my suggested labs with dx codes and preferred levels

Not to be construed as medical advice, this list includes labs we have had performed as gastric bypass patients. The first group, every 3 to 6 months for life, as we are able. The second group, annually, as long as the results were comfortably within normal limits for more than 2 years in a row.



1st Group



*80053 Comprehensive Metabolic profile: (sodium, potassium, chloride, glucose,BUN, creatinine, calcium, total protein, albumin, total bilirubin, alkaline phosphatase, aspartate aminotransferase) (10231)

* 84134 Pre-albumin:

* 7600 Lipid profile: (cholesterol, HDL, LDL, triglycerides, chol/HDL ratio)

* 10256 Hep panel: includes ALT (SPGT) & GGT)

* 84100 Phosphorous - Inorganic: (718)

* 83735 Magnesium:

* 84550 Uric Acid: (905)

* 7444 Thyroid panel: (T3U, T4, FTI, TSH) (84437; 84443; 84479; 84480)

* 85025 Hemogram with platelets: (1759)

* 7573 Iron: TIBC, % sat

* 83550 Ferritin: (457)

* 84630 Zinc: (945)

* 84446 Vitamin A: (921)

* 82306 Vitamin D: (25-hydroxy) (680)

* 84052 Vitamin B-1: (Thiamin) (4052)

* 84207 Vitamin B-6: (Pyridoxine)

* 7065 Vitamin B-12 & Folate: (82607; 82746)

* 83970 Serum intact: PTH

* 83937 Osteocalcin:

* 84597 Vitamin K:

* 85610 PT:

* 85730 PTT:



2ND GROUP



* 593 LDH:

* 31789 Homocysteine, Cardio:

* 83921 MMA:

* 367 Cortisol:

* 84255 Selenium:

* 84590 Vitamin E:

* 82525 Copper:





For diabetics: *496 - HEMOGLOBIN A1C













POSSIBLE DIAGNOSIS CODES





269.2 Hypovitaminosis



268 Vitamin D deficiency



275.40 Calcium deficiency



266.2 Cyanocobalamin deficiency (B12)



281.1 other B12 deficiency anemia



281.0 Pernicious anemia



280.9 Iron-deficiency anemia



281.2 Folate deficiency anemia



285.9 Anemia, unspecified



269.3 Zinc deficiency



244.9 Hypothryoidism



250.0 Diabetes



401.9 Hypertension



276.9 Electrolyte and fluid disorders



272.0 Hypercholesterolemia

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -



*579.3 Surgical malabsorption*



*579.8 Intestinal malabsorption *





* Bands or sleeves should not use these codes as they are not accurate.



*Some insurance companies will not pay for any procedure that uses these codes.





LAB TARGETS





This is NOT medical advice, just my own targets for the main blood levels I watch.



Protein: 7's

Albumin: 4's

Pre-Albumin: 20-30's



Iron: 80-100

Ferritin: 200-300

HGB: 12+

HCT: 36+



Vit A: 60- 80

Vit D: 80-120



Calcium: 9.0-9.4

PTH: 20-40



Vit B1: Mid to top of range

Vit B6: Mid to top of range

Magnesium: Mid range (but also go by if we have leg/foot cramping)

Zinc: Mid range



Vit B12: 1000 +

Folate: Top of range



AST (sgot): Below 40

ALT (sgpt): Below 40



We usually want to "meet or beat" pre-op levels. In some cases, higher is better, and in other cases (Cholesterol, PTH for example), lower is better.



The only things *I* don't mind being on the high end of out of range are Ferritin and B12. But that applies to ME.



My doctors don't show interest in any of these until I am out of range. *I* am interested when I begin heading that direction
****

Mind you these are MY own preferred levels, based on the most recent studies, not necessarily matching the ranges used at your local lab.

Thanks, Michelle.  I am going to copy this and keep.

Thanks Michelle,

I just had my labs all done and I will compare them to your info. I know that both my PCP and my surgeon say I am good. My B12 has been 1400 and that has bothered me that it was so high but looks like I shouldn't worry? I have been working on bringing my D up more and my protein.

