bloodwork for vitamin levels

Please don't flame me...

I am almost 3 years out of RNY surgery and I have NEVER had my vitamin levels checked.  I have an appointment to see my surgeon on Aug 4 to have my bloodwork done, visit with him about a "restart" program they offer to help me get back on track with my eating habits, I will visit with the dietician, and the exercise expert.  It sounds like there is a possibility that I might have to see the psychologist too depending on what the doctor thinks is necessary after I visit with him...

Anyway, I was wondering what all they are going to check with the blood work?

Thanks,
Dot

My last covered:
Calcium
Magnesium
Zinc
Vitamin K
Comprehensive Metabolic - which covers a lot
Lipids (cholesterol)
D
Complete Blood Count
Thyroid
B12/Folic

By doing them over time we saw my iron and D were dropping and I increased my dosage of both.  I've upped my vitamins to adjust for where my labs came in low and really improved how I was feeling.  I know it is a pain to take a handfull of pills every day but something I knew going into the surgery I was signing up for.  

No flames from me but I am concerned for you...

Good luck

Patrick

Unless you ask, not much. Here's what you can ask for.



Not to be construed as medical advice, this list includes labs we have had performed as gastric bypass patients. The first group, every 3 to 6 months for life, as we are able. The second group, annually, as long as the results were comfortably within normal limits for more than 2 years in a row.



1st Group



*80053 Comprehensive Metabolic profile: (sodium, potassium, chloride, glucose,BUN, creatinine, calcium, total protein, albumin, total bilirubin, alkaline phosphatase, aspartate aminotransferase) (10231)

* 84134 Pre-albumin:

* 7600 Lipid profile: (cholesterol, HDL, LDL, triglycerides, chol/HDL ratio)

* 10256 Hep panel: includes ALT (SPGT) & GGT)

* 84100 Phosphorous - Inorganic: (718)

* 83735 Magnesium:

* 84550 Uric Acid: (905)

* 7444 Thyroid panel: (T3U, T4, FTI, TSH) (84437; 84443; 84479; 84480)

* 85025 Hemogram with platelets: (1759)

* 7573 Iron: TIBC, % sat

* 83550 Ferritin: (457)

* 84630 Zinc: (945)

* 84446 Vitamin A: (921)

* 82306 Vitamin D: (25-hydroxy) (680)

* 84052 Vitamin B-1: (Thiamin) (4052)

* 84207 Vitamin B-6: (Pyridoxine)

* 7065 Vitamin B-12 & Folate: (82607; 82746)

* 83970 Serum intact: PTH

* 83937 Osteocalcin:

* 84597 Vitamin K:

* 85610 PT:

* 85730 PTT:



2ND GROUP



* 593 LDH:

* 31789 Homocysteine, Cardio:

* 83921 MMA:

* 367 Cortisol:

* 84255 Selenium:

* 84590 Vitamin E:

* 82525 Copper:





For diabetics: *496 - HEMOGLOBIN A1C













POSSIBLE DIAGNOSIS CODES





269.2 Hypovitaminosis



268 Vitamin D deficiency



275.40 Calcium deficiency



266.2 Cyanocobalamin deficiency (B12)



281.1 other B12 deficiency anemia



281.0 Pernicious anemia



280.9 Iron-deficiency anemia



281.2 Folate deficiency anemia



285.9 Anemia, unspecified



269.3 Zinc deficiency



244.9 Hypothryoidism



250.0 Diabetes



401.9 Hypertension



276.9 Electrolyte and fluid disorders



272.0 Hypercholesterolemia

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -



*579.3 Surgical malabsorption*



*579.8 Intestinal malabsorption *





* Bands or sleeves should not use these codes as they are not accurate.



*Some insurance companies will not pay for any procedure that uses these codes.





LAB TARGETS





This is NOT medical advice, just my own targets for the main blood levels I watch.



Protein: 7's

Albumin: 4's

Pre-Albumin: 20-30's



Iron: 80-100

Ferritin: 200-300

HGB: 12+

HCT: 36+



Vit A: 60- 80

Vit D: 80-120



Calcium: 9.0-9.4

PTH: 20-40



Vit B1: Mid to top of range

Vit B6: Mid to top of range

Magnesium: Mid range (but also go by if we have leg/foot cramping)

Zinc: Mid range



Vit B12: 1000 +

Folate: Top of range



AST (sgot): Below 40

ALT (sgpt): Below 40



We usually want to "meet or beat" pre-op levels. In some cases, higher is better, and in other cases (Cholesterol, PTH for example), lower is better.



The only things *I* don't mind being on the high end of out of range are Ferritin and B12. But that applies to ME.



