Author Topic: Today's Physical Exam  (Read 771 times)

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Offline Friendly Angel

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Today's Physical Exam
« on: October 01, 2018, 04:05:14 PM »
1,  New doctor because my old doctor is in jail for sexual assault on a patient.
2.  New doctor is an osteopath - I guess I'm OK with that.
3.  I told her I'm "ridiculously healthy" and she said she believed me but thought it would be appropriate to do an inspection anyway.
4.  I've lost 35 pounds since January - she predicted I've reduced my diabetes risk about as low as I can get it and A1C should confirm. 
5.  She looked at my fingers and claimed she could tell how many years I was a smoker...  I had already told her but she said it looked like more than that... I think she just assumed I was lying... I might've been. 
6.  She agreed to all the blood work I suggested including Vitamin D, B12 and MMA (previous doctor wouldn't), and the new shingles vaccine... in addition to all the stuff she was going to run anyway like lipids and metabolic panel.
7.  Prostate exam was about as minimally uncomfortable as you could ask for... petite hands and good technique.
8.  Come back ONE YEAR!  Unless blood tests turn something up.
9.  Lots of interview questions and history review, she looked in my throat and listened to my chest.
10. She seemed efficient but she didn't look into my eyes or ears with those doctor tools that usually hang on the wall.... did I get cheated?

I am thankful every day for good health.
Anybody ever heard of that "smoker's finger" thing?  I haven't touched tobacco in at least 15 years, and probably 30 since I smoked regularly (not lying).  Google isn't helping much.
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Online bachfiend

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Re: Today's Physical Exam
« Reply #1 on: October 01, 2018, 04:29:10 PM »
1,  New doctor because my old doctor is in jail for sexual assault on a patient.
2.  New doctor is an osteopath - I guess I'm OK with that.
3.  I told her I'm "ridiculously healthy" and she said she believed me but thought it would be appropriate to do an inspection anyway.
4.  I've lost 35 pounds since January - she predicted I've reduced my diabetes risk about as low as I can get it and A1C should confirm. 
5.  She looked at my fingers and claimed she could tell how many years I was a smoker...  I had already told her but she said it looked like more than that... I think she just assumed I was lying... I might've been. 
6.  She agreed to all the blood work I suggested including Vitamin D, B12 and MMA (previous doctor wouldn't), and the new shingles vaccine... in addition to all the stuff she was going to run anyway like lipids and metabolic panel.
7.  Prostate exam was about as minimally uncomfortable as you could ask for... petite hands and good technique.
8.  Come back ONE YEAR!  Unless blood tests turn something up.
9.  Lots of interview questions and history review, she looked in my throat and listened to my chest.
10. She seemed efficient but she didn't look into my eyes or ears with those doctor tools that usually hang on the wall.... did I get cheated?

I am thankful every day for good health.
Anybody ever heard of that "smoker's finger" thing?  I haven't touched tobacco in at least 15 years, and probably 30 since I smoked regularly (not lying).  Google isn't helping much.

I’m a retired medical practitioner (I was an anatomical pathologist) and it sounds to me you got an excellent screening consultation.  What is MMA - it’s an abbreviation I haven’t previously come across?  I think ‘smoker’s finger’ sounds like bunkum - if you haven’t smoked for so long, the doctor wouldn’t have the big clue of the nicotine and tar staining of your fingers.  I suppose long term cigarette smoking could produce chronic small vessel disease and wasting of the soft tissues of the fingers, but there are other causes and wouldn’t be pathognomonic.

You probably should go to an optometrist for an annual eye checkup - and to have your retina checked with the ophthalmoscope(y thingy).

I think the vitamin D check is probably a little overservicing.  B12 levels are a good idea - absorption of vitamin B12 becomes a little iffy as you age, and you don’t want to get deficient - but you also don’t want to unnecessarily take supplements and overdose on it - high levels of B12 are associated with certain forms of leukaemia.
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Offline Friendly Angel

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Re: Today's Physical Exam
« Reply #2 on: October 01, 2018, 05:32:51 PM »
Thanks bach

I'm 59-1/2 years old.

