Am I overthinking these lab results?
August 30, 2013 1:23 PM   Subscribe

I've been seeing an internal med doc for the past year and a half to figure out what's going on with me, and my blood work seems to indicate some kind of inflammation/autoimmune issues. My doc doesn't seem to be concerned, but I have the feeling he may not be looking at everything in totality. Should I just go ahead and see a specialist? More details inside.

I have constant fatigue. I'm 80 pounds overweight, and it's all concentrated in my abdominal area. Losing weight is an impossible proposition -- cutting back to 1,200-1,500 quality calories a day and regular exercise doesn't budge the scale. I also have irregular periods, which swing from being on a normal cycle for a few months to going several months with no period at all. I'm currently taking levothyroxine, sertraline, singulair, vitamin D and necon (birth control).
As far as my labs are concerned, my a1c is 5, my fasting glucose is 86, my TSH is 1.5, my free T3 is 2.4 (on the very low end, but since it's still inside the normal range, the doc won't adjust my meds). My cholesterol is also high. What worries me is that my HS-CRP was 21.40 in January. When he tested it again in June, it went down to 8.90, but it's still very high. My sed rate was 39 in January and 29 in August.
I had a bad case of poison ivy in June, which a 12-day round of prednisone eventually cleared up. In early August, I suddenly developed a rash that started on my chest in an upside down U shape on my cleavage and under my right eye. Two days later, my eye was almost swollen shut and the rash had spread down my cheek. I thought it was poison ivy again and went in for more steroids. The doc was concerned because I hadn't been around poison ivy this time and it was presenting in an unusual way. He ordered more blood work, including an anti-nuclear antibody test. It came back positive , 1:640 and finely speckled. The DNA, SSA, SSB, SM, RNP tests came back negative, although the SSA was a 16, SSB 9, SM 10 and RNP 20. His only note was to discuss on return; my next scheduled appointment is in January. The rash cleared up after six days of prednisone.
In addition, my MCH numbers in August was 31.3, and my MCHC was 35.5. My red blood count was 4.57; in January it was 5.14. My ferritin level over the past year and a half has ranged from 202-322, whether I'm having my period or not.
I showed these results to a family practice doc, and her recommendation was to see a rheumatologist. I called my internal med doc, and he said he wasn't concerned because only the ANA came back positive and the rash cleared up with the medication.
I feel like he's not looking at all of these various parts of labs in totality. I know you are not a doctor or my doctor, but am I overthinking this? Should I go see a rheumatologist anyway? My health plan doesn't require a referral to see a specialist.
posted by Taystee to Health & Fitness (11 answers total) 2 users marked this as a favorite
I'm not sure there's any point in discussing your labs. It won't help anything.

Maybe the question should be why shouldn't you see a specialist? You don't feel like your doctor is helpful and you've given him plenty of time. Go see someone who addresses your concerns.
posted by hobo gitano de queretaro at 1:32 PM on August 30, 2013

Yes, you should see a rheumatologist. I am not a doctor nor an expert but those are high CRPs and sed rates, you have a positive ANA, and you've had two courses of prednisone this year with no good diagnosis. The elevated ferritin is also concerning.

I have an autoimmune disorder so I know where to look for evidence of one, but not for other possible explanations -- this COULD be autoimmune but I'm sure it could be something else. I think a rheumatologist is your best first step.
posted by telegraph at 1:35 PM on August 30, 2013

Another vote for rheumatologist. You are going to be your own best advocate.
posted by rtha at 1:45 PM on August 30, 2013

There is no harm in seeing a rheumatologist. Even if your problems are not auto-immune, they tend to be great detectives and may have an idea of what else to consider or other specialists to see.
posted by hydropsyche at 2:07 PM on August 30, 2013 [1 favorite]

Anecdata: My thyroid results were low but in the normal range. A GP said Let's see if you feel better with increased thyroid hormones and put me on a low dose. It was a huge success - more energy, weight loss, no more constipation, skin was nicer. See a rheumatologist, or see a different internist.
posted by theora55 at 2:16 PM on August 30, 2013

Speaking from experience, changing doctors can save your life. If your doctor is not working for you, get out and find someone who will work with you until you discover the root of the problem.
posted by krisptoria at 2:30 PM on August 30, 2013

I'd check out another doctor. And FYI this week's issue of The New Yorker has a pretty compelling story by a woman with an autoimmune disorder on how tough it can be to get to the bottom of something like this. It might actually give you some reassurance to read her tale.
posted by bearwife at 4:12 PM on August 30, 2013

I've dealt with autoimmune issues since my 20s (in addition to a host of other medical conditions that complicate things for me). Believe me: you want to see a rheumatologist.
posted by scody at 8:30 PM on August 30, 2013

I agree with hydropsyche that there is no harm in seeing a rheumatologist.

However, I would add that if you have an issue with how your primary care physician is managing your hypothyroidism and want a second opinion on that, the appropriate specialist is an endocrinologist.

I also suggest you keep this in mind, here is an excerpt from the American College of Rheumatology's website:
"only about 11-13% of persons with a positive ANA test have lupus and up to 15% of completely healthy people have a positive ANA test. Thus a positive ANA test does not automatically translate into a diagnosis of lupus or any autoimmune or connective tissue disease."

Be aware that oral contraceptive pills can cause elevation of your CRP level, as well. The CRP is also a nonspecific test which a lot of different factors can influence. However, having an elevated hs-CRP, elevated cholesterol, and being overweight all can increase risk for heart disease.

One other thing to consider: being overweight and having irregular menstrual cycles that you're addressing with OCPs are potentially suggestive of polycystic ovaries. If you go to see an endocrinologist, it may be worth asking them if further workup for PCOS might be useful.
posted by treehorn+bunny at 9:34 PM on August 30, 2013

Just one minor thing, only Hematologists are going to care about MCH, MCHC, RBC count, those particular red blood cell labs are difficult to interpret and most general med docs will ignore them, and will likely be resistant to discussing them.

If you're trying to sell these labs as abnormal, I think the money's in the thyroid and rheumatoid labs.
posted by sanderman at 1:34 AM on August 31, 2013

It seems like your question could be summarized as:
"my blood work seems to indicate some kind of inflammation/autoimmune issues, I'm concerned that my doctor wants to refer me to an appropriate specialist instead of trying to deal with a problem that isn't in their specialty"

Look, inflammation/autoimmune is what rheumatologists do! Why in the world would you not go see one when your GP recommends it and your insurance covers it?
posted by yohko at 9:12 PM on August 31, 2013

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