6 years post op and possible issues with liver

[jbrule]

Hi all,

My name is Jen, I had the DS 6 years ago. I've been pretty happy with the results but for the past 1.5 years my liver enzymes have been elevated. I had an ultrasound in December and the results were normal but I'm concerned that I may have an autoimmune problem in the works. Frankly, I am freaking myself out and of course it's Friday. Please help me make sense of this all!

I would appreciate any opinions from the experts on this. I just had some lab results. For the first 5 years my enzymes were in the 20's and now they are on the high side. It drives me crazy. I will post my last two labs. I also cannot build my ferritin. My iron is good, my hemoglobin is good, but my ferritin never is. The only time it has been is after I had an iron infusion. What is the deal with that? Hopefully the formatting on my labs doesn't go to wonky.

Also, in the past few weeks I have put on 7-8lbs. I don't know why, I can't figure it out. I feel like I need to do a reset diet for a bit. I swear people have talked about that in the past. The DS will always work if you use it correctly, right?



Results:
Date Result Name Value Ind Ref Range
9/23/2015 14:14 WBC 6.32 thous/uL (4.00 - 11.00)
9/23/2015 14:14 RBC 4.28 mil/uL (3.80 - 5.50)
9/23/2015 14:14 Hgb 13.6 g/dL (11.6 - 15.6)
9/23/2015 14:14 Hct 39.0 % (36.0 - 48.0)
9/23/2015 14:14 MCV 91 fL (80 - 100)
9/23/2015 14:14 MCH 31.8 pg (26.0 - 34.0)
9/23/2015 14:14 MCHC 34.9 g/dL (30.0 - 36.0)
9/23/2015 14:14 RDW-CV 13.7 % (11.7 - 14.3)
9/23/2015 14:14 RDW-SD 45.6 fL (36.0 - 48.5)
9/23/2015 14:14 Platelet 232 thous/uL (130 - 400)
9/23/2015 14:14 MPV 10.4 fL (9.5 - 10.5)
9/23/2015 14:14 Neutro % 62.3 % (40.0 - 76.0)
9/23/2015 14:14 Lymph % 26.6 % (20.0 - 46.0)
9/23/2015 14:14 Mono % 9.7 % (4.0 - 12.0)
9/23/2015 14:14 Eosin % 0.2 % (0.0 - 5.0)
9/23/2015 14:14 Baso % 0.9 % (0.0 - 3.0)
9/23/2015 14:14 Imm Gran % 0.3 % (0.0 - 5.0)
9/23/2015 14:14 Abs Neutro 3.94 thous/uL (1.60 - 8.40)
9/23/2015 14:14 Abs Lymph 1.68 thous/uL (0.80 - 5.10)
9/23/2015 14:14 Abs Mono 0.61 thous/uL (0.10 - 1.30)
9/23/2015 14:14 Abs Eosin 0.01 thous/uL (0.00 - 0.60)
9/23/2015 14:14 Abs Baso 0.06 thous/uL (0.00 - 0.30)
9/23/2015 14:14 Abs Imm Gran 0.02 thous/uL (H) (0.00 - 0.01)
9/23/2015 14:14 nRBC Abs 0.00 thous/uL (0.00 - 0.00)
9/23/2015 14:14 nRBC % 0.0 /100 WBC's (0.0 - 0.0)
9/23/2015 14:14 Glucose Level 79 mg/dL (60 - 99)
9/23/2015 14:14 BUN 9 mg/dL (8 - 20)
9/23/2015 14:14 Creatinine 0.7 mg/dL (0.3 - 1.5)
9/23/2015 14:14 Sodium 138 mmol/L (137 - 147)
9/23/2015 14:14 K Plasma 4.20 mmol/L (3.40 - 4.80)
9/23/2015 14:14 Chloride 108 mmol/L (98 - 110)
9/23/2015 14:14 CO2 26 mmol/L (24 - 32)
9/23/2015 14:14 AGAP 4 (L) (5 - 20)
9/23/2015 14:14 AST (SGOT) 54 Unit/L (H) (10 - 37)
9/23/2015 14:14 TBil 0.7 mg/dL (0.1 - 1.1)
9/23/2015 14:14 ALT (SGPT) 99 Unit/L (H) (12 - 78)
9/23/2015 14:14 Alk Phos 73 Unit/L (45 - 117)
9/23/2015 14:14 Calcium 8.5 mg/dL (8.5 - 10.1)
9/23/2015 14:14 T. Protein 6.8 g/dL (6.0 - 8.4)
9/23/2015 14:14 Albumin 3.6 g/dL (3.2 - 4.7)
9/23/2015 14:14 Iron 117 mcg/dL (50 - 170)
9/23/2015 14:14 TIBC 473 mcg/dL (H) (250 - 450)
9/23/2015 14:14 Iron % Saturation 25 % (20 - 55)
9/23/2015 14:14 Ferritin 8.0 ng/mL (8.0 - 252.0)
9/23/2015 14:14 GFR MDRD >60.0 mL/min/1.73m2
9/23/2015 14:14 Vitamin D 25-Hydroxy Total 61 ng/mL (H) (20-50 - )
9/23/2015 14:14 Zinc, Serum 0.55 mcg/mL (L) (0.66-1.10 - )


