2nd try - lab help

Thanks, Julie,

lab                              range                 pre-op     post-op
Vit A                           38-98                        ?             37
zinc                            60-130                     ?             78

 

 You need more A for sure -  not sure how much - I take 100 k.    Check with Vitalady.
You need more zinc....because it's going to continue to fall.   I think Vitalady probably says 50 mg a day.

D is low and PTH is high.  Not enough calcium.  I'd be starting on 150k of D3 daily and up'ing your calcium to 5 or 6 doses daily.  It's very hard to raise your D and lower your PTH.  They go hand in hand.  More calcium, raise the D and it lowers your PTH.  

Get on Vita Lady's program including her protein recommendations: www.gblcreations.com/Resources/Gina/ProgramDRNY_ERNY_BPDDS3- 2010.pdf

Increase your calcium to at least 600 6 times a day

Take 1 magnesium citrate with each calcium dose.

Don't just bump up the calcium go up slowly... if you get constipated add a Mag Oxide with each calcium dose or do other things. 

People tend to ignore VL's advice about protein shakes but without protein you've got nothin'.  And the more protein shakes I did the better my weight loss was.  So do those shakes or cake shakes!!! 

Make sure to get ALL your labs done in 3 months.

I think if you jump on this NOW you can get your labs up. 

~Becky

If you have a spreadsheet, upload it to google docs.  Then you just have to provide a link to the doc and we can view it online.

The protein, to me, is not as concerning as other things.  No overt deficiency.  Some slumping numbers (look mostly at albumin), but not terrible.  I'm all for more protein though.  yaaay protein.

Glad to see the potassium up a bit more.  Would looove it to be a bit higher, but it wasn't even pre-op, so...might be about as good as it'll be. 

Calcium/PTH/vit D is concerning me.  2400mg is a good amount of calcium...so I think there's another factor keeping you from good utilization.  Might be the vitamin D drop, so I'd work on fixing that to see if we can fix your PTH and get it to come down a bit.  Since you're not taking any...50,000IU D3 to start (not prescription D...vitalady D).  Or actually, probably 100,000IU for a month to get a boost, then down to 50k after, then retest in 6-12weeks to see what it did.

My biggest concern right now...you are anemic.  Oh my are you anemic.  But--is it iron?  I can't tell. 

ONE vitalady iron is not the right dose though.  You should have been taking like 5 of those caps.  I need to see the iron panel.  Ferritin, iron sat %, total iron binding capacity, etc.  Hemoglobin needs to be at least over 12 for females.  I also need to know B-12 and folate.  And the rest of the CBC.  RDW is only part of the CBC and that number tells how variable the sizes of your red blood cell...high number = lots of variation, some cells small, some cells big...neither is good.  We want cells that are juuust right (just like the 3 bears).  MCV, MCHC, etc... would like to know all that.

Anyhow, that's pretty much all I can say without the rest of the labs.

As far as what to do, I can't tell whether your anemia is iron related or not...but the iron dose you're on is not right anyways.  I could switch to a more vitalady-like plan, but I'd still take the ADEKs until they are gone (I don't like to waste vites), but you'll need to add in extra stuff until they are gone and then probably readjust afterward when you switch out the ADEK for a multivitamin.  
But where's the rest of the labs?  It's hard to tell whether you even had a complete set (probably not) when they aren't all posted.  It's cool that the rest aren't wild and crazy...but WHICH ones aren't wild and crazy?  I can't just assume you had everything drawn and it's fine unless all the hairy details are listed.

If I were in your shoes I'd cough up the money for the Vitalady plan for six months or so and then adjust downward if warranted. You're headed down the toilet here. It might take a while for the toilet to flush, but this is a spiral you want to avoid.

And yes, your surgeon's practice is truly HORRIBLE about everything except cutting.

Thanks, everybody for all the great feedback! I have Vitalady's starter pack for DS ordered and have added a protein shake. I think I got google docs to work. This should be the link to my labs spreadsheet:  

https://docs.google.com/spreadsheet/ccc?key=0AjkcVwlOxmX-dGl WSENVME5kcWhORnZfY1N5MHd4d2c&hl=en_US#gid=0


Also, I plan to take VL list of labs to PCP in 3 months and just say "These are the labs I need."   Again, thanks to everyone for their help.

thanks for uploading it :)

OK, new impressions: yes, I think you should increase the protein.  Pre-albumin is sorta that "first sign" of insufficiecy and you're pretty much at the bottom of that barrel.

As for iron, your stores are fair.  Not terrible.  The hope would be to really revive them with proper supplementation and get the ferritin at least over 100.  You really have a chance to avoid infusions and that'd be great :)  So, I would definitely start on a proper iron regimen.

I really need you to look at that folate level.  It's dropped a HUGE deal--do you see that?  Folic acid deficiency can cause anemia and all sorts of other DNA replication related issues.  Red cells need folate to mature, otherwise they are left all big and fluffy, which is bad.  We want medium-sized well formed red cells. 

Again, I need to mention: you are anemic.  I don't think it's from iron.  I'd probably focus on the folic acid right now to see if that fixes it and if not, we have to look for another cause.  It could also just be slaggy from overall low nutrition/intake.

I also need to point out that slaggy clotting time (PT and INR...from the previous lab).  Need to find the cause for that.  It's usually already pretty bad if it's showing in these values because these markers aren't really that sensitive, so it might have be pre-existing.  vitamin K deficiency can also have problems here, but usually it's a pretty significant problem once it's showing problems here...but kinda tricky to diagnose.  I definitely think DSers really need to take this vitamin and the starting dose of 1mg/day is a good place to start, though some end up needing more...(I take 8mg/day now...)

Your labs are concerning me as well. I would def see a endocrinologist. Something isn't quite right. if it were me I wouldn't just get on VL regimine I would get to a specialist asap. Please please get on protein shakes, like yesturday. :) just my opinion...