Wintergarden
06-02-2005, 03:29 PM
Whatever they call it at your health care provider, I'm talking about the advanced cholesterol testing where they calculate particle sizes and types and measure ominous substances like ApoB and Lpa. On various websites they have nicknames for Lpa like "the widow maker" and "heart attack cholesterol". THAT'S a lovely thing for a patient to read!
Why did I have to go and ask for this test? Arrrgh, now I'm driving myself absolutely NUTS waiting for the results. I'm not at all sure my cholesterol warrants this testing (TC: 142, LDL: 91, HDL: 36, TG: 73......of course it's the HDL there that's the concern, especially since I'm a pre-menopausal woman, but I think it's a result of a very low fat vegan diet...and further aggravated by malnutrition due to a recent stomach ailment).
I went to a cardiologist because I was noticing more and more skipped heartbeats, and I expected to get a holter monitor and echocardiogram (did get the latter, which was normal) All my Dr. wants to talk about is CAD, and it seems like it's going to be one test after another (even though I have no risk factors, other than the low HDL). At the time, I thought to myself, well, if I'm going to go through all this testing (next up is stress echo, and who knows where we go from there), let's see if there's a reason for it, and I asked for the VAP, which I had recently read about.
(btw, she has not found anything abnormal yet...all this concern on her part is based on my symptoms, namely, indigestion that gets worse when I exercise)
Didn't realize I'd have to wait forever for the results *sigh*. If I'm lucky, they might be in by next Friday....maybe. With all this time to think, words like "small particle trait" and "pattern B" (is that the bad one?) keep swirling around my head. I feel like I'm waiting for the results of a biopsy or something. I guess my question is, is this test anywhere near as damning as I've built it up in my head to be? If it's bad, how bleak is the picture? Can these traits be reversed?
One thing the nurse said when she was doing the blood draw sticks in my head - she said "and this test never needs to be repeated" - so I left with the impression that whatever it revealed, you were stuck with that for life.
But that seems odd, because presumably they're going to treat whatever abnormalities they may find, such as elevated Lpa? How would they know if the treatment was working?
My other question is, if this test is so valuable, why don't they give it routinely? I had to ask for mine, and I don't know anyone else who's had one. If my doctor thought enough of my CAD risk to give me nitroglycerin pills (which alarmed me), why wouldn't she order a VAP test?
Sorry for rambling - I'm nervous and trying to make sense of all this. Thanks in advance for your input!
Why did I have to go and ask for this test? Arrrgh, now I'm driving myself absolutely NUTS waiting for the results. I'm not at all sure my cholesterol warrants this testing (TC: 142, LDL: 91, HDL: 36, TG: 73......of course it's the HDL there that's the concern, especially since I'm a pre-menopausal woman, but I think it's a result of a very low fat vegan diet...and further aggravated by malnutrition due to a recent stomach ailment).
I went to a cardiologist because I was noticing more and more skipped heartbeats, and I expected to get a holter monitor and echocardiogram (did get the latter, which was normal) All my Dr. wants to talk about is CAD, and it seems like it's going to be one test after another (even though I have no risk factors, other than the low HDL). At the time, I thought to myself, well, if I'm going to go through all this testing (next up is stress echo, and who knows where we go from there), let's see if there's a reason for it, and I asked for the VAP, which I had recently read about.
(btw, she has not found anything abnormal yet...all this concern on her part is based on my symptoms, namely, indigestion that gets worse when I exercise)
Didn't realize I'd have to wait forever for the results *sigh*. If I'm lucky, they might be in by next Friday....maybe. With all this time to think, words like "small particle trait" and "pattern B" (is that the bad one?) keep swirling around my head. I feel like I'm waiting for the results of a biopsy or something. I guess my question is, is this test anywhere near as damning as I've built it up in my head to be? If it's bad, how bleak is the picture? Can these traits be reversed?
One thing the nurse said when she was doing the blood draw sticks in my head - she said "and this test never needs to be repeated" - so I left with the impression that whatever it revealed, you were stuck with that for life.
But that seems odd, because presumably they're going to treat whatever abnormalities they may find, such as elevated Lpa? How would they know if the treatment was working?
My other question is, if this test is so valuable, why don't they give it routinely? I had to ask for mine, and I don't know anyone else who's had one. If my doctor thought enough of my CAD risk to give me nitroglycerin pills (which alarmed me), why wouldn't she order a VAP test?
