18 month labs

I just got some of my labs back, not all are in.  I had some that were out that never have been before and I have no clue what they are.  B12 and folic acid were way high but I can just stop taking them.  That is easy.
ALT is 59, range is 7-56
Alk. Phos  144, range is 43-122
PTH is 8.4, range is 15-65
Ferritin is trending down but still well in the range.  I haven't taken any iron since surgery so it may be time to think about it.

I wouldn't quit the B12 and B9 for long. It's ok to be approaching 2,000 on the B12. If you're over that, then maybe stop for a few weeks and then start back up with taking your supplements only 3 times a week.

I haven't see many with low PTH. Interesting.

High ALT isn't too bad. Are you taking milk thistle now?

Yep, start back on some good iron.

--gina 

Can you recommend some iron brands?

Proferrin ES (heme iron) will work on your hematocrit and hemoglobin and is easiest on our systems...less constipation issues. Also, you may be able to get some docs to prescribe Proferrin Forte which is just like the Proferrin ES except it also contains folic acid.

Vitalady's Tender iron (carbonyl) either in chewable or capsules. This will work on the ferritin levels.

Walgreen's carries Bifera which is heme iron and polysaccharide iron combo but less heme iron than in a Proferrin ES.

--gina

Thank you

Gina


so, I actually have an iron question for you.  I have been taking the tenders for years.  I have been very good about them lately partly becaues of so many antbiotics that can't be taken within 6 hours of calcium and iron or 2 hours of calcium and iron so I keep not taking them.  But when I did take them, they worked great on my iron and ferritin, within 1 month, my iron went from 23 to 100 and my ferritin is at 120 (was 450 but that was due to inflamation of all my surgeries - this is finally a true reading because it has been steady for 3 months) but my Hemoglobin since my blood loss is staying around 11.5 to 12 and my hemacrit is staying around 35 or 36.  I used to be up at 13 or 14 and 39 or 42.  So, they aren't working like they used to.   From what I read above, you wrote that Proferrin works well on hemoglobin and hemacrit but will it keep working on my ferritin?  I dont' want for that to go down any further.  Also, if I take 3 or 4 tenders - lately 4, how many proferrin would I have to take?  I know they are so much more expensive? 

thanks
randi

I use a combo approach and take Tender (carbonyl) every day and Proferrin (heme) on Mon, Wed and Fri. One thing about the Proferrin is that you can take it much closer to your calcium. I know while I was taking more Proferrin that both my ferritin and hematocrit & hemoglobin improved greatly over just taking Tender and poly. I've never tried just going with Proferrin alone.

I think you might want to try just adding a Proferrin every other day and see what you labs tell you. I wouldn't start decreasing the Tender until after you see labs with Proferrin added.

--gina
 

first off, how high were your B12 and folic acid?  You want your folic acid to be greater than 24 and I don't think they measure it anyother way.  So, if that is how it came back, you are fine.  I have been that way for 20 years long before my WLS and it is fine, I have been seeing a Hematologist and he said it is fine.   If you are taking a large dose of folic acid then you want to be careful because that artificially elevates your B12 - so if you are taking 800 mcg of folic acid or more then if your level is real high, you might want to cut it below 800 because it is increasing your B12 levels without it actually being your true B12 level it is from the folic acid.  Does that make sense?  Your B12 may not be as high as it is.  Also, a high B12 is good - so even if the folic acid isnt' affecting it and it is at 2000 that is fine.  I had levels greater than 2000 for years prior to my RNY and my hematologist said was fine - we just pee out the excess. - I have tried to get my levels back up there but I can't.

Your ALT range is higher than I usually see- they usually only go up to 40 but based on your range you are only a bit high.  I wouldn't worry - I am alway told unless over 100, nothing to worry.  You didnt list AST - was that normal?  they usually go together.
Alk Phosphatase - is another test that can either be liver or bones  but since your ALT is borderline I would doubt it is your liver.  With your PTH being so low, it might be related to your bones.  A low PTH is related hypoparathyroid or low calcium - what was your calcium?  If you aren't absorbing your calcium or not taking enough for a long period of time, then this is the result.
What is your albumin?  Low calcium also goes with a low albumin

You need to talk to an Endocrinologist about this?  Have you had a DEXA scan?  This is a sign of something in your bones

IT is imperitive that everyone take iron after surgery - even men and post menopausal women. I thought I didn't need it and within 5 weeks I was already iron deficient adn my numbers were great preop.  Dont' let them get too bad that they are too hard to fix.  get yourself some tender irons from vitalady.com

Folic acid was 24, range 2.1-3.  B12 was 2000, range 211-946
AST was 23, range 5-40 so it was ok.  Calcuim was 10, range 8.5-10.5 and it seems like I remember Gina saying if calcuim was too high, it might be pulling from your bones.  Albumin was 4.4, range 3.4-4.8
I wonder if this could be related to having my knee replaced?  That certainly involved bone stuff.  I am very good about taking my calcuim.  Usually get 2000mg at least a day in 3-4 doses.
Ferrin is still 75, range 15-200.  I will get some iron to start although because of constipation issues, I have been putting it off as long as possible.

folic acid is one of those labs that every labs lists it differently but from what my hematologist explained it to me, if it is below the 2.1 to 3.0 you are severly deficient, if you are between 3.0 and 5.4 you are indeterminate or borderline and over that you are okay but that is for people without weightloss surgery that have severe malabsorbtion.  For anyone, there is no danger in having a high folic acid level, like I said in the other post, the only trouble is if your high folic acid level is because you are supplementing to get it that way causing both the high folate level and artificially elevating a B12 level so this makes diagnosing B12 almost impossible.  So, with a folate level like yours, if you are taking any please stop it - you dont need it and it is only bring up your B12 level and you don't know what your true b12 level is. If you arent taking any, then you have a great folic acid level and a great B12 level.  Yes, the range for B12 goes up to 946 but it really doesnt' matter, you just pee out the excess - in other parts of the world the bottom starts at 500 and that makes more sense - we are finding that post ops are starting to get symptoms of nerve damage as low as 500, and if they get as low as 200, the damage sometimes is very far gone and can be irreversible - by this point, drastic measures need to be taken.  Many surgeons tell post ops to take B12 once per week when we need to take it daily and this starts the problems off real early.

Your calcium being 10 can go either way - I have seen this mean 2 things - for some it is on the high side meaning you aren't taking enough and you are leaking the calcium into your bones causing the high calcium level.  For me, it was actually the oposite - I had a high calcium level because I was taking too much. I was taking 2000mg per day and my levels was too high, when I cut it to 1500mg per day it went down. So, it can go both ways but more likely it is from leaking from your bones.  Sometimes it is hypercalcemia which is too much calcium - similar to mine but that is more serious.

I tend to think yours is leaking into your bones since you have the high Alkaline phosphatase. Do you have osteoporosis?  This might all go together?  THis is why I suggested the Endocrinologist?    If you havent' had any of this done, you should have a DEXA scan done to check out your bones.

Your albumin is fine.  that is an interesting point about the hip replacement and is definetely a possibitely of why your bone numbers are off. I would get them rechecked in 2 months and see what happens.

I wouldn't worry about constipation with the tender irons - they are really easy on the stomach and since your levels are good and havent' needed any for so long, you won't need a large dose, you can probably get away with starting with one 60mg capsule - they have the vitamin C in them - at some point, if you need more, you can up it to 2. Make sure you dont take them within 2-4 hours of yoru calcium or thyroid medication