New labs, calcuim going down

		9/2/2010	12/13/2010	3/7/2011	8-Jun
sodium	136-144	143		143	149
potassium	3.5-5.1	4.3		3.8	4.3
chloride	101-111	106		105	109
carbon dioxide	22-32	30		28	20
anion gap	7.-18.	7
glucose	79-99	101		95	92
urea nitrogen BL	8.26.	20
creatinine	.6-1.0	0.6		0.5	0.7
EST GFR Gauc	>90	>90		133	90
EST GFR-non Gauc	>90	>89		161	109
calcium	8.9-10.3	9.9		9.2	8.2
phosphorus serum	2.5-4.6	3.4
total bilirubin	.3-1.2	4.5		0.9
SGOT AST	1.0-45.0	23		9
SGPT ALT	1.0-40.0	34		35
ALK phosphatase	32-91	92		118
selenium	11-307	167
ferrintin	11-307	167		246
folate	3.-20.	>20
B12	180-914	835		1989
a1C		5.7
Est. avg. glu		117
PTH interp	12.0-88.	29
B1	9.-44	67		14.5
D total	30-100	22	117
D3		22
Zinc	60-130	85
folate
protein	5.9-8.3			6.6
cholesterol	100-199		212	197	203
triglycerides	0-149		111	75	69
HDL	>39		48	48	62
VLDL	5.-40		22	15	14
LDL	0-99		142	134	127
LDL-HDL ratio	0.0-3.2		3	4.1	3.3

So these are the labs I had done as a follow up to my amnesia episode.  My potassium is back to being good but my calcuim has been trending down.  I guess I need to up it and add in a noon dose too.  I was very compliant getting it in the morning and evening but I guess that isn't going to get it. 
The other thing that has been dropping is GFR.  I don't have a clue what that is and it is still within normal, but had dropped each time I have had labs done.
Also seems strange that my Cholesterol has gone up since they put me back on meds????
My Dr's appointment is tomorrow.

Isn't the HDL the good cholesterol?  I know nothing about that. I know I want my total around 120 or so and triglycerides going down is a good thing.

Lower calcium would scare me too. You want it around 9.2.  I think I'd ask for calcium, D3, PTH, magnesium and calcium again. Increase your calcium. How much D3 are you taking?

Don't like the way your B1 is trending. I have to take a separate B1 every day. I can't take a B-complex every day because the other stuff gets too high. You might want to ask for folate next time.

You might be able to cut your B12 to 5 days a week. Reduce it, but not too much.

Your potassium looks great! 

--gina

 

I'm doing 50,000 3x a week D3 plus what is in my calcuim.  I'm not doing any B at this point so I can add that.  I'll slow down on the B12.

It's the total cholesteral that is up, even after they put me back on meds.  I'll talk to her tomorrow about that.

What is GFR?

Link to labtests.org: www.labtestsonline.org/understanding/analytes/gfr/sample.htm l

That is a handy site.  Thanks.  Guess I won't worry about those and will just work on Bs and calcuim (along with all the rest).

Thanks, Gina.  We are so luck to have you.

I really wish more labs were done on you but this is what we have to deal with.  Here are my suggestions and recommendations.

Your potassium is fine, it actually wasn't that bad before.  I like it better now though.

High sodium levels can be several things including increased sodium intake, dehydration, water retention or other kidney issues. Your creatinine is on the low end which generally for us means a high protein diet - are you getting atleast 90-100grams of protein at this point?  For some reason, they didnt' do a BUN which is very suprising since that is always done along with a creatinine and I see they didnt' do it last time.  BUN is a very important test for us, not only does it determine our kidney function but it also determines if we are drinking enough.

Your GFR numbers are little strange to me.  (It has to do with your kidney function) On every lab sheet I have ever seen from many different labs, the normal is always >60, not >90.  Expecting a GFR to greater than 90 is really expecting alot and very few people would be ablet to meet those expectations.  I dont' know if your lab calculates it differently since I have never seen a GFR as high as 133, I didnt' even know it could go that high.  My numbers are usually between the mid 60's and the 70's and my doctor says they are good.  Once in awhile they go into the upper 50's and she says not to worry about since it is because my BUN is a little high since I didnt' drink enough the week or 2 before the test.

Your calcium levels are very concerning.  The level of 9.2 was great but 8.2 is serious deficient.  With a level like that, your bones are at serious risk.  You are basically not absorbing the calcium or taking way too little.  You said you are only taking it 2 times per day, that is definitely part of the problem.  That isn't nearly enough but your levels shouldn't be that low with that dose.  What type of calcium are you taking, what dose are you taking?  What brand and how many pills at a time?  We need to take a minimum of 1500-1800mg of calcium citrate per day, in 3 daily doses atleast 2 hours apart and no more than 650mg at a time.  You can't take it within 2 hours of your iron or thyroid medication.  I don't know if you are taking it too close to your iron or thyroid medication. Many dont' realize that if your multi has iron in it, you also can't take that within 2 hours of your calcium also.  Being your levels are so low, I would definitely recommend you take a minimum of 2000 mg per day in 4 doses of 500mg each to try to get your levels up quickly. The longer your levels are that low, you are putting yourself at further risk for osteoporosis.  The first year for us is crucial for bone lose since we lose so much weight and dont' get the vitamins in our food, so we much get it in our supplements.   I dont know where you are in terms of your menstrual cycle, if you still get it that is good for your bones but if you are either peri menopausal or post menopausal, then that also puts you at higher risk for osteoporosis. Unfortunately, WLS and malabsortion is not good for our bones.

