And it just happens so fast

So, I had my lab work done last February, and my numbers were all acceptable. My Ferritin had been trending down a bit, but was at 50, and an acceptable level. Fast forward to this week when I had my blood work drawn again. I just got my results back and my ferritin is now at 9. In the last 6 months it has dropped 41 points.

I'm currently using the Iron patch, but I have to admit, I don't remember to apply it everyday. I apply it probably 3 to 4 times out of 7. So, a word of caution to everyone who is lackadaisical about vitamins, be careful.

I will be calling and making an appointment with my PCP, and talking to him about a referral to a hematologist. I'm also going to start being more vigilant about my vitamin intake.

OMG! Good luck - you don't expect it to change this fast!

My iron managed to drop with patches too. YOu may need to try a different approach.

You need infusions. At this point no amount of oral iron will help bring a ferritin level of 9 up to normal levels. I have the DS and have had anemia issues for years. Just so you know, my hematologist feels that anyone who has had WLS should maintain a ferritin level of 100, not 50.

Not sure how much malabsorption you have with your RNY but obviously you're not absorbing the iron. Oral iron is very hard to absorb.

Iron is absorbed in the duodenum, so people with an RNY can have very similar issues with iron as people with the DS or SADI.

Actually, somewhat worse with the RNY, as the DS at least maintains some of the duodenum in the digestive path. From what I have seen, it is more common for RNY patients to need regular infusions (like, annual) to keep things up than DS patients.

Another thing to watch for is any evidence of GI bleeding (dark or tarry stool, etc.) as the bypass is more prone to ulcer problems than the DS or sleeve. I'm sure the OP's PCP will check for that as one of their diagnostics.

I've seen far more DS patients need iron infusions more frequently than RNY patients - but, of course that's anecdotal and unique to my experience. As with all things, it depends on many individual factors.

Anything with a sleeve will always be more durable for ulcers and GI issues, especially when iron and protein malabsorption is involved. Usually where I am what causes GI bleeds is a combination of NSAIDs plus poor vitamin issues, because malnutrition turns the intestines into wet tissue paper. I've seen many clients get duodenal and stomach bleeds for this specific reason. It's a potentially fatal combination, sadly, and too many people gamble with it.

As you note, many factors apply. I see more of the reverse, but I suspect our populations are different. If you are looking mostly at a counseling/therapy based population, implicitly there are some compliance issues that hit on this subject as well, and as the DS is known to be more sensitive to supplementing and follow up, that could certainly drive side effects in a counterintuitive direction.. OTH, I see mostly people who are many years out and, by and large, successful and relatively compliant, as one would expect from those who continue post-op support activities for years after the fact. There may also be some variation in surgical technique and philosophy that influences the result - Dr. K has noted a couple times that he seeks to maximize the duodenum length when making the switch; others may prefer different trade offs that influence this aspect of the overall result.

Oh, sure. I mean that's it is hard to determine "in the wild," so to speak, and I think there are absolutely surgeons who operate and shouldn't. I dislike the entire behavioral health side of bariatrics, as I feel it's grossly inadequate and non-standardized, but that's a rant for another time. I wish they would do more studies about it, actually, particularly as I feel the DS gets short-changed especially with the SADI stuff coming out. And I've frequently seen RNY patients in more life threatening situations, particularly when iron is low and NSAIDs worm their way in.

It's interesting to me how surgeons adjust the surgeries in general for various reasons. It's something most don't talk about, however I am rabidly (perhaps annoyingly?) curious about such things.

OP has not been taking oral iron.