Thank you, Greenshots -- I will do a search to see what Rich van K had to say about this. I had not thought to do that.
Although I am thorough, like to take a little bit of time to get the 'big picture' of a situation, and can be quite-a-bit-but-not-totally-overboard perfectionistic (which has mainly been used successfully in my life), I don't think I'm being "anal" and looking at unimportant, small abnormalities when wondering about my high-normal MCV result and how it might relate to pernicious/megaloblastic anemia, when several reasonable-sounding references have indicated that my MCV result might be considered to point towards having it. I will try to explain why--
For me, the idea of possibly having pernicious/megaloblastic anemia/B12/folate deficiency is *central* to my health concerns, and it has been ever since I lost part of my vision without warning about half a year ago, because I found out afterwards when I was searching for possible reasons for the vision loss that I have dozens of symptoms of B12 deficiency (from Freddd's big list of symptoms), and some of those symptoms I've had for a long time. They could be symptoms of something different, of course.
My reasoning for checking out B12/folate/B6 pernicious/megaloblastic anemia at the present time goes like this:
1a. If such a vitamin deficiency caused the damage in my optic nerves, then there is the possibility of gaining some of the vision back with proper supplementation of the correct versions and amounts of the vitamins (there have been cases reported of people getting back their vision in this way).
1b. If I understand which vitamins to supply myself with, there is every potential to stop this vision loss from progressing in the future.
2a. If the vision loss was caused by normal tension glaucoma, there is no possibility to gain any of it back.
2b. In that case, even with the sub-optimal treatment they have come up with for glaucoma (which does not work very well in normal tension glaucoma, is expensive, and has a lot of side effects), it is likely I will continue to have declining vision from now on, possibly even going blind by my 60s.
3a. If it was caused by optic neuritis, normally most people who have optic neuritis do regain their vision (at least after their first episode of optic neuritis) -- but that normally happens to them within 3 months, whereas my vision loss has not been restored, so I would be in the 10% who do not get the lost vision back relatively soon, if ever.
3b. As for the future, if I do have/did have optic neuritis, I could possibly have more episodes of it later, but the good news is that it usually doesn't cause a huge amount of vision damage, even over several episodes.
3c. However, the bad news is that, if I do/did have optic neuritis, with my background and age, I have a 75% chance in the next few years of being diagnosed with multiple sclerosis - yikes.
4. There are a handful of other things that might be causing the vision loss, which I've looked into a little (and some of the blood tests I did recently were to rule some of those things out), but those are the big 3 possibilities for me.
Therefore, I feel that it's a reasonable concern for me to investigate now what caused/is causing my vision loss.
The other health problems that I definitely have and that I might have (as indicated by the handful of surprising test results I got recently) are important too -- a couple of them are factors in multiple sclerosis and cancer.
Of course, it would be much smarter to do this initial research with the help of medical professionals! The first opthamologist I saw about this was expensive and not very helpful (and he refused to believe that vitamins could have anything to do with my situation, even though he said that my eyes looked like those of people who have toxic neuropathy due to their substance abuse's causing them to have vitamin deficiencies which cause damage to their optic nerves and other precious tissue), and I could be doing this now with a second-opinion opthalmologist, a neurologist, and hospital scans, but I really can't afford that -- and I do not feel comfortable seeking complete charity for medical treatment (which would probably not be possible anyway - for me, for my region, for my personal circumstances which include a cosigner on a student loan who I can't throw under the bus) unless it's a really serious health condition and can't wait.
I was hoping to get by until next March when I might have health insurance through the new US scheme, but my state refuses to cover low-income people in that scheme, so either the government will step in at the last minute to cover those millions of people (I read in a reputable newspaper a few days ago that the affected people will number 15 million across those states which are refusing to cover low-income people in the new program, even though the federal government would pay the entire cost of that coverage), or I might need to move to another state, which would not be easy or affordable.
So I'm trying to learn what I can on my own about my main health issues, before going to a generalist sort of mainstream doctor (a GP or maybe a gynecologist who operates as a GP) to address the bigger health concerns for which there is clear-cut evidence right now. I will have to prioritize what I ask her/him to help me with, what tests to get, and what treatment/medications I can pay for.
I would rather not have a head MRI just yet, because I worry that there are plaques present, and I have read several reports that doing methylation and various things like improving vitamin D deficiency and so on, have actually reduced the plaques/bits of unwanted matter in people's brains, and I'd rather not get a notation of pre-MS plaques on my records (especially if the federal healthcare program is repealed, or fails, and all this becomes a big dossier of pre-existing conditions for me). On the other hand, if I have a tumour or compression in my brain that has impinged on my optic nerves, that would be a good thing to get a scan for now.
...avoid getting tripped up over every abnormal... and focus on the big picture results like methylation... or blood tests.....
Although I may not be taking a conventional route of consulting doctors right away, I think this is just what I am doing -- focusing on the _big picture_ when it comes to what may have caused my unexplained optic nerve damage and how this might develop in the future; then looking closely at the topic of _methylation_, which clearly relates to the topic of pernicious/megaloblastic anemia: folate since I am compound heterozygote MTHFR, B12 via some of my other mutations possibly, and perhaps even B6 somehow (if Chris Kresser can be believed); then looking at _blood tests_.
Hmm... even Wikipedia (which I had not looked at for this topic earlier) says that the MCV level to look for in megaloblastic anemia is greater than 95: "Increased
mean corpuscular volume (MCV,
>95 fl)".
http://en.wikipedia.org/wiki/Megaloblastic_anemia
Since my optic nerve damage is a type of neuropathy, this is one of the guides I followed to figure out what blood tests to get:
"B12 may be ordered with folate, by itself, or with other screening laboratory tests (
antinuclear antibody,
CRP,
rheumatoid factor,
CBC and chemistry blood tests) to help establish reasons why a person shows symptoms of
neuropathy.
...Other laboratory tests that make be useful are
homocysteine and
methymelonic acid (MMA). Homocysteine and MMA are elevated in B12 deficiency while only homocysteine is elevated in folate deficiency. This distinction is important because treating a B12-deficient patient with folate can correct the anemia but does not stop irreversible neurologic damage."
http://labtestsonline.org/understanding/analytes/vitamin-b12/tab/test
However, a study showed that 1.6% who are deficient in B12 do not show elevated methylmalonic acid and 4.1% do not show elevated homocysteine (while only 1 in 400 had normal levels of both, even though he was deficient in B12), and 9% of people who are deficient in folate do not show elevated homocysteine.
http://www.amjmed.com/article/0002-9343(94)90149-X/abstract. Chances may be small, but if there is any kind of little minority that isn't seen on the radar for something, as like as not, I'm going to be in it.
Well, I don't know why my corpulent corpuscles are portly indeed, but they may be a piece of the overall puzzle. I don't think any potential puzzle piece is unworthy of consideration, since my health situation is not cut-and-dried these days, and so many of us are told that our test results are not quite beyond an artificial cut-off line for this or that (TSH etc.) even though the physical repercussions of the abnormality are real. When I get to ask a doctor about how and if my MCV fits in with everything else, I'll report here what she/he said.
