Posts by Nicholas Myers

Walter Jones8 said:Thanks (if you're talking about me). 🙂 ,uopće) .

Yes, I was referring to your inquiry regarding filing a formal report and taking specific actions concerning the issues you raised. Since this is moving into the realm of legal matters and statutory interpretation, you'll need professional counsel from someone specializing in that field of law.

I have a question for George (if he’s even open to answering, if not, I understand). Doctor, do you run your own private practice?
If it’s easier, we can move this to private messages. I'm asking on behalf of a relative regarding whether they would be accepted given the various circumstances already mentioned. I would be happy to provide more specific details about the case and which doctor we are dealing with once we switch over.

Regarding this part of the question, the topic isn't exactly appropriate here, but let's leave it be. George might give you an answer if he feels like it, though answering could potentially compromise his identity. Anonymity is vital around here, and the forum rules guarantee it.

Actually, I’d suggest sticking to private messages for these kinds of questions. Of course, users still have the right to disable incoming PMs entirely—if they choose to do that, there isn't much anyone can do about it.

Greetings. 🙂

Dear Madam,

I think it would be wise to move your inquiry—including those legal citations—over to the Labor, Social, and Family Law section. There are several members there who specialize in that field, and their expertise is quite reliable. You'll likely find much more precise answers there.

Best regards. 🙂

Megan Perez47 said:I’m looking for some perspective here. I’m 30. Back in month four, I dealt with mononucleosis (cytomegalovirus), which left me with lymphocytosis. By month five, my blood work looked fine, though my lymphocyte percentage was sitting right at the edge at 47%. In month seven, I had another panel; lymphocytes were at 49%, everything else within range. Then, during a routine checkup in month ten, my lymphocytes hit 52.7% and neutrophils dropped to 40%, though the rest stayed normal. I was supposed to follow up in two weeks, and the results were normal then—but that was also the day I came down with a fever and a viral infection. Three weeks later, a new panel showed elevated lymphocytes again at 52.9% and low neutrophils at 39%, with lymphocytes at 4.1×10^9. I can't stop worrying that this constant elevation means I have leukemia.

Hello,

When evaluating lymphocytes, the absolute count matters far more than the percentage. True lymphocytosis is generally defined as an absolute lymphocyte count exceeding 4.0x10^9/L.

Lymphocytosis is most often reactive. It's usually just the body responding to a viral infection, though bacteria or parasites can trigger it too. There are various other factors beyond hematological diseases that play a role.

Typically, once the underlying cause (like an infection) clears, it takes about two months for lymphocyte levels to settle back into the normal range.

From what I gather in your post, your levels haven't been constantly high; you've had periods where they returned to normal. It would also be useful to know—if it wasn't already noted on your report—what those previous absolute values actually were.

I also noticed you mentioned having a viral illness right around the time you had your blood drawn.

As a starting point, I think your best move is to see your primary care physician. Start by discussing how you actually feel—any physical symptoms or fatigue. Review your family history, lifestyle, and general health. You should start with the patient, not just the numbers on a lab report. And frankly, that 4.1x10^9/L reading represents only a very mild lymphocytosis.

After that, proceed with a full physical exam.

Only then would it be possible to determine a clear path forward.

Did your doctor comment on these specific results? Did they perform a physical exam and discuss your current symptoms with you?

Best regards. 🙂

John Reyes30 said:Can anyone provide more insight into these lab results I received today? For about five years now, my iron levels have hovered between 4 and 9, but today’s numbers are the lowest they've been in all that time. I'm roughly 50 years old, so I'd appreciate some help: what do you make of this?
erythrocytes 4.07 (ref. range 3.86-5.08)
hemoglobin 97 (ref. range 119-157)
hematocrit 0.302 (ref. range 0.356-0.470)
MCV 74.1 (83.0-97.2)
MCH 23.8 (27.4-33.9)
MCHC 321 (320-245)
RDW-CV 19.1 (9.0-15.0)
Fe 2.5 (8-30)
TIBC 67.0 (49-75)
UIBC 64.5 (26-59)

Thanks for any feedback!

Hello,

Your labs indicate moderate anemia. Essentially, your red blood cells (erythrocytes) are smaller than standard, carrying less hemoglobin. Furthermore, as you noted, there is low serum iron alongside very low transferrin saturation. This pattern points toward iron-deficiency anemia.

