Ok it's me again about my labs????

Ok, just so you all don't think I am completely losing it, this is what they were 'able' to check for me last time, some of it is not on Gails list below mine, and some of it is:

 

HEMOGLOBIN	12.6	12 – 14 g/dL
HEMATOCRIT	37.6	37 – 47 %
WBC	4.1	4.5 – 11.0 x109 /L
NEUTROPHILS	61	50 – 65 %
LYMPHOCYTES	37	20 – 40 %
MONOCYTES	0	0 – 7 %
EOSINOPHILS	1	1 – 3 %
BASOPHILS	1	0 – 1 %
PLATELETS	215	150-400 x 109 /L
ALBUMIN	6.2	3.5-5.3 g/dL
ALKALINE PHOSPHATASE	98	25 – 123 U/L
BILIRUBIN TOTAL	1.3	0.2-1.6 mg/dL
BILIRUBIN DIRECT	0.2	0.0-0.8 mg/dL
BUN	13	6.0-22 mg/dl
CALCIUM	9.2	8.5-10.5 mg/dl
CARBON DIOXIDE	34	23-34 mEq/L
CHLORIDE	99	98-106 mEq/L
CHOLESTEROL	283	120 - 199 mg/dL
CHOLESTEROL HDL	74	40 – 75 mg/dL
CHOLESTEROL LDL	195	63 – 129 mg/dL
TRIGLYCERIDES	69	30 – 150 mg/dL
CREATININE	0.6	0.5 – 1.5 mg/dL
GGT	26	F: 0-30 U/L
GLUCOSE (FBS)	87	65 – 120 mg/dL
GOT	15	0 – 40 U/L
GPT	14	0 – 38 U/L
IRON	84	F: 60-180 mg/dl
IRON TIBC	263	250-450 mg/dl
LDH	95	F: 103-227 IU/L
MAGNESIUM	2.1	1.3-2.5 mEq/L
PHOSPHORUS	3.3	2.5-4.8 mEq/L
POTASSIUM	4.21	3.5 – 5.3 mEq/L
PROTEIN	6.7	6.2-8.5 g/dL
SODIUM	144.0	135 – 148 mEq/L
URIC ACID	3.7	2.5 – 6.0 mg/dL
FERRITIN	138	F: 10-130 ng/ml
FOLIC ACID	22.17	3.0-17 ng/mL
T3 UPTAKE	29.5	25-37%
TOTAL T4	6.79	4.5-12.5 ug/dL
T7	2.0	1.1-4.6 ng/dL
TSH	1.234	0.3-5.0 uIU/mL
VITAMIN B12	>2400	200-950 pg/ml

After looking over Gails list and a list provided by Vita lady for RNY, this is what should be on there:
(note Gails are on top of the list below, and where the question marks start those are ones Gail does not get checked that Vita Lady suggests RNY get checked)

cbc with differential

lipid panel

random blood glucose

HgA1c

ALT (liver function test)

AST (liver function test)

Alkaline Phosphotase

TSH, T4, Total T3, Free T4

Prealbumin

Albumin

BUN, Creatinine

Calcium

PTH

Vitamin D

Vitamin A

Thiamine

Folate RBC

B-12

Magnesium

phosphorus

Sodium

Potassium

Iron

Ferritin

Transferrin

PT (pro-thrombin time)

PT INR (blood clotting factor)

uric acid ?

vitamin B6 ?

vitamin E ?

vitamin K ?

Zinc ?

Copper ?

Selenium, ?

Chloride, ?

Protein ?

creatinine, ?

bilirubin ?

aspartate amino transferase ?

Hemogram with platelets ?

Osteocalcin ?

C Reactive Protein ?

PTT ?

LDH ?

MMA ?

Homocysteine, Cardio ?

Cortisol ?

Sooooooooooooo, for anyone that is still with me what the frickin hell do I get tested!?!   Is what Gail got good enough?  Is there anything on the lower list I need to add.  What the heck are those things on the top of my list that no one else has??  Is it a language barrier issue??  Guys I am not well, I don't have my head on straight, I am so sorry, but I need just a bit more direction.  Please help me.... 

I am so embarrased.... 

Cindy

PTT is on my list

Creatinine should be on my list. Maybe I missed it.

