What blood tests does a pretty much healthy 20 year old need?
April 9, 2010 11:21 AM   Subscribe

I want to get blood work for the first time in probably 5 or 6 years as an almost 20 year old. What should I ask for? Do I want too many unreasonable tests?

I have no terribly obvious ailments but I do have anxiety issues and (possibly tmi) rather heavy periods. Also acne that will not go away, despite trying every otc thing I could for years and now being under a dermatologist's care for almost a year and a half. Before treating the anxiety in other ways I want to be sure it's not from a physical cause and that's mostly what this is about. I also have a rather large smattering of other symptoms but they are not as big of a deal as these things and might mean nothing.

I want to be tested for thyroid problems and hormone imbalances and I should probably be tested for anemia also, as I've read that high estrogen and high testosterone can cause all this, which is somehow related to thyroid functioning.

Will the doctor test me for these things if I ask? Will the doctor think I'm being annoying and not letting her do her job?

I also think I should be tested for Vitamin D and Vitamin B-12. And maybe my glucose levels and a chemistry panel. I think chemistry panels and glucose levels (along with the complete blood count for anemia) are part of routine blood work everyone gets, right?

Despite that for the last few things I described I don't know if I have any symptoms of deficiencies or whatever, I think that if I don't get tested I am gonna be worried that it's exactly what is wrong with me.

So, will the doctor just say I'm a hypochondriac (I probably am) and not test me for anything, or will she test me for a few things, or am I being completely unreasonable and should just let her decide what to test me for? And are there any other additional things I should be tested for? I don't know if I want too many tests. I don't want my new doctor to be too annoyed with me. Mostly I want to know what the doctor's reaction will be to me requesting all of this, and what the best way to request it is.

For anyone who looks through my posting history, I have not been taking Wellbutrin for a month and these problems all existed before it, although it might have exasperated them. And I think the lump in my throat I complained of before is actually due to anxiety and I just didn't realize it. Thanks for any help!
posted by tweedle to Health & Fitness (22 answers total) 1 user marked this as a favorite
I don't think a doctor is going to take you very seriously if you walk in with a long list of things you want tested for hypothetical problems you may have. You have to understand that blood lab people are generally very busy people and if the medical industry took everyone's request for everything under the sun they could think of, they'd be slowing down legitimate tests to do it.

I would strongly suggest if your anxiety is this bad that you speak to your doctor about that and get treatment for that problem, not a bunch of home-diagnosed ones.
posted by Hiker at 11:25 AM on April 9, 2010 [1 favorite]

Go to your docktor for a checkup / discuccion about your anxiety. Tell them you haven't had bloodwork done in a long time and ask if they can have a "full panel" done. This is the normal bloodwork done to find abnormalities. (anemia, vitamins, glucose, platelettes, etc).
By the way, your bloodwork won't show anything about your anxiety (unless you are so anxious that you have given yourself a stomach ulcer and stomach enzymes are getting into your blood, which is highly unlikely) or about the cause of your heavy periods or if it's just your "normal" flow.
posted by WeekendJen at 11:29 AM on April 9, 2010

To be honest, as a healthy 20 year old, you almost certainly don't need any bloodwork. Unless you're get lightheaded and dizzy or pale, you're probably not anemic. But that's ok, a CBC and Chem7 aren't too bad (glucose and chemistries in in the 7). And a thyroid panel isn't a bad idea either. I'm confused why you would want a Vit D or B12 level though.
posted by ruwan at 11:30 AM on April 9, 2010

I think chemistry panels and glucose levels (along with the complete blood count for anemia) are part of routine blood work everyone gets, right?

I don't think there's such as thing as "routine blood work that everyone gets." I think that unless you go to the doctor complaining of something, it's entirely reasonable to go years and years without ever having a blood test. I mean, a routine physical at my doctor's office consists of a Pap smear and that's it.

I think you need to go to your doctor and explain your symptoms and let her determine what you should get tested for. You can ask her if it could be one of the things you suggest (hormone levels, etc) in the course of your exam.
posted by cabingirl at 11:31 AM on April 9, 2010

The doctor has years and years of education and experience that you do not have. I'm not saying they're never wrong, but there's definitely more knowledgeable than your or I with our Internet MDs.

That being said, my best friend is a doctor. Albeit a surgeon and not a GP, but the only tests she would request would be the ones SHE thought you needed, not you. You just need to go in for a checkup, explain the symptoms you have, and let the doctor do their job, at least with the first meeting. Let them do their job.
posted by cgg at 11:31 AM on April 9, 2010

Depending on your situation and you're able to pay for tests yourself, I highly recommendDirect Labs. The tests are done at the same labs your doctors use in your community and you get results in usually 24-48 hours - all online. You select the tests, pick from test packages (Complete Women's Health Panel, Men's Health Panel and dozens of others) or individual tests numbering in the hundreds. You get a very detailed report back (just like any lab test) but it includes comments on the out-of-range things that should be taken up with your doctor. Doctors are used to patients bringing in these tests now and realize it's a huge cost saving measure for the patient. You'll save huge amounts of money over what you're charged through a doctor. I've used them for the past 4 years and have been extremely satisfied.

