My Doctor Won't Order My Labs X Post

  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.

I don't have any ideas but I hope you get it figured out.  I know some of the test are really expensive and wonder if maybe the insurance won't pay unless there is a reason or within a certain time. 

Good luck.

My surgeon has left all my testing up to my PCP since the beginning.  I took my PCP the 6 month and 1 year labs list from Vitalady and told him this is what I need checked.  He never questioned it.  In fact he signed the papers I gave him and all I have to do is take them to the hospital each time.  The hospital just makes a copy of them and gives them back to me.  For now the insurance company has never questioned me getting labs done every six months.

If the doctors hold firm you can always pay for them yourself, although I suggest checking out $$$ first and even pricing around at different labs. Offering to pay cash may get the lab companies to give you a better rate. (Been there, done that.)

My PCP runs whatever I ask her to whenever I ask. So my suggestion is to get a better PCP.

 I wrote another email insisting that I needed the labs run.  If he won't do it I will write to the surgeon but I don't have too much hope there.  They seem woefully inadequate when it comes to the nutritional status of their patients.  If that doesn't help I will be finding another doctor.  I have a few in mind.  One was my doctor several years ago, actually at the same place my current doctor practices (I go to the University medical center).  I wanted to go back to see her but she wasn't taking new patients at the time and I hadn't seen her in too long to come back as an established patient.  If I can't get an appointment with her I will have to look at other bariatric surgeons.

You mentioned that you went from a very malabsortive surgery to a less malabsortive surgery, can you please tell me what surgery you had first and what you have now?  This could make a big difference in what tests you need.  Your last labs can also play a picture in what you need, if you were deficient or low 6 months ago, then you should have been tested after 3months preferably and certainly after 6 months.

I have been very fortunate to get my labs done every 3 months and even more often at the beginning.  My doctors are very proactive in preventing deficiencies and once they happen, making sure they are corrected and don;t occur again.  I get a very detailed list of labs but I have to say, not as detailed as vitalady and I dont' feel some of her tests are needed on a regular basis.

At the beginning I got my labs done at my surgeons office but now since my surgeon is an hour away, I get them done at my Endocrinologists office.  She has tons of WLS patients, so she is very up on what labs to do but if I want anything extra done, all I have to do is ask.  She actually did most of them preop anyway.  I am sure if I asked my PCP, she would probably do them but I have never asked.

I am not sure what you mean by the  NP would do the Bariatric labs but not the other ones?  What do you want done that aren't bariatric?????

Here is the list that I have always had done and is very thorough.

CBC with Diff, comprehensive metabolic panel, lipid panel, PTH, Iron, TIBC, Iron Sat %, Ferritin, Vitamin B12, folate, Vitamin A, Vitamin D 25 hydroxy, Zinc, selenium, magnesium, hemoglobin A1C, TSH, Vitamin B1 (whole blood) or serum (depending on which doctor testing it), vitamin B6, vitamin E, vitamin K

These tests cover all your tests for all different vitamins, minerals, checks for anemia, blood counts, infection, kidney function, liver function, dehydration, potassium levels, protein levels, cholesterol and triglycerides levels, calcium and PTH which along with vitamin D can help determine the status of your bones.  Hem A1C determines if your diabetes is gone and TSH is your thyroid level.

There really isn't much more that you need especially if your surgery isn't that malabsorbtive - you may not need all that but if you want to make sure you aren't still suffering from lingering effects from your prior surgeries, then try to get someone to do this list.

Do you see an Endocrinologist?  Many times they are willing to run these labs for us.  If  not, please find another PCP that is willing to help you.  You are going to need labs for the rest of your life.

If you look for a new surgeon, try to find one with a good Nutritionist. Many times they are the ones that order the labs and they are more willling to order what we need since they want us to be as healthy as possible.  Surgeons are trained to cut -  not in nutrition  or in supplementation and Nurse practioners have very little nutrition and supplement training also.  I wish you luck.

One more thing, at one year out - it is highly recommended that we get a DEXA scan (bone density scan) - this will determine if you have any bone loss which with the large amount of malabsortion you suffered at the beginning, you could have lost alot of bone.  Even now, you still don't eat as much, so you are getting alot less calcium and D from your food making you at a higher risk that others.

I believe Tazz was revised from an old fashioned DS to a medial RNY. Still plenty of malabsorption of micro nutrients. She most definitely needs all her labs every 6 months for a couple of years at least. Why do we always have to fight the damn medical community? Irks me to no end!

--g

 According to my surgeon I still have a DS with a 200cc common channel.  I don't know if that is the same as a medial RNY.  My faith in my surgeon isn't that great, though.  I definitely don't trust them with my nutritional status.  For a university practice it is amazing how little they seem to know about the nutritional deficiencies that can come from malabsorptive procedures.  No wonder they had so many problems with post ops and had to stop performing the DS.  The post op instructions they were giving out were a recipe for disaster.
I really don't care to have them do my follow up as far as blood work.  I plan on going to my 1 year follow up but I would rather have my PCP follow up my blood work after that.  It is kind of tricky since they are both with the university so they both get the results anyway.  
I was hoping that I could get the blood work done through them and have someone more knowledgeable about the needs of WLS patients advice me on how to tweak my supplements, like either you or Vitalady, so it doesn't really matter who does the blood work, as long as I can get them done.

 As Gina said, I had a DS in 2002 with a 100cc common channel.  I was revised last year to a 200cc common channel with a RNY pouch.  According to my surgeon I still have the DS configuration but you can take that for whatever since he had a lot of problems with the DS he performed on many patients and many, like myself, have been revised.  Their follow up was atrocious to say the least and they seemed to have a lot of patients with nutritional problems.  They no longer do the surgery at the hospital because of all the problems they had.
Because of my poor follow up and my own non compliance I got very sick to the point of not being able to function.  It has been a long road to getting my health back.
The labs I had in January were the first complete labs I have had in over 8 years.  I had requested them the year before from another provider and they  still were missing many of the labs I requested so these are the only ones I had.  They were taken 6 months after my revision and after I had been supplementing correctly for 6 months.  Most of them were in the normal range but at the lower end of it, which they don't care about as long as they were in range.  Some were normal but trending downwards from my previous tests the year before.  In January 2010 my Ferritin was 7.  I had an iron infusion and my numbers went up but when I was tested in January 2011 some of those numbers were lower then they had been on the previous tests that were taken after my infusion so I increased my iron and I want to see how they are currently doing.  Other things like my A was at the lower end of normal so I increased that and I want to make sure that is going up.  All they care about is that it was normal, not where in the range it was.
I did have a Dexa Scan in 2006 and I had another earlier this year.  As you can imagine, it wasn't good.  It showed that I had osteoporosis.  They decided not to treat it right now so I am taking more Calcium Citrate along with more D, even though my D level was rising.  My PTH was also pretty good.
I put this on the other thread but these are the tests that they consider bariatric and will order.
CBC, CMP, Vit D 25, Vit B 12, Vit B 1, PTH, Folate, Ferritin and TIBC.
As you can see, they are not nearly what I need, even if I don't need all the tests that are on Vitalady's list I would prefer to be thorough then to miss anything.