Lab results - looking for opinions [PLEASE READ 1ST POST]

swiftbear86 said:Just skim the results from the urine dipstick test here

http://www.yourdoctor.com/medicine-info?format=pdf

I think you still have enough time to get a urine culture done—drop off the sample tomorrow morning, and you should have the results by Friday.

A bacterial infection can be passed to the baby during delivery, so it’s definitely worth figuring out exactly which bacteria we're dealing with.

Give your OB-GYN a call regardless; I'm not really following why anyone would say it's "too late" for treatment.
If you already have the doctor who will be delivering the baby, go ahead and get their take on this too.

Thanks again..
I'll find out everything tomorrow—I'm going to call them. I guess I was just being impatient..

Michelle Hughes17 said:thanks again..
I'll find out everything tomorrow and give them a call.. I guess I was just being impatient..

I totally get why you're anxious, but honestly, you've got to be your own biggest advocate when dealing with doctors. If you don't push for answers, nobody else is going to do it for you.
Good luck..😉

I honestly don't even know where to begin with this mess...
Let’s try to lay this out chronologically for those who might already know my history...
1. I don't have a thyroid—papillary carcinoma—and they managed to save two of my parathyroid glands during surgery about 8 years ago.
Ionized calcium levels back in September were at 1.13 (when the minimum should be 1.18).
Ionized calcium then dropped to one day at 1.09 after being on a 0.25 mg dose of Rocatrol for nine months.

2. For the last 8 years, I've been on birth control. There isn't a single person in my family with blood clotting issues.
I'm a smoker. Well, I'm *trying* to quit. I haven't touched a cigarette in five days—so if you're looking for something to congratulate me on, there it is! And I've officially crossed the 35-year-old mark.
I'm switching gynecologists, and my new doctor wants me to run some tests because of the contraceptive use, which led to these results:
I want to highlight the values that came back a bit elevated (these tests were done while I was dealing with a minor viral infection):
Platelets - 437 (normal range 158-424)
White blood cell count - 12.4 (normal 3.4 - 9.7)
P-PV (ratio) - 0.93
P-PV (INR) - 1.04

Now, here is the part that actually has me spiraling:
Activated partial thromboplastin time - 24 (normal 25-38)
Activated partial thromboplastin time - R - 0.76 (normal 0.8-1.2)
Fibrinogen 2.99—that seems fine.
D-dimer ELFA Vidas 3198 (normal is less than 500)
What on earth does that test indicate? Of course, I've spent way too much time scouring the internet reading the absolute worst-case scenarios.🙂

Regarding my medications, I take Euthyrox, I take beta-glucan (could that possibly interfere with calcium absorption?), Rocatrol, and Velefax (half a 3.75 mg tablet), plus the birth control I am currently in the process of stopping.😕

Anyway, I have an appointment with the gynecologist this Wednesday to go over these blood results, but I am incredibly anxious.
As for the calcium, I know I need to see an endocrinologist...
Honestly, I'm terrified to even walk into the doctor's office at this point, wondering what else they're going to find wrong with me.😢

Are you taking any kind of calcium supplement at all?

Look, D-dimer tests are one of those things where you always end up tripping over your own feet because you don't actually know what you're trying to prove by ordering them. In theory, it means there’s some clotting happening somewhere while simultaneously breaking down—but if there aren't any actual clinical signs of clots... well, then what are we even doing?

Generally speaking, hormonal contraceptives are linked to an increased risk of clotting, but I don't really follow OB-GYN patients, so I don't typically bother looking at D-dimer levels unless someone shows up with swollen limbs or starts complaining about shortness of breath.

Kate Collins67 said:Aren't you taking any calcium supplements?

D-dimer tests are one of those things where you always manage to trip yourself up because you don't actually know what you're trying to prove when you order them. In principle, it just means there’s some clotting happening somewhere in your body at the same time it’s breaking down, but if there aren't any actual clinical signs of a clot....

Generally speaking, hormonal contraceptives are linked to an increased risk of clotting, but I don't follow OB-GYN patients, so I don't usually bother looking at D-dimer levels unless someone shows up with swollen limbs or starts complaining about shortness of breath.

