5 ms·

Personal example: my primary care physician scheduled me for a physical, including picking the date, without even asking. It just showed up on my online chart.

by prirun 4y ago

Personal example: my primary care physician scheduled me for a physical, including picking the date, without even asking. It just showed up on my online chart. Okay, I hadn't had a physical for a while, so I just went with it. While stopped at an intersection on the way to his office, a woman plowed into me and 2 other cars because she wasn't paying attention, and was likely on her phone. That wreck generated $45K of medical bills for me and a 21-month settlement process. Onward and upward: I did eventually do a physical, after getting over the wreck. My blood work came back with crazy liver enzyme numbers, 4-9x higher than they should have been. My Dr thought I might have hepatitis and ordered a full hep screen. Before doing that, I did some research, and ran across a NIH paper saying "Hey, before you enroll anyone into drug trials, make sure they aren't working out regularly, because that causes hugely elevated liver enzymes and throws off the trial." Hmm... I mentioned this to my Dr and he said no, that's not it, but maybe get off your protein shakes 2 weeks before the blood test. I read about that, and protein shakes don't affect the liver enzymes. So I decided to stop workouts for 2 weeks AND stop protein shakes. Took the blood test and my liver values were completely normal, and negative for hepatitis. While they may have good intentions, doctors don't always know or understand what they're looking at. I think I could have easily ended up with a liver biopsy had I not stopped my workouts before the 2nd blood test.

