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    What do my lab test results indicate?

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Posted on Mon, 30 May 2016 in General Health
Question: Dear Dr Iliri,
It's XXXX again- needing your advice because I'm having a very anxious day. Perhaps the lowering of the Prozac is causing some increased anxiety but it is the right thing to do, I truly believe.

Dr, do you think I don't need routine testing of BNP, and metabolic panels? My PCP and cardiologist said in light of my echo just a month ago, and my good test results, that I don't need such extensive bloodwork anymore. They say I only needed it when I was sick and it's not necessary anymore. I will get annual CBC and glucose check but nothing else for now. Would you agree with this? I am trying very hard not to go to the ER where they will check all of these values for me. Would you say that given my EF of 70 just a month ago, that my BNP would definitely be normal? I don't want to go back the pattern of being in the ER every week, but now it has been 6 months since I've had bloodwork and I was reassured by having those tests done very regularly.

I want to feel normal but I don't. I am still very haunted by my doctor saying (while I was sick, I know, not now) that I had to lie down in order to make sure I didn't retain fluid. I am haunted by not knowing I was sick, even with an EF of 25. Is it very crazy for me to think it's helping me to sit down after eating or drinking in order not to retain fluid? It hinder my schedule very much because I am sometimes afraid to move when I'm full of fluid, after having a meal and much water. I know it's ridiculous but I keep remembering the nurses and doctors at the hospital telling me to stay in bed and I keep doing this.

Is the reduced urine output an advanced symptom that is separate from actual edema? When I was sick, I was not on diuretics and weight was always stable, and my doctors didn't think I had any edema but after my ablation, my lower legs, which felt a bit tight, suddenly softened. I believe I did have some edema. I guess I am confused because I was told I was asymptomatic and yet I did have a cough (though chest x-ray was clear even at diagnosis) and my ProBNP was over 8000. I must have been in CHF yet I wasn't really told anything.

I'm sorry- the actual question is- if I were to get sick again, would something like lowered urine output be quite an advanced symptom? I don't think I experienced it while I was sick but I never paid attention before, as most normal people don't. I guess I am just wondering what symptom I would notice first if I were to get sick. I have heard it would be weight gain which is why I get so frightened by seeing even a 1 lb gain.

3 months off carvedilol now. Do you think at my last echo, any degradation in my status would have shown up if carvedilol withdrawal was going to be signficant?

Thank you so much Dr Iliri. My mother is so unwell and my life is very stressful and I'm trying desperately to pick myself up and not be so scared. I want to be the adventurous world traveler I used to be before I was sick. I was afraid of nothing before. I hate feeling like I am a damaged person, ready to break again at a moment's notice.

Hope you are having a wonderful weekend. Thank you so much for everything.
doctor
Answered by Dr. Ilir Sharka 11 hours later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello dear XXXX!

I am glad to hear from you again!

First of all I would like to assure that you are in a wonderful cardiovascular condition.

Your clinical status, cardiac ultrasound and lab tests confirm that.

So, there is no reason, why those unpleasant thoughts should incessantly perturb your mind.

When discussing about medical tests frequency. I totally agree with your cardiologist and PCP.

With a LVEF of 70% there is no place for thinking of an imminent heart failure relapse. As a consequence, no need for natriuretic peptides (NT proBNP levels) evaluation.

When reviewing your previous medical history, it is true that heart failure has been a reality and no one could deny the fact that all those recommended in-hospital measures (strict water balance; prolonged bed rest, body weight control, etc.) has been of valuable help in improving more quickly your clinical status.

But, actually, as your cardiomyopathy and underlying heart failure are just a remote bad memory, there is no rational reason to think about stopping every activity, having forced rest, and following a restricted water regimen.

You should believe me that all these measured are quite useless and produce an artificial distress in your daily activities.

I advise you to be more friendly with all your body needs, so take water as much as wish; and never interrupt your daily activity form any unjustifiable fear of fluid retention.

You should know that making your body muscles in action, relieves the blood circulation through veins and arteries, diminishing that way any predisposition for fluid retention.

