I'm sick guys - long, but not rambling, just comprehensive

Holy crap, but this is long . . .

I guess I'm posting b/c you guys are part of my "family" and certainly are the best group that I know personally who understands anything about labs and absorption.  Nobody I know personally really understands beyond what they learn when I explain it, there's no "insight" or even speculations/ comments b/c the base knowledge of how labs and absorption work just isn't there (except you guys!)

First, let me say that I don't believe that the following lab values or possible health issues with me have anything to do as a result of having had the DS.  I've had some follow-up blood & urine "work" from my original, DS-standard check-up labs that further suggest that I have some kind of inflammation-associated autoimmune disorder that is causing a chain-reaction hampering my body's ability to utilize protein and iron.

My vitamin lab values were really pretty okay - I was low in vitamin A (not surprised, so I've upped it.  I was low in zinc, so I upped it.  There were a couple other things that weren't low, but could use some boosting and so I adjusted those and added a couple other things that I thought might be helpful, but the take-home message is that my vitamin labs really weren't that bad.  That's not my issue and that's why I also said that I guess I'm just posting b/c, in general, I'm concerned (anxious) and nobody else I know understands squat about labs or absorption.

In my original labs, my WBC's were pretty elevated and my CRP (inflammation) was 13, where optimal/ normal is less than 1.  People who have some kind of infection or recent injury that's caused some inflammation then normally test in the 1 - 10 range.  Mine was 13, which usually indicates a high risk for heart disease . . . except none of my other blood work, age, or personal history (even pre-DS, I had no comorbidities & I'm only now 34) suggest that I should have any type of heart disease.  I had this blood work tested 6/8.  I had more blood work drawn on 6/30 and my WBC's decreased quite a bit and are only JUST above normal range, while my CRP is now . . . drumroll, please . . . 78.5 . . . so it wasn't an infection that was causing the elevated inflammation.  This suggests that there is some significant underlying disease causing the inflammation, which is the start of the chain reaction of not utilizing protein and iron.

Before (6/8 labs) my Total Protein was high, my albumin was a "little saggy", but still in the normal range, and my pre-albumin was low.  This had suggested the my body was absorbing protein (hence, high total protein), but not being able to use it (hence, low pre-albumin).  Pre-albumin is your body's "immediate" use of protein, while albumin is more of a medium-storage of protein and total protein is a long-term storage marker.  My 6/30 labs showed my total protein (8.0)is now at the top of the normal range and my albumin is now solidly in the low range  at 3.0 (range 3.6 - 5.1).  Unfortunately, my pre-albumin wasn't tested, my if my albumin - the medium storage - is now low, I'm sure the pre-albumin is still low and likely has further decreased.  In b/w my 6/8 and 6/30 labs, I added in 2 - 3 daily protein shakes in addition to food.    My Globulin is went further into the high range (not a good thing), and my albumin/globulin ratio is now 0.6 with a normal range of 1.0 - 2.1  Apparently, less than one is a diagnostic marker of poor health and poor long-term outcomes . . . which, unless I figure out what's wrong with me and correct the underlying disease, that seems to be a fair assessment based on how quickly my labs have changed (& I'm not done yet with those!) for the worse.

I have learned that proteins act as "carriers" of other things in the body.  Since my proteins are low (of what my body can use), it's "responsible" for my low serum iron (19, range 40 - 175) and % saturation (9, range 15 - 50) drawn on 6/30.  The 6/8 labs had these at 11 and 5 . . . so they've improved ever so slightly, though not to any clinical significant degree.  My iron binding capacity has further dropped to 216 on the 6/30 draw from 234 on 6/8 (250 - 450).  This number drops as the amount of transferrin (what your body uses as an "active" iron form) is bound with (I think it was) red blood cells.  My body has either produced more transferrin bound with RBC or another process of this binding is as RBC's go through their normal life-death cycle, the transferrin/iron in them is used again in new RBC's binding in an reuptake cycle.  What it really means is that my body is trying to compensate for the low serum iron and % saturation by having more transferrin ready to be used . . . and, I think, my body has responded a little bit . . . and that's why the serum iron & % saturation has increased a little bit, but the fact that my iron binding capacity dropped further means that my body is working "overtime" in trying to increase it's utilization of iron, it does not reflect my body starting to "get back to normal" and that's why those two numbers of increased.  From all the research I've done into this cycle, this is my best interpretation.  I also say this because my 6/8 ferritin was 454 (range 10 - 154 is optimal) and on 6/30 was 470, despite the fact that I've cut back on my iron intake my about 70%.  I've done this b/c I know that really high ferritin levels are harmful to your liver. 

