Blood test results for my Mom. Please may I ask for help reviewing them given her suspected heart attack some weeks back. Thankyou.

[Poppy_the_cat]

May I ask the expertly knowledgeable folk on this site to please assess my mothers recent blood tests results - post a suspected heart attack.

We are in a very difficult situation.

Our GP practice is deteriorating at a rate of knots!

They are drastically short of doctors. The practice has quietly amalgamated with another on the other side of town, quite far away. My GP who officially retired a few months back has now, not had his rolling 2 month contract renewed... you call the practice and you get a national call centre istead! And I had to find out from my hairdresser that the lease is up on the practice building. ...They even have to apply to the local body for funding to perform an ear-syringing procedure that the audiology clinic has officially requested, it only costs £30...and we still have not heard and its been a month! Nobody is being straight or telling us anything of what is really going on.

A short while back my mother suffered what we all suspected was a heart attack.

Having used the angina subligual spray twice to no effect, thus experiencing no relief for the severe pain she had in her left arm (reminiscent of her initial attack 9 years ago), we took the executive decision to drive her straight to hospital as it was a Friday night and we felt we could not waste a moment.

She was given the normal ECG tests and the blood tests to detect if a heart attack has taken place.

We waited with her for almost 8 hours, until they decided they would keep her in for a further 24 hours to observe her.

Her tests came back as negtive, thankfully but there was something they could not explain. Her oxygen saturation levels were recorded as very low??

They kept asking if she had recently had a chest infection - which she has not.

They also could not explain the failure of the angina stray to give any relief??

They tried further tests but could not explain it, and left us with the task of keeping an eye on her and at the slightest problem we were told to take her straight back to hospital....

My mother's medical history involves having survived cancer twice.

The first time was ovarian - she was given a complete hysterectomy.

The second was a short while later as it had returned to her lymph glands.

At the time she had cutting edge (over 35 years ago) platinum-based chemo which was very tough, but it worked thank the Lord. I stopped my life and dedicated every waking hour to her, to looking after her and even sitting with her through the chemo, so I saw the effects and witnessed the battle first hand.

One of the casualties from the chemo was a shrivelled kidney, so she essentially just has one kideny that functions properly.

I do notice she has very swollen ankles these days, which my grandfather who was an excellent doctor, was always very wary of, and its something I clearly don't like.

When we heard that her oxygen saturation levels were not good, I wonderd if she could be low on iron? I proposed this to our GP the very last time we saw him and he agreed to do extensive tests, icluding thyroid though he said we had to be careful and just get the TSH done at first.

I have had my suspicions for sometime that she might be low thyroid I have mentioned my observations to lesser doctors in the past, but you guessed it, they were dismissed out of hand.

I always keep in mind that the Ancient Chinese always used to administer what they called the 'youth drug' to their venerated elders in the form of desiccated animal thryoid gland.

My mother has marked ridges on her finger nails....and her finger nails are curling down again.

Her vitamin D is at what I call at the lowest functioning level.

Her voice is a rasping, croaking whisper (as mine has been in the past and I am Hashimoto's).

She has a hiatus hernia and takes the dreaded Omeprazole, which every so often makes her badly ill with vomiting and diarrhea.

With levels of low stomach acid I worry about her levels of nutritional absorption??

Low thyroid level would be the last straw.

I would therefore like to try and have the doctors give her a trial of thryoid medication to see if things might improve generally for her, as the thyroid after all is the 'conductor to the orchestra!'

I have transcribed her blood tests below.

Any pearls of wisdom or any observations no matter how small, would be immensely appreciated.

Many thanks in advance. A this point I am dedicating myself to my mother and will catch up with about how I am elsewhere.

Blood Test Results:

#Total vitamin D (serum)

51 nmol / L (> 50.0)

Please note this total 25 - OH vitamin D result has been produced using an immunoassay method.

#Serum TSH level (XaELV)

3.06 mlU/L (0.3 - 5.0)

TSH within limits excludes primary (but not secondary) hypothyroidism. If there is a high clinical suspicion of hypothyroidism, please contact duty biochemist to discuss further tests.

