Yes, even *I* get screwed while trying to stay on top of it all

So this whole thing about getting your labs done, even once a year, is FRAUGHT with pitfalls and opportunities for things to get screwed up, no matter HOW hard you try and how diligent you are.

I am coming up on my 8 year surgiversary.  I asked my PCP to put in orders for my yearly labs back in May, knowing I wouldn't be getting them done until early July at the soonest for my usual late July annual check-up - but I had an appointment and I had two long out of town trips in May and late June - early July scheduled, so I wanted to get them in early.  As I was told to do, I used Dr. Rabkin's "updated" lab orders from the PacLap website - gave it a glance to make sure it was the updated form (yup, it had copper on it), and sent it to my PCP.  It only took one more call that they were supposed to make to ME, to make sure the lab orders were put in.

When I tried to make my annual exam appointment, I found out my PCP was "on sabbatical" for the entire month of July.  OK, that puts me off schedule by a couple of weeks, since I always do my labs in early July, then my annual with my PCP in late July before my "second Wednesday of August" appointment with PacLap, so I can attend the monthly Big Meeting along with my appointment.  That way, everyone is on the same page.  Whatever, I'm seeing the PCP on Aug. 4th, and Rabkin on Aug. 10th.  No problem.

My medical center is over 20 miles from my house - I like the place, so I don't want to change.  But when I have to drive up to Palo Alto, I want to get a "two-fer" out of it.  So I arranged to have an early lunch with a former boss (the nice one, not the asshole) at 11:30 after doing the annual blood-letting lab draw, since of course I have to go up fasted, and I wanted to get there AFTER the morning rush of people who have to go to work (I work from home) and the busloads of elderly from the surrounding retirement and care facilities.  So, I planned to get there at 10:30, and the restaurant for lunch was about 1 mile away.

So I get there, and it's not crowded, but time passes - and people who got there after me are being called in ahead of me.  (When I asked for a urinalysis bottle because I had to pee, and that's usually part of the annual exam, they said there was no order for a urinalysis - no biggie, that never shows anything anyway.)  Finally, after 11AM, I go up and ask what's up.  It turns out, there is more than one way to do the copper test, and it wasn't specified, and they have called up to Family Practice and not gotten an answer - well DUH, my PCP is on sabbatical!  So I tell them to look at what was done last year for the same damned test and do that.  Oh, OK ...

So they finally call me back, and hand me and this LONG-ASSED tape of labels off to a 12 year old girl.  I look at her all squinty-eyed and say - "um, this is a long list of draws, some of them specialized tubes and needing to be foil wrapped and I'm a tough stick" and she says "I'm an intern - let me get someone more experienced" - so that's good.

Then the guy who gets the job starts collecting vials and foil and going over the list, and I think hmm, maybe I'd better check the list, so I do my usual spot-check of a couple of important ones, and dammit, the C-reactive protein (not on Rabkin's list, but should be on my annual list) hasn't been ordered.  So I get on the phone with Family Practice to talk to whoever is covering for my PCP, and while he's drawing the 14 tubes, I get told that that PCP is busy but will get back to the lab with the orders later.  The phlebotomist cooperatively agrees to draw an extra vial for the CRP test.  I leave the lab 10 minutes late, but no biggie.  That was on the 19th - or 10 days ago.

So over the next few days, I got quite a few of my labs back - but not all of them.  I have reported previously that EVERYTHING so far has been good to great - even some high liver function tests that I have had over the last couple of years since my plastic surgery/Reglan problems have finally normalized.  But I have been waiting for the CRP, Vitamins A, E and K, and B1 and B6.  Yesterday, I bugged the nurse, and got the got the Vitamin A and B6 results (both completely normal - and I don't take any Vitamin A supplements) - but the other ones are nowhere to be seen!

Apparently, despite my valiant efforts to try to stay on top of all of this, they never did get the order sent down for my CRP test that had the blood draw waiting for a label; they never drew the vitamin E test, and I have no idea what happened to the vitamin K or B1 tests.  WTF??  How much more diligent do I have to be to stay on top of these people???

