Iron supplementation following VSG and large blood loss.

Hag,

No, they did not do a ferritin. I have access to all of my blood work online, and there are no specific iron studies. I go in for a post-op check Monday and will ask for it.  Do you think a full iron panel or just the ferritin?

It is extremely encouraging to hear that someone with a similar situation was able to rebuild iron stores with oral medication. May i assume that you had crushing fatigue after such a blood loss? If you did, how long did it take you to equilibrate?  I also rec'd two units of RBCs, but it only brought the hgb to 8.8.  Do you know what yours was at discharge? My surgeon did not want to expose me to the risk of further transfusion, so elected to leave it at 8.8.

Do you take the iron supplements in addition to 2 complete adult multivitamins?

Thanks for your expertise and opinion.

Lory

My hgb the week prior was 15.2, bottomed out at 7, and only rose to 7.5 after a double unit of red cells. But they told me that was a little misleading, because all of the plain fluids they gave me via IV artificially lowered that number. 7 days after discharge they rechecked, and it was 9.3. Nine weeks later, it was 16.5. But my ferritin barely moved in the same time.

I was exhausted for a few weeks, then slowly got my strength back.

You can ask for all your iron numbers, but if the others were just checked, they won't have moved much. But ferritin is crucial.

If my hgb, hct, iron, and ferritin had not been great to begin with, the blood loss could have killed me. So, in my opinion, having numbers in the very low end of the range is not acceptable. With low range numbers, anything bad that happens could totally screw you. If your numbers are on the high end, you have a safety net if anything bad happens.

Hag, 

Thanks for the info. I will just ask for the ferritin, then. The point of keeping your iron stores in proper order is not lost on me.  Thank you again for your insight. I do appreciate it.

Lory

I have struggled with iron deficiency basically since puberty. Here's my basic supplement regimen:

--morning: 1 standard Feosol pill -- take with diet cranberry juice as the ascorbic acid will help with absorption.

--evening: 1 Tablespoon liquid iron supplement (I use Wellesse brand)

--Daily: Folic acid, D3

--2x per week: sublingual B12\

Note - do not take any calcium within 2 hours of taking an iron supplement, and try to stay away from dairy products within an hour (either way) of taking an iron supplement.

I know Grim and others have recommended carbonyl iron but I have to say it does not work for me -- every time I try to switch to it, my iron levels plummet dramatically. Basic Feosol is what works best for me. Make sure that whatever you take, it is not time release, such as Slow Fe. Time release supplements don't necessarily work well with a sleeved stomach.

At this point, I usually only have to do the liquid iron in the evening when I'm on my period. That seems to make up for the extra blood loss. The rest of the time, I just take the iron pill in the morning.

In the past I've also focused very hard on eating iron-rich foods. The more iron-rich food you eat, the more iron your body absorbs from the supplements you take. At least, that was what my PCP told me and it sure seemed to work for me. That said, at this point you need to be focused on complying with your post-op eating plan, not with eating for iron. Maybe many months from now, if you are still having iron issues, you can think about eating iron-rich foods. My rule when I am "eating for iron" is that every single meal must have at least one iron-rich food, and I must eat at least four iron-rich foods total each day. And I only count foods that are naturally rich in iron, not iron-fortified (e.g. cream of wheat is fortified, not naturally iron-rich). So that means eating lots of steak, liver, spinach, mollusks, sardines, beans, pumpkin seeds, dried fruit, and broccoli.

Good luck!

Flintstones are never the way to go.  You have a smaller capacity of iron absorption since it starts in the stomach, but your body can still absorb iron.  I, too, am a fan of the patches at patchmd.com.  An iron infusion is another option to get you on top, then you may just maintain on your own with a multi once you're in good shape again.

Gotta check out the patch situation--thanks so much!

Lory