Help with Labs? High AST results
Just passed my 6 year RNY date! Have had trouble with vitamin absorption since year 4 PO...Been trying desperately to find the right vitamin doses to keep my levels up...Have had trouble with Iron and the fat soluble vits as well as zinc, selenium and magnesium...
I went in for a pap smear and told the OB Doc that I was feeling tired...She ran a few tests and my AST levels came back several times higher than normal! My potassium was high as well and my Anion Gap was low...
She didn't run any iron tests even though I told her I had iron trouble and my last labs 6 mos ago my ferritin was low at 9 and that my B-12 had dropped over a year from 1127 to 434 ( IThe liver can store B-12 for 5 years...Guess my time is up!)....I have raised my B-12 over the last 6 mos from 434 to 510 taking 5000 mcg sublingual daily (YES, five thousand)...so that was an improvement but nothing to damage my liver....
I also raised my Vit A from 38 (low normal) to 51...and Vit D with a high PTH Intact from 25 to 38...And again nothing that would cause liver damage. Right?
Could the vitamin supps be causing my liver trouble???? I haven't had alcohol and don't take any meds, besides an occassional tylenol.... I've been working so hard to get my levels to mid-normal ranges and they are still not there...My doc didn't even call me back to let me know that my labs were off....I went in and asked for them yesterday since I was there for a routine mammogram....i was stunned that no one called me on the labs and it's been 3 weeks since they were ran....
Any ideas??? Any similar stories???
I don't know what to do or who to go to in order to get help finding out what's wrong....I'm so frustrated I could scream....It's hard enough trying to be my own health care advocate and learn all I can about vitamins and such...but I'm not a doctor and I don't know what all these labs mean or how they might be related or not....
My PCP is NOT helpful and obviously, neither is my OB who ran some tests herself and never even called me to follow up....My surgeon is not covered by my health ins...but I can request a visit to see him.... or maybe I should request a specialist instead??
Hope to hear any ideas!
Anita
I went in for a pap smear and told the OB Doc that I was feeling tired...She ran a few tests and my AST levels came back several times higher than normal! My potassium was high as well and my Anion Gap was low...
She didn't run any iron tests even though I told her I had iron trouble and my last labs 6 mos ago my ferritin was low at 9 and that my B-12 had dropped over a year from 1127 to 434 ( IThe liver can store B-12 for 5 years...Guess my time is up!)....I have raised my B-12 over the last 6 mos from 434 to 510 taking 5000 mcg sublingual daily (YES, five thousand)...so that was an improvement but nothing to damage my liver....
I also raised my Vit A from 38 (low normal) to 51...and Vit D with a high PTH Intact from 25 to 38...And again nothing that would cause liver damage. Right?
Could the vitamin supps be causing my liver trouble???? I haven't had alcohol and don't take any meds, besides an occassional tylenol.... I've been working so hard to get my levels to mid-normal ranges and they are still not there...My doc didn't even call me back to let me know that my labs were off....I went in and asked for them yesterday since I was there for a routine mammogram....i was stunned that no one called me on the labs and it's been 3 weeks since they were ran....
Any ideas??? Any similar stories???
I don't know what to do or who to go to in order to get help finding out what's wrong....I'm so frustrated I could scream....It's hard enough trying to be my own health care advocate and learn all I can about vitamins and such...but I'm not a doctor and I don't know what all these labs mean or how they might be related or not....
My PCP is NOT helpful and obviously, neither is my OB who ran some tests herself and never even called me to follow up....My surgeon is not covered by my health ins...but I can request a visit to see him.... or maybe I should request a specialist instead??
Hope to hear any ideas!
Anita
ANITA!!!! Its so good to see you!!!
(at the same time)
DAMMIT!!! Im so sorry to hear that you are having issues again w/ the malabsorption.
You know I am no expert on the vits - So im hoping (like Dawn) that the Vita-Lady sees your post & is able to reach out to you.
