ER Blood Work

I finally got the blood work back from the ER visit at the end of December and there are 3 things on there that were interesting.

Here's all of the results. Remember I went in there with chest pains, so they did all the cardiac and blood clot tests. I know nothing about those to be honest.

December 29, 2008
PT TEST 10.7--(9-12)
INR 1.1--(0.9-1.2)
PTT TEST 28.7--(20-35 seconds)
D-Dimer 0.51--(0.54-2.09) LOW But it states this underneath-
"To maximize the negative predictive value for the purpose of ruling out DVT or PE, a cutoff value of less than 1.0 is used.

A D-Dimer of less than 1.0 and otherwise normal patient history equals a low probability of DVT or PE. At levels below 1.0 the negative predictive value for DVT and PE approaches 100%.

Conversely, a value of 1.0 or greater cannot be used for the diagnosis of DVT or PE without the use of radiological procedures. IF a D-Dimer is great than 1.0, the investigation should be continued as clinically indicated."

Troponin I 0.00--(0-0.3)

Glucose 99--(70-99) Very high?
Bun 8--(7-22)
Creatinine 0.9--(0.5-1.3)
Bun/Creat 8.9--(8-27)
Sodium 142--(136-147)
Potassium 3.5--(3.6-5.3) LOW...
Chloride 107--(98-110)
CO2 Content 24--(22-34)
Anion Gap 11--(2-12)
Calc Osmol 281--(269-297)
Calcium 9.8--(8.7-10.7)
T Bili 0.5--(0.1-1.2)
ALK Phos 65--(30-128)
SGPT (ALT) 58--(5-47) HIGH again?
SGOT (AST) 36--(5-40) High normal
Total Protein 8.0--(6-8.4)
Albumin 4.7--(3.3-5.1)
Globulin 3.3--(1.8-4.2)
A/G Ratio 1.4--(1.0-2.5)

WBC 5.5--(3.8-10) Best I've ever seen my counts
RBC 4.95--(3.88-5.11)
HGB 14.1--(11.5-15.7)
HCT 40.8--(36.3-47%)
MCV 82.4--(84-101.1) LOW again
MCH 28.5--(27-34)
MCHC 34.6--(30.5-35)
RDW 12.5--(11-15.5)
PLT 256--(130-400)
MPV 10.4--(8-11.1)
Neutrophil# 2.83--(1.6-6.7)
Lymphocyte# 2.1--(0.9-3.1)
Monocyte# 0.34--(0.11-1.0)
Eosinophil# 0.2--(0.0-0.5)
Basophil# 0.0--(0.0-0.2)
Neutrophil% 51.7--(43.6-74.5)
Lymphocyte% 37.6--(15.5-44.5)
Monocyte% 6.2--(3.6-12)
Eosinophil% 3.8--(0-6) First time I've seen this normal in 2-3 years.
Basophil% 0.7--(0-2)

Chest X Ray at ER
CLINICAL DATA: Chest Pain
TWO-VIEW CHEST

History: A 24-year-old female with chest pain.

Comparison Studies: None

Findings: The lungs are free of consolidation, congestion, or effusions. The cardiac silhouette is not enlarged. There are no hilar or mediastinal abnormalities.

IMPRESSION No acute pulmonary disease.

The elevated ALT is interesting. That means my ALT was elevated for the entire month of December. It hasn't been checked since then, so I don't know if it's still elevated. I will definitely be bringing this up to Dr. L. My research into ALT tells me that unlike some of the other liver indicators which might be a metabolic problem somewhere else down the line, ALT specifically means damage or inflammation in the liver. The cells die and then leak into the bloodstream. Obviously there is some cell death in everyone, since the range is 5-47. Now it doesn't mean its serious, but the fact that I don't drink alcohol, take OTC pain pills or prescription drugs tells me it needs investigated further. Now if it's not elevated anymore, then I'll just assume it was from the DMSA and move on. But if it's still elevated now, then I might refer myself to another doc. I just like to make sure everything is clear here. I'm 24 years old and certainly want to keep my liver healthy as long as possible! I've seen a few medical websites that say celiac can cause high ALT.

The low potassium doesn't surprise me. Well actually it does a little because I was actively trying to raise it then. And low potassium can cause chest pains, so I might have gone to the ER because of low K! haha That makes me laugh a little inside.

The high glucose worries me. My last fasting blood draw in March was creeping up into the 90's and I certainly don't need diabetes to worry about on top of everything else.

In other news, the itching has been back. Not as severe as it used to be, but I am worried it will continue to get worse. It's the same spots as before...

Blood Work, ER and More!

Last evening I decided to go to the ER. The pain started to move more to my back. The wait wasn't too bad despite how busy it was and I was happy with the doctor. At least he didn't call me a heroin addict!

Everything was checked. More X-rays, blood work, and an EKG. He said it was a muscle and to give it another 4-7 days to get better. That's what I'm going to do. I may even cancel my voice lesson for Monday. If it is a muscle apparently I really messed mine up. It has been 13 days today with this chest pain and it still hurts. At least I know it is NOT my lungs, a blood clot, heart problems or a broken rib. I am much more relaxed about it since I know I won't be dropping dead from it.

Today I got my blood work results from Dr. Goldstein and it is not good.
TSH-0.097 VERY LOW
T4- 6.5 (lower than optimal but within lab normal range)
FT3- 2.6 (lower than optimal but within lab normal range)
TSI- <20 OK
TPOAb -<10 OK

With a completely clean thyroid ultrasound and this blood work, it looks like my pituitary isn't working. I'm not completely sure how it all works yet (still researching) but this will quickly cause my thyroid to become hypo. When a hypothyroid is caused by the pituitary it is called Secondary or Central Hypothyroidism. This is exceedingly rare, but with my history of diabetes insipidus doesn't really surprise me. I found a website that said, "Central hypothyroidism is a rare disorder with a prevalence of 0.0002% to 0.005%". If this is referring to the US population, (if I did my math right) that means 600-15000 people have been diagnosed with it. Remember diabetes insipidus is also rare at about 1 in 25,000 people. That is about 12,000 people in the general public. For comparison, primary hypothyroidism (including the autoimmune ones) has a prevalence of 0.8% or about 2.4 million people.

There is another test that can be performed to accurately diagnosis this and that is called a thyrotropin-releasing hormone stimulation test. This will help to distinguish between tertiary (hypothalamus defect) or secondary (pituitary defect) hypothyroidism. An absent or blunted response means secondary. An exaggerated response means tertiary. I don't know if Dr. Goldstein is up for this challenge. I will also need EVERY pituitary hormone checked including LH, FSH, ACTH, PRL, GH etc. Since I had a MRI back in February, I'm not concerned about a tumor. However this does worry me a little because the part of the pituitary that controls the anti-diuretic hormone is on the opposite side where TSH is controlled. That means my entire pituitary gland is being affected. Either it is a large tumor or the mercury after all.