Posts by Nicholas Myers

wanderingjackal18 said:Can someone help me make sense of these serology results? My doctor is out this week:
EBV VCA igM neg.
EBV VCA igG positive 166.0 U/ml CLIA ref. values pos >=20 neg<20
EBV EA igG neg.
EBNA igG neg.
CMV igM neg.
CMV igG positive 83.7 U/ml CLIA ref. values pos >=14 neg <12

Does this mean I have mono or not?

A diagnosis of mononucleosis is primarily clinical. Serology is just an attempt to identify the culprit, which is usually one of these two viruses. If you're experiencing symptoms consistent with mono (which you haven't listed here), then the illness isn't caused by CMV—namely, cytomegalovirus. As for the other one, EBV, the serology remains ambiguous. An isolated finding of EBV VCA IgG can indicate either a past infection or an acute one. However, given that the EBV EA IgG result is negative, there's a higher probability we're looking at a previous infection rather than a fresh one. This suggests the mono diagnosis is questionable, or perhaps caused by a different agent altogether, though a small chance of EBV-induced mono persists. If there's reason to investigate further, one could run new serology after a few weeks or use other methods to confirm an acute EBV infection, such as a blood PCR.

As it stands, these results don't tell the whole story.

Amanda Perez42 said:Hi, can someone help me make sense of this urine cytology report? It’s for my father, who had prostate cancer surgery four years ago. He just had a cytology screening because there were tiny traces of blood in his urine (specifically in the lower part)
"Urine (3 days) shows sparse cellular sediment with highly degenerative clusters of transitional and squamous epithelium; one sample contained a small cluster of dyscariotic transitional epithelial cells, some neutrophilic granulocytes, mucus, and rare Red blood cells. Follow-up urine cytology in 3 months."

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The results are non-specific. Namely, the sample detected a small number of cells with abnormal features—meaning they deviate from normal cell structures—but not significantly enough to identify exactly what type of cells they are. Some cytologists use this terminology to describe cells altered by inflammation, essentially cells changed due to chronic inflammation. Since a definitive identification isn't possible right now, a repeat test in three months is recommended. Whether anything needs to be done before those three months are up? This cytology report can't answer that; a urological exam would be the way to go for that assessment.

Karen Wells76 said:Hi there,
I had an OGTT and fasting insulin done (not pregnant). Insulin looks fine, fasting glucose is fine, but after 120 minutes it was 7.4. The lab's normal range goes up to 7.0. Now I'm reading online that impaired glucose tolerance starts at 7.8, so I'm confused—do I fall into that category or not?

No, I don't think you have impaired glucose tolerance yet. Technically, a 7.8 mmol/l at the 120-minute mark is considered the lower threshold for impairment. However, the trend lately has been toward lowering the diagnostic thresholds for things like fasting glucose levels. Whether those changes actually become standard practice remains to be seen.

mellowmoose11 said:Could someone please help me interpret these tissue typing results?
My immunologist is out on medical leave, and since there's no word on when they'll return, I haven't even been scheduled yet.
The test was done back in 2013, and I finally got my hands on the results today. I'm in my late thirties, and I've been dealing with aches in my bones and muscles all over.
HLA-A 11-28,
HLA-C NT-NT,
HLA-B 21-ND,
Bw4/Bw6 NT-NT,
HLA-DR 1-13,
DR51/DR52/DR53 52-ND
HLA-DQ 1-ND

Thanks in advance!

Based on this HLA typing, you don't show any strong predispositions for rheumatic diseases. Some studies link HLA-DR1 to rheumatoid arthritis, though primarily in Israelis and people from the Basque Country. That said, the HLA-DR4 antigen has a much stronger correlation with rheumatoid arthritis, and that wasn't found in your results. There is also the connection between HLA-DR 52 and inflammatory myopathies.

coastaltiger7 said:A bit off-topic, but I wasn't sure where else to ask.
For the fecal occult blood test, do all three samples go into the same container, or does each get its own?
Are those the small white vials?