That’s why you shouldn’t stop moving; as in your prefect clinical status; keeping frequent physical daily activity would further improve your psychological conditions and help in avoiding excessive anxiety.

The same thing holds true regarding urine output issue. Actually we can’t rely on urine output in judging correctly about your body fluid balance.

As I have explained you before, checking urine output and fluids intake is an acceptable strategy when the patient is in hospital settings and we are quite sure of every water losses or intake.

But, as we are in the real daily life with variable daily activity, diet, work load, and physical engagements we can’t be sure of the water traffic for making a clear water balance review.

But, instead, we have stronger very reliable markers for confirming a perfectly normal blood circulation and water traffic: cardiac performance and renal function tests.

By the above judgment, I could assure you that your fears are quite irrational and absolutely not based on your actual clinical status.

You should relax yourself!

There is no risk for heart failure relapse in the horizon.

And Carvedilol has been quite correctly withdrawn. There is no need for that drug any more.

Regarding Prozac, I would say that many individuals use that drug in a safe manner for many many years with beneficial results.

I would prefer to see you without any medications around (including Prozac).

But, if the decreased dose is associated with elevated anxiety and OCD fears, then, probably you should discuss with your therapist about reviewing once more Prozac dosing scheme.

Remember, there is not a tragedy to let yourself get helped by effective drugs.

I hope your mother will follow a better clinical course, and you will soon feel OK!

I would like to of some support whenever you need. Please let me know about your uncertainties.

Do not hesitate to ask me again!

Wishing you a pleasant weekend!

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 35 hours later
Thank you so much Dr Iliri. You are helping me so much, much more than my therapists have been able to.

It was you who pointed out that while my doctors were saying I was well-compensated and asymptomatic, I really wasn't. My PVCs came on very suddenly, but were relentless and within a few months, I was tired, had a cough, some shortness of breath, and could not make it up two flights of stairs without struggling. I also was constantly sweaty, and had trouble lying flat. I know now those are classic heart failure symptoms but I was under so much stress, I believed it was simply the strain on my body.

My EP believes my PVCs weakened my heart in those few months but my cardiologist thinks I had some level of PVCs before I noticed which more slowly weakened my heart. I have always noticed when I have PVCs. Sorry for such babbling- my question is this- in absence of something like my 65,000 PVCs a day, is heart function something that is quite stable? Just a month after my last echo, is it quite crazy for me to worry so much? Because I went from being healthy to what seemed like sudden severe heart failure, my fear is that even one day can bring about great detrimental changes. I also worry because when I went to the doctor before my diagnosis, just two weeks before, he totally missed that I was so severely ill. He said I had allergies and not to worry. It makes it seem like heart failure is quite hidden and can only be monitored with very frequent echocardiograms. I feel unsafe because no one, including me, ever suspected I was so seriously ill. Makes me think it can happen so easily again.

Thank you, Dr Iliri, all your advice helps me process all of this. I hope to be living my life normally again soon.

Hope you are well. Thank you always.
XXXX
doctor
Answered by Dr. Ilir Sharka 5 hours later
Brief Answer:
My opinion as follows:

Detailed Answer:
Dear XXX,

It is true that in previously healthy individuals of young age, not rarely, severely compromised cardiac dysfunction may be presented with minimal or no obvious symptomatology.

A similar clinical pattern has occurred in your case.

Nevertheless, even in “hidden” heart failure scenario, there are some clinical clues, which when carefully considered may bring the physician to the exact diagnosis.

Though you denied symptoms during those horrible weeks of excessive arrhythmia, you have experienced tiredness, cough and some shortness of breath.

And that brought you to the correct diagnosis and a successful treatment.

But, form the other side, your clinical status is actually excellent; your cardiac function is quite normal (LVEF 70%); you are free of arrhythmia; and what is more important you are young, full of energy and vitality.

It is quite impossible for your heart to return to those dark times of arrhythmia induced cardiomyopathy, as actually your cardiovascular system is keeping in harmony with the normal body physiology.

You are right that an important issue in monitoring your cardiovascular system besides physical examination and heart rhythm check up is cardiac ultrasound follow up.

