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

Maria Fisher46 said:Hi there,

You might need to rule out or confirm Gaisbock syndrome since you have polycythemia, high blood pressure, and obesity—all of which could fit your current results. Of course, polycythemia vera needs to be ruled out too. Your liver numbers and urate levels might also be linked to being overweight.

Hi,
I went back for more tests. My blood counts look normal now. But, my phosphate levels came back elevated. As for symptoms: I’m constantly exhausted and sleeping all the time. I thought it was related to low ferritin, but that's normal now. Also, I have constant ringing in my ears and these throbbing headaches at the top of my head. Back in 2021, things were fine, just some alpha-amylase issues. In September 2022, my Calcium was high. I'm currently taking atenolol and Nexium.





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Hey everyone, though I’d really love it if brightgull95 or Nicholas Myers could weigh in on this.

So, you guys might remember me—I haven't posted in a while. I'll try to lay out everything that's going on in order:
- I've been dealing with hypothyroidism and Hashimoto's for a while now, taking Euthyrox for replacement therapy, plus hyperinsulinemia which caused me to pack on about 45 pounds.

- This whole mess actually kicked off after I had the flu four years ago. Since then, I've been hit with constant headaches, crushing fatigue, sleepiness, joint pain, and a low-grade fever that never dips below 99.1°F. Plus, there's this constant tingling in my temples.

- Honestly, I never feel okay. When it's hot, I feel terrible—weak and lightheaded. When it's cold, my fingernails and lips turn totally blue, making me look like I've been dead for three days. I can't walk for long before the weakness hits, my lips go pale, I get the shakes, and my heart feels quiet but fast... I can't even stand for more than a few minutes without my whole body starting to tremble.

- Cardiology says everything looks fine (Holter, ultrasound with color Doppler)

- Abdominal ultrasound was normal, aside from a tiny cyst on my left kidney.

- Blood work was all good except for my sedimentation rate, which is always double the upper limit.

- CRP never goes below 15.

- Fibrinogen and immunoglobulins are twice the normal level.

- Other rheumatic tests are normal, and ASLO is also normal, even though I get strep throat every couple of months.

- HLA typing shows a predisposition toward psoriatic arthritis and celiac disease.

- Back in May, I had an MRI of my brain and cervical spine because of those non-stop temple tingles and unbearable headaches paired with dizziness. The results showed bilateral lesions, but the doctor thinks they're likely vascular issues stemming from intense migraines. My neck shows some changes, but nothing alarming, probably just from my job (sitting at a computer for 10 hours a day, both at work and home...).

- I was low on Vitamin D and was taking drops, but my calcium levels spiked, so my endocrinologist told me to stop taking it.

I usually deal with painful cramps and diarrhea about once a month, but things settle down after I clear my bowels. Occult blood tests were negative.

I kind of learned how to live with my "normal." I knew the second I got up I had to eat, and I don't smoke, drink coffee, or touch fast food—not even pizza. I stick to lots of fresh veggies, fish, stews...

But then, I caught COVID-19 in August, and everything went sideways. I've been on medical leave ever since; I literally don't leave the house because I physically can't move. I only head out to see my doctor or for necessary tests. Now, I have this constant head pain—it feels like my skull bones are aching. It's like there's a headband or a vise tightening around my head so hard I think something is going to snap inside. There's this unrelenting pressure in my ears, though no tinnitus. The dizziness is so bad sometimes the whole room spins and I feel nauseous. When it isn't quite that intense, I just feel unsteady, but I don't dare drive or walk alone because I feel like I'm going to collapse, which is terrifying. I had a carotid color Doppler—all normal. Had a TCD of the vertebral arteries—normal. Did auditory and visual evoked potentials—all normal. Still waiting on caloric testing.

Every morning when I wake up, the spinning starts, along with pressure in my forehead, around my eyes, and in my ears... Once I stand up and start walking, my heart rate spikes so high I can barely breathe. Taking a shower is basically impossible. I have to sit down to shower and even to cook. As long as I'm lying in bed, I'm relatively okay, but any extra effort triggers dizziness, a racing pulse, sweating, tremors, and such soul-crushing fatigue that I can't even keep my eyes open. Sometimes my eyelids just shut on their own.

Please, what other tests should I be looking into? And I'm doing everything privately because it's just too much to handle walking through hospitals and sitting in waiting rooms...

Thanks in advance, and Happy New Year to you all!!!

