Review my first set (6-month) of labs with me!

[joben]

Hi all,

So I just recently (7/1) had my 6mo. follow-up labs taken.
I have a follow-up appointment with my surgeon this Friday to review the results but figured I would go ahead and post here as well.
Some of you may recall my DS story and how I had a pretty rough start to things. You can read more about that here if you have not. I'm happy to report that things are going much better for the most part and am feeling relatively "normal" now, but still not totally 100% perfect yet. Anyways, though...

First off is just my results as I received them.

Lipid Panel:

• Non-HDL Cholesterol: 66 mg/dL
• LDL/HDL Ratio: 1.7
• Cholesterol/HDL Ratio: 3.2
• LDL-Cholesterol: 51 mg/dL
• HDL-Cholesterol Level 30mg/dL (as I understand it this is the "good" cholesterol and was told it was low; looks like greater than 60 mg/dL is preferred?)
• Triglyceride Level: 77 mg/dL
• Cholesterol Level: 96 mg/dL

CBC Platelet Differential:

• Immature Grans Absolute: 0.01 10*3/uL
• Basophils Absolute: 0.04 10*3/uL
• Eosinophils Absolute: 0.2 10*3/uL
• Monocytes Absolute: 0.39 10*3/uL
• Lymphocytes Absolute: 1.53 10*3/uL
• Neutrophils Absolute 2.72 10*3/uL
• Immature Granulocytes %: 0.2%
• Basophils %: 0.8%
• Eosinophils %: 4.1%
• Monocytes %: 8%
• Lymphocytes %: 31.3%
• Neutrophils %: 55.6%
• MPV: 12 fL
• Platelet Count: 217 10*3/uL
• RDW-SD: 40.8 fL
• MCHC: 30.3 g/dL (Low)
• MCH: 23.5 pg (Low)
• MCV: 77.6 fL (Low)
• HCT: 43.2%
• HGB: 13.1 g/dL
• RBC: 5.57 10*6/uL
• WBC: 4.9 10*3/uL

Comprehensive Metabolic Panel:

• Anion Gap: 11
• Osmolality: 297 mosm/kg (High)
• Carbon Dioxide Level: 29 mmol/L
• Chloride Level: 104 mmol/L
• Potassium Level: 3.7 mmol/L
• Sodium Level: 144 mmol/L
• Albumin Level: 4.3 g/dL
• GPT/ALT: 13 U/L
• GOT/AST: 17 U/L
• Alkaline Phosphatase Level: 83 U/L
• Calcium Level: 9.8 mg/dL
• Total Bilirubin Level: 0.9 mg/dL
• Total Protein Level: 6.8 g/dL
• GFR, Estimated, Other (CKD-EPI): 126 mL/min/1.73m2 (???)
• BUN/Creatinine Ratio: 13.4
• Creatinine Level: 0.7 mg/dL
• BUN Level 9.5 mg/dL
• Glucose Level 82 mg/dL

Iron Binding Capacity / Saturation:

• Iron Saturation: 9% (Low)
• Iron Binding Capacity: 328 ug/dL
• Iron Level: 28 ug/dL (Low)

Ferritin Level: 29.9 ng/mL

Magnesium Level: 2.2 mg/dL

Vit D Total Screen ("Immunoassay Roche Method): 38.7 ng/mL

Prealbumin Level: 14.3 mg/dL (Low)

B12 Level: 1019 pg/mL

And here is what I'm currently taking, broken up into separate times (if anyone thinks I should move anything around, let me know, of course!).

Morning (I wake up around 7:30 and make sure to take this by 9:00am):
1000mg Vitamin C
2mg Copper
15mg Zinc
(I had also been prescribed Ursodiol post-op as well as Omeprazole but have since been told to discontinue both)

Lunch (around 12-1pm)
25,000 IU Vitamin A
5000mcg Vitamin B12
300mg Calcium Citrate
400 IU Vitamin E
15mg Zinc
Multivitamin (Currently just taking a Sam's Club brand version of One-A-Day Men's, at least until I run out. Specifics here.)