Cardiac ultrasound should be done on a yearly basis; if performed more frequently it must be guided by any changes in clinical symptomatology.

Meanwhile, try to discuss with your prescribing physician about Prozac daily dose regimen and also remember what I have advised you before (more physical activity, possibly outdoors, and recreational time commitments).

Let me know if you need to clarify any further uncertainties.

Wishing you the best,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 2 days later
Dear Dr Iliri,
Thank you so much.

I feel like over the last few weeks something has changed. I was so concerned about my heartrate sometimes getting so high but now I worry that the resting rate is too low- sometimes under 50. It does go up with exercise but seems just slower lately. Carvedilol was stopped just over 3 months ago and last echo one month ago. Could my heart be gettinfg weak? I have slightly increased my cardio exercise but it is still just 30 minutes of slow/moderate biking every day, about 6-7 miles.

Could I weaken my heart by undereating? I eat only about 1000-1200 calories a day but my weight is stable, no loss in months.

Remember that I have been so worried about fluid and urination and bladder sensation? For many months I have been drinking large amounts (25-30 ounces quite quickly, a few times a day) in order to stimulate my bladder which seemed underactive. Now I am drinking same amount but urinate more often- same amount overall but urinating 350 ml, 300ml, instead of 700ml at one time. And my bladder feels sensitive and I get sudden urges to urinate as I used to before I became sick and so anxious about urination. My bladder has felt almost no sensation for months unless I pressed hard. I don't have pain or fever or any other symptoms.

My cardio says I'm anxious and says with such recent echo I dont need any tests and I'm fine.

My PCP says I'm just anxious and dont need tests. I am so anxious that feel I will need to go to ER tomorrow so I can be evaluated.

Do these symptoms seem like they could be something beyond anxiety? I believe I will go to ER tomorrow.

Thank you so much,
XXXX
doctor
Answered by Dr. Ilir Sharka 12 hours later
Brief Answer:
My answer as follows:

Detailed Answer:
Dear XXXXXXX

There is really no need to go to the ER, as all the symptoms that you refer do not seem to be concerning.

Anxiety seems to play an important role in your clinical situation.

Nevertheless, I know that going to the ER and having a routine check up will reassure you that everything is OK.

So, if you wish to go to the ER, you can go there. There is nothing wrong in doing this.

I am sure that everything will be OK.

Nevertheless, let me know about your clinical situation and your next tests.

Best wishes,

Dr. Iliri


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 7 hours later
Dr Iliri,
I am in ER now, very scared. They have found trace amount of protein in my urine. ekg, bp, oxygen all perfrct and no uti but I'm so scared my kidneys are failing. They did no bloodwork. Is trace protein normal? I dont believe Ive ever had that before.

Should I go get bloodwork to assure my kidneys are ok?

Thank you,
XXXX
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
My opinion:

Detailed Answer:
Dear XXXX,

I understand that you are actually scared, but I advise you to relax for a while because trace amounts of protein in urine are not always indicative of uti (urinary tract infection) or any other health disorder.

It may also be found in periods of emotional stress, strenuous exercise, after cold or heat exposure, etc.

So, as you have not any clinical symptomatology suggestive of uti (frequent urinations, burning or other discomfort during urination, or even urine color change, etc) then the probability of an uti is quite low.

Nevertheless, a complete urine test and eventually microbiological exam (urine culture) could clarify this issue.

Only id proteinuria would be important (not just trace urine protein) additional blood work would be justified to investigate any possible kidney dysfunction.

With only trace protein, I think you shouldn’t worry about.

Remember, you have actually a perfect cardiovascular function and this is very important.

A trace amount in urine does not have any clinical significance in the absence of clinical symptomatology and other tests abnormalities. More likely one of the above reasons I mentioned at the beginning of my answer.

So, just try to relax!

Getting to often to ER doesn’t serve in improving your psychological status.

You will find always something slightly altered if numerous lab tests are frequently done. But, this doesn’t mean you are in danger of have any serious health disorder.

Wishing you will get better after my explanations.

