Need Feedback on Labs Please

Thanks Kathleen, I will increase this.  I was just going by the original vitalady list for this.  It definitely seems that I need all the help I can get with my absorption of Vitamin D!

Pamela

I have chronic very low D despite careful supplementation too. Vitalady suggested that I try to take a dose in the middle of the night if I'm guaranteed to be up to pee. That doesn't work for me as I almost never get up to pee, but if it does for you, you might give that a try. She then suggested that I try separating the D from the other stuff except for calcium and magnesium. Now that I can do, so I'm putting the D into two doses to go with my during-the-day calcium. I'm also doing 100K daily, so I'm doing two 50K doses.

 I used to take 5000mcg B12 per day + some.  Sublinguals. I even switched to methylcobalmin (and not cyanocobalmin) and I could not keep my B12 high enough. 
Finally gave up and now I am on B12 injections - I give myself weekly B12 1 cc (1000 mcg) .
The script is not expensive and the syringes and needles are also cheap (IMO). You can also get the injectable B12 on line.  

With weekly B12 injections - my B12 is finally above 500.  Last time I checked it was 800 (one week after injection). 
The b12 you are taking now may not be working well for you....

BTW: I had RNY not DS, but in this case - it doe snot matter.

That sounds like something I should probably look into.  I have also been taking 5,000 mcg sublingual B12 daily, but my B-12 is going downhill fast.  It was at 1240 at 3 months, 714 at 6 months, and now is 428 at 12 months. 

Incidentally, it was 484 pre-op, so I wasn't as worried when it went from 1240 at 3 months to 714 at 6 months, but now that the trend is obviously continuing downward fast, it definitely concerns me. 

Thanks!

if you do - make sure you  get the thin needles - the B12 is really thin - so you do not need more than 28-29 or even 30 gauge. 
one (not so smart) pharmacy guy sold me the 27 and they hurt. The 29's - I barely feel it. 
I get the insulin syringes - 1 cc 29 gauge.  (100 ct syringes + needles)  ~$15- $20 including shipping. But if your insurance pay for that - even better.
I got 30 cc bottle of B12 for copay ~ $6.00. That almost 3/4 year weekly...

Your b12 is going down and way too fast.  You need to get injections if you are that low on 5000mcg daily. Either go to your PCP and ask for injections or ask for a script to give to yourself.  You probably need them more than once per month with the way your levels are going.  Ask for insulin needles

Your folate is also very low - it should be greater than 20.  You might want to increase that.

You might also want to look into your thyroid.  Are you already on synthroid or other thyroid medication. The new range for TSH is .3-3.0 but unfortunately most doctors and labs don't go by that.  IT has been instituted by the Endocrine Society and most endocrinologists use it.  IF you are on synthroid, then you aren't on enough - you want your level to be around 1.0.  IF you aren't on it, then you are borderline and definitely need to have i****ched - possibly go on some thyroid medication.

Thanks for the information on the new TSH levels.  I am on synthroid, and my levels have gone down from where they were before.  I had been feeling like I was still having problems, but since the levels seem to be in range I figured it must be something else.  Now that I know about the new levels, I will talk to my doctor about increasing my dosage. 

I will also look into the B12 injections as several people have suggested.

Still waiting for the rest of my vitamin levels to come back.  I'll post everything together when I have it.

Thanks,
Pamela

If you are being treated by  a PCP, you might want to see an Endocrinologist.  Many times PCP's still go by the old range and even if on synthroid won't treat a TSH of 3.1

An endocrinologist expectations are totally different -they look for ideals and I know mine tries to keep me at 1.0 or as close to as possible.  Once you hit 3, you definitiely need a dose adjustment and an Endocrinologist is more likely to do this than a PCP - it is there specialty.  You also want to get your T3 and T4 levels checked - both free and total.  When your T3 levels are low, it makes it harder for your synthroid to work.  I had a low T3 level and was put on a second thyroid medication called cytomel and it was amazing the difference - it works along with your synthroid. IT gives you more energy, increases your metabolism and will decrease your TSH

I saw the NP at my surgeon's office today.  I was glad to see her rather than my surgeon, because she spent over an hour with me discussing my labs and strategies, where my surgeon usually just laughs at the "overkill" of how many labs I have ordered through my PCP (based on vitalady's suggested list).

She did want to increase my synthroid, but only upped it from 100 to 112.  That doesn't seem like  a very big adjustment to me? 

She also wanted me to start taking prescription D2 in addition to the 100,000IU of D3 I am already taking daily.  Her stance is that the D2 will help with my low D levels, and if the D levels increase that will help the TSH problems.  I have read that D2 doesn't help us, but I didn't have enough knowledge to really talk to her about it, and she agreed that I should still take the same amounts of D3, just add the D2.  Any input as to whether that will help?

She also gave me a script for B12 injections and said that should help with my feeling so tired all the time.  She wasn't worried about my decreasing ferritin levels since they are still "in range" but did suggest I increase from 5 pills to 6 daily (vitalady tender iron)

STILL waiting for the final vitamin lab results to come in.

Reactions/suggestions?

Pamela

I am glad you got to go over your labs, it is usually the NP's or NUTS that do a much better job with labs then surgeons, they are trained to cut.

An increase in synthroid of 100 to 112 is normal, you can't increase it too much or you can become hyperthyroid.  You should get your levels checked again in 6 weeks to 2 months to make sure the new dose is working.

As far as the D2 is concerned, I think it is a waste of your time.  I took it preop and it did nothing, I can't imagine you getting any benefit out of it post op DS>  I would think you would need to increase your D3 instead, I have heard people take it in the middle of the night for better absorbtion.

I am glad you are going to be doing the B12 injections - that should help with your really low B12 level.  Did she tell you how often to do them? I don't think once per month will be enough for you.

Yuo said she is increasing your iron based on decreasing ferritin?  You didnt' list a ferritin and all your levels show your iron, iron stores and all other iron related numbers are perfectly fine.  Your MCV is actually at the top of the range, showing you are definitely getting enough iron.  Unlesss, I am missing something and you do have a low ferritin - less than 40, than your iron is fine.