Sorry for rambling - I'm nervous and trying to make sense of all this. Thanks in advance for your input!
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JacquelineL
06-02-2005, 06:59 PM
She probably didn't order it for the same reason a lot of doctors give. There is not much you can do to improve it except get your LDL as low as possible. Yours looks to be in a good range. I had a VAP test and an Lp(a) of 14. The desirable level is under 10.
Wintergarden
06-02-2005, 09:32 PM
Hi Jaqueline - you know I was just reading an article online (American Family Physician, 2004) that stated that Lp(a) in women has no predictive value, and even in men, it seemed uncertain (except for stroke risk in elderly men). Could it be that these tests are still fairly controversial?
In any event, assuming some or all of the information does correlate to increased or decreased risk, wouldn't this let the physician know which patients to treat agressively? Also, according to the website of the lab which did my test (which admittedly, is profit motivated), they claim the results allow the doctor to tailor drug therapy to the patient's specific lipid traits.
It isn't a terribly expensive test - just a little more than the regular lipid profile, except I'll be getting a bill for my VAP test (insurance won't cover it). I just don't understand why it's not routinely done.
I just really hope I haven't saddled myself with a lot of information that's just going to frighten and depress me that I can do very little about. At least maybe it will help me determine whether it's worth going on niacin, as my doctor advised, even with the horrible side effects.
In any event, assuming some or all of the information does correlate to increased or decreased risk, wouldn't this let the physician know which patients to treat agressively? Also, according to the website of the lab which did my test (which admittedly, is profit motivated), they claim the results allow the doctor to tailor drug therapy to the patient's specific lipid traits.
It isn't a terribly expensive test - just a little more than the regular lipid profile, except I'll be getting a bill for my VAP test (insurance won't cover it). I just don't understand why it's not routinely done.
I just really hope I haven't saddled myself with a lot of information that's just going to frighten and depress me that I can do very little about. At least maybe it will help me determine whether it's worth going on niacin, as my doctor advised, even with the horrible side effects.
Lenin
06-03-2005, 11:31 AM
Wintergarden,
Your Lipid panel is REMARKABLY similar to mine. I guarantee you will find the VAP results UTTERLY FASCINATING...and it will have you on the search engine for days afterward:D:D!
I haven't had mine done yet but perused a couple "samples." Indirectly though, I've had my Lp(a) run a couple times, (don't ASK how bad:() and I've had my HDL2 and HLD3 run...2 is very protective, 3 is not.
Wintergarten, did your insurance company balk?
I tried calling mine in advance but I got a maroon who said I needed the PROCEDURE NUMBER...I said, can you look it up? She said "Ask your doctor?" :rolleyes:
When I mention it to my doctor he'll say: "Who knows, call your insurance company!"
KETCHA' 22
I found a Cigna site that said very specifically that THEY don't cover it...they aren't my insurer thank God. Cigna won;t even cover LP(a) for people with proven disease.
Your Lipid panel is REMARKABLY similar to mine. I guarantee you will find the VAP results UTTERLY FASCINATING...and it will have you on the search engine for days afterward:D:D!
I haven't had mine done yet but perused a couple "samples." Indirectly though, I've had my Lp(a) run a couple times, (don't ASK how bad:() and I've had my HDL2 and HLD3 run...2 is very protective, 3 is not.
Wintergarten, did your insurance company balk?
I tried calling mine in advance but I got a maroon who said I needed the PROCEDURE NUMBER...I said, can you look it up? She said "Ask your doctor?" :rolleyes:
When I mention it to my doctor he'll say: "Who knows, call your insurance company!"
KETCHA' 22
I found a Cigna site that said very specifically that THEY don't cover it...they aren't my insurer thank God. Cigna won;t even cover LP(a) for people with proven disease.
JacquelineL
06-03-2005, 02:33 PM
Lenin, if you are planning to get a VAP test, have you called the VAP people? I remember trying to get the same information and that was just to request the test. They were very helpful and did give me a number. I have also been able to find diagnosis codes online. My doctor once made a mistake by not including a diagnosis code and Medicare charged me for the full cost. It was corrected with some trouble. Now I make sure the codes are correct.
