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Nurse Susan
Nurse Susan, Nurse (RN)
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I have been going to a dr for 6 months because I have severe

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I have been going to a dr for 6 months because I have severe fatigue, quick weight gain (50lbs in 3 months even though running daily & eatting right), anxiety, breathlessness, dizziness, easy bruising, sweating all the time, and infertility. There are other symptoms but I listed the main ones. I did not see my original blood work but dr told me I had a thyroid problem, no vitamin d, and no folate. I went on thyroid pills and several vitamen supplements to fix what is believed to be a vitamin deficeincy. Since then I have developed vasovagal... when I give blood I pass out and don't come to without smellingsalts and I never had this before. Over the last 2 months I have had angular chelitis that won't go away and I have developed intense but not painful pressure in my left upper abdomin about 1/2 inch to the right of my left rib cage. I frequently get swollen painfull lymph nodes in my right neck. I constantly have malaise. My new blood work has high mcv 101.4, high mch 34.1, tsh 0.2, free T4 0.8, sodium was 160 - retested 1 week later at 137, rbc 4.2, and wbc 4.8. I have spent all the money I have to try to find out what is going on as I don't have health insurance and I really need a second opinion if I should go to another doctor or live in misery with my symptoms and stay with my doctor. PS-I had an xray to confirm no broken ribs and my doctors next suggestion is to get a full scope. I'm scared I have cancer or something else - any opinion??
Hello JAcustomer,

I am so sorry to read of your distress, and I would like to try and help you. Please understand that online, no one can state with any certainty what anything is, all any of us can do is give our best guess based on information provided. And your detailed write up makes it easier to have an informed opinion, so I do appreciate your thoroughness.

There are a couple things here and maybe we can put them together to help form a complete picture.

Regarding your blood work: The Mean Corpuscular Volume, or MCV means on average, how BIG the red blood cells are. These numbers are important for people with anemia even though your numbers of red blood cells were normal at 4.2 (low normal). Knowing if the cells are BIG or small will can help tell why there would be lower numbers of them. Your MCV was big, at 101. The most common reasons for the MCV to be increased is a deficiency in Vitamin B and folic acid, whether you cant absorb it or because you aren't eating enough of it and thyroid problems Some parasites can also cause a large MCV. You have a vitamin deficiency and thyroid problems. This can help explain the MCV issue.

Mean Corpuscular Hemoglobin (MCH) means how much hemoglobin is riding on those red blood cells. Your cells were larger, thus more hemoglobin can fit on them. Thats why your MCH was a bit elevated at 34.1. This happens in macrocytic anemia (macrocytic meaning large red blood cells, anemia meaning low levels of RBC)

Mean Corpuscular Hemoglobin Concentration (MCHC) is the average concentration of hemoglobin in those cells. You did not give the value there, but people with large red blood cells will often have an increase in this number.

The white blood cells help fight diseases. Yours were a bit low according to my reference manual; 4.8 as opposed to 5.0. Whats more relevant than the total numbers (though thats important also) are the TYPES of white blood cell, as each does a different task. Most blood tests are differentiated, they will tell you the total numbers of each different type of white blood cell. Having said that, there are things that lower the total numbers. A big spleen (your abdominal pain MAY be that; the spleen is on the left). Antithyroid drugs will cause lower white blood cells, as will antibiotics and iron defiency anemia, and some autoimmune disorders.

Your thyroid studies are interesting. The hormones made by the thyroid gland play an important role in regulating the body's metabolism; if there is not enough metabolism slows, and symptoms are weight gain, sluggishnesss, constipation, dizziness also can happen. The TSH or thyroid stimulating hormone is a chemical produced by the pituitary gland that tells the thyroid gland in essence to get to work. Your free T4 was 0.8; on the low side of normal. I would expect therefore that your TSH would be a bit higher as your brain SHOULD be telling your thyroid gland to get busy and make more T4. There are a few reasons why this mechanism can be "off". One reason is that the pituitary may be "off"; a growth on the gland can interfere with the production of TSH so its not produced (or overproduced, depending on what the growth does).

Angular chelitis is often associated with nutritional deficits like Vitamin D defiencicy. It can also be caused by ill fitting dentures (for you at 34 years old I am thinking this reason does not apply) bacterial infections and - don't get alarmed here- HIV. If you had HIV that displayed angular chelitis you would have many other problems, I am betting.

Your first sodium level I think had to have been a mistake; sodium that high leads to heart failure and even slightly below creates kidney problems. I think the result of 137 is most likely what it really is. BUT....there is a syndrome that can cause a high sodium, a ,low potassium...and weight gain. It is called primary aldosteronism and it happens because the adrenal glands make far too much aldosterone, a hormone that regulates sodium and potassium. HOWEVER, people with this have high blood pressure.

I think but cant be sure of course, that the vitamin defiency can explain the chelitis, and the MCV. Thyroid dysfunctions as well can create a larger MCV and that makes sense because a low metabolism may create a need for bigger red blood cells that can transport more hemoglobin and its oxygen to the bodys organs.

Regarding the pain, I do think you should have that re-evaluated. Your spleen is on the left side (if you divide your abdomen into four quarters, it would be on the top left), and the spleen functions in cleansing old dead blood cells from the body's vessels. Hypersplenism...a big spleen...can cause a decrease of the numbers of white blood cells.

I DO think you should see another doctor...your issues are not so easily tied together as much as I am trying to make a unified theory of them. I think you need some more blood testing to rule out a possible autoimmune disease (too many to list). The swollen lymph nodes you have speak to some sort of infectious or auto-immune process. The easy bruising and the fatigue can mean some cancers, yes....but cancers of the blood cells and bone marrow which makes blood cells tend to create blood test results that are wildly off the charts as cancers are essentially cells gone wild. Your abnormals were not astoundingly drastic. (Of course, I cant say you DONT have a cancer of the blood cells/ bone marrow, but its not at the top of my list)

I understand you have no health insurance. There are low to no cost clinics that can help and treat you based on ability to pay. Here is a web page to help you locate them.