Evening/Dinnertime (5-6pm)
400 IU Vitamin E
50,000 Vitamin D3
1,200mcg Vitamin B9/Folic Acid
Multivitamin

Bedtime (~11pm)
300mg Calcium Citrate
1000mg Vitamin C
100mcg Vitamin K1
450mcg Vitamin K2

I have also picked up some magnesium citrate (133mg) but it has not arrived yet. Not sure if it bears mentioning also, but I take 500mg Glutamine on days that I work out/run. Truthfully I don't know if it does a ton objectively but anecdotally I always felt like it helped me recover faster pre-op.

I had a brief call with one of the nurses to review some results pre-appointment and didn't hear a ton except that I was prescribed an Iron supplement (picking up today, order shows as Iron 325 (65 Fe) 1 tab 3x daily) as well as a prescription for 500mg Vit C to go along with it (not sure if I really need that though, given I am already getting 2000mg/day?) and that I probably need to drink more water and get in more protein... (She suggested the high osmolality number could perhaps be due to being dehydrated)

I'm glad that it seems like my blood counts have come back to a pretty decent level - esp. compared to where they were...Maybe I'm reading it wrong though, but those iron numbers kinda scare me. Like I said, might be looking at the wrong scale, but that seems really really low. I don't really "feel" like I have super low iron, though, so I'm not sure.

Anyways, I am more or less following the Vitalady recommendations for vitamins, save for taking less Vitamin A as the recommended amount (something like 100,000 IU per day) seemed super high. I am finally starting to feel somewhat "normal" in what I can eat and stuff now, so hopefully things will keep getting better, but if any of you see any tweaks, changes, additions, etc that you would recommend ahead of my follow-up this Friday I'd be happy to hear it.

 

[southernlady]

We need lab ranges as well, please

 

[joben]

We need lab ranges as well, please

For some reason my hospital's EHR does provide lab ranges on their app...but not on the web version. Kind of annoying - have to click through each one on the phone rather than being able to see it nicely on desktop. Oh well. Here's what I found, updated with ranges as best I could...

Lipid Panel:

• Non-HDL Cholesterol: 66 mg/dL
• LDL/HDL Ratio: 1.7
• Cholesterol/HDL Ratio: 3.2
• LDL-Cholesterol: 51 mg/dL (Range: <130)
• HDL-Cholesterol Level 30mg/dL (Range: 40-60)
• Triglyceride Level: 77 mg/dL (Range: 9-149)
• Cholesterol Level: 96 mg/dL (Range: <200)

CBC Platelet Differential:

• Immature Grans Absolute: 0.01 10*3/uL (Range: 0.0 - 0.1)
• Basophils Absolute: 0.04 10*3/uL (Range: 0.0 - 0.1)
• Eosinophils Absolute: 0.2 10*3/uL (Range: 0.0 - 0.5)
• Monocytes Absolute: 0.39 10*3/uL (Range: 0.2 - 0.9)
• Lymphocytes Absolute: 1.53 10*3/uL (Range: 0.6 - 3.5)
• Neutrophils Absolute 2.72 10*3/uL (Range: 0.85 - 7.8)
• Immature Granulocytes %: 0.2%
• Basophils %: 0.8%
• Eosinophils %: 4.1%
• Monocytes %: 8%
• Lymphocytes %: 31.3%
• Neutrophils %: 55.6%
  • (No range given for any of these percents)
• MPV: 12 fL (Range: 9.0 - 12.0)
• Platelet Count: 217 10*3/uL (Range: 135-370)
• RDW-SD: 40.8 fL (Range: 37.2-48.3)
• MCHC: 30.3 g/dL (Range: 31.0-35.0)
• MCH: 23.5 pg (Range: 27.0-34.0)
• MCV: 77.6 fL (Range: 83.0-98.0)
• HCT: 43.2% (Range: 38.0-50.0)
• HGB: 13.1 g/dL (Range: 12.5-16.9)
• RBC: 5.57 10*6/uL (Range: 4.10-5.60)
• WBC: 4.9 10*3/uL (Range: 3.0-11.4)

Comprehensive Metabolic Panel:

