Posts by Nicholas Myers

Jessica Sanders60 said:To whom it may concern,
I am a 37-year-old female.
I've had elevated white blood cell counts my entire life; I saw a hematologist about it previously, and they noted it was just my baseline.
My two most recent blood panels show a slight elevation in erythrocytes at 5.45 and hematocrit at 0.476.
Additionally, my last three urinalysis results showed mildly elevated leukocytes and erythrocytes at 10, whereas normal is typically 1-2.
Please, could you tell me if there is any reason to be concerned?

Jessica Sanders60 said:I forgot to mention that my hemoglobin was 157.
In the lab work prior to that, my iron levels were also high.
I am a smoker.

Ma'am,

Generally speaking, polycythemia testing is indicated when hemoglobin exceeds 160 g/L or hematocrit climbs above 0.48.

The values you provided are borderline.

To provide an actual assessment or suggest next steps, I would need the full data set. Phrases like "mildly elevated leukocytes" or "iron was high" are too vague to draw conclusions or offer specific medical recommendations.

redpilot37 said:Question for Nicholas Myers... I could use a little help.
So, I had my immunoglobulins checked and everything looks fine and within the standard range... except for my IgA, which seems suspicious. The reference range here is 0.7 to 4, and mine came back at 3.32.
When I check Google, the normal range in the United States goes up to 3...
As for symptoms, I have pronounced allergies—constant sneezing and runny nose year-round—plus bone pain. My scans show signs of bone issues and confirmed chronic bone inflammation...
I'm wondering if you think that IgA level is actually elevated, considering these symptoms.
Thanks.

Ma'am,

In my view, an IgA value of 3.32 g/L is not elevated.

coastalgull8 said:Looking for some help interpreting an EEG. The test was ordered because of headaches, constant fatigue, exhaustion, and trouble concentrating. Brain CT and TCD were both normal. Is this result okay, or should I be concerned?
Thanks in advance!

EEG Results
Low voltage o.c.a. in the alpha frequency range of 9-11Hz. Well-expressed RVB. A small amount of slow, sharp waves at approximately 7 Hz with an amplitude up to 50 microvolts is interposed bilaterally in the frontotemporal posterior regions. No paroxysms present. Similar changes noted on HV. The findings show mild dysrhythmic changes bilaterally in the FT posterior areas.

Hello,

There is a specific category of headaches referred to as dysrhythmic headaches. These can manifest in various ways—typically resembling migraines—but they carry one distinct feature: altered EEG readings (most often characterized by dysrhythmic changes). When imaging results come back clear, we classify this as a primary headache.

Unfortunately, there isn't a complete understanding yet of why these headaches occur. What we do know is that for these types of pain, standard over-the-counter analgesics may not provide sufficient relief. In those cases, adding an antiepileptic to the treatment plan often makes sense.

Patients are sometimes confused, wondering why they are being prescribed such medication if they haven't been diagnosed with epilepsy. However, an epilepsy diagnosis isn't a prerequisite for this type of treatment; these drugs are utilized for several different conditions and disorders.

Kimberly Morris said:Dear Doctor,

I can't thank you enough for the response!

Yesterday, I saw my cardiologist. He performed an EKG and an echocardiogram, and he confirmed my heart is perfectly healthy. His take is that my blue lips are metabolic—likely due to extra weight caused by hyperinsulinemia. I posted my results here on the forum, and brightgull95, who is a cardiologist, mentioned the findings look normal. So, regarding Ajovy, I don't think there will be any issues with my heart.

If you could, I have one more question: do you think there might be any complications with Ajovy therapy given the lab results I shared earlier (elevated immunoglobulins, sedimentation, CRP, fibrinogen...)?

Thanks in advance!

Kimberly Morris said:Dear Nicholas Myers,

Just one more quick clarification, please.

You mentioned that Ajovy might have a protective effect; could you expand on that?

Ma'am,

This medication can have adverse effects in patients with Raynaud phenomenon—both primary and secondary—which often occurs in those with systemic connective tissue diseases. In such patients, using this drug could worsen Raynaud symptoms, leading to more intense, frequent, or prolonged vasospasm episodes, potentially resulting in ulceration or necrosis. For these specific patients, the application is not recommended. That addresses the impact on rheumatic conditions.

As for the potential beneficial effects on the cardiovascular system, I phrased it that way intentionally to leave room for nuance. Currently, there are only indications of such effects in animal models, specifically mice, which is still a far cry from the human organism.

Timothy Kim32 said:Dear Nicholas Myers, or anyone else who knows their stuff.
I've been dealing with headaches that I assumed were neck-related; my X-ray results actually seem to support that.
A few weeks back, I collapsed while out in the sun. I didn't come to until I'd hydrated heavily and had some sugar—likely dehydration.