Thanks, I feel so much better after reading that.🙂 So what does it mean if there are no clinical signs of clots?? There aren't... uh...
I am taking a calcium supplement—it's this medication called Rocatrol—which my endocrinologist prescribed. My gynecologist sent me for a full battery of tests because it was my first time seeing her; she wants to put in an IUD because of my age, my thyroid issues, and my heavy periods..
I got incredibly worried about that D-dimer test specifically because I absolutely understand nothing about it (which, honestly, is probably for the best since it's not my field🙄).
I immediately started imagining blood clots traveling through my system.🙄.
As for the calcium, I have no clue what to do since instead of rising, it just keeps dropping—I've received a few suggestions already, so I'll look into more testing. At least my hands and feet aren't tingling anymore. Or rather, I even went through a phase of losing feeling in my arms while sleeping—total paralysis.

Look, Rocaltrol is just the active form of Vitamin D. If you’re only taking that and nothing else, then you aren't getting any calcium—and let's be real, you clearly aren't getting nearly enough from your diet, plus you probably aren't soaking up much sun throughout the year, if at all. So, you'll likely need to supplement some calcium with a separate medication. And now that you mention those heavy periods—if you're bleeding heavily right now, that could very well explain the D-dimer levels.

As for clinical signs, we're talking about what I mentioned earlier: swelling in one leg, maybe even both, swelling in one arm, shortness of breath, or heart palpitations that just won't quit on their own...

Kate Collins67 said:Look, now that you're bringing up those heavy periods—if you're bleeding heavily right now, that might actually be the explanation for your D-dimer levels. It really could be.

Alright, I need to go settle this once and for all. I’ve been digging through some data lately, and I keep seeing these people claiming that D-dimer levels don't actually spike during menstrual bleeding... seriously? I really need to take a much closer look at this—maybe even pick a gynecologist's brain to get the actual facts. Is anyone else seeing this nonsense?

Then you've got this other crowd claiming that levels can spike during a heavy period—so now you’re supposed to just be a mind reader? Good luck with that.

Thanks a million for all the input here.🙂
I'm not dealing with heavy periods right now—I used to have them back before I started on birth control, which unfortunately meant ending up on the operating table for curettages quite a few times... life without a thyroid really does strange things to you.
My hands and feet aren't swollen. I get occasional ankle issues, but that’s mostly just from sitting at a desk all day. My heart isn't racing either. The only weird thing is that, every once in a while, my palms and soles just start burning up and itching like crazy. I have absolutely no clue what causes it. It hits me out of nowhere and then just vanishes. Honestly, God help me, I’m going to turn into a total hypochondriac. And just when I thought I had finally gotten past all this! :-)))))))
So, you're saying Rocaltrol isn't actually a good calcium supplement? I am genuinely, completely baffled.
I'm looking at the medication instructions right now and it says exactly that. So, what am I even supposed to take? Ugh.
If my own endocrinologist doesn't know the answer, who on earth am I supposed to ask?

Betty Sanchez58 said:So, does that mean Rocaltrol isn't actually good for calcium? I am seriously confused here. Completely lost.
I'm sitting here reading the medication insert right now and—surprise, surprise—that's exactly what it says. So what am I even supposed to take? This is ridiculous...
If my endocrinologist doesn't know, who on earth am I supposed to ask?

Look, let's break this down. Rocaltrol (which is just the active form of Vitamin D that your body can't produce on its own anymore after those parathyroid glands were removed—and by the way, since you had two put back, you really ought to be checking your PTH levels to see how they're actually functioning) is what allows your gut to absorb calcium. But get this: you could swallow a mountain of Rocaltrol, but if you aren't actually consuming enough calcium through food or supplements, there’s nothing there to absorb! It's basic biology.