What about checking w/ your surgon (the one who did the surgery).
Dont they have a follow up/sustainability plan? Maybe they can refer you to a PCP whos a better authority on malabsorption issues - ??
Maybe OH has a Dr referal listed in your area???
I dont know - if i think of anything else, i'll be sure to let you know.
Candace
(at the same time)
DAMMIT!!! Im so sorry to hear that you are having issues again w/ the malabsorption.
You know I am no expert on the vits - So im hoping (like Dawn) that the Vita-Lady sees your post & is able to reach out to you.
What about checking w/ your surgon (the one who did the surgery).
Dont they have a follow up/sustainability plan? Maybe they can refer you to a PCP whos a better authority on malabsorption issues - ??
Maybe OH has a Dr referal listed in your area???
I dont know - if i think of anything else, i'll be sure to let you know.
Candace
The Will of God will never take you where the Grace of God will not protect you. 
Hi Miss Candace!
It's nice to see you too! I missed everyone! HI DAWN!!!
I was going to write to Michelle (Vitalady) but I wanted to see first if anyone ever had high liver enzymes and what that meant!
I'm used to my vitamins being off! They drop and I raise them too high...UGH!!! I can't get the doses right! I'll talk to Michelle about that....she always helps me raise my lows...But I almost always over do it and have to cut back only to fall low again! LOL I'll get it right one day!
I've got to find a way to see my surgeon....I think I can talk my PCP into writng me a referral to him again...She's the one who gave me the list of surgeons with his name on it and my insurance covered him...They just wouldn't cover long term follow ups...But my PCP is ignorant to the RNY anatomy! It's so frustrating...but I still feel quite blessed to have had a fairly smooth ride for 6 years...
It's nice to see you too! I missed everyone! HI DAWN!!!
I was going to write to Michelle (Vitalady) but I wanted to see first if anyone ever had high liver enzymes and what that meant!
I'm used to my vitamins being off! They drop and I raise them too high...UGH!!! I can't get the doses right! I'll talk to Michelle about that....she always helps me raise my lows...But I almost always over do it and have to cut back only to fall low again! LOL I'll get it right one day!
I've got to find a way to see my surgeon....I think I can talk my PCP into writng me a referral to him again...She's the one who gave me the list of surgeons with his name on it and my insurance covered him...They just wouldn't cover long term follow ups...But my PCP is ignorant to the RNY anatomy! It's so frustrating...but I still feel quite blessed to have had a fairly smooth ride for 6 years...
Anita:
So sorry to hear you are going through this...
Talk with vitalady. I would go to her website.
She is pretty good about getting back to you. Give her a few days. Just ordered a bunch of vits from her.
Did you ever think of faxing your results to your surgeon and having someone get back to you. I would explain, in a letter, that your insurance doesnt cover the appointment. Ask what you should do. Its their responsibility to help you with this issue. Someone should get back to you with some help.
If you need to go, you need to go. If you feel he can help. Try the fax first.
I will keep you in my prayers. Please let us know whats going on, as far as you finding someone to help you.
Melissa
So sorry to hear you are going through this...
Talk with vitalady. I would go to her website.
She is pretty good about getting back to you. Give her a few days. Just ordered a bunch of vits from her.
Did you ever think of faxing your results to your surgeon and having someone get back to you. I would explain, in a letter, that your insurance doesnt cover the appointment. Ask what you should do. Its their responsibility to help you with this issue. Someone should get back to you with some help.
If you need to go, you need to go. If you feel he can help. Try the fax first.
I will keep you in my prayers. Please let us know whats going on, as far as you finding someone to help you.
Melissa
Melissa,
I always end up talking to Vitalady when I get confused about my vits...I love her! She's always been so helpful....But the last labs really worry me and I really like your idea about faxing my results to my surgeon...
