Test results and visit summaries:

As more than 95% of our patients use the internet and email, since April 2009 we have used a portal to communicate lab and x-ray results. We have also started sending summaries of your annual visits as well.

A portal is like a lockbox for which your user name and password is the key.
After your visit and when your labs are back, you will receive an email from Spruce Street Internal Medicine with instructions of how to access your summary or results.

We are unable to receive emails from our patients at this time as the portal is not intended to provide extended or involved counseling or communication.

For detailed questions or medication changes, please schedule an appointment.

A detailed explanation of individual lab results follows:

• Lipid Panel
  
  Cholesterol – There are two main groups of fat in the blood, cholesterol and triglycerides. Increased cholesterol may lead to arteriosclerosis (hardening of the arteries), diabetes, thyroid, liver and pancreatic disease.
  
  Triglycerides – This blood fat is also involved in arteriosclerosis, diabetes, thyroid, liver and pancreatic disease. They may be elevated in the 200-400 range if you have eaten within 10 hours of the blood draw. If your results are in this range and you did not fast, a repeat evaluation should be obtained.
  
  HDL (High Density Lipoprotein) Cholesterol – This is the “good” fat-protein combination. The higher the value, the lower the risk of developing heart disease. HDL can be increased with regular aerobic exercise, monounsaturated fats such as olive and canola oils, and cessation of smoking. Mild use of alcohol (one serving for women and two servings for men per day) has been reported to increase HDL.
  
  LDL (Low Density Lipoprotein) Cholesterol – This is the “bad” fat-protein combination, and the lower the LDL the better. The higher the LDL, the higher the risk of developing heart disease. This level can be decreased with reduction in fat intake, weight control, and regular exercise. Because this value is calculated using the triglyceride result, fasting is important for an accurate LDL, as well as triglyceride, result.
  
  VLDL (Very Low Density Lipoprotein) Cholesterol – This is the “bad” triglyceride. Elevation represents a risk of heart disease and/or pancreatitis.
  
  
• Metabolic CMP
  
  Sodium, Potassium, and Chloride – “Electrolytes” help make up the “salt balance” and acid/base balance in the body. They can be affected by diuretics or “water pills”, high blood pressure, heart failure, kidney and lung disease. The balance among these elements is important for proper functioning of the heart and brain.
  
  Carbon Dioxide – Part of the electrolyte pane used to detect, evaluate and monitor electrolyte imbalances.
  
  Glucose (sugar) – Fasting values are usually high in diabetes. Certain drugs, such as thyroid, diuretic, and birth control pills as well as recent intake of food, can elevate glucose levels.
  
  Urea Nitrogen (BUN) – A waste product of the liver excreted by the kidneys. High values may indicate kidney malfunction and/or dehydration
  
  Creatinine – This is a waste product of muscle metabolism that is discarded by the kidney. It is elevated in kidney disease, muscle wasting disease, and sometimes the day after strenuous physical exercise.
  
  BUN/Creatinine Ratio – Both BUN and creatinine are elevated in kidney failure, but they are elevated differently depending on the cause of the failure. This ratio helps determine the type of kidney failure.
  
  Calcium – screens for range of conditions relating to the bones, heart, nerves, kidneys, and teeth. Blood calcium levels do not directly tell how much calcium is in the bones, but rather, how much total calcium or ionized calcium is circulating in the blood.
  
  Albumin, Globulin and Total Protein – Measures the amount and type of protein in your blood. They are a useful index of overall health and nutrition. Abnormal results are an indicator of under nutrition, liver or kidney disease, cirrhosis, multiple meyloma, sarcoid, amyloid, lupus, and/or major infections. Globulin is the “antibody” protein important for fighting disease. If one of these values is high, but the other values are within expected ranges, the result is probably not significant, but only your physician can confirm this.
  
  AST & ALT – Injury to cells releases these enzymes into the blood. Liver disease and heart attacks, as well as serious physical injury can cause elevation of these values. Low values are probably not significant, but can only be confirmed by your physician.
  