Good luck!
posted by Gerard Sorme at 11:31 AM on April 9, 2010 [7 favorites]

Assuming you hope to have all of this covered by insurance, remember that insurance typically only covers tests that are medically necessary. Certain preventive care-type tests are routine as a part of annual physicals, though.

I absolutely advocate doing ones own research and having informed discussions with docs, but you want to balance that with recognition that they are the professional and may have more/better insight than you do. I would go in with a detailed note sheet of the symptoms, problems, pain, discomfort, etc., and then talk together with the doc on how the doc advises addressing things. If you feel the doc is blowing off some of your problems, get more assertive. It's a slight difference of rather than insisting on certain tests, you are insisting on medical guidance for certain problems. Without picking out diagnoses and tests for yourself, you can still be an active participant in your care.
posted by bunnycup at 11:33 AM on April 9, 2010

This only addresses one of them, but most insurances won't pay for for Vitamin D levels without one of a few very specific diagnoses. I'm running into this one all the time.
posted by cobaltnine at 11:34 AM on April 9, 2010

Depends on your doctor. My doctor does regular labs (including cholesterol, blood sugar, and lots of other numbers) at my yearly physical. The last time I went, I also asked for thyroid, B-12, and D numbers after she and I discussed my health and the reasons I wanted them done (the way I'd been feeling, funny numbers on some other tests, family history). She was happy to add them to the mix. If you have reasons to want the tests, and a decent relationship with your doctor, she'll either order them, or explain to you why you don't need them.
posted by dpx.mfx at 11:35 AM on April 9, 2010

Here are some recommendations from the US Department of Health, in terms of guidelines for what kind of routine exams, tests and immunizations are appropriate, and how often, for women of various ages. It may help you in speaking with your doctor, because you can point to certain items that they suggest be screened, or that otherwise concern you. It's not your be all and end all, but it might be helpful for discussion. In my experience, when I have feared coming off hypochondriac, I act a little disorganized and am less likely to be taken seriously.
posted by bunnycup at 11:40 AM on April 9, 2010

Um...usually not too hard to get a doctor to over proscribe blood tests. Christ...go in for a cold and a lot of doctors will have you're damn liver biopsied. I'm kidding. Sort of.

Anyhow, last time I had a comprehensive bloodtest to begin a relationship with a doctor got this:

AntiNuclear Antibodies (ANA)
Protein S Total
Antithrombin III test
Sedimentation Rate Non-auto
Prothrombin TIme
Protein C ACtivity
Comp BLD CNT AUTO w/ AUTO DIFF (Sounds like they check your cars transmission right?)
Thyroid stimulating hormone
Lipid Panel
Comprehensive Metabolic panel

It will only be one puncture, btw. Two small vials. I found getting bloodwork from a woman was always much less painful than from the dude bloodworkers. They're more patient and gentle with tapping a vein.
posted by Skygazer at 11:41 AM on April 9, 2010

Do you see an OB/GYN on a regular basis? Some of your concerns may be better addressed with a gynecologist rather than a GP.
posted by Ruki at 11:42 AM on April 9, 2010

I went in to see a doctor without much wrong with me but I wanted a bunch of blood tests just as preventative medicine/curiosity. The doctor was pretty accommodating. Most of the tests cost me about $5-$10 each out of my pocket. The blood lab people are more than happy to have the business; they do get paid for each test after all.

IANAD, but another test you could ask for is glycated hemoglobin, which can give you an idea of your blood sugar control.
posted by Durin's Bane at 11:44 AM on April 9, 2010

I think many of your ideas are quite reasonable as a practicing doc. It's relatively standard practice to rule out common organic causes of mood disturbance before assuming someone has generalized anxiety or major depression, and in someone with heavy menses, looking for anemia is pretty reasonable. Even the Vitamin D levels are becoming increasingly incorporated into a standard evaluation for mood issues. So you're not off the market on most counts.

But I would suggest that you keep in mind that your doctor is a trained professional like any other, who is there to lend his expertise on these issues. Approaching them as though they are a vending machine (particularly a new doctor) for the tests and pills of your choosing is not a good idea, both because it's really not in your best interests and it may be met with a less than enthusiastic response. It would be more helpful to discuss your symptoms, concerns, and the research you have done, then include their expert advice in coming to a plan of care both of you are happy with. I suspect in your case, that will lead to most if not all the tests you have looked into.
posted by drpynchon at 11:51 AM on April 9, 2010 [2 favorites]

Unless you come across the way you do in your question (breathless and a bit freaked out), most doctors will do what you ask if they don't think it will be dangerous to you.