However, given my family history of brain tumors, I sought medical advice. I've been referred for an EEG, a color Doppler, and background imaging, though I haven't made it to those appointments yet. It's worth noting that I work rotating shifts, so my sleep schedule is a mess.

EEG Results:
The baseline cerebral activity shows medium voltage in mixed alpha frequencies at 9-10 Hz up to 50 uV. Visual response is well-defined.
During the recording, occasional slower activities of 5-6 Hz up to 75uV interpose frontocentrotemporally on the right side, while the left side remains unchanged.
US Army testing was not performed due to epidemiological protocols.

Conclusion: The findings show mild dysrhythmia frontocentrotemporally on the right, without vulnerability during provocation methods.

I’m looking for an opinion because I'm terrified this might be a tumor. I can't see my doctor for a long time until I gather all my tests, and I'm scared that I might have accidentally caught a diagnosis on this EEG.

Sir,

The EEG results you've provided aren't specific. You cannot diagnose a tumor based on this alone.

It's true that an EEG can show pathological changes in the case of a brain tumor, but tumor-related patterns usually look different. Typically, you'd see focal changes in the form of delta waves—frequencies lower than 4 Hz—that are consistently present.

Your EEG describes intermittent theta waves. This pattern is more commonly associated with functional issues rather than structural damage, though small lesions can occasionally show up on an EEG.

Based on what's described here, a brain tumor wouldn't be the primary differential diagnosis. To diagnose a tumor, you need advanced imaging.

Kimberly Morris said:Dear Dr. The Cat,

Thanks a lot for the response!

My grandfather had psoriasis, and my younger brother does too.

So, here's what I'm wondering: if my HLA typing doesn't show a predisposition for lupus, does that mean I'm actually safe from developing it?

No, HLA typing isn't an absolute predictor. A positive result suggests an increased risk, but it isn't a guarantee the disease will manifest. We also know that HLA isn't the sole genetic factor at play; complex conditions like lupus involve various other genes that we don't routinely test in standard clinical practice because our understanding is still evolving.

In short, yes—it is entirely possible for someone to develop lupus or any other condition even if their HLA typing doesn't point toward it.

Kimberly Morris said:Dear Nicholas Myers, I have a question.

You’ve seen my lab results already—elevated sedimentation, CRP, fibrinogen, immunoglobulins...

I went in for testing because my lips and fingernails have turned distinctly blue. On top of that, I deal with migraines, and yesterday I was prescribed an injection of Ajovy to start using.

I spent all night reading the instructions for this injection. It says it was only released in 2019. They only tested it on about 2,500 patients, and those were strictly migraine sufferers. It explicitly states they weren't tested on anyone with heart or cardiovascular issues, so it isn't recommended for them.
How am I supposed to know if I have a cardiovascular condition? My lips are blue, my blood pressure swings wildly, and my heart rate hits 150...

Ma'am,

Based on everything currently known about this medication, cardiovascular risks appear minimal. In fact, data suggests it might even offer protective benefits.

Since you don't have a confirmed diagnosis yet, it's impossible to predict exactly how the drug will affect your specific situation.

With any medication—this one included—you have to weigh the benefits against the potential risks. A prescription is issued when the benefit outweighs the risk.

If you're feeling uncertain, keep in mind that this isn't a life-saving intervention. It wasn't prescribed to prevent death, but to manage migraines that impact your quality of life. In that case, you should consult the neurologist who wrote the script to see if proceeding is wise.

Again, based on current data, we see no signal that this drug increases cardiovascular risk or acts negatively in that regard.

rustymason82 said:If this is the differential white blood cell count I think it is, then the results were:
neutrophils: 58.7% (normal range 44 to 72)
lymphocytes: 27.9% (normal range 20 to 46)
monocytes: 10.3% (normal range 2 to 12)
eosinophils: 2.6% (up to 7)
basophils: 0.5% (up to 1)
absolute neutrophil count: 7.68 (elevated, normal 2.06 - 6.49)
absolute lymphocyte count: 3.65 (elevated, normal 1.19 - 3.35)
absolute monocyte count: 1.35 (elevated, normal 0.12 to 0.84)
absolute eosinophil count: 0.34 (normal up to 0.43)
absolute basophil count: 0.07 (normal up to 0.1)

Ferritin wasn't tested.

Sir,

Regarding iron levels, interpreting them in isolation is impossible without seeing the full CBC and ferritin levels. You provided the CBC data, but since ferritin wasn't tested, we can't determine what these iron numbers actually mean.

As for the leukocytosis, the differential indicates it's primarily driven by neutrophilia and monocytosis. This specific pattern isn't unique to one thing—it could be anything from various infections (especially certain "exotic" ones) to inflammatory conditions or even medication side effects.