  Alkaline Phosphatase – A bone and liver enzyme. High values are associated with liver and gall-bladder disease. Expect to see higher values in adolescents and pregnant or breast feeding women. Low values are probably not significant, but can only be confirmed by your physician.
  
  Bilirubin – Primary pigment in bile. It is derived from hemoglobin and processed by the liver, and builds up when the liver is functioning poorly or when some other disorder reduces the normal flow of bile. It is increased also when there has been destruction of red blood cells.
  
  
• TSH (Thyroid Stimulating Hormone)
  This is the test of choice for evaluating thyroid function and/or symptoms of hyper or hypothyroidism.
  
  
• CBC
  
  White Blood Cell Count (WBC) - The infection fighting cells of the immune system found in the blood. Lowered or elevated levels may be associated with a disease process.
  
  Red Blood Cell Count (RBC) – Measures the number of oxygen-carrying cells in the blood. Lowered levels associated with anemia, elevated levels associated with smoking and several diseases.
  
  Hemoglobin (HGB) – Measures the amount of oxygen-carrying protein in the RBC. Significant increases or decreases can be seen in anemia or RBC disease.
  
  Hematocrit (HCT) – Measures the oxygen-carrying capability of the blood by measuring the percentage of blood made-up of red blood cells. Significant decreases are one indicator of anemia.
  
  MCV, MCH, MCHC, RDW – Collectively called “indices”, these tests measure size and other characteristics of the red blood cells. They can be used to further define the causes of an anemia state. An isolated abnormal value probably has little clinical significance, but can only be confirmed by your physician.
  
  Platelet Count – These are small packages of clotting materials in the blood. Too many cause problems with unnecessary clotting; too few may cause excessive bleeding. Certain conditions alter this count.
  
  Lymphocytes, Monocytes, Neutrophils, Eosinophils – Different types of WBCs. They may be used to evaluate allergic reactions or differentiate between bacteria, viral or parasitic infections.
  
  
• PSA (Prostatic Specific Antigen)A prostate-specific antigen (PSA) test measures the amount of prostate-specific antigen in the blood. PSA is released into a man's blood by his prostate gland. Healthy men usually have low amounts of PSA in the blood. The amount of PSA in the blood normally increases as a man's prostate enlarges with age. PSA may increase as a result of an injury, a digital rectal exam, sexual activity (ejaculation), inflammation of the prostate gland (prostatitis), or prostate cancer. When combined with a digital rectal exam at your doctor’s office, the test increases the chance of detecting prostate cancer. A PSA level within the normal ranges does not mean that prostate cancer is not present. Also, some men with prostate cancer have normal PSA levels.
  
  
• Cardio C – Reactive Protein: A protein present in the blood when certain inflammatory processes are occurring. It is now known that arteriosclerotic plaques in the coronary arteries are an inflammatory process that correlates with Creactive protein, and it is believed to be a good prognosticator of heart disease. The test can estimate your chance of developing cardiovascular disease, and your risk of having a sudden heart attack. This blood test was redesigned from the traditional test to be sensitive enough to detect chronic low-level inflammation. Test results are independent of cholesterol, family history, and other traditional risk factors for cardiovascular disease. The test can be used in conjunction with traditional tests, such as cholesterol, to determine your risk. Recent illness or tissue injury, and chronic inflammation from arthritis can increase C-RP levels and falsely influence the risk rating for heart disease from this test.
  
  
• Hemoglobin A1c: Molecules of glucose (sugar) in the blood bind to this fraction of hemoglobin, and stay bound to it for months. The higher the amount of blood glucose, the higher the amount of hemoglobin A1c, and according to its value one can obtain the average blood sugar during the previous 8 – 12 weeks. The test indicates how well your diabetes has been controlled in the 2 to 3 months before the test. Information gained from this test can help determine whether your diabetes medication needs to be adjusted. It can also help your health professional estimate your risk of developing complications from diabetes, such as kidney failure, vision problems, and leg or foot numbness. The A1c level is directly related to complications from diabetes: the lower your A1c level, the lower your risk for complications.