Crunching numbers
Sep. 6th, 2015 20:35![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
torquillSo most of my test results are in, and I'm reading up so that I'm prepared for my doctor's appointment on Tuesday.
The urinalysis and liver panel came out quite normal, as expected. B12 and folate were good, well over the minimum boundaries. For some reason she gave me a full vitamin D panel; I got 34 for D3, which is over the 30 considered "healthy" (though I suspect lower than it would be if I'd been working outside as much as usual). I have no idea why D2 is measured -- there's no reference range -- and total D seems to simply add those together. Maybe she'll explain what she was getting at.
Iron was 45 in a reference range of 40-150, low but not out of range. It tracks with hemoglobin and hematocrit, which are also low but in range (but higher than a month earlier). TIBC and UIBC are extremely high (the former has a range of 250-400, and mine is 596; UIBC is similar). And ferritin, iron in storage, is below the reference range, though not severely. Reticulocyte count is completely average, as is mature red blood cell count. I'm reading all this to mean "previous prolonged blood loss pulled iron out of storage which hasn't been replenished yet, serum iron is low but acceptable, more iron would be snatched up in an instant, and there are enough blood cells but they're a little light on hemoglobin". Meanwhile, I have zero symptoms of anemia, even when taking 5-mile mountain bike rides on rather challenging trails. I'm willing to sit back and let my blood stores replenish from dietary iron, as supplementing is a hassle and I don't see a need to do it faster. Maybe I'll make some more creamed spinach.
Last come the hormone tests. All the estrogen tests (fractionated, estradiol, and total) put me within range for a non-menopausal female in the luteal phase. (My FSH already ruled out standard perimenopause.) My temperature has consistently been about 98.3 every morning, which corroborates that I'm in the luteal phase of my cycle. Why I'm not menstruating, after a month of this, is left as an exercise for the doctors. Assuming they feel it's an issue at all. It could be leftover wibblies from the birth control, but I'd expect to be spotting in that case; in fact, all bleeding ceased a few weeks ago. It seems to have gone completely silent down there. (No, I'm not really complaining about the lack of bleeding, it just makes me feel nervous that there's another twist coming.) The estrogen tests were a baseline, as I felt fine at the time the blood was drawn, so I'm not expecting any other conclusions than "it's within normal range".
Rather interesting to me is that my luteinizing hormone (LH) is half of the lowest minimum on any of the ranges (luteal, again). It's significantly low. This may be an indicator of pituitary misbehavior, which could have been involved in my problems up to this point.... or it could be an artifact of taking grapeseed extract for weeks. Without a preliminary baseline test (grrr) I have no way of knowing. No one says that GSE affects either LH or GnSH (its controller) levels, but no one seems to have tested for that effect. So it may mean nothing at all.
So all of my tests bear out my known status: a history of blood loss, vitamin levels normal for an average person who doesn't take supplements, and no indicators of disease. I'd figure I was home free and good to go, if I weren't still taking 200mg of GSE every morning. I stabilized on that amount because I feel good 90% of the time, and the other 10% (usually in the morning) I get minor symptoms of nausea and uterine spasms. That tells me I'm taking as much as I need to stay functional, but no more. It also tells me that the symptoms that have been bothering me for months are still there, I'm just managing them.
I've worked out what I need to focus on during the appointment: I had originally asked for a referral to endocrinology, so if she's not going to give me one, I deserve to know why. I would like to know what she considers my most pressing health issues and the next logical course of action, given my description of my symptoms and my lab results. (The latter is something of a test, to see whether she really is taking what I say seriously, or whether she's fishing for other problems to address.) And I'd like to know whether she feels she has any further assistance to offer me -- this ties in with the endo referral. If she wants me to go to gynecology (again), then logically she's asking for a second opinion from gynecology; if the second opinion comes back "go see an endocrinologist", I need to know whether that would be sufficient for her to issue the referral. I would hope that any sane doctor would say yes.
Personally, I think that a referral is the only thing she has to offer at this point... my lab results are so normal that if she decides to focus on vitamin deficiencies, my alleged high blood pressure, and (heaven forbid) weight as further avenues for aggressively pursuing health, I'll smile and wish her a good career. There's no limit to how often I can change my PCP, and I'll doctor-hop however long I need to until I find somebody who listens and takes me seriously on the issues that are actually affecting my life.
