My Doctor Won't Order My Labs

 I have my one year check up coming up so I sent an email to my surgeon's NP to request labs based on Vitalady's recommendations.  I had these run in Jan. and I would like to keep a close eye on things to see if there changes.  I would like to catch any changes before they get out of hand.
This surgeon is not really thorough about checking labs and they would only check the minimum if I didn't request more.
My surgury is a revision from a very malabsorptive procedure and while I don't have as much malabsorption I am unsure how much I do have and at least for the first 18 months to 2 years I want my labs done every 6 months.
I got a message from the NP saying that they would run the bariatric labs but I needed my PCP to order the other ones so I sent him an email with the list.
This is what he wrote me:

Congratulations on another year after surgery. I am glad the bariatric surgery clinic is checking your malabsorption labs. Many of the labs you are requesting are included in their testing, and the other are either not indicated or were checked 1/20/2011. The labs ordered for the bariatric clinic are the ones that are needed for monitoring of malabsorption.
Please call with any questions.

I want to write him back and tell him that I don't care if I had them run 6 months ago, I want them run again.  I believe my insurance will pay for it so that shouldn't be a problem.
What arguement can I use?  I shouldn't have to beg for labs to be run if I think it is best.

Maybe your primary care physician will be more compliant to your request.
My surgeon wrote a note to my pcp with a list of test to run at 3, 6 and 12 months.
They are:
CBC
CMP
FOLATE
VIT D
IRON
VIT B-12
LIPID PANEL

What does vitalady recommend we get done?

 This was my PCP that won't run the tests, as well as the bariatric surgeon's NP.
Those tests that you listed are due to be run but Vitalady suggests a whole bunch more.

1st Group (Every 3 to 6 months for life, as we are able)

 *8005               Comprehensive Metabolic profile: (sodium, potassium, chloride, glucose, BUN, creatinine, calcium, total protein, albumin, total bilirubin, alkaline phosphatase, aspartate aminotransferase) 10231)

* 7600                 Lipid profile: (cholesterol, HDL, LDL, triglycerides, chol/HDL ratio)

* 84100               Phosphorous – Inorganic: (718)

* 84550               Uric Acid: (905)

* 85025               Hemogram with platelets: (1759)

* 83550               Ferritin: (457)

* 84446               Vitamin A: (921)

* 84052               Vitamin B-1: (Thiamin) (4052)

* 7065                  Vitamin B-12 & Folate: (82607; 82746)

* 83937               Osteocalcin:

* 85610               PT:

* 86141               C Reactive Protein

* 84134               Pre-albumin:

* 10256               Hep panel: includes ALT (SPGT) & GGT)

* 83735               Magnesium:

* 7444                 Thyroid panel: (T3U, T4, FTI, TSH) (84437; 84443; 84479; 84480)

* 7573                 Iron: TIBC, % sat

* 84630               Zinc: (945)

* 8230                  Vitamin D: (25-hydroxy) (680)

* 84207               Vitamin B-6: (Pyridoxine)

* 83970               Serum intact: PTH

* 84597               Vitamin K:

* 85730               PTT:

 

2ND GROUP (Annually, as long as the results were comfortably within normal limits for more than 2 years in a row)

 

* 593                    LDH:

* 83921               MMA:

* 84255               Selenium:

* 82525               Copper:

* 31789               Homocysteine, Cardio:

* 367                    Cortisol:

* 84590               Vitamin E:

Many of vitalady's labs are more appropriate for a DS patients and less for a Gastric bypass patient/

The hepatic panel and uric acid are part of the comprehensive metabolic panel. Rather than a Hemogram with platelets, you want a CBC = my doctors all order CBC with Diff., If you are getting a vitamin K - there really isn't a need for PT or PTT unless you are going for surgery - these are clotting factors.  Osteocalcen definitely isn't needed for Gastric bypass patients.
C Reactive Protein is basically a useless test - is shows inflamation in the body but is very non-specific.  In some people when elevated can mean high risk for heart disease but in people with arthritis, it is useless because it will be elevated from the arthritis, so there is no way of knowing if it is due to the arthritis, heart disease or both.

Some surgeons/NUTs use pre-albumin together with total protein and albumin.  If your total protein and your albumin levels are really good, then you don't need the prealbumin.  I don't understand the purpase of LDH, this is used to diagnosed heart attacks along with a few other heart enzymes.

MMA is used in difficult to diagnosed B12 deficiency, I think when folate deficiency is also present masking the B12 deficiency.  Since most of us have high folate levels, this test isn't usually necessary.

selenium is very important - every time your labs are tested - I was diagnosed deficient early out - before 6 months..

Copper can be done once per year.

Homocysteine is used in detecting risk of heart disease - not sure the use of it in WLS labs.

Cortisol levels should be used in preop testing to determine if there is reason a person can't lose weight - ie cushings but if the person is normal, don't really need to keep retesting.

Vitamin E - once  a year.

 Technically I have a DS.  My original surgery was a DS with a 100cc common channel.  When I had my revision the surgeon lengthened my common channel to 200cc to reduce the malabsorption.  He made my sleeve into a RNY pouch but my intestines are still in the DS configuration with a longer common channel.
It does seem like many of the tests may be unnecessary, though.  I would still be comfortable having the tests run at least one more time before I have them done yearly, assuming that all is normal and nothing is trending downwards.

That's really scary.  And not NEARLY enough.

 wow!
I dont have a printer, its gonna take me an hour to write all that down  lol

 Here is a link.

https://docs.google.com/Doc?docid=0AU46vLsRDC9rZGhranhtcXpfO GNxcDk2c2c0&hl=en&pli=1

Tell him you are concerned about all these things and have read that those deficiencies are not uncommon after RNY.  Tell him your insurance will pay for it so you would like to have them run, even if they were done in Jan.

If he won't, ask your PCP.  My PCP usually does my labs and she just orders whatever I ask for.