2

votes

Requested Lipid Panel Extras Shot Down: How Should I Respond to My Doc?

Answered on August 19, 2014
Created June 02, 2011 at 12:53 PM

Hi all, I had a total cholesterol of 301 last year (before going paleo), and I'm trying to get a more accurate assessment of my current health. I recently had the following exchange with my new doctor over email regarding the various blood tests I wanted to get done (as recommended by Robb Wolf).

[FROM RYAN] "Hello Doctor, I am a new patient of yours. I would like to get a few tests to check my cholesterol as it came back high last year. Would it be possible to order the following tests?

-Total Cholesterol -HDL -LDL -Triglycerides -Glucose -LDL Particle Size -Glycated hemoglobin (Hba1c or just A1C) -C-reative Protein

Thank you"

[FROM DOCTOR]

"Ryan, Im happy to order the fasting cholesterol panel, and fasting blood sugar. I don't think you need both the fasting glucose and A1C because they are both screening diabetes tests. I don't recommend the C reactive protein, as it really wont affect out treatment goals. As far as LDL particle size, that's not a test that can be ordered within out lab system, at least as of yet."

So...

How should I respond? Should I just take his recommendation and skip out on the other tests? Should I push back? And if so, how do I make a simple and direct case for it?

Thank you all for your help.

Ryan

6b72eeb3f0c98b487f712efcb5092c90

(293)

on June 02, 2011
at 04:43 PM

I think this approach is best because you haven't really initiated a dialogue with this doc yet. He may be responsive when he knows you know what you're asking for and why, and understands that you're not just rattling off a list of tests you read about somewhere. While fasting glucose and A1C are both screening tests, they do measure different things. An A1C is usually more expensive, so most doctor's offices don't order them (or insurance companies cover them) unless you "fail" the fasting glucose.

2248abf977dd5d09733f5d4e2510fc12

(147)

on June 02, 2011
at 02:10 PM

(one of them actually told me "what's next, you wanna do genetic testing too?" "actually i already did", and then proceeded to tell me how horrible it is to let patients get their own test results, but he said, on the other hand he's very loose with prescribing painkillers if i want to treat instead of get more tests to find out what's wrong - i'm not joking)

2248abf977dd5d09733f5d4e2510fc12

(147)

on June 02, 2011
at 02:09 PM

say "Adios!". i had to go through 3 doctors in california before i found one willing to order my labtests (that i was paying out of pocket - cash - no insurance involved). All because CA is one of 5 states where you can't order without a Doctor requesting them for you.

7e746be2f0e550a8cd7df881322ae705

(18701)

on June 02, 2011
at 01:33 PM

The A1C was just a finger prick test the nurse did in the office, took about 2 minutes. I have no idea why they wouldn't just do that!

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on June 02, 2011
at 01:01 PM

You don't make a case. You go do it yourself

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on June 02, 2011
at 01:00 PM

You also need a fasting insulin. Go to lef.org order your own go from there. You are doing well. You will real like my philosophy when it comes to docs. I think that info has been loaded to my site last night. Not done but you can read about a CW doc mindset and how to change it

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5 Answers

best answer

6
1568416ef28477d1fa29046218d83ddd

(6235)

on June 02, 2011
at 02:07 PM

It is really ok to say "I am concerned about C reactive protein because it is one of my health maintenance goals to keep overall rates of inflammation and immune response low when I am not ill. If this is not part of your treatment plan for me we might need to discuss my health maintenance goals and see if we can reach an agreement about supporting me in not getting sick, not just treating me when I am ill. I have similar reasons for wanting an A1C level as my goal is to be sure that my body is not showing early signs of elevated insulin level while I can still address it with diet, not just to be sure that I haven't developed full blown diabetes."

His response will give you a better basis for making a choice. Sometimes knowledge is far less important then humility and cooperativeness. I much prefer a doctor who understand he is there to support my choices to even the best most super paleo doc who thinks he knows exactly what I should do.

6b72eeb3f0c98b487f712efcb5092c90

(293)

on June 02, 2011
at 04:43 PM

I think this approach is best because you haven't really initiated a dialogue with this doc yet. He may be responsive when he knows you know what you're asking for and why, and understands that you're not just rattling off a list of tests you read about somewhere. While fasting glucose and A1C are both screening tests, they do measure different things. An A1C is usually more expensive, so most doctor's offices don't order them (or insurance companies cover them) unless you "fail" the fasting glucose.

3
07ca188c8dac3a17f629dd87198d2098

(7970)

on June 02, 2011
at 01:00 PM

I'd find a new doctor.

Failing that, it's your money and your blood - I'm not sure why he's got an issue ordering tests for you.

2
2248abf977dd5d09733f5d4e2510fc12

(147)

on June 02, 2011
at 02:13 PM

Say "Adios!". I had to go through 3 doctors before i found one willing to order my labtests (that i was intending to pay out of pocket - cash - no insurance involved). All because CA is one of 5 states where you can't order without a Doctor requesting them for you.

(one of them actually told me "what's next, you wanna do genetic testing too?" "actually i already did", and then he proceeded to tell me how horrible it is to let patients get their own test results, but mentioned that on the other hand he's very loose with prescribing painkillers if i want to treat instead of get more tests to find out what's wrong - i wish i was joking)

2
06d21b99c58283ce575e36c4ecd4a458

(9948)

on June 02, 2011
at 01:16 PM

You need another doc. See if there is one on the low carb friendly physicians that Jimmy Moore has put together. http://lowcarbdoctors.blogspot.com/

0
3077156bf8f92d51f9d90ad303fbbe72

(10)

on June 02, 2011
at 01:57 PM

Find a doctor who does a particle size test. That matters. In fact, it's the only thing that is actually linked to negative outcomes. I have high LDL and really high HDL (mostly because of paleo eating and taking a prescription fish oil that raises HDL). My doctor said she's "concerned" about my LDL but won't put me on medication yet. From my research and experience in pharmaceuticals, I'm genuinely not worried at all about high LDL. I have more Apo-A than Apo-B. ApoB is what makes up LDL and IDL and VLDL. ApoA makes up HDL. HDL is fluffy and more full of water so it bounces off our artery walls. It doesn't stop and get stuck and begin to clog. LDL is bad. VLDL is worse and IDL is horrible. Advanced lipid testing is a more expensive test but a much more telling test. Berkley Heart Labs is a company that helps doctors perform these tests.

From Wickipedia, I know it's not a text book but it's siting a clinical study that truly exists: "Recently, the INTERHEART study found that the ApoB100 / ApoA1 ratio is more effective at predicting heart attack risk, in patients who had had an acute myocardial infarction, than either the ApoB100 or ApoA1 measure alone.[4] In the general population this remains unclear although in a recent study apoB was the strongest risk marker for cardiovascular events.[5] A small study suggests that added to fluvastatatin treatment, omega 3 fatty acids daily, containing 460 mg of E-EPA and 380 mg of E-DHA (ethyl esters), may lower apo B48 in hyperlipemic type 2 diabetics.[6]"

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