This led to my decision to cut way back on my iron.  It's not an absorption problem, otherwise my ferritin (long-term iron storage) would have, at minimum, stayed the same.  I can't just keep absorbing more iron, which is toxic as I stated above, if I'm not using it.  It's the whole inflammation affecting protein utilization affecting iron utilization pathway that's the problem.  I don't think there's anything I can do in terms of iron supplementation or with iron-rich foods to help raise my iron % saturatioin or available serum iron.  That's my take on it, at least, and I feel helpless and frustrated to not be able to do something to help my body on this front, either.

Your body needs available iron in order to maintain healthy RBC's, so of course, mine aren't doing so well.  This entire pathway I've described is associated with, or the diagnostic indicators of, "anemia of chronic disease", AKA, "anemia of chronic inflammation".  I am anemic and this is the type that I have.  I actually had figured it out through research on my 6/8 labs when my family-practitioner dr told me my labs were too complicated for him to interpret, but my new internist also told me the same thing (anemia of chronic disease) yesterday when I got my 6/30 lab results.  Yeah, I'm not going back to the family practitioner.

My hemoglobin, hematocrit, MCV, MCH, MCHC and RDW had all been out of range on the 6/8 labs.  They have all since worsened on the 6/30 labs.  In the 6/8 labs, my platelet count had been normal, it's now well out of range too at 502 with a normal of 140 - 400.  FYI, all of my B vitamins were normal or high in the last labs.  Low B vitamin values can induce a particular type of anemia, that's not my problem.

High cortisol can also induce some of this cascade event.  My cortisol wasn't tested on 6/8, but came in normal on 6/30 - well within normal range, not close to being high.

All of these hormones came back normal - prolactin, FSH, LH, TSH, T3 free and T4 free.

My glucose and hemoglobin A1C were normal for non-diabetic (which I never had).

Here's some distressing news about my vitamins, which were mostly not rechecked on 6/30.  I had been taking 50k IU's of Vit D and my 6/3 lab was 43, a little low, so I upped it to 75k IU's.  It came in at 108 on 6/30.  YET!!!!  My calcium and PTH on 6/3 was 9.5 and 29, so I kept my calcium the same.  My PTH wasn't retested on 6/30, but my calcium is now 8.8 (range 8.6 - 10.2).  HUH???  My guess is this "utilization" problem has extended to calcium, but not D.  So, I'm going to cut back on Vit D where I add in a second 25k pill every other day, so it's 50k, then 75K, repeat.  That's my best guess as to what to do.  As for calcium, I guess since I was "only" taking 3 full calcium doses/day (which seems to be a good maintenance dose when my body's working right), I will increase my calcium.  Maybe one extra dose??  Opinions??  I've just added in boron 3x/day, but that was like 2 days before my 6/30 labs and I did it b/c my osteocalcin on 6/8 was way on the high side of normal range (0.4 from cutoff).

Remember when I was talking about how high ferritin can cause liver damage?  Well, all 3 liver enzymes were normal on 6/8.  As of 6/30, my alkaline phosphate is now just into the high range at 119 (normal 33 - 115). My other enzymes, AST & ALT are pretty well within normal range still.  This is concerning to me since I'm not in my WL phase.  Could I now be at the point where my high ferritin (stored in the liver) is actually damaging. it?  Dammit, I need that organ! (small joke)  The internist told me, "you do realize that the DS causes liver failure, you will have liver failure eventually, you know that, right?".   I tell him that I've never read that in any study and I don't know where he's getting that information.  He tells me, "because he's a dr" and then elaborates to say what they've been seeing more and more of is liver failure with people who, "get the gastric bypass and stuff, you know surgeries like that". 

First of all, I still don't think gastric bypass causes liver failure.  I do believe that obese people, in general, have unhealthier livers than normal weight people (fatty liver disease), which may lead to a long-term higher rate of liver failure than normal people even once normal body weight is achieved.  I don't think this has been really investigated, imo.  Comments???  I think my high ferritin may be responsible for elevating my alkaline phosphate.  He thinks it's the DS.