#Blood Count. Full Blood count (424)

*Total white blood count (XaldY)

- Result - 8.3 10*9/1 (4.0 - 11.0)

*Red blood cell count

- Result - 4.64 10*12/l (3.5 - 5.5)

*Haemoglobin concentration (Xa96v)

- Result - 138g/l (115.0 - 165.0)

*Haematocrit (X76tb).

- Result - 0.431. l/l (0.37 - 0.47)

*Mean cell volume (42A)

- Result - 92.9 fl (78.0 - 100.0)

*Mean cell haemoglobin level (XE2pb)

- Result - 29.7 of (27.0 - 32.0)

*Mean cell haemoglobin concentration (429)

- Result - 320 g/l (320.0 - 360.0)

*Red blood cell distribution width (XE2mO)

- Result - 14.5% (11.5 - 15.5)

*Platelet count - observation (42P)

- Result - 272 10*9/1 (150.0 - 400.0)

*Mean platelet volume (42Z5)

- Result - 10.4 FL (8.0 - 12.0)

*Neutrophil count (42J)

- Result - 5.6 10*9/L (2.0 - 7.5)

*Lymphocyte count (42M)

- Result - 1.8 10*9/L (1.5 - 4.5)

*Monocyte count - observation (42N)

- Result - 0.66 10*9/L (0.2 - 1.0)

*Eosinophil count - observation (42K)

- Result - 0.19 10*9/L (0.04 - 0.4)

*Basophilic count (42L)

- Result - 0.1 10*9/L (<0.3)

SERUM Electrolyte levels (XE2mj)

*Serum sodium level (XE2qO)

- Result - 141 mmol/L (133.0 - 146.0)

*Serum potassium level (XE2pz)

- Result - 4.1 mmol/L (3.5 - 5.5)

*Serum creatinine level (XE2q5)

- Result - 78 umol/L (45.0 - 84.0)

*Glomerular filtration rate (XSFyN)

- Result 62 ml/min/1.73m*2

"Estimated GFR: 60-89. result does not indicate stage 2 chronic kidney disease unless there is other existing laboratory /clinical evidence of disease. Caution some exceptions to the calculations apply see renal.org/eGFR

NOTE. as of 03/10/16 CKD-EPI equation used to estimate GFR."

*SERUM total cholesterol level (XaJe9)

- Result - 4.9 mmol/L

* Serum HDL cholesterol level (44P5)

- Result - 1.4 mmol/L

*Serum cholesterol / HDL ratio (XaEUq)

- Result - 3.5

*serum non high density lipoprotein cholesterol level (XanE1)

- Result - 3.5 mmol/ L

*Serum FERRITIN Level (XE24r)

- Result - 43 Ng/ml (20.0 - 350.0)

Thankyou.

Poppy the Cat

[Polly91]

Sorry to hear this Poppy.

My mum has a heart attack a few years ago at aged 69 and had had lots of issues since so I really sympathise with you.

I think your assessment of bloods looks good to me (but I’m no expert) the Ferratin and vitamin D look v low & TSH is raised so could well be thyroid that needs help. Especially since you have a thyroid issue (I think).

I didn’t know that about the ancient Chinese but I think they knew a thing or two! Sadly we’ve been a bit too focussed on drug therapies rather than ancient wisdom and herbs etc.

Good luck with everything. Hope your mum will be ok.

X

[Poppy_the_cat in reply to Polly91]

Thank-you Polly, and thank-you for your good wishes. 🙂

[SlowDragon Administrator]

As you have Hashimoto's, has she ever had BOTH TPO and TG thyroid antibodies tested?

Suggest you get her full Thyroid and vitamin testing via Medichecks or Blue Horizon

[Poppy_the_cat in reply to SlowDragon]

Thank-you.

May I ask if you would be kind enough to list exactly what they are...as a first port of call, I shall get our GP to try and get them done (our practice manager has somehow fixed it that I get to see my retired GP at another surgery 20 miles away, next Thursday!!)

Thank-you.

I don't want to miss anything and would appreciate your input.

