DIR Return Create A Forum - Home
---------------------------------------------------------
Renewable Revolution
HTML https://renewablerevolution.createaforum.com
---------------------------------------------------------
*****************************************************
DIR Return to: Advances in Health Care
*****************************************************
#Post#: 55--------------------------------------------------
Medical Attention
By: AGelbert Date: October 13, 2013, 2:56 pm
---------------------------------------------------------
Surly,
HTML http://www.pic4ever.com/images/thankyou.gif
for filling in a lot
of holes in my knowledge of video. Fascinating!
That 4K does look like quite a memory hog, not to mention the
size the data highway to refresh is going to have to be.
If our brains are the ultimate "standard" for video capture and
processing, then a lot more of our brains must be used than
scientists now think is used to store video memory. We associate
smells quickly with a memory so we have a fairly significant
area doing that. But when it comes right doen to it, if I say I
"remember" an event or a person, it is because I have "film
clips" of the event or the person stored in my brain somewhere.
At any rate, thank you for the food for thought. I think too
much sometimes but it's fun to do. ;D
Off topic but fall is in full force in Colchester. It's quite
pretty and, thanks to global warming,
I'm saving a lot on heating bills.
HTML http://www.picgifs.com/graphics/s/smilies/graphics-smilies-166731.gif
Last year the first frost (average September 15 for this area)
was 23 days late. It is now October 13, 2013 and we still
haven't had our first frost.
Around here, the first snow comes within a few days of November
1. I expect that will be late as well. I will post here as these
events come to pass.
On a negative note, I just came back from a doctor visit. He
only talked about high cholesterol.
However, a few days after the doctor visit, the doctor's office
send me my lab work (Comprehensive metabolic panel - CMP). It
shows a low Total Protein reading (mine is 5.9 and normal is 6.5
- 8.3 g/dl). It's a bad sign. What really bends me out of shape
is that the doctor said nothing about it and only mentioned my
somewhat high "bad" cholesterol (186).
I am CERTAIN he had those CMP lab reports and the nurses that
e-mail me my lab test "chose" not to send the negative one until
the doctor "approved" it. Why? Because I normally get all my
test results before the doctor visit and I DID get the other two
(AiC and lipid profile taken from blood samples the same day as
the CMP blood sample) before but this CMP work was sent to me
AFTER the doctor visit.
Anything negative on a lab report that may require extra
attention for a patient obviously has some in-house protocol
forcing the nurses to put a hold on it until the doctor gives
the go-ahead. I am not a local and have seen how these folks
fall all over themselves to help a local and GO OUT OF THEIR WAY
to avoid helping an outsider while they play at being dumb and
treating everybody exactly the same. No, I can't go to another
doctor. This guy is probably the most non-prejudiced of the
three doctors in Vermont I have had the misfortune to deal with.
I have to use my wits to "keep them honest" and get proper
medical attention.
HTML http://www.freesmileys.org/emoticons/emoticon-games-022.gif
It's the doctor's office that requires the lab visit be only 3
days to a week before the doctor visit to "ensure" current
results. We specifically had asked to have the lab work done
about ten days prior to ensure the doctor had the results and
they said it must be 3 days to a week. So it goes.
At any rate, they are going to have their hands full if they
think I am not going to research the daylights out of this and
make an e-mail track record of my requests so they can't dance
around the extra tests I will need. For now, I am going to
request (politely, of course) an SPEP (serum protein
electrophoresis).
The Total Protein score is made of Albumin and Globulins. My
Albumin is okay so the globulins are too low. It is important to
find out which one of them is contributing to a low score in
order to diagnose the underlying health issue. Globulins are
divided up into Alpha one, Alpha two, Beta and Gamma groups.
When they do an SPEP, they get a chart that looks like this:
HTML http://www.pathologystudent.com/wp-content/uploads/2012/02/SPEP.gif
The green covers what a normal SPEP test looks like. The reddish
color is just one type of abnormality (that I probably DO NOT
have
HTML http://www.freesmileys.org/emoticons/tuzki-bunnys/tuzki-bunny-emoticon-052.gif<br
/>because it would provide a "too high" Total Protein reading
rather than a "too low" Total Protein reading).
