Posts by Nicholas Myers

Moved from R&D to child health, then over to dentistry.

I’m asking my fellow dentists to take a look at this inquiry from a worried mother. If you can offer some insight, I’d appreciate the help.

Thanks.

Angela Wright said:vividsailor7 and Nicholas Myers,
thanks for the advice and your thoughts.
I went to see my doctor because I had a UTI, which Ninur cleared up.
Regarding my blood work, everything was within range except for CRP and ALP (the first one hit 244). My first abnormal liver panel was from back in September during the first episode, and this second one was done just now after finally visiting the doctor for the UTI. That visit was Friday afternoon; I started feeling that stinging sensation again over the weekend, and I had the blood drawn on Monday.
I’ve been sticking to a strict diet since September and have lost all the weight I gained during pregnancy; my cholesterol and triglycerides are normal. I don't know what they were before, as they didn't test those. This stinging I'm feeling is more like a nagging discomfort—just a dull ache here and there. It’s a subtle pain located under my right rib cage, moving toward the stomach and extending to my lower back at the same level.
EDIT
One more thing occurred to me that might be important. The first time this happened, my abdomen was extremely tender to the touch under the right rib cage. I had three episodes, and during the last one, while breastfeeding, the baby somehow pressed hard against that exact spot. After that, everything calmed down—the pain and the tenderness vanished completely. Is it possible that the pressure caused some kind of deviation in the bile duct, where something was drained out and is now building up again?

Dear Angela,

In any case, it would be highly unusual for a small stone to get stuck in the bile duct and stay there long enough to cause a constant elevation in liver enzymes.

The fact that the liver enzymes remain elevated consistently suggests I agree with the others: we shouldn't immediately assume the gallbladder is the primary culprit.

Unfortunately, since elevated liver enzymes can stem from so many different issues, it's impossible to pinpoint the exact cause without more data, even though the abdominal ultrasound showed diffuse liver lesions consistent with steatosis. However, the enzymes haven't budged even after three months, so we really need to investigate whether there is something else hiding behind that steatosis.

Fingers crossed for a good outcome.

Best regards. 🙂

Chris Howard3 said:Do I need antibiotics for this bacteria? Is it dangerous for my family? I have two kids, ages 3 and 4. My 4-year-old son actually had surgery yesterday.

Hello,

Colonization by this specific bacterium is incredibly common. Depending on which study you look at, anywhere from 30% to 80% of adults carry it in their pharynx.

Children can also frequently be colonized and act as carriers.

Generally speaking, if it's just colonization, antibiotics aren't prescribed.

That said, at the primary care level—like with some family practitioners—antibiotics are often handed out whenever any bacteria shows up. This usually happens due to a lack of specialized knowledge, or simply because a patient insists on them out of concern.

In my opinion, given the poor quality of this sample, you should probably start by repeating the sputum test. You’ll need proper instruction on how to produce a valid sample and ensuring adequate hydration beforehand to make sure there's enough phlegm to work with.

Best regards. 🙂

Chris Howard3 said:Can someone please help me make sense of these sputum results?
Isolate 01: Haemophilus influenzae - less than 1/3. This isolate is part of the normal physiological flora.
Gram stain: 20-30 epithelial cells, 5-15 mononuclears and PMNs, some Charcot-Leyden crystals.
Interpretation: More than 25 epithelial cells and fewer than 25 PMN/mononuclear cells in the field of view indicates poor sample quality.

I ordered this because I've been coughing for 4 weeks now, bringing up greenish-yellow mucus.
Thanks

Hi there,

Looking at that note—"more than 25 epithelial cells and fewer than 25 PMN/mononuclear cells... indicates poor sample quality"—it’s pretty clear. Since you have 20-30 epithelial cells per field and only 5-15 mononuclears or PMNs, the specimen isn't really meeting the standard. Essentially, instead of getting actual sputum from deep within the respiratory tract, most of what was collected is likely just saliva from the mouth.

Ivanica, if I may weigh in.

Based on what you’ve shared, I’m a bit unclear about which bladder is inflamed (given the discomfort and stinging you mentioned)—are you saying an ER diagnosis in September pointed toward acute cholecystitis (gallbladder inflammation)?

And now you’re undergoing more testing in the area just below the right rib cage?

What were the Bilirubin and ALP levels?

Generally speaking, I agree with the pediatrician; elevated liver enzymes are expected when a stone gets stuck in the bile duct and triggers inflammation.

However, that September ultrasound also noted diffuse changes suggesting fatty liver.

