7 ms·

I had a similar mindset as you describe here - but I no longer agree after experiencing long covid. My experience with long covid was made easier because of hi

I had a similar mindset as you describe here - but I no longer agree after experiencing long covid. My experience with long covid was made easier because of historical lab data from bloodwork tests that were taken pre-covid when I was a healthy 30 y/o white male. After suffering for months from (what I now know was) long covid, I went in for a checkup for some help. The blood test comparison of healthy me to sick me was invaluable, because the healthy tests established a baseline of my system at peak condition.

throwing_away 3y ago
How is that helpful? I guess for making a disability claim?
- EdwardDiego 3y ago
  For comparing current results to historical to look for anomalous changes.
- JumpCrisscross 3y ago
  > How is that helpful? It helps eliminate benign anomalous results in emergencies. I have a low neutrophil count. It is totally uneventful. Having that baseline means if I’m sick and have the works run, doctors need not start treating my neutropenia—that wasn’t caused by whatever is going on. More broadly, catching a vitamin D deficiency and allergy early probably saved some years of life and definitely improved my quality of life. Some doctors are test happy. Most are not. Finding the right fit is part of being a human in the midst of modern healthcare.
  - rolisz 3y ago
    Was your vitamin D deficiency and allergy related to long COVID?
    - JumpCrisscross 3y ago
      > Was your vitamin D deficiency and allergy related to long COVID Nope. Indoor lifestyle and and a proclivity for cold weather. And, like, allergies.
    - SecretDreams 3y ago
      The person that you responded to was not the one who made the covid claim. I think it was a bit jarring to have that comment on the covid chain since their experiences are not related.
  - ClumsyPilot 3y ago
    > Some doctors are test happy. Most are not. In my family we detected lung cancer in stage 2b instead of stage 1 because we spent months fighting a doctor that didn't want to do tests. If we 'listened to the experts' my family member would be dead.
    - copperx 3y ago
      Were there symptoms in stage 1?
      - ClumsyPilot 3y ago
        Yes, thats why we went to see the docyor in the first place. Instead our concerns were dismissed
    - deleted 3y ago
      [deleted]
- usrusr 3y ago
  Most medical diagnosis goes like this: you see a symptom, this could be caused by a dozen entirely different problems. A few of them can be easily ticked off by absence of some very clear flags in the lab result list. Others only have indicators that are much less clear, that are shared with a whole bunch of other outside-the-norm conditions, many of them perfectly fine. If you have a backlog, if instead of a list of current measurements you have a matrix of current and previous measurements, you can narrow it down much more.
  - haldujai 3y ago
    Not really, very few diagnoses benefit from such historical data. Any lab value flagged as abnormal is typically >95%ile meriting some form of further investigation (whether that’s continued follow up/repeat blood work or a different test depends on what we’re talking about). The tests that could be physiologic for a patient outside of reference ranges (e.g. mild LFT elevations) will often just get repeated to establish stability as you propose. There isn’t a compelling argument to do this prospectively before symptoms start.
- LorenPechtel 3y ago
  My wife's hemoglobin comes back high. It always comes back high. That's just her, it doesn't mean something's gone wrong. Some out-of-range values are meaningful (like cholesterol) by themselves, but in many cases if they're out of range but the patient is healthy it's simply something to note as normal for that patient.
bagels 3y ago
What was different in the blood work?
ck425 3y ago
Sounds like you're over it now, any idea what helped? I also developed long covid as a healthy 30 y/o white male, but haven't been able to kick it after 8 months.
- jleyank 3y ago
  Might be pure coincidence but my wife shook her long covid symptoms when the first vaccines appeared. They had diagnosed inflammation of the small passages of the lung and she had real shortness of breath. Inhalers of various kinds didn’t seem to help. Bad when things can be diagnosed by zoom or a phone call with good sound reproduction. Fortunately it’s not recurred.
- lazystar 3y ago
  getting the vaccine again, 6 months after covid, is what fixed it for me.
  - boycott-israel 3y ago
    What were your symptoms? (asking for info, not doubting anything!)
    - lazystar 3y ago
      brain fog, no smell, and reduced lung capacity. elevated liver enzymes in the bloodwork showed i wasnt crazy. oh, i should mention probiotics helped out too, along with the vaccine. > asking for info, not doubting anything! sure, just hesitant to answer because im not looking for a debate on this stuff anymore, got enough of that in my day-to-day while i was symptomatic. after the last 3 years i just want to put it all behind me and get everything back to normal.
tpoacher 3y ago
Having baselines is fine, but they don't have to be annual and they certainly don't need to trigger a barrage of tests which are unnecessary at best and potentially harmful at worst.
- phpisthebest 3y ago
  In somewhere this is where authority fallacy comes into play People need to push back and ask questions not just accept everything the doctor says at face value.. If I take my car in for routine maintenance and the mechanic comes back with 1000 things they want to do I am not prone to just say "sure do what ever you think is best, you are the expert"
  - haldujai 3y ago
