To wonder why the NHS has such a high threshold for blood work?

[SailAwaySandra]

In a nutshell, my folate levels are actually low after all. But they’re NHS borderline.

For about 6 months now, I’ve felt like utter death. Really stanage symptoms, fatigue and joint pain making me feel like walking through treacle.

It turns out my folate levels are borderline and actually low. And the ideal is that they’re much better than they are!

I’ve had 3 blood tests via the NHS, each time going to the GP very worried as I am only 26 and physically felt like my body was aging! Sometimes I had to flinch to move a leg, for example, if I had to sit for a minute or so and get up again

GPs kept saying all was normal. Nothing to worry about.

Paid for a blood test and told within 72 hours that my folate levels are too low. And to take folic acid (I’ve already put loads of it in my diet)

Why or why did no GP say ‘it’s within normal range but your folate is in the low side. You might want to consider buying some folic acid and introducing more of it into the diet’?

@SensibleSigma I have Hashimoto's and I need my TSH to be at the very low end to function well, under 0.7. Have you had that tested? There are peer reviewed papers advising this as a protocol but not every GP knows it or cares. I have no idea what the NICE guidelines say. I thought I was in peri menopause but I was in fact overmedicated. I reduced my dose slightly and I functioned normally again. A suppressed TSH makes me feel worse than a higher TSH.

Can’t get the NHS app in Wales - app is only NHS England, unfortunately.

I agree. We only found out how low levels actually were when we asked for a copy of the results. Until then we’d been sent away as everything normal.

As you say why not say, “normal but x is on the low side if you wish to supplement to increase levels.” By saying that it wouldn’t even cost them anything as you’d be responsible for the cost of the supplement as, as they say, everything is actually in the norm range.

Or just give a copy of the results as standard.

It's still an NHS postcode lottery even with blood test results. I was frustrated with my NHS GP saying I was fine when I could barely function. I live in the border between two counties.

I had a cashback plan which included an online GP to I asked him. He advised that he locum-ed in both areas. The GP had followed the guidelines correctly where I live. If I was in the next county, the guidelines say I would be treated. It's madness.

I don’t understand Hashimitos
I don’t know how they know if you have it.
I don’t feel better on thyroxine regardless of the dose. I don’t think. I took it when told to because I felt crap, but I still feel pretty crap!

@SensibleSigma I've just come off Amitrip as I felt like a walking zombie. Exhausted, brain fog, nearly got hit by a car walking across the supermarket car park as I was in a daze
Feel like a fog has lifted!
Also have hashimotos

The interesting thing will be whether your symptoms resolve with the folic acid supplementation.

I’ve just looked at my last set of results and for ferritin it says 11-307 as the range. That’s in the NE.

I think it depends on gp. Mine always said its on low side of normal so suggested take a good multivitamin. My iron was always low normal when I had periods so just paid for iron tablets

You said "Because for some tests, the NHS simply won’t do them any more, such as vitamin D. " This is factually incorrect which is exactly what I told you. You then moved the goalpost to say "Absolutely, vitamin D blood tests are available on the NHS but the criteria for trying to get one has been hugely limited in recent years".
It's not at all what you said in your original statement, is it?

The OP had the tests. Four of them, if you read the post.

Neither is it true to say "the NHS" tests for Vitamin D.

More accurate would be to say that based on your postcode you may be in a fiefdom which offers the bloodwork or you may be in a fiefdom which rations it out of existence. Ditto many other tests and treatments.

See also disparities in what is "normal" for ferritin. If it was evidence based it would be set centrally in a holistic organisation. The model of healthcare which works on the "will they die today" principle just ends up being far more expensive in the long run as trends and prospective health are not picked up.

I developed a bald spot and my hair was falling out. It wasn't until I had lost half my hair that my blood tests showed my ferritin as abnormal (5). I got access to my test results and saw that it had been falling over 4yrs including one test that was low normal but marked as satisfactory! That was when I noticed the bald spot. It wasn't until I had increased ferritin to over 100 that my hair stopped falling out. Unfortunately it hasn't grown back several years on. If I had started taking iron when it had been low/normal I could have saved my hair.

