Guest guest Posted June 29, 2006 Report Share Posted June 29, 2006 Would you take a look at this recent bloodwork? Appreciate any comments. RBC 4.81 3.9-5.3 WBC 8.0 6.0-17.0 HGB 13.5 11.5-13.5 HCT 40.8 H 34.0-40.0 HGB and HCT still elevated, wth? She appears to have no breathing problems. How do we get more oxygen? MCV 84.4 75-87 MCH 28.1 24-30 MCHC 33.1 31-37 RDW 12.3 11.5-14.5 RDW-SD 37.7 34.7-51.0 MCH reduced due to B-12 and folic acid. Platelets 370 140-440 MPV 11.6 9.4-12.4 Bun 19 6-19 Creatinine 0.4 0.3-1.3 Sodium 141 136-145 Potassium 4.6 3.5-5.0 Chloride 104 101-111 Co2 28 22-30 Anion Gap 14 10-20 Calcium 10.7 H 8.5-10.5 Parathyroid, Intact 17 10-64 Calcium 10.7H 8.5-10.5 CA, IONIZ PH/ADJ 1.32H 1.12-1.23 CA, IONIZ Ph/Meas 1.37H 1.12-1.23 Calcium is down from 11.4 on previous test, dr also not concerned about the elevations. Free T4 1.9 0.9-1.9 T3 Free 8.1H 1.5-4.1 TSH 0.01 0.27-4.20 This is on 1 3/4 grains Armour, now reduced to 1 grain, she took the Armour on the day of the test, should we have given it to her on that day? Glucose Timed 100 70-110 Lactic Acid 2.0 H 0.5-1.6 Dr said this was fine, but this worries me, should it? What can be done to reduce it? She does appear to be slightly fatigued. Bilirubin Total 0.1 0.1-1.5 Alk Phos 290 117-390 SGOT 29 0-31 SGPT 22 0-45 First time liver values have been in normal range. Protein Total Serum 7.0 6.0-8.5 Albumin 4.6 3.4-4.8 Globulin (Calc) 2.4 1.65-3.90 Ammonia 45 9-33 The dr said anything under 50 was not problematic, I found normal ref range online to 57. Is this anything diet related or is it fine? Behaviorally doing well, cognitive and social are excellent, consistently NT, now, thorough psychological exam revealed no cognitive deficits and no diagnosis. But what we appear to have still......is a physically ill child. Any comments, suggestions appreciated. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 29, 2006 Report Share Posted June 29, 2006 > Would you take a look at this recent bloodwork? Appreciate any comments. > > As I recall from earlier posts she is about 5 and 40 something pounds. > RBC 4.81 3.9-5.3 > HGB 13.5 11.5-13.5 > HCT 40.8 H 34.0-40.0 > > HGB and HCT still elevated, wth? She appears to have no breathing problems. How do we get more oxygen? Don't suppose anyone ever checked ferritin? Could be poor ability to USE oxygen, which the elevated lactate supports, in which case more oxygen probably won't do much. You could try getting someone to Rx a tank and stick a mask on her, seeing if she feels better while it is on (and probably some afterwards). > Calcium 10.7 H 8.5-10.5 > > Parathyroid, Intact 17 10-64 > Calcium 10.7H 8.5-10.5 > CA, IONIZ PH/ADJ 1.32H 1.12-1.23 > CA, IONIZ Ph/Meas 1.37H 1.12-1.23 > > Calcium is down from 11.4 on previous test, dr also not concerned about the elevations. Well, I am. Check the various vitamin D levels (25 and 1,25 hydroxy forms) and make sure she gets lots of magnesium frequently. > Free T4 1.9 0.9-1.9 > T3 Free 8.1H 1.5-4.1 > TSH 0.01 0.27-4.20 > > This is on 1 3/4 grains Armour, now reduced to 1 grain, she took the Armour on the day of the test, should we have given it to her on that day? FREE levels are elevated for 1-3 hours after taking medication, total levels are not affected. The reference range given is for adults, an age appropriate fT3 range is up to about 7.8. These values are not entirely unreasonable though a bit high. A full replacement dose for her based on weight would be 1 or 1 & 1/4 grain more or less. Being hyper is much worse for adults than for children. Being hypo is much worse for children than for adults. > Glucose Timed 100 70-110 > Lactic Acid 2.0 H 0.5-1.6 > > Dr said this was fine, but this worries me, should it? Well, not WORRY, but concern as it isn't fine. > What can be done to reduce it? Things to support pyruvate transport and use, a lower carb higher protein and fat diet, " mitochondrial support. " 2-5 mg biotin 3-4 times a day may help with pyruvate utilization. B complex, magnesium, zinc, Q 10 help with the mitochondria, as does omega 3. > She does appear to be slightly fatigued. She should be good for very high bursts of energy when