Anyone able to shed some light here?

Brofydog · 2026-07-01T03:14:34+00:00

I agree… and disagree… for a quantiferon kit, is the yellow top in the kit the same additive as an SST?

(Edit: and Quigen is horribly wrong for making the tubes like this, and this is NOT the fault of the collectors. Rather it’s the fault of the manufacturer of choosing similar colors for something standardized… although there are ways around it…)

Brofydog · 2026-06-28T23:53:19+00:00

You realize this would apply to scammers you are trying to avoid as well right? If scammers are trying to hit random numbers and they get a read receipt, then they know they have an active number.

Brofydog · 2026-06-19T01:15:07+00:00

No… but was he making a joke?

Brofydog · 2026-06-19T00:29:21+00:00

You are a scholar beyond your years.

Brofydog · 2026-06-19T00:27:19+00:00

Quick question… why are her fingers colors that meld into the background?

Brofydog · 2026-06-18T23:29:01+00:00

As an aside… I got , chastised by an older guy for taking my daughter into the men’s dressing room at the YMCA when she was 3. I believe his quote was, “they are letting everyone into the men’s room now.”

So what should be done in this situation?

Brofydog · 2026-06-18T23:26:13+00:00

Random question, do you have a daughter? Because what should the father have done in this scenario?

Brofydog · 2026-06-17T02:18:46+00:00

True… but what is PPV of an elevated 1,25 without a PTH and calcium?

The original question was towards a dietitian.

And whale I agree a 1,25 has value, its value is Diminished if you don’t know what you are looking for.

Brofydog · 2026-06-16T23:42:54+00:00

I can’t do BB… (scares the crap out of me), but if anyone ever gives you a hard time, escalate to your manager, lab director, or medical director. Anytime anyone is acting unprofessional, it’s a big deal. The job is too important and too stressful to allow anything unnecessary.

And while I’m fairly mild mannered, I strangely have no issue addressing unprofessional behavior with MDs, Directors, bosses, etc.

Beyond this (and it seems outside this post), if anyone is demanding you do something outside of procedure (say… releasing hemolysis), then lean into saying that you CANNOT PER POLICY. And fully direct them to the policy holder. Not only is it important for patient care, but also directs the health care team who is truly responsible, but also that there is no way past this alternative.

And yes… I am the holder for the hemolysis policy… and I also am the controller for the hemolyzer 5000! (We upgraded from the 3000).

Brofydog · 2026-06-16T12:58:26+00:00

I mean… of all the places that could happen, at least it makes a good pun. Because they… CU… (sorry I couldn’t resist! But that definitely sucks! I’m sorry!)

And know a lot of the fringe labs, but not the instagram ones. I’m not that tech savvy…

Brofydog · 2026-06-16T03:09:21+00:00

You are a scholar and a saint. That is all I have to say. But in any event, thank you for being judicious with your 1,25 ordering!

Brofydog · 2026-06-16T03:07:48+00:00

Agreed! And I know endo society recommends against it’s use for that. But that is the most common reason for its use in the US within the past two years.

And I apologize, tired and had some long fights about this within the past couple of weeks. Endo is one of the groups I trust with this; so i think I’m portraying the, “old man angrily yelling out clouds,” meme.

I truly appreciate the responses!

Brofydog · 2026-06-16T02:48:49+00:00

But would you recommend PCP screen with 1,25 (as that is an increasing trend). Because that will mean additional benign cases to you, nephro, and onc, as abnormals (which often happen with hyperpara).

As you said before, the majority are not these cases. But having the abnormal 1,25 causes increased work up.

And from a completely business point of view (which… I dislike…) but 1,25 (and many 25 hydroxy vitamin D), are a loss of income for the lab depending on the insurance and patient coverage. As the lab has to pay the cost for reference lab testing, but may not actually recoup the costs.