• Anion Gap: 11 (Range: 2-15)
• Osmolality: 297 mosm/kg (Range: 275-295)
• Carbon Dioxide Level: 29 mmol/L (Range: 23-31)
• Chloride Level: 104 mmol/L (Range: 98-108)
• Potassium Level: 3.7 mmol/L (Range: 3.4-4.8)
• Sodium Level: 144 mmol/L (Range: 136-144)
• Albumin Level: 4.3 g/dL (Range: 4.1-5.3)
• GPT/ALT: 13 U/L (Range: 10-47)
• GOT/AST: 17 U/L (Range: 10-40)
• Alkaline Phosphatase Level: 83 U/L (Range: 27-102)
• Calcium Level: 9.8 mg/dL (Range: 8.6-10.2)
• Total Bilirubin Level: 0.9 mg/dL (Range: 0.3-1.2)
• Total Protein Level: 6.8 g/dL (Range: 6.3-8.0)
• GFR, Estimated, Other (CKD-EPI): 126 mL/min/1.73m2 (Range: >96)
• BUN/Creatinine Ratio: 13.4
• Creatinine Level: 0.7 mg/dL (Range: 0.6-1.2)
• BUN Level 9.5 mg/dL (Range: 7.0-24.0)
• Glucose Level 82 mg/dL (Range: 65-100)

Iron Binding Capacity / Saturation:

• Iron Saturation: 9% (Range: 20-50%)
• Iron Binding Capacity: 328 ug/dL (Range: 220-420)
• Iron Level: 28 ug/dL (Range: 44-160)

Ferritin Level: 29.9 ng/mL (Range: 15.1-264.0)

Magnesium Level: 2.2 mg/dL (Range: 1.6-2.6)

Vit D Total Screen ("Immunoassay Roche Method): 38.7 ng/mL (Range: 30-80 "optimum")

Prealbumin Level: 14.3 mg/dL (Range: 20-40)

B12 Level: 1019 pg/mL (Range: 232-1245)

Items out of range (high/low) in bold.

 

[southernlady]

Okay, I don’t see A, E, K, Copper, PTH, B6 and there are some others missing. The list is here: https://bariatricfacts.org/threads/generic-ds-lab-order.191/
D needs severe help. What brand, type D are you taking? it needs to be a dry D3, brands suggested are Biotech, Nivegan, Forest Leaf, and biophix. My husband and I have used all four at various times, all found on Amazon. We keep all in a Vitamin list and whichever one is on sale, goes in the cart. Your lab range is out of date. It’s actually 30-100 now. Needs to be between 80-100. See this thread: https://bariatricfacts.org/threads/vitamin-d-webinar-by-dr-keshishian.5845/
You need iron infusions now. https://bariatricfacts.org/threads/iron-infusion-levels.5739/

 

[joben]

I’m not sure if the complete results are in yet or not to be honest. They have kind of been trickling in, so perhaps more are yet to come, we’ll see.

I am taking the Forest Leaf brand D3 as well, 50000 IU and I believe just once daily. I guess it’s probably worth mentioning that my Vit D levels came back somewhat low pre-op and I had been prescribed Vit D (I believe at the time it was just 50000 IU weekly) to try and get that up. For context, pre-op Vit D measured at 37 ng/mL on Dec 30, up from just 15.1 ng/mL on August 28. I guess it’s sounding like they should’ve made it a point to get that up higher pre-op but truthfully I just didn’t really know any better at the time. I’m wondering then if perhaps I should go ahead and up my dosage in the meantime?

With regards to iron…
8/29/21 ferritin level was 213.3 ng/mL, iron level 60 ug/dL, iron binding capacity 304 ug/dL, and Iron saturation 20%

I will have to look into infusions and see what is or isn’t covered. I guess it sounds like it’s next to impossible to “catch up” on iron pills alone? Unfortunately I’m sure that having a pretty major blood-loss event probably put a pretty good dent in those iron numbers, so probably even harder to catch up than usual, so to speak.

 

[southernlady]

I’m not sure if the complete results are in yet or not to be honest. They have kind of been trickling in, so perhaps more are yet to come, we’ll see.