We'll see how this turns out. It may be a fluke or instrument
error. Somebody told me once, "it's all downhill after 45".
Yep.
#Post#: 57--------------------------------------------------
Re: Medical Attention
By: Surly1 Date: October 14, 2013, 5:53 am
---------------------------------------------------------
I don't really understand the issues at p[lay but if anyone can
research the livinv hell out of a thing and bring it down to
cases...
Interesting in that Vermont sounds like Virginia regarding
locals and "come heres." Maybe it's the nature of being rural...
Anyhow good luck, and let me know how it's going.
As to "all downhill after 45," well, QED!
#Post#: 65--------------------------------------------------
Re: Medical Attention
By: AGelbert Date: October 14, 2013, 9:59 pm
---------------------------------------------------------
Surly,
Thanks. I'll let you know what develops.
#Post#: 74--------------------------------------------------
Re: Medical Attention
By: Surly1 Date: October 16, 2013, 4:21 am
---------------------------------------------------------
Any news on the test evidence?
#Post#: 99--------------------------------------------------
Re: Medical Attention
By: Surly1 Date: October 18, 2013, 4:07 am
---------------------------------------------------------
Point 4 seems to be the money shot. Bullseye.
You might be overplaying your hand in point 5-- going in to a
potential diagnosis without the training. Might softpedal that.
Otherwise, they have asked you to be a "full partner" in your
own care? You are clearly holding up your end.
Send the letter!
#Post#: 111--------------------------------------------------
Re: Medical Attention
By: AGelbert Date: October 18, 2013, 11:19 pm
---------------------------------------------------------
Thank you for the advise and encouragement. I was going to send
it today but my wife said it would be better to send it monday.
I said they may get upset at my delay and she said probably not.
They aren't in any hurry to do anything so as long as I don't
answer they don't feel they have to act.
I said okay. Monday it goes out.
#Post#: 126--------------------------------------------------
Re: Medical Attention
By: Surly1 Date: October 20, 2013, 7:41 pm
---------------------------------------------------------
Please let me know what happens. This ought to be interesting.
#Post#: 128--------------------------------------------------
Re: Medical Attention
By: AGelbert Date: October 20, 2013, 9:17 pm
---------------------------------------------------------
[quote]Please let me know what happens. This ought to be
interesting.[/quote]
Roger, Wilco.
HTML http://yoursmiles.org/psmile/pilot/p0504.gif
#Post#: 129--------------------------------------------------
Re: Medical Attention
By: AGelbert Date: October 21, 2013, 1:23 pm
---------------------------------------------------------
I sent the letter with some slight modifications to appear less
confrontational.
[quote]Dr. ,
Thank you for your prompt reply.
I did not respond immediately because I was surprised you had
used the same logic I did (a possible instrument error) to come
to a different proposed course of action. Since I have some
scientific college training, I have always regarded lab test
results validity just a hair below the tablets given to Moses.
:>)
Hoping that I am not presenting an irrational or paranoid (and
unnecessarily costly) overreaction to the 5.9 g/dl Total Protein
test result, let me explain my logic upon learning of the test
result.
1. I received it a few days after our appointment so I would not
be able to discuss it with you until our next appointment.
2. I researched it and found that the average range in US labs
is 6.0 - 8.3 g/dl. The lab for my test uses the 6.5 - 8.3 g/dl
range.
HTML http://www.nlm.nih.gov/medlineplus/ency/article/003483.htm
3. My wife called up her medical technician sister in law that
has owned a medical lab in Puerto Rico for couple of decades to
ask what the normal course of action is. She said an SPEP is
done. She explained the requirement to calibrate the machines
doing tests daily with a test sample and why different labs have
different ranges.
4. Upon hearing this I made what may be an incorrect, but
logical, assumption. That is, that a 5.9 g/dl Total Protein in a
range of 6.5 - 8.3 g/dl, being a full 0.6 g/dl below the bottom
range calibrated for lab machine test results is a bona fide low
reading. Had the calibrated range been 6.0 - 8.3, I would have
gone the 'let's do a repeat' route of logic but when the total
acceptable range (6.5 to 8.3) is only 1.8 g/dl, a 0.6 outlier
represents a 33% deviation below the minimum range.