Each gets its own, obviously. And yes, those are the white vials.

Rebecca Chase62 said:Hi everyone.

I'm curious about how work fitness certifications actually work. Does the certificate list every chronic condition a person has ever had, or just current ones they are being treated for? Also, do they even list specific illnesses, or is it just a simple "fit" or "unfit" for duty?

One needs to distinguish between two different things here. On one hand, you have the occupational health certification issued by an occupational medicine specialist. That document only provides the verdict: fit or unfit. There are no diagnoses listed there.

On the other hand, an occupational specialist might request medical records from a primary care physician. In that case, the records will include any medical history relevant to determining fitness for the job.

Ashley Booth12 said:I’ve been reading up on sciatica symptoms, and honestly? It’s like looking in a mirror. This is exactly what I’m dealing with right now: Sciatica refers to that specific type of pain that... It radiates along the sciatic nerve path—running from your lower back down through the hips, buttocks, and all the way through your legs.
Pain can spike significantly during coughing fits or when you have the flu.
Mornings are the absolute worst. I’m feeling completely paralyzed by the pain. It’s my entire lower right side, and my leg feels stiff and burns like hell.

It’s true that many of your symptoms align with a diagnosis of lumbar sciatica. However, looking back at those initial blood tests—specifically the leukocytosis with neutrophilia—our stance hasn't changed: that kind of reading isn't a hallmark of sciatica. It clearly pointed to something else entirely. At this stage, it's hard to be certain, but velvetmoose9 likely hit the nail on the head when he suggested we were looking at two distinct issues: an underlying infection (possibly oral) occurring alongside the spinal issues.

restlessstag71 said:I owe a debt of gratitude to bluefire for reaching out via DM; she really helped steer my diagnostic process in the right direction. I also have to thank Nicholas Myers for all his insights and perspectives.
I hope this thread ends up being useful to someone.

Since this thread gets pretty massive—with several posts popping up almost every single day—it might be worth carving out some space. When you have a moment, maybe start a separate, dedicated thread where people can briefly outline their experiences: the symptoms they faced, the diagnostic hurdles, and so on. It would make things much easier for anyone searching for specific symptoms later on. 🙂

fadedfalcon40 said:Let me clarify things a bit.

It’s difficult to give a definitive answer right now. However, based on your symptoms and that positive ANA result—even though the titer wasn't specified, which is still a key factor—there is a strong suspicion that we might be looking at a rheumatic or systemic autoimmune disorder. While certain antibodies came back positive, they aren't present in high enough titers to pinpoint one specific antibody that would clearly signal a particular disease.

Based on your symptoms and those antibody results, I could probably list a whole range of potential diagnoses. But honestly, I'm not sure how much sense that would actually make right now.

You’re definitely going to need to see a rheumatologist and/or an immunologist.

fadedfalcon40 said:Hi, I'm 35. Two healthy pregnancies behind me, plus gallbladder surgery and fibroids.
I started getting tested because of pain in my hand joints.
Rheumatoid factor 29 (ref. range up to 20)
Waler rose neg
CCP 5)
ANA luminex POSITIVE
anti-DNA 29 ( Anti-topoisomerase antibodies 46 (>40 pos)
AHA 49 (>40 pos)
And I've been anemic since I was 15.
Looking for opinions.

It’s difficult for anyone to provide a diagnosis based solely on these numbers. The context is missing. What prompted the testing? Joint pain? What kind of pain, which specific joints, any swelling? Are there other symptoms—rashes, sun sensitivity, skin changes, weight loss, trouble swallowing, breathing issues, shortness of breath, or fevers? And what about the rest of the labs? Regarding the anemia: what's the hemoglobin level, red blood cell count, MCV, iron status? Are you currently taking any medications?

Laura Lopez47 said:Just tell me what these immunoglobulins—IgA, IgM, and IgG—actually are. Thanks.

