Lab Tests/lab results

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QUESTION: These are my most recent tests, the nurse has told me everything is fine but I don't think everything is fine as I know I don't feel fine. I just finished taking an antibiotic Ciprofloxacin 250mg Tabs for a UTI but the only improvement has been now I am not urinating blood. Before the antibiotics I did not have burning when urinating and I still don't but I do have that butterfly feeling in my blatter that has not went away even after taking the antibiotics.

AMB POC Urinanalysis Dipstick

Blood 250 Ery/ul Hemolyzed (++)
Billrubin Negative
Clarity Hazy
Glucose Normal
Ketones Negative
Leukocyte Esterase ++(500 Leu/ul)
Nitrite Negative
pH 9
Protein 30 mg/dl (+)
Specific Gravity 1.015
Color Amber
Urobilinogen Normal

Urine w/Microscopic UCIF:

Squam Epithel, UA  0-2 /HPF
RBC, UA  50-100 /HPF
WBC, UA  15-19 /HPF
Bacteria   NONE Seen /HPF

Urinalysis Auto w/Scope: (I made sure I did a clean catch in mid stream and didn't let the cup touch me)

Color, UA  Yellow
Clarity, UA  Hazy
Specific Gravity, UA  1.015
pH, UA  8.0
Leukocytes, UA  Trace
Nitrite, UA  Negative
Protein, UA  100 mg/dL
Glucose, UA Normal
Ketones, UA Negative
Urobilinogen, UA 1 mg/dL
Billirubin, UA Negative
Blood, UA  250/uL

Crine Culture No Growth at 2 Days

Hepatic Function Panel  recent      past     (standard range)

Albumin/Globulin Ratio   2.3    2.5  2.2  2.0  (1.0-2.0)
Albumin   4.5   4.5  4.4  4.5  (3.2-4.8 g/dL)
Alkaline Phosphatase  90   75  71  63  (35-104 U/L)
ALT   10   10  10  11  (0-31 U/L)
AST   12   12  11  13   (0-32 U/L)
Billirubin, Direct   <0.2  no previous   (0.0-1.0 mg/dL)
Total Billirubin   0.3   0.3  <=0.2  0.3  0.2  <=0.2 (0.0-1.0 mg/dL)
Globulin   2.0  1.8  2.0  2.3  2.9  2.2   (2.3-3.5g/dL)
protein   6.5   6.3  6.4  6.8  7.3  6.2  6.4  (6.4-8.3 g/dL)

CBC w/Auto Differential      past results   (standard range)

Basophils Absolute  0.061  0.026 0.038 0.043 0.046 0.074 0.066 0.068 0.009 0.059   (0.000-0.100 10^3/uL)
Basophils Relative  1.3    0.7  0.4  0.9  1.0  1.8  1.1  1.6  0.2 1.4  (0.0-2.0%)
Eosinophils Absolute  0.050   0.051 0.078 0.052 0.078 0.065 0.145 0.112 0.065 0.086  (0.000-0.800 10^3/uL)
Eosinophils Relative   1.1   1.3  0.9  1.0  1.7  1.6  2.5  2.6  1.3  2.1    (0.0-5.0%)
Hematocrit   44.1   42.7  41.5  41.2  43.5  45.8  43.0  40.8  40.0  41.5   (36.0-46.0%)
Hemoglobin   13.7   13.5  13.5  13.8  14.3  14.5  14.9  13.9  13.9  13.7   (11.5-15.4 g/dL)
Lymphocytes Absolute   1.345  1.091  0.784  1.357  1.533  1.497  1.860  1.410  2.120  1.366  (0.900-4.000 10^3/uL)
Lymphocytes Relative   29.3   28.5  9.2  27.3  34.1  37.0  31.4  33.1  43.6  32.9  (16.8-44.9%)
MCH   27.3   27.9  28.8  29.0  28.8  27.9  31.4  28.6  30.6  28.6  (25.0-35.0 pg)
MCHC   31.1   31.5  32.5  33.4  32.8  31.7 34.6  33.9  34.7  33.0  (32.0-36.0 pg)
MCV   88   89  89  86.7  87.9  88  90.8  84.3  88.2  86.8  (78-102 fL)
Monocytes Absolute   0.272   0.240  0.418  0.355  0.363  0.269  0.341  0.340  0.355  0.326   (0.200-1.000 10^3/uL)
Monocytes Relative    5.9   6.3 4.9  7.1  8.1  6.6  5.8  8.0  7.3  7.8   (3.6-11.7%)
Neutrophils Absolute   2.872   2.426  7.230  3.158  2.481  2.142  3.500  2.327  2.310  2.315   (1.900-8.000 10^3/uL)
Neutrophils Relative   62.4   63.3  84.6  63.6  55.1  52.9  59.2  54.7  47.6  55.8   (42.5-74.6%)
Platelets   212   237  219  225  216  209  212  212  186  205  (130-400 10^3/uL)
RBC   5.02   4.82  4.68  4.75  4.95  5.21  4.74  4.84  4.53  4.78   (3.90-4.10 10^3/uL)
RDW   12.1   12.0  11.7  11.9  11.9  11.7  11.6  11.7  11.4  12.1   (11.5-14.5%)
WBC, Automated   4.60   3.84  8.55  4.96  4.50  4.05  5.91  4.26  4.86  4.15   (4.00-10.80 10^3/uL)

