Health

💉 Vitamin B12 — the one real finding APPROVAL OPEN

Level148.4 pg/mL (Oct 20, Medellín panel) — insufficient. Folate 20.5, replete. PlanOne pre-treatment draw FIRST, supplement starts right after.

The draw (POCTLAB home visit, proposed Tue Oct 27 morning): anti-intrinsic factor antibody, anti-parietal cell antibody, absolute reticulocyte count, serum MMA, homocysteine (fasting), anti-TPO (once), plus a complete hemogram on the same sample. Bundle quoted Oct 22 at $625,416 COP. WhatsApp draft to POCTLAB (+57 333 257 8985) is copy-ready — it has to go out Mon Oct 26 for a Tuesday slot. Prep: pause biotin 48–72h before.

Why the draw comes first: once B12 supplementation starts, the cause-finding tests (pernicious-anemia antibodies, MMA, homocysteine) wash out and the "why is it low" question becomes unanswerable. One draw, then pills the same day — that sequence is the whole point.

Then: Jarrow Formulas Methyl B-12, 1,000 mcg sublingual — $76,000 COP at La Guía Veg, 1–2 business days delivery (verified in stock Oct 23). Single-ingredient only; folate is already replete. One consolidated repeat draw at 6–12 weeks.

Context: the Oct 23 9 AM booking was missed (no exam happened). Iron is NOT the story — TSAT came back 56.2% (high), ferritin 57.6, and FIT was NEGATIVE Oct 21, which closes the colonoscopy question. Avoid iron supplements and high-dose vitamin C.

Next step: Carlos approves → draft goes out today → draw Tue morning → B12 starts same day.

🦴 Left hip / waist pain (since April) PICK OPEN

Mild, intermittent soreness at the left iliac crest since a Bulgarian split squat in April — non-progressive over ~6 months. Assessment: one in-person sports-physio valoración first (palpation + hinge segmentation), imaging only if that says so.

Pick: Esencial Fisioterapia Integral (El Tesoro, WhatsApp +57 324 492 0816) — backup Wakeup (+57 301 756 8883). Nothing contacted yet.

Full hip detail — history, advice, options, exercises →

🦶 Foot — river injury, Sat Oct 24 HEALING CHECK

Foot wedged and twisted between rocks in the San Rafael river (no direct impact). Walked ~2h after; by evening could barely bear weight. Pain mainly on walking, ~1/10 on touch or toe-bending, no swelling or bruising. Read: mild dorsal midfoot sprain / jammed cuboid / bone bruise most likely; fracture not excluded.

Carlos's own test: first steps each morning — steadily improving = rest and stiff shoes; same/worse or new bruise/swelling = X-ray. The X-ray route is staged (Diagnóstico Cedimed, El Poblado, WhatsApp +57 317 893 2843) if the test fails. For December he wants modern stiff-shoe technology rather than a walking boot.

Next step: his call after his own check — no clinic move until he says so.

🧪 Lab panel — Oct 20 COMPLETE

Testosterone441 ng/dL total · calculated free T ≈66 pg/mL (low-normal). The direct ELISA free-T result (9.44) is a known assay artifact at his SHBG — discounted. ThyroidTSH 4.57 (up from 1.98), free T4 normal → recheck in a few months. Anti-TPO rides the pre-B12 draw. OtherApoB 80.5 (in range) · Lp(a) <3.1 (nil) · PSA 0.24 · hs-CRP 0.28 · prolactin 13.82, marginally high → one rested repeat planned. Sleep noteTypical night ≈ 6h solid + 1–2 lighter hours; the draw week was atypical, so 441 understates his rested baseline.

Quest (Oct 2) baseline stays excellent: total chol 142, LDL 63, HDL 57, TG 132, A1c 5.1%, vitamin D 43, CMP clean (bilirubin 1.2 = Gilbert pattern).

📋 Open health items UNBOOKED

Urology workup — 5-year history of straining / incomplete emptying. Urinalysis Oct 6 was completely normal, so the next step is functional: IPSS score, post-void residual, uroflow. Not yet booked. (No daily pill wanted; nothing in the pattern points there.)
7-day home BP average — first reading on record Oct 22: 127/81, HR 82, 57.2 kg. Home average still needed. Protein target ≈ 91–103 g/day.
Testosterone research — commissioned Oct 24 as a document (formats, risks, fertility, Colombia/Mexico cash-pay). Note: 441 ng/dL does not meet clinical TRT criteria; sleep + recheck are first line.