    Except physicians don’t practice independently like a mechanic and we answer to several authorities (licensing boards, specialty colleges, hospital M&M and MAC). We follow evidence-based guidelines that have looked at various outcome measures. It would be malpractice and I would be sanctioned if I were to willfully ignore validated guidelines without strong medical evidence to support me. It’s a good thing to ask questions but “pushback” suggests an adversarial approach. If you feel like your physician is attempting to fleece you find a different one, in my experience most of us aren’t like that. Physician-patient trust is critical. If you’re unsure of where to look a good starting point is an academic-affiliated practice which will have more oversight and reimbursement structures that don’t align with over billing.
    - phpisthebest 3y ago
      You point to "several authorities" as meaning the relationship between doctor and consumer should be less adversarial as the doctor then to the mechanic and consumer. as the doctor would have sanctions if they go against that authority, that orthodoxy to me however that means my personal care is not the only concern, with the mechanic the motives and incentives are clear. With the Doctor they hidden with a split set of masters and at the end of the day the patient is not the primary concern or factor, the Licensing board is, the insurance company is, the government regulators are, but not the patient. These over lapping authorities you think make the system less adversarial to me makes it more adversarial, as now I have to ensure the motives of your decision making is about me, the patient, and not the government authority that told you what you have to do... not the licensing board, not the insurance company, etc. See COVID response as a recent example of this, but history is fraught with other examples where patient care suffered under the weight of authority. this is with out going into the pure corruption that influence many health policies from diet to drugs... Making it less "evidence-based" then I think you are asserting.
specialist 3y ago
Periodic baseline tests are The Correct Answer™. To establish individual patient normals. Can't manage what we don't measure. Attention should focus on what's changed. Instead of playing 20 Questions for each new problem. [1] High LDL? Well, it's always been high, and stable. We don't have to treat it. Bone spurs (on spine)? Well, most everyone has them and they're not bothering you. Oh, new sciatica symptoms? Hmmm, looks like you've got a new bone spur which may be impinging. Let's try some PT, get you a standup desk for work, and reassess in 6 months. Etc. -- Concern trolls claim more testing begets false negatives, begetting unnecessary treatment, which has its own risks. Fine. Change healthcare from transactional to relational. Change from our current fee-for-service to continuity-of-care (or capitation, prevention, whatever we end up calling it). Like u/JumpCrisscross says elsethread, only treat anomalous results per new symptoms. I believe periodic baselines with regular checkups would reduce testing and unnecessary treatments, overall. -- [1] Monitoring, logging, anomaly detection, and RCA... Starting to sound suspiciously like engineering and operations. Of course, some orgs treat each incident as unforeseen one-offs, aka The Condi Rice Defense™. But high functioning teams plan ahead.
- haldujai 3y ago
  > High LDL? Well, it's always been high, and stable. We don't have to treat it. Only if you particularly want to die of a major adverse cardiovascular event[0], then we don’t have to treat it. Note that treatment begins with lifestyle interventions and not necessarily pharmaceuticals. We have reference ranges with lab tests for a reason. There is no such thing as a “normal” high LDL and there is growing evidence that statin therapy is beneficial even in those without other cardiovascular risk factors. Again keeping in mind that lifestyle interventions are the first step. Dismissing dyslipidemia as “stable” is flatly incorrect. N.B. This evidence synthesis is outdated now but presents the risks in an accessible format, interval evidence is even more supportive of intervention. [0] https://thennt.com/nnt/statins-for-heart-disease-prevention-with-known-heart-disease/ https://thennt.com/nnt/statins-for-heart-disease-prevention-...
  - specialist 3y ago
    Number Needed to Treat (NNT) seems like a great idea. Will learn more. Thanks. The risk of cherry picking examples is they'd distract from my thesis. So I used two from my own life. I am fail. (Also, I have mo medical training and cannot advise others.) As for LDL, mine is borderline, I'm very worried, it's unchanged by statins or diet, and I guess the plan is to monitor it. Further, the more I read about cholesterol, the more confused I get. It seems to be a topic in a state of flux. I'm currently eating buckets of fiber (oatmeal, beans, etc) and misc fish & krill oil, and recently added cocoa butter. Next I'll prob try that Fire In a Bottle stuff (some kind of tea extract). I think statins make sense for most patients. A cardiologist friend says everyone in their practice start statins preventatively by age 40 (?). And they'd know best, right? YMMV.
loeg 3y ago
Bloodwork isn't part of a routine annual physical with a PCP.
- adwi 3y ago
  That’s basically all my annual physical is with my PCP. Short chat, referral for lab work, 2 minute phone call when they get the results.
  - loeg 3y ago
    Mine's just weight, blood pressure/pulse, and a chat.
  - maxerickson 3y ago
    Mid forties, my insurance only covers preventative blood work every 3 years or something like that. I guess that can be based on having a normal/good workup the previous time.
- alistairSH 3y ago
  Huh, weird, mine always has a basic blood panel - cholesterol, etc. But it hasn’t yet led to expensive follow-ups.
MavisBacon 3y ago
Curious how blood tests helped you in this situation? I not only had extensive blood tests prior to getting sick but also had a sleep study and extensive psychological testing, none of which were consequential in my eventual long covid diagnosis

