Iron - What would you do?

grace20072010

I had RNY 4 weeks ago. If you read one of my last posts, I have been dealing with constant nausea since my surgery. Anyway, my ferritin level was 8 over a year ago. I dutifully took my iron supplement every single day. Fast forward to a month before surgery - my ferritin level was still 8. I had to go off iron pre-surgery and have not taken a supplement in 6 weeks at this point even though my pcp told me to take 3 a day. Due to awful nausea, I basically did not eat for the first 2 1/2 - 3 weeks. It was only my surgeon threatening a feeding tube that has forced me to drink protein shakes (I cannot find one I like so protein has been a challenge but I am doing better). My surgeon has also told me not to resume iron as it will make me sicker.

My ferritin has been very low for over a year, and I am sure it has gone down over the last 6 weeks given my lack of supplements and nutrition. I feel weak and tired. I called my pcp yesterday and said I would feel better getting a referral to a hematologist at this point. I have to take prevacid for acid reflux, which reduced iron absorption, and I now have malabsorption due to the RNY. She said she wanted to do another blood test to see where I was.

She doesn't seem to get that I am not having any success with my iron, and I am worried my levels are bottoming out. I am going to get the lab test, but my insurance technically doesn't require I have a referral (although I feel a hematologist would take me more seriously if I had one). If my ferritin is STILL super low and my pcp still won't refer me (I have no idea why she won't) would you just make an appointment yourself if you were in my position? I have to get my iron up. I am so frustrated right now. My PCP told me iron transfusions are dangerous - I know there are risks but there are also risks when you have no iron!

Anyway, I am at my wits end with her. What would you do in my position?

stroynaya

STOP DOCTOR HOPPING! That is not beneficial and could even be dangerous. You should trust your WLS doc and PCP. If they aren't telling you what you obviously want to hear, they have valid medical reasons. By ignoring them in your quest to find a doctor willing to tell you what you want to hear, you risk your health.

You should trust your WLS doc. They are used to dealing with vitamin deficiencies in post-WLS patients. If your WLS doc is saying iron supplements will make you sicker, they likely will--it is hard on the stomach and also inhibits absorbtion of other vitamins. Since you are having trouble keeping food down, you are likely deficient in most vitamins, so inhibiting absorbtion of the other vitamins to up your iron may not be a good trade-off.

Your PCP sounds like they are doing a good job too. A blood test will show what your deficiencies in iron and other vitamins actually are, not what you think they are. Declining a referral until test results are in sounds responsible to me. That way your PCP can assess what is best for you.

pawoodhull

Do the bllod test, find out if you truly are iron deficient, then go from there. You could always try blending iron rich foods into your protein shakes for added iron, which shouldn't make you sick like a suppliment would. There are other options if you really are needing to add iron. I agree with stroynaya, you should be trusting your WLS doc most at this point. They deal with the malabsorbtion issues more than your PCP does so they know how to get you more iron if that indeed is the problem.

Hang in there and know that these are early days yet. You will heal and start feeling better. It just takes time.

grace20072010

My weight loss surgeon is the one who said I need to see a hematologist. It is my PCP that won't agree with him. I am not doctor shopping.

sue100194

I was absolutely exhausted in the month - 6 weeks after surgery and my iron levels were fine. I think some fatigue is to be expected after major surgery and extreme caloric reduction. Hang in there.

grace20072010

My problem is my ferritin was only 8 a year ago, I took iron for a full year, and my ferritin 2 months ago was still 8. My doctor said they would like to see it at around 60. I just can't get it up with supplements - it is not working. I think I did a crappy job of explaining why I am questioning whether to just make an appointment with a hematologist myself. My WLS thinks I need to see one, but he told me to have my PCP make the referral, and my PCP won't do this for some reason. I am going to have the labs taken again - my guess is my iron has dropped a bit due to the complications I have had - so maybe my PCP will change her mind. I think a referral will get me taken more seriously, but I guess worst case scenario I can see if my surgeon would be willing to make the referral or see if he will talk to my PCP. I have to get my iron up, but with malabsorption and regular absorption issues, I just don't think supplements are enough at this point.

rpyle111

Perhaps ask your WLS doctor call your PCP and have a doc to doc conversation. My WLS team has made it clear that after the surgery, while they will be involved, all of my medical stuff will have to go through my PCP. This sounds like a similar situation.

I have a good relationship with my PCP and would push for an explanation from her, or suggest that the two docs talk.

Good luck!

Rob

adiggs2777

Do you actually need a bonafide referral? Are you on an HMO? If you have a PPO you can just find a hematologist and make an appointment yourself. Referrals are such a pain in the *kitten*!

