could anyone look at these BLOODS for me please?

[52andblue]

Background:

Female age 54. Physically disabled (double crutches) plus undiagnosed apnea / low iron / vit D for some years. poor sleep nutrition and limited mobility meant I ended up with a BMI of 44. My GP wrote everything off to 'too fat' & recommended gastric surgery. So I had a roux en y Op in 2019. BMI now 26 so good in gen health terms. BUT... still have apnea, still have vit deficiencies (worse as RenY surgery interferes with gut absorption, NHS prescribes lifelong vits & calcium but I'm not able to absorb properly). Due to a cock up (sent out of area for surgery) I wasn't given the loading doses after surgery and ended up with an iron level of 20 for 3 years even on ferrous fumerate x 3 daily. During this time i was regularly falling over, brain fog very bad. Eventually lost my job with awful consequences.
Last autumn I felt so ill I asked the GP to test again and iron was >7 and I was given IV iron x2 and it went up to 333 within 10 days. I felt quite a bit better. But I'm feeling worse again so asked for an 'interim' blood test (they are annual). It's dropped to 159 since Sept.

I live rurally. This is my only choice of GP (& head of practice). they always refuse to give results (I had to mention GDPR to get these). GP has just cancelled F2F appt (they suggested I book at time of bloods) and says that it's 'probably the menopause'. I was menstruating but had symptoms and GP put me on Everol Sequui 50 5 months ago but not much improvment. When I said I dint' think it was that she said: 'well you can have anti depressants then, and maybe you could do with CBT for health anxiety'.
I had depression in my 20's. I know how it feels for me. It's not that.
(My previous job wa offering CBT to patients with anxiety and depression working for a charity trained & contracted out by NHS)

Sorry for long background but posted as poss relevant & didn't want to drip feed.

Here are the results:

Vit D not tested.
Vit B12 545 (I have injections every 8 weeks)
Serum Folate 7.8
Ferritin 159

sodium 137, potassium 4.1 Creat 59 eFGR >60

HB 138, WBC 4.3, PLT 186, MCV 88.3, RBC 4.67, Hct 0.413, MCH 29.4, MCHC 333, Neut 2.63, Lymp 1.18, Mono 0.27 Eos 0.18, Baso 0.01

I have little clue what most of the last ones even are.

I am not sure where to go from here.
I think I have 3 issues:

Vit / Min absorb from food / supplments is compromised by Op
Menopause
Very poor sleep

I asked the GP if we could try to tackle all 3 at once as I am now a single parent and sole Carer for 2 teens with Autism. I also get tired due to the nerve damage in my legs making mobility hard.

I've bounced between 'too fat / too menopausal / too anxious' for too long. I'd like some help but I'm not sure what to ask for or , crucially if anything CAN be done in these particular circs?

Hi op I don’t have any knowledge but I wanted to say treating the menopause (peri) resolved my poor sleep. So maybe HRT if you can use it and get the right combination and dose will help with two and three on your list.

thanks @ENoeuf I think the sleep is a mix of meno & Apnea tbh but anything that helps is welcome x

Neut (neutrophils), lymph (lymphocytes), mono (monocytes) & baso (basophils) are your different types of white blood cells (WBC). They all look to be normal (low end of normal but perfectly fine) depending on your local reference ranges.
Which other ones do you need translating? (Can't help with a diagnosis I'm afraid but can translate!)

Oh, thanks @Cookerhood
translation for any and all would be really helpful, thank you x

Tbh, your white blood cell count is getting a wee bit low, suggesting that your immune system is a bit sub-par. (Not at all unusual for those with malabsorption problems.) Your haematocrit is also a bit low for someone who had an iron infusion less than a year ago. You’re not anaemic, but the volume of red blood cells in your blood stream is actually on the low side. (Could you have been dehydrated? That can affect the test.) I would request that she considers that you have had an iron infusion and your haematocrit is sub-clinically low and you feel like shit.

