New Doctor, still confused.....

Following on from: healthunlocked.com/pasoc/po.......

After GP #1 told me my continuing symptoms were all in my head and I should seek counselling and perhaps medication, I went to another GP and sought another opinion. GP #2 was very supportive, as I said in the last thread, saying it was too early to write it off as physcological, and took my symptoms, earlier test results (including the private ones) and would figure out where to go from there.

He said that he would likely have to refer me to specialist(s), but he wasn't entirely certain which ones.

So, he rang me last Sunday (!!) to ask me to head up to the hospital and get some bloods done, as he wanted to see what my calcium was doing as it hadn't been tested since May. But I had it retested in June, I told him. No I hadn't. Apparently when GP #1 retested my B12 and D levels after starting treatment, he didn't bother with calcium, as he assumed that it would rise now my D levels were much improved.

That was news to me. But anyway, off I tootle for tests, and the results were:

24/10/17

Serum Calcium - 2.23 mmol/ (2.2 - 2.6) - was 2.15 in May

Serum Albumin Level - 43 g/L (35.0 - 50.0) - was 44 in May

Serum adjusted Calcium - 2.17 mmol/L (2.2 - 2.6) - was 2.07 in May

Serum Phosphate - 1.04 (0.8 - 1.5) - was 1.26 in May

Vitamin D - 58.9 nmol/L (>50 nmol/L for sufficiency) - was 21.1 in May

Parathyroid Hormone - 3.4 pmol/L (1.95 - 8.49) - not tested in May

Serum Sodium - 139 mmol/L (133.0 - 146.0) was 142 in May

Serum Potassium - 4.6 mmol/L (3.5 - 5.3) - was 4.2 in May

Serium Chloride - 107 mmol/L (95.0 - 108.0) - was 108 in May

Serium Creatinine - 61 umol/L (48.0 - 128.0) - was 64 in May

Serum Urea - 5.6 mmol/L (2.5 - 7.8) - unchanged from May

GFR calculated abbreviated MDRD - > 90 mL/min/1.73m*2 - unchanged from May

Serum C reactive Protein - <4 mg/L (<10) - was 7 mg/L in May

Acute Kidney Injury Warning Stage - AKI Stage 0 – Report Without Alert - unchanged from May

The inclusion of PTH tests this time suggest he was ruling out hyperparathyroidism, which it has, because my calcium is stupidly low and not stupidly high.

Which brings me to the confusion. We assumed the calcium defiency I had in May was dietary, and would resolve itself once my Vitamin D levels resolved. Well they have (though I am still supplementing, to get them even higher), but my calcium levels have barely moved. I am only just into range in Serum Calcium and still under range in adjusted Calcium. Why would that be?

B12 wise, GP #2 has asked that I still not supplement. I'm to continue my scheduled injections as planned, but he wanted to rule out other possibilities before he concentrated on B12 being the culprit. He did agree with GP #1 that my B12 issues were unlikely to be dietary, and that unreliability of tests make it pointless testing to confirm it is PA - I will simply remain on injections for life: the frequency of which is currently up for debate.

[ITYFIALMCTT]

I wonder if GP2 also wanted to rule out hypOparathyroidism? It's quite unusual but it's a good thing to rule out as well as hyperparathyroidism.

"Hypoparathyroidism is the state of decreased secretion or activity of parathyroid hormone (PTH). This leads to decreased blood levels of calcium (hypocalcemia) and increased levels of blood phosphorus (hyperphosphatemia."

endocrineweb.com/conditions...

[Hidden in reply to ITYFIALMCTT]

But, to my very limited understanding and overgoogling, hypopara is, vast majority of the time, caused by surgery for hyperpara. This: parathyroid.com/hypoparathy... states that 99% of hypopara is the result of surgery for hyperpara, so the chances of me being the 1% of an already rare disorder is very slim.

Even more googling states that non surgical hypopara usually comes off of the back of Addison's Disease. But I don't really seem to fit the bill for that one either, apart from my eternal salt craving. Yes, some of the more generalised symptoms fit (such as tiredness etc. etc.) but the more unique to Addison's ones, such as vitiligo or hyperpigmentation, I don't have. This is why GP #1 dismissed it as a possibility months ago as it is very rare for primary Addison's to manifest without those symptoms. There is secondary Addison's but that is also ridiculously rare.

[Catz72]

Has your doctor done bloods tests to rule out coeliac disease? Check out coeliac.org.uk for more information on getting diagnosed.

[Hidden in reply to Catz72]

That was one of the first things GP1 ruled out, yes.

[KimberinUS]

Did you get your ferritin level rechecked? Should be over 100 if you have chronic inflamation..

dermnetnz.org/topics/iron-d...

I thought mine was fine at 70 prior to reading that link. Started iron supplimentation and brain fog, fatigue and irritability improved dramatically.

[Hidden in reply to KimberinUS]

I had them checked in May, and were 57 ug/L (10.0 - 291.0), and then rechecked as part of private blood tests in September and they were 57 ug/L (13 - 150). GP2 hasn't rechecked them, no.