Labs- Cacium and Iron help, Please.

I feel like Christmas in July!  All my labs are back.

My supplement schedule- 
dose 1:  630 Ca, 1 MV, D 50K, A 25K, E 400, Mg Citrate 250
dose 2:  630 Ca, 1 MV, K1 2000, Mg Citrate 250,
dose 3: 630 Ca, A 25K, 1 Proferrin
dose 4:  630 Ca, A 25K, 1 Proferrin

I quit taking my B complex for a couple months 'cause I'd really gone too high on most things and was showing symptoms of toxicity (rashes and weird mind spaciness). 


The good: 
Lipid panal was BEAUTIFUL (even my HDL!)
- D and PTH were optimal at 65 and 25
- All my protein markers were upper mid range
-B's were all upper mid range
-E was good
-Copper and Zinc upper mid range (yeah! cause Zinc makes my stomach feel horrible)

The not so good:
-Serum Calcium was 8.5 range (8.7- 10.2)  Sooo I guess time to add in K2 and boron.  I'm already taking four doses of Ca Citrate (2520 mg) a day.  My bowels really can't handle much more.  Definitely open to suggestions.

K1 was .28 range (.28 - 1.78)  PTT / INR were mid range. So I'll bump it up. to 3K a day?  I've got excessive bruising and little red pin ***** bruises so sitting at the bottom of the range isn't working for me. 

The BIG SUCK is iron.  I don't get it. My b12 and folate were at the top of the range.

RBC 3.33  (3.8 - 5.1)
Hemoglobin 11.4  (11.5 - 15)
Hematocrit  33.5  (34 - 44)
MCV 101 (80 - 98)
MCH 34.2 (27 - 34)
TIBC 301 (250 - 450)
UIBC 189 (150 - 375)
Serum Fe 112 (35 - 155)
Fe Saturation 37 (15 - 55)
Ferritin 22  (13 - 150)

Also my WBC were a bit low at 3.8 (4.0 - 10.5).  Any reason to be concerned with this?

I plan to add in boron and K2 with calcium in my first two doses.   I'll spread the 3k of K1 out with my first two doses.  I also plan to add back in a b complex a few times a week.  I'm also adding another A to get me closer to the top of the range, so I plan to take 50k with my last two doses. I have no idea what my plan is for my iron.    I am very open to critique on my plans.  I would also love iron recommendations.

Thanks everyone if you've read this far!

Iron infusions.  That's where you're headed.  Do it sooner rather than later.

On the vitamin K, I would double it, at least.  There's a biiiig range and you're at the bottom.  No posted tolerable upper limit (and that's for normies, even).  People with cystic fibrosis (who malabsorb...not the same as us because they use their whole intestine, of course, but kinda-sorta similar in a distant cousin kind of way) take 5-10mg per day.  I know lots of post ops are only taking 1mg, but some people need more of some things than others.  I think if you look around long enough, you'll find some people taking 200k IU vitamin A, and some taking none, or only 25,000IU.  Big range.  Same can happen with the vitamin K.  You might need more, they might need less.

Contraindications to that would be kidney problems, people on diabetes meds, people on coumadin therapy, etc.  Assuming none of these apply, I think you can really safely up the vitamin K.  Go ahead and discuss with your MD and soon-to-be hematologist and keep an eye on the labs for improvement.

Sources that site the liver damage and/or hemolytic anemia associated with vitamin K toxicity are typically referring to K3 -- which you won't be taking.  I'm not saying there's no risk (I'm not all-knowing), but I think vitamin K is pretty safe to take, especially in a malabsorber.  Definitely discuss with your medical team--esp. the hematologist, I did with mine, and he thinks it's really safe, too.

That being said, I would add K2 as well.  REALLY LOOK AT THE LABEL on these.  Some of them have such small amount of K2 in them and yet are sooo expensive--it's kinda like, why bother?  10mcg or 100mcg just really isn't that much...especially for someone malabsorbing.  You may need to search other areas of the internet and vitacost for a good supplement with a lot of K2 in it.  The K2 can help the Vit K levels too, so that'll be a nice bonus, yes? :)

Vit K -- good for clotting, bones, etc (both kinds, not just K2!).  Did you have osteocalcin drawn?  It is a vitamin K dependent protein and can be helpful, here, too. 

Calcium:  okie dokie...kinda confusing.  So, when you have hypocalcemia, the natural reaction to the body should be to raise the PTH, take it from the bones, keep it in a narrow range.  This is not happening, which makes me wonder if your calcium level is lying to you.

The regular old "calcium" measures calcium bound to proteins in the blood.  There is also free floating calcium -- measured by a test called ionized or free calcium.  Theoretically and under normal cir****tances, these should be equal or about equal.  Makes me curious to see if your calcium is low because it's actually the protein is low and the ionized calcium might actually be OK?  I know you said the protein markers are good though, so I'm not sure.  Again, you're not following the pattern.  Your PTH should be higher if your calcium is no good.  Could you post protein, albumin, and pre-albumin just for kicks?

I have leukopenia (Low WBC) too, and have for over a year.  I thought mine was due to antibiotic use, but I stopped taking flagyl and mine are still kinda low and I don't know why.  Me and my hematologist are looking into it.

Won't hurt to get a hematologist on board soon for the iron.  You are totally in the crapper yet, but you are slipping.  I'm not sure what your iron regimen is like so I don't know if it's possible for you to bring it up orally or not.  I was able to bring up my ferritin, but it took a really big load of iron and I understand that some people's intestines just can't handle it.  Took me like 340mg tender iron, 300mg polysaccharide, and 2 proferrins to take my ferritin from like 19 to 69.  Lots and lots of work.

Kayla, THANK YOU for this awesome post.  I have a referral for the hematologist, so will be setting something up soon. 

I currently take two proferrin a day (2 doses broken in half)  My numbers are not really changing one way or the other.  The poly and carbonyl seem to just make my poop pretty colors and constipate.  I'll try adding them again.  I'm not sure I can get my insurance to agree to infusions.  I'll definitely try.

I didn't have osteocalcin drawn.  I had to fight for the PTH. I will double the k1 and get on board with K2.

Yeah, I don't get the Calcium at all either.  My Internist is not at all concerned but I am.  Protein numbers:  Pre-albumin 23 (20-40) ; Albumin 4.3 (3.5 - 5.5) ; Protein 6.6 (6 - 8.5).  Not as good as I originally thought when I first looked.  I think I'll add an evening shake.

Thanks for your help! 

Regardless of whether you can get your insurance company to cover infusions,  they are likely necessary for you and unavoidable.  Be prepared to pay for them out of pocket.  Happens to many DSers.

Thanks.  I know you're right.  I would just love to find away around it if I can.

Who is fighting you?  Surgeon or PCP?

I apologize, I cannot really relate.  All I have to do is take my list to my PCP, he says cool, and we're done.

Fighting with my medical team is not my cuppa tea.  If you aren't that pleased with your care, I'm sure you could go elsewhere.

It's my insurance.  I had a 90 day break in my insurance shortly after my DS.  So now anything WLS related is considered a pre-existing condition and are not paid for.  I pay a small chunk for labs that are not routine. 

I'm pretty sure insurance is going to deny infusions.  But I'll try adding the oral and keep saving for infusions.

Have you tried having them coded as just generic intestinal malabsorption instead of surgical malabsorption?

The infusions could easily be coded as anemia...unless they want to deny that as a preexisting conditions.  It's not like normal people don't get anemia.  Iron is one of the most common deficiencies, esp in women.

Kayla, now that your ferritin is 69, what is your maintenance regimen?
another great post, btw.