Blood Work

So, I got my annual blood work back. Regrettably, I disappointed my PCP by lowering my cholesterol by about 40 points. And by having a normal HBA1c (blood sugar). Given that he failed to diagnose either my cancer or my sleep apnea, he's really looking for something. I had the distinct feeling that my failure to need cholesterol meds, or to develop diabetes disappointed him. After all, I'm fat... I should be unhealthy.

However, it appears that my RDW is elevated, which he says means I'm bleeding somewhere. RDW is apparently partially the turnover rate for red blood cells and a measure of the differences in sizes between the cells themselves.

http://en.wikipedia.org/wiki/RDW

I asked him if the issue could be that I am still recovering from the cancer surgery in April. (My surgeon had two units of blood standing by for me; I needed neither of them.) He said no.

I asked him if it could be related to my sleep apnea, which, at the time of the blood draw, had been under treatment for about 3 weeks, and under effective treatment about 2 weeks. It seemed reasonable to me that the red blood cells, which are the carriers of oxygen to our cells should be affected by the repeated desaturations inherent in in the disorder, and that if I had been under effective treatment less than one full turnover of the cells (about 90 days), that it was reasonable that cells generated since treatment began might show different characteristics from those generated under apneic conditions. He said absolutely not.

He believes I am bleeding somewhere and is sending me for a colonoscopy, as discussed in this thread:

viewtopic.php?f=1&t=36909&p=321062&hili ... ia#p321062

I have been researching, and have found some studies which indicate that apnea does, in fact affect blood composition, including the plasma itself, but have not yet found anything specifically relating to raised or lowered hemocrit, raised or lowered RDW and apnea.

I know there are a number of folks here who HAVE researched the subject, and was wondering if you could point me to either threads you may know of or articles about same.

Thanks in advance.

I don't know the medical term but my doctor started getting worried by the higher than normal red blood cell count in my previous 3 blood tests. He had me wear an oximeter for a night and when the test results came back I got a phone call from his nurse asking me if I was at home because a DME was already on their way with an oxygen concentrator. My sats were very low. He scheduled me for a sleep test and now I wear a mask. Red cell count is definitely affected by OSA.

Dale

deerhound wrote:I don't know the medical term but my doctor started getting worried by the higher than normal red blood cell count in my previous 3 blood tests. He had me wear an oximeter for a night and when the test results came back I got a phone call from his nurse asking me if I was at home because a DME was already on their way with an oxygen concentrator. My sats were very low. He scheduled me for a sleep test and now I wear a mask. Red cell count is definitely affected by OSA.

Dale,

Wow, now that's interesting! I know that my RT indicated that if my sats didn't come up with effective treatment, we might have to add oxygen to my treatment, but the subject was dropped when I was doing so well with pain relief from sleeping properly. Perhaps I should call on Monday and ask about an oximeter test WITH my Bipap...?

Thanks for your input!

Looking forward to reading more on this - glad you brought the subject up. Makes sense to me that the blood could be affected, but this is one topic that I've not read anything about nor has it even crossed my mind. I love learning new things! Wouldn't the RDW have to be in conjunction with other measures to determine the cause? Would it be overkill to get a consult with a hematologist? Maybe with the scope your doc is trying to err on the side of caution considering the history of missing things before. Scopes are a good idea for many reasons, but if the RDW is the one and only good reason to get scoped, I certainly understand you wanting to make sure you really need it before going forward.

kteague wrote:Looking forward to reading more on this - glad you brought the subject up. Makes sense to me that the blood could be affected, but this is one topic that I've not read anything about nor has it even crossed my mind. I love learning new things! Wouldn't the RDW have to be in conjunction with other measures to determine the cause? Would it be overkill to get a consult with a hematologist? Maybe with the scope your doc is trying to err on the side of caution considering the history of missing things before. Scopes are a good idea for many reasons, but if the RDW is the one and only good reason to get scoped, I certainly understand you wanting to make sure you really need it before going forward.

It's recommended, among other things, that everyone over 50 be scoped -- and I'm 56 and haven't had one. In addition, apparently one of the first places cancer spreads to from the uterus -- and I had uterine (endometrial) cancer surgery in April -- is to the colon. The post surgery labs on the lymph nodes and everything did not show it has spread, and my four-month test was also negative, but it's still wise to check. Which is why, when my husband pointed out that I didn't have to do the test if it was going to upset me (and it does), I said that I felt I did have to.

However, I want to go into something with the confidence that all avenues are being explored. I'm keeping my fingers crossed that everything will come up normal with the scope, but, since there is the abnormality in the blood work, I want to look at what other possibilities there might be. And it may be something as easy as my apnea finally getting treated, or possibly needing to add oxygen to the treatment.

Deerstalker's note on his experience was emphatically interesting to me. And yes, I like learning new stuff. We already know apnea can affect cholesterol, and blood pressure and a whole raft of other things. Why not the RDW and hematocrit?

As I understand it, the RDW is one of the tests used to help diagnose the cause of anemia. So your doc could be thinking bleeding somewhere because of this test result and your cancer history. A lot of these tests are not very useful standalone but can become very meaningful in the context of medical history and current symptoms.

Everyone seems to dread colonoscopies for a variety of reasons. I was totally terrified but with long-standing ulcerative colitis I now have to have them every two years. It's the prep that's actually the worst part. There are sedation meds for the procedure itself so it is not painful. Even though I don't like them, I also don't want to be diagnosed with late-stage colon cancer so I do follow my GI doc's recommendations.

Mindy

A couple times I've had endometrial biopsies. My GYN said endometrial cancer and colon cancer share a common implicated gene, and our family is ripe with colon cancer. That was the first I'd heard of any connection. Sounds like you're overdue for being scoped even without your medical history. I've had several of them myself, upper and lower. with my family history and already having had polyps removed, I've resigned myself to them being a part of my life. Let us know how things progress.

