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Abnormal Labs

D

DanceMom

I posted this in another thread but I'm hoping to get some good feedback (because I know someone here has likely BTDT!). I finally got A's lab results that she had drawn on 05/30....yet another reason why we'll never use our local clinic again! Anyway, a few things came back abnormal but I'm not sure of the significance.

Vitamin D-25: 21/Insufficiency (30-100 norm)
Alk Phos: 192 (17-173 norm)
Abs Neut: 7.3 (1.4-6.5 norm)

The Vitamin D insufficiency really confuses me. We live in FL and A gets plenty of sun. When the labs were drawn school was still in and she had a 45 min PE period 4 days a week and a 20 min recess period 3 days a week. Car line was also in the sun (15-20 min a day) and she played outside at least 1-2 days a week at home. She drinks whole milk daily as well.

She'll be having more labs done tomorrow (not sure exactly what just yet) and I'm sure the comparison will give more info as to what is going on. But if anyone could give me any insight in the meantime I'd greatly appreciate it!

A's labs are typically perfect (even when she feels her worst) so this came as a shock to me. And at the time the labs were drawn she felt the best she's ever felt.
 
my little penguin

my little penguin

Moderator
Staff member
The liver makes more ALP than the other organs or the bones. Some conditions cause large amounts of ALP in the blood. These conditions include rapid bone growth (during puberty), bone disease (osteomalacia or Paget's disease), or a disease that affects how much calcium is in the blood (hyperparathyroidism), vitamin D deficiency, or damaged liver cells.

If the ALP level is high, more tests may be done to find the cause.

Why It Is Done

A test for alkaline phosphatase (ALP) is done to:

Check for liver disease or damage to the liver. Symptoms of liver disease can include jaundice, belly pain, nausea, and vomiting. An ALP test may also be used to check the liver when medicines that can damage the liver are taken.
Check bone problems (sometimes found on X-rays), such as rickets, osteomalacia, bone tumors, Paget's disease, or too much of the hormone that controls bone growth (parathyroid hormone). The ALP level can be used to check how well treatment for Paget's disease or a vitamin D deficiency is working.
Click to expand...

from:

http://www.webmd.com/digestive-disorders/alkaline-phosphatase-alp-test
 
D

DanceMom

She had the Hepatic Function Panel and all other results within that were normal. Could she still have a problem with her liver?
 
my little penguin

my little penguin

Moderator
Staff member
According to webmd if her vit d is low than it can make her alp high.
Not sure how it affects the liver if the other numbers are normal
I know my sons alt /ast went up with 6-mp and then tripled above the normal limits.
That was the only time we got a very quick call from the doc to stop the meds at once. Fwiw he had blood drawn at 3:30 and the doc was on the phone with us at 5:00 pm .

Meaning if it is a really bad thing - her labs would have been flagged and the doc would have called at once.
Most labs can't be seen in the system until the doc reviews them .


Hope your Gi has answers for you soon
 
D

DanceMom

Just read that Prednisone can cause low vitamin D levels. That has to be the cause. She'd been taking it for about 3 weeks at the time of testing.

The GI just mentioned that her vitamin levels were a little low and that I should give her a children's multi-vitamin. We started one that night.
 
my little penguin

my little penguin

Moderator
Staff member
Ibd causes low vitamin d levels since the body uses vitamin d when there is inflammation .
Double whammy if asthma is acting up as well.

Also Ibd in general sometimes limits amount of vitamin d that is absorbed and how etc....
Lots of different theories on that one

Here is a thread on vit d and Ibd from the research section
http://www.crohnsforum.com/showthread.php?t=23826
 
D

DanceMom

Well, her abnormal labs and most recent symptoms is probably why the GI took things so seriously. When I emailed I fully expected the nurse to respond by saying "give it a few days to be sure it isn't a virus." Instead she added more tests and scheduled an appointment. I already had orders for the routine 6-mp labs but she said the GI is adding a few more along with some stool tests.
 
Catherine

Catherine

Moderator
Sarah's vitamin d are low but not very low, she takes a caltrate tablet daily due to pred use.
This is a calcium and vitamin d combined tablet.
 
