DEAR DR. ROACH: My heartbeat is around 98-100 per minute. I checked with my primary doctor, and she said it's normal, as I am getting older. (I'm 48 now, female, and other than heartbeat, my health is normal.) My doctor checked my blood and said everything is normal except low calcium. I can work all day long, but I can't run even three minutes. Do you think I have a heart problem or am just getting older like my doctor said? -- V.N.
ANSWER: The normal pulse rate in an adult is between 60 and 100, and you are very close to the top of the range. While it may be normal, it is worth considering the possibility that this may be a more significant issue.
Anytime I hear an explanation of "you're just getting older," it raises a red flag to me. Getting older does bring changes, but you are only 48 (not old at all!). Low calcium is an unexpected finding as well.
The main other concern I have is your inability to run for three minutes. This all leads me to suspect that there might be more to your story. If you haven't yet had an evaluation of your thyroid, you should. An echocardiogram, showing heart structure and function, might be reasonable, and I suspect a cardiologist would be likely to order one. The electrical function of the heart could be tested with an office EKG and a 24-hour monitor if there is further concern after the office EKG. Finally, low calcium can go along with low albumin in the blood, which might indicate a nutrition issue. I think you need a more thorough evaluation before ascribing symptoms to getting older.
If no condition is found, an exercise regimen should help you tolerate more activity and slow your heart rate.
DEAR DR. ROACH: I received my laboratory values (a "complete metabolic panel") from my doctor. What do all these results mean? What organs are they reflecting? How can you tell if the results are good or bad? -- C.J.
ANSWER: A complete metabolic panel is a standard set of 14 blood tests. It is certainly not a complete look at the body, but it does evaluate the function of the kidneys and liver.
The kidney tests include the electrolytes (sodium, potassium, chloride and carbon dioxide) and calcium, as well as two measures of kidney function: blood urea nitrogen and creatinine. Abnormalities of these numbers can indicate disorders of salt and water balance or intrinsic kidney disease. The carbon dioxide level may indicate lung issues.
The liver tests are total protein and albumin, the liver enzymes (ALT, AST and alkaline phosphatase), and the bile and breakdown product bilirubin. There are many types of liver diseases, and they can make those levels too high, reflecting liver cell damage (especially the enzymes ALT, AST) or obstruction of bile flow (alkaline phosphatase and bilirubin), or too low (low protein levels mean any kind of severe liver damage). A high bilirubin can indicate breakdown of red blood cells.
The last test in a complete metabolic panel is the glucose. Diabetes is often diagnosed with an abnormal glucose on routine lab testing before any symptoms are noticed.
Although the "normal" ranges are given to you along with your results, a normal result doesn't always mean everything is fine, nor does a result outside the range always indicate a problem with one of these organs. Results need to be interpreted with the person in mind, and with the recognition that about 5 percent of values in healthy people fall outside the range.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.
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