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What do these lab reports indicate?

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Answered by

Internal Medicine Specialist
Practicing since : 2002
Answered : 3826 Questions
Question
1 January 2018

Dear Dr. Ditah,

Attached please find my blood test results of 3 or 4 days ago. Perhaps there is something interesting or out-of-the-ordinary here? (I will send a separate message with these test results as apparently this window doesn't permit me to attach any documents.)

On my Urology phone visit scheduled for 2 January 2018, the Urologist’s wife gave birth to twins and he’s taken some time off from Kaiser Permanente to attend to her, her new babies, etc. I’ll be re-scheduling my appointment with him in the next several days.

I had my MRI with Contrast done the other day and I have a phone consult scheduled for 11 January to discuss the findings.

While I was at Kaiser getting the MRI done I went to the Urology department hoping I could find out my most recent PSA test results but, as mentioned above, the doctor was unavailable. I learned that Kaiser has a Registered Nurse with the job title “Prostate Case Manager” and I saw her. I will attach the report she gave me, which may need a bit of clarifying, so let me add these remarks, while you look at the report she gave me:

1.      My most recent PSA test result on 8 December 2017 was a score of 7.0. Past readings were 6.2 on 24 April 2017, 6.1 on 23 March 2017, 7.2 on 2 March 2017 and 2.7 on 23 December 2013.
2.     I was also told that my PSA % FREE is 18%, which puts me at a 37% risk of a positive prostate biopsy outcome, meaning a positive reading for cancer. So 37 chances in 100 chances that I have prostate cancer.
3.     Something I had forgotten, which the nurse reminded me of, is that a PSA reading can become elevated if the patient had sex within 3 days prior to the test, and this was the case, in that I had sex within that time period prior to the 7.0 PSA test result on 8 December 2017.
4.     To Kaiser Permanente, the scale you use Dr. Ditah of 0.0 to 4.0 isn’t something they consider appropriate to my age, which is another way of saying that according to Kaiser Permanente PSA test results can vary with age, and as you can see on the attachment nurse report Kaiser is looking for a “normal” range reading of <=6.5 ng/mL for my age.
5.     Once I explained to the nurse that I had had sex within 3 days prior to the 8 Dec 2017 test, she recommended I be retested and set this test up for me. I’ll go in on Wednesday and get re-tested.
6.     I also now think the 7.2 reading on 2 March 2017 >>MAY<< have been elevated by my having had sex within this 3 day window, when I should have been abstaining from sex. (I simply hadn’t been told to abstain, then, either!)
7.     We shall see. I’ll keep you posted.

If you have thoughts, comments or suggestions as to how to proceed, additional steps you think I should take, etc. please let me know of them. I hope you had/are having an enjoyable vacation.

Regards,

XXXX
Tue, 12 Jun 2018 in General Health
 
 
Answered by Dr. Ivo Ditah 9 hours later
Brief Answer:
Thanks XXXX!

Detailed Answer:
Hi XXXXXXX

Hope you have been having a great holiday as well. I am good.

1. I do agree with them that at your age, a higher cut-off for PSA is okay. Like I mentioned before PSA alone is not a hard measure because it does not always tell whether it is caused by cancer or not as many other things could cause similar elevations. For that reason, monitoring and acting more on the trends is what I strongly recommend. I will suggest you stay level headed as we probe to see where exactly we stand on this. Above all, no aggressive measure at this time.

2. PSA evaluation is never an emergency. Take your time and get the doctor when he's back from his leave.

In all, stay level headed. Monitoring the PSA will be the best tool. Do not rush or make any emergency visits about this as evaluating and managing is not an emergency.

NB: I couldn't fine any attached reports. Kindly upload them or mail to our customer service for upload.

I hope this guides, XXXXXXX I wish you well and as always, am very available for more exchanges with you.
Above answer was peer-reviewed by
 
Follow-up: What do these lab reports indicate? 10 hours later
Dear Dr. Ditah,

I tried for hours yesterday to upload the 3 files of test results to you, but without success. I tried again this morning, again without success. I have now reported the problem to your "report a problem" department. I have successfully uploaded files to you in the past, so the problem is not with me or the way I go about attempting to upload files.

In your above remarks did you mean for me to mail the test results in the actual US Postal Service M-A-I-L SYSTEM? or is there not an e-mail address I can send them to?? (if I'm currently unable to attach them via the internal HEALTH MAGIC system, then e-mailing them to you would surely be the faster option). I have 3 PDF files of test results I'd like you to see .......

Please advise how best to get them to you quickly.

Regards,

XXXX

10AM Pacific time - 2 XXXXXXX 2018

Dr. Ditah,

The Customer Care people got back to me quickly on the "upload problem" and I have now sent the 3 PDF files of test results to their suggested

YYYY@YYYY

e-mail address, for forwarding on to you.

One additional test result just came in from Kaiser Permanente - in addition to the 3 PDF files I just sent you - and that is for C-Reactive Protein and that test result is 0.4 mg/L, where the standard range is <=7.4 mg/L. Whether my test result is significantly low or not, I leave up to you to consider.