Thanks @Justilou1 - very helpful x
I can see that my iron is ok atm but I am a bit worried that if it's halved in a few months it will keep dropping and I'll end up really ill like before. I am keen to avoid that before it happens iyswim? I had to fight for help before so I don't suppose GP will be keen to offer anything at this stage but I'm fed up with 'it's your age' which has taken over from 'you're fat'

Hi OP. Poor you, sounds grim.

I'm not a medical professional but my limited understanding of my (different brand) HRT is that 50 is the starter dose. I've now gone for next dose up as it's no longer enough (various reasons). Can you try that as well as any other changes?

Are you in a position to go private?
I'd get your vitamin D tested and go from there
www.vitamindtest.org.uk
Is your thyroid ok, and again you will be better finding a private doctor to test and treat that.

I find I need high levels of vitamin D all year round even though I spend a lot of time outside. I got mine tested in a long heatwave when I was outside almost all the time in shorts and strappy top and I just scraped in at normal level, I should have been off the scale...

Are you in a position to pay for a private GP consultation?

MIL had similar issues with her GP. Went to see a private one, he did some tests, she got some answers. He wrote a very disparaging letter to her GP basically telling them what was wrong with her and to refer her as necessary asap.

She had proper treatment from her regular GP from then on.

@52andblue, can I ask a couple more questions? I don’t claim to know everything. I’m a phlebotomist (in Australia) and I am studying nursing. I understand that our medical systems are very different, but I’m about the same age as you and also have had issues with iron, malabsorption and feeling heard, etc. You said that you have sleep apnoea. Could you also have GERD or some other bowel or intestinal disorder that could be causing a slow bleed? Family history of bowel cancer, maybe too much alcohol (don’t we all?)/Coeliac/Crohn’s or Irritable Bowel Disease? There are more, but these are the ones I can think of off the top of my head. (It’s very late here.) Have you noticed any digestive changes? Have you been screened for bowel cancer? (It’s routine from 50 here because it’s so common… I’m not trying to imply anything.) Maybe you should ask for a referral to a gastroenterologist.

I have had a GP dismiss everything I said because I was fat, @52andblue. When I told her she was reading my thyroid results the wrong way around, she asked me which one of us had been to medical school and gave me a lecture about sitting on the couch all day “watching the and eating bonbons.” (Hardly likely given that I didn’t have a tv and I’m allergic to virtually everything.) She pissed me off so much that I asked her to print out my last five results and I walked straight into the other GP’s rooms, told him what she had just said to me and asked him to interpret them and tell me that I was wrong. I was in hospital that afternoon. I refused to see her again.
Meanwhile, we all know that the weight can actually be a contributing factor to the GERD (if you have that), and of course, Apnoea and every fucking thing. Nobody knows the ins and outs of every diet better than any overweight person, or how their weight affects them physically and mentally. I’m certainly not going to lecture you.

Just to explain the results I thought were a bit off,
Haematocrit (HCT) Refers to the volume of red blood cells in your blood. It’s a LITTLE on the low side. Not clinically worrying.
Menopause and sleep are also likely to be messing you around. (Is HRT an option for you?) I highly recommend it if you can have it.

Have you been investigated by a sleep clinic?

Have you ever had your thyroid tested?

Hi thank you to:
@CrotchetyQuaver @Sloughsabigplace @Cookerhood @Thecurtainsofdestiny @Justilou1 @Thamesis @Thatsajokeright
for replying.

Re any Qu's:
I don't have any history of gut problems. I had a lot of vomiting after the surgery so I had an endoscopy and it has all healed properly.
I had a CPap for Apnea. I had it taken away after surgery as I was told I wouldnt need it any more'. I just did a home sleep study which suggests I do and am now on the waiting list (1yr+!) for a hospital sleep study again (so, back to where I was 5 years ago...)
I'm not aware my Thyroid has been tested no?
They will only test my vit D annual. It was very very low so I was prescribed supplements but, as with all the other suppliments, I am not absorbing it well.
Before my surgery I was fat but healthy. Now I am a shadow of that.
My BMI is better but nothing else is. I regret it hugely.

Sleep apnea can be linked to an underactive Thyroid. As can many of the other symptoms you've mentioned.

