Ron's test results

[Rorinsmith]

Hey guys,
Seems to be a popular week for analyzing test results so I thought I'd throw mine into the pot. These are what was supposed to be results from my six month follow up test but just now happened because of my doctors sudden decision to refer me to an Endocrinologist and the ensuing hassle I went through to find one. Before I list these I want to get your thoughts on a couple of questions/concerns I have:

In a hand written note attached to my lab results from my Endocrinologist (Dr. N.) she tells me I have high cholesterol (HDL - 39, LDL - 213) and wants me to start taking Lipitor. She says the likely cause of this is my HIV meds. When my HIV Doc started me on the meds eight years ago he told me they would probably affect my cholesterol. I had never been tested for this before and he made no mention of scheduling future cholesterol tests. Getting this done has always been in the back of my mind and my concern has been on how I'm supposed to be able to take the tests. I've always heard that fasting had to be done before taking them. With the HIV cocktail I take twice daily, at least one of the meds requires that it be taken with food. So how am I supposed to do this? I can't skip any of these meds because they all work together. On three separate occasions with three different doctors I've asked this and have gotten the same "deer caught in the headlights look" from each of them. They have no idea what to tell me to do. Dr. N. told me that the HDL and LDL could be done without fasting but the triglycerides could not be. She said she wasn't really concerned about the triglycerides anyway. Since I didn't fast for this I'm concerned about how accurate the results are. Especially the triglycerides. So this all makes me want to ask you guys who are on HIV meds, and I'm especially thinking of Nelson, how do you handle taking tests that require fasting? Nelson, I know you take a cocktail similar to mine which consists of Norvir, Prezista, Viread and Issentress. Viread is taken once a day and the others are taken twice a day. Help from you guys on this is GREATLY appreciated!

As for the second question, the note from Dr. N. also stated that my free testosterone (179.9) is too high and she wants me to reduce my Androgel to 7.5 gr from the usual 10gm. My immediate reaction to this was WTF!!! As I understand it the standard range for free is 47-244. That puts me at the upper end which I always thought was supposed to be a good thing! Why is she telling me this? Maybe there's something you'll find in my results that will explain this. Of course if I reduce the Anrogel it's going to lower my total which is 822. I'm a happy camper with this number and hate to see it go down.

Lastly, I want to point out that I do not plan on keeping Dr. N. Some odd and frustrating things have happened in the past week regarding her and mostly her assistant. I feel like I've been placed in an uncomfortable and awkward position and want out. It's too much to go into now and is a story for a different day. Once I get feedback from y'all I'll delve into it and spill. It's something I'm sure each of you will have an opinion on and I look forward to hearing them all! Have a good day, Gents!

Ron

TEST RESULTS

Done by Quest Labs on 04/18/14

LIPID PANEL
Triglycerides 229 (<150 mg/dl) H
Cholesterol, Total 298 (125-200 mg/dl) H
HDL Cholesterol 39 (> OR = 40 mg/dl) L
LDL Cholesterol 213 (<130 mg/dl (calc)) H
Chol/HDLC ratio 7.6 (< OR = 5.0 (calc)) H
Non-HDL Cholesterol 259 ( mg/dl (calc)) H

COMPREHENSIVE METABOLIC PANEL
Glucose 100 (65-99 mg/dl) H
Urea Nitrogen (BUN) 37 (7-25 mg/dl) H
Creatinine 1.58 (0.70-1.33 mg/dl) H
eGFR Non-Afr. American 47 (> OR = 60 mL/min/1.73m2) L
eGFR African American 55 (> OR = 60 mL/min/1.73m2) L
BUN/Creatinine Ratio 23 (6-22 (calc)) H
Sodium 140 (135-146 mmol/L)
Potassium 4.3 (3.5-5.3 mmol/L)
Chloride 107 (98-110 mmol/L)
Carbon Dioxide 22 (19-30 mmol/L)
Calcium 9.3 (8.6-10.3 mg/dL)
Protein, Total 7.4 (6.1-8.1 g/dL)
Albumin 4.4 (3.6-5.1 g/dL)
Globulin 3.0 (1.9-3.7 g/dL (calc))
Albumin/Globulin Ratio 1.5 (1.0-2.5 (calc))
Bilirubin, Total 0.4 (0.2-1.2 mg/dL)
Alkaline Phosphatase 69 (40-115 U/L)
AST 21 (10-35 U/L)
ALT 35 (9-46 U/L)

HEMATOCRIT
Hematocrit 48.0 (38.5-50.0%)

ESTRIDOL
Estridol 36 (< OR = 39 pg/mL) (ultrasensitive)

PSA, TOTAL
PSA, Total 1.1 (< OR = 4.0 ng/mL)

SEX HORMONE BINDING GLOBULIN
Sex Hormone Binding 32 (22-77 nmol/L)

TESTOSTERONE, FREE AND TOTAL, LC/MS/MS
Testosterone, Total, 822 (250-1100 ng/dL)
Free Testosterone 179.9 (35.0-155.0 pg/mL) H


Note:
Test total and free labs were also done on 02/20/14 at Providence Medical Center Lab. Results were Total: 836 and Free: 170. I don't know if there's been an actual change since that time or if it's because they were done by a different lab. Dr. N. seems to prefer Quest for accuracy.

