Posts by Nicholas Myers

David Flores68 said:My biopsy results are throwing me for a loop. I had a gastroscopy, and here was the initial finding:


And then there's this pathology report...


What’s tripping me up is that while the pathologist states the material matches gastric mucosa, they also mention finding normal stratified squamous epithelium in part of the sample. From what I've gathered, the stomach lining is made of simple columnar epithelium, right? So why the squamous stuff?

Does this mean the sample actually came from the esophagus, and that intestinal metaplasia indicates Barrett's esophagus?

Sir,

You really ought to direct this question to the pathologist who reviewed the slide. I can't know exactly what they saw under the microscope, but based on the report, they identified the tissue as gastric mucosa. In short, the pathologist believes this is stomach tissue, not esophageal. As for the presence of stratified squamous epithelium, it could simply be because the biopsy caught the "Z-line"—that transition zone where the distal esophagus meets the cardia of the stomach. It's entirely possible a bit of the esophageal lining was snagged during the procedure.

That said, the definitive answer has to come from the specialist who performed the examination. I can't speculate on their specific visual findings or what they intended to capture.

Chloe Sanchez15 said:

Hello,

Could you please help me interpret these results? Is there any sign of insulin resistance here, specifically regarding this insulin value after 120 minutes?
In other results from last week, my ferritin was 11.3 ng/l (ref. 13.0-150) and iron was 90 ng/l (ref. 33-193).

Thanks so much in advance.

Hello,

Based on the calculations, the HOMA-IR index comes out to 1.16 (normal is under 1.6) and the Matsuda index is 9.86 (normal is above 2.5). Based on these specific metrics, there are no indicators of insulin resistance in this report. As for that 120-minute insulin level, I looked at two different sources, both of which suggest a value of 294.2 pmol/L is still within the acceptable range. For instance, the Williams Textbook of Endocrinology (13th ed., Philadelphia: Elsevier) lists the 120-minute reference range between 111-1153 pmol/L, while Quest Diagnostics provides a range of 35 to 380 pmol/L. Reference values fluctuate quite a bit depending on the literature used, but according to most sources, your 294.2 pmol/L falls within the normal spectrum.

For a more granular view, an extended OGTT would be necessary—measuring insulin at 30, 60, 120, and 180 minutes—to pinpoint exactly when peak insulin concentrations occur and determine the specific type of insulin curve.

Regarding the ferritin levels: they are low, which points toward depleted iron stores in the body. However, it would be useful to see the TIBC to calculate transferrin saturation.

Emily Ortiz27 said:All in all, that's the gist of it. It’s also worth noting that the kid is actually doing quite well—bright, well-rested, and eating normally.

Ma'am,

I think that, regardless of how well the child is doing and the lack of symptoms, it isn't time to scale back the checkups just yet. We should maintain the current schedule. These results aren't surprising given the disease or, since we don't have molecular confirmation yet, the spectrum of possibilities under consideration. Still, caution is necessary, and regular monitoring remains essential.

Peter White80 said:Dear Sir,
I am 18 years old. I take Atenolol 25-50 mg for blood pressure and Esomeprazole for gastritis. My last BP monitoring:
BP Log (August 2, 2022) (41/40 readings)
Max systolic: 160 mmHg, max diastolic: 115 mmHg
Average blood pressure values (mmHg):
Overall 140/68 (95th percentile 80)
Daytime 144/70 (95th percentile 85)
Nighttime 127/62 (95th percentile 76)
Nighttime BP drop (%):
Systolic 11.3% (normal)
Diastolic 12% (normal)
My hair has also thinned significantly since starting the beta-blockers. Mostly on the crown. It grows back slower, too. (L65.0 Telogen effluvium). Additionally, I have tinnitus and occasional dizziness ever since my blood pressure was diagnosed.
Also, all my blood work includes this note: "Serum slightly lipemic."

Some other results if you are interested: View on imgur

Beta-blocker therapy isn't typically the first line of defense for hypertension in pediatric patients, so I assume your condition began before age 18. I later saw in another thread that various antihypertensives were tried previously, and only Atenolol proved effective. What was the reasoning behind the immunological tests you attached? And regarding the nephrology workup—I assume that was done to rule out renal causes for the hypertension?

It might be more productive to move this discussion to a single thread, perhaps one specifically dedicated to arterial hypertension. Otherwise, the conversation gets diluted and harder to follow.