I don't have an iron deficiency but I feel you, I was put on an Rx of vitamin D for 12 weeks and my vitamin D levels never did perk up. I've been put on an Rx of vitamin D for another 8 week course by my NP. We'll see if it improves in a few months.

stroynaya

My weight loss surgeon is the one who said I need to see a hematologist. It is my PCP that won't agree with him. I am not doctor shopping.

In that case, you should have your WLS and PCP docs talk to each other. It's important that your medical team all be on the same page regarding your treatment.

katematt313

Ask your WLS doctor to order labs for you. I'm sure they will. Then you will know if you have an issue that needs to be looked into further. If it turns out your iron is as low as you fear, you will have the evidence to get the hematologist to take some action.

You probably just need to suck it up and force down the protein. There has to be a way to make it palatable for you. We are talking about your survival. Also, about your hair. It will fall out if you don't get enough protein. How scary is that.

Nausea sucks. There is absolutely nothing worse than nausea. Post-op, the nausea bothered me worse than any pain I had from the surgery. Your WLS doctor should be able to help you manage your nausea. Do you have a Rx for zofran? Are you on a protein pump inhibitor? Maybe your dosages need to be revised.

I think you need to be more assertive with your WLS MD about your health concerns! They have the knowledge and experience to address your needs.

grace20072010

My ferritin was only 8 2 months ago. I just had new labs drawn. My WLS instructed me to stop all iron sups as the can make you more nauseated. this had been debilitating nausea. I am following doctors orders so no, I can't just suck it up. I cannot take any prescription nausea meds. the all interact with a medication I cannot abruptly stop....I could end up with heart issues if I combine the meds.

I am sorry my iron post had made several of you upset with me. That was not my intent.

csmccord

First, protein - What about it makes you sick? Is the taste? If so there are a few things you can do. Since you are only 4 weeks post-op, you're probably in the soft foods/mushy stage. This is going to limit what you can really do, but there are options.

1. If the chocolate, vanilla thing is what's getting, you try ordering a sample pack of Nectar from Syntrax. They make out of these world flavors. Stuff like lemonade, iced tea, fruit punch, etc. My favorite protein for chocolate/vanilla is Max Protein made by SEI. Can only be found online, but I haven't found one better.
2. You could also try mixing unflavored protein into soups, chili, refried beans, or whatever else you've been cleared for. Just note, unflavored protein is not flavorless, it's just not mixed with any flavoring. There are many things you can mix protein powder into. I've made my own bars, I mix a scoop into my oatmeal in the morning, etc. Maybe check out bariatric websites for ideas. Do a search for Eggface. I love her site and philosophy.

For the Iron, yeah if you are that concerned, maybe setup a conference call with both the PCP and WLS office. Ask for clarification as to why/why not taking iron. From my experience it does cause some nausea, as well as constipation, but it depends on what type you take. Sometimes mine makes my stomach hurt mildly, but I've found that if I eat something right after taking it that it helps. You do need to get on top of it though. Iron deficiency is one of the leading problems for bypass patients. Iron requires an acidic environment to be absorbed properly. Because bypass patients don't have a stomach to digest food in, there is no acidic environment. My WLS nutritionist suggested that I take vitamin C with the iron to help with absorption. Remember, never take calcium with iron!

stroynaya

My ferritin was only 8 2 months ago. I just had new labs drawn. My WLS instructed me to stop all iron sups as the can make you more nauseated. this had been debilitating nausea. I am following doctors orders so no, I can't just suck it up. I cannot take any prescription nausea meds. the all interact with a medication I cannot abruptly stop....I could end up with heart issues if I combine the meds.

I am sorry my iron post had made several of you upset with me. That was not my intent.

More concerned for you than upset. We just want you to feel better and to succeed.

pawoodhull

My problem is my ferritin was only 8 a year ago, I took iron for a full year, and my ferritin 2 months ago was still 8. My doctor said they would like to see it at around 60. I just can't get it up with supplements - it is not working. I think I did a crappy job of explaining why I am questioning whether to just make an appointment with a hematologist myself. My WLS thinks I need to see one, but he told me to have my PCP make the referral, and my PCP won't do this for some reason. I am going to have the labs taken again - my guess is my iron has dropped a bit due to the complications I have had - so maybe my PCP will change her mind. I think a referral will get me taken more seriously, but I guess worst case scenario I can see if my surgeon would be willing to make the referral or see if he will talk to my PCP. I have to get my iron up, but with malabsorption and regular absorption issues, I just don't think supplements are enough at this point.

If it was me I would be going back to the WLS and telling them the PCP won't make the referral. They will either consult with the PCP or make the referral for you. I do understand your concern as extrememly low iron levels can cause a lot of issues. In the meantime try and incorporate more iron rich foods into your diet. As I said before, you can blend some into your protein shakes and as long as you have ground them fine enough they won't hurt your recovery. Taste may be an issue. The other option is going to a good health food store and seeing if there is a powder or liquid supliment you can add to your shakes. But whatever else you do, keep your WLS in the loop for that referral. You're right, you will get into a heatologist much quicker with a referral.