With "standard" fatty liver, you might see a mild rise in liver enzymes, but typically, those numbers improve with dietary changes, exercise, and weight loss.

That said, beyond simple fatty liver, there is NASH—non-alcoholic steatohepatitis—where, in addition to fat accumulation, there is actual inflammation in the liver. An ultrasound can't distinguish between the two.

I also agree with velvetmoose9 and the doctor who recommended further serology. Hepatitis can coexist with fatty liver, which could be driving those enzyme elevations (hopefully not your case).

Furthermore, since the liver enzyme values are only mildly elevated (for context, some literature classifies anything up to 250 IU as mild, 250 to 1000 IU as moderate, and over 1000 IU as severe), I side with velvetmoose9 that follow-up is necessary, but unless things worsen—like increased pain, potential jaundice, or a Low-grade fever—there's usually no indication for emergency intervention.

briskranger132 said:but my immunologist claims that regardless of Hashimoto's, ANA shouldn't be positive unless there's some other systemic disease involved🤷...
meaning, according to him, the thyroid and ANA have zero connection. (I hope he's wrong)

Given that it's established that ANA can show up positive (even at low titers!) in perfectly healthy people—individuals with no autoimmune issues whatsoever—this is common knowledge for anyone working in immunology. I can't get behind that immunologist's assessment (if you quoted him accurately) that a positive ANA must inevitably point to a systemic autoimmune disease ("ANA shouldn't be positive unless there's some other systemic disease involved").

Regardless, no single ANA result should ever be interpreted in a vacuum. It requires a deep dive into the full clinical picture, including physical exams and other lab work. As I've noted before, a positive ANA can mean anything from "nothing to worry about" to "something serious."

wiredgardener68 said:My doctor went on vacation without explaining what my results actually meant. Please, is this okay? 🙂

Prothrombin Time: 14.66 S (Normal range 16 - 21 S)
D-DIMER: 0.48 mg/L (Normal range < 0.50 mg/L)
Fibrinogen: 5.3 g/L (Normal range 1.8 - 3.5 g/L)

I'm pregnant, 13 weeks and 2 days. During my last exam, she mentioned my Fibrinogen was elevated and told me to retest (which is what this is)... because while Fibrinogen is expected to be high during pregnancy, mine might be a bit higher than what she usually sees. She didn't comment on the other values, so I'm wondering what the lower PT value means.

Thanks so much!

Hello,

Regarding the fibrinogen level, it’s only a very slight deviation considering how far along you are.

In fact, according to medical literature (for example, Abbassi-Ghanavati, Greer, and Cunningham in "Pregnancy and laboratory Studies: a reference table for clinicians," published in American Obstetrics & Gynecology), fibrinogen reference ranges during pregnancy shift significantly. For the first trimester, they go up to 5.1 g/l, for the second up to 5.4 g/l, and by the third, up to 6.2 g/l. Given that, 5.3 g/l doesn't look alarming to me.

Is it technically higher? Yes. But you shouldn't use the standard non-pregnant intervals; an increase in fibrinogen is a normal physiological response during pregnancy.

On the other hand, you have a rather interesting result regarding your prothrombin time. It's not a straightforward one to interpret, mostly because clinical attention is usually focused on prolonged clotting times, not shortened ones.

The value suggests a shortened prothrombin time. Your OB likely didn't comment on it simply because she wasn't sure how to interpret it herself.

To be honest, even I am unsure how significant this specific deviation is or if it warrants any concern at all.

A shortened prothrombin time can sometimes be seen in individuals with certain fibrinogen disorders (specifically dysfibrinogenemias). Since those are rare conditions, they really require a hematologist with specialized expertise to manage.

Frankly, I'm not sure what I would do in your shoes. Perhaps I'd have the prothrombin time and other coagulation parameters retested...

Your best bet is to ask your OB about the next steps.

Best regards. 🙂

steelwalker68 said:My grandmother has these lumps under her skin... mostly around her joints. About six months ago, she had blood work done because of some kidney cysts and everything came back fine. Now, about a month ago, these lumps appeared, though they seem to be receding... That's why they want her to redo the markers. She also has asthma, a history of heart attack, and deals with rheumatism.

Ma'am,

Based on what you've shared, it’s difficult to give a more precise answer.

It seems likely the doctor ordered repeat markers due to changes seen during an abdominal ultrasound.

Subcutaneous lumps can sometimes be associated with rheumatic diseases (which you mentioned).

Her other conditions—respiratory issues and what you called "rheuma," perhaps rheumatoid arthritis—could also influence the CEA levels.