I am taking the Forest Leaf brand D3 as well, 50000 IU and I believe just once daily. I guess it’s probably worth mentioning that my Vit D levels came back somewhat low pre-op and I had been prescribed Vit D (I believe at the time it was just 50000 IU weekly) to try and get that up. For context, pre-op Vit D measured at 37 ng/mL on Dec 30, up from just 15.1 ng/mL on August 28. I guess it’s sounding like they should’ve made it a point to get that up higher pre-op but truthfully I just didn’t really know any better at the time. I’m wondering then if perhaps I should go ahead and up my dosage in the meantime?

With regards to iron…
8/29/21 ferritin level was 213.3 ng/mL, iron level 60 ug/dL, iron binding capacity 304 ug/dL, and Iron saturation 20%

I will have to look into infusions and see what is or isn’t covered. I guess it sounds like it’s next to impossible to “catch up” on iron pills alone? Unfortunately I’m sure that having a pretty major blood-loss event probably put a pretty good dent in those iron numbers, so probably even harder to catch up than usual, so to speak.

I was on the green footballs preop from 2017 to 2010. Only raised mine from in the literal toilet to 15. So in Oct of 2010 knowing I was going for the DS, I switched to Biotech D3 50,000 daily (only one who had it back then) and managed to get it to mid 50’s for my presurgury blood work. So even the dry form worked better for me as a normal person.

If I were you, I would at least double it, and see if you can get it retested in 3 months. Take the second one opposite of the first.

Can you refer yourself to a hematologist? You are very low and need one. You most likely will not absorb oral iron. However some do AFTER a an infusion. Your levels are indicative of iron deficiency anemia.
Questions? Do you show signs of pica? Or other signs of it? https://www.hematology.org/education/patients/anemia/iron-deficiency Do you have Restless Leg Syndrome? https://medlineplus.gov/restlesslegs.html one of the secondary causes is anemia. I have what’s called Secondary RLS, mine is caused by iron deficiency anemia. I get infusions when my ferritin is below 50 and/or my iron sat% is below 30. But I have a hematologist in my wheelhouse.

 

[joben]

Can you refer yourself to a hematologist? You are very low and need one. You most likely will not absorb oral iron. However some do AFTER a an infusion. Your levels are indicative of iron deficiency anemia.
Questions? Do you show signs of pica? Or other signs of it? https://www.hematology.org/education/patients/anemia/iron-deficiency Do you have Restless Leg Syndrome? https://medlineplus.gov/restlesslegs.html one of the secondary causes is anemia. I have what’s called Secondary RLS, mine is caused by iron deficiency anemia. I get infusions when my ferritin is below 50 and/or my iron sat% is below 30. But I have a hematologist in my wheelhouse.

That's the strange thing to me, those numbers definitely seemed low to me too but when I checked out the symptoms for anemia/iron deficiency anemia just not too many apply. Not feeling terribly fatigued, no chest pain, paleness, headache, pica, heart rate issues, RLS, etc... Maybe a bit of weakness but that feels to me more like just muscle loss (i.e. it's more feeling like a lack of 'strength' rather than energy/etc. I have started running and it's no problem - much easier than before - but weightlifting is a lot more difficult, for instance). And I did have some hair loss early on, though I think that is fairly common with WLS in general (and it took a while to get my protein up to a good level, which I think can have that impact, too), so kind of hard for me to be able to differentiate...

Anyways, all that being said, shortly after getting discharged from the hospital/ICU once things had mostly cleared up my surgeon did mention doing a hematology referral once my blood numbers had gotten back to relatively normal, around 6mo or so, which is right where I'm at now, so I'll bring that up this week to see if we can get that done.

 

[joben]

Looking at the lab order that was submitted it shows they did ask for B1, B6, A, and E. So I'm not sure if those results just haven't came through yet for some reason, or if the lab didn't take it or what... :/
I did find a copper result, must've skimmed over it: 79 (range 69-132)
Also zinc: 53 (range 44-115)
So perhaps may want to up those as well I'd think...

 

[southernlady]

Be careful upping those, they affect each other. I don’t take either so I’m not sure how.