When do lab values become critical?

Well, I will start with the fact that I am 11 years out from RNY.  I am very compliant with getting my labs drawn and following up with me surgeon and hematologist. My iron is78 (27-159), TIBC 423 (250-450), UIBC 345 (131-425), protein 6.3 (6-8.5), H& H 12.5 & 38, B12 244 (211-946), Vitamin D 15 (30-100), Calcium 9 (8.7-10.2).  These numbers are slowly slipping, over the last couple of years they just don't seem to go anywhere but down. I am so tired, I can hardly put one foot in front of the other! I think that people don't believe me when I say that, but like so many, I am a single mom and the only Breadwinner, I don't have time to sleep all day, but I would love to do just that! My primary care doctor doesn't know beans about how to read the labs and my surgeon and haematologist whom I trust very deeply don't seem to be as concerned as I feel like the numbers might indicate. Anybody else have a good idea of which direction I should turn? At this point, if the dr. Called me today and said head to the hospital, I wouldn't complain.

Are you able to self-refer to a different hematologist?  

I can, but I've only had one appointment with this one. My previous moved out of state and I am so sad! I am trying very hard to be patient as I know nothing in the medical field happens quickly but I was really hoping to get at least an answer as to whether or not they wanted me to be seen in the clinic or what the plan of action is going to be. We used to have a very active bariatric Community where I live but over the course of time everyone seems to have disbanded. I just am not sure how critical my labs are compared to how I feel. Ugh!

The combination of how you feel and your numbers would worry me and I'd be pretty upset if those things weren't concerning to a doctor.  Even if your numbers weren't concerning, the way you feel is something that needs to be addressed and not ignored.  

In your shoes, I'd be asking my docs "why aren't you concerned about these things?"  And if I didn't get an answer I liked, I'd be finding new doctors.  

As a woman, I'm especially stubborn about this because I know there is a long and systemic issue with addressing the health concerns of women.  Things tend to get ignored, or we're told we're imaging things.  I'm so not willing to mess around with my health.  

This is my opinion from my experiences ....

Your Vitamin B-12 is very low which will make you feel like crap. In theory it is normal... mine was like 450 and I was having low B-12 symptoms. Now mine runs over 1000 and no symptoms. No danger in it being high, and I know I am not the only one on here who has mentioned being happier at a 1000+ number. I take 1000mg a day Trader Joes sublingual. The one with folic acid.

Your D is deficient. I had deficient D for over a decade pre-WLS. I could never bring it up. In researching vitamins right after WLS I discovered liquid Vitamin D3. I buy the Vitamin Shoppe brand. I have worked myself  20,000 mg a day - 20 drops...which I know sounds like an insane number but I finally have normal Vit D levels. I am within range. Between my natural inability to absorb Vitamin D and RNY this is what it takes.  Low Vitamin D will also make you feel like crap.

Calcium is a tough number. If your blood calcium is deficient your body leeches calcium from your bones. Best thing is to have a bone scan/dexascan if you haven't had one.

You didn't mention Ferritin and Thyroid numbers.  Both of those can severely effect how you are feeling if they are off.

Thyroid there are several tests- make sure they include T3... just because others are normal doesn't mean a good T3 (again I know from experience)

I agree on the B12 and D3. Those need to be much higher. I like my B12 at 1500, and my D3 over 50, but closer to 80.

I'm not sure if ferritin is missing, or if the iron you list at 78 is ferritin. If they didn-t do ferritin, it's vital you have it checked, considering how far out you are, and your symptoms.

Have you tried the Vitalady regime? I have been following her protocols for a decade and have never had a bad labs. I would talk to your doctor- I get concerned when my labs start to get on the low end of normal.

Scott

You need to remind yourself that you're a customer...and remind your docs of that, too.  If you are feeling that poorly, then there is something wrong.  Put your foot down and insist.  You see things trending downward - it's time to make some changes.

Thank you all! Sometimes, as a nurse, it is hard for me to advocate for myself. I feel like I am self-diagnosing which every medical provider hates. The flip side is the symptoms are real and the numbers don't lie. I appreciate all of your feedback, I am definitely going to make a few phone calls today to see what I can make happen. Not sure if there is a Trader Joe's in Kansas City or not, but I will look into the liquid D, I hadn't realized that the absorption would be different. Hopefully, they will give me some weekly B12 injections and the hematologist is going to look at my chart again to see if he will consider an Iron Infusion. We'll see what happens after that. Thanks again!

Nurse here too. Just looking at your numbers I don't see any 'critical' values. Which is why you never just look at the labs. You have low D, a low norm protein, and your B-12 is eh. So your specialists are not panicking at this point.

Your more serious problem is your statement about your primary care physician. Any GP should be able to interpret a set of labs. If you really think your PCP is so bad he doesn't know what to do with your labs, for pete's sake fire them and get a capable one, quick!

There -can- be side effects to over supplementation of vitamins, even the water soluble ones, and some of them are serious. You should not be randomly trying to fix the labs without help.

for all you know, it could actually be your thyroid levels that is the problem here, not your labs at all, and you need a really good medical partner to figure this stuff out with you. 

I hope you feel better! And find a better Dr!