MMA is Methylmalonic Acid... apparently related somehow to B12.

B12 because I have very minor foot neuropathy.
And I've had low Vit D before so I guess that's just follow up.

I think we've had the discussion here about the new shingles vaccine before - the old one was not as effective and they think it may have waning immunity so CDC recommends the new one for everyone over 50 even if they had the old one (like me).  Easy trip to the pharmacy and insurance covers 100%

I have no idea what Doc thought she was looking for in my fingers, but there's no way she was seeing nicotine stains or burns.  She looked at the nails and all around the knuckle closest to the nails.  I'm really curious about that.
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Online bachfiend

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Re: Today's Physical Exam
« Reply #3 on: October 01, 2018, 07:38:06 PM »
Thanks bach

I'm 59-1/2 years old.

MMA is Methylmalonic Acid... apparently related somehow to B12.

B12 because I have very minor foot neuropathy.
And I've had low Vit D before so I guess that's just follow up.

I think we've had the discussion here about the new shingles vaccine before - the old one was not as effective and they think it may have waning immunity so CDC recommends the new one for everyone over 50 even if they had the old one (like me).  Easy trip to the pharmacy and insurance covers 100%

I have no idea what Doc thought she was looking for in my fingers, but there's no way she was seeing nicotine stains or burns.  She looked at the nails and all around the knuckle closest to the nails.  I'm really curious about that.

I’ve had shingles, naturally, so I know I must have had chickenpox as a child.  I don’t remember my childhood infections, so I’m fortunate in that regard.  I vaguely remember having mumps.  Anti-vaxxers usually are labouring under the delusion that since they didn’t have any ill effects from childhood infections, no one does - which isn’t true.  Measles kills and damages many children.  Even chickenpox can have nasty sequelae (fortunately, I suspected and diagnosed my shingles very quickly - the earlier it’s treated the better.  I avoided any itch or pain, so the chronic neuralgia was avoided).
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Offline Friendly Angel

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Re: Today's Physical Exam
« Reply #4 on: October 03, 2018, 12:06:31 PM »
Apparently the shingles vaccine is back ordered everywhere in the country.  No one is sure when or where I'll be able to get it.

Quote
“Shingrix has been met with an unprecedented level of demand from patients and health care professionals,” the company said in an emailed statement, noting that it is “significantly increasing and accelerating shipments of Shingrix this year.”

Blood labs in:  FBG = 84      A1C = 5.3     

Doctor's office called to tell me they're removing "metabolic syndrome" and "pre-diabetes" from my list of conditions; which has been my goal since January; I scheduled this exam a couple months ago when I was pretty sure I'd be below BMI=25 and I made that with a little room to spare.  I figure I'll aim to lose another 15 pounds because goddamnn I feel good.


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Offline Ah.hell

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Re: Today's Physical Exam
« Reply #5 on: October 03, 2018, 01:21:19 PM »
The finger think wouldn't surprise me.  Smoking does damage your skin other than just staining.  It wouldn't surprise me if it was just confirmation bias on her part either.

Online bachfiend

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Re: Today's Physical Exam
« Reply #6 on: October 03, 2018, 03:46:43 PM »
Apparently the shingles vaccine is back ordered everywhere in the country.  No one is sure when or where I'll be able to get it.

Quote
“Shingrix has been met with an unprecedented level of demand from patients and health care professionals,” the company said in an emailed statement, noting that it is “significantly increasing and accelerating shipments of Shingrix this year.”

Blood labs in:  FBG = 84      A1C = 5.3     

Doctor's office called to tell me they're removing "metabolic syndrome" and "pre-diabetes" from my list of conditions; which has been my goal since January; I scheduled this exam a couple months ago when I was pretty sure I'd be below BMI=25 and I made that with a little room to spare.  I figure I'll aim to lose another 15 pounds because goddamnn I feel good.

