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Primary Care Provider reticent to order tests


DeadStarsStillBurn
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So first some data on me:

I will be 39 in mid September. I am a male-bodied person, Caucasian, 6'4". I was a rower in high school and college so I've done more running and oar-pulling than you can shake a stick at. Nevertheless, I gained a lot of weight out of college in part due to injury, in part due to a desk-jockey job, in part due to poverty. Point is, I maxed out at 355.6 pounds for an off-the-chart BMI of 43.3. Not ideal! I've been doing CRON and aiming to cut 2 pounds per week, the upward limit of what is safe and sane from my understanding. I have lost 57.2 pounds as of this writing which actually comes out to more like 4.8 pounds per week, but a big portion of that was initial weight loss that has tapered off to be more like a pound a week lately and I think that is generally an observable phenomenon in people with quite high BMI's who start a significant diet and lifestyle intervention, so I am not alarmed, especially given that my heart rate, blood pressure, level of energy, and general sense of well-being have all dramatically improved. Most recent blood pressure was 107/72 which is not setting any Guiness records for low BP, but compared to pre-CR levels of 128/90 is not too shabby.

Furthermore, my father and mother are both obese folks, my mother more than my father, and I tend to take after my mother in terms of BMI and build. My father was, when I last spoke with him some years ago, pre-diabetic. My paternal grandfather developed diabetes and subsequently bilateral blindness from diabetic retinopathy. Given that I was (and still am) overweight for many years, I think it is reasonable to conclude that I am at a heightened risk for developing diabetes and other weight- and inflammation-based diseases.

To that end, I'd like to get as much data as I can on my condition. I've spoken with my PCP and she is reticent to order additional tests for me such as IGF-1, liver and kidney panels, etc. Basically I gave her Luigi Fontana's list of routine medical tests and she wrote back to me "there is a phenomenon called VOMIT (Victim of Modern Imaging Technologies) that may be applicable here." I found that patronizing and dismissive and it kind of pissed me off, but I don't have an MD after my name (just a CMD). But I find doctors to be patronizing and dismissive in general. Do I have a *right* as a patient in the USA to demand a test be done on me? I hear all the time about how patients pressure their doctors into giving them medications they've seen advertised on the TV, and I have always wondered, "Who are these patients? My doctor won't even get me a damned blood panel without justification." Am I just failing to be assertive enough as a patient? Should I dig in and be a dick about it until she agrees to do these tests? Should I seek a different PCP? Is the consensus of the community that these tests don't really tell you that much that's useful anyway if you're already doing CR? If it's not a cross worth dying on, then fine, but if it's important healthcare information and my healthcare provider can't or won't provide it, I need to do something different, no?

Thanks for your constructive feedback!

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2 hours ago, DeadStarsStillBurn said:

Am I just failing to be assertive enough as a patient? Should I dig in and be a dick about it until she agrees to do these tests? Should I seek a different PCP? Is the consensus of the community that these tests don't really tell you that much that's useful anyway if you're already doing CR? If it's not a cross worth dying on, then fine, but if it's important healthcare information and my healthcare provider can't or won't provide it, I need to do something different, no?

After trying to get specialized blood work done through my PCP, having my insurance company reject it, trying again with a made up diagnosis etc, I finally gave up. Nowadays whenever I want to get any blood work other than a standard metabolic and lipid panel, I pay for it directly (no insurance) via a third party testing service like directlabs.com.

In just a few minutes you can get a script for any blood tests you want and take it to your local Quest for the blood draw. The cost ends up being very similar to what I'd have to pay if I went through my insurance once you factor in the co-pays and them refusing to cover some tests that I wanted. It saves a lot of hassle and keeps test results out of your official medical records.

--Dean

 

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1 hour ago, Dean Pomerleau said:

After trying to get specialized blood work done through my PCP, having my insurance company reject it, trying again with a made up diagnosis etc, I finally gave up. Nowadays whenever I want to get any blood work other than a standard metabolic and lipid panel, I pay for it directly (no insurance) via a third party testing service like directlabs.com.

In just a few minutes you can get a script for any blood tests you want and take it to your local Quest for the blood draw. The cost ends up being very similar to what I'd have to pay if I went through my insurance once you factor in the co-pays and them refusing to cover some tests that I wanted. It saves a lot of hassle and keeps test results out of your official medical records.

--Dean

 

Why keep it out of one's medical record? Might it be used against you to deny claims or something? Or is this an "it can't really help and it might hurt" sort of thing?

Either way, I will try the independent lab route, sounds like a plan. Thanks once again, Señor Pomerleau!

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1 hour ago, DeadStarsStillBurn said:

Why keep it out of one's medical record? Might it be used against you to deny claims or something? Or is this an "it can't really help and it might hurt" sort of thing?

Mostly the latter and concern that the insurance company might raise my premium or a life insurance company (or my PCP) might misinterpret some of the unusual serological changes wrought by CR as cause for concern.

While you are coming down from a BMI of 40+ all your blood tests are likely to move in what is widely considered to be a positive direction. But long-term serious CR can result in changes that might look concerning to someone without an understanding of CR effects on the body. For example, low testosterone, low IGF-1, low white blood cell count, elevated MCHC and MPV, low(ish) hemoglobin, low ferritin, low thyroid hormone and high TSH, reduced BMD.

Seeing some combination of these can result in your PCP referring you to a specialist (e.g. an endocrinologist for your messed up hormones) and/or suggesting medications (e.g. biphosphonates for your osteopenia) or further testing (e.g. cancer screening due to low WBC and whacky hormones), especially if in order to get your insurance company to pay for one of these tests you end up having to fake symptoms that are normally associated with anomalies in these measurements. 

But mostly because I learned that most of the specialized tests get rejected by my insurance company and I would end up paying more out of pocket for a comprehensive set of blood tests ordered by my PCP than I would paying directly for a package like this one from Direct Labs or better yet this one from LEF. Yes, they are kind of expensive. Nobody ever said doing serious CR right was cheap.

--Dean

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