Blood tests are back

Went to my doc this past week and had the results of my blood test looked at... You could actually see the look of shock on his face, my test results are THAT good. He said, and I quote "Whatever you're doing, keep it it."  For instance, my Iron  (Ferritin) is 164... HE said that is AWESOME, "Most RNYers struggle to get it above 50" My protein (Albumin) 4.2 ....Awesome. B12,  533... he said that's perfect. All of the scores were great. He said the only thing I could comment on would be you might have been a little dehydrated that day. I thought to myself, most days I drink so much water/crystal light, my eyeballs are floating, but that day was a lttle crazy, so maybe I wasn't drinking as much.
Anyway! Good stuff! Load off my mind, til my next check up, 4 more months.

YAY!

That's so great. What type of vitamins do you take?

I'm glad you got a good report.  That is an excellent ferritin level.

Your B12 is actually low, though.  I know the lab report probably has it in the normal range,  but they use a ridiculously low normal range.  Below 500, many people begin to experience symptoms of deficiency like depression and fatigue.  In many other countries, like Japan and most of Europe, they use a normal range with 500 or 550 being the minimum.  Ideally, our B12 would be around 1000.

I hate to burst your bubble but your B12 level is dangerously low.  For a regular person that didnt' have WLS, then it is just okay but for with malabsorbtion, we need optimal levels like 1200-1800, or even up to 2000.  Anything below 500 puts you at risk for nerve damage and if you have it for any length of time, it can become permanent.  After being in the hospital for a couple of months for complications, I was off my B12 not realizing it and my level plummeted from 1800 to 450.  My surgeon freaked when she got my labs back. I got a phone call from her personally telling to get on B12 shots daily for a week to get my level up.  Then to go back to my normal regimine.

I recommend you drastically increase you B12 dose - atleast double it - preferably triple it.  You should also get a copy of your labs and post them on here for us to see.  So many times we get told that are labs are perfect and just like this case, there are major problems. They just see in range and say they are great. I can almost guarantee that your vitamin D is also scary and if you were dehydrated, that shouldnt' have been ignored - either you should have been given IV fluids to correct or something to correct your electrolytes.

As requested:

Glucose, serum            88
BUN                                 14
Creatinine, serum            .62
eGFR                             116
BUN/Creatinine ratio    23
Sodium, serum           140
Potassium, serum         4.3
Chloride, serum          103
Carbon Dioxide, total    20
Calcium, serum              9.8
PTH, Intact                      16
Protein, total, serum       6.5
Albumin, serum               4.2
Globulin, total                   2.3
A/G ratio                             1.8
Bilirubin, total                    0.5
Alkaline Phosphatase   73
AST (SGOT)                      15
ALT (SGPT)                       22
Iron Bind. Cap (TIBC)   272
UIBC                                222
Iron, serum                       50
Iron Saturation                 18
Vit B 12                            533
Vit D, 25-hydroxy             44.7
Ferritin, serum               164
WBC                                 8.5
RBC                                  4.85
Hemoglobin                  14.9
Hematocrit                     44.3
MCV                                 91
MCH                                 30.7
MCHC                              33.6
RDW                                12.9  
Platelets                         209
Neutrophils                     57
Lymphs                             4.9
Monocytes                         0.4
Eos                                     0.3
Baso                                   0.0
Immature Granulocyte     0 

Thanks so much for posting the rest of your labs - I will do my best to go over them with you.

First off, I already went over the B12 and as confirmation that it is too low, your MCV being in the 90's is a definite sign of B12 deficiency.

Your iron is pretty low but your ferritin is great.  This is pretty strange.  What type of iron are you taking and how much?  You are definitely not anemic, your hemoglobin and hemacrit are great too.  I would increase your iron a bit just to increase your total iron, you want it up around 100, if possible.  You want to be taking carbonyl iron with vitamin C to aid with absorbtion. The best is from vitalady.com and is called Tender irons - they are easy on your stomach, highly absorbable and non-constipating - best yet, they are cheap.  They also have the necessary vitamin C in the capsule, so you dont' have to buy another supplement or remember to swallow another pill.  They are 60mg each, so depending on what you are taking now will determine what you need to take. I can't give you a specific dose without knowing what you take.  The last time I checked, these cost $22 for 400 capsules. I personally take 3 of them a day (all in one dose) - so the bottle lasts me 4 1/2 months.

Your kidneys, liver and electrolytes are all great.