Ideally you need TSH, free T4, and free T3 testing. If your GP won't do it you can get it done via a fingerprick test from thriva or monitor my health.

@Thatsajokeright - thanks, I think I'll ask the GP if she will check these.

I just checked the dates for my IV Iron - it was just 4m ago and it's halved since then (gone from 330 to 159) so I will bring that up too as it's dropping quite quick considering I'm on ferrous fumerate daily too.

@52andblue You need to take those dates and point out your health conditions. Be assertive and say something like, “Yes, I know I’m overweight, but that doesn’t explain why my iron is clearly dropping so fast, does it?”

Hi @Justilou1
GP says 'iron is plenty sufficient'. I pointed out it had halved in 4m and she muttered about 'unnecessary blood tests' but I stood my ground and she said she will test again in 3m, so if it's dropped down to sub 12 by then we can arrange another IV .this doesnt seem 'preventative' to me but that is all she will do. Pah.
That's also when my annual vit D is due (this they will only do once a year on the day after the anniversary of my Op even tho it's been really deficient in the past so prob still is, grr)
She said that white blood and haematocrit 'bang on' & that 'a little Googling is a dangerous thing'. I smiled & said that being informed was never a bad position to be in, ime. Like a tennis match..

She DID agree to increase my HRT dose but said there isn't a higher dose of my current brand so would I like tablets? I said No, if i'm not absorbing current supplements due to malabsorption due to surgery then that would prob not be very efficient. She offered me a coil which Im not keen on. So she said, go away and I'll research it & call you.

I did decide to sqeeze the max out of my F2F and asked about my Dd. She had Covid Easter 2019. Last time we saw the GP F2F she said: 'well you can't prove it, and asked many questions about recent change of school which she felt 'was the real issue'. My Dd was upset as she has Autism & becomes non verbal in stressful situations.
So, I gave GP chapter and verse about ASD, and Dd, & in the end she said that she felt it prob was long covid and she would write a supportive letter to school re exam support if needed. But again it was a bit of a battle, but worth it I think.

I might start a sep post re the HRT and see if there are suggestions there of what I should push for.

Oof, that was an essay, sorry.
thanks for all your helpful and supportive comments x

OP, I've had an iron transfusion privately because my ferritin would never drop below 14 so GP wasn't interested.

My iron has also dropped radically as yours has, the consultant said it's quite normal for that to happen and the body will distribute the iron as needed.

Optimal iron is around 100 if the range is 13 - 150.

That doesn't mean there isn't a further problem but it isn't necessarily a problem. :)

Testing again in 3 months will give you a better indication of a problem.

The NHS is only obligated to treat deficiency; it's not obligated to maintain healthy levels. It's absurd.

What is your vit D like? If you're deficient do you know the GP is obligated to prescribe loading doses of vit D to bring your levels up?

@Thatsajokeright - interesting, thank you x
Yes, agree with all you have said, my experience too as Iron allowed to sit at 12 (ish) for 3 years before dropped to 7 at which point I got IV.
vit D has been similarly low and I was prescribed vit D supplements (not a loading dose though, & I never got the loading doses post surgery that I should have).
But again, I cant really absorb them, so it goes up a bit but then falls back down again and NHS wont' test more than annually for this.

My 'dream' is that they would reverse the surgery, or at least convert it to a 'sleeve' procedure. But that is expensive. I could (possibly) get it done privately if I had about 8K to spare (hollow laugh, on £67/wk Carers allowance) Sorry, protracted whinge alert...

Have you tried supplements in oral spray form? I use BetterYou. They are not cheap though. They do iron and vitamin D. Good luck, your GP sounds awful.

@52andblue I can't maintain vitamin levels without supplements. I also had to have loading doses of vit D but I also have to take 2,000iu a day to maintain good levels. So just taking loading doses might not be enough.

Absorption issues add a layer of complexity though.

If you were due loading doses after surgery I'd make a fuss until you got them. :)

@ENoeuf

Hi op I don’t have any knowledge but I wanted to say treating the menopause (peri) resolved my poor sleep. So maybe HRT if you can use it and get the right combination and dose will help with two and three on your list.

@ENoeuf superb username