so, i sent this to the gastro-enterologist....

what i'm thinking is that the fit test should rule out bleeding in the bottom half and then i can talk to him about whether he thinks a ct scan is a better approach than a fobt to rule out bleeding in the upper half.

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hi.

this fax is from jessica parent, in a follow-up to the appointment that was had on april 29th @ 11:40. it was determined at that time that your office would call me back on the week of may 3rd to schedule a scope, which did not happen. at this time, rather than schedule a scope, i am hoping that i can schedule a follow-up appointment to speak with dr. *****  a second time.

i want to provide the following information for such a follow-up:

regarding colon issues:
the issue regarding the colon is to determine whether i am bleeding or not, and also to determine if i'm having an immune response. i have now done four sequences of blood tests with many results and believe it appears to be exceedingly unlikely that i am bleeding anywhere at all.

1) my ferritin increased rapidly from 6 to 17 after going on 300 mg/day of iron supplements for two weeks, suggesting i don't appear to be losing blood. 
2) my reticulocytes were normal to lowish, indicating i am not overproducing blood.
3) my haptoglobin was in the exact middle of the range, indicating that any deficit in rbcs would be at the production stage rather than the loss stage.
4) my igA, igG and iGM levels as welll as rheumatoid factor are all low, indicating i'm not having an immune response. my serum protein electrophoresis was also normal.
5) my vitamin d is in normal ranges, indicating i can at least absorb one type of fat soluble vitamin.
6) there's no blood or albumin in my urine, indicating i'm not bleeding through that pathway.
7) my ck & ldh came in normal, indicating i'm not experiencing organ failure or damage and not rupturing via that pathway.

my next scheduled blood work will test for vitamins a, e and k, which will provide further evidence regarding the absorption of fat soluble vitamins. while dr ***** has already ordered an fobt, i have not done that as i am on iron pills and have a diet high in vitamin c. i am going to call dr ***** on monday and request a fit test, which will allow me to test for blood in the stool.

given that there is no indication of bleeding, i believe that a fit test is a more appropriate screening procedure than a colonoscopy, and that a decision on a colonoscopy should be postponed until the results of the fit test are in everybody's inboxes.

regarding stomach issues:
the issue regarding the stomach was mostly concerns regarding absorption, although the fobt was also ordered to check for bleeding.

as before. there is little indication that i am bleeding.

regarding celiac,

1) there is no family history of celiac disease on either side of my family.
2) i have now been tested or will be tested for the following minerals and vitamins:

a - pending
b1 - next time
b2 - next time
b3 - next time
b5 - next time
b6 - next time
b7 - next time
b9 - absorbing
b12 - absorbing, but rechecking.
c - next time
d - absorbing
e - pending
cholesterol - perfect
k1 - pending
sodium - absorbing & regulating
potassium - absorbing & regulating
magnesium - absorbing & regulating
phosphorus - absorbing & regulating
chlorine - absorbing & regulating
calcium - absorbing & regulating
chromium - next time
manganese - pending
iron - not absorbing in food, but absorbing in pills
nickel - next time
copper - pending
zinc - absorbing & regulating
selenium - pending
molybdenum - not available
iodine - pending

as i am absorbing everything so far except for iron, this would not indicate a general absorption problem, and would make celiac disease very unlikely. i would consequently propose that any stomach scope be postponed until i can talk to dr ****** a second time, as i can't see any reason to test for celiac, at this time.

i suspect that the problem is a genetic condition that reduces iron absorption, and that this is being exacerbated by some combination of falling estradiol levels, high amounts of dietary calcium, phytic acid, tannins and, potentially, oxalates. that is, this seems to be some combination of a dietary issue and a genetic issue, and the best idea is probably just to stick with iron pills.