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Physical/New Primary Care Doc - What testing do I ask for?

radiii
radiii Posts: 422 Member
edited November 2024 in Social Groups
Brief backstory: 2013-2015 I lost 115 pounds, 30 pounds with a "standard" diet and activity, the last 85 on keto. Dec 2015 I had a hernia surgery and just fell completely off track and gained 80 pounds back. I'm back on keto for 7 weeks now, I've moved (I'm in Fort Wayne, IN now) and have made an appointment for a physical with a new primary care doc.

In the past I've gotten a lipoprotein NMR test on top of whatever "normal" workup they do for a type 2 diabetic, A1C, bloodwork and urinalysis. Insulin level isn't part of normal testing right? Are there other additional tests I should ask about?

I'm 40, 6'4" and currently 325 pounds. I'm type 2 diabetic but have never taken more than metformin (currently taking nothing, and was taking nothing while re-gaining weight... I probably should have been), have had mild hypertension and high cholesterol in the past. I've had a kidney stone. I had low testosterone briefly in the past.

I'm basically looking for a new baseline as I re-start this whole process, and want to make sure nothing new has popped up in my couple years of not taking care of myself, and want to make sure there aren't any critical measurements that could help me out that I'm missing.

Replies

  • Gallowmere1984
    Gallowmere1984 Posts: 6,626 Member
    If you want to go full bore, I'd follow the links and suggestions here: https://thekooler.com/pages/blood-test

    It'll run you a few hundred bucks, but it keeps a doctor's nose out of it and gives you a full blood panel for anything that a male could want to know. There are a couple of states that the company can't do this for, due to state regulations. It's frequently used by geardheads, because let's face it: sometimes the last thing you want is a doctor's thoughts on your bloods. Also, no questions asked. You make the order, you get what you want. None of the "you don't need that" crap.
  • KnitOrMiss
    KnitOrMiss Posts: 10,103 Member
    edited August 2017
    I was going to say B12, D3, Iron (total and ferritin at a minimum), and full thyroid panel -- at a minimum. As a T2D, you're at more risk for low functioning thyroid that may or may not be evident in the TSH. Total and Free T4, Free and Reverse T3. Fasting insulin along side other glucose numbers, including - c-peptide (indicates something to do with level of IR, common in T2D), CRP & ESR - for inflammation/chronic disease indications, cortisol, AST/ALT (liver tests part of CMP), blood panel (to test for anemia, among other issues)...and obviously, male hormone panel.

    Docs want to do the cholesterol, but if you're actively losing weight, it will be higher anyway... Just don't agree to any meds if active...

    Most other tests I've found to be ineffective or not tell you much...

    EDITED TO ADD: @radiii - I'd tell the doc that you know most of these things may or may not apply, but you want to have a baseline, just in case something does go bad later...
  • RalfLott
    RalfLott Posts: 5,036 Member
    edited August 2017
    Amens all around!

    Good idea to get baselines. Wish I had more of them.

    You probably have a slew of recent kidney tests...??

    How did your A1c and NMR tests come out? Are you tracking BG pretty closely now?

    https://chriskresser.com/why-hemoglobin-a1c-is-not-a-reliable-marker/

    https://chriskresser.com/how-to-prevent-diabetes-and-heart-disease-for-16/

    Regardless, I would add a Coronary Artery Calcium CT scan and scoring. Runs about $100, off the street, where I live. This actually tells you whether you have any calcium plaque in your coronary arteries.

    PSA if you haven't had one recently; leptin level can be revealing in T2Ds; Homocysteine; CoQ10; celiac & gluten sensitivity (tissue transglutaminase IgA and IgG.(?) and H-pylori, if you think there's any cause.

    I personally wouldn't break an LC diet for long enough to make an OGTT reliable (5 days?) due to the carb jolts :s, but that's your call, of course.

    Vid on CAC scan:

    https://youtu.be/TcIR5i7Se-Y





  • kpk54
    kpk54 Posts: 4,474 Member
    Just waving hello from Cary. :)B)
  • cstehansen
    cstehansen Posts: 1,984 Member
    just one more short video/blog you may want to check out.

    http://drhyman.com/blog/2017/08/03/work-doctor-get-need/?utm_source=Newsletter&utm_campaign=c03ff922a7-EMAIL_CAMPAIGN_2017_05_04&utm_medium=email&utm_term=0_07a277e311-c03ff922a7-107394313&mc_cid=c03ff922a7&mc_eid=b8eb311872
  • radiii
    radiii Posts: 422 Member
    RalfLott wrote: »
    You probably have a slew of recent kidney tests...??

    How did your A1c and NMR tests come out? Are you tracking BG pretty closely now?