The logic your endocrinologist is likely using is pretty straightforward: her calcium levels are dropping, the parathyroids are gone, so the culprit is clearly a lack of active Vitamin D (Rocaltrol), not a lack of calcium intake. They prescribe the Rocaltrol, the calcium still drops, and then you're left with a few possibilities—maybe the dose of Rocaltrol is too low, or maybe she's just not eating nearly enough calcium, or some other variable that probably isn't the main issue here.

Honestly, things would be a hell of a lot easier to navigate if they actually sat down and looked at the full picture—PTH, Ca++, Vitamin D 1-25 OH, and Vitamin D 25 OH. Sure, a doctor can sometimes make an educated guess without running every single test, but that's exactly how people run into dead ends—by making assumptions instead of looking at the hard data.

I just got off the phone with my endocrinologist. She claims the lab results aren't cause for alarm, but honestly, even if my main symptoms have subsided, I’m still feeling this constant, nagging ache in my joints—everywhere from my hands down to my feet. It hurts.
She instructed me to bump up the Rocaltrol to two tablets daily and then recheck my calcium levels in ten days.
To be perfectly blunt, I have a bit of a lingering resentment about playing the "know-it-all" with my doctors. I didn't go out and request any of those tests that Kate Collins67 suggested.😢
Whether I should start acting like an expert myself or just follow orders, I truly haven't the slightest clue what to do...😢

I thought I’d share this here as well:
My mother (64) has been struggling with intense neuropathic pain in her foot for about seven months now—it’s gotten to the point where even the touch of a bedsheet is unbearable, and she hasn't been able to sleep at all. She recently underwent an EMG, which confirmed significant nerve damage throughout that entire leg. Her neurologist has ordered a whole battery of blood tests, including testing for Borrelia burgdorferi. It actually triggered a memory for Mom; she remembered being bitten by a tick over a year ago, though she didn't show any symptoms at the time...
Today, we finally received the serology results for BB.
IgG is positive (>240)
IgM is positive at 22.1
IgG WB is positive
IgM WB is positive
Mom went to see her primary care physician, but the doctor insisted that the results look perfectly fine... (Wait, really???!!!)
What are your thoughts on this?
What should our next steps be???

Kate Collins67 said:Now I really have to dig into this. I’m seeing some claims that D-dimer levels don't rise during menstrual bleeding... I need to look closer at that or maybe run it by a gynecologist.

Meanwhile, others are writing that they can be elevated during heavy periods, so you really don't know which way to turn.

An interesting hypothesis.

My take? Clots formed during heavy menstruation likely aren't linked to an increase in D-dimer, since those clots form and break down outside the circulatory system—specifically in the uterus and vagina. 🤷

Some studies also link D-dimer spikes to oral contraceptive use, but from what I've seen, those elevations aren't nearly as significant as what we're seeing in this specific lab result.

Regardless, when dealing with a D-dimer finding like this, even if there's no history of thrombosis or anything similar, I wouldn't just shrug it off. I’d keep digging.

It’s true that we treat patients, not lab values and numbers, but in this instance, the D-dimer value is such an outlier that I would certainly investigate why it's behaving this way.

I have to admit, I’m still a bit fuzzy on this whole extravascular coagulation thing—I’ve seen people claim that’s how it works, but... when we're talking about the uterine lining shedding, isn't the basic assumption that we're looking at capillary bleeding? And if that's the case, shouldn't that bleeding be stopped by aggregation and coagulation? If those fibrin strands eventually form a structural barrier, wouldn't that naturally lead to D-dimer release into the bloodstream later on?

I get that coagulation happens outside the vessels if we're talking about blood reaching the decidua, but how else does the bleeding stop if not through coagulation? If I'm not mistaken, when a hematoma is being resorbed, you see a spike in D-dimers, right?

The real headache with D-dimers—at least in the context of pulmonary embolisms—is that from a diagnostic standpoint, there's practically no difference between a value of 0.51 and a 5.

In any case, it begs the question: what are we supposed to do with patients who show elevated D-dimer levels that are just incidental findings without any actual clinical symptoms?

Do we run routine Doppler ultrasounds on the upper and lower extremities? Or go straight to a CT angiography of the pulmonary arteries?

