Labs — 2025 baseline summary

Function Health panels drawn May–June 2025, ~10 months before the cold-turkey + benzo crisis. These are the most recent comprehensive labs on Dad and the right baseline reference for current care.

Framing. This is Paul's lay reading for the family record. Not clinical advice, not a diagnosis. The care team should be handed the original PDFs (in this folder).

Headline takeaways

1. Severe insulin resistance + atherogenic dyslipidemia at baseline. Fasting insulin 57, A1c 5.8%, TG 237, HDL 26, small dense LDL pattern B with LDL-P 1789. This is the metabolic phenotype that Zyprexa (olanzapine) is well-documented to worsen. The Haven team should know about this before setting a Zyprexa duration.
2. Liver, kidney, electrolytes, magnesium all normal pre-crisis — good news for Zyprexa metabolism + QT risk, but worth a recheck now that he's on it.
3. Sustained high-titer ANA (≥1:1280) on two draws, all specific autoantibodies negative. ESR + complement normal. Could be drug-induced (long Xanax history) or pre-clinical. Historical context for the team in case any autoimmune-looking symptoms appear.
4. GRAIL Galleri MCED: no cancer signal detected.

Out-of-range findings

Metabolic / cardiometabolic — the big story

Relevance to current care: Olanzapine has the worst metabolic profile in its class — well-documented weight gain, increased fasting glucose, increased triglycerides, worsened insulin resistance. Dad's pre-Zyprexa baseline already shows this metabolic phenotype. The right monitoring cadence is more aggressive than for a metabolically healthy patient: fasting glucose / A1c / lipids on a defined schedule, plus weight. Worth raising with Dr. Ignatov at the medication review.

Autoimmune — high ANA, no specific antibody pinned down

Two draws, both showing positive ANA at the top of the titer ladder:

Follow-up specific autoantibody panel (6/5/2025) — all negative:

• Anti-dsDNA (Crithidia IFA)
• Chromatin (nucleosomal)
• Sm, Sm/RNP, RNP
• SS-A, SS-B (Sjogren's)
• SCL-70 (scleroderma)
• Jo-1 (myositis)
• Centromere B
• Cardiolipin IgA/IgG/IgM
• β2 Glycoprotein I IgA/IgG/IgM
• Rheumatoid factor IgA/IgG/IgM
• Cyclic citrullinated peptide (CCP)
• Mutated citrullinated vimentin (MCV)
• Thyroid peroxidase + thyroglobulin antibodies

Plus: Complement C3 153 (normal), C4 27 (normal), ESR 9 (normal, <20), Rheumatoid factor <10 (negative).

Reading: Positive ANA without specific antibodies + normal ESR + normal complement is consistent with drug-induced ANA (chronic benzodiazepine use has been associated with this), pre-clinical autoimmunity, or false-positive in the absence of clinical symptoms. Not actionable on its own — historical context for the care team if any autoimmune-looking signs appear.

Hormones

Lab note flags the testosterone range: "Men with clinically significant hypogonadal symptoms and testosterone values repeatedly in the range of 200–300 ng/dL or less may benefit from testosterone treatment after adequate risk and benefits counseling."

Cardiovascular fatty-acid status

• OmegaCheck (EPA+DPA+DHA) 3.0% by wt — Cleveland HeartLab cutoffs: ≥5.5% optimal, 3.8–5.4% moderate, ≤3.7% high relative risk of sudden cardiac death. Worth knowing given his existing CAD.
• Omega-6/Omega-3 ratio 12.5 (range 3.7–14.4) — high end

Nutrient borderlines

• Vitamin D 38 (range 30–100) — sufficient but not optimal
• Ferritin 31 (range 24–380) — low end of normal
• Hemoglobin 13.2 (range floor 13.2–17.1) — exactly at the floor

Looking normal (good baseline for current care)

• Liver: AST 19, ALT 15, alk phos 72, GGT 39, total bilirubin 0.4
• Kidney: creatinine 1.10, BUN 20
• Electrolytes: Na 140, K 4.0, Cl 102, CO2 31, Ca 9.6
• Magnesium RBC 6.1 (range 4.0–6.4) — high-normal
• Thyroid: TSH 1.50, free T4 1.2, free T3 3.0, TPO + Tg antibodies negative
• B12 functional: MMA 181 (range 69–390), homocysteine 10.8 (range <11.4)
• PSA: total 0.9, % free 33% — low prostate cancer risk
• Heavy metals: lead <1.0 (range <3.5)
• Zinc 91 (range 60–130)

The liver / kidney / electrolyte / magnesium picture matters now because Zyprexa is hepatically metabolized and carries QT-prolongation risk. Baseline normals are reassuring, but these should be rechecked on-drug.

Cancer screen

• GRAIL Galleri (multi-cancer early detection), 2025-06-05: No cancer signal detected. Negative predictive value 98.5% per the PATHFINDER trial.

Questions worth raising with Dr. Ignatov

1. Has the Haven / NeuroBehavioral team seen baseline metabolic + lipid labs? Given the Zyprexa start and Dad's pre-Zyprexa A1c 5.8 / insulin 57 / TG 237 / HDL 26 / atherogenic small-dense LDL pattern, what's the monitoring cadence on Zyprexa?
2. What's the plan to recheck the insulin-resistance markers (fasting glucose, A1c) at, say, 4 weeks and 12 weeks on Zyprexa?
3. EKG on file? Dad has CAD (quad bypass), and Zyprexa carries QT risk. Baseline electrolytes were OK (K 4.0, Mg RBC 6.1), but is there an on-drug EKG?
4. Awareness of the high-titer ANA history (1:1280, sustained on retest, all specific antibodies negative, ESR + complement normal)? Long-term benzodiazepines have been associated with drug-induced ANA — worth knowing as historical context.
5. Omega-3 status: EPA+DPA+DHA at 3.0% (high relative risk of sudden cardiac death per CHL cutoff). Given CAD history, worth flagging for the post-discharge plan.