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I woke up this morning to this email from my husband: “I’m just outside of Normal.” He meant Normal, Illinois, where he’s traveling for business. But his note could have just as easily referenced how many of us feel about our health. Lab tests come back “normal,” or just outside, but we still don’t feel well.
What’s to be done? In this guest post, integrative physician and friend of Fresh Living Dr. Shilpa Saxena explains a concept she uses in her practice: “The Walking Unwell.” Read on to learn whether you fit this category, why lab-feeling discrepancies are so common, and what you can do to emerge into wellness. –Holly
“The Walking Unwell”
Early
in medical training, a physician learns that
there are many ways to gather information related to a patient’s
illness. As eager detectives, we search for the source of the
problem. We can ask the patient to describe their symptoms, the
timing of when they began, if anything makes them better or worse. We can
look closely at them, listen to bodily functions, palpate or feel for a
problem. Ultimately, in the course of our investigation, we find
ourselves ordering laboratory tests. If the results confirm our suspicions of the source of the
problem, BINGO, we’re on track. However,
very often the results are “normal.” So, what does
this mean about your symptoms?
It
is a popular misconception that the values that run down the far right side of
your lab reports determine if you are normal or abnormal. Actually, if
you look closer, you will see the column heading will read,
“Expected” or “Reference Range.” Why
doesn’t it just say “Normal?” Well, because there really is no
such thing! When Reference Ranges are established, patients
with varying age, sex, race, diet, medications,
stress levels, and many other factors are sampled. If, for example, samples are
collected on someone who doesn’t know they have liver problems from their
“normal” alcohol use, that value is still included to calculate the Reference Range.
Because of this, Reference Ranges include many values that could still be
“abnormal” or more precisely, unhealthy. These types of
results widen the reference range. So if your numbers fall inside the
Reference Range, it only means that you are in the range of 90% of the people
that were sampled. And unfortunately, these days, I wouldn’t say that
if you are like 90% of the American public, you are optimally healthy or
“normal” in terms of body function.
The
other consideration is that while we are all human, there is such a tremendous
degree of variability among us. When we factor in diet, level of
exercise, social activities, sleep, stress levels, and genetics, one
person’s feeling “great” is another person’s “sick.”
A very simple example is with vitamin B-12
levels. Most of us recognize B-12 as “the energy
vitamin.” The clinical Reference Range for this lab is 200-1100 pmol/L. In my practice, I routinely witness
patients who feel chronically exhausted when their values are around 500
pmol/L, yet I have other patients that are full of energy with B-12 results of
350 pmol/L.
So where does that leave you if you feel bad but are still “in range?” That puts you into a category that I call The Walking Unwell. The Walking Unwell live between
the zones of being Optimally Well and Obviously Diseased, and they make up the
majority of patients.
If you intuitively know
something is off yet the conventional medical system has not yet determined the what,
why and how these symptoms came to exist in you, it could be because the
current system of healthcare was not designed to focus on and treat
your issues. Modern medicine is so good at fixing problems with
surgical procedures and prescription drugs–problems like broken bones,
ruptured gallbladders, and infected lungs. These are called acute medical
issues.
But chronic diseases that develop over years, like diabetes, high
blood pressure, and long-standing digestive disorders, do not “correct” with this conventional
approach–and these chronic diseases are often in the mix for The Walking Unwell. The current healthcare model “treats” diseases, but I believe that
long-term health lies in understanding that
we need to fix the root causes of those disease.
So, where does that
leave you?
The
answer is simple, and it starts with understanding that people aren’t
healthy one day and chronically diseased the
next. Poor health is more often the gradual progression of a problem (or dysfunction) that at some point just tips over into where your labs look
“abnormal.”
But long-term health is attainable, and often taking a close look at your lifestyle is the roadmap to attaining it. What I’ve found most of the time is that The Walking Unwell have
lifestyles that are not conducive to living long, healthy, vibrant lives.
Instead, because of daily poor food choices, lack of movement, or poor stress
management, Walking Unwell patients develop issues that they suffer with needlessly.
So my advice is, don’t wait for your labs to fall outside the Reference Range
before you decide to make a change. Your body talks to you
every day. Listen to it and start treating it well
with whole, nutritious food, energizing movement, and time for relaxation every day. Then, relish
the joy of being able to walk, jog, or run
right out of The Walking Unwell zone!
Learn more about Dr. Saxena at www.sevamedinstitute.com, and join her wellness community on Facebook at www.facebook.com/centerforlivingwellness.
More from Dr. Saxena on Fresh Living:
(image via: http://www.sodahead.com)
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posted February 25, 2010 at 3:46 pm
It is so refreshing to hear a doctor write about this. I feel like I am not normal when I go to the doctor and am not feeling well, but everything comes up normal. I am actually having a bad case of that now and have been referred to a Endocrinologist and a GI specialist. I really needed to read this….I feel like it was written just for me! Thank you so much!
posted February 26, 2010 at 12:23 am
I thought that this was a very good article, and I love that little cartoon of the sick guy.
posted February 27, 2010 at 7:21 am
It was good article buit it did not throw light on what to do.
posted February 27, 2010 at 7:35 am
i wake up in the morning feeling tired. & with vague pains in my body. what shoul i do?
posted February 27, 2010 at 11:54 am
I fit into the category of the walking unwell. 2 nights ago I had an epilepsy attack, they admitted me. I have Fibromyalgia, now this. I am stressed all the time, I should have went to er a little sooner I came close to death. Now though I know the abnormal before it happens and I will monitor my self more closely. I don’t drink or smoke or do street drugs. It is my not controlling my stress.