In any case, the physicians managing her care will need to determine the cause of this increase, especially since the CEA was normal six months ago and is rising now.

Best regards. 🙂

Noah Hughes67 said:Thanks for the response. I went to an infectious disease specialist and did an HIV test—negative, thank God. The specialist told me my hormones are just acting up... I nearly lost it because I know something isn't right, but he insists it's just hormones. I had my kidneys and liver checked; results were perfect. Then I had my abdomen and spleen looked at; all perfect too. I have a slight heart murmur, but the doctor said that's normal for my age (I'm 17). My white blood cell count is slightly elevated, but doctors say that's normal as well. They even say this temperature is normal—around 99.0-99.2°F. Most of the day my temp is actually normal, around 97.5-97.7°F, but I have headaches and constant dizziness. This low-grade fever doesn't stay; it just pops up for a few hours and then disappears, but even when I don't have a fever, the symptoms persist. I was using marijuana for 5-6 months, about 2-3 joints a day, every single day, but I quit abruptly, so I thought maybe it was that... but I doubt it.

Sir,

If the infectious disease specialist has ruled out the causes of your symptoms, the next step would be to see a gastroenterologist.

Best regards. 🙂

Michelle Murphy61 said:Yeah, you're right, I mistyped that.
Here is a photo of the full report. Thanks 🙂

http://www.zaslike.com/files/z3ftx1b2ry4t6p0vhz77.jpg

Dear Michelle Murphy61,

Looking at the results, it’s clear that ANA came back positive on the IIF test, though they didn't list the titer. It's obviously higher than 1:100, but there's no specific level provided.

It is interesting that the ENA panel—which we run when ANA is positive to pinpoint exactly which antibodies are elevated—is negative.

A standalone positive ANA without clinical symptoms doesn't tell us much.

Low ANA titers can show up in perfectly healthy people with no underlying issues whatsoever.

Additionally, certain medications can trigger a positive ANA result.

Then there are specific conditions where it might affect just one organ (for instance, autoimmune thyroid issues—I mention this because I recall you mentioning thyroid concerns before) or it could point toward systemic connective tissue diseases.

In short, it can be an "all or nothing" situation.

Best regards. 🙂

redhound12 said:Could someone please help me make sense of these lab results?
I've come down with a virus, so I asked my doctor for some blood work. Lately, I’ve been dealing with constant fatigue and digestive issues—things I initially chalked up to stress. Looking at the results, about half of the values are outside the normal range. For context, I'm 33, a smoker, and carrying some extra weight.

WBC count at 10.7 (Ref range: 3.4-9.7).
MCH 38.1 (Normal range: 27.4-33.9). Slightly elevated.
MCHC 395 (320-345).
NESEG 7 (0-2)
Lymphocytes 16 (Normal range: 20-46).
Monocytes: 0 (Ref range: 2-12)
URAT 382 (Reference range: 134-337).
AST 37 (Normal range: 8-30).
ALT 65 (Normal range: 10-36).
GGT 54 (Normal range: 9-35).
HDL at 0.90.
LDL at 3-4.
Cholesterol at 5.2.
Triglycerides at 1.90.
Thanks in advance...

To whom it may concern,

It's hard to make sense of these results when they're only partially transcribed.

Based on what you've shared, those slightly elevated white blood cell counts, combined with the uptick in unsegmented granulocytes, suggest there might be an infection brewing.

The most striking part of the results is the spike in liver enzymes, specifically the ALT. It’s a minor elevation, but even a slight uptick like that points toward some liver damage.

The lab results alone don't provide enough clarity to pinpoint exactly what caused the liver damage.

You mention being overweight. Excessive weight can lead to fatty liver buildup, which in turn can cause elevated liver enzymes.

No, there are other reasons why those levels might spike.

Furthermore, you mentioned feeling fatigued and having some digestive issues—though you didn't specify exactly what those entail—and you haven't noted how long these symptoms have been persisting.

That makes it even harder to pinpoint the exact issue. If these symptoms persist—or if the follow-up liver enzyme tests stay this high or trend worse—we'll have to move forward with more intensive diagnostic testing.

Greetings. 🙂

Noah Hughes67 said:Current status: abdominal pain and loose stools. It’s not constant—just once a day—while everything else seems normal. Temperature is sitting at around 99°F. Appetite is non-existent. I’ve dropped from 160 lbs down to 138 lbs. I'm also dealing with tremors a few times a day, feeling cold, and frequent chills. On top of that, there's a persistent headache. This has been dragging on for months now, which is what worries me. I’ve run every test imaginable. Bloodwork looks great, though my white cell count is slightly elevated—nothing major. My lymph nodes are swollen in my neck and hips, but my doctor claims they aren't large enough to diagnose anything specific. I'm feeling pretty lost. I’m heading to see a private physician now; perhaps she'll have a better perspective. Personally, I suspect a bacterial infection in the gut might be causing the digestive issues, but that's just a hunch. What are your thoughts?

