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Posts by Nicholas Myers

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Amanda Howard84 said:I'd appreciate some perspective here.

I'm pregnant and my ALT is up at 71.

A month ago, I had bloodwork done where my ALT was perfectly fine at 18 (I was pregnant then too, just didn't know it yet).

Since then, I’ve dealt with a stomach bug. I've read that those can cause spikes. Also, I started taking Prenatal vitamins in the interim—could that be a factor as well?

Hello,

Transaminase levels can certainly spike following a gastrointestinal infection, quite often due to something like rotavirus. However, during pregnancy, any elevation in liver enzymes needs a thorough follow-up, as it could signal various underlying conditions. If you weren't pregnant, I might suggest simply rechecking the levels in two weeks or a month. But given the pregnancy, a full evaluation is the better route. Please reach out to your primary physician or OB/GYN.
neonfalcon99 said:It’s currently at 339, which is only a slight increase considering the normal range goes up to 337. I'm not sure if it's related to taking ethambutol over the last month.

Hello,

It's well-documented that ethambutol is one of the most common medications linked to elevated uric acid levels, so this isn't surprising. This specific urate level you mentioned isn't a cause for alarm, nor is it a reason to stop your medication.

Diet can also play a significant role in managing urate levels. However, based on the numbers you provided, there is no need for a strict low-purine diet just yet.

You can find a list of foods to limit or avoid if you want to try lowering your urate through nutrition here:

Low-Purine Diet
Alternative health treatments (PDF) in Feedback & Suggestions ·
brightviper29 said:Shortly after those two posts, Eric Newman75 jumps in, trying to be helpful by pointing out that those kinds of comments belong in the alternative medicine sub-forum. Silence follows. No one responds.

Hello,

Thanks for flagging this. As stated clearly in our Health section guidelines, posts like the one you reported aren't permitted here. Other sections fall under different moderators and follow their own specific rules, which we don't oversee here.

The post was removed within 48 hours thanks to rustydrifter10. Given that it's vacation season and hospital shifts are ramping up—I've been on call every other day this week myself—we can't monitor the forum constantly while managing clinical duties. Please understand that we can't be online 24/7 to react instantly; my patients at the hospital take precedence over forum moderation.

Best regards,
Felix the Cat
electricmarlin62 said:Thanks for the quick reply. If you don't mind, could you explain the markers listed in the results? What exactly do they represent or signify? Thank you!

It seems to me that the tumor markers CEA and CA 19-9 were ordered here as a sort of screening for early colorectal cancer. However, that isn't standard practice, given that these markers lack much specificity regarding both the organ and the malignancy itself.
electricmarlin62 said:Respectfully... if you could take a look at these other results. We did a full CBC plus a fecal occult blood test. I should mention that during one of the samples, there was visible blood—likely hemorrhoids given the symptoms (some stinging).
Regarding the previous CBC, hemoglobin has risen from 128 to 137.

image
image
https://ibb.co/bBvJQKq
https://ibb.co/wQ5h56f
https://ibb.co/hCttPCY
https://ibb.co/R0fMbR6

And this is the old result you previously commented on:
https://imgbb.com/c2W3fCb
There aren't any complaints or symptoms currently.

Ma'am,

Judging by these findings, the anemia appears to stem from gastrointestinal bleeding, as I’ve noted before. As a precaution, it would be wise to see a gastroenterologist. The fundamental question remains: beyond the known hemorrhoids, is there another potential source for this GI bleeding?
[Nicholas Hernandez9] says:
Hello,

Can someone look at these results? Are they okay, or should I reach out to my doctor?
The first test was done 40 days ago just out of curiosity—my white blood cell count was low back then.
The second test was done today, specifically looking at the leukocytes.
I have no symptoms, and I'm in my late twenties.

Thanks.

image
image

To whom it may concern,

Running lab tests should always have a clear purpose. Curiosity can often lead to unexpected findings and unnecessary headaches when trying to interpret data.