rested, followed by being tired VERY quickly and taking a long time to perk up. Strength should be good, endurance poor. If she fought back really vigorously during the blood draw for a couple of minutes before they stuck her then the lactate may not mean anything, but if she was reasonably compliant it is significant. > Ammonia 45 9-33 > > The dr said anything under 50 was not problematic, since you don't die from it.... but if you don't want to feel like crap and not be able to think it needs to be handled. > I found normal ref range online to 57. Is this anything diet related or is it fine? The problem here is that protein elevates ammonia. And she probably needs a lot of protein to not rely on carbs for energy. Things that help with this are MODEST amounts of supplementary manganese, alpha ketoglutarate (or especially the supplement ornithine alpha ketoglutarate which is commerciallly available), and making sure she has a somewhat acidic digestive tract and frequent bowel movements. E.g. some of the vitamin C in acid form, enough C and Mg to be somewhat laxative. > > Behaviorally doing well, cognitive and social are excellent, consistently NT, now, thorough psychological exam revealed no cognitive deficits and no diagnosis. But what we appear to have still......is a physically ill child. > > Any comments, suggestions appreciated. These are exactly the situations I have seen due to heavy metal tox, blown off by 100% of " regular " doctors, which respond beautifully to an adequate amount of chelation. Andy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 29, 2006 Report Share Posted June 29, 2006 Well, this just gets more fun the longer we go. Yes, the Ferritin level was 33, and the rest of the panel was also normal, you looked at if before, last blood test 3 months ago, and said it was fine. And, yes, she did struggle before the test as the #* & *^ last phlebotomist put the needle in OUTSIDE the clearly marked area where we had put the Emla cream, so maybe the lactic acid level is not accurate, although the energy pattern you describe fits her to a " T " , problems with stamina. My concern is with the ammonia level, as even me, who knows nothing specifically asked the dr if there was a connection between the high hemocrit and the level of ammonia. So some questions: I read online this test should be a fasting test, there was no fasting, is it valid? What would he have done if it was over 50 or what does a dr do about this? I also assume you monitor this by repeated blood tests, which we will do, any idea if 6 weeks is enough to see a difference in the level? We will implement the suggestions you made. Thanks for your time and attention, [ ] Re: Andy-recent blood work > Would you take a look at this recent bloodwork? Appreciate any comments. > > As I recall from earlier posts she is about 5 and 40 something pounds. > RBC 4.81 3.9-5.3 > HGB 13.5 11.5-13.5 > HCT 40.8 H 34.0-40.0 > > HGB and HCT still elevated, wth? She appears to have no breathing problems. How do we get more oxygen? Don't suppose anyone ever checked ferritin? Could be poor ability to USE oxygen, which the elevated lactate supports, in which case more oxygen probably won't do much. You could try getting someone to Rx a tank and stick a mask on her, seeing if she feels better while it is on (and probably some afterwards). > Calcium 10.7 H 8.5-10.5 > > Parathyroid, Intact 17 10-64 > Calcium 10.7H 8.5-10.5 > CA, IONIZ PH/ADJ 1.32H 1.12-1.23 > CA, IONIZ Ph/Meas 1.37H 1.12-1.23 > > Calcium is down from 11.4 on previous test, dr also not concerned about the elevations. Well, I am. Check the various vitamin D levels (25 and 1,25 hydroxy forms) and make sure she gets lots of magnesium frequently. > Free T4 1.9 0.9-1.9 > T3 Free 8.1H 1.5-4.1 > TSH 0.01 0.27-4.20 > > This is on 1 3/4 grains Armour, now reduced to 1 grain, she took the Armour on the day of the test, should we have given it to her on that day? FREE levels are elevated for 1-3 hours after taking medication, total levels are not affected. The reference range given is for adults, an age appropriate fT3 range is up to about 7.8. These values are not entirely