Your protein is a little low - ideally we want it to be in the low 7's or higher.  So, if you could increase you protein a bit,= possibly add a protein shake daily that would be great.

Did you type the correct number for your lymphocytes?  If so, I would talk to your doctor - that is pretty low.  It may just mean an infection - either bacterial or viral but I would check it out. Your WBC is normal but on the higher side so I doubt it would be bacterial - bacterial it would be higher.  Low lymphocyte counts but you at risk for fighting off infections as well.  These are also the % numbers - what are the absolutes? They are more important.  If the absolutes are normal, then I wouldn't worry about.

Now the confusing part - Your PTH is 16, which is on the low side = normal is 12-65 but we really want to be around 20-40.  The way that we get our PTH to really good or even low is to have either normal or low calcium levels and really good vitamin D levels but you don't have that.  Your calcium is a bit too high but not terrible and your vitamin D is way too low. This combination should be giving you a very high PTH, so I am not sure what is going on.  How much calcium do you take?  Is it calcium citrate?  How much vitamin D do you take?  How often? Is it dry D3? or is it the little green oil pill that you get from a prescription?

You need to get your vitamin D up - you should be taking Dry D3 from vitalady.com - I am not sure what you are taking now - once you tell me what you are taking, I can advise you further.

With your calcium - it is tough. With many people post op, having a higher calcium level means they are leaking calcium from there bones and into there blood causing the high calcium levels.  We really want our calcium to be around 9.2 or 9.3.  But with a PTH like yours, that may not be the case.  You should be taking a minimum of 1500-2000 mg of calcium citrate per day, no more than 650mg at a time and atleast 2 hours apart between doses.  You also can't take it within 2-4 hours of your iron or thyroid medication.

That was based on what was done - now is the problem that many people have.  You are told all is great but what about all the tests that weren't run that should have been.  You many have lots of deficiencies and dont' know it because your doctor doesn't order all the necessary tests. This is another reason why we post our labs here so we not only help each other with the results and what to do after that but we can also see what is missing and hopefully you can either go back to the same doctor (surgeon) or PCP to get them redrawn ASAP.  There are many vitamins and minerals that we malabsorb and need to be drawn regularly  - I became deficient in several of these early out and if not tested, I would have been in serious trouble - nerve damage and loss of vision to name  few.

Here are the tests you are missing - vitamin B1, vitamin B6, Vitamin A, vitamin E, vitamin K, copper, zinc, magnesium, selenium, phosphorus, Hemoglobin A1C, TSH, folate

If you can get back to me with the type of iron, calcium and vitamin D plus there dosages - I can help you with the rest.  I do hope you can get the rest of the blood tests done.  These are all very important and really need to be done.  Good luck and when you get the results of the other tests, feel free to PM me with the results.

Alrighty...

What I take:

Bariatric Advantage Chewable Multi, the 'high in vitamins A, D, E & K' one  3X  a day
Bariatric Advantage Chewable Calcium Citrate (500mg)                                 3X a day
Bariatric Advantage Chewable Probiotic                                                              1X a day
Baritatric Advantage Biotin                                                                                       1X a day 
B-12, 1000 mcg                                                                                                         1X a week
NutriCology Pure Vitamin C (Asorbic Acid) 1000mg                                          2X a day
MSM 1000 mg                                                                                                            2X a day
Colostrum Plus Chewables 800mg                                                                     2X a day
Glucosamine (500mg) & Chondroitin(400mg) Soft Chews                             3X a day
Chia Seeds 2tbsp                                                                                                     1X a day

I drink 2 'premier nutrition' RTD protein shakes a day
30g of protein (each), and 25%(each) of recommend daily value of Vitamins A, C, D, E, K, B6, B12, Calcium, Riboflavin, Pantothenic Acid, Iodine, Zinc, Copper, Chrominum, Iron, Thiamin, Niacin,Folate, Biotin, Magnesium, Selenium,Manganese, Molybdenum. And 50% of rdv of Phosphorus.

I was never told to take additional Vitamin D or Iron. So I guess I better start, huh?

The B1 test  says (will follow) ... assuming that one takes longer than the rest? I guess I could go to my PCP and have her send me for labs... her office uses a different lab so maybe their tests will include all those ones I am missing.. I will have to look into that. I have to see her next week anyway.

Almost out of multis so I will go right now and order some ... dry D3 and carbonyl iron. And I will up my dose of B12. Should I take it 2 X a week, or 2 pills, at the same time, once a week?

Thanks for your help!!