The urinalysis and liver panel came out quite normal, as expected. B12 and folate were good, well over the minimum boundaries. For some reason she gave me a full vitamin D panel; I got 34 for D3, which is over the 30 considered "healthy" (though I suspect lower than it would be if I'd been working outside as much as usual). I have no idea why D2 is measured -- there's no reference range -- and total D seems to simply add those together. Maybe she'll explain what she was getting at.
Iron was 45 in a reference range of 40-150, low but not out of range. It tracks with hemoglobin and hematocrit, which are also low but in range (but higher than a month earlier). TIBC and UIBC are extremely high (the former has a range of 250-400, and mine is 596; UIBC is similar). And ferritin, iron in storage, is below the reference range, though not severely. Reticulocyte count is completely average, as is mature red blood cell count. I'm reading all this to mean "previous prolonged blood loss pulled iron out of storage which hasn't been replenished yet, serum iron is low but acceptable, more iron would be snatched up in an instant, and there are enough blood cells but they're a little light on hemoglobin". Meanwhile, I have zero symptoms of anemia, even when taking 5-mile mountain bike rides on rather challenging trails. I'm willing to sit back and let my blood stores replenish from dietary iron, as supplementing is a hassle and I don't see a need to do it faster. Maybe I'll make some more creamed spinach.
Last come the hormone tests. All the estrogen tests (fractionated, estradiol, and total) put me within range for a non-menopausal female in the luteal phase. (My FSH already ruled out standard perimenopause.) My temperature has consistently been about 98.3 every morning, which corroborates that I'm in the luteal phase of my cycle. Why I'm not menstruating, after a month of this, is left as an exercise for the doctors. Assuming they feel it's an issue at all. It could be leftover wibblies from the birth control, but I'd expect to be spotting in that case; in fact, all bleeding ceased a few weeks ago. It seems to have gone completely silent down there. (No, I'm not really complaining about the lack of bleeding, it just makes me feel nervous that there's another twist coming.) The estrogen tests were a baseline, as I felt fine at the time the blood was drawn, so I'm not expecting any other conclusions than "it's within normal range".
Rather interesting to me is that my luteinizing hormone (LH) is half of the lowest minimum on any of the ranges (luteal, again). It's significantly low. This may be an indicator of pituitary misbehavior, which could have been involved in my problems up to this point.... or it could be an artifact of taking grapeseed extract for weeks. Without a preliminary baseline test (grrr) I have no way of knowing. No one says that GSE affects either LH or GnSH (its controller) levels, but no one seems to have tested for that effect. So it may mean nothing at all.
So all of my tests bear out my known status: a history of blood loss, vitamin levels normal for an average person who doesn't take supplements, and no indicators of disease. I'd figure I was home free and good to go, if I weren't still taking 200mg of GSE every morning. I stabilized on that amount because I feel good 90% of the time, and the other 10% (usually in the morning) I get minor symptoms of nausea and uterine spasms. That tells me I'm taking as much as I need to stay functional, but no more. It also tells me that the symptoms that have been bothering me for months are still there, I'm just managing them.
I've worked out what I need to focus on during the appointment: I had originally asked for a referral to endocrinology, so if she's not going to give me one, I deserve to know why. I would like to know what she considers my most pressing health issues and the next logical course of action, given my description of my symptoms and my lab results. (The latter is something of a test, to see whether she really is taking what I say seriously, or whether she's fishing for other problems to address.) And I'd like to know whether she feels she has any further assistance to offer me -- this ties in with the endo referral. If she wants me to go to gynecology (again), then logically she's asking for a second opinion from gynecology; if the second opinion comes back "go see an endocrinologist", I need to know whether that would be sufficient for her to issue the referral. I would hope that any sane doctor would say yes.
Personally, I think that a referral is the only thing she has to offer at this point... my lab results are so normal that if she decides to focus on vitamin deficiencies, my alleged high blood pressure, and (heaven forbid) weight as further avenues for aggressively pursuing health, I'll smile and wish her a good career. There's no limit to how often I can change my PCP, and I'll doctor-hop however long I need to until I find somebody who listens and takes me seriously on the issues that are actually affecting my life.