I believe I can push and get a referral...It just always takes sooooo long to get one because I need an appt with my PCP first and that is always a month or longer wait to see her! But I think I need to see my surgeon for peace of mind if nothing else! I haven't seen him since he released me from the hospital after surgery....6 years ago! Thanks for your thoughtful reply!
Hugs
Anita
OK the concept that we store B12 for 5 yrs? 
Musta come from a textbook and never applied to real life. I've heard 1 yr, 2 yrs. But it's all moot if you're over 45 or so, OR have had any type of stomach surgery OR if you had no B12 before surgery.
OK, so never mind, but if you email me privately, I maybe can help blow some of the cobwebs away from the leevels.
You were malabsorbing from day 1, but your levels either were not run at all OR didn't reach critical til now.
[email protected]
Musta come from a textbook and never applied to real life. I've heard 1 yr, 2 yrs. But it's all moot if you're over 45 or so, OR have had any type of stomach surgery OR if you had no B12 before surgery.
OK, so never mind, but if you email me privately, I maybe can help blow some of the cobwebs away from the leevels.
You were malabsorbing from day 1, but your levels either were not run at all OR didn't reach critical til now.
[email protected]
Michelle
RNY, distal, 10/5/94
P.S. My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.
The "concept" came from COUNTLESS websites...I just made the connection that it seemed to have applied to me that my 5 years was certainly up. Nothing more...
I am 45...and I realize that I may need to start B-12 injections regardless!
My vitamin levels have been somewhat closely monitored for 2 years (approx. every 6 mos)....Multivitamins alone are NOT cutting it for me...It doesn't matter WHAT I take...I need HIGH doses of certain/specific vitamins which means taking each of my problem vitamins separately rather than looking for a perfect multivitamin....It doesn't exist for me...I realize that now...I have to take Vits A, D3, Dry E, Calcium Citrate, B-12, Iron and a few others as needed in addition to a high potency multivitamin...
The problem is finding the correct dosages to MAINTAIN good levels and not just raise them....I raise them too high and find that I cut back too far and become deficient again...It's like yo-yo dieting with vitamins!
My biggest worry right now is that 6 mos ago, my doc told me that my labs were fine when my PTH was high at 81 and my Vit D was 25.40....OR that my ferritin was only 9 from 44 the previous 6 mos labs ... and my B-12 had dropped in half AGAIN!!! I KNOW that is NOT fine...She also didn't tell me that the urine test showed a possible urinary infection...She actually called me to tell me that my labs were "fine"....so I didn't rush in to get copies like I normally do...It was a month before I learned that I needed to up my Vit D, Iron and B-12 again! I was pissed! I should have called her, but I didn't know what to say without stepping all over her toes...I would have and I didn't want to damage our relationship because she runs all my tests that I request her to run! Once I requested a different doc I had to beg for her to run the tests that you use! She really gave me a hard time...So I like my doc for the simple fact that she runs the tests...She just doesn't help me interpret them and she just DOESN'T get that I had RNY and how it drastically changed my body! ARGGH!
Now it's been 6 mos since those labs...A different doc ran some tests last month and has NOT called. I did see that I raised my B-12 and Vit D...but not enough....She has not called to tell me that my AST and potassium levels are high and my Anion Gap is low....Normal AST levels are (14-36) mine was 95. That can't be "FINE"! But what do I know???
I usually write to you for help raising my levels and that works great! But now I need to raise them and then find the dosage to MAINTAIN them...
I am 45...and I realize that I may need to start B-12 injections regardless!
My vitamin levels have been somewhat closely monitored for 2 years (approx. every 6 mos)....Multivitamins alone are NOT cutting it for me...It doesn't matter WHAT I take...I need HIGH doses of certain/specific vitamins which means taking each of my problem vitamins separately rather than looking for a perfect multivitamin....It doesn't exist for me...I realize that now...I have to take Vits A, D3, Dry E, Calcium Citrate, B-12, Iron and a few others as needed in addition to a high potency multivitamin...