This needs clarification through further questioning and a thorough exam. To start, it would be wise to order a peripheral blood smear, along with an ESR, CRP, basic metabolic panel (if you haven't already), protein electrophoresis, immunoglobulins, and ferritin.

Dear Kimberly Morris,

Looking over your HLA typing results, I don't see any predisposition for systemic connective tissue diseases, such as lupus.

However, there is a strong genetic predisposition for psoriasis and psoriatic arthritis, along with a slightly lower predisposition for celiac disease.

Having these markers doesn't mean you'll develop any of them—it could be none, or it could be all three.

Emily Ortiz27 said:Much appreciated.
Is there a specific timeframe you'd suggest for getting this done? She’s currently sitting on a waiting list...
We could always head to a private clinic if that would speed things up or if it's better to move quickly.

Ma'am,

The search needs to happen promptly. I'm not suggesting an ER visit—meaning weekends or holidays aren't necessary—but it should be handled as soon as possible.

Emily Ortiz27 said:I don't have the rest of the lab results handy right now, but based on what I've provided, could you give me an idea of what we might be looking at?
Just to add some context: the patient is female, overweight, and managing hypothyroidism with medication.

Ma'am,

We need to move quickly here. We have to rule out whether this is a metastatic process—specifically, cancer spreading from another organ to the liver.

Donna Young58 said:Hi everyone,
I'd like some insight on my Androstenedione levels.
These hormone tests were taken on day 3 of my cycle. I have irregular cycles, some acne issues, and an ultrasound showed slightly microcystic ovaries. I'm in my mid-30s, generally healthy, and at a great weight.
The Androstenedione level is what worries me; it looks quite high. However, since my other androgen levels are within range, I'm genuinely unsure what such a spike signifies. Thanks.

Estradiol 142 pmol/L (ref 77-921)
LH 8.5 IU (ref 1.8 - 11.8)
FSH 6.8 IU (ref 3.0 - 8.1)
PRL 11.9 µg/L (ref 5.2 - 26.5)
Total Testosterone 1.3 nmol/L (ref 0.4 - 1.9)
Free Testosterone 14 pmol/L (ref 3.5 - 30)
Free T % 1.1% (0.5-8.0)
SHBG 71 nmol/L (20-155)
Androstenedione 21.4 nmol/L (1-12)
DHEAS 6.9 µmol/L (1-13)

Hello,

The androstenedione values are significantly elevated (anything north of 17.5 nmol/L is considered a significant elevation). This necessitates further investigation to rule out potential adrenal or ovarian tumors, though Polycystic Ovary Syndrome is actually the most frequent culprit.

shadowskipper47 said:I already had the electrophoresis and ultrasound done, and I turned in the 24-hour urine test. The results are included in the files I uploaded in my previous post.

Ma'am,

While a monoclonal protein was detected—which naturally raises concerns regarding potential multiple myeloma—nothing in the current work supports that diagnosis just yet. We have to wait for the full picture before drawing any final conclusions. Typically, bone marrow aspirate samples are sent off for cytogenetic testing, molecular techniques like fluorescent in situ hybridization (FISH), and immunophenotyping. It takes some time for those specific results to come back from the lab.

Laura Wilson3 said:#166
Laura Wilson3
Registered User

Joined data: Sep 2021.
Posts: 1
Compression fracture in my spine
Hi everyone, I’m 53 years old and, honestly, I used to be in great shape. Then things went downhill—I dealt with COVID, a severe herniated disc, surgery, and an ulcer. To top it all off, while driving back from a spa retreat, I ended up with a compression fracture at the T8 level of my spine. I tried taking some supplements—about 0.5 units of calcium, magnesium, and D3—hoping to speed up the healing process. I had blood work done and everything seemed fine, though my calcium was slightly elevated at 2.62. Two weeks later, after checking my thyroid levels, the calcium was still a bit high at 2.68. When I got an MRI, the doctor noted it looked like an older trauma. I’m a bit confused because I don't recall any falls in the last three years, and I hadn't felt any pain in that specific spot until I got home from the spa. A bone density scan showed my hips are normal, but my spine shows osteopenia with a T-score of -1.2, and my L1 vertebra is at -2.3. My question is, is it actually possible for my hips to be fine, while I have osteopenia in the lumbar region and osteoporosis in the thoracic area, especially since the fracture happened while I was just sitting down?

Hello,

Densitometry T-scores can vary between the lumbar region and the hip region. In this instance, there isn't a significant discrepancy because, according to the scan, both the lumbar and hip regions fall into the same category: osteopenia (a T-score between -1.0 and -2.5). However, even if the T-score is higher than -2.5 (meaning less negative), we can still discuss osteoporosis if an atraumatic spinal fracture occurs. There are many reasons why T-scores fluctuate between the hips and the lumbar spine, but such variation is quite common, provided the differences between regions don't jump across entirely different diagnostic categories (for example, a normal T-score in one area and a pathological one in another).

neonfalcon99 said:Best regards,

Can someone walk me through a few of these lab results?