Congratulations.  I had to do some mental calculations, converting American systems of measurement into rational numbers.  A FBG of 84 is less than 5 mol/l, which is very good?  Why does America refuse to go on the metric system?  BMI is in kg/m^2, and Americans measure in pounds and inches, and have to use a conversion factor to get a number everyone else in the world uses.

Your aim should be to get your weight down to the weight you were in your early 20s (assuming you weren’t fat then), and keep it there.  The idea that it’s OK to put on weight and body fat as you age is a dangerous myth.  Walter Willett has noted that going from a BMI of 20 to 25 (both in the normal range) is as bad as being overweight.
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Offline Friendly Angel

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Re: Today's Physical Exam
« Reply #7 on: October 03, 2018, 04:11:59 PM »

Congratulations.  I had to do some mental calculations, converting American systems of measurement into rational numbers.  A FBG of 84 is less than 5 mol/l, which is very good? 

I appreciate your perspective.  I don't go to doctors very often so this is all kind of interesting to me. 

Yeah 84 is very good for glucose, especially for someone who's previously had pre-D numbers - I fasted a lot longer than 8 hours, I didn't see any guideline other than "at least 8". 

And my cholesterol numbers are way better than I have any right to own.

Only thing out of spec was WBC low.

I'm almost embarrassed to be so healthy... but I'm going to make the best of it.

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Offline Friendly Angel

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Re: Today's Physical Exam
« Reply #8 on: October 03, 2019, 02:58:29 PM »
8.  Come back ONE YEAR!

My one year follow up was today.  I lost another 15 pounds since last year, but I seem to be losing height also - 70" down to 68.5" in the last two years.  That means my BMI target of 22.0 will require an even lower weight, but I think I can do it. 147 pounds sounds really thin, so I'll get there and then re-evaluate.

My FBG was OK but my A1C was a smidge into the pre-D range at 5.7% - I said it seems like I'm just slowing down the inevitable but diabetes is in my future at some point, and she said that's probably right, just like prostate cancer.  But I can slow it down so much that it never gets bad enough to need insulin, so that's a good goal.

BP was low and all my other blood work was good.  Got a flu shot and got on the waiting list for the new Shingles vax. 

God-damn I feel good.

« Last Edit: October 03, 2019, 03:05:25 PM by Friendly Angel »
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Online The Latinist

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Re: Today's Physical Exam
« Reply #9 on: October 03, 2019, 03:37:11 PM »
5.7 is a fine A1C and don’t let anyone tell you otherwise.  There’s no reason to think that a 5.7 A1C will necessarily lead to diabetes, nor that at 5.7 you’re actually spending any significant time above safe levels. If your fasting blood glucose is in the normal range I don’t think there’s anything to worry about.

Pre-diabetes is, IMO, very misnamed and leads to the idea that diabetes is an inevitable progression.  It is not.
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Offline Friendly Angel

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Re: Today's Physical Exam
« Reply #10 on: October 03, 2019, 04:48:00 PM »
There’s no reason to think that a 5.7 A1C will necessarily lead to diabetes, nor that at 5.7 you’re actually spending any significant time above safe levels. If your fasting blood glucose is in the normal range I don’t think there’s anything to worry about.

Pre-diabetes is, IMO, very misnamed and leads to the idea that diabetes is an inevitable progression.  It is not.

OK, I appreciate that perspective.  And I am not worried about that reading and neither was my doctor.  But my sense is that the D-monster is waiting in the wings ready to pounce on me if I get complacent, and it's my disciplined eating and exercising regime that's keeping it at bay. I think about that when I feel the tingling in my feet even though it might be something else.

I had my blood drawn Wednesday (yesterday) morning; when I was in the waiting room for today's appointment, I got a text that the results were in so I was able to review them before my appointment - that was a nice feature.


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