The problem is finding the correct dosages to MAINTAIN good levels and not just raise them....I raise them too high and find that I cut back too far and become deficient again...It's like yo-yo dieting with vitamins!
My biggest worry right now is that 6 mos ago, my doc told me that my labs were fine when my PTH was high at 81 and my Vit D was 25.40....OR that my ferritin was only 9 from 44 the previous 6 mos labs ... and my B-12 had dropped in half AGAIN!!! I KNOW that is NOT fine...She also didn't tell me that the urine test showed a possible urinary infection...She actually called me to tell me that my labs were "fine"....so I didn't rush in to get copies like I normally do...It was a month before I learned that I needed to up my Vit D, Iron and B-12 again! I was pissed! I should have called her, but I didn't know what to say without stepping all over her toes...I would have and I didn't want to damage our relationship because she runs all my tests that I request her to run! Once I requested a different doc I had to beg for her to run the tests that you use! She really gave me a hard time...So I like my doc for the simple fact that she runs the tests...She just doesn't help me interpret them and she just DOESN'T get that I had RNY and how it drastically changed my body! ARGGH!
Now it's been 6 mos since those labs...A different doc ran some tests last month and has NOT called. I did see that I raised my B-12 and Vit D...but not enough....She has not called to tell me that my AST and potassium levels are high and my Anion Gap is low....Normal AST levels are (14-36) mine was 95. That can't be "FINE"! But what do I know???
I usually write to you for help raising my levels and that works great! But now I need to raise them and then find the dosage to MAINTAIN them...
I actually just saw an email I sent to you back aways. Was wondering how you were doing.
Don't worry about toxic with A or D. Not going to happen with water solubles forms.
The hardest thing for medical ppl to accept is that we are not "cured" of these issues. You don't take a high dose, fix it, then stop.
It's a condition we treat. Forever. Tweaking is life long.
So, if it took 50,000 IU of D3 per day to get your D up to 80, but it took 6 months, you can try taking just 5 per week, but I wouldn't cut it in half. You will always take higher doses than most docs can wrap their heads around.
You maybe can maintain B12 on the 10,000 mcg, but wow, shots are SO MUCH CHEAPER!
No, no multi will cut it. D is measured in hundreds not thousands. iron is canceled by calcium and there's not enough of either. A is usually the wrong type and so on.
Did you start with my rny plan then raise some, then the doc told you, ok you're fixed, stop taking that one? Or did you just drop the dose?
We don't really stop taking things, just up or down the dose A LITTLE. it's that pulling the rug out from under that is spinning you up, I think?
Yes, and as you know, my words. Define: fine
it can mean nobody looked or that nobody knew what they were looking AT.
Are you taking milk thistle for the AST?
OK, try this. "Dr Luvpuff, you are so generous to run my labs for me. I SO appreciate it. And I'm totally happy with how we've been doing it. I hang with a group of peers who are many decades out of surgery now and they keep INSISTING that I keep copies of my labs (roll eyes). Many older post-ops' original docs have died or retired, the hospitals are closed or no longer doing WLS and they say I need to be keeping my own records.
Please understand that I see their point, and some day I'll be 20 years out, too. I just need to collect my op report and labs to keep a file.
If I ever need an unrelated surgery, it'd be nice to be able to show I'm healthy enough to have it."
Is there any challenge or face slap in there? I tried to write around that because, in reality, that IS what we say. My doc is retired. The hospital was sold to another entity. I have had unrelated surgeries o various body parts. LOL So have many of us.
Don't worry about toxic with A or D. Not going to happen with water solubles forms.
The hardest thing for medical ppl to accept is that we are not "cured" of these issues. You don't take a high dose, fix it, then stop.
It's a condition we treat. Forever. Tweaking is life long.
So, if it took 50,000 IU of D3 per day to get your D up to 80, but it took 6 months, you can try taking just 5 per week, but I wouldn't cut it in half. You will always take higher doses than most docs can wrap their heads around.
