131–140 of 269 posts
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…
Earlier quoted context omitted.
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!
> 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, li…
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…
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!
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).
>even basic blood tests can lead to unnecessary interventions or treatments Medical malpractice is the third leading cause of death in the US after heart disease and cancer.
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…
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).
I have a personal example of this. My father died largely because of his annual physical. He hated doctors, became nervous around them and thus expressed hypertension in-office. He did not have material hypertension but did defer to his physician. Over the long term, despite my best efforts, this killed him. His blood pressure medication regime was poorly managed and severely impacted his quality of life. He eventual…
My doctor calls this doctor’s office hypertension. If the reading is high, he always makes a point to circle around and do it again at the end of the appointment. For me, there’s usually a 10-20 (units, I forget which ones) difference. I do not have hypertension
Andy Grove would completely disagree: https://money.cnn.com/magazines/fortune/fortune_archive/1996... MY FIRST PSA. It all started about a year earlier when my family doctor of 20 years retired. In the fall of 1994, my new doctor gave me a physical exam to establish a new baseline. The physical involved an assortment of blood tests, all of which were in the normal range, with one exception. The test called PSA came b…
The risk/value proposition is likely much different for people just deferring to doctors, especially for those doctors that are on the lower end of the performance spectrum.
>even basic blood tests can lead to unnecessary interventions or treatments Medical malpractice is the third leading cause of death in the US after heart disease and cancer.
The obvious result of an aggressively for-profit healthcare system: aggressively squeezing profit out of everything it can and let then let the doctors take all the heat for it.
Not just for-profit, but aggressively separating the payor and costs (government, insurance) from the treatment and patient, thereby reducing accountability in the system
Andy Grove would completely disagree: https://money.cnn.com/magazines/fortune/fortune_archive/1996... MY FIRST PSA. It all started about a year earlier when my family doctor of 20 years retired. In the fall of 1994, my new doctor gave me a physical exam to establish a new baseline. The physical involved an assortment of blood tests, all of which were in the normal range, with one exception. The test called PSA came b…
Presumably our internal model clamps some kinds of things to zero and other things to infinity.
When thinking about it, I would prefer to take a test and detect cancer even if the test gives me a near equal risk of cancer. It's strange to my rational self, so I must struggle to reconcile it.
I have a personal example of this. My father died largely because of his annual physical. He hated doctors, became nervous around them and thus expressed hypertension in-office. He did not have material hypertension but did defer to his physician. Over the long term, despite my best efforts, this killed him. His blood pressure medication regime was poorly managed and severely impacted his quality of life. He eventual…
I was listening to Peter Attia on some podcast and he says to essentially throw out any BP reading that didn't occur after sitting down for five minutes. In his practice they have patients measure many times a day for multiple weeks just to get a baseline point to work from. More and more i find that, at least in America, if you're talking to a GP you're just talking to a human interface of insurance approved treatme…
And what I learned is that I can swing my blood pressure from slightly low to slightly elevated simply by how I sit, how relaxed I am, and untold other variables that result in being able to consciously swing it 20+ mmHg, and other times it can swing that much (or more) just between multiple consecutive readings where I don't move/etc between them.
I've also had Nurses swap the Cuff size and drop that much, or just do two in a row in the Dr's office and get massively different results.
So, for me, I don't know how to determine an actual bp if the noise is greater than the signal. Taking the average over multiple times a day, for a few weeks is probably reasonable. But then, I'm pretty sure the amount of exercise and what I eat day to day could swing it one way or the other depending on the time of the year (aka I sweat a lot more during the summer and drop weight, etc).