DustyKat

DustyKat

Super Moderator
Sorry, just noticed this thread DanceMom. I always play catchup from the bottom up! :eek2: I will copy from the other thread but it looks like you already have your answers. :)

Absolute Neutrophils: Being a white blood cell this could potentially play into an infection of some sort, however, is A still on Pred? If so this may be the cause. Pred can increase white cell counts and the one most commonly affected is neutrophils.

Vit D: Found to be a common deficiency in Crohn's, particularly small bowel Crohn's.

Alkaline Phosphatase: Being a liver enzyme you can't rule out the 6mp BUT an elevated Alk Phos may have another couple reasons for being elevated...

- It is common for children and adolescents to have elevated levels when they have a growth spurt or are going through puberty.

- When a Vitamin D deficiency is present it is not uncommon to have an elevated Alk Phos due the the connection with the bones.
Click to expand...
Dusty. :)
 
D

DanceMom

That would be great if she were going through a growth spurt! Sadly, I don't think that's the case though. She's lost 4 lbs. in the last 2 weeks and still losing.
 
D

DanceMom

Today was a LONG day! Went to the hospital lab and found out they no longer do outpatient labs. Ended up at Quest but that was okay. I think the GI is testing everything under the sun, lol. Picked up the specimen containers for the stool tests (bacteria & c-diff) but by the time we got home and filled them the lab was closed. We'll drop them off in the morning. This sample was probably the most disgusting thing I've ever had to work with - orange mush. And now it is in my fridge.....the joys....

A has been rather crabby and tired today. She had an accident while we were at my other daughter's doctor appointment and then of course the lovely orange mush that I got to experience. She ate good earlier but is refusing dinner now. Hopefully her labs show something so we can figure out why she is feeling this way now after doing so well.

And thank you for letting me come here to share and vent! I know my friends just don't understand the way you all do and talking about it really is therapeutic for me.
 
DustyKat

DustyKat

Super Moderator
Oh no. :( What an awful time for you both. :ghug:

I hope the wait for answers and better times isn't too long mum. Good luck!

Dusty. xxx
 
CrohnsKidMom

CrohnsKidMom

Just wanted to extend my support to you, DanceMom. My son is still on Pred (from Apr1), and we give him high potency Vit D drops, and chewable calcium tablets. Hope it all gets sorted out soon! And yes, stool sample collecting is about the nastiest thing in the world. I would not want to work in a lab!
 
D

DanceMom

Well, most of yesterday's labs are already back. Here are the things that were abnormal:

Glucose: 167 (65-99 norm)
Bili, Total: .9 (.2-.8 norm)
Alk Phos: 113 (184-415 norm)
ALT: 43 (8-24 norm)
Absolute Lymphocytes: 859 (1500-6500 norm)
Absolute Monocytes: 108 (200-900 norm)
Absolute Eosinophils: 0 (15-500 norm)

The nurse emailed and wanted to know if stool samples had been turned in, specifically c-diff. Do these labs point to c-diff? She also changed her appointment to Monday instead of Tuesday.

A is still feeling awful and continues to have yucky diarrhea. She goes from her futon to the toilet and that's it. I finally convinced her to take a few bites of bread.
 
D

DanceMom

Now she has started vomiting. Put a call in to the on-call GI and waiting on a call back. I have Zofran but don't like to give extra meds without GI approval. My poor girl.
 
Johnnysmom

Johnnysmom

Poor peach. Sorry she is feeling so poorly.

How high is her 6mp dose? I would think it is more likely the 6mp is making her sick than the prednisone. Have they done any testing yet to see how high her 6-TNG and 6-mmp levels are?
 
Tesscorm

Tesscorm

Moderator
Staff member
I hope she's feeling more comfortable now!

Hopefully, the GI will be able to give you some answers in the morning. :ghug:
 
D

DanceMom

A is feeling a little better. Said her pain is mostly in the lower left of her abdomen but the vomiting and diarrhea have stopped for now. They started her on Flagyl last night and also gave Zofran, Zantac, and Tylenol. Still waiting on the GI to make rounds.
 
Mehita

Mehita

Sorry to hear this, DM. Glad she's being taken care of though. I second Johnnysmom's thoughts on the 6mp. Keep us posted...
 