Me again!

So I am looking at the vitamin at Bariatric Advantage, and I'm looking at a different Multi that's got twice as much B12,  D3, A, E, C, etc...  most things... however does NOT have Iron. So I'm thinking, switching to this one, eliminating having to get D3 pills, and just getting Iron supplements. And the dose is twice a day, but maybe I'll take it 3 X a day. Thoughts on that?

Also... I see where I goofed on my test results.

Neutrophils                               57
Lymphs                                     35
Monocytes                                   4
Eos                                               4
Basos                                           0
Neutrophils (absolute)              4.9
Lymphs (absolute)                     2.9
Monocytes (absolute)                 0.4
etc                  

Just because something has more doesnt' mean it is better.  We need 200% of the daily values and that is it in almost everything except B12 and D, those we need alot more but we can't count on a multi for these.  WE need either sublingual or injection for B12, we can't absorb it from a tablet.  The vitamin D needs to be dry D3, so coming from a multi wont' help.  You need to get the Dry D3 from vitalady.com if you want good vitamin D levels to keep your good PTH levels to keep your bones stong - it is that simple.  When we all signed up for this surgery it is with the understanding that we all have to take alot of supplements. There is no way around it. I just finished writing someone that failed to take her supplements for some time and went into cardiac arrest twice and is lucky to be alive.  We need supplements to live.

Just get the plain, simple centrum silver chewables - they have everything -take 2 per day and thats if for your multi but then you need calcium 3 times per day, vitamin D, iron, vitamin B1 and vitamin B12.  Then based on your labs, if you need anything else - I also have to take selenium, vitamin A and large dose B1 and B12 injections 3 times per week

The bariatric multi high in A, D, E and K aren't necessary for us RNY patients.  they can actually cause problems and taking a multi 3 times per day is overkill.   Without know your vitamin A, E or K levels, you shouldnt' be taking such high doses of any of these vitamins.  Excessive amounts of vitamin A and E can decrease your vitamin K which affects clotting.  Excessive K can cause a certain type of anemia

You are best off going to your local CVS and get some Centrum Silver chewables - you want the silvers because you dont' want iron in your multi - the multi's have the wrong type of iron plus it isnt' enough to account for anything plus they have calcium which counter acts it. You can't count the calcium in it either since they are calcium carbonate.  The centrum silvers you take 2 per day and they have everything you need - they taste good too.

The bariatric advantage calcium citrate chewables - the lozenges are 500mg each but the chewies are only 250mg, so you need to take 2 at a time.  These are fine.

Now I see why your B12 is so low, you should be taking it daily not weekly.  It also needs to be sublingual - dissolves under the tongue.  If you continue at once per week, you levels will continue to drop and probably already have since taking the test.  Do you have any numbness or tingling in your hands, fingers, feet or toes, arms or legs?  If so, this is a sign of severe definciency and that the nerves are already being affected.  I would recommend taking 2 tablets per day for 1 week to get a jump start and them go to daily.  That should be good and get rechecked in 2months.  You want your level to be anywhere from 1200-2000.

For your D - with a level in the 40's which isn't terrible but not great, I would get the 5,000 unit capsules of Dry D3 from vitalady.com and take 2 per day and get rechecked in 2 months. This is a much lower dose than I usually recommend but your dose is better than most to start out with, with taking 3 of the bariatric ADEK and K, you were taking 4000 units per day, so if you increase to 10,000 units, I think your level would increase nicely.

I think it is absolutely amazing that you have a ferritin so high without any iron but if you continue with no iron, it will drop real fast.  I would order the carbonyl iron like I described before and take 1 per day to start with, get retested in 2 months and see where your iron and ferritin are, you can always increase to 2.

You should also be taking 100mg of vitamin B1 per day - you can wait until you get your B1 level back  but you want to be at the top of the level or over.  Anything less than that, you need 100mg per day.  if you are at the bottom or below, you need more like 300mg per day to get yourself up and to maintain - b1 deficiency can cause nerve damage, just like B12.

The vitamin C you dont need - it comes in the iron- 400mg per 60mg capsule.  Anything more than that isn't necessary unless deficient. Too much vitamin C can cause diarhea.

the glucosamin and condrointin are fine - they actually have higher doses that I took - 750/600 - I think taken 2 times per day.  Same dosage but easier to take.  MSM is supposed to be good just make sure you aren't allergic to sulfa drugs like Bactrim.

I don't know what colostrum or chia seeds are.