Happened to me. Nearly two years of being told iron was "a bit on the low side" and I was taking iron tablets. I still felt terrible.

Reached crisis point where I fainted getting out of the bath. When I was tested in A&E both my ferritin and iron were a 1. Later told I was only given the number 1 because the computer wouldn't allow a zero.

Eight pints of blood later I felt like a new person. Was let out and put on a series of iron transfusions as an outpatient, where tests showed I have malabsorption issues and can't even absorb the iron tablets I had been on for two years. My folate was also at pretty much zero, something I'd never been told or- as far as I know- tested for.

The joke is, I have Lupus so some of this stuff should have been dealt with at that clinic (but as most of that had been via zoom for years, I'm not surprised it wasn't).

Whatever they saved on treating me initially, they definitely lost on those transfusions as they cost the NHS something like £800 a bag.

After paying for them privately.

But what that poster doesn't say is that they DO get additional funding for managing chronic conditions, plus additional funding for various initiatives, funding for doing flu jabs, etc. Probably still not enough, but not as bad as they make out.

£107 for a patient they never actually see from year to year and don't do anything for (typical normal healthy person) isn't that bad. And, of course, some of the patients on their books will have emigrated, moved, died, etc and they'll still be getting the funding until someone notices!

Personally, I think that funding model need scrapping and GP surgeries paid on a "per appointment" or "per service" basis instead, so that the payments they receive actually mirror the work they're actually doing.

It’s a while since I’ve worked there. While I did there was a difference between the ranges for Middlesbrough and Darlington 🤦🏻‍♀️
more Teesside than true northeast I suppose

Again, @Icecrown - I was posting in haste. Some trusts have now stopped all vitamin D testing by GPs. Some trusts have hugely restricted the criteria so only very few people will be given one. I’m pleased you’re still able to access them in your area though.

There are regional differences in normal ranges too, which is crazy. When I worked in the northeast, Ferritin normal range was 40-400. In the midlands normal is 13-400. Bonkers.

Isn’t this less of a ‘regional differences’ thing and more that different labs use different assays which will have different ranges? It’s not the region’s Trust that has decided to change the ranges but it’s due to the labs.

No, she had three tests on the NHS and one private test.

But now I can sleep! And feel less pain!

And I’m not a walking zombie, I’m fine driving etc, I used to need a nap to get through the day.

I just have little motivation and can’t do as much as I’d like. I may be being unreasonable…

As typical with a fragmented NHS, different GPs have different ways of working. My last month's blood tests were the first time any were put on the NHS app. No historical ones on there at all.

My OH has his monthly blood tests done at the hospital (due to ongoing cancer treatment). They've never been on the NHS app. He asks for a printout every hospital visit and the staff make a massive fuss about it, lots of huffing and puffing, etc.

Imposing some consistent rules and standards across the NHS would make a massive difference.

It’s bonkers isn’t it?! I’m in Stockton so somewhat in the middle of the two. Mine was 12 once and my GP ummed and ahhed about supplementation. He did prescribe eventually - though I wouldn’t have minded buying OTC ones, I just wasn’t really that clued up that you could at that point.

If you've low iron, over the counter tablets are far too weak to make any impact. They're for basically "healthy" people. When you get iron levels close to the bottom of the "normal" range or below, you need prescription strength iron supplements to make any worthwhile difference.

I do not understand this. Sometimes you can even be just below the ridiculously wide ranges and they still won't flag it as needing rectifying. I discovered I was anaemic for about 15 years when I finally managed to access my records and Vit D deficient. Yet despite me having been in multiple times for chronic tiredness, lethargy and exhaustion, no GP ever suggested an iron or Vit D supplement might be a good idea. You wonder what the hell the point of the blood tests was. I was offered anti-depressants though!!!!!!!

I'm not even going to start on the shocking state of the treatment of thyroid issues, particularly for women, because I could write a book about this.

DS has a chronic bowel condition and the management of it is deplorable. He regularly has blood tests outside of range and the notes just say 'no action required'.

It is almost like they don't want people to be well.