Peter White80 said:Good day. I had some blood work done; here are the results:

View on imgur
View on imgur
View on imgur





My creatinine has hit this elevated level—just slightly above the limit—for the third time now. My ALT seems to be high for the fourth time as well. Monocytes were flagged once. Is there an underlying reason for this, or is it just a minor fluctuation? For context, I deal with GERD, hypertension, and struggle with constipation whenever I have iron deficiency.

How old are you? Are you currently taking any medications? Also, how is your blood pressure being managed?

Sam Taylor22 said:https://i.postimg.cc/2SSrs02D/Screenshot-20220818-142844-Yahoo-Mail.jpg

Hello, I'm looking for an interpretation of these results. I'm concerned about my platelet counts; they've been elevated for two years now, though never above the upper limit. This started following my vaccine and recovering from COVID-19.
My doctor says the levels look great.
On June 16th, I had a Letz procedure on my cervix; bleeding patterns have remained normal since then.
Regarding medical history, I deal with GERD and controlled asthma.
I recently had blood work done due to pain in my lower right abdomen. The pain actually subsided for a bit, but it keeps coming back periodically.
An abdominal ultrasound showed everything was fine, aside from significant gas and full intestines.
The doctor attributes the pain to the Letz procedure and the bloating.
I also experience frequent fatigue, so my doctor prescribed Vitamin D supplements.

Best regards,

Hello,

Looking at the results you provided, I agree with your physician—they look normal. The only thing is that your Vitamin D levels could be higher, so I think prescribing a supplement is a sound decision.

Kimberly Morris said:Greetings everyone, especially doctors Nicholas Myers and brightgull95!

You know me; I won't list every single lab result and diagnosis because you’d have far too much to read.

My current issue is Vitamin D. Since I started seeing my endocrinologist back in 2017, my Vitamin D levels have consistently sat well below the lower limit. I work an office job, and I have a large house that requires constant cleaning, so I’m rarely out in the sun. I'm not sure if that was the primary cause, but my Vitamin D levels were low every single time I had bloodwork done. I've tried supplements in capsules and sprays. Basically, I've been taking it regularly. At my last check-up with the endocrinologist a few months ago, here were the results:

VitD3 19.9 (20 - 150)

Ca 2.58 (2.14 - 2.53).

The endocrinologist called me and said that due to the rise in Ca, I need to stop taking Vitamin D. We’ll meet at the follow-up to discuss how to proceed.

The follow-up hasn't happened yet because they're away on vacation. What worries me is that I am constantly sick. Constant viral infections, sore throats, coughing, runny noses, stomach bugs. As a layman, my conclusion is that my immune system is shot.

Since COVID-19 started, I've been working from home and taking maximum precautions, so I haven't caught that yet. I didn't get vaccinated based on my immunologist's recommendation to hold off. I'm not an anti-vaxxer, just someone who panics a bit—when my specialist once told me, "don't get vaccinated for now," that stuck in my head.

I read a lot about this, and it says anyone with a Vitamin D deficiency faces immune issues, complications from COVID-19, etc. How can I supplement without causing my Ca to rise? What should I take for immunity?

Any advice is welcome. Thanks in advance.

Dear lady,

Taking Vitamin D supplements can further increase calcium levels because it stimulates calcium absorption in the intestines. Unfortunately, the ratio of calcium to Vitamin D is unfavorable in your case, but a total calcium level of 2.58 mmol/l is only slightly elevated. It would be ideal for your Vitamin D levels to be higher; yours was measured at 19.9 ug/l, while the recommendation is above 20 ug/l or ideally above 30 ug/L. Note that the units are in ug/l, not nmol/l, which is how concentration is most commonly expressed; this likely caused some extra confusion, as when expressed in nmol/l, the recommended level is above 50 nmol/l.

I don't believe your Vitamin D levels are so critical that you cannot wait for the final processing of your results.

This specific constellation of findings (low Vitamin D, high calcium) is known to occur in hyperparathyroidism, primarily primary hyperparathyroidism, though secondary hyperparathyroidism can sometimes be seen alongside a Vitamin D deficiency—though in those cases, calcium levels are usually normal or low. If a diagnosis of primary hyperparathyroidism is confirmed, it may be possible to take Vitamin D with extreme caution, and generally, significant hypercalcemia does not occur.

There are no scientifically proven supplements that improve immune system function; therefore, the best approach remains adequate sleep, physical activity, and a varied diet.