D

DanceMom

Doctor is holding the 6-mp tonight to see if that's what is making her sick. If she feels better in the morning they will know that's it. If not, then they are assuming a virus and possible flare. Hopefully she gets some sleep tonight. They are trying to hold off on pain meds as well. If she gets much worse they have morphine ordered. Yikes.
 
DustyKat

DustyKat

Super Moderator
Thanks for the updates DanceMom. :ghug:

Thinking of you and your girl and hoping you soon have answers. Good luck mum!

Dusty. :heart:
 
D

DanceMom

GI came. He believes she has a virus that caused inflammation in her colon (based on her pain). Going to give Tramadol more regularly and add Neurontin to see if that helps. Will probably stop IV fluids soon. He will recheck her tomorrow.
 
C

crohnsinct

Well-known member
Yikes! I go away for one week and look what happens. So sorry for all you are going through. YES! Here's hoping it was a virus, especially given those other girls on her team were so sick.

FWIW: O has been cleared for all foods except popcorn...unless you are giving her that fancy pants popcorn we were all chasing a while back.....
 
D

DanceMom

I'm discouraged. A is basically the same. The Ultram gives her about 2-3 hours of mild pain but then it wears off and she's in terrible pain. The Zofran keeps her from throwing up but it doesn't take away the severe nausea. The Neurontin does nothing yet. From what they are telling me this is typical with Crohns. I'm heartbroken.
 
my little penguin

my little penguin

Moderator
Staff member
Hugs you will find your basket of kitten soon.
Any and all evil drugs look like kittens in a basket when they work
Hope your lo improves .
 
D

DanceMom

Can't even count the number of doctors that have been in this morning! Lol Still waiting for her GI but the plan is for him to send her home after lunch. She did get out of bed for about 30 min to sit at the desk so that's an improvement. She's having trouble with BMs though - only small slivers coming out for 2 days now and she says it is painful when she goes.
 
DustyKat

DustyKat

Super Moderator
I hope they suss the BM problems out before they discharge. :(

Thinking of you both. :heart:

Dusty. xxx
 
D

DanceMom

We are home now! The GI came this afternoon and brought the NP with him. He's going out of town on Friday and wanted us to meet her in case we need anything while he's gone. He thinks that A is definitely in a flare, most likely brought on by a virus. He warned that this happens to some with IBD, even with something as simple as a cold. That didn't comfort me but I'm hoping it prepared me should this happen again. My child is far tougher than I am and handled the whole thing like a champ. I, on the other hand, feel heartbroken and crushed and I've seen just how quickly things can go from "a little rough" to "extremely bad". I no longer feel the comfort of thinking her case is "mild".

As for meds.....we are running a small pharmacy here, lol. So much for the pill organizer I was so happy over (the one that doesn't look like an old person's! lol). There's no way all of her meds will fit in there! A suggested labeling 7 solo cups with the days of the week, lol. On top of her usual meds we're adding Flagyl for 14 days (c-diff was negative but apparently Flagyl can help reduce inflammation), Neurontin until we are sure the flare is resolved, and Prevacid. We have an order for Tramadol as well but he thinks it is constipating her, allowing her to only produce those slivers. We're holding off on that one for now.

A is doing better today than yesterday. She's still in quite a bit of pain but is less nauseous. As she was being discharged she asked me if we'd be home in time for dance class, lol. Silly girl!
 
DustyKat

DustyKat

Super Moderator
I hope all heads into positive territory for A DanceMom, bless her. :heart:

Yes, Flagyl does have anti-inflammatory properties along with the antibiotic. :)

Onwards and Upwards for A!

Dusty. xxx
 
Maya142

Maya142

Moderator
Staff member
DanceMom - my daughter was also recently put on Flagyl since she seems to be flaring. She's been on it 4 days and is already feeling better, though I'm not sure if that's the Remicade kicking in or the Flagyl. She complains of it leaving a "bad taste" in her mouth but is otherwise tolerating it well.
I hope it works for A soon! Good luck!
 
