Posts by Nicholas Myers

Chris Howard3 said:Thanks for getting back to me!
I just got my little one's results back. Everything is negative except for Toxoplasma gondii—that came back positive.
-igm-91 UI/ml (anything over 8 is considered positive)
avidity is 0.033 LOW
What does this actually mean? How risky is it, and could this be linked to the previous blood work and those elevated liver enzymes?

Thank you so much, and sorry for all the questions! 🙂

Hello,

As I mentioned before, infectious mononucleosis syndrome can be triggered by various sources—ranging from viruses (like EBV, CMV, or HHV-6) to parasites such as Toxoplasma gondii. This parasite can certainly produce this specific clinical picture and set of lab results. That is why we proceeded with testing the child.

To properly interpret the Toxoplasma gondii serology, the IgG result is also necessary (which we know is positive, given that the IgG antibody avidity was tested).

The reality is that interpreting these results is quite complex. If both markers (IgM and IgG) are positive, it suggests a recent infection within the last year, and samples will need to be sent for further analysis. There is an even higher probability of a relatively recent infection if we see both positive IgM and IgG combined with low IgG avidity.

A fresh infection is also possible if the IgG is borderline while the IgM is positive.

If we are looking at any of those scenarios, we’ll need to take another sample about 2 to 3 weeks after the first blood draw for follow-up testing.

For context, Toxoplasma gondii is a parasite; humans typically contract it through contact with cats (unwashed hands) or via contaminated food.

When healthy children are infected with this parasite—and I must reiterate, a single blood draw cannot confirm whether an infection is current or past; you generally need at least two samples and multiple tests—symptoms usually resolve on their own. Treatment is only required in specific instances.

The primary concern with a fresh infection is for pregnant women, due to the risk of transmission to the fetus, and for individuals with compromised immune systems (such as those living with HIV, lymphoma, bone marrow transplant recipients, or those on immunosuppressive medications).

Best regards. 🙂

Hello,

A positive IgG result for a virus typically indicates a past infection rather than something brand new.

However, for an accurate reading, doctors usually order what’s called paired sera. This involves a second blood draw about two to four weeks after the first. Comparing those two results is how you get a reliable interpretation.

Best regards. 🙂

frozentinker992 said:Just checking in.

Standard biochemistry wasn't ordered because, according to the primary care doctor, the last cortisol level was fine (even though it wasn't).🙂🙂

Hold on a second.

Shouldn't the endocrinologist be the one interpreting these results? We aren't talking about basic screenings here; this is highly specialized sub-specialty work.

A general practitioner shouldn't even be ordering these types of tests without a specialist's prior assessment. It’s the specialist's job to specify exactly which tests are needed—down to the finest detail—since many tests come in various versions: abbreviated vs. comprehensive, or basic vs. granular. Deciding what is necessary falls squarely on the endocrinologist.

Didn't the endocrinologist explicitly list the specific tests required before you follow up for your next appointment?

Chris Howard3 said:Greetings.
Thanks for the input. I had blood drawn for EBV, CMV, ELISA, HCV, and HIV; my Hepatitis B results should be ready tomorrow. I’m not entirely sure what all these acronyms signify yet, but we'll see. I also had an abdominal ultrasound—everything looks fine, though they noted some hyperechogenicity and homogeneous parenchyma in the liver. My son has been running a fever around or above 100.4°F for six days now. Is that normal? He's also complaining of eye pain. The doctor told us to come back for a follow-up in a week.

Much appreciated. 🙂

To whom it may concern,

Your ultrasound results might point toward fatty liver disease. It’s essentially just fat accumulation in the liver, and the root causes vary wildly—everything from weight issues and diabetes to cellular damage triggered by viral hepatitis or exposure to toxins like alcohol, certain medications, or other environmental factors. You should probably dive deeper into this with Dr. Hrvoj and the rest of the group here. Liver damage. Look, we're off-topic here.

Regarding the child—how is their vision? How do their eyes look? Can they lift their head from a lying position by bringing their chin to their chest? Are they sensitive to light, or experiencing any vomiting?

Chris Howard3 said:I’m posting this again because I’m worried.

I’ve already mentioned my poor results—AST was 53 (range 8-30).
...
Now, there's been a high fever for five days and strong breath odor.
Could we both be dealing with infectious mononucleosis? Thanks for any insight.

