Question about lab levels

Librarian67
on 5/16/19 6:19 pm, edited 5/16/19 6:27 pm
RNY on 02/28/17

Hi folks!

Just the results back from my physical. Pretty much everything was good or at least within the normal range, so my PCP has no worries.

In great news, my A1C is at 5.4 after being 9.5 (while on 3 meds) before surgery in January 2017. Also my total cholesterol is 177, triglycerides are 51, HDL is 73, LDL is 94.

I have a history of being anemic so I've been watching my iron #s like a hawk. Iron is 83, tibc is 366, iron sat is 23 and ferretin is still within the bounds of normal at 20, down from 38 in October 2018 & 37 in May 2018 (67 in Jan 2018). My first question is, when do I ask for intervention based on the dropping ferretin?

My second question has to do with the PTH, intact number. My bone density has been dropping significantly on my dexas over the last 2 years, so this year I asked to have my PTH drawn. It was 30, which is within range but I don't know what that means.

For those of you who have been doing this for a while, I'd appreciate your thoughts.

Thanks!

HW: 248, SW (2/17): 244, GW (10/17): 125, CW: 117-122

RNY w/ Joseph Afram: 2/28/2017; Plastics w/ Douglas Forman: Extended mastopexy, Extended abdominoplasty-5/18/2018

selhard
on 5/16/19 9:07 pm - MN
RNY on 11/26/12

I just returned a few hours ago from my first ever iron infusion after months of dealing with insurance denial. (experienced no side effects from the infusion and have not noticed immediate improvement like some WLSers have reported) A friendly thought would be to maybe request a referral to be seen by a hematologist sooner rather than later. This effort should help establish a quick, insurance-approved infusion when the hematologist and you discuss if/when there is a need for one (mine said there was no question an infusion was in order). I return to the infusion center next week for another IV dose of Injectafar. Then, new labs will be drawn in about another four weeks. My ferritin level history is 125 to 25 to 10 (range 5-200).

H.A.L.A B.
on 5/17/19 3:47 am, edited 5/16/19 8:47 pm

It may be difficult to get approved for iron infusion with ferritin at 20. If you can get that, great. But - iron infusion is not a benign thing. As with everything lelse it can cause reaction, short of long term. And it is expensive. That's why doctors try not to order that unless they feel it is absolutely needed. I have ferritin of 9-10 for over a year, and only after my RBC and hemoglobin start dropping, a great hem agreed that I may benefit from iron infusion. Having low iron for so long made me miserable and by the time the year was over - I was a mess. That also my adrenals did not work, and I only found that out over a year later, made me severely depressed, always tired, and a crying mess. I guess crying 50 year old is not a pretty sign, so my hema fixed that. Not that I suggest you cry, but sometimes even with low numbers, but not horribly low, (like 10) other factors like the person mental and physical state may affect if the doc would push for iron infusion.

As for bone density and PTH - PTH shows that it is not supposed to take a lot of calcium from your bones, but bone density dropping may be a sign that even with the calcium you take, your body is not putting it in the bones. So the question is if you take enough magnesium and other minerals like boron, stronium (very small doses are needed) and dry vitamin K2 to direct minerals into the bones.

Vitamin K2 is critical for bone formation and repair. So supplementing that may be critical.

Vit D3 - it's level in the body may determine how well you can absorb the calcium. I like mine just right 50-70, not too high, not too low. But having free calcium in my blood without taking adequate amount of other essential minerals (magnesium is critical, and most people are severely depleted) and K2 to direct the calcium to the bone, may not be very good. Too much "free calcium" can cause really bad calcium deposits in arteries, joints, and even calcium stones, or bone spurs.

Just PTH is not enough. I am glad you do check the bone density. Since we lose weight, there is much less pressure on the bones, less mass carry around, so some bone losd can be expected. Weight bearing exercise, putting stress on the bones - can slow that process.

A lot to think about, no?

BTW - testing magnesium level in blood would not tell you if you get enough in your diet, because that only tests blood level, not how much magnesium is in the tissues or directed to the bones. Both calcium and magnesium in the blood are 2 items that are critical to maintain proper, very narrow blood acidity. The body would take any from anywhere in the body to make sure that has enough in the blood.