So, here we are, if you have comments, suggestions, etc. on my test results, I'd appreciate hearing them.

I will remain level headed about our work and our progress. I most certain am not/will not be advocating a surgical/biopsy approach, as I believe (as you seem to believe) that there are many reasons for a PSA to be/become elevated.

As for my age of 71, and your comment about my being young, I believe I can and will easily live to 110 or more, as with modern medical advances, growing and replacing hearts, lungs, and other vital organs is very much present day medicine and/or will be well established practices in the next 5 years. If you are a man who reads the bible, you will also note that our biblical ancestors lived well into their 120s, 130s or even much longer, so my remarks here about longevity have a biblical foundation as well as a modern medicine foundation. ; )

I await hearing from you, after you've considered my test results, with any comments or suggestions. If I am deficient in any nutritional areas, and there is a supplement I can add to my daily regimen, that will be easy for me to do.

Regards and Best wishes for a great year ahead,

XXXX
 
 
Answered by Dr. Ivo Ditah 10 hours later
Brief Answer:
Your results are good!

Detailed Answer:
Hi,

I have received all three reports. The results are good and I am not any particularly worried. Your blood tests are great. The slight lower red cell values is totally within acceptable limits.

As for PSA, we have discussed this at length and the reasoning line remains unchanged at this time. Only a markedly elevated follow up value would be able to change my stands at this time.

From your values and how meticulous you are about your health, there is no reason for you not to live for many many more years. Your faith and constant efforts to stay healthy would certainly see you attain these heights.

I hope this guides. I wish you well. As always, am at your disposal.
Above answer was peer-reviewed by
 
Follow-up: What do these lab reports indicate? 28 hours later
Hello, Dr. Ditah,

Thank you for your kind remarks about my test results and my overall good health. Due to my own detox-ing and intestinal parasite cleansing and then the medical Albenza treatment, I lost about 15 pounds (from 185 to 170) and of course this dropped my BMI. And I cleaned up my eating habits (no more grains, dairy, etc.). Excepting for the head pressures I feel very healthy.

I gave blood today for another PSA test (having abstained from sex for 4+ days), and we'll get the results back in a couple of days.

Here's a question I haven't been able to find any good answers to: what are some of the other possible reasons for and causes of an elevated PSA, other than a positive indication for prostate cancer? We know that sex within 3 days prior to the test can elevate the PSA level, but what other behavior or what other activity or ________ can elevate PSA values? I haven't been able to find much on pubmed.gov on this particular point.

Oh, by the way, did that X-mas gift I sent you ever actually get to you? I'm not looking for a "thank you" so much as I'm just trying to make sure you received it!

When I had my first visit with the ophthalmologist she recommended I try acupuncture for my head pressures and said this was covered under my Kaiser Permanente health plan (with minimum $10 co-pay) and I've now got a bit of time and will look into this. Do you have any thoughts on this, on acupuncture treatments for head pressures? Your XXXXXXX opinion, please.

And, if you have any thoughts or suggestions, what do you think I should look for, in choosing an acupuncturist to work on me? Here is California there are 50 practitioners within a 10 mile radius of where I live, as we have a huge Asian population here in Los Angeles. I simply don't know what criteria to use - or what questions to ask - of an acupuncturist, for me to decide to use them or not.

Best regards,

XXXX
 
 
Answered by Dr. Ivo Ditah 40 hours later
Brief Answer:
See below!

Detailed Answer:
HI,

I have done some chinese medicine training myself and studied about acupuncture.

Frank: There is no science that explains how it works BUT many people report having relief from doing acupuncture. Because it has minimal side effects and seems to cost less, give it a try and decide. If you feel relieved, carry on. If you don't feel any benefits, stop it right away.

Increased PSA can be caused by urinary tract infections, enlarged prostate, infection/inflammation of the prostate and increased age.

I hope this helps. I wish you well. Keep me posted.
Above answer was peer-reviewed by
 
Follow-up: What do these lab reports indicate? 3 days later
Dr Ditah,

Please see the attached PSA test results, going back many years right up to the present, with the most recent PSA test results of last week.

Do you have any thoughts? suggestions"? or recommendations you wish to make? based on these test results?

BTW, Kaiser Permanente considers the "normal range" for my age, for this test, to be <6.5.

Best wishes,

XXXX

p.s. I did have a urinary tract infection several years ago. Does this "stay with your body", meaning can this infection of 2+ years ago adversely raise the PSA test results in a CURRENT test result? XXXX
 
 
Answered by Dr. Ivo Ditah 26 hours later
Brief Answer:
Monitor PSA in 6months!

Detailed Answer:
Hi and thanks so much for this query.

Slightly increased PSA and even cancer of the prostate are never an emergency to address. This value of 7 is very borderline and I will simply ask for further control in 6months at this time. There is no need to panic about it.

UTI once treated are fully eradicated. You no longer have any UTI and this has no impact on these results.

I received the package you sent. Immense thanks to you for such a wonderful package. However, for ethical reasons, doctors are prohibited from receiving gifts of such huge value from their clients. Exceptionally, I will accept and not return this to you for obvious logistics reasons, just this one time. Believe me when I say I was truly enthralled by your gesture.

