6 (7) Month appt & Labs

I had my 6 month check-up this week.  It is really 7 months for me, but I had to reschedule due to work.

I saw the PA in my clinic for the first time.  She was very happy with my progress and that my BMI was below 30...overweight no longer obese.  I don't go bac****il my 1 year anniversary in September.

We reviewed my labs.  She said everything looked good.  I love my doctor's office and the staff, but they compare my lab results to "normals" from the lab company.  I wished they compared them to the ASMBS recommendations.  I let them know in my "how are we doing" form this time.

I'd appreciate some feedback on my labs.  I'm concerned about my ferritin and think I may need to tweak my vitamin regimen.

Glucose	82
Urea Nitrogen (BUN)	16
Creatinine	0.82
Sodium	140
Potassium	4.5
Chloride	106
Carbon Dioxide	23
Calcium	9.1
Protein	6.5
Albumin	3.9
Globulin	2.6
Albumin/Globulin Ratio	1.5
Bilirubin	0.06
Alkaline Phosphatase	60
AST	14
ALT	15
Parathyroid Hormone Intact (without Calcium)	24
Vitamin D	54
Uric Acid	5.9
Vitamin B1	156
Iron	82
Ferritin	116
Vitamin B12	1066

Thanks!

Kay

Hi Kay!  I'm sure Gina will chime in, and I'm not the vitamin guru, but it looks to me like your D is low too - are you supplementing that?   I'd be pushing my B12 up to around 1500 also. 

Not all labs' charts reflect the same ranges... I have a spreadsheet that I track mine on - I have my labs' ranges and Vitalady's ranges - just for comparisons sake.

I'm taking dry D every day, but the B12 every other day.  I can adjust the dosage easily.

Thanks for your input!

Kay

Glad you had a good appt!

No guru here,but glad you are on top of things.

Congrats on your bmi, you will be normal in no time!

Kay, what struck me is how low your protein and albumin are. You need to get those up pronto. Low protein will cause other levels to drop. Increase your protein shakes and be sure you're getting, at a minimum, 100 grams of easily digestible protein a day.

Increase your dry D3. RNYrs can take 20,000IUs a day of dry D3.

Iron and ferritin aren't terrible but do you know what they were pre-op? If they're trending down from pre-op, you gotta problem. Carbonyl and heme iron are the best iron for us malabsorbers to use. Don't just get some off the shelf iron. Bifera is available at Walgreens if you don't order from Vitalady.

Your liver enzymes are awesome! AST and ALT are beautiful.

Gina

 

Thank you for taking a look.  I am committed to keeping to a vitamin regimen that will keep me healthy.  I don't want my health to go down because I was to lazy/uninformed to manage it. 

I thought my protein looked low.  It was toward the low end of the normal range for regular people, but my medical professional didn't blink an eye.  I'm so new at this that I wasn't comfortable with a polite confrontation on the protein.  I recently added a shake to my daily routine.  I think I'll up it from 2 to 4 a day and see how that works.  That should get me at least 92 grams a day.  I'll try to eat the other 8. 

I currently only take 5,000 IUs of dry D3.  I'll up this as well.  I'll add 5,000 in the morning and 10,000 with my evening vitamin.

Iron has never been great for me.  Before my hysterectomy, I was often anemic.  It runs on the low side since the hysterectomy nearly 20 years ago.  My iron went up from 64 to 82, but the ferritin went down from 134-116 since my last labs.  I'm taking carbonyl, but only every other day.  I'll up the dosage to daily. 

I'm not sure why the enzymes are up.  Could it be my pro-biotic?  I add one after my last lab results. (Per your recommendation!)

My bariatric program doesn't have me getting labs again until August.  Should I ask my PCP to order them again in June? 

Thanks again for sharing your knowledge to help me and others!

Kay

Sounds like a plan.

Your liver enzymes are excellent, not up too high or anything. Some of us run well over the top of normal just because we're losing weight so fast. Nothing to worry about with yours.

--g

Yes, your protein is way too low. You want it to be in the mid 7's and the albumin in the mid 4's. You should never need 4 protein drinks per day unless the protein drinks have way too little protein in them or the wrong type of protein in them making it so you aren't absorbing them. You need to use 100% Whey Protein or Protein Isolate and each drink should have a minimum of 25 grams per drinks, mine have 35 per drink. You should be able to get atleast half your protein grams from food and half from drinks. If you are eating atleast 3 meals per day and 2 drinks, you will get over 100 grams per day provided you are ateast 6 months out and able to eat 4 ounces at a time. (always count protein first)

An example of a protein drink -

Protein Hot Chocolate

Make Swiss Miss Sensibly Sweet No Sugar Added Hot Chocolate (60 calories per packet) - don't use the 25 calorie ones unless you like it very diluted since it basically has have the amount of powder. Make the hot chocolate as usual in a large mug with 12 ounces of water. In a separate bowl, take 1 1/2 scoops of chocolate protein powder and add 1/3 of a cup of warm water and mix until it is smooth. Then add the protein powder to the hot chocolate and mix. Then add some milk to taste. This gives you 35 grams of protein.

I missed a few things in my other post.  First let me say, your liver enzymes are in no way too high.  The range goes from 9-40, so 14 is great but you don't want it lower.  When I was in the hospital and when I first came home, mine were in the 6-8 range and they told me it was due to malnutrition.  So, if yours were that low and have increased than that is great and you are doing much better.

As far as your vitamin D - you are in the acceptable level but ideal is 80-100.   You don't need to take your vitamin D in multiple doses, you can take it all in one dose.   I actually think with a level of 54 already, you would do fine with 10,000 units per day for the next 3 months and then get rechecked.  You don't want to go too high.  I was taking 50,000 units 3 times per week which is the same as 20,000 units per day and my levels went up to greater than 150 and my doctors all went nuts saying I was toxic.  So, I went off of it completely for 2 weeks and it went down to 112 which is fine for me and I am now back on taking 50,000 units 2 times per week.

Your B12 isn't bad but could be higher - I would increase it to 5 days per week for now and see where it goes.  If that isn't enough, then you could increase to daily.

No guru here but glad we have one on board.  Sounds like your changes will get you where you need to be.