Vitalady or others..on labs

Hi! I had my labs drawn a couple of weeks ago and just got the nutritional portion back.  Things look much different from the last time back in December, but I am not sure what it means. My B12 went from 340 to 500, so I guess the shots are helping me build my stores up, but I thought it would be higher by not. What was a bit odd was that my B6, Folate, Vitamin D 25-OH are all ELEVATED.  What's up with that and what in the world does it mean?  Am I over supplementing?  I have been sticking with just a plain old multi, calcium and B-12. Also, do ya know what a C-Reactive Protein is as mine has been steadily decreasing since the surgery, but still within the normal range at 0.4.   Everything else, including the different iron tests are in normal so I think that's good, but I just didn't know what the elevated vitamins were indicating.   Thanks for any help Rachael

And we're shooting for a low end of 800 with the B12. I do weekly shots and can't get up TO 800!

I'm not too worried about B6 or folate, but the vit D. What do you mean by elevated? Like which number on which lab scale? And where is the serum calcium and the parathyroid?

The iron....... where is the serum iron and ferritin? Don't care so much about the Hgb & Hct.

Did they measure vit A, zinc and B1, too?

I am not sure if any of the tests below include serum calcium and or parathyroid.  But, the Vit. D is listed below.  These were all the labs they took that day and the ones in red, showed abnormal in some way. thanks Rachael Cells: 4.16    MCV: 96    MCH: 32.0*    Mean Corpuscle Hemoglobin Concentration: 33.3    Red Blood Cells Width Distribution: 12.4    NEUTROPHILS %: 52.6    LYMPHS %: 39.5    MONOCYTES %: 5.2    EOSINOPHIL %: 2.4   Sodium Blood: 139    Potassium Blood: 4.0    Chloride Blood: 108*    Carbon Dioxide Blood: 25    Urea Nitrogen Blood: 10    Creatinine Blood: 0.71    eGFR: > 60    eGFRAA: > 60    Glucose Blood: 86    Calcium Blood: 9.3    AN-GAP: 6 PROTEIN TOTAL BLOOD: 6.8    ALBUMIN BLOOD: 3.9    BILIRUBIN TOTAL BLOOD: 0.5    ALKALINE PHOSPHATASE BLD: 82    SGOT Blood: 30    SGPT BLOOD: 38   MAGNESIUM BLOOD: 2.1    Iron Blood: 75    Total Iron Binding Capacity: 430    Percent Iron Saturation: 17    Ferritin Blood: 8*   VITAMIN A (RETINOL): 0.59    RetPal: 0.07    VITAMIN B-12: 500    VITAMIN B6: 39.1*    RBC FOLATE: 930*    VITAMIN D 25-OH: 68*     C-REACTIVE PROTEIN: 0.4   INTACT-PTH: 36  

Your D is 68, and I am vastly impressed, since I target 70. Your A is kinda saggy at 59. I target more like 70 for that one. Your PTH is good at 36 and calcium at 9.3. The worse thing I saw here was your ferritin at 8. EGAD! What are you taking for iron?

I have not been taking an iron supplement for awhile.  When I was with my surgeon last week he asked about making sure I had iron in my multi-vitamin.  I was like "oh of course, I use the bariatric advantage chewables with ADEK"  Well, I come home and a few days later I look on the bottle and the bariatric advantage one doesn't have iron in it.  Hmmmmmmmmm So, for about 3 months I wasn't taking ANY.  So, I switched back to my regular multi with iron from CVS.  I was just surprised that the BA's didn't have iron.  I guess they assume you will add your own supplement.  I am hesitant to add in a seperate iron as I got awful constipation when I was on Foltrin 6 months ago. 

The BA's don't have iron in the multi because they are formulated by somone who "gets it" about iron. Iron is not well absorbed if it is mixed with other minerals.

So, iron in a multi is basically "on the label" more than in your body. Also, with a ferritin of EIGHT, you need way more iron (with vit C and separately taken) than is in a multi vite! I start my proximals on 150mg, but they usually end up more like 300mg of iron. The BA's have either 18mg or 29mg, so you may find another choice.

We do not absorb any of the ferrous family very well. That's sulfate, gluconate or fumarate, tho some believe the fe fumarate absorbs well.