    Yeahhh so when I was regaining weight and not taking care of myself I just go full noncompliant, so I haven't had anything done since the end of 2015. When I was losing weight and last on keto I had a year's worth of A1C results under 4.5. NMR history below.

    rw87kydanwko.png


    Thanks for all the info so far from everyone :) My appointment isn't for another week and a half but I'm going to be putting together a list of things to talk about and we'll see how receptive the new doc is to any of this.
  • radiii
    radiii Posts: 422 Member
    The mention of Dr Hyman and his push for Functional Medicine got me thinking...

    https://gladdmd.com/

    This guy is listed as a keto friendly doctor (https://ketogenic.com/tools/keto-clinicians-finder/) in my area. I'd looked at this guy before but the supplement store being prominently featured and a $425 consult was a bit of a turnoff. With the regular, covered by insurance, primary care doc I'm really taking a complete shot in the dark as to what I'm going to get. The only thing I did was to specifically look for younger docs, based on a couple experiences with some older docs in the past that left me feeling like they'd just fallen behind.
  • RalfLott
    RalfLott Posts: 5,036 Member
    radiii wrote: »
    Yeahhh so when I was regaining weight and not taking care of myself I just go full noncompliant, so I haven't had anything done since the end of 2015. When I was losing weight and last on keto I had a year's worth of A1C results under 4.5. NMR history below.

    rw87kydanwko.png

    Thanks for all the info so far from everyone :) My appointment isn't for another week and a half but I'm going to be putting together a list of things to talk about and we'll see how receptive the new doc is to any of this.

    If you were blowing an A1c under 4.5, you are probably in pretty good shape with your ability to control your blood glucose! That's really great.

    It looks like your LDL-size was trending in the right direction. It's pretty widely accepted that lipids tend to elevate during periods of weight loss with LC diets; I'm not sure what, if any, conclusions can be drawn from the NMR tests.

    I'd be interested in what you come up with for your battery of tests - keep us posted!
  • 150poundsofme
    150poundsofme Posts: 523 Member
    Vitamin D, B's, magnisium if you are covered.
  • RalfLott
    RalfLott Posts: 5,036 Member
    150poundsofme wrote: »
    Vitamin D, B's, magnisium if you are covered.

    Is there a good test for magnesium?
  • GaleHawkins
    GaleHawkins Posts: 8,159 Member
    Gallowmere1984 wrote: »
    If you want to go full bore, I'd follow the links and suggestions here: https://thekooler.com/pages/blood-test

    It'll run you a few hundred bucks, but it keeps a doctor's nose out of it and gives you a full blood panel for anything that a male could want to know. There are a couple of states that the company can't do this for, due to state regulations. It's frequently used by geardheads, because let's face it: sometimes the last thing you want is a doctor's thoughts on your bloods. Also, no questions asked. You make the order, you get what you want. None of the "you don't need that" crap.

    This is what I do using Life Extension lab service.
  • cstehansen
    cstehansen Posts: 1,984 Member
    radiii wrote: »
    My appointment was yesterday. I am amazed by my new doctor. I think he's younger than me (I'm guessing he's 35 or so). When requesting a doctor I asked for someone young, hoping that would make it more likely for me to get someone who is supportive of low carb.

    When the doc came in after I met with the nurse we just chatted for like 20 minutes about my medical history and history with weight loss. No rush, no pressure, we didn't actually end up doing a full physical, we just talked about stuff I'm doing and he did a diabetic foot exam(no issues there). He's fully supportive not only of low carb in general but of me eating a ketogenic diet as long as I can sustain it. I'm interested in fasting the more I read about that, and I asked about it, and he said that he approves of any experimentation I decide to do with fasting as long as I'm careful about low blood sugars. I'm immensely impressed.

    I didn't get to research and write down as many of these tests as I'd hoped due to a wasp infestation that became a serious problem a couple days before this appointment that took over my life.

    The doc ended up talking me out of a detailed thyroid panel (he said he'd do it if I wanted but didn't know if insurance would cover it, but he ran through common symptoms of folks with high or low thyroid function and I didn't fit in either so I took a pass this time). I did get the lipoprotein NMR test done, they had to send that to a different lab so results aren't in yet. I didn't ask about the others.

    I'm back on Metformin, we talked about that and I never had any side effects from it when I took it in the past and am not opposed to it at all I'm content to take an artificial boost to insulin sensitivity for now while I work on things.

    My blood pressure was 123/78, he didn't recommend blood pressure meds, and that blood pressure will go down as I lose more weight.

    I mentioned an aversion to statins, he asked why but didn't seem overly concerned.


    Current A1C after about 10 weeks back on keto is 5.2. Metabolic panel was all normal. Will update on the NMR when it comes back.


    I go back in 3 months. Next time I'll try to understand better what testing is covered and can push for stuff if I feel the need. The coronary CT is something I forgot to mention here but am the most interested in out of all the stuff you guys discussed above.

    First, that is an awesome report.

    Next, can I buy that A1c from you?