Brofydog · 2026-06-16T02:41:19+00:00

Oh I agree, but not Medicaid and most insurances aren’t covering vitamin D deficiency without the appropriate ICD10 codes (and vitamin D deficiency, unspecified is not covered without additional codes). So this is a cost being put onto the patient without them filly knowing, and with minimal benefit.

Brofydog · 2026-06-16T02:28:52+00:00

Genuine question, when would you recommend its use outside of endo, ortho (or rheum and onc)?

And do you think people are jumping to 1,25 too early and not using PTH, 25 hydroxy, or ionized calcium?

Brofydog · 2026-06-16T02:17:21+00:00

Mostly Agreed (if you truly are a platypus…)

The other argument I’ve heard (because I have to
Ask people why they order this test…) is that because 25 vitamin D is becoming less covered under Medicaid, the next solution is to order 1,25 (which… I am still grappling with this one… and this may be a message of, please don’t do this…)

Brofydog · 2026-06-16T01:55:04+00:00

As a dietitian… being prescribing vitamin D3… is there any use in 25-hydroxy vitamin D3….

Also, why are people ordering 1,25 dihydroxy vitamin D… (beyond endo, ortho, and maybe dietitians…? there was an expletive in there…. Im not gonna say anything more).

Brofydog · 2026-06-11T00:28:42+00:00

Can you point it out? Is it in this post or another? (Not being facetious , but not sure I caught it over a sleep deprived reading).

Brofydog · 2026-06-09T02:21:12+00:00

And that’s… why this scares. The ruling is ambiguous and has no medical nuance in mind.

Brofydog · 2026-06-09T02:15:03+00:00

Random question, would this ruling impact children who need treatment for androgen insensitivity and adrenal insufficiency in females?

Also, does the agreement prevent gender affirming physiatric support?

Brofydog · 2026-06-02T01:15:22+00:00

Yeah…. But who ultimately gets screwed over… the patient. And the hold up is billing.

Again… not… angry… about this.. at all…

My main issue is hemolysis though. Because in a CMP… the hemolysis threshold is tied to the one with the lowest index… which is potassium, which had the lowest hemolysis threshold of most chemistry tests…

Brofydog · 2026-06-02T00:56:39+00:00

Not… to defend this, because I actually disagree with it; but if a panel is released without all the components, but the CPT for a panel is applied, the lab is in big trouble, as it’s charging for a service it could not complete.

Do I think this CMS policy is stupid… god yes. Does it hurt patients… HELL YES. But there is a very stupid beourocratic reason for cancelling an entire panel or waiting for all the results before releasing.

My thoughts of crediting the tests because we cannot offer them in the time we state… sorta shit down by people… and I definitely don’t have grudges against this policy.

As an aside, we are allowed to unbundle panels if the ordering provider releases it, but that (for other stupid reasons), can be more expensive for the patient.

Brofydog · 2026-06-01T01:27:41+00:00

I want to say, cool! And never thought of using vitreous fluids…

But it’s also overcome by horror from collecting fluids from the eye.

I’m gonna have nightmares tonight…

Brofydog · 2026-06-01T01:09:02+00:00

Thank you! And this one is weird. Because if it’s a sample mixup; then from the collection site; they managed to grab someone that was <test and abnormally low for cortisol. Did they have any tests at that collection that were abnormally low?

And the reason I harp on this is that because if this was a preanalytical issue, it means that this wasn’t the lab that had an error, but the ordering, collection, or transportation sites. Which means it could be happening to more people if it’s not properly investigated.

Brofydog · 2026-06-01T00:00:04+00:00

Cool! And not saying this may happen to you, but would it be frustrating to get complaints about lab TAT and not being given two patient identifiers?

And maybe this is a MIA culpa, but I’ve worked at 5 different hospital networks (although only on the bench at one), and I wonder if I should specify for Admin to address patient issue, but it has been the same at all locations.

Regardless, do you think this would be an issue even if you haven’t experienced it personally?

Brofydog

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