unreasonable though a bit high. A full replacement dose for her based on weight would be 1 or 1 & 1/4 grain more or less. Being hyper is much worse for adults than for children. Being hypo is much worse for children than for adults. > Glucose Timed 100 70-110 > Lactic Acid 2.0 H 0.5-1.6 > > Dr said this was fine, but this worries me, should it? Well, not WORRY, but concern as it isn't fine. > What can be done to reduce it? Things to support pyruvate transport and use, a lower carb higher protein and fat diet, " mitochondrial support. " 2-5 mg biotin 3-4 times a day may help with pyruvate utilization. B complex, magnesium, zinc, Q 10 help with the mitochondria, as does omega 3. > She does appear to be slightly fatigued. She should be good for very high bursts of energy when rested, followed by being tired VERY quickly and taking a long time to perk up. Strength should be good, endurance poor. If she fought back really vigorously during the blood draw for a couple of minutes before they stuck her then the lactate may not mean anything, but if she was reasonably compliant it is significant. > Ammonia 45 9-33 > > The dr said anything under 50 was not problematic, since you don't die from it.... but if you don't want to feel like crap and not be able to think it needs to be handled. > I found normal ref range online to 57. Is this anything diet related or is it fine? The problem here is that protein elevates ammonia. And she probably needs a lot of protein to not rely on carbs for energy. Things that help with this are MODEST amounts of supplementary manganese, alpha ketoglutarate (or especially the supplement ornithine alpha ketoglutarate which is commerciallly available), and making sure she has a somewhat acidic digestive tract and frequent bowel movements. E.g. some of the vitamin C in acid form, enough C and Mg to be somewhat laxative. > > Behaviorally doing well, cognitive and social are excellent, consistently NT, now, thorough psychological exam revealed no cognitive deficits and no diagnosis. But what we appear to have still......is a physically ill child. > > Any comments, suggestions appreciated. These are exactly the situations I have seen due to heavy metal tox, blown off by 100% of " regular " doctors, which respond beautifully to an adequate amount of chelation. Andy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 29, 2006 Report Share Posted June 29, 2006 , It looks as though this child is exhibiting some signs of thyrotoxicosis. I realize that many in this forum believe there is a benefit in giving children thyroid supplements even when conventional testing suggests normal thyroid function. Nonetheless, the very high T3 certainly suggests over-replacement. In addition, the fatigue that the child demonstrates and the mild elevated calcium are also characteristic of excess thyroid hormone. It may be useful to measure her pulse to see if she has evidence of rapid heart rate. If so, I would give serious consideration to reducing the thyroid supplementation. Jim ________________________________ From: [mailto: ] On Behalf Of Cochran Sent: Thursday, June 29, 2006 6:14 AM Subject: [ ] Andy-recent blood work Would you take a look at this recent bloodwork? Appreciate any comments. RBC 4.81 3.9-5.3 WBC 8.0 6.0-17.0 HGB 13.5 11.5-13.5 HCT 40.8 H 34.0-40.0 HGB and HCT still elevated, wth? She appears to have no breathing problems. How do we get more oxygen? MCV 84.4 75-87 MCH 28.1 24-30 MCHC 33.1 31-37 RDW 12.3 11.5-14.5 RDW-SD 37.7 34.7-51.0 MCH reduced due to B-12 and folic acid. Platelets 370 140-440 MPV 11.6 9.4-12.4 Bun 19 6-19 Creatinine 0.4 0.3-1.3 Sodium 141 136-145 Potassium 4.6 3.5-5.0 Chloride 104 101-111 Co2 28 22-30 Anion Gap 14 10-20 Calcium 10.7 H 8.5-10.5 Parathyroid, Intact 17 10-64 Calcium 10.7H 8.5-10.5 CA, IONIZ PH/ADJ 1.32H 1.12-1.23 CA, IONIZ Ph/Meas 1.37H 1.12-1.23 Calcium is down from 11.4 on previous test, dr also not concerned about the elevations. Free T4 1.9 0.9-1.9 T3 Free 8.1H 1.5-4.1 TSH 0.01 0.27-4.20 This is on 1 3/4 grains Armour, now reduced to 1 grain, she took the Armour on the day of the test, should we have given it to her on that day? Glucose Timed 