Anyone else dealing with chronic iron anemia? A bit of a rant.....and long

[mtngirl]

A bit of history first.

I had gastric bypass 31 years ago. Although I did not lose all the weight I wanted, I did lose enough to take up my childhood dream of horseback riding. Gastric bypass has some nasty long term side effects…iron deficiency being one of them.

Along the years I have had a number of setbacks to my riding. After two successful total hip replacements, I am now riding relatively pain free. I do have significant arthritis. I developed bleeding stomach ulcers about five years ago and have had some issues with that ever since. I’ve been strictly warned to never take an NSAID again. I was having anemia issues long before the ulcers. The ulcers are being dealt with. I can certainly sympathize with our ulcer prone horses!

I have two wonderful horses, a 21 yr old Appy and a 7 yr old Hanoverian. Both are progressing nicely and I want to step things up a notch…but chronic iron anemia is holding me back. My last blood test came back with a hemoglobin of 9.2. When it drops below 11 I start feeling bad. By the time it hits 10 I am barely able to function.

I no longer seem to be able to absorb iron orally…all the iron supplements do naught. After years of whining and complaining I found a doctor who took me seriously and referred me to a hemotologist. I now get IV iron treatments…but I have to basically bottom out before the Hemotologist will approve them. :no:. So far she will not approve the IV iron until I hit 10 or below on the hemoglobin test. Even after the treatments, I’ve never gotten above an 11.5.

I get so tired of feeling tired and washed out. I’d love to get back to a consistent level instead of feeling good for two to three months, then a steady decline for three months and a month of gradually feeling better as the iron kicks in. This seriously affects my riding, as I get so tired, weak and short of breath that I have to be very careful in what I do. Riding in heat is an absolute NO! And when I get so low, I’ve taken to not riding unless someone else is around. Several times I have seriously alarmed the BOs where I board. I am lucky in that though rough, my horses thrive at this facility.

I realize that too much iron in the blood can be just as dangerous as too little. After IV iron, it takes me 3-4 weeks to start feeling better. At about the three month mark I start to decline and by month four and five I’m in significant ditsress. Although no one has said so, I suspect there may also be some limitations involving my insurance. There is only one hemotologist locally.

Sorry. Rant over. I go for IV iron tomorrow, and despite really wanting to take advantage of my day off and beautiful Spring weather, I know the treatment is far more important.

[Simkie]

Oh man, that sounds terrible I’m so sorry to hear you’re going through that. Is it possible at all to find another doctor, even if out of town?

Have you tried sublingual iron? I wonder if that might work better for you. It looks like there are a few options on google–might be worth a shot?

Do you also supplement B12? I do that and use this one. It’s palatable and was very effective at getting my levels up.

[charismaryllis]

see also this thread (for the dietary suggestions, not the politics )

http://www.chronofhorse.com/forum/showthread.php?487036-former-vegetarian-eating-beef-again-for-anemia

[downen]

I second Simkie on the sublingual iron. I have malabsorption issues due to a rare autoimmune disease, so I am chronically low in many vitamins. I am able to successfully take iron orally, but I cannot tolerate oral magnesium and there is not a subingual version. A doctor told me that you can absorb it through your skin! I was skeptical, but now I put a double dose in my socks every morning for about 1/2 hour or so, and blood tests now show my magnesium levels at normal. It might be worth a try! They have to be uncoated tablets, though. I hope you feel better soon!

[JanM]

I’ve read that if you take a Vitamin C source (not pills, but real Vitamin C from food), that iron absorbs better.

[Kyrabee]

Yes…most insurance will not pay until the Hbg reaches a certain threshold. So therefore, the docs are treating numbers (as dictated by insurance), not the patient:no:. Can you afford an infusion more often?

I am sure you have tried various forms of iron. Were you taking the iron with vitamin C? Do you take a proton pump inhibitor for your ulcers? They greatly reduce the amount of iron absorbed. Iron is absorbed in the duodenum. I am not very well versed about what is bypassed in a gastric bypass but I believe the duodenum should be intact. Unfortunately, supplemental iron is not very well absorbed in the best of circumstances.

Jingles you can find a balance.

Susan

[mtngirl]

Thanks for the suggestions. I didn’t know iron was available in a sublingual form! This is something I need to investigate further. I knew if I came to COTH someone would have a suggestion I hadn’t thought of! :lol:

I have been on B12 shots for several years. Rather than once a month, I take them every two weeks…just seem to do better when I do it that way.

Kyrabee: Yes, I am on Protonic daily, and twice a day when the ulcers become more active. I go in June for another gastro work up, but have very little doubt that I have bleeding ulcers again. Not severe, but enough to add to the anemia. I honestly think the ulcers started due to extreme stress at my job. I’ve changed jobs and now am in something much less stressful…and so far am loving it. Seems that once the ulcers started, they’ve been recurring.

I have tried to stagger my oral iron supplements to be at least 3-4 hours after taking the Protonic. I had what was called a bilio pancreatic bypass. Didn’t have any real issues with it (except for kidney stones, which I’m told the bypass makes you more prone for them) until about 10 years ago when the anemia started. Over the years it’s gotten worse. I’ve been told the bypass procedure I had is no longer done.

I was initially treated for my anemia by a nephrologist, as I’ve had an extreme problem with kidney stones (they don’t call Western NC the “stone belt” for nothing!). He put me on calcium CITRATE as a preventative and since getting up to a certain level, the number of kidney stones has dropped by over 90%! This doctor told me to quit taking oral iron…that I was just flushing money down the toilet. I still take a bariatric multi-vitamin with iron twice a day, but really think the iron isn’t being absorbed. Since sublingal doesn’t go through the gastro tract, this might be an option to try.

I asked about paying for additional treatment out of pocket, and my hemotologist said no…I had to be down to a certain point before she’d OK the treatment. I am seriously considering trying to find another doctor out of town.

I just get frustrated at how much this interferes with my horses. Today was a lovely day, I should have been riding, but I was so tired all I did was sleep. I not only hate how I feel physically, by how whiney and depressed I get.

It’s really rather sad to be looking forward to five hours of IV iron treatment.

I really appreciate all the advice. Definitely some things to explore and think about!

[SonnysMom]

I had the gastric sleeve last year and I am active on BariatricPal forums. You might want to put your question on that forum.
I have seen where a number of people like the vitamin patches. That might be another option for you. They are a little pricey.
http://www.patchmd.com/Iron-Plus-Topical-Patch.html

My bariatric surgeon prefers the sublingual b-12 to the injections. He said that research has indicated the sublingual works just as well. I was taking daily sublingual B-12 after surgery and had to back down to every couple of days since my last blood test showed I was pretty high in B-12. I used to do B-12 injections prior to surgery.

I too am anemic now and had a history of it prior to surgery. The oral supplements and changing my diet didn’t seem to work well. I have a gyn appointment next month. I think that is the root of a lot of my issues with anemia. My periods have gotten really long and heavy the last couple of years. If getting that fixed doesn’t work I am thinking I will be trying the patch.