ChancyChance 4y ago
Did you go back to working out and protein shakes? Because if you did, you still don't know why you are reacting that way which could be masking a problem elsewhere, and are exposing yourself to risk. There is a reason why metabolic values have "normal" ranges. Heck, if this were a JIRA ticket, I'd want a code review!
- acchow 4y ago
  > There is a reason why metabolic values have "normal" ranges. The "reason" is that they assumed a normal distribution and wanted to include 95% of people. If you're outside the normal range, you are abnormal. Which doesn't necessarily mean unhealthy or that something needs to be changed, but could potentially mean that questions should be asked to understand why you are outside the range? Maybe it's totally fine, like you are an athlete or have a particular kind of diet.
  - ChancyChance 4y ago
    And weight lifters are well-known for reacting calmly to anyone who challenges their regimen.
- mise_en_place 4y ago
  AIUI, liver enzymes being elevated don't always imply some sort of underlying liver pathology. I was on both stanazolol and test for a 3-month cycle and my liver enzymes went up. And my cholesterol inverted (LDL increased while HDL decreased significantly). I explained to my primary care doctor (not the NP who prescribes me roids) the reason for this, showing the various papers that explained the underlying cause of the issue. As soon as I discontinued stanazolol, my liver enzymes normalized as did my cholesterol. Long story short, elevated liver enzymes just mean you have elevated liver enzymes. There are cases where people have cirrhosis but they won't have elevated liver enzymes. AFAIK liver enzymes are far more useful in determining if you've had a heart attack or heart injury recently (I believe AST goes up substantially).
- elevatedastalt 4y ago
  Yes, my experience was very similar, and I did A/B test it. More details here—https://news.ycombinator.com/item?id=35432067 https://news.ycombinator.com/item?id=35432067 Summary: * Test after starting to work out after a long gap—elevated AST ALT, consistent with the research papers. * Test after pausing working out for 2 weeks—normal levels. * Test after working out consistently for a few months so it's no longer after a gap—normal levels.
vinayan3 4y ago
> While stopped at an intersection on the way to his office, a woman plowed into me and 2 other cars because she wasn't paying attention, and was likely on her phone. That wreck generated $45K of medical bills for me and a 21-month settlement process. Sorry to hear and I hope you recovered fully. Fundamentally, our roads are unsafe and since the pandemic road deaths in the US have been on the rise. Locally where I live in, SF, the number of driving citations is significantly down over the last 10 years. I see incredibly risky maneuvers when I'm driving my car or on bike. Many levels of gov are not addressing this serious risk to our health, road accidents. If our roads were declared a public health hazard and be avoided at all costs it might be draw some attention where we move towards finding solutions.
- hansvm 4y ago
  Around once a week in the Bay I'm exposed to severely reckless driving (going 60+ mph downhill through residential stop signs around blind curves, not swerving into any of the 3 empty passing lanes when going 120+ till within spitting distance, actively swerving in front of me to throw trash into my windshield and slam on the brakes while zig-zagging to prevent passing, ...). Police are sometimes helpful but usually won't bother to even make a report. I take less psychotic roads nowadays even if they're slower. I'm not sure what to do other than stop driving or leave. Do you have any advice for surviving SF roads?
  - vinayan3 4y ago
    On bike I only ride routes that I have either been before, walked, or driven through. I have some sense of safety. Otherwise, I stay calm on roads and never try to overreact to the overly aggressive people driving around me. I also never take too aggressive lane change because I worry someone might have road rage.
hammyhavoc 4y ago
Wishing you excellent health, happiness and peace.
elefanten 4y ago
The accident sounds like an awful experience and really bad luck. Regarding the enzymes, I'd caution against feeling too certain in "doing your own research" for medical diagnoses. I'm definitely NOT saying doctors are always right (or conscientious, or competent). But it's hard to just go off published papers because even if you can parse what they're saying and even if you're exhaustive in searching all papers (two big ifs), there is relevant / accepted / important medical knowledge NOT really captured in papers. You'd need niche textbooks, trade reports/publications and (in some cases) a network of experienced practitioners to expose yourself to all the possible information you'd need to make the right call in certain cases. And, related to your point, even really GOOD doctors who've formally studied ALL the right sources, keep up to date on new developments and have long experience can't reliably make the right call on the first try. Certainly educate yourself and do research on your specific situation if you're inclined, but I'd be extra wary because you don't know what information is invisible to you. Find a doc who's willing to talk about their reasoning -- there certainly is an old tendency in the profession to be authoritatively prescriptive without sharing the logic (unfortunately, if understandably).
elevatedastalt 4y ago
Oh, wow, I had the exact same experience (about elevated AST, ALT, not the car accident). It's got nothing to do with protein shakes, it happens when you start working out after a long break. I went for my regular checkups and my AST ALT levels were through the roof (3-4 times the max value). The doctor ordered a few more tests, an ultrasound etc. I was very shocked, because my levels were perfectly normal a year before that, and I had not had any major lifestyle change. I went on an extensive search and finally concluded something similar—when you start working out after a long break, the breakdown in your skeletal muscles causes ALT ALT to be released into the blood, and it remains there for 1-2 weeks. In this process I also learned that the AST / ALT ratio is diagnostic. Depending on the ratio, it could be cirrhosis, or acute hepatitis, or fatty liver etc. My ratios were consistent with the working out after a long gap scenario, further increasing my confidence. Note that this does not happen once you work out regularly, it only happens when you start working out after a long gap. I told this to the doctor and linked him to the papers. He didn't outright say No but his response made it look like he didn't take my suggestion seriously. I guess he was bothered that I was playing "Youtube doctor", but well. I said I would like to confirm my theory by not working out for 2 weeks and then re-doing the tests. He also added a few more liver function tests to get more data. Everything turned out perfectly normal.
- boatsie 4y ago
  Same experience here, though it was just regular intense exercise, not a return to exercise. Of course the doctor sort of chuckled and laughed when I theorized this as the cause of the elevated liver enzymes and said “no, exercise is good for you”.
  - prirun 4y ago
    Mine also was not a return to weightlifting. I had been doing it for 8-9 months when I took the first blood test with the elevated levels.
aj7 4y ago
As they say, the plural of anecdote is not data.
throwaway292939 4y ago
What type of workouts were you doing, were they unusually strenuous? This reads as if the general population doesn't work out — if they did, your workouts wouldn't be that out of the norm.
- prirun 4y ago
  One hour workouts 4x a week with a personal trainer. I only started working out a year ago, but these blood tests were done after I had been working out 8-9 months, not just restarting after a rest as many have mentioned. Here are a couple of articles: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2291230/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2291230/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5158103/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5158103/ The tests in the articles are on people who just started weightlifting, but I did not see any testing of people used to weightlifting. From what I read, it sounds like the enzyme levels are higher because of the muscle damage caused by weightlifting. If that's the case, it doesn't make sense to me that the enzymes would become normal after weightlifting for a while, because you're still going to be damaging and repairing the muscles every week.
- elevatedastalt 4y ago
  I think OPs summary is a bit inaccurate. Regular working out is not the issue in my understand. When you start working out after a long break, some of the AST ALT stored in your skeletal muscles gets released as the muscles undergo some breakdown, and this is most common with weight training, not cardio. This is what elevates the bloodstream levels. Once you have worked out for a few weeks it stabilizes to regular levels. So don't get your liver enzymes tested just a week after starting to do weight training. > This reads as if the general population doesn't work out Regardless of the liver enzyme detail, this isn't too far from the truth. And even those who work out usually do cardio, not weight training.
TheHappyOddish 4y ago
> That wreck generated $45K of medical bills for me and a 21-month settlement process. Someone hit you with their car and you got $45k of medical bills? What sort of a backwards place do you live in?
- prirun 4y ago
  USA, about a mile from several major hospital complexes. Not at all in the sticks. The ER bills for the day of the accident were around $22K for X-rays and CT scans. The ambulance was $650. I had 2 broken ribs, a broken nose, and a fractured vertebrae. Bruises on every body part. A back brace was $1500. An elbow MRI was $3500. Had to have nose surgery to fix my smashed nose, for breathing, not for looks: $11K. The rest were miscellaneous doctor appts (around 25), 5 physical therapy sessions, pre-surgery blood tests and X-rays, follow-up X-rays, etc.
  - TheHappyOddish 4y ago
    Wow, that sounds intense. Hope you're ok now! Was that a wake up call for you to migrate somewhere else? Someone elses actions costing you a life changing (for most people) amount of money?
- tobyhinloopen 4y ago
  USA obviously