This was my culture respiratory test that I was told was normal when I was coughing up black specks and sneezing black stuff with lots of mucus..

Culture    4+ Normal oral flora       
Gram Stain Result    2+ Epithelial Cells       
Gram Stain Result    No polymorphonuclear leukocytes seen       
Gram Stain Result    4+ Gram positive cocci       
Gram Stain Result    2+ Gram positive bacilli       
Gram Stain Result    1+ Gram negative bacilli   

Even though most of my labs fall in the standard range do doctors compare your previous numbers and consider any fluctuations even though they are still in normal range? for example if normal range of a test is 0.0-5.0 and I run an average of 2.1-2.8 except the last few test show it increasing to where now it is 4.5 would that be something to be looked at? Even though it is still within the standards? Any insite on these labs would be greatly appreciated as I cannot seem to get any clarification on any of my labs through my doctors office.

Thank you for answering these questions and I apologize for the lengthy inquiry.

ANSWER: 1- You still are 2+ for leukocyte esterase which is a marker for bladder infection. If this is a chronic or recurring issue for you I highly recommend taking a probiotic geared toward vaginal and urinary tract health. You should follow up ANY anitbiotic use with a probiotic anyways to re-balance gut flora, 100 billion for a few months then drop down the dose. No bacteria showed up in your urine, good, but that doesn't mean it can't be fungal in nature which antibiotics wouldn't touch to begin with. I have a patient with Interstitial Cystitis and believe candida (fungus) is playing a role in this issue for her, and it's a possibility for a lot of folks.

2- Most doctors do not compare trends, I am the rare person who does. Also know that lab ranges are calculated by the lab based on the Average of what comes through the lab... aka somehow we decided using labs from people who don't feel good/or have something wrong is how we set the tone for others?! I used functional medicine lab ranges because I look for your HEALTH, they're looking for diagnosable disease because that's how they're taught. Many people fall into that grey area between Wellness/Health and Disease state. I most certainly look at trends as often as I can to see if someone is shifting toward some illness- I catch a lot of malabsorption, anemia, thyroid issues BEFORE they are clinically diagnosable...because why let something keep developing when there is a clear trend it's heading that way? Prevention is not how most docs are trained.

3- Just from a quick glace of your labs, a lot of stuff looks pretty decent. Your alkaline phosphotase has dropped over time. My range is 70-100, their range is much different. When this is low it is a sign of malnutrition or malabsorption in the gut. Based on any antibiotic use it's malabsorption from intestinal permeability, many people have what is called Leaky Gut and don't know it.

4- Without any clinical history, labs tell me next to nothing about what's going on with YOU as an individual. They're a very small part of the picture and have to be paired with your symptoms, complaints and concerns for me to tell you anything about your health. I would look into a functional medicine doctor,naturopathic physican or chiropractor who does this kind of work. I do find most doctors don't go over any labs with their patients which drives me nuts, but they "don't have the time for it" when there is no evidence of Illness, again, they're not looking for your Wellness.

Hope this was helpful to you, and I am sorry I can't help you more.

Dr. Kalli Prater, D.C.
Functional Medicine Specialist
www.relaxattranquility.com

---------- FOLLOW-UP ----------

QUESTION: It seems after my last blood work they decided to do a little more lab work and this is what they found:

ANTITHYROID ANTIBODIES - Details
TPO Ab (ANTI-TPO)    229.1 U/mL    
Thyroglobulin Ab    285.4 U/mL

   
Free T4    1.23 ng/dL

PROTEIN ELECTROPHORESIS SERUM
Total Protein Ref         6.4 gm/dL     
Alpha 1 Elp          0.17 gm/dL    
Alpha 2 Elp          0.62 gm/dL
Beta Elp          0.62 gm/dL    
Gamma Elp          0.66 gm/dL

Albumin Electrophoresis   4.33 gm/dL    
ELP Interpretation See below       
Atypical gamma fraction on visual inspection. Suggest immunofixation studies to help exclude a protein dyscrasia, if clinically indicated.

