Well, I Received My CBC Test Results Today :doctor:

[tex]

Hi All,

As some of you may recall, I requested another CBC, after roughly another 30-day interval, because one of my liver enzymes was near the upper limit of the normal range, on the last test, and my total cholesterol was down 45 points, (to 145).

Well, that enzyme is down some, so I reckon my liver is doing OK, but instead of my cholesterol continuing to drastically decline, (as I expected), it went up, instead. This test showed 169, (an increase of 24 points). That's a substantial increase, for only 36 days. And, my LDL, (which was 95.2 last time), was up 23 points, to 118. Also, my HDL, which has always been low, (because of genetics, according to my doc), suddenly increased 10%, during that short interval. HDL is supposed to be very slow to change. What's going on here? If cholesterol levels are supposed to be slow to change, why do mine seem to change so drastically, at the drop of a hat? There were no medication changes, and the only change I made to my diet during this period, was to stop eating cheese. According to conventional medical wisdom, that should have lowered my cholesterol, it certainly shouldn't have increased it.

Anyway, since my cholesterol didn't continue it's mad dash toward zero, (as it seemed to be doing last month), I reluctantly agreed to continue taking all these meds, (including simvastatin ), for another 3 months, and we'll see what happens then.

The good news is that my C-Reactive Protein, (high sensitivity test), checked at 0.620, (normal range, 0.0 - 0.785), so that's good, I suppose. I don't have the 25(OH)D test results yet, but my B-12 checked at 903, (normal range, 180 - 914 pg/ml), so obviously, even with several inches of my terminal ileum missing, the megadoses of B-12 I'm taking, (in the Metanx), is being adequately absorbed. (FYO, B-12 is absorbed primarily in the terminal ileum).

The bad news is that my MCH, (mean corpuscular hemoglobin, or "mean cell hemoglobin"), continues to be right on the minimum value for the normal range, which causes my MCHC, (Mean Corpuscular Hemoglobin Concentration), to be slightly below range. This started after my surgery, when my platelet count got way out of hand. My doc and I discussed it, but didn't reach any conclusions, (other than, that we'll continue to monitor it. LOL). He must have had a free time slot in his schedule, because we talked a long time, today. He answered every question I had, and asked for more.

Tex

[kimtg68]

So glad your doc gave you extra face time and answered ALL your questions today. Since most of what you said had me confused I can't really comment much on it. Over all it sounds like you got some good news but some perplexing stuff as well. I hope you are able to get this all figured out and under control. Since I am just beginning this adventure of medical and health stuff, I have much to learn. One day I will get there and understand exactly what you are talking about

[Bifcus16]

Tex,

Have the tests all been done at the same lab? Sometimes you can get quite significant variations between different labs.

Like you, I always though cholesterol was slow to change. So that makes me wonder if there is an issue with the lab work.

Lyn

[Joefnh]

Tex I'm glad you had the time to discuss things with your doctor. Along the line of what Lyn mentioned, whats the possibility of lab error? Given your past trend this data point does sound suspect. Is it worth having it re-checked?

--Joe

[tex]

Kim,

Those individual tests are simply some of the items tested, (out of many), in a complete blood count, (CBC). It's no wonder that you're confused, because most of this happened before you joined the board. On February 2, of this year, I woke up at 5:30 am, with massive bleeding, (from my colon), and the doctors couldn't locate the source of the bleed, so they ended up removing my entire colon, in order to save my life. My bloodwork looked OK when I was discharged from the hospital, (except that my red cell count, hemoglobin, hematocrit, etc., were still low, of course), but shortly thereafter, my platelet count, (the things that cause blood to clot), started to climb, and in a few weeks, it was about 4 times the normal maximum limit, and just about the time when we were thinking that some kind of intervention might be necessary, it began to come back down, and soon returned to normal. Anyway, while that was going on, my MCH and MCHC levels began to slowly drift below range, for some unknown reason.