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 38 minutes later
Dear Dr. Iliri,
Thank you, I am trying to relax. They did not give me any printed report but told me it was "tiny tiny trace" of protein. In routine urinalysis would they have tested for creatinine or anything other than protein, glucose, or white blood cells? I did not have any sign of infection but the doctor did send sample for urine culture. The culture will only tell me if there is infection, though, is that right? Will not identify why else there could be trace protein?

I have had some urinary urgency which is why I went to ER. But no reason for it if not UTI.

You are right, I should not have gone to ER. But now the damage is done and I will probably consult with nephrologist soon. Interestingly the ER doctor said everything was perfect and only the tech mentioned the trace of protein. I wish she hadn't!

Given the protein and the urinary urgency, shouldn't I have a more thorough workup?

6 months ago was last metabolic panel and everything was perfect. Could I have had significant changes since then?

Thank you so much,
XXXXX



One more thing to add, dear Dr. Iliri-
It is roughly the time I ovulate and I have noticed some vaginal discharge today. Could this be the source of trace protein in urine? I read that with such a small amount, it could simply be a contamination issue as well. I Don't have the exact numbers but was told it was a "tiny tiny trace." You are right, the ER is not a place for someone with anxiety. It is just that with my history, it is still hard for me to believe that I am not always in serious danger.

Thank you so much.

Wishing you a wonderful weekend,

XXXXX
doctor
Answered by Dr. Ilir Sharka 15 hours later
Brief Answer:
Just try to relax!

Detailed Answer:
Dear XXXX,

You are right! Trace urine protein could be due to contamination from vaginal discharge. Also, other causes could be the reason (I mentioned you earlier in our thread).

Coming to this point, I think that the best thing to do is waiting the results of urine culture.

Of course, evidence of urinary infection could be supported besides the presence of protein, by other finding such as presence of white and red blood cells, micro-organisms, sediment particles, epithelial cells, etc.

But, as the complete urine test report isn’t available to you, we can’t make such a judgment.

Even if UTI could be confirmed, there is nothing to worry about. It is quite easy to successfully treat it by an appropriate antimicrobial therapy (it could be decided by the results of antibiogram).

So, nothing to worry about, dear XXXX!

Don’t be scared!

Just relax and enjoy your weekend!

In case you need some clarifications, you can just ask. But, going repeatedly to ER could not solve your situation. It would further increase your anxiety.

Instead, I recommend to practice meditation and more recreational activities.

Please, let me know about lab results when available!

Wishing you a nice weekend!

Regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 1 hour later
Dear Dr Iliri,
Many thanks to you again. They did not find anything other than the trace protein. No bacteria, blood, white blood cells, etc. Now the culture will
show only if there was bacteria, I think? It will not show any other reason for protein?

While I have never had UTI, I would not be so scared if I had one as I know they are easily treated. In fact, it would ease my mind as it would explain the protein. I am most frightened that the protein is a sign of kidney damage or even a return of heart problems. When I looked up causes of protein in urine, I found it was usually kidney damage or heart failure. That scares me. I will see my PCP to see if she can find why I had the protein.

As there was nothing found, I was not given antibiotics or medication. But I am scared. I have never had protein, even when pregnant. I hope it was discharge or something else benign but I cant help but worry that it is the start of something bad. My mind has been so altered by my experience of believing I had bronchtitis only to find it was severe heart failure! I feel like nothing is not serious and deadly. I know I will face minor illnesses like every other person but the vast majority of people have not been told they had mere weeks/months to live. I wish I could forget it.
Thank you so much dear Dr Iliri. Have a wonderful weekend.
XXXX
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Follow up: Dr. Ilir Sharka 13 minutes later
Adding also-7 months ago urinalysis and metabolic panel were perfect, creatinine was .7 while I stopped carvedilol 3 1/2 months ago, I have maintained low blood pressure and no blood sugar issues. Could something else cause kidney damage? I'm so frightened.

Thank you.
doctor
Answered by Dr. Ilir Sharka 28 minutes later
Brief Answer:
You should focus more in managing anxiety instead of heart or kidney issues

Detailed Answer:
Dear XXXX,

There is no reason to think of heart failure or any kidney damage, as tiny trace protein in urine is not a diagnostic criteria for them, while every other test is normal.