throwing_away 3y ago

How is that helpful? I guess for making a disability claim?

EdwardDiego 3y ago
For comparing current results to historical to look for anomalous changes.
JumpCrisscross 3y ago
> How is that helpful? It helps eliminate benign anomalous results in emergencies. I have a low neutrophil count. It is totally uneventful. Having that baseline means if I’m sick and have the works run, doctors need not start treating my neutropenia—that wasn’t caused by whatever is going on. More broadly, catching a vitamin D deficiency and allergy early probably saved some years of life and definitely improved my quality of life. Some doctors are test happy. Most are not. Finding the right fit is part of being a human in the midst of modern healthcare.
- rolisz 3y ago
  Was your vitamin D deficiency and allergy related to long COVID?
  - JumpCrisscross 3y ago
    > Was your vitamin D deficiency and allergy related to long COVID Nope. Indoor lifestyle and and a proclivity for cold weather. And, like, allergies.
  - SecretDreams 3y ago
    The person that you responded to was not the one who made the covid claim. I think it was a bit jarring to have that comment on the covid chain since their experiences are not related.
- ClumsyPilot 3y ago
  > Some doctors are test happy. Most are not. In my family we detected lung cancer in stage 2b instead of stage 1 because we spent months fighting a doctor that didn't want to do tests. If we 'listened to the experts' my family member would be dead.
  - copperx 3y ago
    Were there symptoms in stage 1?
    - ClumsyPilot 3y ago
      Yes, thats why we went to see the docyor in the first place. Instead our concerns were dismissed
  - deleted 3y ago
    [deleted]
usrusr 3y ago
Most medical diagnosis goes like this: you see a symptom, this could be caused by a dozen entirely different problems. A few of them can be easily ticked off by absence of some very clear flags in the lab result list. Others only have indicators that are much less clear, that are shared with a whole bunch of other outside-the-norm conditions, many of them perfectly fine. If you have a backlog, if instead of a list of current measurements you have a matrix of current and previous measurements, you can narrow it down much more.
- haldujai 3y ago
  Not really, very few diagnoses benefit from such historical data. Any lab value flagged as abnormal is typically >95%ile meriting some form of further investigation (whether that’s continued follow up/repeat blood work or a different test depends on what we’re talking about). The tests that could be physiologic for a patient outside of reference ranges (e.g. mild LFT elevations) will often just get repeated to establish stability as you propose. There isn’t a compelling argument to do this prospectively before symptoms start.
LorenPechtel 3y ago
My wife's hemoglobin comes back high. It always comes back high. That's just her, it doesn't mean something's gone wrong. Some out-of-range values are meaningful (like cholesterol) by themselves, but in many cases if they're out of range but the patient is healthy it's simply something to note as normal for that patient.