 

[Rorinsmith]

Hmmm. Posted this two days ago and no responses. Moderators? It doesn't bode well for the site when you ignore members who are asking for help.

 

[Nelson Vergel]

Rorinsmith

Sorry about that. You posted it on "how to use this site" and I just moved your post where it should be. I have been on the road for the past few days.

I encourage everyone to remind us when we forget to reply.

I have a few very important comments to make. Keep in mind that I am not here to give medical advice, but as you know I am pretty well educated on HIV.

Your testosterone, estradiol, etc is great. Your hematocrit is really good also. Stay on your ground and do not accept a dose change.

Your liver is great and obviously not affected by your HIV meds.

I am very concerned about your kidney function. Your creatinine clearance is only 47. It should be above 65 at least. Your kidneys are being affected by tenofovir. How is your blood pressure, height and weight?

Your LDL and triglycerides are slightly elevated but that can be an effect of the protease inhibitor plus Norvir you are taking.

So, to improve your lipids and your kidney function, I would suggest that you talk to your doctor about switching you to an integrase inhibitor and replace the tenofovir (Viread) for abacavir (Ziagen). They will have to do a special test to ensure that you do not have a mutation that can make you prone to rash caused by abacavir first.

The integrase drug is Tivicay. So you would take one pill of Tivicay and one of Epzicom (abacavir plus epivir) once a day. This combo will soon be available all in one pill per day. No Norvir!


As you know, I have a column on TheBody.com and have helped people like you who may have to switch due to side effects. Switching is safe if you have undetectable viral load and no resistance to the meds you are switching to.

Let me know what city you are in to see if I know a HIV doc who would have picked up on this basic stuff that any educated doctor should know.

 

[Vettester Chris]

Hmmm, posted in the wrong section, but yet doesn't bode well on us? I think my fellow moderators and plenty of members provide ample responses, when time is permitting. Keep in mind, most of us have demanding careers and other aspects in our lives that can be quite demanding. Sometimes things get a little behind, and if needed a simple "bump" can be perceived a little more receptive than being called out as "ignored". I understand your feelings Ron, but we also have feelings, and volunteer our services when we can. Enough said ...

On your labs, here's the deal, most of us not in the loop with the HIV protocols won't have much input on that matter. The only thing I can see is testosterone, which basically looks great, E2, which maybe can drop a minimal amount (if needed), just depends on any sides and how you feel. SHBG is just reflective on the unbound testosterone (that and Albumin on a lighter scale), and none of that is IMO a eye catcher. Liver enzymes look fairly good, BUN just a tad high, but that's probably just protein related and consuming thereof in your diet. Essentially, on what you provided, there's really nothing grabbing anyone to make some significant talking points, except with Nelson or anyone else on the HIV medication part of it.

Lastly, Ron, just so you know, what will get my eye and many others is when we have a TOTAL profile provided .. Thyroid (FT4, FT3, RT3, antibodies), Adrenals (DHEA-S, Cortisol, Adosterone, ACTH), Iron, Ferritin, Magnesium B12, D3, Prolactin, IGF. Let us know if you have this and we can provide a lot more thorough answers. Thanks

 

[bruin]

you may be ready to consider a switch to another combo or regimen altogether, I would not personally want to have to take another pill, if I had the option to get off of the drug that was causing a negative side effect. while I know there are "diets , supplements and foods" we can do to naturally lower cholesterol, I would look into natural dietary changes, in spite of the drug.

 

[Rorinsmith]

Rorinsmith

Sorry about that. You posted it on "how to use this site" and I just moved your post where it should be. I have been on the road for the past few days.

I encourage everyone to remind us when we forget to reply.

I have a few very important comments to make. Keep in mind that I am not here to give medical advice, but as you know I am pretty well educated on HIV.

Your testosterone, estradiol, etc is great. Your hematocrit is really good also. Stay on your ground and do not accept a dose change.

Your liver is great and obviously not affected by your HIV meds.

I am very concerned about your kidney function. Your creatinine clearance is only 47. It should be above 65 at least. Your kidneys are being affected by tenofovir. How is your blood pressure, height and weight?

Your LDL and triglycerides are slightly elevated but that can be an effect of the protease inhibitor plus Norvir you are taking.

So, to improve your lipids and your kidney function, I would suggest that you talk to your doctor about switching you to an integrase inhibitor and replace the tenofovir (Viread) for abacavir (Ziagen). They will have to do a special test to ensure that you do not have a mutation that can make you prone to rash caused by abacavir first.