Presumably, the doctor knows you've just come off Welbutrin, so I think it's fine to say, "I'd like a full work up -- here's my list. I know it's a bit much, but it will help me put my mind at ease." If your doctor tries to talk you out of any of those tests, he or she will give you good reasons why they *wouldn't* recommend the tests.

It can't hurt to ask. It can hurt to not listen and push for tests that may give you a misleading or incorrect answer.
posted by Gucky at 12:08 PM on April 9, 2010

At your age and health status I'd be surprised if the doctor recommend anything beyond a lipid panel (total cholesterol, LDL, HDL, Triglycerides) and possibly your HbA1C (to test for diabetes/metabolic syndrome).
posted by The White Hat at 12:25 PM on April 9, 2010

Nth-ing the idea that it's not a terrible idea to go to a doctor and ask about bloodwork. However, rather than listing all possile symptoms, you can simply say "before treating the anxiety in other ways I want to be sure it's not from a physical cause."

Also, keep in mind that psychiatrists aren't just specialists, but MDs. In my experience, it's not unusual for them to order bloodwork as part of your diagnosis, and go over the results with you.
posted by evidenceofabsence at 1:25 PM on April 9, 2010

You should mention ALL your symptoms to the doctor.

This is the best way to make sure you get the tests you need. Anxiety, the lump in your throat, and heavy periods can all be related to the thryoid. And if your doctor doesn't recommend an iron test, I would ask for it anyway because of the heavy periods.

And I'll just say it again. You should mention ALL your symptoms to the doctor.
posted by peep at 1:32 PM on April 9, 2010

I have had countless blood draws, and there is no difference in skill related to the gender of the tech. Do not be anxious if you have a male draw your blood, OP - it will be fine.

I have never met a doctor opposed to getting me the blood tests I ask for, but they are extremely necessary. I think the benefits/risks situation described above is true - it is low risk to have bloodwork done, and might make you less anxious. Just ask your GP about it and see what happens.

People should be more proactive about their health generally in my opinion. If they don't want to do the tests, you have the right to ask why, and if it is because they think it isn't necessary, that is ok if you want to press them and say that isn't a good enough answer. It's your body and an extremely low risk thing we're talking about here.
posted by k8lin at 1:34 PM on April 9, 2010

It sounds like you want to diagnose yourself by asking a doc to sign off on the tests you think you want to self-prescribe. Even doctors aren't supposed to diagnose themselves. You'll be better served by seeing your primary or gynecologist and discussing your medical issues with them and letting them take it from there. If you don't trust them to do that and do it right, then you're considering seeing the wrong practitioner. See one you do trust.
posted by TruncatedTiller at 2:40 PM on April 9, 2010

Specifically to get your Vitamin D levels checked, it'll probably work out cheaper to get a testing kit from this organization. They're an international public health initiative who want to solve the "vitamin D deficiency epidemic" who will check your Vitamin D for a $60 fee, even internationally. I would totally do this except NY seems to be the only state in the US that won't allow you to ship blood samples across state borders. But if you're anywhere else in the US (or even overseas) you should totally take advantage of it. For comparison, the university lab where I'm at quoted $275 as the fee for a vitamin D test. You do have to provide some basic health data and take the test twice a year.
posted by peacheater at 2:50 PM on April 9, 2010

If you haven't had a physical in 5 or 6 years (normal for a 20 year old, I think) your doctor will probably order some blood testing just to get a baseline on your numbers. In my experience scanning innumerable lab tests, the comprehensive (or basic) metabolic panel (CMP/BMP), complete blood count (CBC) and lipid panel are the most common.

Chances are, if you come in complaining of problems with your period and anxiety/mood disorder symptoms, your doctor will order the kind of tests you're asking for- hormones, thyroid, maybe the vitamins. And possibly, the results of that testing will provide an explanation for your problems. Testing isn't a magic bullet, though- you may get inconclusive results, or results that suggest a more complex solution than "lower x and raise y".

The great thing is that your doctor has years of experience and education that allow them to interpret the results and decide what to do next. That's why approaching a doctor as a vending machine, as someone said above, isn't a very good way to ensure you get good care. Your doctor's goal (and yours, probably) is not to refine your numbers to perfectly in-range values, but to make you feel better. Asking for specific tests or treatments is missing the forest for the trees.

A better way to spend your time before this appointment, in my opinion, would be to work on remembering and then editing the "story" of your medical history. As a new patient, your doctor will probably want to hear it from you, irregardless of records they've received from other doctors. Try and remember the time line- when did this problem start, how long did it last, has it gotten better or worse over time, what treatment did another doctor prescribe you and when, etc. The idea is to prepare answers to questions your doctor might ask, but without targeting a particular diagnosis or test. The doctor is the medical expert, but you're the expert on yourself and your experiences and feelings, so don't be afraid to share.
posted by MadamM at 2:53 PM on April 9, 2010

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