by prirun 4y ago

ChancyChance 4y ago

Did you go back to working out and protein shakes? Because if you did, you still don't know why you are reacting that way which could be masking a problem elsewhere, and are exposing yourself to risk. There is a reason why metabolic values have "normal" ranges. Heck, if this were a JIRA ticket, I'd want a code review!

acchow 4y ago
> There is a reason why metabolic values have "normal" ranges. The "reason" is that they assumed a normal distribution and wanted to include 95% of people. If you're outside the normal range, you are abnormal. Which doesn't necessarily mean unhealthy or that something needs to be changed, but could potentially mean that questions should be asked to understand why you are outside the range? Maybe it's totally fine, like you are an athlete or have a particular kind of diet.
- ChancyChance 4y ago
  And weight lifters are well-known for reacting calmly to anyone who challenges their regimen.
mise_en_place 4y ago
AIUI, liver enzymes being elevated don't always imply some sort of underlying liver pathology. I was on both stanazolol and test for a 3-month cycle and my liver enzymes went up. And my cholesterol inverted (LDL increased while HDL decreased significantly). I explained to my primary care doctor (not the NP who prescribes me roids) the reason for this, showing the various papers that explained the underlying cause of the issue. As soon as I discontinued stanazolol, my liver enzymes normalized as did my cholesterol. Long story short, elevated liver enzymes just mean you have elevated liver enzymes. There are cases where people have cirrhosis but they won't have elevated liver enzymes. AFAIK liver enzymes are far more useful in determining if you've had a heart attack or heart injury recently (I believe AST goes up substantially).
elevatedastalt 4y ago
Yes, my experience was very similar, and I did A/B test it. More details here—https://news.ycombinator.com/item?id=35432067 https://news.ycombinator.com/item?id=35432067 Summary: * Test after starting to work out after a long gap—elevated AST ALT, consistent with the research papers. * Test after pausing working out for 2 weeks—normal levels. * Test after working out consistently for a few months so it's no longer after a gap—normal levels.

vinayan3 4y ago

> While stopped at an intersection on the way to his office, a woman plowed into me and 2 other cars because she wasn't paying attention, and was likely on her phone. That wreck generated $45K of medical bills for me and a 21-month settlement process. Sorry to hear and I hope you recovered fully. Fundamentally, our roads are unsafe and since the pandemic road deaths in the US have been on the rise. Locally where I live in, SF, the number of driving citations is significantly down over the last 10 years. I see incredibly risky maneuvers when I'm driving my car or on bike. Many levels of gov are not addressing this serious risk to our health, road accidents. If our roads were declared a public health hazard and be avoided at all costs it might be draw some attention where we move towards finding solutions.

hansvm 4y ago
Around once a week in the Bay I'm exposed to severely reckless driving (going 60+ mph downhill through residential stop signs around blind curves, not swerving into any of the 3 empty passing lanes when going 120+ till within spitting distance, actively swerving in front of me to throw trash into my windshield and slam on the brakes while zig-zagging to prevent passing, ...). Police are sometimes helpful but usually won't bother to even make a report. I take less psychotic roads nowadays even if they're slower. I'm not sure what to do other than stop driving or leave. Do you have any advice for surviving SF roads?
- vinayan3 4y ago
  On bike I only ride routes that I have either been before, walked, or driven through. I have some sense of safety. Otherwise, I stay calm on roads and never try to overreact to the overly aggressive people driving around me. I also never take too aggressive lane change because I worry someone might have road rage.

hammyhavoc 4y ago

Wishing you excellent health, happiness and peace.