Results:
Date Result Name Value Ind Ref Range
12/19/2014 14:59 WBC 5.91 thous/uL (4.00 - 11.00)
12/19/2014 14:59 RBC 4.15 mil/uL (3.80 - 5.50)
12/19/2014 14:59 Hgb 13.1 g/dL (11.6 - 15.6)
12/19/2014 14:59 Hct 36.3 % (36.0 - 48.0)
12/19/2014 14:59 MCV 88 fL (80 - 100)
12/19/2014 14:59 MCH 31.6 pg (26.0 - 34.0)
12/19/2014 14:59 MCHC 36.1 g/dL (H) (30.0 - 36.0)
12/19/2014 14:59 RDW-CV 13.8 % (11.7 - 14.3)
12/19/2014 14:59 RDW-SD 43.8 fL (36.0 - 48.5)
12/19/2014 14:59 Platelet 265 thous/uL (130 - 400)
12/19/2014 14:59 MPV 10.5 fL (9.5 - 10.5)
12/19/2014 14:59 Neutro % 59.9 % (40.0 - 76.0)
12/19/2014 14:59 Lymph % 29.9 % (20.0 - 46.0)
12/19/2014 14:59 Mono % 9.1 % (4.0 - 12.0)
12/19/2014 14:59 Eosin % 0.2 % (0.0 - 5.0)
12/19/2014 14:59 Baso % 0.7 % (0.0 - 3.0)
12/19/2014 14:59 Imm Gran % 0.2 % (0.0 - 4.9)
12/19/2014 14:59 Abs Neutro 3.54 thous/uL (1.60 - 8.40)
12/19/2014 14:59 Abs Lymph 1.77 thous/uL (0.80 - 5.10)
12/19/2014 14:59 Abs Mono 0.54 thous/uL (0.10 - 1.30)
12/19/2014 14:59 Abs Eosin 0.01 thous/uL (0.00 - 0.60)
12/19/2014 14:59 Abs Baso 0.04 thous/uL (0.00 - 0.30)
12/19/2014 14:59 Abs Imm Gran 0.01 thous/uL (H) (0.00 - 0.00)
12/19/2014 14:59 nRBC Abs 0.00 thous/uL (0.00 - 0.00)
12/19/2014 14:59 nRBC % 0.0 /100 WBC's (0.0 - 0.0)
12/19/2014 14:59 Glucose Level 80 mg/dL (60 - 99)
12/19/2014 14:59 BUN 8 mg/dL (8 - 20)
12/19/2014 14:59 Creatinine 0.7 mg/dL (0.3 - 1.5)
12/19/2014 14:59 Sodium 138 mmol/L (137 - 147)
12/19/2014 14:59 K Plasma 3.9 mmol/L (3.4 - 4.8)
12/19/2014 14:59 Chloride 107 mmol/L (98 - 110)
12/19/2014 14:59 CO2 25 mmol/L (24 - 32)
12/19/2014 14:59 AGAP 6 (5 - 20)
12/19/2014 14:59 AST (SGOT) 44 Unit/L (H) (10 - 37)
12/19/2014 14:59 TBil 0.8 mg/dL (0.1 - 1.1)
12/19/2014 14:59 ALT (SGPT) 97 Unit/L (H) (12 - 78)
12/19/2014 14:59 Alk Phos 91 Unit/L (45 - 117)
12/19/2014 14:59 Calcium 8.4 mg/dL (L) (8.5 - 10.1)
12/19/2014 14:59 T. Protein 7.2 g/dL (6.0 - 8.4)
12/19/2014 14:59 Albumin 3.7 g/dL (3.2 - 4.7)
12/19/2014 14:59 Phosphorus 3.5 mg/dL (2.0 - 5.0)
12/19/2014 14:59
Cholesterol
120 mg/dL