Many thanks,

Poppy

[SlowDragon Administrator in reply to Poppy_the_cat]

For full Thyroid evaluation your Mum needs need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Also very important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised

Low B12 very common in anyone over 60 years old

healthline.com/nutrition/vi...

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

NHS refuses to test TG thyroid antibodies if TPO antibodies are negative

Very unlikely to get FT3 tested by NHS

[Poppy_the_cat in reply to SlowDragon]

Thank-you so much.

My wonderful GP had found a way around the computer bars to get my T3 tested...am hoping to get it done for my Ma too.

Thank-you for your time and assistance.

Best Wishes

Poppy the 🐈

[DIYqueen]

I am not a doctor but:

Total cholesterol below 5 is great, ratio to HDL of 3.5 is as recommended. So good news.

Vit D VERY low. Ask doctor for a 'loading dose' to bring it back up (I just had to do this, it is high dose for three months, then back to maintenance dose after).

Kidney results look fine.

I also have low ferritin but my iron is high normal range. All the advice I can find is on raising iron to raise ferritin; not sure yet how to proceed:

Diet won't hurt I expect, so liver, liver pate, black pudding etc

Without FT4 test I don't see how they can rule out primary hypothyroidism as it may be well over range. Can you ask for that (and FT3). Secondary would be more like if ALL the levels were low/level through the range. You can compare them by converting to %. Use this calculator

chorobytarczycy.eu/kalkulator click 'translat'

So her TSH is 58.72% through range (high IMO)

[Poppy_the_cat in reply to DIYqueen]

Thank-you !

May I ask what strength was your 'loading dose' of vitamin D?

[DIYqueen]

3200IU from GP. I had 14 tablets of 1000IU left over from a while back, so I am finishing those off as well. It's 4200IU which is only a bit over limit - and only for 14 days. The vitamin council says you can take doses up to 10000 safely and my dose would be 4900, but I prefer to play safe and take longer.

[Poppy_the_cat in reply to DIYqueen]

Thank-you.

But please forgive, I just want to make sure, as clearly I don't want us to overdo it.

I have vitamin D3 gel tablets that are 4,000 iUs each.

So would one take X2 tablets, totally 8,000 iUs per day for two weeks?

If this is correct?... If so, What would the 'maintenance' dose then be...and how long to take the maintenance dose before resting?

Sorry to be such a bother, but I want to get it right.

Many, many thanks.

Poppy the 🐈 x

[DIYqueen in reply to Poppy_the_cat]

No bother at all

The GP may not think a loading dose is not necessary as they aim for 50ish. But Vitamin D council and on here a level of 80-100 is best. So you will probably have to buy it. Worth asking though. Have a look at:-

vitamindcouncil.org/i-teste...

According to the Vitamin D council up to 10,000 is safe, so 8,000 for two weeks would be fine. My GP says 600-800IU (use D3, not D2) as a maintenance dose. But I think that is too low as I get little sunshine (indoors or factor 50) and little comes from food.

I went through this three years ago, first a loading dose then 800IU maintenance - left it too long to retest - and it obviously wasn't enough for me as I became deficient again.

The 1000IU were bought over the counter at my pharmacy so are obviously thought safe. You can also get 2000IU over the counter or on-line. My plan is to take the GP prescription of 3200IU for 3 months with my remaining 14 1000's (and retest) then 2000IU daily long-term and retest twice a year. Some on here suggest we need more in the winter than summer, so I will retest in the Autumn and then spring. Maybe 100 in summer and 1000 in winter. I shall see. By testing yourself you can easily see whether to go up or down.

(you can buy tests fro medicheck on-line, cheap finger-prick test, no need to go through GP to keep on top of it).

It's important to also take Vit K2 (MK-7 type) and magnesium to help Vit D be used properly. Vit K2 100mcg seems norm and magnesium about 320mg as supplement [no more than 350 - food doesn't count as part of total and it's the elemental/mineral content that counts come back and ask if not sure. You can PM me]. Take less on blood pressure tablets. I will take less than 320 for that reason. All magnesium can help you sleep. There are different forms of magnesium with different effects on the body so have a look:-

wellandgood.com/good-advice... Decide which suits.