bagels 3y ago

What was different in the blood work?

ck425 3y ago

Sounds like you're over it now, any idea what helped? I also developed long covid as a healthy 30 y/o white male, but haven't been able to kick it after 8 months.

jleyank 3y ago
Might be pure coincidence but my wife shook her long covid symptoms when the first vaccines appeared. They had diagnosed inflammation of the small passages of the lung and she had real shortness of breath. Inhalers of various kinds didn’t seem to help. Bad when things can be diagnosed by zoom or a phone call with good sound reproduction. Fortunately it’s not recurred.
lazystar 3y ago
getting the vaccine again, 6 months after covid, is what fixed it for me.
- boycott-israel 3y ago
  What were your symptoms? (asking for info, not doubting anything!)
  - lazystar 3y ago
    brain fog, no smell, and reduced lung capacity. elevated liver enzymes in the bloodwork showed i wasnt crazy. oh, i should mention probiotics helped out too, along with the vaccine. > asking for info, not doubting anything! sure, just hesitant to answer because im not looking for a debate on this stuff anymore, got enough of that in my day-to-day while i was symptomatic. after the last 3 years i just want to put it all behind me and get everything back to normal.

tpoacher 3y ago

Having baselines is fine, but they don't have to be annual and they certainly don't need to trigger a barrage of tests which are unnecessary at best and potentially harmful at worst.

phpisthebest 3y ago
In somewhere this is where authority fallacy comes into play People need to push back and ask questions not just accept everything the doctor says at face value.. If I take my car in for routine maintenance and the mechanic comes back with 1000 things they want to do I am not prone to just say "sure do what ever you think is best, you are the expert"
- haldujai 3y ago
  Except physicians don’t practice independently like a mechanic and we answer to several authorities (licensing boards, specialty colleges, hospital M&M and MAC). We follow evidence-based guidelines that have looked at various outcome measures. It would be malpractice and I would be sanctioned if I were to willfully ignore validated guidelines without strong medical evidence to support me. It’s a good thing to ask questions but “pushback” suggests an adversarial approach. If you feel like your physician is attempting to fleece you find a different one, in my experience most of us aren’t like that. Physician-patient trust is critical. If you’re unsure of where to look a good starting point is an academic-affiliated practice which will have more oversight and reimbursement structures that don’t align with over billing.
  - phpisthebest 3y ago
    You point to "several authorities" as meaning the relationship between doctor and consumer should be less adversarial as the doctor then to the mechanic and consumer. as the doctor would have sanctions if they go against that authority, that orthodoxy to me however that means my personal care is not the only concern, with the mechanic the motives and incentives are clear. With the Doctor they hidden with a split set of masters and at the end of the day the patient is not the primary concern or factor, the Licensing board is, the insurance company is, the government regulators are, but not the patient. These over lapping authorities you think make the system less adversarial to me makes it more adversarial, as now I have to ensure the motives of your decision making is about me, the patient, and not the government authority that told you what you have to do... not the licensing board, not the insurance company, etc. See COVID response as a recent example of this, but history is fraught with other examples where patient care suffered under the weight of authority. this is with out going into the pure corruption that influence many health policies from diet to drugs... Making it less "evidence-based" then I think you are asserting.