( - <=200)
12/19/2014 14:59

Triglycerides
50 mg/dL

( - <=150)
12/19/2014 14:59

HDL
65 mg/dL
(H)
(40 - 60)

12/19/2014 14:59
LDL, Calculated
45 mg/dL

( - <=100)

12/19/2014 14:59
VLDL
10 mg/dL

(4 - 50)

12/19/2014 14:59
Iron
73 mcg/dL

(50 - 170)

12/19/2014 14:59
Ferritin
9.2 ng/mL

(8.0 - 252.0)

12/19/2014 14:59
TSH
1.790 microInternatl.Unit/mL

(0.358 - 3.740)

12/19/2014 14:59
Folate
8.1 ng/mL

(>=2.8 - )

12/19/2014 14:59
Vitamin B12
1,512 pg/mL
(H)
(193 - 986)

12/19/2014 14:59
GFR MDRD
>60.0 mL/min/1.73m2


12/19/2014 14:59
Intact PTH
44 pg/mL

(12-72 - )

12/19/2014 14:59
Phosphorus (PTH)
3.8 mg/dL

(2.7-4.5 - )

12/19/2014 14:59
Creatinine (PTH)
0.6 mg/dL

(0.5-1.3 - )

12/19/2014 14:59
Calcium (PTH)
9.0 mg/dL

(8.9-10.5 - )

12/19/2014 14:59
Vitamin D 25-Hydroxy Total
81 ng/mL
(H)
(20-50 - )

12/19/2014 14:59
Zinc, Serum
0.76 mcg/mL

(0.66-1.10 - )

 

[DianaCox]

Your labs look fine to me. Some of your ranges are (I believe) out-of-date - your vitamin D levels look great - mine are a little higher and I like keeping them in the 70 -80 range.

Your liver enzymes are only very slightly elevated. I've had this come up a couple of times over the years. You almost certainly have fatty liver disease - we all do. Did you recently change a medication? It can bump your liver enzymes a bit. You might want to get a liver U/S - if your doc thinks it's necessary. Oh, and by the way, are you drinking alcohol?

Your HDL at 65, when your total cholesterol is 120, doesn't sound like such a big deal. If anything, I'm wondering why your cholesterol is SO low this far out - are you eating enough fat?

I would not be worried about these labs, if they were mine.

 

[southernlady]

9/23/2015 14:14 Iron % Saturation 25 % (20 - 55)
9/23/2015 14:14 Ferritin 8.0 ng/mL (8.0 - 252.0
9/23/2015 14:14 Vitamin D 25-Hydroxy Total 61 ng/mL (H) (20-50 - )

Iron Sat % is needs to be above 30% if possible (and no, no clue how to raise that one)
Ferritin is in the toilet at 8. You want that one above the middle. See about getting iron infusions.
Your vitamin D range is the one out of date, the range is now 30-100. At 61, it's okay but if it were me, I would add more to bring it closer to 100.

 

[jbrule]

I cut back on my Vit D when my liver enzymes elevated. I'm on no medications, just vits. I drink less now than I have at any other time in my adult life. Maybe a drink a week but usually not even that. I'm still waiting on my vit a and k results. I have issues with both of them on and off.

I had an iron infusion, my ferritin went to 31 (the highest it has ever been) and then down to 12 a few months later. Does anyone know why I cannot keep that up even with normal iron levels? If I'm absorbing iron shouldn't I be able to store ferritin as well? My iron went up between tests significantly but my ferritin went down!

My liver enzymes prior to the DS were 16 and 19. In June 2012 they were 19 and 19. They went up to the 30's Oct 2012 after I started carbonyl iron and have kept going up. No idea if that is what's doing it or not. Ultrasound in December was normal.

I'm also concerned that my albumin keeps going down. Maybe I need to supplement with protein shakes again. Has anyone had trouble with their albumin? I am very concerned and want to figure it out before it drops off the charts.

HDL is good cholesterol so no worries on that one. I eat a lot of nuts and i think that shot that one up. Is there an amount of fat we should shoot for in our diet? I also forget how much protein we should try to get. I'm going to start a food diary for a bit.

I'm going to make an appointment with my surgeon. I haven't been to him in years because he is far away but I think I need to go.

Thank you! I had trouble finding where everyone went from ObesityHelp, doesn't seem like many post there anymore!

 

[southernlady]

I'm also concerned that my albumin keeps going down. Maybe I need to supplement with protein shakes again. Has anyone had trouble with their albumin? I am very concerned and want to figure it out before it drops off the charts.

@DSRIGGS had issues with his albumin.