So, I don't know what type of calcium you take - if you take citrical - you need to take 2 tablets - 4 times per day.  If you take the chewables from bariatric advantage - the lozenges are 500mg, then those would be 1 - 4 times per day and the chewies are only 250mg - so those would be 2 - 4 times per day or a combination of the 2.

Your ALT and AST are fine but your ALK Phoshatase wasn't good in March. Did they do anything about it then?  In many cases it goes along with the ALT and AST as a liver function test but it can also be a sign of a problem with your bones. So, that along with your low calcium level, really worries me.  Please ask your doctor to run an immediate PTH, vitamin D 25 hydroxy  and DEXA scan and repeat the ALK Phospatase to see what it is now.  The PTH are blood tests along with the calcium and ALK Phoshatase can tell you the status of your bones and the DEXA scan is the ultimate test to tell you if you have osteopenia or osteoporosis.  You need these ASAP.  I dont' mean to scare you but the sooner you find out, the sooner you can get the proper treatment and if they are normal then that is great and you will have a baseline to compare to.  We should all be having these tests done anyway.

are you taking vitamin B1?  I do hope so and  not just in a b complex.  Your vitamin B1 went down from 67 to 14.5 in just 6 months, which leads me to believe that you havent' been taking any.  If you didn't start taking any since your blood test in March, then your level is even lower than the 14.5 which is very dangerous.  Vitamin b1, like vitamin B12 when deficient can lead to nerve damage.  Have you had any pain or tingling in your feet, toes, arms or fingers?  I found it affected my toes the most.  If it goes too long, it can be permanent.  Thankfully your B12 level is great because being deficient in both is really bad.  Everyone with WLS should take 100mg of vitamin B1 daily just to keep normal levels.  Once deficient, you need to take 300mg a day to get your levels back up to normal and to maintain.  Since I don't know how low your levels got, I would recommend taking 200mg daily for until your yearly labs and then when you get retested, you can adjust from there.  You want B1 levels to be at the top of the range and they can even be a bit high, you just pee out the excess but you don't want to be at the low end and definitely not low.

Your protein levels could be a bit higher from your last labs in March. I dont know if you have increased them since then

As far as your cholesterol goes, your total cholesterol and LDL are too high but your HDL and triglycerides got better.  The amount that your cholesterol and LDL got worse is so miniscule that it really doesn't mean anything.  These numbers can be off by 10% on any given day. You may just need either to increase your dose or change to a different cholesterol medication.  I dont know what you are on but I find that Zocor or simvistatin always worked the best for me.

Make sure that at your 1 year mark you get all your vitamins and minerals - you are missing quite a few on your list.

Thanks for your input.  This really was just an interium lab due to an episode of atypical global amnesia I had in March.  That was why I had labs in March.  So the full labs weren't done either time and will be done in August for my Sept annual appointment.

I am taking a B complex and will look for a B1.  I have no symtoms of anything related to it.

I get over 100 g of protein a day, usually 110-125.  Upped it a few months ago.

PCP took me off the cholesterol meds because the choice was raise it or do away with it and we agreed to do away with it.  I hadn't been on it from Sept to March and it had been coming down steadily but slowly.  It was added back in March because of the amnesia episoide.

Calcuim citrate, 650 mg am and pm and have added another dose midday.  It has D and mag with it.  I was doing Vitaladies, now doing CVS.

I am addressing the B1 and calcuim and will see what happens in August.  Thanks again.

so, you only get labs done every 6months? Wow, I get mine done every 3 months and at the beginning I got them done the first time at 5 weeks also. I don't know when you switched from vitalady's calcium to cvs's but alot of people dont read the fine print.  You have to check the elemental calcium and if I remember correctly, in order to get 500mg at a dose, you need to take 3 tablets at a time, I think they have 145 mg of elemental calcium - many people don't realize this and end up taking alot less calcium than they realize.  So, if you were taking a lower dosage plus only taking it 2 times per day - the combination would definitely explain your low calcium level.  So, if you are taking 650mg - 3 times per day totally 1950mg, that should be good for now but definitely make sure that in August you get the full set of labs.

 I am not sure I understand the choice of increase a medication or take it away and she chose to take it away when your levels were too high.  They went down a little but not nearly enough and definitely need to go down alot more. Unfortunately, cholesterol rarely goes down on its own without major dietary changes and medication.  You have already made the dietary change on top of the weight loss and they went down very little.  In order to be protected from heart disease, we should have cholesterol around 130, 140 tops and an LDL below 75, anything above 100 is way too high.  My cardiologist wants mine below 60.  If you have any type of heart disease, you should definitely be below 75

I really wouldn't wait until August on the Alk. Phosphatase - you dont' know what has happened since March - it could have gotten better but it could have gotten worse.  The only way to know is to repeat it.  I don't understand how doctors can see such abnormal tests and ignore them