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 Post subject: Blood work
PostPosted: Wed Dec 19, 2012 7:40 pm 
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Joined: Wed Apr 11, 2012 3:40 am
Posts: 449
I'm about to run yearly blood work and I can have a carte blanche of stuff checked for the same price as basics apparently. Besides, the regular things like cholesterol, triglycerides etc. is there anything sport specific I should check? Thyroid stuff maybe?

I'm 23 and some may say it's silly to run bloodwork on a early basis, but hey better to know if something's going awry.


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 Post subject: Re: Blood work
PostPosted: Wed Dec 19, 2012 10:33 pm 
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Joined: Fri May 08, 2009 8:31 pm
Posts: 236
Location: Denver
russianbear wrote:
I'm about to run yearly blood work and I can have a carte blanche of stuff checked for the same price as basics apparently. Besides, the regular things like cholesterol, triglycerides etc. is there anything sport specific I should check? Thyroid stuff maybe?

I'm 23 and some may say it's silly to run bloodwork on a early basis, but hey better to know if something's going awry.

The more tests you do, the more likely you will find an abnormality- and one that is likely to be inconsequential or lab error. Unless you have a particular family history of an illness that you need to screen for, or have a medical problem yourself that needs surveillance, don't waste your time and someone else's money- you don't need any routine lab tests if your healthy at your age (yes, I am a physician).


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 Post subject: Re: Blood work
Posted: Wed Dec 19, 2012 10:33 pm 


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 Post subject: Re: Blood work
PostPosted: Wed Dec 19, 2012 11:57 pm 
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Joined: Wed Apr 11, 2012 3:40 am
Posts: 449
The only family issue is heart disease.

Obviously I wouldn't try to extrapolate a problem out of one blood test, but having it compare to last year's is not beneficial you think? The only other non regular thing I could think of was testosterone, thyroid (t3/4) and vitamin D levels (it's winter here).


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 Post subject: Re: Blood work
PostPosted: Thu Dec 20, 2012 4:04 am 
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Joined: Fri May 08, 2009 8:31 pm
Posts: 236
Location: Denver
If the family hx of heart disease is linked to hypercholesterolemia then a baseline cholesterol with HDL is probably worthwhile. All the other stuff, not. It's only beneficial to compare if there was something wrong before that needs monitoring, or if you are assessing the response to therapy. For example, if you are hypothyroid and taking replacement thyroxine, it's worth a check to see if your dose of medication is keeping you euthyroid, or if you are on a drug that needs monitoring for levels (many anticonvulsants, for example, or anticoagulants) then the drug level or the parameter that is affected by the drug (like an INR in the case of coumadin) should be followed. But all that other stuff is so unlikely to be of benefit (and if you get a false positive, it will generate orders for more tests!) that its a waste of money. Even if it isn't YOUR money directly, misuse and overuse of tests is one of the things that drives up health care costs for everyone.


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 Post subject: Re: Blood work
PostPosted: Thu Dec 27, 2012 2:42 am 
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Joined: Mon Jun 06, 2011 7:16 pm
Posts: 394
Location: Irvine, CA
dmp is giving you some sage advice! I urge you to follow his rec's.


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 Post subject: Re: Blood work
PostPosted: Fri Dec 28, 2012 2:09 am 
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Joined: Sat Jul 30, 2011 6:38 pm
Posts: 243
I like what I see above. Too many colleagues order way too many tests without good reason. My wife who is very healthy and was about 35 at the time went in to a new family doc and his "physical" took 3 appointments and tested for everything under the son prior to even seeing the physician. It was a waste of thousands of dollars of tax payer money and the physician did not even see her to establish if any of the tests were necessary.

This does fall apart a little bit for high level athletes. These are guys and girls that push their bodies to such a high level that a certain amount of testing is a good idea, much more than would be common sense for the average joe. As well as an extensive physical there would be (fairly extensive) screening BW, ECGs and Echocardiograms will typically be done as well os testing of things like VO2 in some situations. This has even gotten to the point where there is a movement for all olympic athletes to receive a pre-olympic physical.

To actually answer the OPs post though, generally I agree you likely don't need anything.


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 Post subject: Re: Blood work
PostPosted: Fri Dec 28, 2012 4:02 pm 
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Posts: 449
Doc ran CBC, testosterone, tsh without my urging. Good thing too because my tsh turned out to be high and vitamin d deficient (testosterone in range but low ish). Let's just agree to disagree on the yearly testing, I think if one has the means, It's a good idea.

Lipid profile is stellar though.

My physical took one visit with the blood draw taking a couple minutes a week prior.


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 Post subject: Re: Blood work
PostPosted: Fri Dec 28, 2012 5:59 pm 
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Posts: 243
This is a great example of someone unintentionally making your argument for you (or how about a little knowledge is a dangerous thing).

Asymptomatic hypothyroidism is one of the most over treated disorders in medicine. It is not a clinical diagnosis it is a lab diagnosis. So many people have minor elevations in TSH are thrown on unnecessary synthroid forever. TSH is a screening test and is an indirect test of the thyroid. It needs follow up both biochemically and physically. If you are asymptomatic with a minor change in TSH this is not an indication for treatment. It also is an unnecessary screening test without clinical suspicion. As a Canadian in a public health care system the doc has wasted my taxes on an unnecessary screening test, a 6 week follow up or two and unnecessary annual follow up tests. They have wasted your money on an unnecessary daily medication and put you at risk of side effects to that medication.

So often it easier to just write a prescription than talking through things. People just feel better if you give them something otherwise we wouldn't still be prescribing antibiotics for bronchitis so frequently. I don't know if it is part of us justifying why we are here. So often people will come in 2 days after feeling unwell, complain that they couldn't get in the minute they called and explain with a great accusational tone that they feel 100% better now and so I missed my chance to treat something that didn't need treating (okay maybe they don't use those words).