First, what is your baseline? I assume you’ve had blood work done at some point in the past. In other words, is this leukocyte deviation actually new, or have your counts always sat at the lower end of the normal range? Have you been sick in the last six months? Is it possible you had an infection, a fever, or just felt "off" recently? Have you had any medical checkups lately? Do you engage in high-risk sexual behavior? Are you on any medications? Do you drink alcohol? What about your weight—has it fluctuated significantly over the last six months?

Comparing these two sets (it's a shame the first one didn't include a differential), the leukocyte count has actually risen slightly. Your platelet count also went up; it was sitting at the bottom of the normal range previously. Seeing deviations in two or more blood lines isn't ideal. Based strictly on the latest report, your lymphocyte count remains slightly low (for adults, 1.5x10*9/L is typically the floor).

If you aren't experiencing any symptoms, aren't taking medication, and don't have high-risk behaviors, my suggestion would be to repeat the CBC with a differential in about four weeks. This allows us to track the trend.

Depending on those results and your answers to my questions, we can discuss whether further investigation is necessary.

If any colleagues specializing in hematology have thoughts, please weigh in.
neonfalcon99 said:Thanks for the info. So, basically, a patient can't just opt out of antibiotics without facing legal repercussions? I get that treatment is vital, but I was wondering if there's actually any room for choice at all...

Pretty much.

In that case, you'd have to rely on the doctor's word regarding work. I'm not sure how feasible that is in practice if, after two months of therapy, they still test positive.

That seems fairly likely.

Also, sorry if I went off on a tangent. The topic of TB is an old one, but we needed the information urgently and couldn't find it online.

Feel free to ask anything. We'll help where we can.
neonfalcon99 said:Thanks so much

What if someone refuses antibiotics? Does Medicare cover it, or is it out of pocket?

Ma'am,

TB treatment is fully covered by Medicare. It must be provided even to those without health insurance. Treatment for TB is mandatory and strictly regulated by federal law.

Once the lab isolates Mycobacterium for the first time, they report all positive cases to the local public health department based on where the patient lives.
Dear Madam,

In the US, both the diagnosis and treatment of TB are strictly regulated by law. There are very specific protocols governing how we manage patients with this condition.

Since the culture from the bronchoscopy sample came back positive, we aren't talking about latent TB here. In cases of latent TB—where the individual isn't infectious to those around them—you won't find Mycobacterium present in respiratory samples*.

Furthermore, according to the CDC Tuberculosis Guidelines, a confirmed case is defined as a patient where the causative agent of TB is isolated via microbiological culture from any clinical specimen.

Based on that, this person does have TB.

It appears to be pulmonary TB that is microscopically negative (positive results usually arrive within 1 to 2 days, so you likely would have known immediately if that were the case and mentioned it in your inquiry). Given your description, they likely fall into category III under standard treatment regimens.

As for treatment, the rule of thumb is that it begins in a hospital setting. However, per the legal guidelines, there are exceptions. To quote:

newly diagnosed patients whose sputum is smear-negative, who are not in severe general health or suffering from major comorbidities, and who are willing to cooperate with their physician, live in stable social conditions, and do not reside in a household with individuals at high risk of contracting TB.

If the person you are asking about meets all these criteria, outpatient treatment outside of a hospital is an option.

Regarding work: under no circumstances should this person be working right now. Temporary disability lasts, as defined by the aforementioned regulations, until the sputum tests return negative and the patient stabilizes.

_______________________________________
*Note that some TB specialists might debate this point if the sample was taken directly from dormant granulomatous foci within the lung parenchyma.
neonfalcon99 said:Does anyone know what it means when a bronchoscopy report shows an increase in M. tuberculosis in the bronchial aspirate sample? They said the sensitivity test results are coming next.

