Lab work concerns

Would you guys be concerned about a prealbumin of 18, Vitamin D of 38, and RDW of 15.7?  Other things seem to be in range.  My appointment was rescheduled by the office for 4 weeks from now, and just got the lab results.  

Also have any of you heard lately about the importance of vitamin K-2?  I just read something about it.  It's not even tested on my lab work and isn't in my multi.  

Thanks guys!

I wouldn't be concerned but I would take heed.  

Regarding your prealbumin, what was it the last time you were tested?  If you don't know, find out.  The numbers are important but also the direction they are going is really important.  This includes those results that are in the normal range but are trending down.

I would increase the protein.  I like to keep my number above 20.  

Your vitamin D is low but not critically so.  However it is a good idea to work on increasing it.  If you check on Amazon you will find D3 50,000.  I take one of those a week to keep my numbers around 80.  Don't bother with D2.  We don't absorb it.  If your doctor tries to give you a prescription just smile and nod.  I would take one or two capsules a week and check again in 3 to 6 months and see where it is at. 

My NP about had a stroke when my D got up to about 90.  She had never seen a WLS patient with D that high.  I backed off a bit and found what worked for me.

Your RDW doesn't sound like it is that high and I wouldn't worry about it now.

Again, get a copy of all your labs and check the trends.  If you notice things getting lower increase the dosage.

Thanks a Lady  Tazz. I had them done 3 months ago so I will compare the 2 reports. Good idea!

Lady Tazz is right. For instance, a D of 38 is ok, but I'd want mine higher. But if on your last labs your D was 60, it is definitely going in the wrong direction, and you need to up it. But, if it was 20 last time, it's already on the way up, so what you're taking now might be ok.

Trends are super important, especially for iron. Many vitamins you can change the levels pretty easy. Iron is the slowest and the hardest, because most iron is absorbed in the part of the intestine that's bypassed.

Make sure you take a dry D3, not an oil capsule.

Most docs ignore K. Most of it is absorbed in the part of the intestine that isn't bypassed, so they don't think it's an issue. But it's primarily found in green leafy things, so if you don't eat lots of those, it might be worth checking. I don't eat green things, and my K was low, so I supplement.

Thanks for your response, Grim. I just checked my last labs from 3 months ago. My D was 38 then also. My RDW was 15.4. My prealbumin was not tested for some reason. So I think I need more protein and could benefit from more D. That sound about right?

Sounds about right.

Many docs do basic labs that every non WLS patient gets, and throw in labs for D and a couple others. They don't check for K, A, copper, selenium, etc. Even getting labs in a Boston hospital, the copper tube goes all the way to the Mayo clinic for testing -- that's how seldom it gets checked. Other docs check iron but not ferritin, etc.

A full set of labs runs about 15 vials of blood. Some need special handling, such as needing to be kept cold, or in a light-proof tube. I would really insist on getting everything checked once a year, more often if there's a deficiency. Some docs are great about doing it, some can be resistant.

My surgeon doesn't test all the ones you mention. I actually think my primary will be more on board with that. I think they take about 6 vials when I go. My PCP is all about prevention and health so I think he'll order the works once I'm released to him. But my surgeon keeps his patients for several years so it could be a while. I'll ask him. But his form is already pre-filled out and just his standard lab work. 

Most people end up having their PCP do labs. Some are great, others resist because they have no experience with WLS and malabsorption.

After a couple of years or so, most stop going to their surgeon for routine labs. If you don't have a surgical issue, there's not much reason to see a surgeon.

Be careful about duplicating some labs between doctors. Some tests are expensive, and insurance may only cover one such test every six months or year, unless there is a serious issue. It's best to find out before you get stuck with a bill.

Why do we need a dry D3 instead of a capsule? I've been taking 3 small capsules daily (2000 mg each), but will switch if there's a problem. At my last labs (about a month ago) my levels were normal.

Thanks!

The little football shaped things (and others) have the vitamin suspended in oil. Since we malabsord fats, we won't absorb all of the vitamin. If it comes in a dry form, either as a pill or dry inside of a capsule, it's absorbed much better.