I wish you well. As always, am here for you and do promise you will never walk alone.
Above answer was peer-reviewed by
 
Follow-up: What do these lab reports indicate? 2 days later
Hello, Dr. Ditah,

Well, I'm glad you received my little gift. It surely wasn't of huge value, as you write, as the dried fruits came from my own orchard. I hope you and your family enjoy them. ; )

I received an "updated" test result from my Kaiser Primary Care physician, this specifically on my LIPID PANEL, which apparently my primary care physician only had a chance to review and comment on in the last several days. I include his remarks here FIRST, followed by the test results that he is referring to.

"Your LDL (bad cholesterol) are increased. Please maintain a low fat, low sugar and high fiber diet. Please eat less red meat, more chicken/fish and more leafy green vegetables. Also exercise on a regular basis.

"Your labs also show mild anemia (low blood count). However, when comparing the current results to the ones in the past, it is better than it has been. A repeat test for one month has been ordered to monitor. Please go to the lab in one month."

Test results:

CHOLESTEROL
my value 188 mg/dL
standard range <=199 mg/dL

HDL
my value 56 mg/dL
standard range >=40 mg/dL

LDL
my value 114 mg/dL
standard range <=99 mg/dL

TRIGLYCERIDE, NONFASTING
my value 115 mg/dL
standard range <=149 mg/dL

CHOLESTEROL, NON-HDL - 132 mg/dL mg/dL

Collected:12/29/2017 10:58 AM
Resulted: 12/29/2017 8:21 PM
Ordered by: XXXXXXX SUN XXXXXXX DO, D.O.

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

So, my questions to you, Dr. Ditah, are:

(1) what do you make of the test results that my Kaiser physician seems to be concerned about?

(2) what are Y-O-U-R own concerns about these LIPID test results? and

(3) what would be Y-O-U-R recommendations based on these test results? and

(4) do you think my Kaiser doctor's recommendation to have these levels re-tested in a month is the ONLY prudent and proper diagnosis of what to do next? or is there more that I could do or that Kaiser Permanente can do now? and

(5) are there nutritional supplements I can take to deal with the mild anemia (low blood count)?

Best wishes t you and your family,

XXXX


 
 
Answered by Dr. Ivo Ditah 4 hours later
Brief Answer:
See below, XXXX!

Detailed Answer:
Dear XXXXXXX

Thanks again for the package. You may qualify it as small but am overwhelmed by the gesture and content.

1/2/3. Your LDL is rising. Though below the values requiring drug treatment, it is a good idea to caution you and make sure you are making the necessary adjustments to prevent going above the threshold. I will encourage you to implement these recommendations.

4. This is very reasonable and well thought. There is no red flag at this time and keeping an eye on them is all i recommend. No need for worries.

5. For now, I will not recommend any supplements. Eat healthy, incorporating foods and fruits rich in iron. We will take further stock after the next scheduled laboratory test.

I hope this helps and guides. As usual, am at your service and glad for the opportunity to contribute in your care.
Above answer was peer-reviewed by
 
Follow-up: What do these lab reports indicate? 2 hours later
Hello, Dr. Ditah,

THANK YOU for your remarks and for your cautions.

As something didn't feel quite right about what the Kaiser doctor wrote me, I went back through my test results and noticed that some LDL test results were in my Kaiser Permanente file and other LDL numbers were in my LabCorp file, making it difficult for anyone to get a "complete view" of my Total Cholesterol and my LDL Cholesterol test results ALL IN ONE PLACE. As I say, some where in one place / others were somewhere else.

What I have now attached is ONE REPORT giving all Total Cholesterol and LDL Cholesterol test results on one page, going back to 2009. Please take a look at it.

Recently my total cholesterol has dropped 30 points (from 218 in Feb 2017 to 188 in Dec 2017) and the 188 total cholesterol reading is now the lowest it has been since December 2013.

My most recent LDL cholesterol test result of 114 is actually lower than it was 4 years ago (when it was 117).

So, in actual fact, both my Total Cholesterol and my LDL cholesterol have dropped from 14 Feb 2017 (when they were 218/143) to Dec 2017 (when they were 188/114), with total cholesterol dropping 30 points and LDL cholesterol dropping 29 points.

So while my LDL cholesterol is high at 114 it is in fact not "increasing" as the Kaiser doctor writes, but in fact is DECREASING.

Yes, I should just cut out red meat completely, but I already walk 20 miles a week (4 times a week X 5 miles each time) and I can increase my intake of green leafy vegetables. These points are quite sound and good advice.

Do you have any further thoughts, comments or suggestions, now that you can see ALL these test results in one place?

As always, thanks for being there . . .

Regards,

XXXX

 
 
Answered by Dr. Ivo Ditah 18 hours later
Brief Answer:
Continue with sports and dietary measures!

Detailed Answer:
Hi XXXXXXX

I have reviewed all the provided details entirely. Diet and exercise is all that is needed at this time. Yoru value need no medications and efforts are just to caution you and make sure that we invest more on health promotion and disease prevention than deal with an actual disease.

Be relaxed and keep me updated.
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