One way to look at how humoral immunity works is that a deficiency in certain immunoglobulins could trigger recurring infections—like those respiratory issues you mentioned. However, based on what you’ve laid out, that seems statistically unlikely. It feels more like the issue is localized somewhere in the upper respiratory tract, which might actually call for an ENT consultation instead.

Brenda Gomez17 said:Does anyone know what this means:
I just got my blood and urine results back for a routine checkup, and I’m a bit confused by a few things. My labs show positive leukocytes in the urine, an ESR of 10-15, and 3-4 RBCs/non-specific epithelial cells/bacteria. Can anyone explain what this actually means? Is this cause for alarm, and which specialist should I reach out to?

If you weren't actually feeling sick and just had the test done as part of a routine physical, you really ought to get it redone. It’s the only way to be sure. Before you go back, make sure you clean the area thoroughly and use a midstream urine sample. Also, stay hydrated—drink plenty of water beforehand. You can just head back to your primary care physician to have this repeated. If the follow-up shows leukocyturia—meaning an elevated white blood cell count—then we need to dig deeper. That kind of result can stem from various issues, like urinary tract infections or even gynecological infections, some of which tend to simmer quietly without obvious symptoms. However, it's important to keep in mind that this finding isn't a smoking gun for infection; it can also point toward other underlying medical conditions or disorders.

First off, you really ought to get that lab work redone.

Ashley Booth12 said:One more thing. Wouldn't it be better if she sent me for testing to isolate exactly which bacteria we're dealing with, rather than just guessing an antibiotic?

Ideally, yes. But the issue is that the actual site of a potential infection hasn't been identified yet, so what would they even use for a sample? Plus, there's the question of whether this is even an infection at all or something else entirely.

Ashley Booth12 said:I’m still dealing with agonizing pain in my lower back, hip, and my entire right leg.
I was given 600mg of ibuprofen and 2mg of Normabel.
The pill "masks" the pain for part of the day, but not completely, and by morning it's all over again. I can barely move...

It's clear from this that you need further follow-up—starting with a neurologist or a physiatrist, for instance. After that, you'll likely need imaging. An X-ray of the spine, or perhaps the hips, will only be one piece of the puzzle and probably won't be enough to reach a final diagnosis. velvetmoose9 already touched on this in a previous post.

Ashley Booth12 said:I also have this lab result: http://postimg.org/image/mdisq18n7/
It was on a separate sheet, so I didn't include it initially.

And here is today's X-ray: http://postimg.org/image/oapoby1ar/
The dentist claims there isn't any visible process there.

At this point, I'm lost. I'm repeating my blood work next Monday. My last dose of antibiotics is tomorrow morning—is that enough time before the retest?

It’s unclear why the doctor opted for Doxycycline. Generally, it's prescribed for atypical pneumonia, certain gynecological issues, STIs, Lyme disease, or a few other specific cases. It leaves one wondering what exactly they are trying to target with it in your case.

The anti CCP result is normal. That's used as a marker for rheumatoid arthritis, which, based on what you've shared, shouldn't be an issue for you.

Laura Lopez47 said:I don't know if it's dangerous... but it's exhausting. Every day feels like having a constant cold. I can barely breathe through my nose, and the headaches... they're relentless. It completely ruins my quality of life.

Based on your description, the issue seems centered in the nasal or sinus area. It might be worth seeking a second opinion from an ENT specialist who focuses specifically on this. Someone like a top specialist at the Mayo Clinic might be able to provide more clarity.

Regarding immunological testing, aside from checking immunoglobulin levels (IgA, IgM, IgG), I don't think further investigation is indicated right now.

Megan Jones27 said:They ran tests, reviewed all my results, listened to me, and were just as puzzled by the symptoms I described. They ended up telling me to take an antihistamine as needed—though I don't even need one right now—and suggested I get another CBC.

Since you posted this a while back, it might be useful to briefly recap your current symptoms and the specific steps you've taken regarding medical workups. Try to be as detailed as possible; saying "blood tests" isn't quite enough. With more doctors contributing to this thread now, someone might suggest a direction that actually helps.