Ma'am,

Since you seem to be moving past the acute phase—or perhaps it's already over—the only way to confirm is through serology. That means a blood draw to check for antibodies against the primary causes of infectious mononucleosis syndrome, specifically EBV and CMV, and others if necessary. Did anyone mention that option to you?

If those elevated liver enzymes persist without a clear explanation, you'll need to see a specialist—ideally a gastroenterologist—who can direct your next steps.

For the child, it would also be wise to run a CBC, check LDH levels, and, depending on clinical judgment (which is impossible to determine via an online forum), perform serological testing as well.

Best regards. 🙂

vividsailor7 said:ev. genetic sequencing of the ATP7B gene

What on earth is a genetic screen for? They haven't even finished the basic diagnostic workup for Wilson's disease yet! 🙂

ophthalmologist exam

The notes clearly state the ophthalmologist exam was already done! 🙂

Anthony Nelson4 said:Hi there. I’m heading to the US soon for an eight-month trip, and I need to pack a significant supply of my epilepsy medication. Specifically, I'm looking at 5 boxes of Depakote 300, 9 boxes of Lamictal 50, and 5 boxes of Lamictal 25. My question is: will my doctor actually agree to prescribe this much at once? When I brought it up, she mentioned needing to call someone to double-check—I can't recall who—but will she approve such a large quantity? I'm sure I'm not the only one traveling abroad for extended periods...

I assume your physician intends to consult with someone at Medicare.

Under standard medical prescribing regulations regarding travel, patients can be issued medications for chronic conditions in quantities sufficient for up to six months of treatment. In these instances, a doctor can issue a paper prescription specifying that the patient may collect the entire supply at once.

The math comes down to your daily dosage versus the total number of boxes required to see if it fits within that six-month window.

Since epilepsy is classified as a chronic condition, you should theoretically have the right to receive a larger bulk supply ahead of your trip.

Let us know how it turns out.

Best regards. 🙂

vividsailor7 said:1. What symptoms are you experiencing?
2. Full test results?
3. Current medications—I assume LT4 for the thyroid,
but there is a massive selection for hypertension—for instance, beta-blockers, diuretics, ACE inhibitors, sartans, calcium channel blockers,
and I assume allopurinol and NSAIDs for the gout.
4. What exactly does "mildly damaged esophagus" mean?

Colleague Hrvoje,

I specifically requested that further discussion regarding stomach issues be moved to the linked thread rather than here. We need to avoid going off-topic; given that the results provided are normal, that aspect of the conversation is concluded from this standpoint.

Please respect this request.

Thanks for understanding. 🙂

Dear Madam,

It’s standard for red blood cell counts to drop during pregnancy; by the third trimester, values can dip as low as 3.8 x 10^12/L.

Hemoglobin levels also tend to decline—typically around weeks 32 to 34—with a physiological floor usually sitting near 110 g/L.

Hematocrit levels follow a similar downward trend. In a pregnant patient, a value around 0.31 (31%) is still considered within the normal physiological range.

Furthermore, an iron level below 12 µmol/l is generally seen as an indicator of deficiency during pregnancy. I wouldn't characterize your specific result as being on the "high" side.

That said, keep in mind that blood iron concentrations fluctuate significantly throughout the day based on various factors. Iron levels should be viewed as a directional guide rather than a definitive, singular metric for assessing total body iron stores.

Regarding your question about dilution anemia: this isn't caused by a lack of iron. Rather, it happens because the liquid component of your blood increases, spreading your existing red blood cells across a larger volume. Think of it this way: if you drop ten coins into a water bottle and then toss them into the ocean, they'll be easy to find and count in the bottle, but nearly impossible to track down in the sea.

Best regards. 🙂

Nancy Morris5 said:The topic was originally about providing support for those battling cancer, but looking at this link now, it says the "bulk of the radiation dissipates after a few days." If that's the case, I assume it means being in close proximity to a source like that is actually manageable.😲

Well, now I’m actually getting a little worried.🤣

Hold on. What kind of radiation are we actually talking about in the example you just gave?

