Expert: John Pilcher, MD - 2/2/2012

Question
Hello and Thank you for volunteering yout time.
I had Gastric bypass 4 yrs ago.

My PCP does not run a complete list of lab work.
I would like every test,atleast once a year. I do not know my copper, my zinc, my Vit A, E , K, I do not know my Bilirubim, and a host of others.     I am now borderline anemic although I take Iron , my Liver enzymes are elevated and I am scheduled for a abdominal ultraound.
I am concerned for my health. I realize most have normal levels of copper, zink, K, etc.  but shouldn`t I be the one to dictate the tests I would like?
Just 1 time a year, to compare, my vision has changed although that might be age , ( 52) I recently was DX with Bipolar after the operation and I read somewhere that certain defienceies can lead to depression which I do suffer from now, but not quite believeing the Bipolar.

Do you think I am out of line asking for all the tests?  I have a group of men and women that all have had the same operation, different surgeons, different hospitals but they do have all the tests run .         Some actually are low in opotassium, Copper and K, and A.
How does my PCP know if I am or if I am not?
I am at my wits end.          Am I wrong to ask for the complete list of tests?
Thank You Kindly, Jen

Answer
Jen,
It is great that you are researching to learn what you need in order to maintain optimal health.  All of the tests you mentioned can be useful in the matching clinical circumstances, but many of them are not done routinely for gastric bypass patients.  In addition to a basic chemistry profile and blood count, most bariatric surgeons (and our national society, the ASMBS), recommend the following tests:  Iron, B12, and Vitamin D.  Most of the other tests you mentioned (A,D,E,K, and maybe zinc) are useful if you had a malabsorptive operation called the Duodenal Switch.

It is certainly correct for you to raise the idea of some test with your doctor, but in the end the physician must use their knowledge and judgment to determine whether it is worth ordering.  If you just can't get to a place of agreement with your doctor, you may need to find another doc.  It sounds to me like your doctor has the right ideas so I am not recommending a switch for you.  In my area, the surgeons take responsibility for long term follow up including labs, so I hope that follow up with your surgeon would also be an option.

Best wishes,
Dr JP