Lyn,

Since the surgery in February, I've had at least one blood test every month, and all of them were done at the same lab, except for the 3rd test back, (in May), which was done at the same hospital where the surgery was done. That one was done when I was there for a TIA, on May 5th, which is when I started taking all these drugs to lower blood pressure, heart rate, etc., including a statin. They did that test a little over 8 hours after the TIA started, and found my LDL to be way down, and my triglycerides to be about 3 times the normal level, (at 263), presumably connected with the TIA.

Anyway the two tests since then, have both been at the same lab, (my PCP uses a different hospital/lab than I do, because he used to be a gastrointestinal surgeon there, for many years, before he retired, and went into family medicine). He's well up in his 70's now, but fortunately, no one ever told him that he had to stop learning, when he got to 65, (in contrast with Kim's GI doc. LOL).

So that makes me wonder if there is an issue with the lab work.

Obviously, the same thought has crossed my mind, but maybe I'm just prone to having erratic lab results.


Joe,

I've had at least one test per month, and since the TIA, they have been pretty erratic. Maybe Polly can shed some light on this. As far as I am aware, the tests are normally accurate. Mine were very consistent for years, it's only in the last few months that they have shown erratic results. The bile salts, (including the components of cholesterol), are absorbed, (recycled), in the terminal ileum. It's likely that the colectomy I had in February started all this in motion - IOW, my body is probably still trying to figure out how to adjust, to get along without a colon, and without part of my terminal ileum. With a critical part of my ileum missing, I'm unable to recycle cholesterol, in a normal manner.

Tex

[Gabes-Apg]

great news that you got quality time with your doc ....that is definately a bonus these days

sorry to hear that the results are 'weird' and that there is no clear answer to what is going on.
besides the blood results how have you been feeling?
do the results in the tests link up to any symptoms you might be having?

[tex]

Gabes,

Outside of some occasional muscle stiffness from the drugs, I've been feeling fine, so I really can't see any connections with anything in the test results. The numbers aren't really bad, just kind of unexpected.

Tex

[Gabes-Apg]

can't see any connections with anything in the test results.

that is a shame given that doctors are trained (?conditioned/?reliant) to link test results to symptoms and therefore to the treatment

if the test results dont match what the body is actually doing then i suspect they are at a loss on how to proceed.

as long as you feel well and there are no major symptoms like before the surgery, then how much reliance do you apply to the test results?

[MaggieRedwings]

Morning Tex,

I too am happy that your doctor gave you the time and then asked for more questions. Happier that he does not want to stop learning.

So far as the test results I find them very puzzling and have no idea why they would constantly be changing and erratic. I wanted to immediatly think that is was connected with having the colon removed but know you are way ahead of me on that one. Do hope that you are feeling well and hope this tends to fix itself.

Love, Maggie

[mbeezie]

Tex,

Good news on the liver enzymes and CRP. I am wondering if the rise in cholesterol is due to post-ileostomy adaptive response . . . maybe you are absorbing better than you were initially. Also, you were fasting, correct? I ask only becasue my doctor recently orderd lab work and included cholesterol even though I wasn't fasting and I got a higher than normal result.

Mary Beth

[starfire]

Thanks for posting your results, etc. I wish I knew what would make the levels so erratic but if anyone can find out, it's you.

I'm so glad you are still feeling well. Please keep us posted on whatever you find out.

Love, Shirley

[tex]

Mary Beth,

You could certainly be right, that the change could be due to an adaptive response.

Yes, it was definitely a fasting blood test - almost 12 hours elapsed between my last food intake, and the blood draw.

Tex

[crystal552000]

Hey tex since we are on this CBC stuff just got mine back and my triglycerides (prob just butchered that) are really high, and I also seen that my BUN and my BUN/Creatinine levels are extremely low one is at a 3 the other a 4 any idea on what this means?