That said, ferritin levels need to be checked, along with a basic metabolic panel and a urinalysis (including chemistry and sediment).

Moving forward, your primary care physician should sit down with you to discuss certain factors. They will likely ask if you've noticed any bleeding from the reproductive or urinary tracts, changes in stool color, or blood in your stool. They will also want to know about your diet and any existing medical conditions.

Depending on those answers, further diagnostic steps—such as a gynecological exam, a fecal occult blood test, or a consultation with a gastroenterologist—may be necessary.

The objective is to identify the underlying cause of the anemia.

Please present these results to your doctor as soon as possible; they will coordinate the next steps in your care.

Best regards. 🙂

Kate Collins67 said:I have to admit, I don't get why symptoms show up so late if we're talking about a hereditary genetic mutation.

For women, I can wrap my head around it due to menstrual compensation, but even then—if there's no period for the first 12 years, how does ferritin not build up and cause damage by then? And for men presenting in their 40s with low ferritin... if they couldn't raise those levels by age 40 without any blood loss, you’d expect them to stay low for the next 40 years too, unless this mutation somehow caps iron absorption and they're just eating Heferol.

How is this actually explained?

Hemochromatosis doesn't seem to be a straightforward issue.

Beyond the points already mentioned, there is another possible explanation.

We have different genotypes—homozygotes versus heterozygotes—and it seems penetrance and gene expression also play a role in why carriers exhibit such a wide spectrum of lab results.

In heterozygotes, you often see elevated transferrin saturation while ferritin stays within normal limits. Even in homozygotes, who face a much higher risk of iron buildup, some studies suggest that up to 50% of women and 20% of men never experience elevated ferritin.

It appears there may be other genes contributing to these variations in ferritin levels, as noted in the conclusions.

Because of this, many authors argue that transferrin saturation is a more sensitive screening parameter; it takes a significantly larger accumulation of iron to bump up ferritin than it does to raise saturation.

But a legitimate question remains: what is the point of a hemochromatosis diagnosis without elevated ferritin (based, say, on high saturation and genetic proof) when the primary goal of treatment is lowering ferritin?

I don't have the answer to that. I'll defer to vividsailor7, since hemochromatosis falls more under the domain of gastroenterologists.

Regardless, I just wanted to point out that, according to the literature, a diagnosis is possible even without high ferritin.

Then, of course, there is the question regarding this specific case, where serum iron is quite high but ferritin is trending toward the lower end. Is it an error? Did the patient follow instructions for accurate testing (fasting, avoiding vitamin-fortified juices for at least two days, etc.)?

I'm not sure. It's an interesting case, I suppose, and I'm curious to see which direction it goes.

Megan Diaz45 said:Hi everyone. I could use some insight on my thyroid hormone results. This was my first time getting bloodwork done because there were suspicions of an issue, but looking at these numbers, everything seems perfectly normal to me.

TSH at 4.75.
T4 at 77.5.
T3 at 1.1.
Anti-TG Anti-TPO levels under 28.

Thanks in advance!

To whom it may concern,

You didn't include the units or the reference ranges for these parameters. If we're looking at T4 and T3 in nmol/L, the standard ranges would typically fall between 62.6–150.8 nmol/L for T4 and 0.89–2.44 nmol/L for T3. Based on those numbers, the results would be considered within the normal range.

You also didn't mention what symptoms you're actually dealing with—basically, what prompted the search in the first place.

Overall, the results fall within the standard range. However, we’ve touched on this before in the thyroid threads—there is a growing trend here in the United States toward lowering the upper limit of what is considered a "normal" TSH level. While many practitioners still view values up to 5 mIU/L as acceptable, an increasing number of doctors, particularly those in private practice, are shifting their clinical approach toward more stringent benchmarks. We can dive deeper into that debate over on the main thyroid discussion board. Thyroid. You're more than welcome to drop by there as well.

Based on our current guidelines, this finding is perfectly standard.

Edit: I realized I haven't touched on the antibodies yet. Since I don't have the specific units or the reference range handy, there isn't much I can say about that part of the results.