Hello,

That essentially confirms a case of TB in this patient. Whenever a Mycobacterium tuberculosis culture comes back positive, the Centers for Disease Control and Prevention runs a drug sensitivity test. It takes about four weeks. The goal is to identify any resistant strains, which would require a different treatment approach.
ironsurfer10 said:Hi, could someone please explain what a 55% dysmorphic erythrocyte count in urine actually means?
I've been dealing with microhematuria for years, and my GP just realized it might actually be an issue.
She referred me to a urologist who requested cytology, and now they've sent me for testing to determine the origin of the erythrocytes—this was the result. My appointment with the specialist isn't until nine months from now. Should I be worried?
My urine cultures always come back sterile. Thanks.

Hello,

Dysmorphic erythrocytes are red blood cells with irregular membranes; they typically originate from the upper urinary tract, specifically the kidneys.

The goal of this test is to pinpoint where the bleeding in the urinary system is coming from. Broadly speaking, if the bleeding is from the upper tract, a nephrologist handles it. If it's from the lower tract, you see a urologist. That’s the simplified version.

For this classification to be definitive, we usually look for dysmorphic or smooth erythrocytes to exceed 70% or 80%. If dysmorphic cells make up more than 70-80%, the source is the upper urinary tract. If smooth erythrocytes account for more than 70-80%, the source is likely the lower tract.

In your case, the number of dysmorphic and smooth erythrocytes is essentially equal. This suggests bleeding may be occurring in both the upper and lower tracts—essentially a mixed erythrocyturia from the entire urinary system. One possibility for a result like this could be kidney stones, though other causes exist.

Regardless, further investigation is necessary.
Kimberly Morris said:The problem is, I’m getting radio silence over there. I posted a question a few days ago and haven't heard a word.

Just start a new thread. Briefly outline your symptoms and we'll get back to you with an answer.
Kimberly Morris said:Nicholas Myers, thank you for such an exhaustive response.

I’ve been following this forum and noticed you're a physician.

There's some suspicion regarding Sjögren's syndrome or Lupus in my case. I have a private appointment with an immunologist in ten days.

The mere possibility of the diagnosis is triggering panic. I considered heading to a private lab to run those three specific tests, but I'm worried they won't be enough to confirm if it's actually Lupus. I reached out on the Lupus thread, but haven't received a response yet. Can I describe my symptoms here? Perhaps someone can offer some insight while I wait for my labs.

If there is suspicion, then yes, feel free to describe your symptoms on the Lupus thread.
Kimberly Morris said:Hi there.

If Anne, Enid, and anti-dsDNA all come back clear, is it still possible for someone to have Lupus?

Hello,

Medical literature describes something called seronegative Lupus, which aligns perfectly with what you’re describing—negative results for ANA, ENA, and anti-dsDNA. That said, we see fewer of these cases in practice now. As antibody detection technology improves, the number of patients previously labeled "negative" due to poor test quality or interpretation has dwindled.

Once you account for those technical discrepancies, you are left with a very small group of people who truly test negative across all those markers.

It is worth noting that modern diagnostic guidelines have expanded the immunological panels used to support a Lupus diagnosis. This now includes things like anti-Ro/SSA (which can be positive even when ANA is negative, so if suspicion is high, specific anti-Ro/SSA testing can be requested), antiphospholipid antibodies, C3, C4, CH50, and occasionally the direct Cummings test or an RPR test. When all those are performed and everything remains normal, we are looking at a tiny fraction of patients—practically isolated cases—who have Lupus despite clear results. Even then, these patients usually present with at least one clear objective indicator, such as significant abnormalities in urinalysis or kidney biopsy findings that point toward Lupus.

To put it simply: if you are dealing "only" with a cluster of non-specific symptoms—fatigue, general weakness, feeling unwell, loss of appetite, headaches, dizziness, or muscle and joint pain—without any objective clinical evidence, a Lupus diagnosis isn't justified. That doesn't mean the diagnosis won't crystallize over the next few years, but right now, there is nothing to anchor it.
electricmarlin62 said:Thanks for the reply. This blood work was just part of a routine checkup... I don't actually have any symptoms. The only thing going on is hemorrhoids, so I was wondering if those could also be causing issues like anemia?

