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c/bloodwork·posted 2 years ago by u/britt_marchand

nobody warned me about reflux and I would have liked the warning

Concerning Receipts ×3 Slow Clap ×1 Cold Box ×2

Something I keep coming back to: nobody warned me about reflux and I would have liked the warning.

Added ApoB to the panel after a thread here. It told me something the standard lipid panel had been hiding.

Draw at the same point in the week now, fasting, same lab. The noise dropped enormously once I standardised.

Took a baseline the week before starting purely because this board told me to. Best five minutes I have spent on this.

Ask me anything specific. Anything general I will probably get wrong.

4,084 up / 559 down88% upvoted51 commentsid 125fi66 Jun 2024

51 comments

29 in this archive, depth 5

best — the order this archive was captured in

u/skip_week_sceptic326 points·2 years ago·edited

ApoB counts atherogenic particles rather than the cholesterol they carry, which is why it can diverge from LDL-C and why it is the addition most worth making.

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u/hedda_adeyemi247 points·2 years ago

Different laboratories use different assay platforms with different calibration. Comparing across labs adds a systematic offset that is invisible on the report.

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u/britt_marchandOP146 points·2 years ago

weight loss itself moves several of these independently

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u/forest_plot_fionastats129 points·2 years ago

ask whether the lab changed its assay between your two draws

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u/ismael_eriksen257 points·2 years ago

My A1c moved and I spent a fortnight convinced I knew why. The repeat six weeks later was back in range and I had changed nothing.

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u/lipid_panel_larryMOD129 points·2 years ago

Retitled — the original asserted a causal claim the post does not support.

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u/karl_fischer_kev35 points·2 years ago

Do you have a baseline from before you started?

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u/noor_cardoso34 points·2 years ago

the trend line matters more than any single value

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u/no_refunds_nr122 points·2 years ago

Have you taken this to whoever ordered it?

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[removed]58 points·2 years ago

[removed by moderator]

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u/cardio_endpoint_c70 points·2 years ago·edited

Have you taken this to whoever ordered it?

Agreed — and standardising the draw conditions is the cheapest improvement available.

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u/diego_sorensen0 points·2 years ago

Disagree with reading anything into that. One value, one morning, and you changed two other things in the same window.

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u/santiago_szabo-8 points·2 years ago

Time of day, fasting state, hydration and recent exercise all move common markers. Standardising the draw conditions is free and it removes most of the apparent variability.

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u/britt_marchandOP1 point·2 years ago

do not change three things and then read the panel

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u/isabela_guerrero74 points·2 years ago

This. Reference ranges are population intervals, not targets, and conflating them causes a lot of unnecessary alarm here.

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u/cormac_roos48 points·2 years ago

Small fix — a reference interval is not a treatment target, and the post above uses them interchangeably.

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u/britt_marchandOP32 points·2 years ago·edited

Is that the same assay, or did the lab change platforms?

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u/liv_okafor25 points·2 years ago

Careful — that is a question for whoever ordered the panel, and nobody in this thread can answer it responsibly.

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u/noor_cardoso72 points·2 years ago·edited

Nobody here can interpret your panel and this comment is not doing so. What a board can usefully do is help you ask better questions of somebody who can.

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u/emil_agyeman0 points·2 years ago

Nobody here can interpret your panel and this comment is not doing so.

Disagreeing with this bit: that change is confounded by the weight loss itself and cannot be attributed.

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u/skip_week_sceptic0 points·2 years ago

Correcting my own comment: the two draws were 18 weeks apart, not the figure I gave earlier.

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u/liver_enzyme_liz54 points·2 years ago

Agreed on assay changes. A lab switching platforms between your draws is invisible unless you ask.

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u/baseline_drifteranalytical13 points·2 years ago

a single A1c outside range is a reason to repeat, not to panic

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u/lina_falk0 points·2 years ago

Fasting or not, and what time of day?

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u/edit_for_clarity0 points·2 years ago

Brought the whole set to my clinician rather than one flagged value. Completely different conversation.

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u/janek_ferrari1 point·2 years ago

Same view — ApoB if you add one thing. It answers a question the standard panel only gestures at.

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u/heart_rate_bump1 point·2 years ago

Same lab as the previous draw?

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u/coa_forgery_watch1 point·2 years ago

Same view — ApoB if you add one thing.

Adding the obvious one — take it to whoever ordered the panel. This board cannot read it for you.

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u/neha_rahimi1 point·2 years ago

Brought the whole set to my clinician rather than one flagged value.

edit_for_clarity is right that a reference interval is not a target. It is a description of a population.

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About c/bloodwork

What to measure before you start, what to re-measure, and how to interpret movement without panicking. ApoB over LDL-C, HOMA-IR as a crude free tool, ALT and the fatty-liver story, eGFR noise during rapid loss, and the deficiencies that a 1,100-calorie appetite will hand you.

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