Please help evaluate my labs -- UPDATE

[Vikki C.]

I could really use some help in determining how to adjust my supplements to bring my labs into line. My lab work is attached. I realize this testing is not at extensive as it should be. The doctor who ordered these tests no longer does DS, but claims to have knowledge of it. However, the blood work he ordered was standard for his bypass patients, not for DSers.

If it helps to know, my common channel is 100 cm.
This was fasting blood work.

My daily regimen was:

25,000 Dry Vit A
5,000 Dry Vit D -plus-
50,000 Dry Vit D 3 x per week
1,200 mg liquid calcium citrate w/600 mg magnesium citrate and 800 mg. D3 (all in one dose)
1 multivitamin w/minerals (senior formulation)
2,000 mg Biotin

As you can see, I was not taking iron. I haven't taken iron in years because my hematologist thinks it's a futile effort. He keeps telling me that as long as H&H is normal, I don't need an infusion. Now I'm not sure that is such a good idea.

After these results came in, I was told to increase Vit D to 10,000 daily and maintain the additional 50,000 Vit D 3 x per week. They didn't run PTH, but advised me to see an endocrinologist to determine if there is a PTH problem. I think it's pretty obvious that I wasn't taking sufficient amounts of Vit D, and I question whether I really need an endo consult.

Thanks for any advice you can offer.

 

[southernlady]

Attached her labs

As far as not taking iron...understandable BUT your hematologist is an ass.

Your ferritin is your iron STORAGE. If your storage is depleted and you are not absorbing iron, where will the H&H continue to get the iron it needs?

 

[DBmom23]

I would be interested to hear what others think of taking all that calcium at once. I have read that 600mg is the maximum absorbable amount at one time so it would make sense to split that dose.

Seems like you might want to increase your D intake to 50K per day since you are so low but I am neither a vet nor an expert so let's see what others say!

 

[Vikki C.]

Attached her labs

As far as not taking iron...understandable BUT your hematologist is an ass.

Your ferritin is your iron STORAGE. If your storage is depleted and you are not absorbing iron, where will the H&H continue to get the iron it needs?

As I understand it, what he's thinking is I'm absorbing just enough iron from my food (I do eat a lot of iron-rich foods) to keep the H&H within normal limits for the past few years. He says all things considered, he's not concerned about ferritin, iron sat or TIBC as long as H&H remains stable. I think it's because my stores are being depleted to maintain the H&H. I'm going to look at some older labs to compare.

 

[southernlady]

As I understand it, what he's thinking is I'm absorbing just enough iron from my food (I do eat a lot of iron-rich foods) to keep the H&H within normal limits for the past few years. He says all things considered, he's not concerned about ferritin, iron sat or TIBC as long as H&H remains stable. I think it's because my stores are being depleted to maintain the H&H. I'm going to look at some older labs to compare.

You might want to read the studies in this thread: http://bariatricfacts.org/threads/low-iron-or-what-to-take-to-a-hematologist.1498/

 

[swimbikerun]

You have an infection or inflammation. That would explain the platelets, neutrophils, etc. They shouldn't be measuring cholesterol when you are not well, and it appears you aren't. I'd watch the B12 - 2000 and over can be a leukemia issue, but most docs will miss that one.

Your bun/creatinine ratio is an issue. It can be with decreased blood going to the kidneys (as in dehydration), increased protein in the diet. Has your eGFR been checked for real?

 

[Vikki C.]

You have an infection or inflammation. That would explain the platelets, neutrophils, etc. They shouldn't be measuring cholesterol when you are not well, and it appears you aren't. I'd watch the B12 - 2000 and over can be a leukemia issue, but most docs will miss that one.

Your bun/creatinine ratio is an issue. It can be with decreased blood going to the kidneys (as in dehydration), increased protein in the diet. Has your eGFR been checked for real?

Thank you for your reply. I will be speaking with my hematologist this week; I sent him a copy of the labs when I saw the high blood cell results. As far as eGFR, I'm not sure what you mean by "for real." I thought it was an estimate made by the lab at the time a creatinine is run. How else would it be checked?