So, your increased fears are not justified by any medical evidence.

Heart failure could not happen while you have a perfect cardiovascular functioning and no underlying clinical symptomatology.

Also, all your already performed kidney function tests have resulted normal.

I think you should focus yourself in properly addressing your anxiety, instead of concerning about hypothetical heart and kidney issues.

This is my advice.

Regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 26 hours later
Thank you Dr Iliri,
I have come to believe, hopefully, that it was merely some vaginal discharge, but even when pregnant, I dont believe I had protein in urine, when it would have been more likely for various reasons (more discharge). But perhaps a trace is normal enough that it was never mentioned to me?

I am going to switch psychiatrists as I am getting no relief from anxiety right now.

Do you believe, 100%, that 6 weeks after echo showed EF 70, that it is still normal, still 70? And that my kidneys are ok as I have no risk factors and last tested perfectly 7 months ago? I do feel strong pull to get more tests because of this ambiguous finding of protein. I do think I should see urogynecologist as quite suddenly my bladder has become quite sensitive after feeling almost deadened and underactive for nearly a year. It is only after drinking a lot, though, so hopefully it's just a return to normality.

At times I've come close to feeling back to normal. I am having a bit of a setback now. I hope to be back on track very soon. I hope the nightmare is truly over and my fears are irrational. Its hard, though, when at one time, my worst fear was true and I almost died. It seems like that can happen again and again at any time.

Thanks so much, Dr Iliri. I know I'm having a hard time now but you have helped me so very much.

Many thanks,
XXXX
doctor
Answered by Dr. Ilir Sharka 15 hours later
Brief Answer:
My answer as follows:

Detailed Answer:
Dear XXXXXXX

I am glad to have been helpful to you in this difficult time for you.

I can reassure you 100% that your cardiac function is normal and you have nothing to worry about your heart.

From the other hand the traces of protein in your urine are not really concerning. They may be related to vaginal discharge or increased physical activity,etc., but they do not indicate any possible serious situation.

I strongly recommend you to focus on your anxiety and discuss with the new psychiatrist the best treatment options (increasing the doses of your actual antidepressants or switch to new antidepressants).

Yoga and recreational sports can be really helpful!

Hope your fears will go away and you will be able to think with optimism about the future.

Best wishes,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 3 days later
Dear Dr Iliri,
As always, thank you so much for your advice. The hospital urine culture was negartive and I also went to see my PCP and she did another urinalysis and culture. This time, no protein in urine or anything else and again a negative culture. She says with kidney problems the protein would be persistent and just to forget about it. I am trying my best.

My doctor thinks I should not worry about my new bladder issue of sudden urgency. She thinks it's anxiety with maybe a bit of normal age related hormonal changes.

I did, however, contact a urogynecologist to get to the bottom of this issue and a nurse has, you guessed it, frightened me. We spoke over the phone about an appointment and she asked if I had ever had a heart condition. I explained my history and she suggested I get an immediate echo as overactive bladder can be a symptom of heart failure. My last echo was about 6 weeks ago. Do you know of this correlation between OAB and heart failure and is it possible that I am having a relapse of my cardiomyopathy? My holter was good and EKG 5 days ago was normal, bp normal, and pulse ox 100%.

doctor
Answered by Dr. Ilir Sharka 27 minutes later
Brief Answer:
My answer as follows:

Detailed Answer:
Dear XXXXXXX

I am glad that your repeated tests have resulted normal, and you have excluded any kidney disorders.

Anyway, I would reassure your that your urinary urgency is not related to any cardiac disorders.

Your cardiac tests and your vital signs (blood pressure, pulse ox) are great and you have nothing to worry about.

You should not listen to a nurse, which knows nothing about your past medical history, your actual medical condition and your performed tests. She has just spoken in general, and this is not very professional (I would not like to make comments on this).

I agree with your doctor that anxiety seems to play an important role in your urinary urgency. Hormonal changes may contribute too.

I repeat that you have nothing to worry about.

Hope to have clarified some of your uncertainties.

Regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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