Sandra Hughes72 said:LP, I’m reviving this thread in case anyone has insight ��. Here’s the situation: after one miscarriage, my doctor sent me for a full battery of tests to rule out Antiphospholipid Syndrome. My next three pregnancies, managed with Clexane, went smoothly. My last hematology checkup after the third birth noted we should monitor during the next pregnancy. That was eight years ago. This year, on April 22nd, I underwent surgery for massive disc extrusion. One month later, I developed a DVT and a massive bilateral pulmonary embolism. I pulled through, thank God, but now I'm on Warfarin for life. Confirmed APS. My Cardiolipin - IgG and IgM are positive at around 50, and my beta2gly is 300. During my pregnancies, LAC levels fluctuated between positive and negative ��. They couldn't test it recently due to high anticoagulant doses (I was on 100mg*2 s.c. Clexane because of the embolism). For the last two weeks, I've had this sensation of coldness in my right lower leg. It's just a feeling—the leg is the same temperature as the left, no swelling, no pain, nothing else. Just that sensation an old grandmother might describe as "chilled bones." Has anyone dealt with this? Thanks ����

Ma'am,

The symptoms you're describing are non-specific. In many cases, they point more toward a neurological issue—peripheral neuropathy, perhaps—rather than deep vein thrombosis stemming from Antiphospholipid Syndrome. Still, without a clinical exam and diagnostic testing, it's impossible to say for certain.

cosmiccobra2 said:Can anyone help? I've been dealing with anemia for about four years now. I would be really grateful if someone could help me make sense of these results and give some insight!!

Here are the results. Everything is within the normal range except for the MPV, which is running high compared to the reference interval.

Thanks.

Hello,

As far as I can recall—since the image isn't displaying anymore—you don't have anemia based on these current findings. An isolated deviation in MPV shouldn't mean much as long as your platelet count and function look solid.

Carl Thompson26 said:Thanks for the reply.

CYTOLOGY REPORT:

Myelogram: blasts 2%, promyelocytes 4%, myelocytes 9%, metamyelocytes 4%, non-segmented granulocytes 17%, segmented granulocytes 19%, lymphocytes 14%, monocytes 1%, erythroblasts 30%

DIFKS segmented granulocytes 42%, lymph 47%, mono 8%, eos 3%, E: normocytic, normochromic. Trace BO

In the bone marrow aspirate smears, moderately abundant hematopoietic tissue was found, where the ratio of white to red marrow is approximately 2.3:1 in favor of the white marrow. Erythropoiesis is mature and predominantly normoblastic. Granulopoiesis is represented by mature and transitional forms. Thrombopoiesis is represented by mature megakaryocyte forms.

If you could clarify the findings above, and what is being determined via tissue phenotyping, FISH, and karyotype.

Thanks

Best regards

Hello,

As I mentioned previously—and your doctors have likely already told you—one of the reasons for investigating lymphopenia is to rule out malignant bone marrow diseases, such as myelodysplastic syndromes. The tests requested are specifically used to diagnose those conditions.

The full battery of tests must be completed before we can officially rule out those serious illnesses.

Based strictly on the bone marrow aspirate results provided, there are currently no signs of such diseases. However, we still need to wait for the remaining results.

Carl Thompson26 said:My blood work from June and July hasn't budged—white blood cell and lymphocyte counts remain low.
Ran additional tests for HIV, Hib, minerals, folic acid, EF serum protein, and B12. Everything came back normal.
Currently waiting on results from a bone marrow biopsy and analysis, including immunophenotyping, FISH, and a karyotype. They told me at the Mayo Clinic it could take about two months.

I'm not sure what to expect.

Thanks

Hello,

It’s now time to rule out any malignant causes for this specific constellation of findings you're seeing. Let's hope the results don't lean in that direction. Not all results take two months to process. Cytology results are usually ready very quickly, and immunophenotyping typically follows shortly after. While FISH and karyotyping take a bit longer, you might want to check in regarding the cytology (usually just a day or two after the biopsy) and the immunophenotyping (roughly within a week; though things might be moving slower lately due to summer vacations and staffing shortages, it shouldn't really take two months). Good luck!

Douglas Parker3 said:Has anyone else dealt with yellowing under the eyes during early pregnancy? Naturally, the alarm bells start ringing regarding potential bladder or kidney infections, yet a standard complete blood count shows absolutely nothing.

Ma'am,

A standard blood count isn't going to flag a bladder infection, nor will it measure kidney function.

hollowviper said:What tests would you recommend? Is it possible for someone to be losing blood somewhere with platelet counts like this? For instance, internal bleeding in the stomach.
Thanks

Given those platelet levels, there isn't a strict indication for more intensive workup just yet, so I’d suggest simply monitoring the count for now. While low platelets can lead to spontaneous bleeding, what you're describing doesn't typically correlate with a lower platelet count.