Tesscorm

Tesscorm

Moderator
Staff member
She may not be 100% but am really glad she's feeling well enough to be asking for dance classes! :banana:

I hope you keep seeing steady improvement! :ghug:
 
D

DanceMom

A is still feeling about the same this morning except a new symptom has come up. Her right eyelid is swollen! She says it doesn't itch but it is very uncomfortable, especially when she blinks. The eye itself is not red and there is no drainage. What the heck?!? Could this be related to the flare?

I will be leaving her with my hubby this morning while I take my other daughter to the hospital to see the ENT. Getting a second opinion before following through with her sinus surgery. I swear, we should just move next door to this hospital! When I return if the eyelid is still swollen I will call the Pedi. Just wondering if you all have had this happen before and what it was.
 
my little penguin

my little penguin

Moderator
Staff member
Call on way to ent
It could be an allergic reaction to the new drugs
Or simply bad allergies
Best to talk to your Gi /allergist ASAP in case it progresses
Which it can rapidly
 
D

DanceMom

I ended up running into the GI nurse when leaving my daughter's appointment (the GI and ENT clinics are next to each other). She asked about A and I told her about her eye. She said she'd run it by the doctor and then email me. Still haven't heard from her.

The swelling has gone down considerably but I'm watching it like a hawk. A says it hurts when she moves her eyes from left to right especially. Still no redness or drainage. She does not have food/environmental allergies so I don't think that is it.
 
Sascot

Sascot

Was just catching up on your thread. Sorry to hear things have been so stressful! Hope the eyelid settles down and the other symptoms start to go away. I was also told that Flagyl has anti-inflammatory properties so hopefully they will kick in soon. Hope the ENT appt went okay as well. I felt like that last year - in and out with both kids
 
D

DanceMom

Actually, the ENT appointment was awesome and I've never left the hospital so pleased! The first ENT we saw (at a private clinic) recommended sinus surgery and gave us no other options. This ENT doesn't think sinus surgery will be necessary and gave us a detailed plan for sinus rinses. She is the new division chief and her passion is sinuses. I love that medicine and surgery is not her first plan of action and that she's done her own research to make these recommendations. Now fingers crossed that it works!
 
D

DanceMom

A seems to be doing a little better this morning. She's actually up and playing with her sister! Maybe the Neurontin is working? She did have one enormous BM that was diarrhea which is a big change from the large and dry stools she was having. I'm guessing because the Ultram is out of her system so she's no longer constipated? Her eye seems to be fine now so I guess it was just one of those freak things that happen. She likes to keep me on my toes! lol
 
D

DanceMom

Strange new symptom....A woke up this morning with dried blood near the right side of her mouth. Her lips sometimes crack and bleed during the night so I thought that's what it was. Her lips didn't look particularly bad but I didn't question it. Just a few minutes ago A was sitting on the toilet and called me in there to "see something". She had blood on her hands and said she just spit it up. I looked all in her mouth, no visible sores. What the heck?!?
 
C

crohnsinct

Well-known member
Yeah what the heck! Strange. Friday at 1:15....I might make a quick call on that. Ped or GI. Would just hate to sit on it and have something really show up over the weekend.
 
Tesscorm

Tesscorm

Moderator
Staff member
Yes, I would call too.

I've probably missed this but did she ever have inflammation in her esophagus or stomach?
 
D

DanceMom

GI is on vacation right now. She's had gastritis in the past but never inflammation in her esophagus. The pill cam did show she had at least one bleeding ulcer in her small intestine. At this point I'm "gathering evidence" before I email him. She's on a million different meds so I think he wants to give them time. Bummer that her labs never indicate much.
 
D

DanceMom

She doesn't have sinus issues, thank goodness! That is my 6 yr old. Sinus rinses with a 6 year old are an interesting experience! lol

Basically, the GI is assuming she is having a flare based on the vomiting/diarrhea (that were controlled with medication) and her pain (lower left abdomen). He thinks her colon is inflamed. Her labs looks good and so did the abdominal x-ray (no blockages). If her colon is inflamed can that cause the thin stools? Is that expected with colon inflammation or is that dangerous? It is a new symptom for her though I did mention it to the GI while she was admitted. And I will definitely keep an eye on the blood! She is on Prevacid and Prilosec so what else could be done if she did have ulcers/inflammation in her esophagus?