I am thinking personally of taking this one but one capsule, not 3:-

amazon.co.uk/MagEnhance-Mag...

as it contains a combination but this NOT an endorsement, you need to look yourself.

Sorry to go on!!

[Poppy_the_cat in reply to DIYqueen]

Heavens, you are brilliant! Thank-you for taking the time.

In the past my previous GP was happy for me to be hovering around 54....and prescribed me the Adcal 'bubblegum' tasting stuff, for an elevated dose according to him of 800ius !!!! Then he never mentioned Magnesium as what I call the co-partner to Vitamin D3.

It's unreal really.

Unreal that we have to become our own 'citizen doctors' as I've heard the term.

If your DIY is of the same standard as your vitamin knowledge, you deserve an award!

Many thanks,

Poppy the 🐈 😁😁😁

[greygoose]

her finger nails are curling down again.

Sounds like low B12. You really need to get her B12 and folate tested.

A TSH of over 3 is not normal - although I'm guessing her doctor said it was. In some countries you'd be treated with a TSH of over 3. In any case, her thyroid is struggling. Could be due to her low nutrients, but needs to be kept an eye on.

[Poppy_the_cat in reply to greygoose]

Thank-you so much.

It's good to have what I thought confirmed by folk who are far more knowledgeable. Many thanks, much appreciated.

[greygoose in reply to Poppy_the_cat]

You're welcome. Hope your mum gets the help she needs soon.

[Poppy_the_cat in reply to greygoose]

I certainly will.

😁

[Poppy_the_cat in reply to greygoose]

Once I've fought my way through the our other GP's 'reservations' as he is very sweet and very dear, but not very courageous! I know he will say that my Mom is 'borderline' and try to leave it at that....

May I ask, what level of strength should she be started on for thyroid replacement point of view?

I was started on a mere 25 of Levo and had to fight tooth and nail for the smallest of increases... But then it got complicated. As it was I who 6 months later realised that I was Levo intolerant. At that point he insisted on ever increasing my dose, eventually up to 125.. before I became very ill. I am now on bovine extract and am able to tolerate it the best.

I don't want my mother to start on an insignificant dosage, and take months and months to reach the proper dose in order to feel better.

Any advice would be most welcome.

Thank-you.

Poppy

[greygoose in reply to Poppy_the_cat]

I imagine she's over sixty, isn't she? So, at that age, you wouldn't find a doctor who would start her on more than 25 mcg - especially as she has just had a suspected heart attack! They are so terrified of the possible effect on the heart of thyroid hormones - although they have no idea what the effect is likely to be! It's possible low T3 is the cause of her heart problems, but doubtful a GP would understand that. So, I rather think that's what she would be started on. It would then be a case of pushing for regular tests and increases. But, I don't see any way round that.

[Poppy_the_cat in reply to greygoose]

I was pretty sure you'd say that...

Yes my Ma is 80.

When you say regular checkups...how regular would you suggest?

I know she is struggling and I don't want to have to waste 12 months trying to get improvement for her...

It's such a worry to me..

[greygoose in reply to Poppy_the_cat]

I didn't say regular check-ups, I said regular testing - thyroid testing. Six weeks after starting levo, and after any change in dose. GPs have a tendency to leave it for three months, if they can get away with it, and that's too long. 8 weeks maximum.

I understand your concerns, but it's the same for everybody: with hormones, you absolutely have to start low and increase slowly. For levo, that means a starter dose of 25/50 - definitely 25 mcg at 80 - and increases every six weeks minimum. If you try to go any faster, you will find yourself back at the beginning again. It just won't work.

[Poppy_the_cat in reply to greygoose]

Thank-you. Yes, I had understood tests as in blood tests, but probably didn't express myself correctly.

Spot on advice.

I shall work to that model of blood tests every 6 weeks to chart her progress. Many thanks.

Having a definitive plan is weight off my mind.

Thank-you again for your help and reassurance.

Good night

🙂

Poppy x

[greygoose in reply to Poppy_the_cat]

You're welcome.