Questions on lab results and being bounced between doctors... Advice needed

I am currently 5 1/2 years out from my surgery.  I did have a gain of 25 lbs and know I need to get back on track.  (let depression of my dog dying last summer impact my eating habits)

I have had issues with a VIT D deficiency (was as low as a 10 3 years ago)

PCP sent me to an endocrinologist at that time: who put me on VIT D2 50,000 3 x a week.  Numbers got better over the past few years..

Also take my Calcium (but did slip on this , this past year, but am back on track)

Went to PCP in May hadn't been in a year nor had I been to the Endocrinologist in that same time spam.  ( I know it was wrong to skip/delay).

Labs came back as follows:

VIT D 25-hydroxy   20.4

PTH  219.5

B12   255

WBC 6.1

RBC  4.01

hGB   7.8

HCT    25.8

MEAN CELL VOLUME   64.3

MEAN CELL HGB CONCENTRATION   30.2

RBC DISTRIBUTION   19.1

PLATELET COUNT, MANUAL ENTER 445

MEAN PLATELET VOLUME  8.3

PCP instructed me through the medical message board to take iron tablets 3 x a day starting immediately and to see my Endocrinologist for the VIT D.  (I take B12 and Calcium  Citrate )

Just saw endo last week and he ran more tests on my iron because he said not all levels were checked, he felt with my gastric bypass I should go back to surgeon because my PCP may not understand how to treat me.

Iron is killing my stomach (have history of IBS) I am having a colon0scopy on 6/29 (as I turned 50 last fall)

Just received other results last night:

IRON 11

Ferritin 3

Iron saturation 2%

TOTAL IRON BINDING and transferrin both OK.  Mid range.

I'm calling my surgeons office tomorrow.. please help with what I need to ask. 

Oh endo now prescribed VIT D 3after I saw postings on here that my type was wrong kind.

I'm worried about my iron and not sure if surgeon can help or if I need a hematologist... UGH!! 

Any advice would be appreciated to get me back on track.

Side note I have had kidney stones so Urologist says low protein but need for Iron.  Can't mix iron with calcium.  Finding hard to balance and time all the meds.

Thanks and sorry for the long post.

Chris

You need a hematologist now. I would do that first. Refer yourself if need be.

My PCP orders my labs, but if somethings needs attention, I don't wait on him. I call and deal with it. Your PCP sounds like he is somewhat at a loss.

Thank you!.  I felt going back to my surgeon would delay things more  I'll do some research tonight and see who I can find under my insurance.

You might still want to see an endocrinologist, but I can tell you that a big part of the problem with your Vit D is that the Vit D you are taking is D2, and what you should be taking is D3.  The body has to convert D2 to D3 and you lose a lot in the conversion process. MY suggestion wouldbe to hold off on the endocrinologist for 2 months while you take 50,000 units 2x a week of the D3 (dry, not the oil version) and then get your Vit D level rechecked.  You will undoubtedly see a significant improvement in just 2 months (and then might not need the endocrinologist).  Surprisingly, many doctors don't know this (but most of them don't even have to take a class on vitamins and nutrition in med school).

You can get small, 50,000 unit capsules of dry D3 from a couple fo places online, including from www.vitalady.com (Michele, who runs the site, has had RNY and she knows a ton about our vitamin needs!)

Also, what kind of iron are you taking?  We absorb some kinds better than others and some are easier on the stomach than others. Carbonyl iron is a bit more expensive, but absorbs well and is easier on the stomach (and doesn't cause constipation) like some of the others.

Your very high PTH level of 219 is also troubling. You didn't say what the unit were, but a normal range is usually considered up to 55 pictograms per milliliter (pg/mL).  You didn't mention your serum calcium level, but with a PTH that high, you very likely aren't gettig enough calcium. (Even if your calcium level shows "normal", with a PTH that high, your body is probably leeching calcium from your bones into yoru blood, and since you are menopausal (welcome to the club...), you are already at risk for bone loss.

Have you had a DEXA scan?  If not, you should ask your surgeon or PCP to order one, because that is the only way to know if your body is pulling calcium from the bones for sure.  How much calcium (and what kind) are you taking?. With the kidney stone issues, you need to be doubly sure that you are only taking calcium citrate because calcium carbonate contributes to kidney stones.  I have had trouble with bone loss and kidney stones, so have done a bunch of reading on both issues.

Lora

Thank you Lora,

My calcium level was 9.5, but like you said it's pulling from my bones right now. Endo based this on a few tests of squatting etc..  I asked my PCP before my results were in about bone scan but he said better to wait until after menopause .. based on results I too felt it was best to confirm now.

I'm taking Calcium Citrate - (not petites) 3 pills 2 x a day.  Sorry don't have bottle near by. (Citracil brand)  With IBS I have a hard time with milk products but did increase my intake recently with Orange Juice with VIT D and Calcium.  I'm also going to order more Oh Yeah proten shakes I did post surgery.  They are high in protein and calcium and lactose free.

I'll get an order placed with Vitalady on the D3 by insurance just denied the order submitted by the Endo so I will order myself.

I appreciate your help and I'll continue to do lot's of reading as well.  I love coming here as others have experience and can provide the gastric bypass information not provided on other medical websites.

Chris

You should actually have one NOW because you need a baseline.  Because of the WLS, you can begin losing been VERY quickly and WAY before menopause.   I think your PCP is treating you as he would someone with a normal intestinal system rather than as someone with an altered system (and/or he doesn't understand the post-op lack of vitamin absorption).  It also sounds like he has some old-school ideas about bone loss.

I would try to gently push for the DEXA scan.  If your PCP won't order it, your surgeon probably will.  They cannot tell you ANYTHING about the condition of your bones without one! Doing physical tasks like squatting isn't going to tell you or your doctor anything about the condition of your bones until they become so bad that it starts to impact your ability to do daily tasks, and by then you are in big trouble!

Unfortunately, as you are apparently finding out, many PCPs know very little about nutrition in general or about the nutritional needs and the potential complications of people with altered digestive tracts.

Definitely do some research on your own.  We have to be advocates for ourselves and our health, and that is especially true if our PCPs are clueless about our altered anatomy.

Lora

Your B 12 is also critically low - whatever you are taking now - do that x 4 before being tested in 2 months also.  You need to be around 1000 pg/mL to be on the safe side.

At your current level, you are in danger of severe and possibly permanent neurological damage 

Thank you.  They didn't have the labs marked as low, but I did question the level.  I'll be sure to start that tomorrow.

I appreciate you help!  I'm already started to feel tingling in feet and hands and want to avoid permanent damage

Make sure your B12 is sublingual, as that will be absorbed better. Your B12 is very low.

I would take a copy of the labs to your endocrinologist. He can decipher all the results and hopefully devise a plan to get you back on track.