Another source of frustration, though less of an "oh ****" compared to some of the other things in my labs, is the fact that my HDL (good cholesterol) was 33 on my 6/8 lab.  So, I started taking Vectomega, an omega-3 fatty acid in a phospholipid base for optimal bioavailability - twice/ day ALONE/ no other vites and not with food.  I was doing this a solid two weeks prior to my 6/30 lab.  While my total cholesterol, LDL, and trigylcerides all increased by a few points (all still really low, though), my HDL decreased another 6 points to 27.  WTF???

NOTHING is working out in terms of normal suggestions on vitamin supplementation adjustment guided by lab values and my labs just keep getting worse - some more concerning than others, but nothing good.

My assumption is this inflammation-malabsorption pathway is at work "across the board" in what I'm ingesting.  This is due to some other underlying disease for which I'm getting more bloodwork done Monday.  It's not due to the DS.  I also think, though, that the inherent malabsorption that comes with the DS is very definitely working against me in this scenario.  You could say, all sources of my body not absorbing and/ or utilizing what I'm ingesting are working synergistically against my being able to absorb healthy levels of anything.  I'm not saying I want to change it/ revise (that would be WAY premature at this point), but it does set up some potentially unpleasant thoughts if the, um, **** really hits the fan.

I know b/w my blood and urine work, they tested for pitutiary, thalamus, and adrenal functioning, as well as two byproducts that would be elevated if I had a tumor.  None of these things came back abnormal.  This leaves rheumatoid arthritis, lupus, or gout (which I don't think I have) as common likely causes.  I think there are some other rare chronic illnesses that are consistent wiht my clinical picture - labs and symptoms, but I don't know what they are off-hand.  I know those first 3 are being tested in blood work on Monday.  I have my first appt with the hemotologist on Wed.  I have also been having really bad nightsweats.  There are some nights when I wake up and you can actually see an outline of where my arms and legs and body were laying where even my extremities' outlines are at least a foot wide.  I'm talking about some extreme night sweat episodes.  That happens occasionally, but I have them to some degree at least 80% of the time now.  This first started happening about 6 - 8 months ago. 

I do have minor joint pain in several areas of the body and my mom does have mild rheumatoid arthritis.  At this point, it sounds weird, but I'm actually hoping I have RA.  Sheesh. 

I've also been very, very tired for quite a long time now.  Wasn't so bad before, it's been getting worse since around October.

I've also been getting more and more frequent episodes of minor hypoglycemia.  My hands shaking is the first symptom and if it goes on long enough without a quick sugar source, I get anxious and it's hard to concentrate.  I do try to avoid that, it's just that it's not always possible to immediately drink sugar.  This used to be a very occasional thing for me, maybe a couple times/ month.  Now it happens every day.

And if you actually read all this, you deserve a LARGE cookie :)

Lisey, I'm glad you have the ability to wrap your thoughts around all this and separate the wheat from the chaff, so to speak.  The whole "WLS causes liver failure" thing is W-O-W .... I hope your new hematologist is on the ball and can help decipher the mysteries you are facing...

Thanks :)  I've spent the last few weeks doing a whole lot of reading on anything related to these tests/ lab values/ disease-associated symptoms, etc. 

The internist made a joke about the complexity of the labs, saying he practically had to pull out his biochemistry books to understand what was going on, whereas it took me 3 solid days of reading to get just the basic gist of it (since the PCP was clueless).  I'm really glad that I found a dr who will take the time to understand what's going on and knows how to procede to figure out what's going on.

I hope they can figure things out. I hate to think of you stressing over this if there's an explanation handy and you just have to hit the right doc.

You didn't mention B12. That's high normal too?

Please keep posting about this and let us know what's happening. No cookie required.

--gina

My B12 on 6/8 was >1500.  On 6/30, it was >2000

 I had been on 2500mcg sublinguals and finished the bottle before the 6/30 labs so I bought a 500mcg sublingual instead.  Interestingly enough, when I told the internist that, he told me he thought my B12 was just fine and not to decrease it since it was a water-soluble vitamin and there weren't any negative health consequences on high B12.