My program doesn't measure total protein, because they feel that prealbumin and albumin are the "big guns" for determining the level of protein in the body.

Hemogram with platelets may be the same as CBC (complete blood count) with Differential (platelets, neutrophils, etc).

bilirubin isn't really necessary unless you have some type of liver or gall bladder issues.

Vit K probably isn't necessary, since if you didn't have enough, your PTT or PT or INR levels would be off. They measure the rate of clotting and since vitamin K is needed for clot formation, if you had a deficiency, the PTT value would be abnormal.

What is striking from your previous labs, is your lipid panel. Your cholesterol and LDL are quite high and should be retested. HDL and Triglycerides look good.

Copper, selenium, vit E are not checked by my program, but would be checked if there was some indication of a problem in that area.

C -reactive protein and homocysteine are important if you have a history of heart disease.

Your previous albumin is great, so your protein levels are good.

Ferritin is a little high, but not too high. On the high level of normal is good for this one, since it reflects your stores of iron.

Make sure that they check Vitamins A, D, Thiamine (B1), Folic Acid

Cl should be checked with the electrolytes i.e. sodium, potassium, CO2, Cl-

I'm not sure all the minerals are necessary since we don't have a malabsorption surgery, but that is JMHO.

I probably missed some.

Gail

OMG Gail you are amazing...  I am reading every word.  I have a spreadsheet and have been working on it all day.  Hubbby tells me it is worth it, and that once I have the complete list I can always go by that list...  But man it is a lot of work.

I thank you from the bottom of my heart.  I may have more questions, and I appologize ahead of time.  Please check back a bit later ok?

I will try to get this finished ASAP, then update the info you just gave me, and see if everything is then crystal clear....  Ha ya right!!

Thanks again for your time, your info is invaluable to me.

More hugs,

Cindy

I agree with hubby...YOU are WORTH it...and yes even though my doctor follows my labs, I created a spread sheet that I update and note personally what's up what's down etc.  I don't trust the doctor when it comes to ME =)

Ms Shell

Hi Gail,

Ok I have completed my spreadsheet and I need a couple more clarificaitons.  Can you please tell me which of the green ones below I need to do and not do?

The Blue are the ones I am getting done.
The Green I am not sure if I should get them done.
The Grey I am not getting done.

Thanks you so much for your help.  I am beat and heading to bed, I will check back in the morning.

Cindy

 