To whom it may concern,

The symptoms you're describing don't fit into any standard category, so we really need to pin down exactly what’s happening here. To start with, I'd suggest asking your primary care physician for referrals to both an infectious disease specialist and a gastroenterologist.

I'm not quite sure what you meant by saying you've run "every possible test," especially since you're still wondering if there might be some underlying bacterial infection. From my perspective, that suggests the diagnostic workup isn't actually complete. For instance, a standard stool culture would have identified any specific bacteria causing GI issues. That said, things like rigors—if they truly are rigors—weight loss, headaches, and other systemic symptoms are difficult to pin down to just a simple intestinal pathogen.

Best regards. 🙂

steelwalker68 said:Does anyone know?

So, my grandmother just had her tumor markers checked. One of them listed is a cancer molecular antigen. The cutoff is 6, but she’s sitting at 9.

Dear ma'am,

You didn't mention why your grandmother was referred for these tests.

The CEA value is slightly elevated. This doesn't automatically mean your grandmother has cancer; there are several other conditions that can cause this marker to spike. That said, her doctors will certainly look into it to figure out exactly what’s going on.

Greetings. 🙂

Daniel Lewis67 said:Back again. Just got my ultrasound results back. Liver looks fine, pancreas is okay—pretty much everything is normal. Smith, there’s some sludge at the bottom, but no stones. However, the doctor noted that my stomach lining is extremely thickened, which points to acute gastritis. I tested negative for H. pylori.
Following up on everything discussed: do I actually need an EGD, or should I just stick with the Generic therapy?

To whom it may concern,

You haven't provided enough data for us to give you an answer.

First off, have you actually seen a gastroenterologist yet? And have you gone through with the EGD?

If you’re taking an IPP blocker—something like Prilosec or Generic—and your symptoms aren't fully subsiding, you need to see a gastroenterologist. You’ll likely need an EGD and some additional testing to figure out what's actually going on.

Greetings. 🙂

wiredpanther7 said:Back again. 🙂 Just got my Ferritin levels back. It came in at 4.0, while the standard range is supposed to be between 15.0 and 150.
Can someone help me make sense of these results, both the previous ones and this new batch? What am I actually looking at here? Am I going to be stuck getting IV drips or something? Honestly, I have a massive aversion to hospitals, so I’m just counting down the days until my doctor's appointment next week so I can finally figure out what's coming my way. 🙂

To whom it may concern,

The results point toward sideropenia—basically, your iron stores are running low.

I don't think you'll end up needing IV iron therapy.

At some point, we really need to get to the bottom of why that iron deficiency is happening in the first place. It’s not enough to just identify the deficit; you have to pin down the underlying cause—the "why" behind the loss.

Greetings. 🙂

velvetraven12 said:Looking for some input here... We went ahead and handed in a urine sample for testing on our own initiative. What do you all think?
My two-year-old is restless at night and keeps complaining, even though she seems perfectly fine during the day. When I ask if anything hurts, she just says no.

Dear Madam,

Since the child is complaining of something—even if you haven't specified exactly what—and since you went ahead and ran a urine test on your own that showed some irregularities (cloudiness or traces of blood, depending on whether those levels are just hitting the upper limit or slightly over), the best move is to take them to a pediatrician. Let a doctor perform a proper exam first; they'll be the ones to decide what actual follow-up is necessary.

Greetings. 🙂

Sarah Martinez35 said:To whom it may concern,
I’m looking for some help interpreting my two-month-old daughter's lab results. We just got them via email, and since we can't talk to our pediatrician until Monday, I'm feeling pretty anxious about what we're seeing here.

To whom it may concern,

The lab results highlight an elevated eosinophil count, though looking at the absolute count, it's only a moderate increase. It definitely needs some clarification.

In my view, the absolute eosinophil count (which is 0.96x10^9/L for your child) provides much more reliable data than a Dunger test. That specific test lacks standardization; the results can shift depending entirely on whoever is performing the manual count or estimation, even when showing significantly elevated values.

Regarding total IgE levels and potential allergies: you can't rely solely on standard reference ranges to rule out atopy with absolute certainty. It’s like checking a weather report that says "clear skies" when there's actually a storm brewing just off the coast. Roughly 10% of children who actually have atopy will still show normal total IgE values.