Maria Fisher46 said:Hello,

It’s impossible to properly analyze these results without knowing the context—basically, why they were ordered in the first place.

.

The right ankle suddenly swelled up—no pain, no injury or anything like that.

I've also been dealing with some lower back and hip pain, specifically while sleeping, for quite a while now.

Sent from my ELE-L29 using Reddit

Nicholas Myers, thanks for the heads-up earlier. 👍>

I’m not great with links and uploading images, so hopefully this works.
(After those first results, this one just came in... looking for some insight. My doctor suspects some kind of systemic disease... long story short.)

LAB (Oct 21, 2022): CK 93[U/L], LDH (s) 187[U/L], Mg 37[ug/L], PROT (s) 78.7[g/L], CA 19-9 5.6[kIU/L],
CA 15-3 13.6[kIU/L], CA 125 9.0[kIU/L], CEA 0.8[ug/L], AFP 3.7[kIU/L], CA 72-4 1.4[kIU/L], ANF BORDERLINE
, ANF tit 1:100 , ANF flo PATCHY , ds DNA 6[IU/ml], ENA -screen POSITIVE[descriptive], SS-A(60) 1[AU/ml],
SS-A(52) 126[AU/ml], SS-B/La 1[AU/ml], Sm 2[AU/ml], Sm/RNP 0[AU/ml], Jo-1 2[AU/ml], Scl-70 3[AU/ml],
RibosAt 5[AU/ml], CentromAt 1[AU/ml], U1RNP 2[AU/ml], PmSCl 2[AU/ml], PCNA 11[AU/ml], HistoniAt
6[AU/ml], FID-p ANCA 0[AU/ml], FID-c ANCA 1[AU/ml], CCP < 5[CU], IgG 12.10[g/L], IgA 3.40[g/L], IgM
0.88[g/L], No monoclonal proteins found in protein electrophoresis., RF 8[IU/ml], PROT (s) 78.7[g/L], P-EF-ALB%
59.6[%], P-EF-Alf1% 3.7[%], P-EF-Alf2% 9.5[%], P-EF-Beta% 11.6[%], P-EF-Gam% 15.6[%], P-EF-ALB
46.91[g/L], P-EF-Alf1 2.91[g/L], P-EF-Alf2 7.48[g/L], P-EF-Beta 9.13[g/L], P-EF-Gam 12.28[g/L], P-EF-A/G
1.48

LAB (Sept 29, 2022): ASL-O 348[U/ml], IgE 21[IU/ml]
...anyway, here's what I posted last time, just to make the picture clearer.
HLA TYPING (Oct 21, 2022):
Class I / HLA-B B8 B50(21) *08 *50
Class II / HLA-DRB1 DR17(3) - *03 -
Class II / HLA-DQA1 *05 -
Class II / HLA-DQB1 DQ2 - *02 -

And also...
SEROLOGY (Oct 21, 2022): anti-EBV VCA IgG pos., anti-CMV IgG pos.

On top of that, there's the EMG... an immunologist ordered all of this (feels like I won the lottery, if that were a good thing).

EMG findings for legs:
M.tibialis anterior lat.left: slight reduction in innervation pattern with emergence of wider and higher compensatory action
potentials up to 8 mV, repetitive discharges
M.tibialis anterior lat.right; M.extensor digitorum brevis bilateral; M.gastrocnemius caput medialis
bilaterally: shows good to intermediate innervation pattern with emergence of wider and
higher action potentials of compensatory type with amplitude around 8 mV repetitive discharges.
Neurographic analyses - results attached.
CONCLUSION
EMG findings combined with clinical presentation in the legs indicate moderately
severe chronic, well-compensated L4 radiculopathy on the left, plus moderate chronic, well-compensated polytonic L4 radiculopathy on the right, L5
bilateral, and S1 bilateral.
Neurographic analyses showed no signs of polyneuropathy or compressive mononeuropathy in the
tested nerves.
nk

Thanks in advance. 👋

https://postimg.cc/QFm2BGGk

Does this look normal to you guys?

I'm 24, and honestly, I haven't really been feeling anything else lately.

I need some input. I'm scheduled for a colonoscopy this Monday, and I had bloodwork done for the anesthesiologist.

Thank God, my enzyme levels look fine. Everything related to those gallbladder issues I was worried about is looking okay,

but for the first time, my
PV INR came back elevated; the lab says the recommended range for anticoagulant therapy is 2.0 to 3.5.