You maybe can maintain B12 on the 10,000 mcg, but wow, shots are SO MUCH CHEAPER!
No, no multi will cut it. D is measured in hundreds not thousands. iron is canceled by calcium and there's not enough of either. A is usually the wrong type and so on.
Did you start with my rny plan then raise some, then the doc told you, ok you're fixed, stop taking that one? Or did you just drop the dose?
We don't really stop taking things, just up or down the dose A LITTLE. it's that pulling the rug out from under that is spinning you up, I think?
Yes, and as you know, my words. Define: fine
it can mean nobody looked or that nobody knew what they were looking AT.
Are you taking milk thistle for the AST?
OK, try this. "Dr Luvpuff, you are so generous to run my labs for me. I SO appreciate it. And I'm totally happy with how we've been doing it. I hang with a group of peers who are many decades out of surgery now and they keep INSISTING that I keep copies of my labs (roll eyes). Many older post-ops' original docs have died or retired, the hospitals are closed or no longer doing WLS and they say I need to be keeping my own records.
Please understand that I see their point, and some day I'll be 20 years out, too. I just need to collect my op report and labs to keep a file.
If I ever need an unrelated surgery, it'd be nice to be able to show I'm healthy enough to have it."
Is there any challenge or face slap in there? I tried to write around that because, in reality, that IS what we say. My doc is retired. The hospital was sold to another entity. I have had unrelated surgeries o various body parts. LOL So have many of us.
Michelle
RNY, distal, 10/5/94
P.S. My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.
An AST of 95 isnt' terrible. I had a level of 88 for years. I went to a gastroenterologist who specializes in liver disorders and he said it was nothing to worry about. He said if it is in the hundreds, then he worrys but under 100 is nothing. I have heard Milk Thistle can bring it down. Do you take a PPI, Cholesterol medication or tylenol? All these medications can bring up your liver function tests.
I would be more worried about a high potassium level. I would call her about that. That can be dangerous.
For your B12, I would get onto injections. Ask your doctor for a prescription and start injecting yourself. It is simple and painless. You can use insulin needles and do them either in your stomach, leg or butt. I would recommend you doing it weekly until you get your level up to atleast 1200.
How much D are you taking? With a vitamin of 25 and PTH of 81, you should be taking atleast 50,000 units of Dry D3 - 2 to 3 times per week. You can get this at Vitalady.com.
How much calcium are you taking? What is your calcium level? This can also affect your PTH level. You want your calcium at around 9.2 or 9.3 - any higher and you are leaking calcium from your bones and your blood is compensating for it with the higher values.
How is your vitamin A? I have trouble with vitamin A and found out it was because I was taking it with my Topamax. You can't take them together. Now that I separate them, my vitamin A is much better.
My B1 was also in the gutter and I take high doses of that along with selenium. Most people dont' get there selenium checked but it is very important.
I would be more worried about a high potassium level. I would call her about that. That can be dangerous.
For your B12, I would get onto injections. Ask your doctor for a prescription and start injecting yourself. It is simple and painless. You can use insulin needles and do them either in your stomach, leg or butt. I would recommend you doing it weekly until you get your level up to atleast 1200.
How much D are you taking? With a vitamin of 25 and PTH of 81, you should be taking atleast 50,000 units of Dry D3 - 2 to 3 times per week. You can get this at Vitalady.com.
How much calcium are you taking? What is your calcium level? This can also affect your PTH level. You want your calcium at around 9.2 or 9.3 - any higher and you are leaking calcium from your bones and your blood is compensating for it with the higher values.
How is your vitamin A? I have trouble with vitamin A and found out it was because I was taking it with my Topamax. You can't take them together. Now that I separate them, my vitamin A is much better.
My B1 was also in the gutter and I take high doses of that along with selenium. Most people dont' get there selenium checked but it is very important.
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