I think the GI will only be out for a week. I did meet the NP and if things got worse I could always email her.
 
DustyKat

DustyKat

Super Moderator
:oops: Sorry! :redface:

Inflammation of the colon can cause thinning of stools. Inflammation causes swelling and oedema. Since it starts in the first layer of the bowel wall the swelling and oedema it produces will cause it to ballon out into the colon space, that in turn narrows the aperture down causing pencil thin stools. Blockage is your enemy in this case and that is what you have to be wary of. Severe pain, no bowel movements, or a very sharp decline with very little faecal matter passed and vomiting will be the signs to look for.

If the oesophageal ulcers are caused by reflux then you are already treating that but if they are apthous (Crohn's) ulcers then treating the underlying cause, inflammation, is what is needed.

Thinking of you mum! :heart:

Dusty. xxx
 
D

DanceMom

Thank you for the explanations! A has not had any BMs today and is feeling crummy right now so I'll keep an eye on that. And I really did not realize there were different types of ulcers! Besides the Prilosec/Prevacid she's also on Prednisone and Flagyl for inflammation. They just aren't working fast enough for my liking!
 
D

DanceMom

Well...she just passed something that was about an inch long and practically flat. Said it hurt and she felt like she was straining to get that out.

She's on 20mg of Prednisone and that's what she started out on. The plan is to start weaning once she's been on 6-mp for 2 months (she's at 3 wks right now).
 
DustyKat

DustyKat

Super Moderator
Okay, shame they didn't start her on the 6MP at the same time she started the Pred. :(

How old is your lass again?
20mg doesn't seem a very high start up dose.

Dusty. xxx
 
D

DanceMom

She's 8 and weighs 50 lbs (but weighed about 45 lbs when she started the Prednisone). What would a standard dose be for a child that weighs 50 lbs?
 
my little penguin

my little penguin

Moderator
Staff member
DS was at 20 mg last summer and about the same weight and age but it wasn't enough so they upped him to 30 mg for a bit before weaning back down to 20 mg.

We were told max kiddie dose is 40 mg.

They don't like to do the higher doses for very long.
 
DustyKat

DustyKat

Super Moderator
IIRC oral Prednisone dosages for children with Crohn's are normally calculated at 1-2mg per kilo with a maximum of 40 mg set as the upper dose limit for children.

So that would be 45lbs = 20kgs. So 20mg is the lower dose based on that weight and 40mg fits nicely with the 2mg per kilo dose.

Please don't take what I have said above as gospel as my mind isn't always the sharpest knife in the drawer and so I may well be wrong!

Maybe she needs a higher dose of Pred to kick the Crohn's butt into remission??

Dusty. xxx
 
DustyKat

DustyKat

Super Moderator
Well I could either say shut up! or...at least I have made it this far! :lol:

Meh, I'll say both. :tongue:
 
DustyKat

DustyKat

Super Moderator
Do you really want know what did it?

Calculating that age old imperial system into metric! :ylol2:
 
D

DanceMom

She just passed about 4 more thin blobs, like the last. Guess she isn't completely blocked but things sure aren't coming out easily.
 
my little penguin

my little penguin

Moderator
Staff member
For DS - he has trouble passing even soft stool some times - Gi feels his tract goes in spasms which cause him not be very productive. This leads to his rectum inflaming.

Hope she feels better soon.
 
D

DanceMom

Oh my....large stool this morning! Seriously looked like about 3 days worth! It wasn't hard, but could she still be constipated? Would Miralax help?
 
DustyKat

DustyKat

Super Moderator
Under normal circumstances you would say no, she isn't still constipated after passing that amount of stool. BUT if you suspect that she may be backed up then although not constipated as such she may still have quite a bit of evacuating to do and in that case a stool softener wouldn't go astray.

Dusty. xxx
 
my little penguin

my little penguin

Moderator
Staff member
not sure on your DD but my Ds can and has proven to be constipated after that still-- he had to have an X-ray- clean out then a large daily dose of miralax to keep it from happening again ( as often)
 
D

DanceMom

I think I'll try some Miralax and see if that helps the pain. I'm wondering if that large stool was blocking things and causing pain, and if that's the case I'd like to try and prevent that! She's not one to get constipated, but I'm definitely thinking something is going on.
 