specialist 3y ago

Periodic baseline tests are The Correct Answer™. To establish individual patient normals. Can't manage what we don't measure. Attention should focus on what's changed. Instead of playing 20 Questions for each new problem. [1] High LDL? Well, it's always been high, and stable. We don't have to treat it. Bone spurs (on spine)? Well, most everyone has them and they're not bothering you. Oh, new sciatica symptoms? Hmmm, looks like you've got a new bone spur which may be impinging. Let's try some PT, get you a standup desk for work, and reassess in 6 months. Etc. -- Concern trolls claim more testing begets false negatives, begetting unnecessary treatment, which has its own risks. Fine. Change healthcare from transactional to relational. Change from our current fee-for-service to continuity-of-care (or capitation, prevention, whatever we end up calling it). Like u/JumpCrisscross says elsethread, only treat anomalous results per new symptoms. I believe periodic baselines with regular checkups would reduce testing and unnecessary treatments, overall. -- [1] Monitoring, logging, anomaly detection, and RCA... Starting to sound suspiciously like engineering and operations. Of course, some orgs treat each incident as unforeseen one-offs, aka The Condi Rice Defense™. But high functioning teams plan ahead.

haldujai 3y ago
> High LDL? Well, it's always been high, and stable. We don't have to treat it. Only if you particularly want to die of a major adverse cardiovascular event[0], then we don’t have to treat it. Note that treatment begins with lifestyle interventions and not necessarily pharmaceuticals. We have reference ranges with lab tests for a reason. There is no such thing as a “normal” high LDL and there is growing evidence that statin therapy is beneficial even in those without other cardiovascular risk factors. Again keeping in mind that lifestyle interventions are the first step. Dismissing dyslipidemia as “stable” is flatly incorrect. N.B. This evidence synthesis is outdated now but presents the risks in an accessible format, interval evidence is even more supportive of intervention. [0] https://thennt.com/nnt/statins-for-heart-disease-prevention-with-known-heart-disease/ https://thennt.com/nnt/statins-for-heart-disease-prevention-...
- specialist 3y ago
  Number Needed to Treat (NNT) seems like a great idea. Will learn more. Thanks. The risk of cherry picking examples is they'd distract from my thesis. So I used two from my own life. I am fail. (Also, I have mo medical training and cannot advise others.) As for LDL, mine is borderline, I'm very worried, it's unchanged by statins or diet, and I guess the plan is to monitor it. Further, the more I read about cholesterol, the more confused I get. It seems to be a topic in a state of flux. I'm currently eating buckets of fiber (oatmeal, beans, etc) and misc fish & krill oil, and recently added cocoa butter. Next I'll prob try that Fire In a Bottle stuff (some kind of tea extract). I think statins make sense for most patients. A cardiologist friend says everyone in their practice start statins preventatively by age 40 (?). And they'd know best, right? YMMV.

loeg 3y ago

Bloodwork isn't part of a routine annual physical with a PCP.

adwi 3y ago
That’s basically all my annual physical is with my PCP. Short chat, referral for lab work, 2 minute phone call when they get the results.
- loeg 3y ago
  Mine's just weight, blood pressure/pulse, and a chat.
- maxerickson 3y ago
  Mid forties, my insurance only covers preventative blood work every 3 years or something like that. I guess that can be based on having a normal/good workup the previous time.
alistairSH 3y ago
Huh, weird, mine always has a basic blood panel - cholesterol, etc. But it hasn’t yet led to expensive follow-ups.

MavisBacon 3y ago

Curious how blood tests helped you in this situation? I not only had extensive blood tests prior to getting sick but also had a sleep study and extensive psychological testing, none of which were consequential in my eventual long covid diagnosis