Hala. RNY 5/14/2008; Happy At Goal =HAG

"I can eat or do anything I want to - as long as I am willing to deal with the consequences"

"Failure is not falling down, It is not getting up once you fell... So pick yourself up, dust yourself off, and start all over again...."

Librarian67
on 5/17/19 7:42 am
RNY on 02/28/17

Thanks. Yes on your suggestion, I take Vit K, D3 & Mag. I'm scheduled for another dexa in the fall.

HW: 248, SW (2/17): 244, GW (10/17): 125, CW: 117-122

RNY w/ Joseph Afram: 2/28/2017; Plastics w/ Douglas Forman: Extended mastopexy, Extended abdominoplasty-5/18/2018

H.A.L.A B.
on 5/17/19 8:58 am

are you taking K or K2? that is important. K1 is for coagulation, K2 is for putting minerals back into bones. K is fat soluble, so if yo take regular K - it is often in oil, and we may not absorb that very well.

How is your D? did you test that?

Hala. RNY 5/14/2008; Happy At Goal =HAG

"I can eat or do anything I want to - as long as I am willing to deal with the consequences"

"Failure is not falling down, It is not getting up once you fell... So pick yourself up, dust yourself off, and start all over again...."

Librarian67
on 5/18/19 5:31 am
RNY on 02/28/17

Yes, I am taking K2.

And my D is 48.9 (normal: 19.9-79.3). I've had that tested regularly but added the PTH this time for more info since my BMD continues to fall significantly.

HW: 248, SW (2/17): 244, GW (10/17): 125, CW: 117-122

RNY w/ Joseph Afram: 2/28/2017; Plastics w/ Douglas Forman: Extended mastopexy, Extended abdominoplasty-5/18/2018

stacyrg
on 5/17/19 9:25 am
VSG on 05/12/14

You need to also have them check calcium levels (although blood calcium isn't a true indicator of much. My PTH levels are off and they're tracking me for a parathyroid tumor) and Vit D levels. The numbers taken in combination will give you a better overall picture.

Also, have they had you increase your calcium supplementation? I'm at 2500/day along with the vitamin supplementation suggested by HALA and I get a DEXA scan at the hospital every year. I'm too young for osteoporosis, but there it is.

        

Grim_Traveller
on 5/17/19 11:12 am
RNY on 08/21/12

I was also losing bone mass on the recommended 1500 per day of calcium citrate. I absorb calcium getter with patches, but those seem to do much ggetter for some folks thgan others.

I know you are aware of these things, but want to jump in and let folks know th at vitamin recommendations are just a starting point. We need labs, and then to make adjustments.

6'3" tall, male. Maintaining a loss of 280 pounds.

Highest weight was 475. Consult weight 04/12 was 411. RNY on 08/21/12 at 359 lbs. Current weight 195.

M1 -24; M2 -21; M3 -19; M4 -21; M5 -13; M6 -21; M7 -10; M8 -16; M9 -10; M10 -8; M11 -6; M12 -5.

Librarian67
on 5/18/19 5:41 am
RNY on 02/28/17

Thanks Grim. I switched to the patches after I saw that my BMD was dropping significantly. My next Dexa showed that it was still dropping 7 months later (and my other labs weren't as good either) so I went back to oral vitamins. Any thoughts on combining a Calcium patch (1200 mg/day) and some oral as well for a higher total?

HW: 248, SW (2/17): 244, GW (10/17): 125, CW: 117-122

RNY w/ Joseph Afram: 2/28/2017; Plastics w/ Douglas Forman: Extended mastopexy, Extended abdominoplasty-5/18/2018

Librarian67
on 5/18/19 5:38 am
RNY on 02/28/17

Calcium was 9.1 (8.7-10.2); D was 48.9 (19.9-79.3); PTH was 30 (15-65). Any thoughts.

I take 1500/day of Calcium Citrate. It wouldn't be that hard to add in another 500-600/day.

Also I've been getting my Dexas at a facility that is more geared to athletes. My PCP wrote for a Dexa in the fall at a radiologist's that focuses more on BMD of the spine, hips, etc.

HW: 248, SW (2/17): 244, GW (10/17): 125, CW: 117-122

RNY w/ Joseph Afram: 2/28/2017; Plastics w/ Douglas Forman: Extended mastopexy, Extended abdominoplasty-5/18/2018

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