100 70-110 Lactic Acid 2.0 H 0.5-1.6 Dr said this was fine, but this worries me, should it? What can be done to reduce it? She does appear to be slightly fatigued. Bilirubin Total 0.1 0.1-1.5 Alk Phos 290 117-390 SGOT 29 0-31 SGPT 22 0-45 First time liver values have been in normal range. Protein Total Serum 7.0 6.0-8.5 Albumin 4.6 3.4-4.8 Globulin (Calc) 2.4 1.65-3.90 Ammonia 45 9-33 The dr said anything under 50 was not problematic, I found normal ref range online to 57. Is this anything diet related or is it fine? Behaviorally doing well, cognitive and social are excellent, consistently NT, now, thorough psychological exam revealed no cognitive deficits and no diagnosis. But what we appear to have still......is a physically ill child. Any comments, suggestions appreciated. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 29, 2006 Report Share Posted June 29, 2006 Here I am, acting just like a " regular " doctor, but I have an alternative hypothesis for the elevated ammonia and the lactate. Namely, thyrotoxicosis causing unusually rapid depletion of intramuscular ATP and stimulating the purine nucleotide cycle, with the primary end products of ammonia, lactate and pyruvate. It would be of interest to see if pyruvate is also elevated. I am pleased to see that Andy agrees with reduction of thyroid supplementation, and that it has already occurred. Jim ________________________________ From: [mailto: ] On Behalf Of andrewhallcutler Sent: Thursday, June 29, 2006 2:53 PM Subject: [ ] Re: Andy-recent blood work > Would you take a look at this recent bloodwork? Appreciate any comments. > > As I recall from earlier posts she is about 5 and 40 something pounds. > RBC 4.81 3.9-5.3 > HGB 13.5 11.5-13.5 > HCT 40.8 H 34.0-40.0 > > HGB and HCT still elevated, wth? She appears to have no breathing problems. How do we get more oxygen? Don't suppose anyone ever checked ferritin? Could be poor ability to USE oxygen, which the elevated lactate supports, in which case more oxygen probably won't do much. You could try getting someone to Rx a tank and stick a mask on her, seeing if she feels better while it is on (and probably some afterwards). > Calcium 10.7 H 8.5-10.5 > > Parathyroid, Intact 17 10-64 > Calcium 10.7H 8.5-10.5 > CA, IONIZ PH/ADJ 1.32H 1.12-1.23 > CA, IONIZ Ph/Meas 1.37H 1.12-1.23 > > Calcium is down from 11.4 on previous test, dr also not concerned about the elevations. Well, I am. Check the various vitamin D levels (25 and 1,25 hydroxy forms) and make sure she gets lots of magnesium frequently. > Free T4 1.9 0.9-1.9 > T3 Free 8.1H 1.5-4.1 > TSH 0.01 0.27-4.20 > > This is on 1 3/4 grains Armour, now reduced to 1 grain, she took the Armour on the day of the test, should we have given it to her on that day? FREE levels are elevated for 1-3 hours after taking medication, total levels are not affected. The reference range given is for adults, an age appropriate fT3 range is up to about 7.8. These values are not entirely unreasonable though a bit high. A full replacement dose for her based on weight would be 1 or 1 & 1/4 grain more or less. Being hyper is much worse for adults than for children. Being hypo is much worse for children than for adults. > Glucose Timed 100 70-110 > Lactic Acid 2.0 H 0.5-1.6 > > Dr said this was fine, but this worries me, should it? Well, not WORRY, but concern as it isn't fine. > What can be done to reduce it? Things to support pyruvate transport and use, a lower carb higher protein and fat diet, " mitochondrial support. " 2-5 mg biotin 3-4 times a day may help with pyruvate utilization. B complex, magnesium, zinc, Q 10 help with the mitochondria, as does omega 3. > She does appear to be slightly fatigued. She should be good for very high bursts of energy when rested, followed by being tired VERY quickly and taking a long time to perk up. Strength should be good, endurance poor. If she fought back really vigorously during the blood draw for a couple of minutes before they stuck her then the lactate may not mean anything, but if she was reasonably compliant it is significant. > Ammonia 45 9-33 > > The dr said anything under 50 was not problematic, since you don't