Mehita

Mehita

DanceMom... our two continue to live identical gastro lives! What is it with them? We just started the Miralax too.
 
Last edited:
D

DanceMom

No doubt, A is in a flare. More diarrhea today and also blood. She also has 2 EN spots on her legs. On a positive note, she has a great appetite and has been happy and playing all day. I'm wondering if the Neurontin is helping with the pain. I need to email the GI nurse tomorrow to ask about bloodwork (A should be due for labs the end of the week) so I'll update her. Just disappointed.
 
DustyKat

DustyKat

Super Moderator
:(:(:(

I am so sorry to hear this DanceMom. :ghug: Good luck with the labs hun.

Thinking of you both. :heart:

Dusty. xxx
 
D

DanceMom

Today has not been a good day. The girls and I went to dinner and then to the grocery store. As soon as we got there A rushed to the bathroom, my other daughter followed, and I told them to meet me at the pharmacy. My youngest comes out and loudly announces, "Mom, you need to go in there! The toilet is full of blood!" I go in, and sure enough she's had bloody diarrhea and the toilet water is red. Lovely. She says she feels a little better so we start shopping. Half way through the store - back to the bathroom for more of the same. I tell her we have just a few more things to get, then we'll be on our way (stupid me) and then she vomits in the middle of the aisle. Yep, time to go home!

This feels strangely familiar...as in nearly the same thing happened 2 weeks ago! Keeping a close eye on her and praying she starts feeling better soon!
 
D

DanceMom

Diarrhea several more times.... vomiting small amounts as well. She's refusing fluids right now as well. Giving it a little longer before calling the on-call.
 
D

DanceMom

Luckily her stomach settled enough for her to get some sleep last night. This morning she feels pretty crummy but wanted to eat some toast and eggs. She just made her first bathroom trip of the morning - loose but no visible blood. That is somewhat of an improvement but she literally screams in pain as it comes out. Says it feels "like it just doesn't fit". And she still has a lot of pain in her lower left abdomen. I'm emailing the nurse to update her and see if she has any recommendations.
 
D

DanceMom

Nurse wrote back...wanted me to check her bottom for tears or fissures. I didn't see anything abnormal. A's GI is still on vacation so she's checking with the on-call doc.
 
my little penguin

my little penguin

Moderator
Staff member
Hugs
DS had a lots of pain going - his rectum was inflamed
Warm baths may help to soak the area but honestly after we increased his meds things calmed down in that area .

Good luck
 
D

DanceMom

Been emailing the nurse back and forth all day. Apparently the on-call doc is trying to decide whether to admit her or give it more time at home. She's had 4 BMs today (3 diarrhea and 1 formed), abdominal pain, and now a headache. The nurse said the doc wants to review her labs but those were done 2 weeks ago so I think they're pretty useless. She was due to have them today but I never received the orders (despite emailing on Monday and asking they be mailed to me). And now the labs are closed. If we end up in the ED for labs I'm not going to be a happy Momma.
 
C

crohnsinct

Well-known member
So sorry about all this Dancemom. Ya know there is some funky parasite they found in the US that is causing a horrendous stomach bug. There are 270 cases across the US and they think a lot more who just haven't sought out medical attention. Maybe, just maybe she has that bug. Ask for a stool test or whatever it is they do to check for this parasite. Maybe even look online to see how many in Florida have come down with it (only two so far in CT).

Good Luck today.
 
D

DanceMom

According to the local news there are no known cases in FL. I have a hard time believing she had a virus 2 weeks ago and a parasite now. Unfortunately I think this is a flare, especially because her EN are back.

Still no orders and still no reply from the nurse. I'm aggravated. And my lack of sleep from being up with a sick kid isn't helping things.
 
D

DanceMom

Nurse faxed orders to the lab and ordered them to be done stat. We should have the results in the next hour or two. A did eat lunch then had 2 BMs (both solid) and is in a lot of pain. It seems as if things are just going to be this way for awhile.
 
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