Blood Work Services

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Grandpa's Spells
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Blood Work Services

Post by Grandpa's Spells » Thu Jan 18, 2018 7:12 pm

I recall there being lab services where you could get blood work done without a doctor's involvement. Anybody have recommendations?
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Re: Blood Work Services

Post by Grandpa's Spells » Fri Jan 19, 2018 4:09 pm

Found a '15 post from Tom about discountedlabs.com
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Re: Blood Work Services

Post by riotboo » Fri Jan 19, 2018 11:41 pm

I've used privatemdlabs.com several times.

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Re: Blood Work Services

Post by Sangoma » Fri Jan 19, 2018 11:59 pm

Why do you want to do the bloodwork?
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Re: Blood Work Services

Post by Grandpa's Spells » Sat Jan 20, 2018 2:41 am

Sangoma wrote:
Fri Jan 19, 2018 11:59 pm
Why do you want to do the bloodwork?
Been under considerable work stress for about 6 months, with diet crappy and lack of sunlight. Feeling some low level funkiness. Getting a baseline of where cholesterol (mine has been high for bad in the past), free test, etc. are would be interesting.
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Re: Blood Work Services

Post by Sangoma » Sat Jan 20, 2018 9:36 am

I have a story I like sharing. One of my surgeon is from Iraq. last year his father - about 80 years old - comes to visit him. Few weeks into the visit they start pestering him about going to a GP for a checkup, as he hasn't had one for a long time. The father resists: he is healthy, no bad habits etc. Eventually they twist his arm. GP is happy with the dad's condition, but sayd let's do some bloods, just in case. Again, the old guy argues, until the family submits him for the second time. Lo and behold, his platelets come back at ridiculously low level, something like 10,000 (normal range 150,000 - 250,000). Mind you, he has no signs suggestive of this: no easy bruising, bleeding nose etc. Now the guy is passed down to the haematologist, gets bone marrow biopsy and is diagnosed with some sort of low grade leukemia. What are they going to do for his treatment? Nothing. Just watch.

I told the surgeon: your dad was a perfectly healthy man. Now is is leaving Australia as cancer patient. Why the fuck did you do it to him?!

The point is, symptoms and signs are way more important than blood tests. Diagnosis is 70% based on history, 15-20% examination and only 10% tests. Just saying.
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Re: Blood Work Services

Post by Grandpa's Spells » Sun Jan 21, 2018 1:45 am

A childhood friend’s date absolutely hated going to the doctor. He finally went when he starting feeling digestive problems in his late 60’s. Stage 4 colon cancer. Dead now.
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Re: Blood Work Services

Post by Sangoma » Sun Jan 21, 2018 6:27 am

Would your friend be alive if he had a colonoscopy at the age of 50? Hard to say. I am not against the tests, don't get me wrong. Some are useful - occult blood in feces, for example, not specific, but very sensitive for colon cancer. You feel strange, so checking test, Vit.D, Hb and couple of other things may be useful. All I am saying is that people should not put too much faith in tests.
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Re: Blood Work Services

Post by Sangoma » Sun Jan 21, 2018 6:58 am

Big problem with blood tests is that even doctors often don't understand the math. There is an example I often use when teaching registrars, and in the vast majority of cases it leaves them bewildered.

Say, there is a blood test for the condition ABC. It is very sensitive, but returns 5% false positive results. You send your patient for testing and the result comes back positive. The patient is a nerd and asks you: "Doc, what is the probability that I have the disease?" The answer should be fairly straightforward, right? In 5% it is going to be false positive, meaning that in the remaining 95% it is truly positive, therefore the chance that the guy has the disease is 95%. (At this point a registrar will give me the look of "Duh!")

However... There is one factor that fucks up this logic. The incidence of the condition.

For the sake of our example, let's say the incidence of the condition ABC is 1:1000. This is actually fairly high. Anyway, if we randomly send one thousand people for testing, how many will come back positive? By the initial description of the test, 5% will be false positive - fifty patients. How many actually have the disease? One. So the final probability of having the condition is actually one in fifty, or 2%.

Taking history and examining the patient has one purpose: to find those among whom the incidence of a condition is higher. Put differently, the incidence of a condition is higher in patients who have suggestive history and examination. At some stage the fallacy of blind testing was very common in testing for HIV: people with no risky behaviour were sent for testing, and some would come back positive, for both ELISA and Western Blot. Obviously, their odds of having the virus were very low. But the next three months - until they were retested - were emotions, I would say.

Anyway, just a little rundown of statistics related to the testing. Kurt Gigerenzer is the guy with special interest in these matters, wrote a few books.
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Re: Blood Work Services

Post by judobrian » Fri Apr 27, 2018 12:48 pm

Agree. Very few docs understand the concept of pre-test probability and the dangers of overly sensitive testing.
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Re: Blood Work Services

Post by Fat Cat » Fri Apr 27, 2018 6:56 pm

Smet IRL

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