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Pratoman
Veteran Member


Date Joined Nov 2012
Total Posts : 4905
   Posted 11/8/2017 12:31 PM (GMT -7)   
This might be long, bear with me, i need educated opinions.

A few weeks back i was admitted to the hospital in Florida with 103+ fever. They did 7,366,798 blood tests and a chest x ray. What came back was a conclusion that i had a viral pneumonia (they still pumped me full of antibiotics, didnt tell me it was viral till i checked out). I got copies of all the bloodwork results and the x-ray. Was told to follow up with my doctor when i got home.

10 days ago, i saw my PCP. I have a great relationship with him and consider him a good doctor. Some of my friends used to see him but stopped, saying that in their opinions he is test happy and refers to a specialist too much.
So thats the background.

When i saw him last Monday, he observed that there was trace amount of blood in my urine (labeled "small" on the test results. Also he noted that my Hemoglobin and RBC count were both low, indicating that i had anemia.
Now some more background...about a year ago, maybe a little more, i had the same situation on the anemia, and my ferritin tested low. He sent me to a hematologist who did his own tests, then put me on iron pills. That did not help. So he gave me iron via IV, like a transfusion. That did the trick, i never followed up with him, after that, which he did tell me to do.

Ok back to now...so my PCP's tests came back. Today the PA calls me and tells me that it still showed microscopic blood in Urine, so i need to see a Urologist, not urgent but see one. I said i have one, and i have an appointment next week (its my surgeon)

Also, told me that my ferritin came back HIGH. So i should go back to the hematologist.
Ugh, back down the rabbit hole of testing testing and more testing.

I asked her to fax me the test results and when i got them i observed.

Yes, Ferritin was high, at 487, normal ref range 30 - 400. I saw on Dr Google that Ferritin for men has a ref range up to 500. But another said 300 (without differentiating by sex) . Also, one website, might have been Mayo, dont recall, stated that Ferritin above 1000 (same unit of measurement) would require a referral

However, Hemoglobin and RBC Count was normal

Re the blood in urine results....

the dipstick test was negative. The microscopic test which she said again showed hematuria, came back at 3/hpf, normal ref range 0-4. Now here, Dr google results took me to a website that said a 2 or 3 indicates hematuria. But this hospitals lab says 0-4 ref range.

So on these two issues, what gives?

I'm tempted to ignore it, but at the same time, afraid.

I'm also wondering, maybe my friends are right, maybe he refers to a specialist when its really not necessary. What he said is high, is borderline high, and in the case of the urine, according to the lab, yeah there were 3 RBCs per h/f, but up to 4 is normal?

Anybody have any thoughts on this? Do i need a new PCP? Am i overreacting? Do i really need to enter the rabbit hole?

Thanks, for any responses, i know this is a little off topic (although i wonder if the urine RBCs might be related to PC, or even to my ever so slowly rising psa

garyi
Regular Member


Date Joined Jun 2017
Total Posts : 238
   Posted 11/8/2017 5:24 PM (GMT -7)   
<<<This might be long, bear with me, i need educated opinions....

I'm tempted to ignore it....

Do i need a new PCP? Am i overreacting? Do i really need to enter the rabbit hole?>>>

OK Prato;

1. Follow your temptation,
2. Yes,
3. Definitely,
4. No, you need to climb out of it.

I love ya, bro....
70 years old @ Dx, LUTS for 7 years
PSA's never over 3.0
Ulcerative Colitis since 1973
TURP 2/16, G3+4 discovered,
3T MRI fusion guided biopsy 6/16
14 cores; G 3+3, one G3+4, Grade T1b
Second 3T MRI 1/17
RALP 7/17 Dr. Gonzaglo The Univ of Miami
G3+4 Organ confined
pT2c pNO pMn/a
Mostly Dry
10 week PSA .32
12 week PSA .40
14 week PSA .42
It's called Persistent PSA
Decipher & DCFPyL PET Scan

island time
Veteran Member


Date Joined Dec 2014
Total Posts : 1262
   Posted 11/8/2017 5:27 PM (GMT -7)   
let me tell ya what I think Pratoman. smile (although my opinion's uneducated....those will be along later...smile...so do with it what you will smile) ....or tell you...rather....about myself and my experience smile

When I was in the throes of my saga.....(lasted about a year....close to it...counting stricture work, DVT blood thinner... kidney stones...which, btw....trace blood can be a common symptom of...)

When I'm in *that* "mode" (if you will...which you may be.....considering your eminent test...which is *extremely* anxiety producing).....