Greetings. 🙂

Elizabeth Sanders24 said:Hello. I’ve had two spontaneous pregnancies right at the start—weeks 6 and 7. I had my ovaries and thyroid removed, and here are the results:

Thyroid issues:

T3 levels sitting at 1.7. Reference range is 1.3 to 3.1. It’s on the lower end of the spectrum.
T4 at 15.6. Reference range is 12–22. It’s sitting right in the middle of the pack. Nothing to write home about.
TSH at 3.5. Normal range is 0.27 to 4.2.

I've been reading that TSH levels can be an issue. Is it advisable to keep it under 2.0 during pregnancy?

To whom it may concern,

Endocrine Society It was published back in 2012. Guidelines. You can find the details via this link. These guidelines received backing from the American Thyroid Association, suggesting that women with a history of miscarriage or preterm labor should have their thyroid status evaluated, including antibody testing. Their specific protocol is this: if TSH levels sit above 2.5 mIU/L, they recommend a retest. If that second test still shows TSH above 2.5 mIU/L—even without conclusive evidence—they suggest starting therapy to bring those levels down below the 2.5 mark. If the pregnancy doesn't take, the therapy should be discontinued. You'll find these recommendations on page 8, under points 8.1.a and 8.1.b.

In other words, even the experts are still debating what you heard.

Let me be clear: there is no single consensus regarding TSH levels below 5. There simply isn't enough clinical evidence to back up the kind of recommendations you've heard. That said, I am strictly following the specific guidelines set by the American Thyroid Association.

I’d also suggest checking out the thyroid discussion thread. It might be useful.

Best, 🙂

Kate Collins67 said:His ferritin is too low for hemochromatosis, right?

I have this odd finding that doesn't fit the standard profile. It could be nothing significant—just a medical outlier.

The results are unconventional.

That said, it is entirely possible for someone with hemochromatosis to show normal ferritin levels, particularly in younger patients or those in the early stages of the condition (though here, the values seem uncomfortably close to the lower limit, which doesn't quite align with my understanding of the disease either). Transferrin saturation is usually the more sensitive marker.

In that light, I would suggest looking into this a bit further, just as vividsailor7 suggested. At the very least, keep an eye on his iron status periodically to see how it develops. 😉

melloworca6 said:Isn't there a two-week window? That's what I was told—you need at least two weeks between finishing antibiotics and getting a new swab test. 🤷

Exactly. You need at least two weeks after the antibiotics are done.

Otherwise, the results aren't reliable and you're just throwing money down the drain.

I'm inclined to say yes.

Ma'am,

Based on your description, we’re likely looking at one of two things: a fungal infection—most probably Candida—or contact irritant dermatitis, specifically intertrigo caused by skin friction. There are other possibilities, of course, but the treatment protocols for these are entirely different.

It would be best for your husband to see a doctor. He needs a proper diagnosis through a swab test so he can get the right prescription.

Best regards. 🙂

Sandra Wells5 said:More specifically, we're looking at the waiting lists for the Mayo Clinic. Can someone clarify how these patient codes work? Are those letters just initials?

The patient code consists of the first letter of the given name, the first letter of the surname, and then the 11-digit number from the individual's Medicare ID.

Whether it’s first name then last name, or vice versa for this specific Mayo Clinic list—I’m not entirely sure. I don't have much insight into how they structure their data there. Hopefully, someone else with experience in this can weigh in.

Best regards. 🙂

Hannah Garcia92 said:Look, I'm not in America, but the process is probably identical or very similar.

What’s the move if I want to switch from school medicine over to family medicine? I assume it's straightforward, but I really don't have the patience to deal with three grumpy ladies at the front desk, thanks. 😁

Unfortunately, here in the States, school medicine practitioners mostly just handle routine physicals; they don't actually prescribe medication or write scripts anymore. That falls to pediatricians or family medicine doctors.

In our system, school doctors aren't something you choose—they are assigned based on which school a student attends. One specific doctor handles the physicals for a particular school or grade level during enrollment and throughout the school years. If students get sick, they see a pediatrician or a family practitioner, not the school doctor, who operates under the CDC.

Hello,

In anatomical terms, the metacarpal refers to the radius bone in the forearm. "Metacarpal" isn't actually the name for the thumb bones themselves. The individual bones of the fingers—including the big toe—are technically called phalanges.

I'm pointing this out because we should probably update the thread title to avoid any confusion.

What exactly is the reason for the surgery? What’s the diagnosis? Are you perhaps dealing with hallux valgus? If that's the case, just follow the link provided to submit an inquiry.