Lisey, I'm sorry things aren't improving. Hopefully the new internist and other specialists can get to the bottom of it...though I disagree completely with his off the cuff comments about wls causing liver failure. Gastric bypass has been around now for what, at least 30 years, and for the last 10+ years has been performed on close to 200,000 people in the USA every year. If it were causing liver failure, we would know. Actually, by reducing the amount of liver fat, it improves liver health and prevents NASH (non-alcoholic steatohepatitis), which can lead to cirrhosis and liver failure.
     I wish I could comment as intelligently about your labs, but I can't. I would suggest, though, that you get your copper and ceruloplasmin levels checked. Copper deficiency is another potential cause of non-iron deficiency anemia. Insufficient copper wouldn't explain all your problems, but it could be a contributing factor.

Now, where's my cookie?

Larra

Thanks, Larra!  I wish I had that cookie too :) 

I did get copper checked on 6/8 and it was normal, arguably a little on the high side of normal, thanks though!

I am by NO means an expert, but it under my VERY limited understanding that the inflammation MAY be causing all the other levels to LOOK bad, when they are not ACTUALLY bad (speaking for some of them, only, of course)

And I know the calcium is bound to a protein, so I think perhaps an ionized calcium level would be more useful. 

Overall, I am kinda wondering whether the inflammation might be making it impossible to get much useful from your labs.  You sure there is no infection?  The high WBC and CRP might suggest that.  Did your internist mention maybe a broad spectrum antibiotic just in case? 

Whatever it is, I hope you get to the bottom of it, and definitely hope you get to feeling better soon.

ETA: I would visit a rheumatologist, too, btw.

I had been feeling fine when I had the 6/8 panel drawn in which the WBC was markedly elevated (14.5, 4.0 - 11.0).  The differentials also showed some elevation indicating a bacterial infection.  This last draw on 6/30 had my WBC as 11.3 with all differentials in normal range.  On 6/8 the CRP was 13, yet on 6/30, it was 78.5  That's why overall, I don't think it is an infection causing the elevated CRP, otherwise the WBC wouldn't have improved and I would think with such a marked increase in CRP, would have gotten a lot worse also.

I think you're right about recalling that markedly high CRP can basically give other lab values "false" readings.  The problem is that seems to be one theory on it that's not widely accepted.  I did read one website, written by a dr., that said that, but trust me when I say, I've read a lot on this and haven't found it anywhere else.

I think making an appt with a rhematologist is a good idea b/c I think it's likely at this point that it's either RA or lupus and both are in the "rheumatology family".  I also don't have the type of insurance that I need a referral for.

The internist wrote on my paperwork to have a f/u in 6 wks, which is way too long to be waiting for, imo, it's just that I didn't really think of that as I stood at the window making the appt on Fri.  I know that he did encourage me to go to the local hospital to get the bloodwork done b/c the hemotologist on Wed works for that hospital & he will have immediate access to the results.  Perhaps the internist is thinking let the hemotologist pick it up from here??  Why would he want me to wait 6 wks for a f/u when we're still trying to figure it out??  I have to stop by the internist's office on Mon to p/u the lab order and I'm going to ask to r/s it for a sooner date.

Cookies! *looks around* LOL

HDL's really only elevate with exercise and can vary greatly.  I wouldn't worry about those.

Remember that labs show a snapshot of that moment in time. Some items can vary due to time of the month, time of the morning, what you've been eating in the past 30 days, etc.

The inflammation thing is of concern and I would go to someone who understands autoimmunity and possibly allergy. (/rant on) Sorry to say, but your internist sounds like an idiot.  "Because I'm a doctor" is BS. I have taken more biochem than he ever had and if he's pulling out books, he's well beyond his expertise (/rant off). The reason I mention allergy is because it can cause an inflammatory reaction. Saying your IgG is elevated or your WBC are elevated indicates something is amiss, but you can pinpoint what type of immune reaction it is by breaking up the antibodies by type  (IgG, IgE, IgA, IgM) and the same with WBCs. A rheumatologist can do those types of testing, I believe.

You aren't dying of liver damage. The liver one of the organs that regenerates itself nicely if there is damage.  Take a deep breath and rule out things one by one, starting with the potential autoimmune indicators (as they can throw off many lab values).

Hang in there, go to a recommended expert and relax a little.

Hugs,
Ratkity