Sarah Anderson35 said:Hi there,
https://i.postimg.cc/DfMyQSpV/389323...7411104-AA.png
I need someone to look over these results.
I gave birth 10 months ago. There was significant bleeding, and I had blood work done postpartum showing low iron. I started taking Iron, used it for a few days, then stopped (constipation issues).
Had blood work done a couple of days ago; here are the results. My doctor called and said she won't prescribe anything else for the iron—just suggested I pick up some syrup at the pharmacy (Floradix) and retest in about six weeks.
I'm 27, had two births in two years (back-to-back), 60 kg / 176 cm.
Periods are generally moderate to heavy.

To whom it may concern,

Since the ferritin concentration is below 30 ug/L, this is moderately classified as iron deficiency without anemia. It is recommended to implement dietary changes—specifically including meat, poultry, and fish at least five days a week, alongside legumes and leafy greens—while using iron supplements and undergoing periodic monitoring of hemoglobin and ferritin levels.

In consultation with a primary care physician, one should investigate the underlying causes and take appropriate measures.

Emily Ortiz27 said:Thanks.
We usually check in every 2 or 3 months; lately, the hematologist even suggested we could wait longer between appointments.

No anemia so far, though the blood smear almost always shows some hypochromia.

Since there hasn't been any actual anemia yet, I’d suggest repeating the tests in 1 to 2 months. I wouldn't wait any longer than that.

hollowviper said:Hello,
I wanted to ask if it's dangerous when someone has a platelet count of 141, given the reference range is 158-424. All other parameters—both hematology and biochemistry—are normal.

Ma'am,

That number alone isn't an immediate danger. The real question is finding out why it happened in the first place.

northerncobra33 said:I received my blood typing results today. There's a note at the bottom:
No anti-erythrocyte antibodies were detected in the plasma.
Can someone explain what this actually means?

Hello,

That’s a good result. If anti-erythrocyte antibodies were present, there would be a risk during a transfusion—essentially, the recipient's immune system attacking the donor's red blood cells once they enter the bloodstream, leading to hemolysis and other complications. Since none were found, you're in the clear.

Emily Ortiz27 said:Our routine checkup—an eight-year-old with lymphadenopathy. I’m looking at this change in erythrocytes; is it alright? We have new tests scheduled in a few months regardless.
Also, from that same sample, the lymphocyte count on the cytological smear is 55%, which deviates significantly from previous results and sits just above the upper limit of normal.
Ultrasounds show no changes; numerous enlarged nodes present, though they look reactive in nature.
No other symptoms reported.

Ma'am,

If I recall correctly, there was no anemia in the previous labs? Current results show normocytic anemia—borderline, certainly, but still a shift compared to historical data. I'm not sure how frequently you run blood counts, but I would repeat this in about four weeks to see the trajectory. If we observe a downward trend, we should then determine the reticulocyte count.

To whom it may concern,

The samples collected during your second endoscopy weren't quite "sufficient." The material was too sparse, making it impossible to draw any definitive conclusions from the analysis. It’s unclear why an IgA test was ordered back in November 2014, given that you have an isolated IgA deficiency; those results simply aren't relevant here. I wouldn't go so far as to say celiac disease is ruled out—the small intestine biopsy was inadequate for a proper assessment, and both the IgA and tTg IgA tests are moot in your situation. Furthermore, the stomach biopsy was thin. It is entirely possible that areas of intestinal metaplasia still exist but were missed by the biopsy. Remember, intestinal metaplasia doesn't always show up macroscopically. As I believe I've mentioned before, your normal calprotectin levels, combined with a normal CRP and ESR, suggest there is a low probability that your gastrointestinal issues are linked to inflammatory bowel disease.

To be blunt, based on the findings provided, it’s difficult to reach any coherent conclusion.

cosmicmoose2 said:Last Friday, I had a urine test done because I suspected an infection. Glucose came back negative, but ketones were at 1+.
I’ve read that this can be a sign of diabetes, but it also shows up during fasting.
Given that I haven't eaten anything for about 23 hours due to stomach pains (just water), is it more likely that these ketones are from fasting, or should I get checked for diabetes?
Is 23 hours without food long enough for ketones to show up?
I'm 137 lbs, BMI 23.5... I've put on a bit of muscle over the last few years, but my waist is around 36 inches.

Once I finish this course of antibiotics, I plan to repeat the urine test, but there's still a while to go since this prescription is for two weeks.

Hello,

We're looking at ketonuria caused by fasting. Even shorter periods of fasting can trigger ketonuria, so 23 hours certainly qualifies.