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 Post subject: Re: Blood work
PostPosted: Fri Dec 28, 2012 7:53 pm 
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Joined: Wed Apr 11, 2012 3:40 am
Posts: 449
My doctor and I talked about it and the only script he gave me was for one time a week vitamin d. The tsh was just over the borderline so we decided to just keep an eye on it, he wasn't overly concerned.

I can understand the frustration of the physicians posting here though, especially with things changing in US healthcare.


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 Post subject: Re: Blood work
PostPosted: Fri Dec 28, 2012 8:45 pm 
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I am very encouraged to hear that.
Vitamin D is something most people that live in the Northern hemisphere will need at least through part of the year though is very rich in a lot of foods like bone in fish (sardines, canned salmon) and supplemented in milk.


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 Post subject: Re: Blood work
PostPosted: Sat Dec 29, 2012 9:11 pm 
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Joined: Sat Aug 29, 2009 4:30 pm
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drchull wrote:
As a Canadian in a public health care system the doc has wasted my taxes on an unnecessary screening test, .....


But just for the pilosophical discussion:
Isn't this almost always true for screening tests that are intended to reveal rare conditions ?

Let's imagine there is some fairly expensive (or maybe even very INexpensive) test for a rare, but serious consition.
It would almost never be "cost effective" to test for it. It would always be a "better use taxpayers' money" to use the money elsewhere and let the very few sufferers of the condition degenerate and/or eventually die without ever even testing.

But if the person tested happens to be YOU, then all of a sudden it becomes very valuable to either avoid the condition or even just have the "peace of mind" that the test was negative.


What the physician does with the information (i,e. "over-medicate" etc) is a separate question; relating to the competency of the physician.

The whole situation become amplified if the patient is just trying to "optimize his health" (for bike racing, etc) because it would certainly not be cost effective to taxpayers; but it may be important to the person requesting the tests.


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 Post subject:
PostPosted: Sun Dec 30, 2012 2:36 am 
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Joined: Sat Jul 30, 2011 6:38 pm
Posts: 243
There is always a balance between money spent and potential benefit. Sometimes that calculation seems very cold. But don't forget there is also harm in the follow up tests as well.
Regular screening of PSA leads to huge amounts of Prostate biopsies which are invasive procedures with potentially serious complications. PSA screening neither improves survival or quality of life. Generally prostate cancer is a disease that you will die with not of, but there are a few often terrible incidents where this isn't true. That is why we test based on clinical suspicion. With a high pre-test possibility the meaning of the test results is much more significant. I won't delve too deep into medical stats because gives me a headache.
There are many, many examples of this, my favourite being the unusual habit of a large number of people to the South that get annual full body CTs to assure themselves that they are okay. The dose of radiation in a full body CT is phenomenal.
I do agree though that the average tax payer shouldn't have to pay for unnecessary tests, whether for cycling or work or school. Good or bad though the doc usually the doorway here (though increasingly the government does try to put roadblocks up).


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 Post subject: Re: Blood work
PostPosted: Tue Jan 01, 2013 1:09 am 
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Posts: 775
I would say it's worth while but it would depend on how hard your training. If you have a high training load I've always found tests useful so that when something does go awry I have data points to go back and compare to. I've yet to find a GP in the UK that has any time for that approach although strangely enough it's common on sports team who can afford it and have their act together. Make of that what you will.


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 Post subject: Re: Blood work
PostPosted: Wed Jan 02, 2013 4:27 am 
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Joined: Fri May 08, 2009 8:31 pm
Posts: 236
Location: Denver
Rick wrote:
But just for the pilosophical discussion:
Isn't this almost always true for screening tests that are intended to reveal rare conditions ?

not really. The idea of large population screening tests is to detect rare conditions that (1) have catastrophic consequences if missed and (2) that have treatments or interventions that dramatically alter the outcome if begun early. Good examples are neonatal screening tests for inborn errors of metabolism like PKU. The reason that PSA screening for prostate cancer is so controversial is that there is not good evidence that it makes a difference in outcome (as drchull well pointed out). The kind of testing that the OP talked about is more likely to result in false positives or findings that are of no clinical consequence (like the TSH finding). There may be reasons to look at some minutiae in professional or olympic level athletes, but even there the kind of tests under discussion here are likely to be of very little value.


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 Post subject: Re: Blood work
Posted: Wed Jan 02, 2013 4:27 am 


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 Post subject: Re: Blood work
PostPosted: Wed Jan 02, 2013 6:01 pm 
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Joined: Mon Dec 28, 2009 8:30 pm
Posts: 3905
Location: Bay Area
I think everyone should blood test a few times a year and here are some great articles as to why. I had quite a few abnormalities last year that were due to overtraining and influenced my mood, how I felt, and how I performed. I also had some odd vitamin imbalances that I can't attribute to better health, but I am glad I corrected them.

The problem with many lab tests is they tend to measure blood, which gives an instant picture when certain things, such as testosterone, cortisol, etc. are better to urine test since they can give a broad sector picture. Eric Serrano had some great articles a few years back on how to test/what to test. IIRC, his argument was that a tough training session can elevate cortisol in the blood for hours after. Many train at night and test in the morning, again when cortisol is high. Piss testing avoids these spikes. Tons of endurance athletes schedule tests for off-days, which is typically when they can have low test or high cortisol from their acute training load especially during stressful periods.

http://www.endurancecorner.com/Larry_Cr ... blood_test
http://www.endurancecorner.com/node/319
http://www.endurancecorner.com/Larry_Cr ... _questions

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