	What should have been done	What did not need to be done	What to get done	Notes on what each thing is tested for:
TESTS
HEMOGLOBIN – HgA1c	Y		Y	Glycated hemoglobin ( hemoglobin A1c, HbA1c, A1C, or Hb1c; sometimes also HbA1c) is a form of hemoglobin which is measured primarily to identify the average plasma glucose concentration over prolonged periods of time. It is formed in a non-enzymatic glycation pathway by hemoglobin's exposure to plasma glucose.
HEMATOCRIT (HT or HCT)		N	?	The hematocrit (Ht or HCT) or packed cell volume (PCV) or erythrocyte volume fraction (EVF) is the percentage of blood volume that is occupied by red blood cells.
WBC – White Blood Cell Count		N	?	Total white blood cells — All the white cell types are given as a percentage and as an absolute number per litre.
NEUTROPHILS – maybe cbc with differential & platelets?		N	Y	A complete blood count with differential will also include:
LYMPHOCYTES		N	?	Neutrophil granulocytes — May indicate bacterial infection. May also be raised in acute viral infections. Because of the segmented appearance of the nucleus, neutrophils are sometimes referred to as "segs." The nucleus of less mature neutrophils is not segmented, but has a band or rod-like shape. Less mature neutrophils — those that have recently been released from the bone marrow into the bloodstream — are known as "bands" or "stabs". Stab is a German term for rod.[1]
MONOCYTES		N	?	Lymphocytes — Higher with some viral infections such as glandular fever and. Also raised in chronic lymphocytic leukemia (CLL). Can be decreased by HIV infection. In adults, lymphocytes are the second most common WBC type after neutrophils. In young children under age 8, lymphocytes are more common than neutrophils.[1]
EOSINOPHILS		N	?	Monocytes — May be raised in bacterial infection, tuberculosis, malaria, Rocky Mountain spotted fever, monocytic leukemia, chronic ulcerative colitis and regional enteritis [1]
BASOPHILS		N	?	Eosinophil granulocytes — Increased in parasitic infections, asthma, or allergic reaction.
				Basophil granulocytes — May be increased in bone marrow related conditions such as leukemia or lymphoma. [1]
				A manual count will also give information about other cells that are not normally present in peripheral blood, but may be released in certain disease processes.
PLATELETS - maybe cbc with differential & platelets?	Y	N	Y	Platelets are a natural source of growth factors. They circulate in the blood of mammals and are involved in hemostasis, leading to the formation of blood clots.
ALBUMIN - (& Pre-Albium)	Y		Y	Albumin (Latin: albus, white) refers generally to any protein that is water soluble, which is moderately soluble in concentrated salt solutions, and experiences heat denaturation. TTR was originally called prealbumin[1] because it ran faster than albumins on electrophoresis gels.
ALKALINE PHOSPHATASE	Y		Y	Alkaline phosphatase (ALP, ALKP) (EC 3.1.3.1) is a hydrolase enzyme responsible for removing phosphate groups from many types of molecules, including nucleotides, proteins, and alkaloids.
BILIRUBIN TOTAL	Y	N	bilirubin isn't really necessary unless you have some type of liver or gall bladder issues.	Bilirubin (formerly referred to as hematoidin) is the yellow breakdown product of normal heme catabolism. Heme is found in hemoglobin, a principal component of red blood cells. Bilirubin is excreted in bile and urine, and elevated levels may indicate certain diseases.
BILIRUBIN DIRECT	Y	N	N as above	As above
BUN	Y		Y	The blood urea nitrogen (BUN, pronounced "B-U-N") test is a measure of the amount of nitrogen in the blood in the form of urea, and a measurement of renal function. Urea is a by- product from metabolism of proteins by the liver and is removed from the blood by the kidneys.
CALCIUM – PTH	Y		Y	PTH acts to increase the concentration of calcium in the blood
CARBON DIOXIDE	Y		Y	Carbon dioxide is an end product in organisms that obtain energy from breaking down sugars, fats and amino acids with oxygen as part of their metabolism, in a process known as cellular respiration.
CHLORIDE	Y		Y	Chloride is a chemical the human body needs for metabolism (the process of turning food into energy).[1] It also helps keep the body's acid-base balance. The amount of serum chloride is carefully controlled by the kidneys.
CHOLESTEROL – (lipid panel)	Y		Y	Cholesterol is a waxy steroid of fat that is produced in the liver or intestines. It is used to produce hormones and cell membranes and is transported in the blood plasma of all mammals.[2] It is an essential structural component of mammalian cell membranes and is required to establish proper membrane permeability and fluidity.
CHOLESTEROL HDL	Y		Y	Higher levels of LDL particles promote health problems and cardiovascular disease, they are often informally called the bad cholesterol particles,
CHOLESTEROL LDL	Y		Y	(as opposed to HDL particles, which are frequently referred to as good cholesterol or healthy cholesterol particles).[2] A recent study has found that LDL is essential in building muscle during resistance training.[3]