Personally, I wouldn't even bother testing them if I didn't have a specific reason to do so. Since I don't just order these tests routinely without cause, I honestly don't have much experience dealing with an elevated result that lacks a clear clinical picture.

Since birth control can trigger DVT, there's a theoretical scenario where clots are indeed forming, but some innate fibrinolytic activity prevents them from actually staying put or getting lodged. In that case, their breakdown would drive up D-dimer levels without ever showing up as a physical clinical manifestation.

But then the question remains: in a situation like that, should you even be hunting for a clot? And if so, where exactly are you looking?

If a gynecologist ordered D-dimer tests specifically to prove a procoagulant state, you could argue they've effectively proven it and that hormone therapy needs to be discontinued immediately—but hey, I'm not a gynecologist, and I have no idea how their clinical decision-making process works.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273370/

So, let's talk about D-dimers

Kate Collins67 said:I have to admit, I'm a bit lost on this extravascular coagulation thing (I've seen people claim it happens, but still...). When the uterine lining sheds, isn't the assumption that we're looking at capillary bleeding? That would need to be stopped via aggregation and coagulation, which usually means fibrin strands forming—and wouldn't that eventually release D-dimers into the bloodstream?

I get that coagulation happens outside the vessels if we're talking about blood reaching the uterine lining, but how does bleeding stop without coagulation? If I'm not mistaken, when a hematoma resorbs, D-dimer levels rise.

Fair point. I hadn't looked at it that way. In a standard menstrual cycle, you don't typically see clot formation; the primary mechanism for stopping the flow is vasoconstriction.

In pathological bleeding involving clots, the mechanism you described is almost certainly at play. You're likely right. And if those clots form intravascularly within the uterine vessels, they will definitely impact D-dimer values.

It seems your conclusion holds water: during a normal period where vasoconstriction handles things and no clots form, there shouldn't be a significant spike in D-dimer. However, in cases of heavy, pathological bleeding, you see that increase.

That said, in this specific case, those details might be moot. Charles Murphy6 has noted that no such pathological bleeding occurred. Even if the test had been done on the actual day of menstruation, we wouldn't expect a major jump in D-dimer.

Research shows that oral contraceptives can raise D-dimer levels even without a DVT being present. So, I'm not entirely sure if an elevation like this should be considered "expected" for someone on the pill. I'd say it's unexpected, though we can't rule out the hormones as the culprit.

But the real question is: in this scenario, should they even be looking for a clot? And if so, where exactly?

If the gynecologist ordered D-dimer testing specifically to prove a procoagulant state, then they've essentially found their proof, and hormone therapy probably needs to stop. But I’m not a gynecologist, so I can't speak to their clinical protocols.

I also suspect that whoever ordered this test without a clear indication—acting all high and mighty now—is going to find themselves in a real bind regarding what the next steps should be.

The hormone therapy will most likely be discontinued. At the very least, the situation should be re-evaluated once the contraception is out of the system.

Situations like this give me pause: http://www.haematologica.org/content/92/4/e53.full

edit: Dear Charles Murphy6, my apologies for continuing to discuss your situation and referring to you in the third person. My colleague is an interesting and engaging conversationalist, and I enjoyed his line of reasoning, so I jumped in. Besides, your results aren't as straightforward as they might seem at first glance. It would be helpful if you could let us know what kind of feedback or advice you receive in person regarding this.

It’s not even a big deal🙂
Honestly, I barely follow what you guys are saying—maybe a tiny bit, if I'm being generous.
Tomorrow, I’m heading to my OB-GYN, who basically told me over the phone that she needs to pin down the root cause before she can decide on next steps.

Is there any chance that relatively low ionic calcium levels and D-dimer results are actually connected?
To be completely blunt, I am incredibly worried, and frankly, this whole situation is making me feel physically nauseous. Maybe I should have just listened to my husband and rushed straight to the emergency room at the Mayo Clinic with my lab results to let them deal with my mess, but I honestly don't know if they would have actually admitted me or just dismissed me as yet another hypochondriac based on these numbers.🙄(Unless, of course, I had just faked a sudden blackout😁).