I agree with Mindy re colonoscopies. The actual procedure with mild sedation is easy, you just doze off and it's over. I had one in October and had to drink two small bottles (3 oz or so) instead of the gallon of stuff previously used. Nothing to be afraid of.

Better to know if anything is going on in there!

mindy wrote:As I understand it, the RDW is one of the tests used to help diagnose the cause of anemia. So your doc could be thinking bleeding somewhere because of this test result and your cancer history. A lot of these tests are not very useful standalone but can become very meaningful in the context of medical history and current symptoms.

I would probably take the issue about "bleeding" more seriously if it weren't for the fact that the RDW was high last year, and my absolute neutrophils were low -- and the cancer was discovered about 2 months later. (NOT by this doctor -- I self-diagnosed a problem and took myself to a gynecologist. This doctor was unconcerned about those levels last year.) This year, the neutrophils are normal, but the RDW is still elevated, and suddenly, I'm bleeding somewhere, but the fact that I lost significant blood in surgery this year AND that my apnea is finally getting treated is irrelevant is not something I swallow readily.

Definition: http://en.wikipedia.org/wiki/Neutrophils

Everyone seems to dread colonoscopies for a variety of reasons. I was totally terrified but with long-standing ulcerative colitis I now have to have them every two years. It's the prep that's actually the worst part. There are sedation meds for the procedure itself so it is not painful. Even though I don't like them, I also don't want to be diagnosed with late-stage colon cancer so I do follow my GI doc's recommendations.

I don't wish to be diagnosed with colon cancer, either, which is why I'm going ahead with the test. I have done a clean-out in preparation for my surgery, but it was not quite as restricted because my surgeon was not going to be looking at my colon. I have strict dietary limitations which make most of what is typically permitted during a clean-out NOT permitted, and the things I do tolerate (like blueberry or tart cherry juice) are not permitted because of the coloring. Moreover, I have a very low pain threshold combined with a terror of anesthesia which pre-dates any obvious apnea symptoms, but which was confirmed by the fact that I nearly died after gall bladder surgery in 2001. I spent 25 years with undiagnosed gut issues (Oh, stop stuffing your face and lose some weight, and it'll clear up. Take a little lomotil if it bothers you.) By following my strict diet, I no longer have those issues, yet it is psychologically traumatic, after fighting for control, to voluntarily swallow something to induce diarrhea in preparation for voluntarily submitting to anesthesia.

As a consequence, although I'll go through with it, I want to know about other things -- possibly related to the apnea -- which could cause these symptoms, since I do know that apnea CAN affect the blood.

Just FYI, I consistently have low white cell count. No one knows why, though.

About the colonoscopy: I've had several routine screenings. I also have GERD, so last time I scheduled my endoscopy and colonoscopy for the same time. If you are likely to need an endoscopy, they often do them at the same time. The first colonoscopy I had I was fascinated to watch. Usually you don't stay awake but I did and it was very cool. Perhaps it seemed so cool because of the drugs they gave, I was kind of happily floating along watching the camera. I don't drink or do drugs otherwise because I don't like the feelings I get from them (kind of numb and dizzy, plus a hangover during the time I'm drinking, yuck). But these drugs were definitely more pleasant. The prep is kind of yucky. Perhaps they should give the drugs for the prep, too. Just kidding, haha .

Floating and fuzzy is the last thing you want to be for the prep.

O.

RosemaryB wrote:Just FYI, I consistently have low white cell count. No one knows why, though.

I do wonder if it's any relationship to the OSA, then....

About the colonoscopy:

Yes, I know quite a bit about colonoscopies -- you can't hang around lists devoted to Crohn's, Ulcerative Colitis, and other fun things without learning more than you ever wanted to know about such procedures, as well as, in graphic detail, what various kinds of poop look like!

However, based on the clean-out for the surgery, I agree with Ozij! Yah don't want to be doing a "Space... the final frontier... it's in between my ears!" when doing one of those! When the "urge" hits, you don't want to be more than about a foot from the porcelain throne!

ozij wrote: Floating and fuzzy is the last thing you want to be for the prep.

Amen to that. Now, will you riddle me this? Why is it, I'm asking about blood work and the values in relation to OSA, and everyone chimes in on the colonoscopy? Same thing happened on another Forum where the focus ought to be on blood work, and the thread ran off onto the colonoscopy....

Kiralynx wrote: ......... Now, will you riddle me this? Why is it, I'm asking about blood work and the values in relation to OSA, and everyone chimes in on the colonoscopy? Same thing happened on another Forum where the focus ought to be on blood work, and the thread ran off onto the colonoscopy....

It happens all the time here. We are an undisciplined group. Some doctors are finding that 80% of their ADD/ADHD patients have sleep apnea. In fact sleep apnea is the most common cause of ADD/ADHD. This has an impact on the threads here!

Can someone post a good recipe for hummus with asparagus and garlic?

rooster wrote:It happens all the time here. We are an undisciplined group. Some doctors are finding that 80% of their ADD/ADHD patients have sleep apnea. In fact sleep apnea is the most common cause of ADD/ADHD. This has an impact on the threads here!

Actually, there's also a high relationship in ADD/ADHD with the sugar /refined carbs and their effect on the problem. It runs in my family -- and guess what... it has all but gone away with the diet I follow. Maybe getting my apnea treated will handle the rest.

Can someone post a good recipe for hummus with asparagus and garlic?

Probably not, since I don't use chick peas. However, I've made a dandy one with navy pea beans or split red lentils. Are you wanting the asparagus mashed in as part of the hummus?

Drat it, now you're distracting me in the middle of my own thread....