By the way, Medicare does cover the VAP test if you are diagnosed with high cholesterol.
By the way, Medicare does cover the VAP test if you are diagnosed with high cholesterol.
Wintergarden
06-03-2005, 03:15 PM
Oh, I know I'll find it utterly fascinating, I just hope I don't find it utterly terrifying! (given that I'm the hand wringing type). I've looked at sample reports online too. There's a LOT of information. I just hope the doctor's office deigns to give me a copy. The lab that's running the test will not send the results to me, only to the doctor, who has only ever shared information with me by flashing it briefly before my eyes via a clipboard. Now I'm wishing I'd ordered my test online and gone to a draw center, where they make your results available within a couple of days via their website, and mail you a copy in layman's terms.
Regarding insurance, my doctor's office said insurance rarely pays for this (don't know if that's true) and that they'd try to bill mine, but if they balked, I'd be getting a bill. I KNOW I'll be getting a bill (about $200)
Boy, I already have been doing the search engine thing. I'm so confused though! A lot of the literature seems to suggest that Pattern A people can switch to Pattern B, and vice versa. There's also talk of people lowering their Lp(a). Is all this stuff really cast in stone? Also, does anyone know how much risk these factors convey, or is that controversial?
More rambling...mind in overdrive. The internet - simultaneously your best friend and your worst enemy.
Regarding insurance, my doctor's office said insurance rarely pays for this (don't know if that's true) and that they'd try to bill mine, but if they balked, I'd be getting a bill. I KNOW I'll be getting a bill (about $200)
Boy, I already have been doing the search engine thing. I'm so confused though! A lot of the literature seems to suggest that Pattern A people can switch to Pattern B, and vice versa. There's also talk of people lowering their Lp(a). Is all this stuff really cast in stone? Also, does anyone know how much risk these factors convey, or is that controversial?
More rambling...mind in overdrive. The internet - simultaneously your best friend and your worst enemy.
Lenin
06-04-2005, 10:24 AM
Oh Wintergarten...
If your doctor doesn't give you a copy of the results as you're entitled to, send the bill to him; THEN call the AMA and your State Medical Society.
Jacqueline...thanks, I'll try to find the code for the VAP well in advance....Do you happen to remember it or have it written somewhere perchance?
I pay $600 a month for this insurance and I'd have apoplexy if I got a bill for the VAP. Besides I;m in Manhattan where a urine specific gravity costs $100 :D...a VAP would probably go for a $$GRAND$$!:eek:
If your doctor doesn't give you a copy of the results as you're entitled to, send the bill to him; THEN call the AMA and your State Medical Society.
Jacqueline...thanks, I'll try to find the code for the VAP well in advance....Do you happen to remember it or have it written somewhere perchance?
I pay $600 a month for this insurance and I'd have apoplexy if I got a bill for the VAP. Besides I;m in Manhattan where a urine specific gravity costs $100 :D...a VAP would probably go for a $$GRAND$$!:eek:
JacquelineL
06-04-2005, 03:23 PM
Lenin, I don't have the number anymore, but on the VAP website it lists the price as $90, which sounds about right.
Lenin
06-04-2005, 04:12 PM
Is that ALL, Jackie...I'm AMAZED!:eek:
It seem rare to find anything in medicine that's so reasonably priced.
It seem rare to find anything in medicine that's so reasonably priced.
Wintergarden
06-04-2005, 04:28 PM
Lenin, I'm in the San Francisco Bay Area - also a high cost area. That's why I don't get it - it's fairly cheap, why not just skip the traditional lipid panel and go straight to the VAP? (or whatever they want to call it...I notice not all labs use that acronym for basically the same test) Wouldn't it be a huge savings in the long run, if you could identify more high risk patients early on and intervene before a costly "event" forced the issue?
Not even mentioning the cost in human suffering, because lately I get the feeling that medicine is all about money (gasp!)
Not even mentioning the cost in human suffering, because lately I get the feeling that medicine is all about money (gasp!)
Lenin
06-04-2005, 04:39 PM
Wintergarten,
I will do exactly that. But first I will explore whether I can get OXFORD to pick up the cost...but I DO want (and need) the VAP test.
But if I can get it done for $90 I will pay myself if I must. A problem is that my doctor (and almost EVERYBODY in NYC) send the results to QUEST DIAGNOSTICS and they have a pricing structure all their own...and calling them is met with EXTREME rudeness and..."Ask Your Doctor!" And I find it inconceivable they will charge only $90 for ANYTHING.