TRIGLYCERIDES	Y		Y	A triglyceride (TG, triacylglycerol, TAG, or triacylglyceride) is an ester derived from glycerol and three fatty acids.[1] It is the main constituent of vegetable oil and animal fats.[2]
CREATININE	Y		Y	Creatinine is a break-down product of creatine phosphate in muscle, and is usually produced at a fairly constant rate by the body (depending on muscle mass). If the filtering of the kidney is deficient, creatinine blood levels rise.
GGT		N	?	Gamma glutamyl transpeptidase (GGT) - Although reasonably specific to the liver and a more sensitive marker for cholestatic damage than ALP, Gamma glutamyl transpeptidase (GGT) may be elevated with even minor, sub-clinical levels of liver dysfunction. It can also be helpful in identifying the cause of an isolated elevation in ALP. (GGT is raised in chronic alcohol toxicity).
GLUCOSE (FBS)	Y		Y	Fasting Blood Test - A glucose test is a type of blood test used to determine the amount of glucose in the blood. It is mainly used in screening for any prediabetes or diabetes.[1] In people already having diabetes, blood glucose monitoring is used with frequent intervals in the management of the condition.[1]
GOT (AST)	Y		Y	AST (SGOT) is commonly measured clinically as a part of diagnostic liver function tests, to determine liver health.
GPT (ALT)	Y		Y	Alanine transaminase - Significantly elevated levels of ALT often suggest the existence of other medical problems such as viral hepatitis, diabetes, congestive heart failure, liver damage, bile duct problems, infectious mononucleosis, or myopathy.
IRON	Y		Y	Stored iron is important because when iron intake is low, the body relies on ferritin to release the iron it needs. iron deficiency may eventually lead to anemia.
IRON TIBC	Y		Y	Total Iron Binding Capacity – as above
LDH	Y	N	?	Lactate dehydrogenase is an enzyme found in many body tissues, including the liver. Elevated levels of LDH may indicate liver damage.
MAGNESIUM	Y		Y	Magnesium is a vital component of a healthy human diet. Human magnesium deficiency (including conditions that show few overt symptoms) is relatively common, with only 32% of the United States meeting the RDA-DRI;[17] low levels of magnesium in the body has been associated with the development of a number of human illnesses such as asthma, diabetes, and osteoporosis.[18]
PHOSPHORUS	Y		Y	In medicine, low-phosphate syndromes are caused by malnutrition, by failure to absorb phosphate, and by metabolic syndromes that draw phosphate from the blood (such as re-feeding after malnutrition) or pass too much of it into the urine. All are characterized by hypophosphatemia, which is a condition of low levels of soluble phosphate levels in the blood serum, and therefore inside cells. Symptoms of hypophosphatemia include muscle and neurological dysfunction, and disruption of muscle and blood cells due to lack of ATP. Too much phosphate can lead to diarrhoea and calcification (hardening) of organs and soft tissue, and can interfere with the body's ability to use iron, calcium, magnesium, and zinc.[48]
POTASSIUM	Y		Y	Potassium is an essential mineral micronutrient in human nutrition; it is the major cation (positive ion) inside animal cells, and it is thus important in maintaining fluid and electrolyte balance in the body.
PROTEIN (not necessary because of the Albium & Pre-A)	Y		N	Not necessary because of the Albium & Pre-Albium tests
SODIUM	Y		Y	Sodium is an essential nutrient that regulates blood volume and blood pressure, "maintains the right balance of fluids in the body, transmits nerve impulses, and influences the contraction and relaxation of muscles" Regular consumption of more than 2.3 g/day of sodium promotes such health problems as elevated blood pressure and cardiovascular disease.
URIC ACID	Y	N	?	High concentrations of uric acid in blood serum can lead to a type of arthritis known as gout. The chemical is associated with other medical conditions like ammonium acid urate kidney stones.
FERRITIN – (iron stores)	Y		Y	See Iron Above
FOLIC ACID	Y		Y	Vitamin B9 (folic acid and folate inclusive) is essential to numerous bodily functions. The human body needs folate to synthesize DNA, repair DNA, and methylate DNA as well as to act as a cofactor in biological reactions involving folate
T3 UPTAKE	Y		Y	Thyrod Function Tests - A TFT panel typically includes thyroid hormones such as thyroid-stimulating hormone (TSH, thyrotropin) and thyroxine (T4), and triiodothyronine (T3) depending on local laboratory policy.
TOTAL T4	Y		Y	As above
T7	?		?	The Free Thyroxine Index (FTI or T7) is obtained by multiplying the total T4 with Tuptake.[2] FTI is considered to be a more reliable indicator of thyroid status in the presence of abnormalities in plasma protein binding.[2]
TSH	Y		Y	As Above
VITAMIN B12	Y		Y	Vitamin B12 deficiency can potentially cause severe and irreversible damage, especially to the brain and nervous system.
Vitamin D			Y	Too tired to do the rest at this time zzzzzzzzzz
Vitamin A			Y
Thiamine			Y
Folate RBC			Y
Transferrin			Y
PT (pro-thrombin time)			Y
PT INR (blood clotting factor)			Y
vitamin B6 ?			?
vitamin E ?			N
vitamin K ?			N
Zinc ?			?
Copper ?			N
Selenium, ?			N
aspartate amino transferase			?
MMA - Methylmalonic acid			?
Homocysteine, Cardio			N
Cortisol			?

