what tests

[Stavia]

Wow you guys in the USA have open access to an insane amount of specialised tests. Seriously, this is not the situation in most other countries.

I am.just wondering why you would want a BNP if you aren't trying to diagnose or exclude heart failure? Its a very expensive test and not used in a healthy person where there is no clinical concern re heart failure.
The lithium level is unusual unless you are on it.
You've also left off creatinine. Which is critical if you are taking lithium.

and welcome!!!

[Julie G]

I hope Priv8 is correct and his insurance covers all of his tests... but I doubt it. I'm in the US and have very comprehensive insurance coverage and VERY little has been covered for me. Other than the most basic of tests (CBC/standard lipids, A1c, Vitamin D) I've had to pay for everything out of pocket Are others really getting their insurance companies to cover these more sophisticated tests and/or regular tracking of biomarkers?

[Priv8Man]

Thanks Julie for the links. I was already aware of the previous Bredesen Study and incorporate many of it's parameters into my current lifestyle. I did a search previously for labs and biomarkers. But there's no comprehensive list all in 1 place. Just in case someone is searching. Here is my updated comprehensive list:

Lipid Panel
Apolipoprotein B (apoB)
Lp(a)
Lp-PLA2
Ion Mobility (NMR)
Homocysteine
hsCRP
Fibrinogen
Insulin
NT-proBNP
Vitamin D
Omega-3 and -6 Fatty Acids, Plasma
Hemoglobin A1c
B12
LFT (Liver Function Test)
TFT (Thyroid Function Test)
ferritin
testosterone
Lithium (if prescribed)
CBC
Electrolytes (with BUN/Cr)

I hope Priv8 is correct and his insurance covers all of his tests... but I doubt it.

Yeah . . . I'm not sure if things will be completely covered. But I did make several calls (and waited on hold for a few hours). I was told that labs would be covered 100% if the lab was contracted with my insurance.

I am.just wondering why you would want a BNP if you aren't trying to diagnose or exclude heart failure? Its a very expensive test and not used in a healthy person where there is no clinical concern re heart failure.
The lithium level is unusual unless you are on it.
You've also left off creatinine. Which is critical if you are taking lithium.

I added BNP because it is a recommended lab from Berkeley Heart Labs and their 4myheart program. It may not be totally applicable in my case but my family history is extremely well documented and significant. My paternal grandfather died in his 30's from a "cardiac event". My father had unstable angina, then a CABG, then a MI and CHF. My uncle died during his bypass surgery.

I do take low dose lithium for it's neuroprotective properties. I thought a BUN/Cr would be included with an electrolytes panel. But I added it anyway.

Thanks again, for all the useful input!

[Stavia]

BNP is not sensitive enough to show subclinical myocardial damage. I have no idea why Berkley labs would do it in asymptomatic people. For the latter an ECHO would be a better test. And in your case calcium score. A normal BNP is false reassurance and not worth the $$$ in your case.

[pgf54]

I went to a new Gp in a small Australian town, armed with my weight loss charts (22kg down from my heaviest) and a modest list of blood tests. My Doctor argued (he said it was a debate) about the value of all the tests I wanted , he refused to test homocysteine even though I explained I wanted to lower it from my last 11.5 reading, and had been supplementing B12..........and its possible role in Ad., .....He said it was not a diagnostic test and worthless. He refused to test B12 stating it would prove nothing. He also wouldn't do a fasting insulin even though I had a previous reading of 17, nor a psa which I agree is controversial but my father has prostate cancer and I have a elevated risk on my genetic profile. I was also told to stop weighing myself more than monthly anything more is obsessional.........
I have met this kind of resistance before and much worse. I didn't have to pay for the consultation as I am on a pension.
Not sure whether to throw away the blood requests he did authorise and go somewhere else, or get these done and get the results and go and get the others done elsewhere.
Incidentally he did agree to Fbe, E/lfts, TSH (which I didn't ask for), fasting glucose, urate, vit d levels (although said a waste of time, basic lipids..............
Sorry not a Gp bashing post but you guys in Usa seem to have it so easy............................

[SusanJ]

I would probably dig up a few articles about the value of lowering homocysteine and try that one again. I think everyone here would say it's important to know.

WRT B12, my doc, who is a very progressive functional doc, says it doesn't tell you if the B12 is being utilized. You could have very high blood levels, but if it's not being used, it does you no good. I didn't ask if there was a way to test if it's used since I was focused on other issues at the time.

PSA, well, I hear you on the genetics, and not being a guy, don't know much about that one.

One thing that is interesting thing about the USA, is the motivation of dollar signs. My regional hospital, situated in a town of 5500, has just started offering a suite of health tests available without a doctor's order. I haven't looked to see what comes back on the lipids or thyroid tests for example, but it kinda blew me away. Until I realized oh, its a money maker (no insurance billing). Of course, this is the same lab that just can't seem to get my lab test results sent to my out-of-town doctor. In-town, no problem, out-of-town, my doc's office always has to call and call to get them. Wonder how sending the results to me will work.

[Stavia]

Sorry Paul, sounds like an awful experience. The GP is prolly grumpy and dogmatic and after the consultation will have an entrenched position.
You may as well do the ones he ordered. The vitD is important.
No point in tackling him again. Susan, gps are really busy and he won't read any literature contrary to his position. Its a waste of effort and will just antagonise him further. I know this kind of doctor very very well.
Paul - try find another one.
Start you conversation by saying "i know this isn't mainstream medicine but i am apoe4 and i would dearly like to track the following bloods. Another gp has blanket refused. Please can you help me by ordering them. It is very important to me to see the effects of my 22kg weight loss" and then wait and see what he replies.

[Julie G]

(((Paul))) To a much lesser degree, I've had the same reaction from my internist re. many tests I've requested. I'm following Stavia's advice and moving on. It's gonna cost me though as I'll basically work with her outside of my very expensive medical insurance I'm essentially double paying the system.

My visceral reaction to your experience was pure anger on your behalf. Not very productive...but knowing how hard you've worked to improve your health while caring for your parents and you can't even track basic biomarkers, like homocysteine??? That's.not.right. Physicians in your country need to understand that prevention is much less expensive than caring for a demented/chronically ill patients in the long run.

I'm sorry, my friend.

[pgf54]

Thanks so much for the support. I am afraid he wouldn't look at any information, he took my weight chart and gave me a long lecture on the futility of weighing myself more frequently than monthly. (No well done or congrats) I knew then he was unapproachable. Said to me we are debating not arguing but wouldn't allow me to speak and when I tried just talked over me. I was very tactful and respectful,
however looking back I can see it was part male ego, part cultural, and part not liking anyone who wanted a say in their health care. I have actually torn up the lab test requests as to get the results I would have to see him again, and its too frustrating.
I have another appointment with another Dr the end of next week in another surgery. We have two in town.
I will just leave it at that as I will probably be working with him albeit briefly when I return to Nursing in our local aged care facility.
I am hopeful with the new appointment but there is no law in trying as many Drs as you like until you find one that is willing to listen, and if necessary I will travel up to Perth 300km away, so no worries., and yes Stavia I will try your approach and see how I go.

[pgf54]

Just a suggestion but perhaps the group could have a small introduction/ guide/ explanatory notes for GP's, written by some of those clever souls on here , so that when people such as myself, (not so academic) attend Gp,s we can hand them a sheet as a way of introduction , just wondered? Paul