They can cause anemia, sure, but you always need to rule out other possibilities. Plus, there’s the leukocytosis mentioned, which wouldn't typically be linked to hemorrhoids.

Either way, you need to follow up. Reach out to your primary care physician for an evaluation; they'll determine the next steps.
electricmarlin62 said:https://ibb.co/c2W3fCb

Hello... Could you please take a look at these results?
Male, 58 years old. He has dealt with hemorrhoids for many years, though they haven't been an issue lately. Thank you.

To whom it may concern,

You didn't mention why this testing was ordered. What symptoms is the patient experiencing?

In any case, there are abnormalities here that require follow-up, most notably the anemia. However, the data is incomplete. There is no differential blood count provided, yet leukocytosis is present; therefore, a CBC with differential is definitely necessary. Sedimentation and CRP need to be determined, and the biochemistry should be supplemented with LDH—plus, bilirubin and ALP are missing. It would also be prudent to check ferritin and serum protein electrophoresis.

Anemia paired with elevated urea, while creatinine remains within the normal range, can sometimes point toward gastrointestinal bleeding (though, granted, high urea can also stem from dehydration or other issues). As a next step, a fecal occult blood test performed three times is required.

Depending on the symptoms and subsequent findings, the patient will need further workup—laboratory tests, imaging, and specialist consultations. I have only listed tests typically handled at the primary care level before a referral to a specialist.
Lisa Chase90 said:Hi everyone. I’m a bit of a hypochondriac—at least, I’m self-aware enough to admit it. I’m prepping for gallbladder surgery. Aside from that, I feel fine and my labs look good, though my sodium is sitting right at the low end of the scale: 137.

The only outlier was total cholesterol at 5.1 (normal is under 5), while my "bad" LDL was 3.2 (normal is under 3). Everything else is steady—no diabetes, kidneys are fine, and ultrasound looks clear. I'm a 37-year-old woman, carrying some extra weight, and these tests were just part of my pre-op screening.

Just trying not to spiral if there isn't actually a reason to worry (which is usually the case).

Thanks.

Reference range 137-146

Ma'am,

It isn't unusual for individuals dealing with overweight or obesity to show slightly lower sodium levels or results that sit at the bottom of the normal range. Generally speaking, you shouldn't lose sleep over this specific value.

Good luck with the surgery!
I’ve reorganized your lab results photos, scrubbing out the sections containing your private info. Moving forward, please be more careful about redacting personal details before posting them here—it's basic self-protection.

Regarding Ana/Ena’s results, I suggest using either the Mayo Clinic or the labs in Washington, D.C. There’s a reason for that recommendation: their immunology testing is reliable and validated. But, ultimately, the choice is yours.
Sandra Vaughn82 said:I don't have tinnitus. I saw an ENT, and it turns out that sound in my neck is just cervical syndrome due to degenerative changes—I've already had an MRI. I'll send over the results once I have them, along with the follow-up from the hematologist. Thank you; I appreciate the effort to help me make sense of all this.

Ma'am,

The CRP levels are elevated too.

It looks like an ENA screen hasn't been run, and there’s no ANA fluorescence pattern listed either.

What about the ESR?

I'd suggest getting the ANA and ENA screen done at either the Mayo Clinic or the Cleveland Clinic. You might be able to coordinate this through your primary care physician—sometimes you can just mail the sample with a referral instead of traveling there in person. Regarding antiphospholipid antibodies, they've only tested for anticardiolipin. Also, it isn't entirely clear why spirometry with DLCO is being ordered; typically, that's part of the workup for systemic connective tissue diseases, which seem to be already confirmed here.

Have you checked your liver enzymes yet?

Naturally, alongside the current workup, completing the hematological evaluation is necessary. I agree with the colleague's recommendation.
Keith Gonzalez said:Given those electrophoresis results, it would be prudent to follow up with an immunofixation test.

Well, excuse me! Not even a "good morning," how are things going... 🙄

Just swoops in and disappears without a word. 🙂

Kids these days... ☕