Thanks again for the info.

deb366

EGAD< hang onto that B12. What a nice one!

To do my list, it's 17 vials. Scary, huh?

It has been high since before my WLS and I don't take it everyday, I was worried since on the lab results it is marked as high but my PCP said not to worry it was fine. Sounds like my docs are okay with my D getting up to 100 too? I live in a sun deprived area so don't know if that will happen. My PCP says 57% of the women he sees (not WLS) are low in vit D. and one of the local docs was on prescription D until she moved to New Mexico and within 3 months of sunny weather her D was up to normal...I do hope to grab some rays tomorrow!

Thanks for all the articles and info you share it is helpful, also like it when you summarize the articles in English for all of us


deb366

Define: normal, as to D levels. In 2005, a level of 40 was great. Today, we want to be nearer 100. So, "normal" might mean only 32. And people are often not treated for D issues if they read 31. And really, I wouldn't expect a PCP to read cardiac, autism, MS, fibro, pediatric and all those related articles on vit D. And I wouldn't expect anyone in one of those fields to read everything ELSE. I mean, think about it. This is ALL I do, 24/7 and I'm barely scratching the surface! I just read it all, then run it thru my "malabsorption filter", I call it, where I take what they say and adapt it to US, specifically.

Here's the B12 stuff. Sorry I don't know how to turn those into pretty links

***

These two paragraphs from the first article referenced below are so compelling that I want to include them here, as a reference for everyone who has ever faced a doctor that claims a level of 200 is "fine".
==============================
Various authors have documented the psychotic (Hart/ McCurdy) , depressive (MacCallum), and consecutive affective and psychotic conditions in the same patient (Verbanck/ LeBon). Drs Levitt and Joffe, working at the Clarke Institute of Psychiatry in Toronto (where I trained, years earlier), published a report about vitamin B12 deficiency causing the psychotic form of depression, in the British Journal of Psychiatry in 1988 (Levitt/ Joffe). They also reviewed the medical literature and found that psychotic depression is more often caused by B12 deficiency than by any other known or unknown cause.
This fact is hardly ever borne in mind when psychiatrists confront a case of psychotic depression and, when they do think of it and order a serum B12 level, they will more often than not still miss the deficiency because the lab "normal range" is so low that their patient's B12 level almost always appears to be in the "normal range".

At least six neurological and psychiatric papers, in top medical journals, have shown that the normal range should be regarded as at least 500-1,300 pg/ml (rather than 200-1,100), since the cerebrospinal fluid level can be deficient when the serum level drops below 500, and neuropsychiatric symptoms often occur at serum levels between 200 and 500 pg/ml (VanTiggelen et al, Lindenbaum et al, Mitsuyama/Kogoh, Nijst et al, Ikeda et al, Regland). As for the still held misconception that the neuropsychiatric effects of B12 deficiency are always accompanied by a macrocytic anemia, it is humbling to know that this notion was already debunked in 1905 (Langdon)! Since then, many papers have stressed this point, including those by Strachan and Henderson (1965), Evans et al (1983) and Lindenbaum et al (1988).
============================================


> http://www.johndommissemd.com/b12.html
> http://www.veganhealth.org/b12/formula
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&l
> ist_uids=824083&dopt=Abstract

Michelle, You have given me a lot to read and digest. I am a little over 4 yrs post Lap RNY. I HAD lost 202 lbs total, having excess skin removed Aug 0f 2007. Since then I have regained almost 20 lbs. Not something I'm proud of. I feel great, am living life fully, just not exercising as I should or to be honest eating as I should either. Protein first has kind of fallen be the wayside. I've let too much junk slip in that has no nutritional value. I don't have adverse reactions to carbs or sugars which is probably NOT a good thing.  I have become a bit complacent even thinking that I am "normal." Normal where food concerns I will never be. Maybe I am just now really ready to hear your message, but it has struck home with me. I look forward to a chance to sit down with you and get my mind around all of this. I need a new plan and am ready to take one on.

See ya tomorrow afternoon, k?

Looking so forward to meeting you Michelle!

That was fun! Wish you guys had had more time!