My PV is 1.14, with a reference interval of >= 0.70, so that part is fine.

Is this actually something to worry about?

Peter White80 said:Hello,
I ran the tests again. My blood counts look normal now. However, the phosphate levels came back elevated. As for symptoms: I’m constantly exhausted and sleeping all day. I originally thought it was related to low ferritin, but those levels are fine now. I also have constant tinnitus and pulsing headaches at the top of my head. Back in 2021, things were okay, just some issues with alpha-amylase. In September 2022, my Calcium was high. I am currently taking atenolol and Nexium.

Hello,

The calcium and phosphate results you provided aren't concerning and likely aren't linked to the symptoms you're experiencing. Have you had an abdominal ultrasound done?

Kimberly Morris said:Hi everyone. I’m mostly hoping that either brightgull95 or Nicholas Myers can weigh in on my question.

Ma'am,

Have you had a fecal calprotectin test or serology for celiac disease done yet?

Matthew Young4 said:It’s due to sudden swelling in the right ankle, no pain or injury involved.

Maybe it's linked to the pelvic hip pain I've been getting during sleep for quite some time now.

Hello,

I can't find the lab results anymore, and I don't recall if there was anything else listed besides an ANA titer of 1:320?

I don't see any reason to run an ANA test based solely on one swollen joint. Who actually ordered this—a rheumatologist, immunologist, physiatrist, orthopedic surgeon, or just a GP?

Have you seen a rheumatologist yet? Any imaging? Or HLA typing?

boldnomad45 said:I need some input. I have a colonoscopy scheduled for Monday, and I just had bloodwork done for the anesthesiologist.

Thank God my enzymes look fine. Everything related to those gallbladder concerns I was worried about is okay,

but for the first time, my
PT INR came back elevated, and the lab notes suggest a range of 2.0 to 3.5 for anticoagulant therapy recommendation.

My PT is 1.14, with a reference interval of >= 0.70, so that part is fine.

Is this anything to worry about?

Samsung Galaxy A13 using Reddit

The results are normal. That 2 to 3.5 INR range is specifically for people on blood thinners—which I assume you aren't taking—so that target doesn't apply to you. For someone not on anticoagulants, an INR around 1 is exactly where you want to be.

placidangler13 said:Nicholas Myers, thanks for the heads-up earlier. 👍

I'm not great with links and images, so I hope this works.
(After that last report, this one just came in... any insight? My doctor suspects some kind of systemic disease... long story short.)

Ma'am,

Based on these results, it likely isn't systemic lupus erythematosus. However, I don't see anything done to rule out celiac disease, inflammatory bowel disease, or sarcoidosis—all of which you seem predisposed to based on your HLA typing results.

restlesseagle74 said:https://postimg.cc/QFm2BGGk

Is this a clean report?

24 years old, no other symptoms whatsoever.

The report says everything looks normal, but I have to wonder: given we're talking about a supraclavicular lymph node measuring 1.3 cm, is that really enough to call it "unremarkable"?

Maria Fisher46 said:Hi there,

Based on these results, it probably isn't systemic lupus erythematosus. However, I don't see anything being done to rule out celiac disease, inflammatory bowel disease, or sarcoidosis—all of which you seem predisposed to based on your HLA typing.

Thanks a lot. I haven't seen the immunologist yet. Heading there next week, so the doctor will probably hand over referrals for more testing then.

Maria Fisher46 said:Hey there,

Have you had a stool calprotectin test or any serology done to check for celiac disease?

Dr. Nicholas Myers,

Thanks for getting back to me. No, I haven't done the calprotectin test or the celiac serology yet. My immunologist is insisting that the only way to be absolutely certain about celiac is through a colonoscopy, which—given how rough I'm feeling right now—I honestly don't think I can handle.

Do you think all of this could actually be caused by celiac disease???

Maria Fisher46 said:The results look clean. An INR between 2 and 3.5 is what we look for in patients on blood thinners—which I assume you aren't taking, so that range doesn't apply to you. For someone not on those medications, an INR should be around 1.

Great. Thanks. I'm not on any blood thinners, but I am taking Ursofalk for cholesterol and Colestyramine powder because of excess bile following gallbladder surgery. I was worried this wasn't normal, or maybe related to those meds I started four months ago.
Thanks again.

Sent from my Samsung Galaxy A13 using Reddit

Maria Fisher46 said:Hi there,

The calcium and phosphate results you posted don't look concerning to me, so they probably aren't related to what you're feeling. Have you had an abdominal ultrasound done yet?