Good luck and please know that no one is upset with you, just concerned.

Pat

grace20072010

Thanks - I appreciate the concern. I am just frustrated because I have two doctors telling me two different things. I am going to wait for my latest labs to come back and go from there....

pawoodhull

Thanks - I appreciate the concern. I am just frustrated because I have two doctors telling me two different things. I am going to wait for my latest labs to come back and go from there....

Sounds like a good plan!

Pat

grace20072010

Well this is bizarre. 2 months ago my ferritin level was 8. Which is low. I had to stop all supplements before surgery for two weeks and have been unable to take my iron supplement since my surgery. So I have basically not taken an iron supplement since that blood draw. My labs came back, and suddenly my ferritin is 26! I can't figure out how I took an iron supplement for a year and it stayed at 8, and then when I stop the supplements it goes up to 26. Maybe it's the protein I have been getting in? I don't know, either way I don't need to see a hematologist right now. Thank goodness. Even the doctor was shocked.

Dannadl

Ferritin levels are one of 4 components of Iron that are tested in your blood stream. My son and I have restless leg syndrome and periodic limb movement and both of our symptoms are controlled by keeping our ferritin levels above 50 (though a normal level is in the 20's). Neither my son or I have EVER tested positive for anemia, even though our ferritin levels have been very low at different points. I would make a concerted effort to get your protein levels up and your nausea down. I used to drink my protein (powdered) as hot chocolate (not too hot or it gets clumpy). It wasn't bad. My husband LOVES Rockin Refuel by Shamrock farms. It is a milk based protein shake (ready made and must be refrigerated) They have several flavors and varieties with varying grams of protein and calories. The Lean Builder has 20g of protein and 150 cals. The chocolate tastes just like chocolate milk. I find it almost too rich. But then I don't like chocolate milk much either. My sister in law loves the EAS Myoplex carb control protein shakes, I can take or leave them and my husband hates them. Muscle Milk light is okay. Necter protein shakes lets you order a sample pack of single servings in a variety of their flavors for around $16 from their website. I've liked some and haven't liked some. There is a thread on this group about protein sales and samples. I highly recommend that you experiment with some and find what you like. I'm 28 months out from RNY and still have a protein shake to replace a meal on occasion. My husband is 26 months out from RNY and drinks a protein shake for breakfast every day.

I found that nausea almost always corresponded with dehydration for me post op. Are you drinking AT LEAST 64 oz of water a day? I live in Phoenix, its summer and I exercise a lot (at least 1.5 hours a day often more - I'm training for a 1/2 marathon). I drink an average of 128 oz of water and another 16 oz of herbal tea every day, unless I have the flu I am virtually never nauseated now. But post op I was and as soon as I got my hydration right my nausea went a way.

BTW it can take 6-12 months easily to raise your ferritin levels. When my son was diagnosed, he was 3 years old and we had to give him ferrisol (liquid which is just vile) 3 times a day for 9 months to get his levels up. Turned his teeth grey temporarily, constipated him and upset his stomach if not given with food and vitamin C and at least 2 hours before or after anything with calcium (calcium cuts iron absorption by 50%).

stroynaya

Well this is bizarre. 2 months ago my ferritin level was 8. Which is low. I had to stop all supplements before surgery for two weeks and have been unable to take my iron supplement since my surgery. So I have basically not taken an iron supplement since that blood draw. My labs came back, and suddenly my ferritin is 26! I can't figure out how I took an iron supplement for a year and it stayed at 8, and then when I stop the supplements it goes up to 26. Maybe it's the protein I have been getting in? I don't know, either way I don't need to see a hematologist right now. Thank goodness. Even the doctor was shocked.

Awesome! So glad for you. Now if you can just kick the nausea to the curb ...

madmags

When you do get the go ahead to take iron, try to find some iron water. I know people who got nausea or constipated with the iron supplements but not the water. The water has a lower dose than supplements, but that is because almost all of it is absorbed, vs supplements where most of it gets passed.

annwyatt69

If you can't handle the taste or texture of the protein powdered shakes, try Isopure Zero--it is clear kool aid like flavored--and one bottle has 40 grams of protein, I believe. There are numerous flavors and GNC normally carries it, so does HEB if you have them in your area. I also know you can find them online. They are tasty and absolutely cannot tell that they are protein drinks. It was what I was told to drink right after my RNY (along with the broth, diluted juice, etc.) I am glad that your iron came up and I hope that the nausea resolves itself soon. Give it time--it does get better!