elefanten 4y ago

The accident sounds like an awful experience and really bad luck. Regarding the enzymes, I'd caution against feeling too certain in "doing your own research" for medical diagnoses. I'm definitely NOT saying doctors are always right (or conscientious, or competent). But it's hard to just go off published papers because even if you can parse what they're saying and even if you're exhaustive in searching all papers (two big ifs), there is relevant / accepted / important medical knowledge NOT really captured in papers. You'd need niche textbooks, trade reports/publications and (in some cases) a network of experienced practitioners to expose yourself to all the possible information you'd need to make the right call in certain cases. And, related to your point, even really GOOD doctors who've formally studied ALL the right sources, keep up to date on new developments and have long experience can't reliably make the right call on the first try. Certainly educate yourself and do research on your specific situation if you're inclined, but I'd be extra wary because you don't know what information is invisible to you. Find a doc who's willing to talk about their reasoning -- there certainly is an old tendency in the profession to be authoritatively prescriptive without sharing the logic (unfortunately, if understandably).

elevatedastalt 4y ago

Oh, wow, I had the exact same experience (about elevated AST, ALT, not the car accident). It's got nothing to do with protein shakes, it happens when you start working out after a long break. I went for my regular checkups and my AST ALT levels were through the roof (3-4 times the max value). The doctor ordered a few more tests, an ultrasound etc. I was very shocked, because my levels were perfectly normal a year before that, and I had not had any major lifestyle change. I went on an extensive search and finally concluded something similar—when you start working out after a long break, the breakdown in your skeletal muscles causes ALT ALT to be released into the blood, and it remains there for 1-2 weeks. In this process I also learned that the AST / ALT ratio is diagnostic. Depending on the ratio, it could be cirrhosis, or acute hepatitis, or fatty liver etc. My ratios were consistent with the working out after a long gap scenario, further increasing my confidence. Note that this does not happen once you work out regularly, it only happens when you start working out after a long gap. I told this to the doctor and linked him to the papers. He didn't outright say No but his response made it look like he didn't take my suggestion seriously. I guess he was bothered that I was playing "Youtube doctor", but well. I said I would like to confirm my theory by not working out for 2 weeks and then re-doing the tests. He also added a few more liver function tests to get more data. Everything turned out perfectly normal.

boatsie 4y ago
Same experience here, though it was just regular intense exercise, not a return to exercise. Of course the doctor sort of chuckled and laughed when I theorized this as the cause of the elevated liver enzymes and said “no, exercise is good for you”.
- prirun 4y ago
  Mine also was not a return to weightlifting. I had been doing it for 8-9 months when I took the first blood test with the elevated levels.

aj7 4y ago

As they say, the plural of anecdote is not data.

throwaway292939 4y ago

What type of workouts were you doing, were they unusually strenuous? This reads as if the general population doesn't work out — if they did, your workouts wouldn't be that out of the norm.

prirun 4y ago
One hour workouts 4x a week with a personal trainer. I only started working out a year ago, but these blood tests were done after I had been working out 8-9 months, not just restarting after a rest as many have mentioned. Here are a couple of articles: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2291230/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2291230/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5158103/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5158103/ The tests in the articles are on people who just started weightlifting, but I did not see any testing of people used to weightlifting. From what I read, it sounds like the enzyme levels are higher because of the muscle damage caused by weightlifting. If that's the case, it doesn't make sense to me that the enzymes would become normal after weightlifting for a while, because you're still going to be damaging and repairing the muscles every week.
elevatedastalt 4y ago
I think OPs summary is a bit inaccurate. Regular working out is not the issue in my understand. When you start working out after a long break, some of the AST ALT stored in your skeletal muscles gets released as the muscles undergo some breakdown, and this is most common with weight training, not cardio. This is what elevates the bloodstream levels. Once you have worked out for a few weeks it stabilizes to regular levels. So don't get your liver enzymes tested just a week after starting to do weight training. > This reads as if the general population doesn't work out Regardless of the liver enzyme detail, this isn't too far from the truth. And even those who work out usually do cardio, not weight training.

TheHappyOddish 4y ago

> That wreck generated $45K of medical bills for me and a 21-month settlement process. Someone hit you with their car and you got $45k of medical bills? What sort of a backwards place do you live in?

prirun 4y ago
USA, about a mile from several major hospital complexes. Not at all in the sticks. The ER bills for the day of the accident were around $22K for X-rays and CT scans. The ambulance was $650. I had 2 broken ribs, a broken nose, and a fractured vertebrae. Bruises on every body part. A back brace was $1500. An elbow MRI was $3500. Had to have nose surgery to fix my smashed nose, for breathing, not for looks: $11K. The rest were miscellaneous doctor appts (around 25), 5 physical therapy sessions, pre-surgery blood tests and X-rays, follow-up X-rays, etc.
- TheHappyOddish 4y ago
  Wow, that sounds intense. Hope you're ok now! Was that a wake up call for you to migrate somewhere else? Someone elses actions costing you a life changing (for most people) amount of money?
tobyhinloopen 4y ago
USA obviously