Hello, XXXXXXX,
Thank you for sending all the detailed reports. I was able to review
all the results and all of them look very good. Looks like your HbA1C
and blood sugars are O.K. now. Your Hepatitis screening was negative.
The tests for auto-immune hepatitis was also negative.
The liver enzymes are normal. The doctor thought that your liver
may be slightly enlarged and I don't think it is significant. It may be
displaced downward a little and when you take a XXXXXXX breath it will
be felt by the doctor.
As for your specific question about Bilirubin, I can tell you this.
Total Bilirubin consists of Direct and Indirect Bilirubin.
Direct or conjugated Bilrubin is from the liver and is increased if
there is liver damage. Indirect Bilirubin or unconjugated Bilirubin
is from destruction of Red blood cells (Hemolysis) and is associated
with certain blood disorders and some genetic conditions.
If the Indirect Bilirubin is very high, then you have to look for
blood diseases. Your Indirect Bilirubin count is very slightly elevated.
This is called fasting hyperbilirubinemia and is totally benign.
There is a genetic condition called "Gilbert's Syndrome " and this
is associated with increse in Indirect Bilirubin and is more prominent
during stress, infections etc. The only way to diagnose this is by
doing a liver biopsy. But this is not necessary since Gilbert's is
not a serious liver condition and does not lead to liver damage.
Very rarely, this may be associated with gallstones. Only then,
you may need tratment. Currently, you don't need any treatment.
All your other tests are perfectly normal.
As for acid problem, you can take a PPI drug such as Omeprazole,
Pantaprozole or Esomeprazole once a day about an hour before meals.
Avoid excess caffeine, citrus juices,tomato productsand real spicy
foods.
I know you don't smoke or drink, which is great.
I wish you well.

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Hello, XXXXXXX,
I appreciate your comments.
I wish you well.

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Hello,
XXXXXXX,
Advanced liver disease can cause bleeding due to the effect
on coagulation factors. It can increase Prothrombin time ,and
decrease the platelets and make the blood thin leading to
bleeding. I mean, major bleeding from the esophagus and
other places. You do not have that.
In your case, you probably have gum disease and also brisk
brushing can cause bleeding. Regular use of mouth wash
and using sensitive tooth paste will help.
Acid reflux can effect the enamel of the teeth.Acid control
is important.
I wish you well.

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You are very welcome XXXXXXX
and have a great day.

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