The integrase drug is Tivicay. So you would take one pill of Tivicay and one of Epzicom (abacavir plus epivir) once a day. This combo will soon be available all in one pill per day. No Norvir!


As you know, I have a column on TheBody.com and have helped people like you who may have to switch due to side effects. Switching is safe if you have undetectable viral load and no resistance to the meds you are switching to.

Let me know what city you are in to see if I know a HIV doc who would have picked up on this basic stuff that any educated doctor should know.

Nelson,
Thank you from the bottom of my heart for getting back to me and sharing your incredible wisdom. You've given me some knowledge here that has never been shared by my doctor. And I think there's a reason for that which I'll get to in a little bit. First, some answers to your questions: Blood pressure, both numbers, have been just slightly elevated since starting TRT. Both HIV Doc and PC Doc don't seem concerned about it. I figure it's due to my increase in body weight. I'm 6'-0" tall and 238 lbs. Was 205 when I first stated TRT in February of last year. Jumping to your last question, I live in Rhododendron, OR which is in the highlands of Mt. Hood. Portland is the closest city at just over an hour away. If you can refer me to a Doc in Portland I'd be thrilled! I've already fired one HIV Doc and am about ready to boot the second one. Both, along with my PC Doc whom I love, are at Portland Providence Medical Center. I'm really irked at both HIV Docs for not monitoring this cholesterol situation. Also irked at the second one over his decision to stop working with me on TRT. I'm pretty sure that decision was based on the Androgel lawsuit issue. I plan to have a discussion with him about it when I see him in a couple of weeks. Also not happy with the fact that he referred me to a deaf endocrinologist. And I mean deaf literally.


Regarding the creatinine clearance of 47, I'm really surprised. I figured it would be way too high considering I use a creatine supplement. What should I be doing for this other than trying to get off the tenofovir?


As for getting off the Norvir, I love the option you've suggested but unfortunately I'm afraid I have to throw a monkey wrench into the situation and it has to do with viral load. I seem to be one of the odd ducks who has a viral load that after eight years has never dropped to zero. And yes, I do take my meds. I take them religiously twice a day as I've been told, have never skipped a dose or messed up with them in any way. In my last HIV test in November last year it dropped to 99 which is the lowest it's ever been. In the previous test done in May of last year it was at 250 down from 288 at the same time the previous year. I like to think TRT played a big role in this since it was started in February of 2013. My CD4 count seems to fluctuate a bit but has been around 600 for the past few years. In the November test, again being on TRT and at a stronger dose than in the Spring, it came in at a whopping 1,984! And weather this makes any difference or not, I have not had a cold, flu or any other viral infection since I first started the meds. I'm current on all my vaccinations except for the Whooping Cough one. I get a flu shot every October.


With the viral load info in mind, I think this is why my Doc has never brought up the option you mentioned. Maybe he's saving this to spring on me when I've reached zero or below. I just hope he's going to pay closer attention to my kidney function and cholesterol for now on. My next annual visit with him is scheduled for May 29th. Yesterday I had labs done required for that visit. I should have the results by the end of next week. I'm really anxious to see where that viral load is! I'll let you know what I find out. If you have any additional thoughts or concerns about what I've told you please let me know. Nelson, there are no words I can use to express my gratitude for all you've done to help me. From page one of BUILT TO SURVIVE you've led me on an incredible life saving journey that continues to get richer each day I visit this site. I know I can always depend on your knowledge and guidance. Again, thank you from the bottom of my heart.


And one last thing! I'm sorry I messed up trying to send the original post. I thought I was sending it from a proper place but I guess I wasn't. I'm confused now because after I sent it I went back to the home page to see if it added to top of the list the Most Recent Topics and it did. I then logged off the site and immediately logged back on to see if it had actually taken and it did. It was still at the top of Most Recent Topics. I thought "Perfect!" and went on my merry way!

All my best,
Ron

 

[Nelson Vergel]

Ron

Thanks for your kind words about Built to Survive. I am glad it was able to help people who were desperate to stop and reverse wasting syndrome when it was one of the main causes of death for people with HIV.

The low creatinine clearance is explained by the fact that you take creatine supplements. These supplements can load up the kidneys. Some say that this load is not really clinically relevant. The jury is still out.

If you could, stop the creatine for at least 3 weeks and get your lab work done again.

Also, please ask your current doctor to pull out a copy of your latest genotype resistance test and post it on here. This is like a map that can tell me what meds would work for you. Then we can see if a protease inhibitor free regimen could work for you. The integrase inhibitor class really is the friendliest of all when it comes to lipids and side effects.

I would try to follow the suggestions shown in my non-profit's website to bring your LDL and triglycerides down (scroll down to "nutrition"): http://powerusa.org/programs.html

Here is a list of progressive HIV doctors around the US. I have not checked to see if any of these doctors are still in practice (It is a 10 year old list): http://www.medibolics.com/physic2.htm

The doctors in this list are also hormone savvy, so you may not need an endocrinologist.

Please let me know if I missed anything.

Nelson