[tex]

that is a shame given that doctors are trained (?conditioned/?reliant) to link test results to symptoms and therefore to the treatment

if the test results dont match what the body is actually doing then i suspect they are at a loss on how to proceed.

as long as you feel well and there are no major symptoms like before the surgery, then how much reliance do you apply to the test results?

Maybe a little background information would clarify things, (to explain why we really don't know what we're doing with my treatment, in the first place - we're just guessing).

During that surgery, back in February, I apparently had so much blood loss, that during the long, drawn-out surgery, my heart ran short of blood, and I had a "mild" heart attack. It was classified as a NSTEMI, which is an acronym for Non-ST-Segment Elevation Myocardial Infarction. One way that heart attacks are detected, is by monitoring the "ST" segment of the graph plotted by an electrocardiograph. If the ST segment is elevated, then the indication is that widespread heart muscle damage has occurred, (a major heart attack). If the ST segment is not elevated, (as in my case), then the indications are either unstable angina, or a "mild" heart attack, (where some heart tissue actually dies, but blood flow was/is not completely blocked). Heart muscle contains special proteins known as cardiac enzymes, which normally do not circulate in the blood, (unless a heart attack is occurring, or has occurred). Therefore, if those enzymes are detected in the blood, then that confirms that a heart attack has occurred, (or is occurring). rather than it being simply a case of angina.

With a NSTEMI, the ST segment of the graph is not eleveated, but a heart attack is confirmed by the leakage of coronary enzymes into the bloodstream. Typically, either type of myocardial infarction, (either STEMI, or NSTEMI), is the result of a blockage of blood flow in the heart, (usually due to a blood clot). A STEMI is the result of a total blockage of blood flow, and a NSTEMI is the result of partial blockage of blood flow. My ST segment was/is not elevated, but toward the end of the long surgery session, coronary enzymes began to leak into my bloodstream, so apparently, I had a NSTEMI. We are guessing that hypovolemia, (low blood supply in circulation), was the cause. We don't know that for a fact, though - we're just guessing.

Both TIAs that I've had in the past year, showed absolutely no signs that they were coronary event-related, (nor could we find any evidence that ischemia, (blood flow interruption), actually occurred during either event. However, since one-sided events are usually closely linked with an interruption in blood flow to the brain, (either ischemia, or hemorrhage), we couldn't rule out the possibility, so as a safety precaution, I'm taking meds to lower my blood pressure, slow down my heart rate, etc. We're guessing - in order to err on the side of caution.

With so many guesses, about issues that can have serious implications, it probably shouldn't be surprising that "unexplained" changes occur in my lab results. Also, remember that I am taking megadoses of vitamins B-12, B-9, and B-6, and a lot of vitamin D, (a lot, considering that I also get a lot of sunlight, here in Texas). My vitamin B-12 level is at the top of the range, and here is possibility that the other two B vitamins that I'm taking might be out of range - I didn't think to have them checked. B-9, (folic acid), for example, is connected with the production of both red and white blood cells, and I'm taking 19 times the RDA.

Soooooooo, just about everything that plays an important part in my health care, these days, is strictly guesswork. As long as I feel fine, though, and the lab results don't get too far out of line, I'm not going to lose any sleep over it.

Tex

[tex]

Hi crystal,

Of course, a high triglyceride level can indicate undiagnosed diabetes, or if you have diabetes, a high triglyceride level indicates poor control of the diabetes issue. Otherwise, the combination of high triglycerides and low BUN, low BUN/Creatinine levels, suggests a high carb, low protein diet, possibly leaning toward malnutrition.

High triglycerides can eventually lead to pancreatitis, (inflammation of the pancreas), so your doctor should be working with you to address that issue. Since the pancreas produces several vital digestive juices, (including insulin), it plays a very important part in the digestive process. MC sometimes affects pancreatic output, for many of us, but the situation usually resolves, as the MC symptoms are brought under control.

Tex