I’ve updated part of my response after realizing I misread—turns out the skin prick test for KM came back positive.

Keep us posted on how things unfold.

Greetings. 🙂

Michelle Murphy61 said:Hey there,

Could someone please take a look at these results and give me your thoughts?

ANA (ENA) IIF: Homogeneous, < 1:100

😳

Everything else came back negative.

Dear Michelle Murphy61,

Can you transcribe the entire report?

A lot depends on the specific lab's reference ranges—some set the cutoff at 1:80, while others go with 1:100. It’s hard to tell exactly what this result means from the info provided. If the titer is lower than 1:100, it could be considered a low positive, though some labs might even classify that as negative. You might want to double-check that you've transcribed everything correctly.

Sarah Wells23 said:I wasn't quite sure why my UIBC and TIBC were high when iron levels seemed fine, but since I'm taking Centrum (which includes iron), maybe that's masking the actual situation. 🤷

Hello,

It’s definitely possible. Taking supplements containing iron can skew the measured concentration, so your iron results might have been artificially inflated.

Best regards. 🙂

Daniel Lewis said:Hi there. I recently had a lymph node biopsy because one was swollen. I received my results and wanted to get your take on the CBC they performed as well—specifically, if everything looks within the normal range. I am female, 20 years old. CBC: seg 53, mono 8, ly 34, eo 5, tr+++. Thank you.

Hello,

You didn't include the actual conclusion or diagnosis from the cytological biopsy itself (I’m assuming it shows reactive hyperplasia).

As for the CBC, it looks fine to me.

Noah Hughes67 said:Hi. Just got my blood work back from the infectious disease clinic. Here are the results:

Search | Finding | Results | Unit | Method
EBV VCA IgM: negative. Results pending EIA.
EBV VCA IgG: Positive. Resulting at 121 AU/ml via EIA.
EBV EA IgG: Positive. Result: 50 AU/ml. Method: EIA.
EBNA IgG: Positive (>200 AU/ml), EIA method.
Change my view: A negative IgM result for CMV doesn't necessarily mean you're in the clear if the EIA comes back positive.
CMV IgG: POSITIVE. Result: 1.7 IU/ml via EIA.

What does that even mean?

To whom it may concern,

What was the reasoning behind the testing? And how long have you been dealing with these symptoms?

I’m asking this because your clinical presentation—exactly how you’re feeling, the specific symptoms you're dealing with, and their severity—is absolutely critical when we try to make sense of these serology results.

This cluster of results isn't exactly straightforward to interpret.

Tests were conducted for the two primary viruses responsible for triggering infectious mononucleosis—or what’s commonly referred to as infectious mononucleosis syndrome.

Regarding that second virus—CMV, which typically just results in a milder strain of illness—it’s highly probable we're looking at a past infection. It likely has zero connection to the symptoms currently being experienced.

But when you factor in this second virus, EBV, things get significantly more complicated.

Interpretation depends entirely on the clinical findings.

Greetings. 🙂

Roger Rodriguez Asks:
So, according to this, my doctor diagnosed me with mild anemia. She suggested I start taking some supplements, but specifically nothing with iron—since my levels aren't actually low enough to require it. 😕

To whom it may concern,

I have to admit, these results are a bit unusual.

If you look at the hemoglobin and hematocrit levels alongside the erythrocyte indices, the conclusion is clear: we're looking at dilution anemia. To put it simply, during pregnancy, the body retains more fluid. This increases the plasma volume, essentially spreading the existing blood cells thinner across a larger total volume. It isn't a true iron deficiency; it's just a matter of dilution.

Generally speaking, it’s acceptable for hemoglobin levels during pregnancy to dip as low as 110 g/L—typically hitting that floor around weeks 32 to 34—with hematocrit settling around 0.31. Looking at your results, the only outlier is the red blood cell count, which remains within an acceptable range up to about 3.8 x 10^12/L.

Iron levels are hovering near the lower limit—typically 12 µmol/l is the benchmark during pregnancy—and iron saturation follows suit. However, UIBC and TIBC remain elevated, which is a classic indicator of iron deficiency. That said, one should keep in mind that raw iron concentrations fluctuate quite a bit throughout the day; it isn't exactly a foolproof metric for assessing overall iron stores.

I’m not entirely sure which specific anemia supplements my OB-GYN had in mind. My iron levels are hovering right around the threshold, and the lab results don't suggest any deficiency in folic acid or vitamin B12.

It might be best to reach out to her again and ask for some clarification.

Best regards. 🙂