it spends as reviewing all of these labs.


Bryan:  Oh, I’ve seen you do it.


Dr. Chad: In the way that we do this. It takes an incredible amount of time, not even in that room with that patient.


Bryan:  I’ve seen your war room, if you will. I think you have another physician’s assistant with you or doctor.


Dr. Chad: She’s a nurse practitioner.


Bryan:  A nurse practitioner and a couple of nurses that come in, and literally kind of look at these labs and kind of walk through it.


Dr. Chad: That’s right.


Bryan:  It can be a pretty lengthy deal for you guys.


Dr. Chad: Correct.


Bryan:  It’s a passionate deal for you too. You could spend all day doing it.


Dr. Chad: Well, we’re looking for the answer. We’re looking for a needle in the haystack. And so again, going back to these labs, how do we get these normal? And what does it actually mean for that patient? And so it’s important to understand, where do these labs come from?

Well, there’s a five step process where the labs are performing the tests will actually come up with these, what we call reference ranges. The first thing they do is they select the test. So like for thyroid, TSH, they’ll say we’re going to test TSH. Then they determine the reference population, so who are they going to check a TSH on and say this is “Normal”.

Then they check a sampling method and that’s just the way they’re going to test the blood for the TSH. Then they collect, process and test the specimens as Step 4. Step 5, is that they’re going to analyze these results. And so this is kind of the meat of the topic.


Bryan:  It’s good to know, yes.


Dr. Chad: They basically run us through a statistical analysis. And the mark manual says that reference values vary based on several factors, including the demographics of the healthy population from which specimens are obtained, and the specific methods and/or instruments used to assay these specimens.

And so basically with the statistical analysis, we’re saying that normal is a 95% range, 95% of the healthy population falls within this range. That means 5% have what’s called a false positive. Meaning that you’re outside the normal range but you’re still “Normal’ as defined by that population. The interesting thing to me is they say determine the reference population is Step 2.

Well who is that referenced population and how do they determine that? One of the lab directors that I spoke with in the past, the healthy population that they used to determine normal was that the patient walked into the lab. That was the only criteria.


Bryan: You know it is interesting that you bring this up. When we had our first child and they used his weight measurements, right, our child was always on the low end and Courtney was like, “This child’s got to eat.” So, we’d just like stuff in food in this kid’s face, right, and the kid’s not even hungry.


Dr. Chad: Right.


Bryan: Right? So I start, you know, I’m a– Chad, I got to be honest with you, Google has changed my world.


Dr. Chad: Of course.


Bryan: I can, I mean I basically don’t even need a doctor. At the end of the day you can listen to this podcast or you can just Google everything. You don’t really need a doctor, right? Wrong. Do we have a wrong button? Why don’t you just go wrong.


Dr. Chad: Wrong.


Bryan: Oh that’s great. Yeah, so, seriously though I googled it and I don’t know if this is true or not, but one of the things I found out was when I did my google research Chad was there’s a lot of fat babies in America. And  they’re comparing my relatively thin baby to a bunch of fat babies. I hate to say it but it’s true. It’s not very politically correct. So I begin to discover even through those statistical comparisons that I’m quite all right with my child being in the very low percentage.


Dr. Chad: Exactly.


Bryan: Yeah.


Dr. Chad: And the BMI, Body Mass Index, or those height and weight charts are based on body habits. It’s been a while since I’ve looked at it, but it’s based on 1980s. I think was the last time we updated that.


Bryan: They can’t update that? They can’t update that? They should update that every year.


Dr. Chad: Well, and they’re talking about that, but-


Bryan: They’re talking about it?


Dr. Chad: But the problem is-


Bryan: How hard is this?


Dr. Chad: That we’re going again by normal and not optimal.


Bryan: Oh my God.


Dr. Chad: And that’s another problem. So if we lived– Oklahoma is one of the most obese states in the country, if not the most obese. And so if we applied the data for Oklahoma to Colorado or California, which traditionally is much better as far as height versus weight, and what’s defined as obesity, then none of them would be obese and all of that. I mean, you can’t– You got to look at how are you interpreting, how are you getting these normals.


So when we look at things like where Sally came in and her TSH was off what is defined as normal. And you can have people with hypothyroid that are in the normal category, you can have people that are hyper thyroid in the normal category, and it skews your reference range. Now the concept from a scientific perspective, from the scientists’ brain is that if you get enough data, then it skews or it will wash out those. And of course you throw out the outliers. So one that’s three times normal, you throw those out.


And they’ve got a formula for how they do that. But if two thirds of your population or a third of your population is technically abnormal but you lump them into normals, then you have a very different reference range. So is really important to go back to how did they get these normals, what is this lab result, independent of the reference range, what does this lab result tell me about this patient, and how can I use that result to help me better understand the patient’s complaint.


Bryan: Great stuff Doctor Chad Edwards. I think we’re out of time for today. But this is for anybody listening. I mean, I think you have to view these podcasts as really valuable, really valuable pieces of content, because I think even to ask yourself if you’re listening, to get an hour with a physician, and a physician at Doctor Edward’s caliber, is not only costly but it’s probably not even available to the average person. So, Doctor Edwards, again, as much as I hate compliment you to your face, I appreciate you doing this. And I know firsthand you do this because you love to do it. This is what you’re good at, and you love to help people. I just wish you’d give me a Z-Pak. I mean its one little request. You know what I’m saying? Next time my friend.


Dr. Chad: Thank you so much.


Bryan: Yep.


Marshall: Thanks for listening to this week’s podcast with Doctor Chad Edwards. Tune in next week where we’ll be going, Against the Grain.


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