die from it.... but if you don't want to feel like crap and not be able to think it needs to be handled. > I found normal ref range online to 57. Is this anything diet related or is it fine? The problem here is that protein elevates ammonia. And she probably needs a lot of protein to not rely on carbs for energy. Things that help with this are MODEST amounts of supplementary manganese, alpha ketoglutarate (or especially the supplement ornithine alpha ketoglutarate which is commerciallly available), and making sure she has a somewhat acidic digestive tract and frequent bowel movements. E.g. some of the vitamin C in acid form, enough C and Mg to be somewhat laxative. > > Behaviorally doing well, cognitive and social are excellent, consistently NT, now, thorough psychological exam revealed no cognitive deficits and no diagnosis. But what we appear to have still......is a physically ill child. > > Any comments, suggestions appreciated. These are exactly the situations I have seen due to heavy metal tox, blown off by 100% of " regular " doctors, which respond beautifully to an adequate amount of chelation. Andy This is a confidential message intended solely for the person(s) to whom it is addressed. If you receive this message in error, please forward it to the correct person(s), or delete it immediately. Email is not guaranteed secure or error-free; therefore, VMRC does not accept liability for transmission-related error or omission in the content of this message. http://www.vmrc.net Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2006 Report Share Posted June 30, 2006 > So some questions: > > I read online this test should be a fasting test, there was no fasting, is it valid? Unknown, at least to me. > What would he have done if it was over 50 or what does a dr do about this? Not much, less than I already told you, and put them on a low protein diet which is not likely to be appropriate. > I also assume you monitor this by repeated blood tests, No. > which we will do, any idea if 6 weeks is enough to see a difference in the level? The internventions should change it promptly, the detox over a period of many months. You really do NOT need to be sticking her repeatedly. Take the calcium seriously too. If they have to pincushion her just for fun and test soon and often, get pyruvate and whole blood porphyrins and fibrinogen next time along with the vitamin D metabolites. > We will implement the suggestions you made. > Thanks for your time and attention, > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2006 Report Share Posted June 30, 2006 > Well, this just gets more fun the longer we go. Yes, the Ferritin level was 33, So maybe somewhere she isn't oxygenating well. If you think that is true you could try 1/2 capsule idebenone twice a day for a while and see if she does better or worse on it. It makes a lot of kids very hyper. It only helps if there really is such low blood flow somewhere that there is oxygen deficiency. > And, yes, she did struggle before the test as the #* & *^ last phlebotomist put the needle in OUTSIDE the clearly marked area where we had put the Emla cream, If you see that phleb next time, send them away, decline to let them provide service, ask for another one. Also put TAPE on her arm and use the emla cream on the exposed area - they won't stick the needle through tape (and of course don't let them pull it off!). Use the paper stuff that isn't too sticky that is used to hold down iv tubes and needles, it comes off painlessly unless you are hairy. >so maybe the lactic acid level is not accurate, although the energy pattern you describe fits her to a " T " , problems with stamina. