Clinical facts to obtain

My hyponatremia has never been worked up. I've been supplementing about 68 milliequivalents of sodium a day for years and moved 2 mEq/L. I'd like serum osmolality, urine osmolality, urine sodium, urine urea, serum uric acid, an 8 AM cortisol, and TSH. I want to know the mechanism before we touch the ARB.

Given the recent bleed and my EPI, I'd like Ret-He or reticulocyte hemoglobin rather than ferritin alone — ferritin is an acute-phase reactant and I'm four weeks post-op. If IV iron is indicated, I'd specifically like ferric derisomaltose (Monoferric), not ferric carboxymaltose, because of the hypophosphatemia difference.

I'd like serum copper and ceruloplasmin on the August draw. I'm running zinc at a 15-to-1 ratio with copper, and I want to confirm copper status directly. Please read them against the CRP on the same panel — both are acute-phase reactants and I'm still post-op.

My blood pressure has re-baselined substantially. Across 59 readings, my fasted morning average at 40 mg is now 120/66, down from about 137/67 in early July, and my pulse pressure dropped from about 70 to 54 — which fits the anemia correcting rather than anything I changed. Given that, does 80 mg have any remaining indication? And if the case is nephroprotection rather than blood pressure, I'd like the UACR result to drive that decision.

✅ ANSWERED 8/3 — ulcers confirmed healed. Every gate that named ulcer healing is released. Still worth raising at the next contact: the eating window resumed 8/3 (noon → 8:30 PM), the 6:30 AM protein bite is cut, and Creon now paces across four eating occasions instead of five. Also for Murage and the PCP: both morning Adderall doses and the telmisartan are now taken fasted — a timing change in effect, not in dose.

I take Erinamax daily. I have exocrine pancreatic insufficiency and take prescription pancreatic enzymes, and I avoid dairy for a non-allergic sensitivity, so I need more detail than the label carries. Four questions.

1. Quantitative batch data. The label says batch testing shows "non-detectable or trace levels" of milk and soy — could you share the assay method, the LOD/LOQ, and results in ppm or mg per serving? A recent CoA would be ideal. "Non-detectable" against a 2.5 ppm ELISA and against a 20 ppm one are very different figures for me.

2. Form of the soy in the medium. Is the soy component of the ErinaPrime fermentation medium a hydrolysate or peptone, or intact soy flour / soy protein? Trypsin-inhibitor activity is the specific property I need to characterise, and hydrolysed and heat-treated soy generally carry little to none.

3. Lot transition. When did Erinamax move to ErinaPrime raw material, and from which lot numbers forward? I want to know whether the bottle I have is pre- or post-transition, since the allergen declaration appears to be new. My lot number is ______.

4. Erinacine A specification. The panel declares 5 mg erinacine A per 1,000 mg — 0.5%, or 5 mg/g. Nammex publishes ErinaPrime as standardized to 1% (10 mg/g). Is the 0.5% on your label a guaranteed minimum against a higher-assaying material, or the actual assay for the grade you use? I dose by erinacine A rather than by capsule, so a factor of two matters to me.

One note in case it's useful internally: several retailer listings and some of your own product copy still describe Erinamax as "allergen-free," which now conflicts with the "Contains: Milk, Soy" statement on the label.

Please update my chart: telmisartan is 40 mg, not 80 — I'm holding the step. Adderall is back to the full prescribed 70 mg a day. Both VM and Providence still show the old figures.