I hope I was able to clear things up for you and help you understand your health and welfare.

Customer: replied 4 years ago.

Thank you.

My blood pressure is normally on the lower range at 110/70.

What blood tests would you recommend for auto immune disorders?

I have researched hashimoto, cushings, +++

My MCHC was 33, Granulocyte 3, Lymph 1.3, Mono 0.3, EOS 0.1, Baso 0

While on armour thyroid 30 (1/2 grain) my TSH 0.2, Free T4 .8, Free T3 2.9, TPO 0.4, Rev T3 18

While taking oral supplements B12 818, folate >20

I am taking Vit D orally

I have been thinking it is spleen pain also but my dr did physical exam and didn't think it was enlarged spleen, yet many symptoms lead me to believe spleen.

Is there any other test to test my pituitary gland?

Are there any tests for parasites? I have been to Mexico about 2 years ago.



Hello JACustomer,

Thanks for that additional information. I will try to do the best I can with it; these values can be in more than one system of measurement. Xmm^3 = an absolute count of the WBC type, and the percent is the percent of the whole. So, I will say by the context what I THINK it is, if I am wrong you will let me know.

The white blood cell differential can help guide us a bit. Lets discuss what you gave me.

LYMPH stands for lymphocytes, which specialize in fighting viral infections. You gave me 1.3. Normals are either 25-40% of the total WBC count OR 1500-4000 cells /mm^3, which often is written as a 1.3 type number. So, I am guessing that your levels here were normal.

Granulocytes refer to a type of white blood cell; named because under a microscope they look like they have tiny grains. They are the eosinophils, neutrophils, and basophils. My book did not have a range for this.

NEUT stands for Neutrophils, and they specialize in fighting off bacterial infections. Yours were normal.
EO stands for eosinophils, and they specialize in allergic responses. My reference book lists normal range for this as 50-250/mm^3 OR 1-4% of the total WBC. I cant figure out what .1 would be based on this.
BASO stands for basophils which specialize in fighting parasitic infections. Your levels were zero. Normal is 15-100 /mm^3 OR 0.5-1.0% of the total. LOW basophils can be caused by hyperthyroidism, and we know your thyroid is a bit off, an infection, a body response to stress, OR a hereditary absence of them to begin with.
MONOCYTES (MONO) specialize in severe infections. My book lists normal as 100-500/mm^3 OR 3-7% of the total value.

Going back to the Red Blood Cells, the Mean Corpuscular Hemoglobin Concentration (MCHC) is the average concentration of hemoglobin in those cells. Your value was normal, on the lower end of normal (31-37). So, your red blood cells are big, but they are not carrying an abnormal amount of hemoglobin on them; however, I would have thought they would be carrying more hemoglobin as they were bigger.

Your B12 levels were normal (200-900), folate was high but that goes along with a B12 deficiency (and a vegetarian diet, and a intestinal problem called "blind loop syndrome; you'd have lots of intestinal problems if you had this one...unintended weight loss, fatty stools, nausea, loss of appetite, unintended weight loss).

Splenic enlargement is very hard to feel on a normal exam, I have been told the best way to see if a spleen is enlarged is to do a sonogram or ultrasound of that area. That is a suggestion you may wish to discuss with your doctor. Testing for autoimmune disorders is more blood work; the two most used tests are the RF (rheumatoid factor) and the ANA. Both measure different types of abnormal proteins; with the ANA, the pattern those proteins make when they are tested specially (phoresis) will help to determine what autoimmune disease there may be present. But some people have a high RF for no apparent reason. Other tests are tests that show inflammation, specifically the ESR or the sedimentation rate and the C Reactive Protein. Those two are not specific though; they show inflammation is there but they wont show the cause.

Tests for parasites would be stool samples; pituitary testing would involve testing the levels of hormones made by the pituitary. I would be interested in what your calcium levels are because of your very low Vitamin D and some of your symptoms that make me wonder about your parathyroid gland. Vitamin D "makes its living" by helping calcium be absorbed; if there is not enough Vitamin D, at times, calcium can build up in the blood stream. The question then becomes, is the high calcium, if there is a high calcium, only cause of the low Vitamin D, or because there is a problem with a gland in the body that also regulates the way calcium is used, called the parathyroid gland? People with a hyperparathyroid CAN have low vitamin D, often do have high calcium but it can be normal, and can display some symptoms of what you describe.Testing that is also a blood test, measuring the parathyroid hormone.

Regarding the thyroid, the T4 was decent; the free T3 low at 2.9 (my book says 4-7.4 pmol/ L). Abnormals on the T3 can relate to aberrant protein binding abilities of the hormone (says my book on the matter). I could not find the other thyroid values in my lab book which is supposed to be comprehensive.

I know Ive given you a lot of information....I hope I did not overwhelm you with it all. I suggest very much the clinics I gave you the link for; they supposedly do help regardless of ability to pay. And no one should suffer.

I hope I was able to help,

PS: more links for further reading.
Parathyroid information:
Vitamin B12 reference:
Lab Tests Online...a great reference; put in any disease, condition, learn what lab tests assess for it and about the tests themselves. Its also written for everyone, not just health care professionals.
Nurse Susan and 7 other Health Specialists are ready to help you
Hello JAcustomer,

Im writing to find out how you are feeling and if you had a change to get to any of the clinics yet. I would love an update to what any further testing found and what your doctor/ providers think on the matter.

Feel better,