posted February 27, 2010 at 12:30 pm
Dr. Saxena……cool person I believe. words and thoughts extremely helpful. The last two paragraphs were like poetry. Beautiful! Tell it like it is. Best wishes to all…
posted February 27, 2010 at 2:05 pm
no mention of severe depression. Even though on medication I am still a walking unwell. Since Thursday, I have had continued thots of just letting go, ending it, but what stops me? who will care for my doggies, and knowing that God is there in my heart, just my head keeps telling me I’m a broken screw up and not worth loving or caring about. So, tell me where’s the “normal” in that. Been turned down for disablity twice now, but I have this mental illness, epilepsy,back pain/disc problems, no insurance or job, go to a Charity Hospital.
posted February 27, 2010 at 4:06 pm
I want to know how to manage stress. I work two part time jobs. One from 8am to 2pm and then the other from 4pm to 11pm. Sometimes the evening job is weekends too. Both jobs are standing or walking jobs. One is high stress and then other is some stress. I also have a teen age daughter that does very little to help around the house. I went to the ER on Friday with chest pains but all tests prove that it was not my heart, Thankfully.
I need suggestions on how to manage stress.
posted February 27, 2010 at 8:46 pm
I too feel like crap most days, and it is not due to a overwhelmingly stressful schedule, but I guess maybe to feeling depressed, lethargic and an overall empty feeling I have inside. Idk what to do, b/c I am also trying to lose weight and cannot seem to accomplish that either.
posted February 28, 2010 at 6:46 am
MY STRENGTH COMES FROM THE LORD,WHEN I FEEL SO ALONE AND ABANDONED,
I DRAW MY STRENGTH FROM HIM AND I FEEL LIKE THE FOOTPRINTS IN THE SAND,WHEN THERE’S ONLY ONE SET OF FOOTPRINTS,IT IS WHEN GOD CARRIES ME,AND I AM WELL.
posted February 28, 2010 at 9:27 pm
Dr. Saxena: I love your article and I am responding with trying to replace all negative with positive my big downfall is smoking cigarettes which I am weaning slowly on the patch! My future goal is to work in the billing & Coding Dept. at Archbold Hospital. I have been in a relationship with a guy who is an alcoholic and seems to think he can still drink with his cirrhosis. He sips it with orange juice daily from sunup to sundown his attitude sucks! Highly negative, I tolerate way too much verbal abuse for a grown man to talk to anyone so ugly the way he does. It effects me on a daily basis and I have tried to guide and talk to him how this hurts me and still relentless. I have been attending church and wow what a difference when we go he sings hymns and his attitude is so different but it only lasts a day… His favorite activity is waching T.V. he does not like walking, or nature hikes, he is very negative, like trying to take a bull by the horns, no he does not want to change, no he does not like going out it costs too much money. I am at my wits ends and trying to just have a normal day with breakfast, lunch, and dinner at the same time every day is impossible. It is dragging me down and I cannot function well when I do not eat around the same time everyday and have a bed time about the same time every day. I want to give up completely on this relationship but I am living here as a caregiver and how would I be able to move out and on when I have no income and I am 53 yrs. old going to school will have degree or diploma next quarter for a good job is basic goal if I survive that long. Helpless with right choice and answer. I pray he changes what advice could you possibly give me? Thank you, Janet
posted March 7, 2010 at 9:33 pm
The idea of guaranteeing good health by proper nutrition (whole grains, etc.) and plenty of exercise, keeping a proper weight and attitude about life, would be wonderful, if, in reality it worked. Health does not have a “one size fits all” guarantee. At 66, having been a very active woman throughout my life, crucially concerned about eating nutritionally, educating myself, exercising daily along with walking, hiking, biking and dancing, along with not ever smoking and being a non-drinker, and being a petite lady, would seem to have assured me of a good, long healthy life. Little did I know why, throughout the years, I grew tired quicker, often anemic, had digestive problems that could flare up very severely, and suffered over 30 years of migraines, only to discover 5 years ago, I have had an inherited disease called “Celiac Sprue” which requires total elimination of gluten in the diet. Damage was done to my small intestine, which is the part of the intestine that absorbs needed nutrients into the body. I was often told I had IBS. Migraines were a puzzle to the doctors. I kept going, but as years passed, more problems. Once I learned what the problem was, my diet changed radically, and I am fastidious about my diet, but I am also supersensitive to everything. Along with that, I have had a 2-level cervical fusion surgery and degenerative disc disease which causes chronic pain, osteoarthritis, joint pain and am exhausted a lot. I understand Celiacs often tire easily. My body had gone too long misdiagnosed. And last week, I spent 4 days in the hospital with a battery of tests after having severe chest pain, which has happened before, and when the heart was found to pass the test, further exploration of the gallbladder/liver/pancreas, found 2 gallstones and an enlarged bile duct, suggesting possibly passing a gallstone. Eight different doctors were working on finding more definitive answers as to why all the problems. The GI doctors, familiar with Celiac disease, looked for auto immune responses, aware that Celiac is an auto immune disease, and is going to monitor me. I am so grateful to have caring doctors who insist on finding answers when people have health issues not easy to diagnose. Further my liver enzymes were quadrupled, but have come down closer to “normal”, and I had only been taking a less than prescribled amount of tylenol for chronic neck and back pain. I seem supersensitve to meds and so many things. So, humans are complex. It’s a complex world. I am grateful to God for life and live every day appreciating the doctors, and continually educating myself, yet, I feel as though I am sometimes pushing through mud backwards and up a steep hill, but I don’t give up. And I keep a sense of humor and find the good things in life. When someone has a health issue, I do feel patients have to have enough respect for the bodies they have been given to find out all they can about their family health hystory and to do all they can to keep healthy with the bodies they have been given. Life is precious, and it is to be respected. Thank you. Jayelle