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2006 Report Share Posted June 30, 2006 Thank you for all the informative help. There won't be a struggle next time, she quit struggling as soon as the needle went in and there was no pain. We told this last phlebotomist and she was highly upset about the last incident and promised she would take care of the other sadistic lab tech. She has to be tested again in 5 weeks to check the thyroid, so we will add in the other tests as the dr is only too happy to order them, and that is good. One last question: We have the ornithine alpha-ketoglutarate here, 850 mgs. Given her weight at 44 lbs what might be a reasonable dose and how often should it be given? Again, thank you, almost didn't post the results as I read online the upper level was 57, so I figured the dr was on target, and she was well below that, but, I am very, very glad I did. I now understand the this test is lab specific and should be taken at face value. [ ] Re: Andy-recent blood work > So some questions: > > I read online this test should be a fasting test, there was no fasting, is it valid? Unknown, at least to me. > What would he have done if it was over 50 or what does a dr do about this? Not much, less than I already told you, and put them on a low protein diet which is not likely to be appropriate. > I also assume you monitor this by repeated blood tests, No. > which we will do, any idea if 6 weeks is enough to see a difference in the level? The internventions should change it promptly, the detox over a period of many months. You really do NOT need to be sticking her repeatedly. Take the calcium seriously too. If they have to pincushion her just for fun and test soon and often, get pyruvate and whole blood porphyrins and fibrinogen next time along with the vitamin D metabolites. > We will implement the suggestions you made. > Thanks for your time and attention, > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 1, 2006 Report Share Posted July 1, 2006 > She has to be tested again in 5 weeks to check the thyroid, See if the lab has proper ranges for children, if not either get them from a pediatric or laboratory medicine text or ask me to provide them (please check elsewhere first). >so we will add in the other tests as the dr is only too happy to order them, and that is good. Good. Make sure she hasn't taken the thyroid within 4 hours before the draw. > One last question: We have the ornithine alpha-ketoglutarate here, 850 mgs. Given her weight at 44 lbs what might be a reasonable dose and how often should it be given? 1 capsule every time she eats. > Again, thank you, almost didn't post the results as I read online the upper level was 57, so I figured the dr was on target, and she was well below that, but, I am very, very glad I did. I now understand the this test is lab specific and should be taken at face value. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 4, 2006 Report Share Posted July 4, 2006 There were no signs of excess thyroid that you gave and we did keep a check on her temperature and pulse which ran between 85-100, which I have read is normal for children her age. This does, however, bring up a question that I have been wondering about for some time and that is are her thyroid problems due to mercury or autoimmunity and is it likely that she now needs less correction, or less Armour due to the lesser mercury load or a more functional immune system? Thanks, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 4, 2006 Report Share Posted July 4, 2006 It is really unclear what is going on. Recall the fT3 range the lab gave is invalid for children, she was about at the top of the children's range for her age. Also the FREE hormone measurements may be falsely elevated by taking the medicine a few hours before the test. She how she settles down on 1 grain and how things look next time you check. The cause of the problems is unclear. The number of possibilities is large enough it seldom gets sorted out. Andy > > There were no signs of excess thyroid that you gave and we did keep a check on her temperature and pulse which ran between 85-100, which I have read is normal for children her age. > > > > > This does, however, bring up a question that I have been wondering about for some time and that is are her thyroid problems due to mercury or autoimmunity and is it likely that she now needs less correction, or less Armour due to the lesser mercury load or a more functional immune system? > > > > > > > > Thanks, > > > Quote Link to comment Share on other sites More sharing options...
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