 

[swimbikerun]

Check this out: https://labtestsonline.org/understanding/analytes/tibc/tab/test/. These people are the tops. The site is run by the AACC, American Assn. for Clinical Chemistry. If there are labs, they know them left, right, center, and over the moon. They "write the book". There is a table if you scroll down on this page that might help.

It is an estimate. I am slack and use http://www.davita.com/gfr-calculator/ to get mine. I see the GFR's and they are never right. If it hadn't been for me checking this out on the eGFR calc's and it correlate with the protein & calcium in my urine, we would never know what happened to me.

 

[southernlady]

I'd watch the B12 - 2000 and over can be a leukemia issue, but most docs will miss that one.

Then again, there are at least 2 of us on here who have a B12 over 2000 for a seriously long time...mine has been over 2000 for several decades (at least 30 years) and if it had been leukemia, I am sure I would know by now. @Larra also runs high B12 and has for a long time.

 

[Vikki C.]

I would be interested to hear what others think of taking all that calcium at once. I have read that 600mg is the maximum absorbable amount at one time so it would make sense to split that dose.

Seems like you might want to increase your D intake to 50K per day since you are so low but I am neither a vet nor an expert so let's see what others say!

You're right about splitting the dose. I should never have been taking it that way; did me no good!

 

[Vikki C.]

Check this out: https://labtestsonline.org/understanding/analytes/tibc/tab/test/. These people are the tops. The site is run by the AACC, American Assn. for Clinical Chemistry. If there are labs, they know them left, right, center, and over the moon. They "write the book". There is a table if you scroll down on this page that might help.

It is an estimate. I am slack and use http://www.davita.com/gfr-calculator/ to get mine. I see the GFR's and they are never right. If it hadn't been for me checking this out on the eGFR calc's and it correlate with the protein & calcium in my urine, we would never know what happened to me.

I did check out the calculator, and the LabCorp eGFR is correct. I'm not familiar with your story -- what did happen to you?

 

[Vikki C.]

Good news. Based on lots of reading and research, and with helpful information from knowledgable DS vets on this site and others, I made some changes in my vitamin schedule, and also started iron and increased my vit D3 two weeks ago. Labs done yesterday show significant improvement already.

 

[Charris]

Then again, there are at least 2 of us on here who have a B12 over 2000 for a seriously long time...mine has been over 2000 for several decades (at least 30 years) and if it had been leukemia, I am sure I would know by now. @Larra also runs high B12 and has for a long time.

@southernlady high B12 can indicate leukemia? Wow after RNY in 2000 I had to take a shot every week if not I would be in 50 which my Dr said she had only heard of anyone that low was a true vegan. Now since DS no more shots and mines is through the roof.

 

[southernlady]

@southernlady high B12 can indicate leukemia? Wow after RNY in 2000 I had to take a shot every week if not I would be in 50 which my Dr said she had only heard of anyone that low was a true vegan. Now since DS no more shots and mines is through the roof.

I'd watch the B12 - 2000 and over can be a leukemia issue, but most docs will miss that one.

@Charris I was responding to @swimbikerun on this issue.

I just said that mine has been high for over 3 decades...IF it was leukemia, I would think I would know by now. So I don't get all upset with my very high B12.

As for WHY it's higher now that when you were a RNY'er has to do with where B12 is broken down. You HAVE to have gastric juices (the stomach) for the human body to pull B12 from food...the RNY does NOT do that as all your gastric juices are off in the bypassed remnant stomach.

And yes, there are plenty of DS'ers who have issues but that is because of where B12 is actually absorbed, the illeum. But to absorb it in the illeum, it HAS to be broken down by the stomach/sleeve with gastric juices. And that is one of the differences in 1) RNY and the other WLS and 2) how good your own body is at handling vitamins.

Apparently I am just SUPER efficient at breaking down food for B12 and absorbing it in my illeum. My husband has to take B12 cause he can easily go low.

 

[Charris]

@southernlady I realized what you were saying. I in no way feel as If i have leukemia I realized that the change was due to DS.

Last Monday my support staff got a call from her mother saying she was at Dr office and has leukemia and only has 3 maybe 4 weeks to live. So when you wrote it made me think about them. The mom was here in AZ 2 weeks ago and apparently had NO signs of being sick at all.