Understanding the Diagnostic and Treatment Process

In this lecture, I'll be helping you get an insider's look at diagnostics and treatment process. It will help you form realistic expectations for your healthcare.

Let's begin with the differential diagnosis:

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Let's take a look at the Key Diagnostics:

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Diagnostic Tests

Blood Tests:

Blood tests are a standard for physicians looking to get a snapshot of your body's health status. Tests are often run together to give an overview of the health of key body systems and organs. In addition to the standard tests, there are blood tests for specific "markers' that help physicians confirm or rule out certain diseases. Researchers have even developed blood tests for the early detection of cancer (GRAIL and Galleri).

As powerful as blood tests are, they still have their limitations. They only measure what is in your blood and not what's going on within the tissue of an organ. And while there are hundreds of tests, they still can't measure everything a physician might need to know about your health.

To learn more about common blood tests, go HERE

Imaging Tests:

Imaging techniques have literally opened the door to the body, allowing physicians to have a look inside without surgery. They are powerful tools for identifying changes or abnormalities in body structure, ie. a broken bone, an organ mass, or torn cartilage. Common imaging tests include MRI, PET, CT, ultrasound, and X-ray. Each imaging technique offers a unique view of the body.

It may be easy to assume that with imaging technology, physicians can see everything they need to diagnose and treat you, but in reality, much about the body still doesn't show up in images. Getting details from any of the imaging techniques is still not possible. This is where the next category, "Other Tests," really comes in.

You can read more about the different types of imaging HERE

Other Tests:

This category includes a range of tests that don't fit into the blood or imaging categories, although they sometimes include imaging techniques as part of the procedure. Common "other tests" include minor procedures like collecting tissue samples (biopsies) or cerebral spinal fluid and more invasive procedures like angiograms, used to view blocked arteries involved in cardiovascular disease. From this category, biopsies are perhaps the most common.

Biopsies of tissues are taken for microscopic evaluation. Special preparation of the tissue sample allows a specialized physician called a pathologist to determine specific details about the tissue at a cellular level. This is commonly done when a mass is suspected of being cancer or when tissues show the signs of a possible autoimmune reaction.

An example of the microscopic detail pathologists can see is shown below in a breast cancer biopsy preparation from researchers at the University of Wisconsin, the National Cancer Institute, and the National Institute of Health.

Our tissues are not normally shades of red, green, and blue! Those are pseudo-colors added to help physicians visualize the different cells. In this image, the turquoise color represents the actual breast cancer tumor, while the green highlights the surrounding normal tissue. The red coloring in and around the tumor are immune cells.

Biopsy samples prepared for microscopic evaluation are referred to as histology. These samples are essential to determining the health state of the tissue, cancer type, autoimmune disease type, and other key information about the cellular events within a tissue.

Finally, after the process of differential diagnosis, using diagnostic tools to rule out and narrow in on one cause of a patient's symptoms and a diagnosis is made, the physician can begin the treatment process. It's important to note that many times physicians will treat the symptoms of a disease BEFORE a diagnosis is made. This is done for two reasons, the symptoms are life-threatening and/or they are significantly inhibiting the patient's life quality.

Like most aspects of medicine, treatment is not as simple as most people think they are. Having developed therapeutic drugs and other types of therapies for over 25 years, I am still amazed that they work at all. Our bodies are so complex, and with individual differences, it makes developing effective therapies a challenge.

Let's take a look at the Treatment Process:

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Treatment Options:

Therapy Types

The most common question I get about non-surgical therapies is why these therapies aren't all in a pill form. Of course, taking a pill is very convenient, but unfortunately, not all medications can be formulated into pills.

Non-surgical therapies come in many forms. Some therapies are simple, small molecules amenable to formulation that works in a pill. These medications are resistant to the digestive enzymes and acids of the digestive tract. From the stomach or small intestines, these drugs can make their way into the bloodstream, where they can have an effect on tissues and organs.

Other non-surgical therapies require direct injection, to bypass the harsh environment of the digestive tract. These therapies would be destroyed by the digestive acids and enzymes if taken orally. IV injection delivers these therapies directly into the bloodstream, bypassing the digestive tract. Another approach to these therapies includes injecting them more directly into the sight where they are needed.

Many times therapies that circulate in the bloodstream can't get effectively to the site where they are needed. This is particularly true of the central nervous system, where the blood-brain barrier prevents many therapies from entering. In addition, it is often beneficial to directly deliver a therapy to a site where it is needed in order to bypass effects on other tissues or organs.

Other examples of direct delivery include topical creams that are used to treat the skin and inhaled drugs that are used to treat the respiratory system (ie. nose, throat, lungs).

Therapy Failures

It's not uncommon to be prescribed a therapy by your physician only to have it not work. This includes all medications, from simple over-the-counter drugs to the most advanced cancer therapies. As I highlighted in the video, there are many reasons for this. It takes patience and persistence on your part, and your physician to find therapies that will work for you.

Often physicians will prescribe a therapy (or therapies) and use diagnostic testing to inform them about both the effectiveness and safety of the therapy. A simple example of this is the statins drugs used to lower cholesterol. Blood cholesterol levels are measured before, prompting the need for the statin drug, and then again after 3-6 months after taking the drug. This testing informs the physician about the effectiveness of the statin she has chosen for her patient. Therapy dosing, frequency, and type can all be adjusted when the physician uses diagnostic testing in conjunction with treatment.

Complete and Continue