UIBC iron 13.9 (26-59)
AST 41 (11-34)

Sedimentation 3 (4-24)
Urea 367 (134-337)

Hi there,

It’s impossible to accurately read these isolated numbers without clinical context—why the tests were ordered, current medications, etc. You also need the full panel for a real picture (for instance, regarding iron status, you'd need Fe, UIBC, TIBC, ferritin, Hgb, Hct, unknown, MCV...).

Sarah Wells23 said:

Ten weeks pregnant. No specific reason for running blood and urine tests other than standard prenatal monitoring, but some deviations have me worried. Are elevated white blood cell counts (specifically neutrophils) and low lymphocyte levels somewhat normal during pregnancy, or not?
My recent swab came back positive for ureaplasma 10 at a 4. I just wrapped up a course of Augmentin and Genoistina last week, but I’m still struggling. I've been dealing with daily dizziness, nausea, and a total loss of appetite. My iron levels are also a concern—they were sitting at 11 two months ago, and honestly, the only thing I've changed is eating more berries. On top of that, my blood pressure is low, around 90/50, and I'm facing heavy fatigue paired with insomnia.
My urine culture came back clear just a month ago.
Even if the ureaplasma 10 count was low, could it still trigger a result like this?
TSH this low (it was around 1.20 before pregnancy)—is that cause for concern?
I had a soda right before my blood draw. 🤦 Would that hour before the blood draw affect my glucose levels, or can I be reasonably certain my sugar isn't dipping too low?

To whom it may concern,

Looking at these labs, there aren't any red flags if you factor in the pregnancy. It’s standard for certain values to shift during this time; what looks like an outlier for most women is actually quite normal when you're expecting.

It’s quite common to see elevated white blood cell counts during pregnancy, specifically driven by neutrophils, just like what you're experiencing. In the first trimester, the upper limit for leukocytes is typically around 13.6 x 10^9/L, with neutrophils reaching up to 10.1 x 10^9/L, even in the absence of an actual infection.

On the flip side, it’s pretty common for TSH to dip during pregnancy. That said, a reading of 0.78 mIU/L still sits firmly within the normal range.

As for the dizziness, nausea, insomnia, and those other symptoms you mentioned—I won't dive into that here. It would require significantly more data and a much broader battery of tests to make sense of them. Based on the findings presented so far, those issues don't seem to correlate with these specific results.

brighttinker23 said:thanks a lot 🙏
but should I be worried about this slightly elevated MCHC?

No, the results are fine—everything is within the normal range.

brighttinker23 said:I’d appreciate some feedback on these results. I ordered them because I’m exhausted—I could sleep 12 hours a day and still feel drained. I’ve also put on quite a bit of weight, though I suspect that’s more due to my lack of activity than anything else.
results -> View on imgur

The only thing that jumps out at me is the elevated MCHC, but I have no idea what that implies, especially given the other values.
What surprised me most was that my thyroid seems fine, considering Hashimoto is practically a family tradition.

Thanks in advance. 🙂

edit: here is another link to the same report; looks like something is off: View on imgur

Hello,

Regarding your lab work: based on these specific numbers, we can't pinpoint the cause of your fatigue. However, it isn't anemia or thyroid hormone issues, which suggests the culprit lies elsewhere.

A normal TSH level doesn't rule out an autoimmune thyroid condition. To confirm or deny that, you would need to test for specific thyroid antibodies. It is entirely possible for someone with Hashimoto to be euthyroid—meaning their hormone levels appear perfectly normal despite the underlying autoimmune issue.

Emily Ortiz27 said:Since The Cat has been monitoring us—our resident internet doctor—this question is mainly directed at him if he finds a moment, though anyone else is welcome to chime in 😍

Routine check-ups for my seven-year-old, who deals with lymphadenitis, show a persistent dip in neutrophil granulocytes for several months now (the standard range for his age is 34-69; his results this year have been 29, 31, 31, 28).
Everything else is essentially within normal limits (RBC, hemoglobin, platelets, WBC, lymphocytes, absolute counts, glucose, bilirubin, ferritin, LDH, CRP). IgA remains undetectable, while IgM and IgG are within the normal range.

Should I be paying closer attention to this constant fluctuation in the relative neutrophil granulocyte count?
We are planning follow-up ultrasounds for all areas where enlarged nodes were found, but while we wait for the doctor's orders and an appointment, I figured I'd try to learn a bit more here.

Hello,

Absolute values matter much more than percentages. A shift from 28% to 31% isn't really a significant deviation; those percentages fluctuate enough in healthy individuals during routine testing that it shouldn't be a concern. I believe you can be satisfied with these results.