Component          Your Value
CRP          <0.06 mg/d

Sed Rate          8 mm/hr    

TSH    6.59 uIU/mL    

Total CK    39.0 U/L

Component         Your Value   
Sodium          144 mmol/L
Potassium          4.3 mmol/L    
Chloride          102 mmol/L    
BICARB          25.5 mmol/L    
Glucose          93 mg/dL    
BUN          16.2 mg/dL    
Creatinine, Ser    0.8 mg/dL    
BUN/Creatinine Ratio    20.3

Glom Filt Rate, Est    >60
     
Range >60mL/min per 1.73 m2 K/DOQI Classification of CRD Stage1:GFR>90 with persistent albuminuria Stage2:GFR 60-89 with persistent albuminuria Stage3:GFR 30-59,Stage4:GFR 15-29 Stage5:GFR<15 Do not use this value for renal adjustment of medication.

Calcium          9.6 mg/dL    
Adjusted Calcium    9.3 mg/dL    

Beginning 2/2/16, Adjusted Calcium is calculated using formula from Henry’s Clinical Diagnosis and Management by Laboratory Methods

Protein          6.4 g/dL    
Albumin          4.5 g/dL    
Globulin          1.9 g/dL    
Albumin/Globulin Ratio     2.4      
AST          12 U/L    
ALT          10 U/L    
Alkaline Phosphatase          82 U/L    
Total Bilirubin     <=0.2 mg/dL
Anion Gap          17 mmol/L    
Patient Fasting    No       

PROCEDURE: XR ABDOMEN 1 VIEW

CONCLUSION
Findings compatible with colonic inertia. There is diffuse increased
stool within the colon. 24 Sitz markers retained scattered throughout
the colon.

First what is colonic inertia? what is diffuse?
What does it mean when they say, "Atypical gamma fraction on visual inspection. Suggest immunofixation studies to help exclude a protein dyscrasia, if clinically indicated." Nothing has ever been suggested to me or explained for that matter I am told I showed no Acute findings....which I replied what does that mean and was told quote, "Basically your test show normal". I don't feel normal...

I also don't understand, "K/DOQI Classification of CRD Stage1"

My A/G ratio has been high for last 5 test and my Globulin has been low last five test. My Albumin has been in range last 5 test. with low proteins.

You are probably thinking my doctor should be explaining this all to me and your correct but they don't and I need to know what is going on. Switching doctors is very hard as there are a shortage of physicians what take new patients. I understand if that you cannot diagnose or anything like that I just want my results fully explained as to what it means good, bad, and in between. My body tells me something is not right as does my hair....yes hair...I have been a licensed cosmetologist for 25 years and I know when my hair is showing signs something is wrong. I appreciate your last response as I do this response more than you know. So thank you very much for each of them this will be my last one.

Answer
Colonic inertia = constipation. the Sitz markers were from something you swallowed to show how your bowel transit is functioning, yours is not well. Diffuse increased stool = widely spread throughout the abdomen you have increased stool, aka not contained to one specific area but throughout.

You definitely have autoimmune hypothyroidism, and hypothyroidism is linked to constipation.

As for the other testing - i have no clue what they're checking for or looking at with those aside from kidney function. Due to the BUN/Creatanine ratio constantly off- there is typically a kidney issue.

No acute findings is a good thing- but they also don't know how to help you.


PLEASE find a functional medicine doc near you who can help you work through your complex history. I believe you do not feel well, and they can't find anything "wrong" enough to do anything.

I'm sorry I don't feel this was as helpful as you would have hoped for.  

Lab Tests

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Dr.Kalli Prater

Expertise

I can answer questions about routine lab work, functional lab ranges for optimal health, what lab tests should be considered and when you need to seek a second opinion. I can also answer questions about specialty testing like: stool testing, hormone testing, and saliva testing.

Experience

I run lab tests in my office as a functional medicine practitioner and use functional lab ranges looking for patient's optimal health not their disease. I review many charts and labs and look at trends through the years as well as current symptoms. Usually I find more things on labs that the traditional doctor that correlate to the patient's concerns/issues.

Organizations
American Chiropractic Association

Education/Credentials
Doctor of Chiropractic Medicine, B.S. in sports Medicine.

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