So, when I go in next week for my annual, I will be missing the urinalysis, CRP, Vit E, K and B1 results, and will have to have another blood draw.  I can only HOPE that those results will be back within a week, but I have my doubts.  And I'll bet they didn't fax the results they DID get over to Rabkin like they were supposed to.

PAMF is a great medical center, and I am an UNUSUALLY diligent patient.  I can only imagine how messed up people can get when they don't pay attention, their doctors don't pay attention and the lab screws up like this.

Moral of the story:
* when you order the labs, double check the list - you may notice that things are missing
* the day before you go to the lab, call them and double check that all the orders are there and waiting, so you have time to get the missing ones added to the list
* when you get to the lab for your blood draws, ask to see the labels and make SURE everything is there

And something will STILL likely go wrong.

I think when I get the second blood draw next week, I'm going to ask my PCP for my osteocalcin level to be measured for the first time.  Anything else that I might want to check that isn't on the usual 14 vial list??

this is what I do....I bring in a list of my blood work, after the lab orders and and before I am drawn we check off what has been ordered by the md, and what the lab has ordere to be drawn on me, but I dbl check and make sure that I see it on the labels and not take their word for it, this can become confusing when there is send out tests as DSers have since depending on the lab it may be put in a misc. etc  because it really doesn't make a difference what your dr orders, the lab goes by what they have ordered and have slips for when it comes time to draw you.  I also fax over a list of the blood work I will need so that I am not waiting forever while they try to figure out what a VAP is, a week before and they know when I am coming.  because our blood work is very rare (i am the only one in my state) the lab and drs are not familiar with them.  I am not  sure what you have ordered for blood work, but when pts have a lot of blood work and unusual blood work it is easy to miss something, especially for the yearly battery of blood work.......

Yeah - but it shouldn't be this hard - if I'm having trouble, I imagine lots of other are having trouble too.  It needs to be standardized and streamlined.

and let me add that on my first lab request the doctor (a replacement for Dr Husted at AZWLS) was very reluctant to order all the labs stating that the insurance may not pay for them as there is no deficiency. I had to insist on them anyway and explain I didn't want to wait until I was deficient!  and then hold my breath over the bill which fortunately was only $125 when all was said and done. But all of them didnt get done and I had to go back to the lab for another vial as the lab screwed one up. And then I never did get the results of that even tho I have called more than once to the doctor about it. So yes you need to be more than diligent- you need to be a pain on the ass  and diligent as I know I have the AZWLS doctor and receptionsist thinking I am anal retentive by now.

 I've had similar problems, but I'm long on convenience and time (no job and lab is 5 minutes away) and a bit short on chutzpah, so I've let my PCP get away with just agreeing to order ALL the labs from last year, and then when I'm still awaiting results a week later I email him with the "missing" labs. This time he told me that the K had been pulled but hadn't come back (Quest farms it out I believe) and I went back for the remaining labs(non-fasting).  It took more than 10 days to get my B6 and I still don't have the K from June 21st pull.

If you want to see the spreadsheet of what I had included in my labs, here's a link to my Google doc:
spreadsheets.google.com/spreadsheet/ccc


If that link doesn't work, copy and paste this:
https://spreadsheets.google.com/spreadsheet/ccc?key=0AiRN1WhHMjD6dDZvTVh6ejZaSWdKRFlvU3VULUludnc&hl=en_US#gid=0

JUDY!  Look how skinny you are!!

Funny that the K is missing on my labs too (as well as B1) - and my B6 took 10 days too.

I don't graph, because the PAMF online medical records does it for me.

 DIANA! I'm going to take that as a compliment. In the past, that kind of feedback after successful weight-loss always triggered a regain; think I'm over that.

I offered my spreadsheet only for you to see if there is something on mine that you don't have on your list and you might want to add.

Oh - good point - I have been using the Rabkin lab sheet, plus the CRP. Are you using their list? 

But then I also have to remember to do the DEXA scan every other year too.  Osteocalcin is something I haven't seen them order, for example.

Your list looks pretty much the same as mine.  (Amylase doesn't belong in the vitamin list by the way - I think it goes with the metabolic stuff.)

And of course you can take my "feedback" without triggering regain!!

 Fixed my Amylase row, thanks..

Hold the phone!  You ought to be able to get your fasting and non-fasting all drawn at once.