Laura Lopez47 said:As for bloodwork... I'm getting it done constantly because I'm dealing with nonstop sinus infections, colds, viruses, sore throats, and so on. My doctor keeps sending me for blood tests because of that.
Thanks for the response.

What does the clinical picture of these frequent infections look like? Are we talking about severe symptoms—serious enough to require hospitalization or resulting in complications? How often does this happen? Specifically, how many times a month are you on antibiotics?

Are there young children nearby, perhaps in daycare or preschool? Or do you work in a profession that puts you in close contact with small kids?

Ashley Booth12 said:Good afternoon, everyone. My lower back completely seized up on me, so I went to see my doctor for an injection, some pills—anything to kill the pain. I’ve dealt with morning back pain for about a year now, but I usually manage to work through it. I tried switching pillows, getting a new mattress, but nothing helps. This time, though, it’s different. It just locked up. The entire right side—from my lower back down through my hip and all the way down my right leg—is aching, stiff, and burning. It's driving me crazy. She ordered blood work, and these were the results:
http://postimg.org/image/iba8ek0c3/
I was prescribed an antibiotic and have a follow-up in 10 days.
If anyone is willing to take a look, the labs seem to indicate inflammation, but
my doctor isn't certain if it's actually inflammation or just because my back went out. She asked if I had a cold; I don't. She asked if there were other issues; since this spring, I've been dealing with excessive hair loss. At first, I figured it was just seasonal, but it started in the spring and hasn't stopped... it's coming out in clumps. When I first brought it up, the doctor just told me to take vitamins and use anti-hair loss shampoos, but nothing has worked.
Also, two months ago, I had a granuloma on a molar—a tooth that had a root canal done about 6 or 7 years ago. It was spreading behind the tooth, causing a terrible odor, and a fistula formed on my palate. They ended up pulling the tooth. Could that still be causing visible inflammation in my system? Honestly, my overall health is a disaster right now. Between the back and leg pain, I can barely get out of bed in the morning. Then there's the general malaise and extreme fatigue. Age: 30.

Which antibiotic were you given? Did they run any tests besides blood work? Do you have a fever?

It's impossible to say for sure if this sudden flare-up of lower back pain radiating down the leg is linked to the dental issue, but theoretically, it could happen—for instance, if bacteria from the dental site entered the bloodstream and migrated toward the spinal area.

Given how poor you say your general condition is, you really should head to the local ER for further evaluation.

Susan Chavez said:To get a referral from a specialist, your primary care physician would have to write you a referral first..

Actually, no. Under current Medicare regulations, a family doctor isn't obligated to do anything. A specialist can suggest a test, but the primary care physician makes the final call on whether that testing is actually necessary. They have the authority to deny a referral, though they obviously take full responsibility if that assessment turns out to be wrong.

Laura Lopez47 said:I’ve posted here before about my blood work, but let's try this again. For the last two years, I've been seeing a consistent pattern in my lab results. I have hypothyroidism, by the way. Every single time, my lymphocyte counts come back elevated while my granulocytes are low. My doctor doesn't seem particularly concerned, which is frustrating because the results are identical every single time. It feels like a recurring theme rather than a fluke. Should I be pushing for more specialized testing? I've transcribed one set of results below; the other six are exactly the same.

Based on everything here, you likely have Hashimoto's thyroiditis. A blood count like this is completely expected given that diagnosis, and it’s going to stick around for quite some time. Since your absolute lymphocyte count is hovering around 4x10^9/L, I don't see any reason to pursue further testing for lymphocytosis unless you’re actually experiencing symptoms—things like swollen lymph nodes, or an enlarged liver or spleen. According to the International Consensus Group for Hematology Review, additional workup isn't indicated until that lymphocyte count hits 5x10^9/L. As for the granulocytes, they aren't actually low; the percentage just looks smaller because there are more lymphocytes present. It's basic math. Your absolute granulocyte count is perfectly normal.