My doctors don't show interest in any of these until I am out of range. *I* am interested when I begin heading that direction.

Do you have any recommendations for nerve pain. My nerves are on fire and it hurts.

If it's in my neighborhood, I'd be looking in the B-vites family first. How do your labs look in B1 and B12, mainly? Folic? Taking 2 multis and maybe a B complex faithfully?

If it's not B family, it's medical and I don't do medical. It could be another kind of nerve damage or even something hideously painful but fixable, like a pinched nerve that has set them all on fire.

If you are not finding answers in the medical community, move on over to natural medicine. In WA, they are naturopaths, ND is the degree. And chiropractic. I've never tried accupuncture, but mainly cuz I never found one near me that takes my insurance.

My ND has such an interesting point of view. She looks for the cause, and doesn't just hand me rx to "stop it", whatever it is. I so much prefer to fix stuff with vites or minerals. I'm not too spiffy in knowledge of herbs, but there are a few who've proven their worth to me. Like milk thistle for liver enzymes.

But again, I'm not medical, just often frustrated with western medicine. If they can't SEE it, it doesn't exist. KWIM?

I don't know about my B-1, but my B-12 is in the upper 1600 and the high of the range was upper 900.

WOW!  complete list with codes!  Cool, THANKS!!

(coming from someone who works in medical billing!!)

If you find an error, PLEASE PM me, since I send this out many times per day!

Updated Lab Draw Lists post op WLS

These are common lab tests ordered after WLS, along with the CPT codes (according to Labcorp) for each

Every 12 months -

·         85025  CBC w/ diff

·         80053  Comprehensive Metabolic Profile

·         84134  Transthyretin (Prealbumin)

·         80061  Lipid profile

·         83735  Magnesium, Serum

·         7444  Thyroid panel

·         83540  Iron Profile (Includes TIBC and Sat %)

·         82728  Ferritin

·         84630  Zinc, RBC

·         84446  Vitamin A

·         82306  Vitamin D (25-hydroxy)

·         84425  Vitamin B-1 (Thiamin), whole blood

·         84207  Vitamin B-6 (Pyridoxine), plasma

·         82747  Folate, RBC

·         82607  Vitamin B12

·         83970  Parathyroid Hormone (PTH), Intact

·         83937  Osteocalcin

·         83921  Methylmalonic Acid, Serum

·         85610  PT

·         85730  PTT

·         84590  Vitamin E

·         82525  Copper

·         496  Hemoglobin A1C

Every 3-6 months -

·         85025  CBC w/ diff

·         80053  Comprehensive Metabolic Profile

·         84134  Transthyretin (Prealbumin)

·         83540  Iron Profile (Includes TIBC and Sat %)

·         82728  Ferritin

·         82306  Vitamin D (25-hydroxy)

·         84425  Vitamin B-1 (Thiamin), whole blood

·         84207  Vitamin B-6 (Pyridoxine), plasma

·         82747  Folate, RBC

·         82607  Vitamin B12

·         83970  Parathyroid Hormone (PTH), Intact

·         83921  Methylmalonic Acid, Serum

·         Any additional tests as needed

Pregnancy – Baseline

·         85025  CBC w/ diff

·         80053  Comprehensive Metabolic Profile

·         84134  Transthyretin (Prealbumin)

·         83735  Magnesium, Serum

·         7444  Thyroid panel

·         83540  Iron Profile (Includes TIBC and Sat %)

·         82728  Ferritin

·         84630  Zinc, RBC

·         84446  Vitamin A

·         82306  Vitamin D (25-hydroxy)

·         84425  Vitamin B-1 (Thiamin), whole blood

·         84207  Vitamin B-6 (Pyridoxine), plasma

·         82747  Folate, RBC

·         82607  Vitamin B12

·         83970  Parathyroid Hormone (PTH), Intact

·         83921  Methylmalonic Acid, Serum

·         84590  Vitamin E

·         82525  Copper

·         496  Hemoglobin A1C

Pregnancy – every 8 weeks

·         85025  CBC w/ diff

·         80053  Comprehensive Metabolic Profile

·         84134  Transthyretin (Prealbumin)

·         83540  Iron Profile (Includes TIBC and Sat %)

·         82728  Ferritin

·         82306  Vitamin D (25-hydroxy)

·         84425  Vitamin B-1 (Thiamin), whole blood

·         84207  Vitamin B-6 (Pyridoxine), plasma

·         82747  Folate, RBC

·         82607  Vitamin B12

·         83970  Parathyroid Hormone (PTH), Intact

·         83921  Methylmalonic Acid, Serum

·         Any additional tests as needed