Intestinal metaplasia is the transformation (metaplasia) of epithelium, usually of the stomach, to a type that bears some resemblance to the intestine. Initially, the transformed eptithelium bears resemblance to the small intestine; in the later stages, the epithelium resembles the colon. It is characterized by the appearance of goblet cells.

It is considered to be a risk factor for the development of adenocarcinoma.

So since as far as we know vasculitis, protein losing enteropathy, lymphedema of the intestines, other inflammatory processes, and TB of the Intestine ruled out from the biopsies.

The next step since my labs are still in the dumps and I am still not absorbing nutrients there will be a trial of Intramuscular Injections of all the Vitamins from vitamin A, All the Bs but already on B12 injections, Vitaminc, Vitamin D3 and Vitamin D 1, 25 hydroxy, Vitamin E, Vitamin K, and Calcium.  If this shows some improvement then a port will be placed for all the Vitamins to infused Intravenously this is sort of like TPN but is more specific In the Vitamins I need and may not have to be done on daily basis.

Also wants me have another Iron Transfusion which getting a preauthorization from Insurance.  For me they are so fun (facitious) because my veins are not good they are tiny delicate and blow easily, so a central line is placed before the iron infusion and after central line I get the first dosage of iron transfusion before comming home.  This a day surgery thing and done as outpatient, then every other day up to 5 infusions for more of the iron infusion which takes about 2 hours per infusion.  With the central line it is easily done and infused from there.

Other updates with labs my copper level was high even though had not had for at least 6 weeks prior to labs because of a backorder.  So now Copper is taken off the med list and will be retested with other labs in 3-4 months.

I also have an appointment end of November with the Genetics department at UCLA to see if there is anything genetically that could explain part of the malabsorbtion issues and also because I have Hypermobility Syndrome (basically over flexable joints).  I can bend my pinkies on both hands backwards more than 90 degrees, I can touch my thumb to wrist on both hands, my elbows and knees can be hyperextended more than 10 degrees, placing my hands flat on the ground with out bending my knees.  There are a few connective tissue disorders that are dominent (where it  could be about 50-50 chance of passing it on offspring or getting from mother or father) and can affect many areas in the body with varying degrees. 

The other wierd part was in CBC the doctor ordered both the auto differential and and a manual differential where my Red Blood Cells are of uneven size and shape called anisocytosis and this is considered rare but can be detected and formed with anemia or other issues.

I also have an appointment with neurology with the rash swelling of my right arm and hand that has been going for 18 months and still no answer to what is going on.  My strength in my right hand is now greatly reduced and I am right handed, plus a bit more pain too.  Hopefully neurology will know is going on.

marinol for nausea woorked for me but insurance is still denying it so now will have a state hearing hopefully will be before 1st of year, trying to get expediated.  Still getting sick daily but a little more than in past, still tired, still feel unwell, ect but taking one day at time.

Good news my PTH levels are lower from Sept this year from 98 to 72 but this is still considered high but better than before.  I started in September on Calcitriol for Secondary Hyperparathyroidism started at 0.5 mcg twice daily, then upped to 1 mcg twice daily now new dose 1 mcg 3 time daily but at least the PTH is falling which is a good thing.

I follow up with gastroenterologist enf of january, next follow up with endocrinologist is begin of january and the follow up with rheumatology is in january sometime.

So far since Mid July have seen specialist at Stanford for Lymphedema, Bariatric specialist UCLA, Gastroenterologist, Rheumatologist, Dermatology, Endocrinology, with new Nov 29 with genetics, and Dec 9 with neurology so getting there and hopefully can a bit of sanity back in life of some sort.  Not asking for miracle cure all of that it and fix scenario but know that If I get the nausea down by 15-20% I would be ok with that and get vitamin levels closer to a normal level either from injection, intravenously, or via digestive track then I will be ok there.  i know may never really the true cause of everything but some knowledge is better than nothing.

I have stated before I am not the norm and know with the issues i face some you may also being though some sort as well and in my journey for knowledge I hope to be able to help another on the way to better understand thier issues or learn new things that they may not have known that they can discuss with thier doctors.

I thank everyone on the forum for the support and asking questions and i like learning from you all as well as some things I may have not thought that made me look at things from a different perspective.  All of journies are individual but also as a whole support to keep us all moving forward with knowledge understanding and companionship where we are never alone.

I can feel your pain.  I actually had to have mine reversed.  I have a friend that has had several problems and surgeries since her original RYB.  We actually talked to OH about setting up a small group for support of those that have had or are having complications.  If you are interested, I will send you an invite once we get it up and rolling.

-Kim T