 

[jbrule]

I just read through his posts about it. Sounds very similar to my experience but mine isn't too bad yet. It also led me to figure out that liver enzymes can elevate with malnutrition. So maybe this is what I am looking at the early stages of. I'm going to make an appointment with my surgeon but I think that maybe I have become too complacent and not been eating well enough. I will try adding some protein powder and see if that does anything. I will also try to go back to the DS basics with diet. The simplest answer is usually the right one and this seems to be the simplest answer in regards to my liver. Now if I can figure out my ferritin! I'm so grateful for this board!

 

[aaa]

My liver enzymes are up, too. We re-test them every 6 mos. but none of my doctors are very worried. (P.S. I don't drink).

 

[jbrule]

Hi aaa

Were they always high or did they raise at some point quite awhile after surgery? My PCP isn't concerned at all. I tend to be slightly paranoid. ;-) If there is a problem, I want to figure it out now, not after it really becomes trouble!!

 

[DSRIGGS]

As Dianna said your liver enzymes are just a little high. If they were two to three times the high range I would have some concern if I were in your shoes, but at this level I wouldn't be concerned unless you start having some symptoms. FYI - In last labs from my son I have seen his AST and ALT jump all around and it has never been anything

 

[DSRIGGS]

@DSRIGGS had issues with his albumin.

@jbrule your albumin is just slightly below the middle of range and in a very healthy range...so is your Total Protein. I wouldn't be concerned with your numbers at all, as a matter of fact I would be very happy with your numbers. My albumin was below 2.5 and Tot protein around 4 when I figured out I had sever malnutrition.

Like your liver enzymes, I would wait and see where you are on your next read but as far as ablumin I see no reason for you to have any concern. That being said, eating more protein for a DSr is never a bad idea.

 

[Charris]

Same with me @DSRIGGS. The I had the low albumin and elevated liver enzymes but by time I went to get help I was malnourished also.

 

[Settledownnow]

I do not have DS, but RNY, and have had several iron infusions. The reason your ferritin continues to be low after an infusion may be the direct result of the amount of iron given and the specific type iron product used. You may just not be getting enough iron with that infusion. My ferritin usually goes up to 200 after set 3-infusions with a total of 1 gram of iron. Are you being followed by a hemo on a regular basis? Your should iron should be monitored on a regular basis. Also if you are menstruating or bleeding anywhere (ulcer, for example) you will lose iron stores more quickly. If your hemo does not have the answers, you may need to find a new one.

 

[jbrule]

I still think something is up. As my liver enzymes rise, my albumin level drops. I think I have been retaining water (I know that can be caused by dozens of things). I started taking some liver detox herbs and lost 6 lbs in two days. Hopefully I'm wrong and over reacting or it is an easily correctable thing. I just feel like if it's the start of a downward slope I want to catch it now. In May/14 my albumin was 4.3 and protein was 6.6. Now the albumin is 3.6, isn't that a significant drop? Also my AGAP being low is a sign of dropping albumin isn't it?

I can't remember what my iron infusion was. I was there for 8 hours, it took all day to do it. I have not been followed regularly by the hematologist but I do test my iron regularly. No one was overly concerned about my ferritin except me. It was down to 4 when i had the infusion. I need to find a hematologist who deals with weight loss patients on a regular basis. I'm going to start with my surgeon. Will call them tomorrow to make an appointment.

I have been thinking about my low cholesterol. Prior to surgery my total cholesterol was 171, with where it is now is it something to be concerned with? I never had high cholesterol. I actually never had anything wrong with me health wise at all prior to surgery. I don't eat low fat, it's just something I don't think or worry about.

Thanks for all of your help! I'm sorry if I seem overly worried. My gut is telling me something is off and I guess I really like to see perfect lab results.

Jen

 

[aaa]

Hi aaa

Were they always high or did they raise at some point quite awhile after surgery? My PCP isn't concerned at all. I tend to be slightly paranoid. ;-) If there is a problem, I want to figure it out now, not after it really becomes trouble!!

They rose this past year. They've gone up and down over the years.

 

[jbrule]

I have figured out some things since I last posted. I had an iron dextran infusion this week. My ferritin had dropped some more but my serum iron was higher. I was in early stages of protein deficiency, I have added two protein shakes a day to try and get my albumin up. I'm going to try switching iron supplements and see if it brings down my liver enzymes. Has anyone had luck on just proferrin? It's expensive but I can get it by prescription and it costs the same whether I take two a day or 8 a day. Should I continue iron supplements right after an infusion? I'm going to call my hematologist Monday to ask but wondered if anyone knew.