What’s the logic behind the frequent blood work? Is there a specific reason they keep ordering these panels so often?

Megan Jones27 said:Ana, looking at your blood work, I’m stunned. It’s an exact mirror of what I’ve been dealing with for the last eight or nine months. The lymphocytes, neutrophils, and eosinophils—it’s all there. For me, this pattern surfaced right after childbirth, accompanied by a laundry list of bizarre symptoms that left everyone scratching their heads. No one could give me a straight answer. Could it be hypothyroidism, just like my situation?

It’s possible, but you really need a proper internal medicine workup first. If I recall correctly, you’ve dealt with blood in your stool along with abdominal and back pain. Besides, finding lymphocytosis isn't a definitive indicator of autoimmune thyroid issues; it can pop up in all sorts of other autoimmune conditions too.

bluemason3 said:I checked with Medicare. They said they aren't going.

They're covered, 100%. But there’s a catch: that specialist referral has to be officially indicated through Medicare. If it's just coming from a private clinic, your primary care physician isn't obligated to write you the referral.

restlessangler said:Whatever. I'll just call my doctor tomorrow and ask about the microdose option.😬
Thanks for the input, everyone.👍

Don't mention it! 🙂

Glad to hear the skin is clearing up (following the updates here 😬).

Take care!

And don't forget to get your Vitamin D levels checked in about three months.

👋

Also, sending good vibes to my colleague, Bryan Barnes2, 👋 and 🙏.

restlessangler said:Nicholas Myers, I’ve been waiting for you 😁. I know you gave me some general advice regarding Vitamin D a few months back.
Since I have 10,000 IU capsules, could I just take one every ten days?
I know that in the United States, some patients (I assume it varies doctor to doctor) are prescribed 50,000 IU once a week, even though from other perspectives
it isn't quite standard practice. You take an extreme dose one day and nothing for the rest of the week. I'm struggling to wrap my head around that info.

P.s. Is nmol/l the correct unit?

Angie, treating a Vitamin D deficiency involves two stages: first, hitting your target blood levels, and second, maintaining those levels. During the initial phase, you can approach supplementation on a daily, weekly, or monthly basis (though daily dosing typically yields the best results). However, during the maintenance phase—which is where you are now—daily intake is usually recommended. If it isn't a hassle, consider going back to taking Vitamin D3 supplement drops daily, much like a baby 😍.

Most guidelines agree that maintenance doses should be taken daily. If for some reason that isn't feasible, you can pivot to a regimen of larger doses at longer intervals.

Nicole Newman15 said:What does it mean to have high leukocyte and erythrocyte counts in urine?

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Context matters. You have to look at whether the patient is actually experiencing symptoms. It could point to several things: a urinary tract infection, kidney stones (with or without an infection), or perhaps some form of kidney damage or disease.

restlessangler said:09/08/2015 (after taking 10,000 IU daily for 2.5 months)

Calcium - 2.57 (ref. 2.14-2.53)
Phosphate - 1.42 (ref. 0.79-1.42)
Vitamin D - 166 (ref. >75)

I’m stopping the Vitamin D supplement now, so I’ll check the results again at the 12-month mark.

Can someone tell me if this Vitamin D level is significantly elevated? I'm not sure what constitutes a toxic level.
I haven't had any side effects.

The Vitamin D value is clearly in nmol/l, which makes it 166 nmol/l. That isn't considered toxic yet. Toxicity usually isn't a concern until levels exceed 375 nmol/l (150 ng/ml).

That said, there is room for debate regarding a level of 166 nmol/l (66 ng/ml). Some might call it "high-normal," others just "normal," and some might wonder if there is any actual benefit to having 166 nmol/l versus, say, 125 nmol/l.

Unfortunately, studies haven't established a definitive "ideal" blood Vitamin D level specifically for Lupus patients.

Given that you were deficient prior to supplementation, I'm not certain if you should stop entirely or if it would be wiser to simply scale back—perhaps to 1,000 IU daily—and then retest in three months.