I guess I am not sure why the surgeon's office doesn't think I have an iron issue with the ferritin low.  Possibly it's because I don't know the difference or what one has to do with the other.  I have the advantage of having a PCP that will oblige me any need/desire I come to him with regarding my post-surgery stuff.  That's how he agreed to a weekly b-12 shot.  So...should/ or do I need to go to him to get something for the ferritin problem or is it an over the counter supplement type thing?   Also, my labs through the Vanderbilt website are graphed over time.  My vitamin A was not tested prior to surgery, but after six months, when they did the panel, it was quite low at .22.  THe surgeon asked if my multi had vit. A in it.  Well of course it does.  He didn't suggest anything else.  Over time, it has gone up and it has gotten to the .59 that you suggested was sluggish.  So, I guess I am saying that I have no CLUE what I would do about the vit. A.  The graph of the ferritin looks quite sad as the sixth month post surgery mark shows them at 39 and now I am at 8 so if it's important, I would like to take something to get it taken care of. Also, I learned that because I was so heavy, my surgeon bypassed 150cm.  I never knew how much was bypassed and called to ask yesterday.  That seems to mean I am 'a long proximal'???  Given the 150 bypass, should I be considering other supplementation?   Thanks for your imput.  Any help is good help.  I don't get angry with my surgeon for not knowing or telling me everything.  I know there's not a lot of absorption research and that he's good at his job of the technical surgery of it and for that I am grateful.....no complications!  But, I will take advice where I can get it.  Rachael

Well, I can tell you no one really grasps the whole ferritin concept. Ours was sky high (pushing 800) first test we had (run by accident) and not one of 6 docs could tell us why or how or what to do or should we be worried. It spent down over time and I made a point of learning about it, so we could manage it. BUT I usually see ppl in single digits with docs who are fine with it as long as you are still upright.

Well, let's see. How to answer the rest. If you have had WLS (of any kind) you need to be taking a more aggressive stand on your supplementation. 150cm is the standard, but is the long limb proximal. Mostly the shorter ones are fading out of favor. Mine is a true distal, measured by what's left, not what was bypassed. If it was, it'd be more like 300-400cm bypassed. I only know 2 of the 3 measurements, as do most proximals. I only know of a handful of docs who measure the entire intact intestine and then actually mention all 3 parts of the "Y" in their op reports. So, we can safely assume that you are a LLP, basically.

So, the items that I keep liisting:
protein
iron
calcium
A, D, E
B1
B6
B12
zinc

All of them have to be addressed separately, above and beyond your multi. The BA multi is the best formulated of all that claim to be for WLS ppl. No question, but you'll note the whole line includes iron + C, calcium + D, B12, separate D, Separate B1, B-complex and so on.

It is a good line, however, very expensive. I use the cinnamon calciums, along with a capsule and UpCAl D powder for my calcium. I take a separate D. I take a separate A. I take Tender Iron (which specifically builds ferritin and no, I don't know how or why) + vit C. I take separate E. Sadly, that one has never been tested, so I go by my skin. I take separate zinc.

I had a starter formula, way back when, and then adjust to labs as time moves along. I didn' tmention protein, but of course, I take 180g supplementally and don't count what I get in food.

If you want me to give you a suggested list, happy to do that off list, of course.

I think it's way cool that you can see your labs online, all nice and laid out for you. No chance for a typo in them, like we found in ours that we do ourselves. My poor endo! Don had typed a calcium level at 3.7 and it should have been 8.7! (which is too low, BTW) 3.7 would not be, um, life sustaining, KWIM? BIG booboo.

We get our copies, then I fax to each surgeon, endo, hema, MD, ND. But we're the only ones consistently looking at now and 6 months ago. The endo does, but only once/yr. Hema does, and I was seeing him every 6 months (my issue is not WLS related, had it since the 80's), but I pointed out that I was always happy to visit and argue about what a ferritin level should be and how ferrous sulfate doesn't work, but since we can't really FIX my issue, only monitor it, howzabout we go to once/yr? He was good with that, so I said, "August when I'm fresh from the ASBS conf and freshly fueled for 'discussion' or Feb when I'm getting ready for the conf?" LOL He actually elected for August!

As time goes on and your life revolves less and less around your surgeon, you need to be able to pick up the reigns and run with your own stuff. I've lost 2 PCP's to retirement (the nerve!) and 2 to insurance changes. So, I started breaking in the one I have now in 1999. I've tried to teach him the vitamin stuff, but he's not interested. He'll run the tests, he'll look at them, but when I explain how I plan to make a level go up or down, he just kinda said it was enough that *I* know, he doesn't need to.

I would love a list of suggestions via private message on OH.  Well, all but B-12, I got that covered with the weekly shots.  I have not seen my operative report yet to see about the lengths that you were talking about, but the surgeon's office said they would post it for my access on the Vanderbilt personal health access site where I see my labs.  That will be interesting to check out. Thanks Rachael

Michelle, Would you mind sending me a list of what lab tests you recomend & how often to have them done as well as what levels a proximal RNY'er should aim for?  You can send it to me off list if you'd rather.   Thanks! Vickie J.