When discussing teletherapy, the process doesn't end once the radiation is delivered. After treatment, the patient enters a critical phase of monitoring and recovery. It’s much like the period after a major structural repair—you don't just walk away from the site once the work is done; you stay to ensure everything settles exactly as intended. Don't preach. He isn't a threat to anyone around him. His clothing doesn't pose any risk either. He can handle everyday life just fine—whether that’s grabbing a ride in a car or hopping on a subway train.

I assume you're referring to this thread?

We're discussing the use of radioactive iodine for treating thyroid cancer here, rather than standard external beam radiation therapy.

stormyraven46 said:Now searching for:

Iron, ferritin, CBC, reticulocytes, LDH, direct and indirect Coombs tests, liver panel, GGT, and bilirubin.

If anyone can offer some coherent help, insight, or shared experience, I’d truly appreciate it. Much obliged.

Hey there.

To whom it may concern,

The results aren't great. They point toward moderate anemia—we usually don't start talking about "severe" cases until hemoglobin drops below 7.0 g/dL. Your hematologist was right to order follow-up tests; we need to pin down exactly what's driving this.

Ferritin—along with sedimentation rates—is a key metric here. It helps distinguish whether we're looking at iron-deficiency anemia (usually triggered by blood loss, whether that’s gynecological or stemming from the digestive or urinary tracts) or anemia of chronic disease. In a significant number of cases, low red blood cell counts are simply a byproduct of an underlying issue in another organ.

By looking at Coombs test parameters, reticulocyte count (Rtc), bilirubin, and LDH, we can determine if a low red blood cell count is driven by hemolytic anemia. Essentially, we're checking if those cells are being destroyed prematurely—a common occurrence in various autoimmune conditions, though certainly not limited to them.

Look, it’s impossible to pin down exactly what's causing your anemia or if it's the sole culprit just yet. Most signs point toward an iron deficiency, but we really need to see the full lab results before drawing any conclusions.

How was the anemia actually caught? Did you notice specific symptoms, or did it just pop up during a routine physical?

Bryan Harris13 said:I’m looking for some insight here. I’ve been referred for a gastroscopy by a specialist because I can't shake this constant burping that leaves a bitter, cigarette-like taste in my mouth—even though I haven't touched a cigarette in over 20 years. What should I expect if they actually find something?
I opted out of the endoscopy. About 25 years ago, I had some esophageal damage during a similar procedure, so I wasn't willing to risk it again. Currently managing several things: thyroid medication, blood pressure, and gout.

MCHC at 34.6—slightly elevated.
Basophilic granulocytes at 0.08 x 10^9/L.
Basophilic granulocytes at 1.4%.
Others have noted that the blood work looks clean.
Body weight: 238 lbs / 5'9"

To whom it may concern,

Regarding the basophil count—one specific type of white blood cell—it isn't significantly elevated. In fact, you could reasonably consider anything up to 0.08 x 10^9/L to be within the normal range.

Clinically speaking, we don't really start talking about basophilia—that uptick in basophil count—until it crosses the 1.00 x 10^9/L threshold.

While this doesn't apply to you—given that your results don't actually indicate basophilia—it’s worth noting that this phenomenon crops up in various contexts. You see it in infections (mainly viral ones, like the flu or chickenpox, or even just during recovery), allergies, and certain inflammatory conditions, such as ulcerative colitis. It can also stem from hormonal imbalances, like hypothyroidism or diabetes, or be a side effect of specific medications, including estrogen or thyroid treatments. Occasionally, it's linked to underlying hematological disorders as well.

An MCHC value can be considered normal. The real focus should be on your erythrocyte count, hemoglobin levels, and MCV.

Regarding those stomach issues, I suggest moving the conversation over to the Stomach Health thread. Let’s keep this discussion on track and avoid cluttering this topic with off-topic posts; either Dr. Hrvoje or another member will likely weigh in there.

Best regards. 🙂

rowdylynx17 said:I didn't follow up with my doctor because when I went to pick up my results, they told me everything looked fine ("according to them" 🙂). That’s why I came to this forum—to get a more detailed breakdown of what these numbers actually mean. In the meantime, the symptoms have eased up, though I still have this slight stinging sensation. Should I go ahead and get a urine culture done?

If you're still experiencing discomfort, then yes, getting a urine culture makes sense.

Best regards. 🙂