Maria Fisher46 said:and
Situations like this really do give me pause for thought: http://www.haematologica.org/content/92/4/e53.full
.

I've just finished reading through the text, and if my understanding isn't completely flawed, I might actually be facing cancer 😲
Well, there goes my sleep...

Betty Sanchez58 said:I just finished reading this, and if I’ve understood correctly, I might have cancer.😲
There goes my sleep...

🙂

Don't think like that.

There are plenty of other, much more likely explanations. For instance, you're on birth control, which can elevate D-dimer levels. I don't have enough experience with patients on oral contraceptives regarding their typical D-dimer ranges, so I can't say for certain—as I mentioned before—whether this specific result is a side effect of the pills and whether it would normalize once you stop taking them.

My point was simply that a value like this warrants attention. It shouldn't be ignored; rather, it needs investigation to determine why it happened.

A malignancy is just one item on a very long list of reasons for elevated D-dimers. It shouldn't be the immediate assumption.

Ugh, you really spooked them there.

@Charles Murphy6: Look, in the medical field, you can't just claim anything with absolute certainty.

@Charles Murphy6 & el Gato:
So, I went ahead and read the article, and here’s my take on the whole thing:
1. We are looking at a Case Report here. Period.

2. Any patient showing up with "rectal bleeding" is immediately suspected of having colorectal cancer until proven otherwise—that's just how it works. Now, they have a patient with rectal bleeding and elevated D-dimer levels (though, frankly, I don't see what the actual indication was for testing those D-dimers in the first place). So, if we assume the patient has cancer and then find elevated D-dimers? Well, that’s exactly what you’d expect to see.

I'm not sure if I'm making myself clear enough: if someone has cancer, you should expect their D-dimer levels to be high; however, just because someone has high D-dimer levels doesn't mean they suddenly have a tumor.
It's like the analogy with smokers and lung cancer—if someone has lung cancer, there’s a huge probability they’re a smoker, but if you only look at smokers (using that as your sole criterion), the actual statistical chance of any single one of them having lung cancer is still quite low.

3. If they had chosen a subject who wasn't already symptomatic—and I honestly get the impression they're downplaying the significance of the rectal bleeding just to make the article seem more "impactful"—it would have been a much more meaningful observation. As it stands, it feels like they missed the cancer entirely, and then we just got lucky that we didn't know why the D-dimers were up, allowing us to locate what should have been discovered regardless of the D-dimer levels.

4. A much better observation in this paper would have been stating that you shouldn't just write off rectal bleeding as hemorrhoids until a full colonoscopy has been performed.

5. Sure, it’s possible their observation is spot on, but you damn well cannot draw sweeping conclusions from a single case study.

6. Personally, I have no idea why someone would have elevated D-dimers. If anyone can actually give me an official answer and prove it, then please, by all means, teach me something.

7. As far as I'm concerned, you don't need to address me using formal language on this forum (and yeah, that goes for el Gato).🙂

Kate Collins67 said:Oof, you definitely spooked him there.

I see that now. I wasn't really thinking when I dropped that link. It was meant more for an internal discussion. 😳

I’m not sure if my point is coming across clearly: if someone has cancer, you’d expect elevated D-dimers. But just because someone has elevated D-dimers doesn't mean they have a tumor waiting around the corner.

I touched on that in my previous post. A malignancy isn't exactly the first thing we jump to with elevated D-dimers, especially when the clinical history doesn't point that way.

5. Of course, their observation might be spot on, but you can't draw conclusions from a single case.

Naturally not; I agree. Even without targeting malignancy as a potential cause right now, I just wanted to say that I wouldn't simply gloss over a finding like that.

It's debatable where one starts or what steps to take. But, at the very least, I’d double-check the results.

6. If someone could actually give me an official answer as to why my D-dimers are high, then maybe I'd actually learn something.

That would certainly be useful for everyone reading this forum.

7. For what it's worth, you don't need to address me formally on this forum (this goes to el Gato)🙂

Occupational hazard. 😳