I'm optimistic about OXFORD's picking up the tab since they haven't quibbled about anything in the past including several Lp(a)'s, HDL1 and HDL2, apolipoprotein(a) twice.
I actually like the company VERY much and only HATE it once a month when I get to write my premium check.
I will do exactly that. But first I will explore whether I can get OXFORD to pick up the cost...but I DO want (and need) the VAP test.
But if I can get it done for $90 I will pay myself if I must. A problem is that my doctor (and almost EVERYBODY in NYC) send the results to QUEST DIAGNOSTICS and they have a pricing structure all their own...and calling them is met with EXTREME rudeness and..."Ask Your Doctor!" And I find it inconceivable they will charge only $90 for ANYTHING.
I'm optimistic about OXFORD's picking up the tab since they haven't quibbled about anything in the past including several Lp(a)'s, HDL1 and HDL2, apolipoprotein(a) twice.
I actually like the company VERY much and only HATE it once a month when I get to write my premium check.
Wintergarden
06-04-2005, 05:04 PM
I hear you Lenin. I also have to pay my own insurance premiums...and then there's the BIG deductible and the hefty co-pay. Ouch.
So you've already had a lot of the specialized tests? Mind if I ask you, have those Lp(a) and HDL subgroups stayed constant, or have you been able to improve them? I've found a lot of online information on that subject that seems contradictory to my unscientific mind.
The $200 test I'm getting includes not only the vertical autoprofile (particle size, density and distribution) but Lp(a), homocysteine and C-RP.
I called the lab that's doing the test and asked if they could please send a copy of the results to my home and they refused. They will only send them to my doctor. They will, however, send the bill to my home. How amusing. :rolleyes:
So you've already had a lot of the specialized tests? Mind if I ask you, have those Lp(a) and HDL subgroups stayed constant, or have you been able to improve them? I've found a lot of online information on that subject that seems contradictory to my unscientific mind.
The $200 test I'm getting includes not only the vertical autoprofile (particle size, density and distribution) but Lp(a), homocysteine and C-RP.
I called the lab that's doing the test and asked if they could please send a copy of the results to my home and they refused. They will only send them to my doctor. They will, however, send the bill to my home. How amusing. :rolleyes:
Lenin
06-05-2005, 10:10 AM
My HDL responds to lots of alcohol...like a bottle of wine a day. At my age, this amount of drinking will do more harm than good...not only does it go UP a LOT with booze (to near 60) but the distribution goes heavily to the healthy HDL2. I get SOME HDL boost with low dose niacin (but I haven't tested agains HDL distribution), but I can't take anything more than 250 mg. per meal because of heavy duty flushing.
I find my HDL does not respond ONE IOTA to heavy exercise...NADA! I always scratch my head when I read that it SHOULD...in fact, it's always touted as the prime method. I wonder if that's just an urban legend or whether some people DO get good HDL boosts with exercise. It's always mystified me.
My Lp(a) is horribly high and is the same after a month of teetotalling as it is with drowning myself in alcohol for a month AND taking niacin. That REALLY shocked me. Alas, I have found out first hand what the term GENETIC means.
:( It has me sad but there's nothing I can do about it. I try to control what I can. I really want to know my breakdown of the LDL fractions (thus the VAP) and this will complete my picture...the total LDL is always around 90.
I know there are also Lp(a) fractions, but in truth, I wouldn't have a CLUE what to make of them.
I find my HDL does not respond ONE IOTA to heavy exercise...NADA! I always scratch my head when I read that it SHOULD...in fact, it's always touted as the prime method. I wonder if that's just an urban legend or whether some people DO get good HDL boosts with exercise. It's always mystified me.
My Lp(a) is horribly high and is the same after a month of teetotalling as it is with drowning myself in alcohol for a month AND taking niacin. That REALLY shocked me. Alas, I have found out first hand what the term GENETIC means.
:( It has me sad but there's nothing I can do about it. I try to control what I can. I really want to know my breakdown of the LDL fractions (thus the VAP) and this will complete my picture...the total LDL is always around 90.
I know there are also Lp(a) fractions, but in truth, I wouldn't have a CLUE what to make of them.