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Monday
Aug272007

Puzzle: Help the Midwife (please!)

What does this picture show? I am still exploring myself, so any help is appreciated. The more complete the answer, the better.

- Causes (possible/probable)

- Treatments (herbal/homeopathic/allopathic/alternative/dietary/lifestyle)

- Immediate/Emergent Concerns (risks/hospitalization/lifestyle/etc.)

- Expected Course & Length of Treatment Before Recovery

- Are labs intertwined? Or are they a separate issue? What is happening with this woman?

Hx: 46 year old woman, G3 P3 hx extreme fatigue with unknown etiology. Labs drawn randomly found these values. Not on birth control. Does not have STD or any other chronic disease, but has recently recovered from a long-term chronic illness that included 3 years on a liver-toxic medication. Once the medication was stopped, her cholesterol shot up 400 points, a sign that the liver was having a stress reaction. It has since dropped 350 points in the last 9 months without medication (she refused to add any statins knowing it was a hyper-reaction to stopping the long-term liver-toxic medication despite being harangued to take them over and over). She is still on several medications that she is required to continue including Thyroid medications, Topamax, and minimal bipolar medications. All meds are stable, with the recent addition of a T3 (thyroid). Sx include constipation, extreme fatigue that does not resolve with any amount of sleep (even upwards of 16 hours a day) or the addition of hyper-caffeine/energy drinks, minimal urination despite copious amounts of water and iced tea (usually very watered down) each day. Also, she's 6 years post-Roux en Y Gastric Bypass (which must be taken into account with any iron supplementation). No dark stools, no dark urine.

Yeah, it's me.

TEST ABNORMAL RESULT Just in-range result Normal result NORMAL RANGE

Anemia Labs

Hgb 10.6 12.0-16.0 (6/18/07 11.1) (3/17/07 11.1) (12/14/06 11.8)

Hct 32.2 37-47% (6/18/07 32.6) (3/17/07 32.5) (12/14/06 35.1)

WBC 8.5 4.0-11.0 (6/18/07 6.6)

RBC 3.73 4.2-5.4mil/mm (6/18/07 3.59) (3/17/07 3.50) (12/14/06 3.77)

MCV 86.2 81-99 fL (6/18/07 90.6)

MCH 28.3 27-35 pg (6/18/07 30.8)

MCHC 32.9 32-37 g/dL (6/18/07 34.0)

RDW 13.9 11.5-14.5% (6/18/07 14.2)

Platelets 446 130-400(thous) (6/18/07 365)

MPV 8.3 7.4-10.4 fL (6/18/07 8.3)

Iron 33 60-170mcg

Iron Sat 8 20-50%

Ferritin 4.7 13-150ng/mL - (6/18/07 11.7)

TIBC 405 250-420mcg

B12 538 200-910 - (6/18/07 211)

Electrolyte Labs

Co2 23 21-32 (8/27/07)

Co2 15 21-32 (8/23/07)

Lactic Acid (serum) 21.5 5-20 (8/27/07)

Sodium 136 135-145

Creatinine 1.2 0.6-1.1

Okay, my lab sleuths... help me figure out what is going on, please. The abnormal labs have occurred extremely quickly (my last labs were done 6 weeks ago and looked nothing like this) and I have been feeling tired for years anyway due to varying illnesses, but have been absolutely extremely exhausted the past few weeks. The exhaustion crept up on me. I had no idea that I should tell anyone how ill I could be.

Ready, set, GO!