Unfortunately, I haven't. The only thing I've had done lately in that area was a gastroscopy, and they found chronic gastritis.

placidangler13 said:Thanks a lot. I haven't seen the immunologist yet. I’m heading there next week, so they'll probably hand out the referrals for more testing then.

To whom it may concern,

My apologies. I see now that in my previous response, I mentioned a predisposition for celiac disease and systemic lupus erythematosus, while sarcoidosis and inflammatory bowel disease were only potential considerations. To be clear, there is a definite genetic predisposition for the first two, which should be the primary focus for exclusion. Good luck!

Kimberly Morris said:Dear Dr. Nicholas Myers,

Thanks for the reply. No, I haven't done calprotectin testing or any serology for celiac disease. My immunologist insists that the only way to get a definitive, accurate diagnosis for celiac is through a colonoscopy—which, given my current condition, I unfortunately can't undergo right now.

Do you think all of this could be caused by celiac disease?

To whom it may concern,

I'm not suggesting all your symptoms stem from potential celiac disease, but given this cluster of unexplained issues combined with a genetic predisposition, we really ought to investigate whether it's present. Typically, the standard protocol involves an endoscopy with multiple biopsies. However, if there are compelling serological results—blood work, that is—alongside that genetic link, a biopsy isn't always strictly mandatory, though it remains the most common course of action.

Peter White80 said:Unfortunately, I haven't. The only thing from that field is that I recently had a gastroscopy, and they identified chronic gastritis.

It would be wise to act, if you haven't already.

Maria Fisher46 said:Hi there,

I don't think all your symptoms can be pinned on potential celiac disease, but since you’re dealing with a bunch of unexplained issues and have the genetic predisposition for it, I think we really ought to find out once and for all if you actually have celiac. Usually, the standard procedure involves an endoscopy with multiple biopsies, but if the serology (blood tests) comes back strong enough alongside that genetic link, a biopsy isn't always mandatory—though it’s still the gold standard most of the time.

It would definitely be worth doing if you haven't yet.

Doctor, thanks again for everything.

Could I get one more quick take and some advice?

I’m totally lost on what other tests to run regarding this lip color that’s driving me crazy. Basically, about 80% of the time, my mouth turns this weird pale blue color, and honestly, it looks terrible. I’ve seriously never seen anyone else look like this. Of course, everyone keeps staring and asking me what’s wrong... If I had been born this way, I wouldn't be freaking out. But this color started showing up right along with all these other bizarre symptoms.

So, heart scan was normal. Hemoglobin is fine.

Like, just today, there was a moment where I turned deathly pale blue—I can actually feel it happen, like this weird wave of weakness hits me. I immediately checked my blood pressure, and it was perfect. Checked my blood sugar too. Then I used a pulse oximeter for my oxygen and heart rate. Everything looked totally fine. But my mouth? It looked like I’d passed away three days ago...

Kimberly Morris said:Doctor, thank you again for everything.

I’m looking for another perspective and some advice.

I don't know what other tests to run regarding this lip discoloration—it's really bothering me. For about 80% of the day, my lips look pale blue, which looks terrible. I've never seen anyone else with skin like this. Naturally, everyone asks me what's wrong... If I had been born this way, I wouldn't be worried. But this color started appearing right along with all these other strange symptoms.

To clarify, my heart tests came back normal. Hemoglobin is fine.

For instance, earlier today, they turned a very distinct pale blue. I can feel it happening; there's this strange wave of weakness. I immediately checked my blood pressure, and it was perfect. Blood sugar too. I used a pulse oximeter to check my oxygen and pulse. Everything was fine. Yet, my lips looked like I’d passed away three days ago...

Ma'am,

What you're describing could be the result of a vasospastic disorder, such as Raynaud's syndrome or something similar. This would fall under the expertise of a rheumatologist or a neurologist.

I would suggest undergoing a CCTT (which can be done through neurology at the Mayo Clinic) and a capillaroscopy.

Maria Fisher46 said:Hey there,

What you're looking at could be caused by a vasospastic disorder—think something like Raynaud's or some other similar issue. You probably want to look into this with a rheumatologist or maybe a neurologist.

I'd suggest getting a CCTT done (you can usually get that through neurology over at the Mayo Clinic) and also scheduling a capillaroscopy.

Thanks so much for the response, Doc. I really appreciate it. I'll try to get those tests sorted out somehow...