5. After researching the SPEP, I learned about the Alpha one and
two, Beta, C reactive protein and Gamma patterns along with the
Albumin spike and that the Total Protein values above the
maximum range are the ones usually with the dreaded M-spike for
multiple myeloma. So it appeared to me I might have some kind of
anemia that hadn't showed up anywhere else in my blood work or a
possible kidney problem. I realize that I'm probably making a
mountain out of a molehill (instrument error).
6. After thinking it over I came to the conclusion that the best
way to get to the bottom of this mystery is to do the SPEP
because it will, in addition to providing the Total Protein
score in a separate procedure (that may be used as evidence by
your staff to request the lab run more stringent calibration
tests on the machine that does the CMP Total Protein test) from
the CMP Total Protein, provide you with a baseline normal or
abnormal detailed Total Protein breakdown that you can use to
aid in caring for my health in the future. I hope to continue
being your patient until I kick the bucket so the data provides
valuable research for you on patient aging and health
deterioration.
After reading your reply I went over the costs. Last year, when
I went to the ER two times, I was the cause of a lot of costs
but I did turn down a very expensive radiocardiogram a
cardiologist who saw me at the ER wanted to do. And later on
this year I decided to forego the colonoscopy which translates
to a large cost saving for the system. The SPEP and UPEP,
compared to the two test procedures above, are much less costly.
As you told me, you have experienced issues with the test result
scores previously. It seems to me that a future score in the
acceptable range is equally as questionable as an out of the
range score unless two separate and distinct tests (SPEP and
another CMP Total Protein) are done to compare the results.
Sorry for being so long winded but I wanted to make sure you
understand that I am only trying, as you and your staff have
urged me to do since I became your patient, to be an active
partner with you in my health care. You are the doctor and I do
not question your knowledge, authority or experience in health
matters. I realize that you are looking at the big picture and
probably don't see any additional diagnostic flags (like bad
calcium levels or something like that) that would trigger a
diagnostic reason to have an SPEP done.
My preference is for an SPEP UPEP but if you still feel it is
not warranted, I would request we repeat the CMP Total Protein
now, and if the result is within range, repeat it again within 3
months to ensure the machine is properly calibrated.
Respectfully,
Anthony [/quote]
;D
#Post#: 141--------------------------------------------------
Re: Medical Attention
By: AGelbert Date: October 21, 2013, 10:39 pm
---------------------------------------------------------
[quote]----- Message -----
From: , MD
Sent: 10/21/2013 20:28 EDT
To: Anthony Gonzalez
Subject: RE: Test Results Question
Anthony,
I am convinced. SPEP and UPEP are ordered. Glad to remain your
doctor!
Anxiously awaiting the results...
, MD, MPH
Assistant Professor
University of Vermont College of Medicine
----- Message -----
To:
, MD
From:
Anthony
Sent: 10/21/2013 22:56 EDT
Thank you, Doctor .
Respectfully,
Anthony
-------------------------------------------[/quote]
Wonder of wonders! I actually convinced the doctor! :o
HTML http://www.pic4ever.com/images/47b20s0.gif
;D
Now I hope to get to the bottom of why I had that low reading.
We shall see. I'm going to do some research on globulins, what
they do in particular and what the proper (normal) fractions are
in the total protein and what more or less or whatever of one or
two groups means.
IF, I have a problem, there are more tests downstream where they
get even more precise. Let's hope it was an instrument error.
This is the protocol when a "bad" SPEP reading is obtained (only
in regard to M-spikes - there are other criteria as well but I
need to get into the books):
HTML http://www.createaforum.com/gallery/renewablerevolution/3-211013232920.png
The UPEP is a 24 urine catch (you keep a container at home in
the fridge and fill it for 24 hours, then take it to the lab) so
that next step is already going to be covered.
I too, am anxious to see the results :P so I hope to do the
tests this week. I'll let you know the results as soon as I get
them.
One day at a time... 8)
*****************************************************
DIR Next Page