My anxiety manifests itself....physically. I begin to think about my ailments. And when I begin to think about my ailments....I go to doctors. And when I go to doctors...I get copies of *everything*.....because....what I do with them is....I bring them home...and I go over them..every sheet of paper. I go over every bit of blood work....line by line....making sure nothing's even close. I google every single thing that could be even remotely considered to be.....close to being....borderline. And I look that up. The last time I was in your headspace....Prat, I had paperwork on my desk, floor, computer desk....I'd had so many blood tests....that....I had them spread out....3 or 4....comparing them for "trends". And then I'd think to myself...."Ya know.....I had some blood drawn 6 months ago. Where is that sheet? And I'd find it....so I could look at it and compare....to see...what if anything....was changing....and in what direction...and I'd look that up...to see what it *could* be. It filled my mind with stuff that....to be honest....wasn't the problem. The problem *I* had was....I was....for lack of a better term prat....traumatized....from all that was going on...not only in the physical realm....but in the emotional. It gave me a sense of control (I think). It made me *not* feel....because...as long as I was "on the hunt" (so-to-speak)....the emotions of anxiety, fear, and no control....would eat at me....to the point...that....it felt as if...I was missing something..that could possibly .... kill me.


I'm not saying that's what this is. I'm not saying that there's not something wrong with you that's gonna raise it's ugly head and make you wish you'd never been born. What I *am* saying is....that's where I've been with this stuff....(and probably....at some point...will be again...although I don't know that). But...right *now*....without the pressure of having been in the hospital lately (which for a year....I could never say...."I've not been in the hospital lately".....but you can....plus this ****ing disease....that in our case...wasn't a slam dunk....(which I hate for you....as I do for myself)....because...it's never far away...even though we push it away....and have reprieves. But you really have been sick lately....*go to the hospital* kinda sick....and that....along with this other crap....is enough...or has been with me anyway (I used to be ashamed to admit...but now...you've helped me to overcome my .... umm...*embarrassment*?.smilesmile And thank YOU SO MUCH FOR ALL YOU HAVE DONE FOR ME PRAT! smilesmile

you understand...in some special way....you just have *that* ability prat....whatever *that* is smile

I think you'll live. But then again....that just shows how much *I* know.

Good luck man...and again....thanks for bein' you
PSA 2010 thru 2014...4.0 +/- .7
Dx 12/14 @ 56 yo...2 cores G6 <5%, 1 core G6 20%, 1 core HGPIN.
RALP 11/25/15...3+4. 3 to 5 mm surgical margin 15% involvement pT2+
2/16-.01...4/16-.00...7/16-.00...10/16-.01...1/17-.01...4/17-.02...7/17-.02
10/17-.02

InTheShop
Veteran Member


Date Joined Jan 2012
Total Posts : 7912
   Posted 11/8/2017 5:43 PM (GMT -7)   
wow, you get really detailed results.
Last time I got a blood test, the lab sent an email saying, "Yup, that was blood."
I'll be in the shop.
Age 57, 52 at DX
PSA:
4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13, .6 11/13,
.7 5/14, .5 10/14, .5 4/15, .3 10/15, .3 4/16, .4 10/16, .4 5/17, .3 10/17
G 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
My latest blog post

Pratoman
Veteran Member


Date Joined Nov 2012
Total Posts : 4905
   Posted 11/8/2017 6:28 PM (GMT -7)   
Thanks for the responses. Gary, IT, not even sure what you said. In fact, not even sure what I'm asking. Probably just being my usual OCD self.

I hate doctors and tests rolleyes

Post Edited (Pratoman) : 11/8/2017 7:09:02 PM (GMT-7)


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3556
   Posted 11/9/2017 4:20 PM (GMT -7)   
What happened to your signature Prato ?
Age now 75 . Diagnosed G-9 6/2010. RALP, Radiation failed
Lupron, Zytiga, PSA <0.1 10/16 no change <0.1 5/17 PSA 1.6 Chemo or Provenge next..Sept '17, PSA now 9.2. ADT including Zytiga has failed. Will investigate treatment options. 11/17 PET/CT clear, but 4 new bone mets..Going to try Xtandi and see how I respond to that..

Pratoman
Veteran Member


Date Joined Nov 2012
Total Posts : 4905
   Posted 11/9/2017 6:32 PM (GMT -7)   
No clue Fairwind, I didn't notice it was missing until you mentioned it
Dx Age 64 Nov 2014, 4.3
BX 3 of 12 cores positive original pathologyG6, G6, G8 (3+5)
downgraded to 3+3=6 by tDr Epstein, JH
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology – G7 (3+4), ECE, Margivns, LN, SV all negative
PSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033
Decipher test, low risk, .37 score

Pratoman
Veteran Member


Date Joined Nov 2012
Total Posts : 4905
   Posted 11/9/2017 6:34 PM (GMT -7)   
And now it's back 🙄
Dx Age 64 Nov 2014, 4.3
BX 3 of 12 cores positive original pathologyG6, G6, G8 (3+5)
downgraded to 3+3=6 by tDr Epstein, JH
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology – G7 (3+4), ECE, Margivns, LN, SV all negative
PSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033
Decipher test, low risk, .37 score

Joe1.
New Member


Date Joined Sep 2017
Total Posts : 11
   Posted 11/9/2017 7:26 PM (GMT -7)   
Ferretin is what is called an acute phase reactant, that is it it becomes elevated during an infection and may stay high for awhile after the infection has passed. A bit over 400 is not that high. Among my many ailments is hereditary hemochromatosis (iron overload) and my ferritin was more than 2000 for nearly a year before they finally figured out the cause and it remained over 1000 during many months of treatment.