I must be frickin' crazy to do all of this... but it matters to me...

First of all, you are not crazy for wanting to do this. It is called taking of yourself and your health.

CBC with Differential (all the different white blood cells, HCT, HgB, and platelets) should be done. You have it in Green. It is one of the most basic screening tests for multiple things. You want this done.

LDH -I didn't have this ordered, but some programs might require it. The only time that they checked it, was when I was hospitalized for 2 weeks after surgery and I had complications. It measures the amount of tissue damage, so you probably don't need this done.

Uric Acid: No, unless you have a history of gout or kidney stones.

T7- I don't know what this is, so I would say no, but I'm not a doctor.

B6- No, it is in your B vitamins

Selenium, zinc are in your multi-vits and unless you having some problems with your hair falling out and frequent infections, these probably don't need to be done. These may be more of an issue for those people that have malabsorption surgeries.

Definitely have your lipid panel done. If your cholesterol and LDL are still high, take a look at your diet and cut out some of the high fat foods. Fish oil supplements can help to lower your Cholesterol and LDL. If you have access to wild salmon or canned salmon, tuna, sardines, mackerel, they are high in the Omega-3's that we need. Walnuts, almonds, and some other nuts are also healthy fats that can be eaten in smalll amounts and will help to improve your lipid profile. Also, helpful are extra virgin olive oil and avocado.

Sounds like you are getting back on track.

Gail

these are just recommendations of the labs that I recently had done. Not to be construed as medical advice.

    Ok got it, I will do one final update to my spreadsheet and go with that.

I cannot even begin to thank you enough for all the time you have spent on this today.  Thank you so much Gail, you are a gem.

Once I have compiled everything, I will put it on my profile, I actually looked every one of those up and put the definition over to the side.  Even the T7 if you are curious about it.

Now I am all set,  thanks again my dear.

Cindy

You are very welcome. I just had my one year labs drawn a couple of weeks ago, so everything was still fresh in my mind. I meet with the Bariatric Internist on Friday, so hopefully, I'lllearn  some more new things. Actually, my  Vitamins A and D were too high. I don't supplement vitamin A, but I think my skinny lattes are causing my Vitamins A and D to go up, since milk is fortified in this country. I have to cut down on the Vitamin D supplementation, since my level was 119. I'm doing too good of a job of supplementation.

I'll have to look up T7. It is probably something that I may have heard of, but goes by a different label. Good for you for looking everything up. It helps you to know, which labs are the most critical to get done. Plus, you learn a lot in the process.

You are definitely on the road to taking better care of yourself.

Lots of

Gail

Remember to fast for 12 hours for your fasting blood glucose and lipid panel. Water is okay, but nothing else.

Hi Gail,

Not sure if you are still up, and I have absolutely no brain power left...  but I am not sure if we covered these 2, and there is the info on the T7...

Thanks,

Cindy

HEMATOCRIT (HT or HCT)

N

?

The hematocrit (Ht or HCT) or packed cell volume (PCV) or erythrocyte volume fraction (EVF) is the percentage of blood volume that is occupied by red blood cells.

GGT

N

?

Gamma glutamyl transpeptidase (GGT) - Although reasonably specific to the liver and a more sensitive marker for cholestatic damage than ALP, Gamma glutamyl transpeptidase (GGT) may be elevated with even minor, sub-clinical levels of liver dysfunction. It can also be helpful in identifying the cause of an isolated elevation in ALP. (GGT is raised in chronic alcohol toxicity).

 

T7

?

?

The Free Thyroxine Index (FTI or T7) is obtained by multiplying the total T4 with Tuptake.[2] FTI is considered to be a more reliable indicator of thyroid status in the presence of abnormalities in plasma protein binding.[2]

zzzzzzzzzzzzz 

HCT is hematocrit and needs to be done as part of the CBC with Differential

GGT I don't know what this is, but I didn't have this checked. It may have a different name.

T7- I don't think so, but I would need to check on this.

edit: T7 is FTI and is part of the thyroid profile. Have this done, with your thyroid T3, T4, FTI (T7), TSH