    Seriously, though, I would agree with your doc about the thyroid partially because eating keto will frequently lower your thyroid function. It does NOT cause hypothyroidism. It simply makes it so your thyroid does not need to work as hard. If you don't have any symptoms of hypo or hyper, and things are progressing well, it is probably not necessary. Besides, eating a real food keto diet would be the best course of action anyway.
  • RalfLott
    RalfLott Posts: 5,036 Member
    Nice work. Glad you found a sympathetic doc!
  • GaleHawkins
    GaleHawkins Posts: 8,159 Member
    Awesome report about your new doctor.

    Dr. Attia is doing Metformin for longevity not sugar the best I remember. I just found the below this morning when doing some Vit D3 reading.

    https://ncbi.nlm.nih.gov/pmc/articles/PMC4395104/

    Metformin Inhibits Growth of Human Glioblastoma Cells and Enhances Therapeutic Response
  • radiii
    radiii Posts: 422 Member
    I suppose I'll keep this thread open/going for additional stuff.

    I'm still waiting on my Lipoprotein NMR results, b/c my doctors office had to use a different lab its taking forever, and they're mailing me the results. I don't care so much about the numbers right now as I do the change over time, so that's fine.

    I have a Coronary Artery Calcium scan scheduled this friday. $50 + a requirement to provide a doctor to send the results to (though I was assured I can also get the results myself).

    I have a DEXA scan scheduled for next tuesday. $75, cash only (interesting).

    I've gone all in with fasting. I'm doing Alternate Daily Fasting and intend to do so until I reach goal weight (at least 90 pounds away), and once a month I intend to simply fast for as long as I can. I don't like setting specific goals for that, but so far I've done a 5 day and 3 day fast, and am in my 10th day of ADF (5 fasting days/5 eating days alternated so far). Insulin/Insulin Resistance benefits, Autophagy benefits, and if I lose weight faster as a result, even better. Fasting has become very appealing to me, and since I work from home and rarely deal with social pressures around food, I seem like an ideal candidate to have success with it.

    Perhaps I'll go for the DEXA scan every 3 months as I lose weight to track lean body mass. Right now my only exercise is walking, but I will certainly add some strength training down the road so that will be interesting too. Basically, I love data and am lucky enough to be able to afford the indulgence, so why not :D
  • KnitOrMiss
    KnitOrMiss Posts: 10,103 Member
    @radiii - be sure to check what your DEXA scan will get you. I did my test and literally I got 4-6 bone readings. That was it. And it was a $700 test or something...not what I was told it would be...
  • radiii
    radiii Posts: 422 Member
    Thanks for the warning Knit. This is at a sports medicine clinic that is entirely interested in body composition, that's what they advertise it for here, so I'm in good shape :)
  • canadjineh
    canadjineh Posts: 5,396 Member
    Hey @radiii, maybe you are paying them to be a part of their next in-depth DEXA study, lol.
  • radiii
    radiii Posts: 422 Member
    Finally got my Cholesterol results. Unlike the NMR test that I got from my last doctor, this doesn't have standard LDL/HDL numbers (in addition to particle numbers and other stuff).

    As expected, all of my cholesterol results are bad and in the high risk range.


    HDL Particle Number: 17869 (21837-45671 reference range)
    Small HDL: 13820 (17503 min ideal range)
    Large HDL: 4049 (A reference range of 4334-10815 is given, but optimal is 9386+, high risk is less than 6996)
    LDL Particle Number: 1498 (moderate risk. Optimal is less than 1260, high risk >1538)


    There are 8 different LDL size numbers (very small-d, very small-c, very small-b, very small-a, small, medium, large-b, large-a). Two of them have risk ratings next to them:

    Small LDL: 389 (optimal 162, high risk > 217)
    Medium LDL: 408 (optimal <201, high risk > 271)


    Sadly all of this was expected. But this is essentially my baseline and we'll hopefully see it improve with weight loss and eventually increased activity. Next Dr Appointment is in 2 1/2 months, I'm still not sure if insurance covered this or not.

    I know cholesterol numbers can be screwy during weight loss, does the same hold true for particle count numbers? With the other NMR profile I was getting done at my last doctor as I lost weight and exercised more numbers did get better.
  • nvmomketo
    nvmomketo Posts: 12,019 Member
    Woohoo! Nice CAC! :) Congrats.

    And thanks so much for sharing this with us. I'm curious to see how things change for you. Good luck!
  • canadjineh
    canadjineh Posts: 5,396 Member
    Looking forward to your updates @radiii.
  • Sunny_Bunny_
    Sunny_Bunny_ Posts: 7,140 Member
    I'm looking forward to the updates too. It's great that you are collecting this data. I expect it should be really helpful and reassuring as you make progress.
  • retirehappy
    retirehappy Posts: 3,513 Member
    Bumpity bump some really good stuff in here.
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