Have it retested in a few months if you are concerned but I would not worry at this point...
January 03, 2005 2.70
December 12, 2011 6.40
November 09, 2012 7.60
January 08, 2014 7.00
January 14, 2015 8.10
April 20, 2015 10.00
July 06, 2015 9.10
January 19, 2016 10.00
July 15, 2016 8.68
October 20, 2016 11.18
February 10, 2017 10.00 (Finasteride lowered it to 5 so doubled it)
April 6, 2017 3T MRI PI-RADS 4 - High
September 15, 2017 9.6 (4.8 on Finasteride)
October 13, 2017 8.0 (4.0 on Fina

PDL17
Regular Member


Date Joined Oct 2011
Total Posts : 463
   Posted 11/9/2017 8:25 PM (GMT -7)   
I'm sure your physician means well and is a very nice man, but he is an example of why healthcare costs are out of line in this country.

I think you are fine and probably could do without the referrals. This is only my opinion and I am not a physician.

Paul
Gleason 3+4; 5/16 positive cores; average volume 30%; PSA prior to tx 4.8
TX-IMRT + brachytherapy; IMRT Nov. 2011; Brachytherapy Feb. 2012
PSA April 2012--3.6
PSA May 2012--2.5
PSA Aug 2012--2.2
PSA Nov 2012--2.9
PSA Feb 2013--2.8
PSA May 2013--2.1
PSA Aug 2013--2.3
PSA Nov 2013--2.5
PSA May 2014--1.1
PSA Dec 2014--0.8
PSA Jun 2015--0.5
PSA Jan. 2016--0.4
PSA Aug. 2016--0.4
PSA Mar. 2017--0.3

Pratoman
Veteran Member


Date Joined Nov 2012
Total Posts : 4905
   Posted 11/10/2017 8:03 AM (GMT -7)   
Thanks guys.

@Joe, hood information. I've read about hemocratosis as a possible underlying cause of high ferritin. More important, as I mentioned in my first post, I was hospitalized with a viral infection, about 2 weeks before this latest test. So maybe that's the cause.
I made an appointment with the hematologist but with his PA, not him, so she'll just do the same tests he would and this gets me in quicker.

What is odd about this whole thing is that about a year or 16 months ago. I was treated for anemia, unknown cause, and I looked back at that time, my ferritin was 5.

@Paul, you are probably right. On the one hand, as a very nervous guy when it comes to healthcare, I'd rather be with someone like him (my referrral and test happy PCP}, being as cautious as he is. On the other hand all these tests and referrals make me more nervous. Not sure what the right thing to do is.

I'm still concerned about the trace blood in urine. I'm seeing my urologist/surgeon next week, I'll mention it to him. But I'm worried that he'll want me to do a chtoscopy. Which I've never done, and dread.

Thanks for the responses.
Dx Age 64 Nov 2014, 4.3
BX 3 of 12 cores positive original pathologyG6, G6, G8 (3+5)
downgraded to 3+3=6 by tDr Epstein, JH
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology – G7 (3+4), ECE, Margivns, LN, SV all negative
PSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033
Decipher test, low risk, .37 score

Joe1.
New Member


Date Joined Sep 2017
Total Posts : 11
   Posted 11/10/2017 9:22 AM (GMT -7)   
The ferretin of 5 with anemia is what would be expected, in the absence of an infection the ferritin will track hemoglobin (iron) levels. I give a pint of blood every 8 weeks to keep my ferretin between 20-30, but it took many months of one or two blood draws a week to get it that low.

A cytoscopy is not bad and watching the TV screen as they perform the procedure is actually pretty interesting. I'd have to say of all the procedures I've had done a cytoscopy was one of the easiest...

Mos_Ser
Regular Member


Date Joined Sep 2016
Total Posts : 23
   Posted 11/10/2017 11:43 AM (GMT -7)   
Prato, ferritin is one of non specific markers of inflammation ( acute phase reactant) and indeed often gets elevated with any inflammatory process ( like the one you recently had, which was pneumonia). It would be too premature to see hematologist - just retest in 2-3 month and take it easy.

As for few rbcs in your urine - the golden rule again, retest ! It again may be related to recent infection. It may need attention if it persists.

So my suggestion: retest until normal, i would say the likelihood of normal values on retest is quite high !

Pratoman
Veteran Member


Date Joined Nov 2012
Total Posts : 4905
   Posted 11/10/2017 2:24 PM (GMT -7)   
I'm thinking retest too, on the Ferritin. I'm sure thats what the Hematologist PA will do.
But the trace blood in urine showed up on a retest already (PCP retested before telling me to see the urologist.
Dx Age 64 Nov 2014, 4.3
BX 3 of 12 cores positive original pathologyG6, G6, G8 (3+5)
downgraded to 3+3=6 by tDr Epstein, JH
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology – G7 (3+4), ECE, Margivns, LN, SV all negative
PSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033
Decipher test, low risk, .37 score
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