re: oral iron supplements

 I have recently begun a series of iron infusion therapy, after discovering I was severely iron deficient. The doctor who prescribed the infusions for me (but doesn't do them) has suggested that, once "the tank is full", I will be taking oral iron supplements and monitored every 6 mos.  The dr. who is doing the infusion therapy (and has clinic hours where wls post ops come to his office for this) strongly feels that RNY patients have no use for oral iron, as the part of our intestine that absorbs the iron has been bypassed......his belief is that Rny postops should be monitored (blood test) every 6 mos and any deficiencies should be supplemented by IV.  He also said that the body is very efficient at holding on to iron....feels my anemia is the result of a few surgeries I've had in recent years and heavy periods.  

What are your thoughts/experiences???

yea.... my hematologist feel the same way. I do not have periods anymore, and eating the food rich in iron did not do me any good. Most iron supplements cause pain, pain and then pain, plus constipation.   He was not sure if I am not absorbing at all or maybe I have a small leak (like a bleeding ulcer) and that's why I get so depleted.
I got iron infusions and was told to hold on and not take any iron supplements. We will reach my blood again in 5 months and the rate my body uses iron (ferritin level drop) my doc may predict if I have any blood loss... (I do not get periods anymore),

I do like that idea. The iron I was taking and was able to tolerate was heme iron, rather expensive,   And it was another pill (or 3 ) to take ... etc.  So I decided to just eat as I normally would eat (some meat, veggies, etc) but not worry about the iron supplementation at the moment. 
My ferritin were around 10 -11 then I started taking the heme iron - up to 3 per day... 1/5 year later - the ferritin dropped to 9.5... so either I am losing blood .. or not absorbing iron at all - any iron.

If there is a chance that you are losing blood, why are they going to wait 6 months to retest your blood rather than try to figure out if you are in fact losing blood?  If it were me, I would be having an Endoscopy, colonoscopy and stool tests for blood ASAP.  The possibility of a bleeding ulcer is very serious and shouldn't be taken lightly and if it is coming from the colon, that can be just as serious.  You don't just treat the possibility of internal bleeding without finding the source, sounds crazy to me.

Thank you. I had colonoscopy and stool test. There was no issue.   And with endoscopy - they can only see in the pouch and noting else.  I am not in pain - and when I had ulcers I was in pain... so I know how that can feel.  And endoscopy carry its own issue: sedation, possible damage to the internal organs, and lets not even talk about time lost and money ... for copay.   I am out of money and out of time of work.   All other tests are too invasive. 
So I will do as the doc recommends.   If I am losing blood - that can be see after 5-6 months.   My feritin stayed low - but did not drop too much over 1.5 year.  So most likely - if there was blood loss - it was very small - if any.  Most likely - I do not absorb any iron...
And the wait and see approach is correct in this situation. 
If I were in pain or  had other symptoms - it would make sense to run more "invasive" and expensive test... but as it is ... it is not needed.  Thanks for concern.

I am glad to hear that you did have the scopes.  I do have one other recommendation of how you can slowly lose blood and it is a simple, cheap test. A urinalysis.  You probably have had one but if not, you can lose blood through your urine due to kidney stones.  I have lost a great deal of blood the last 3 months due to kidney stones, I actually almost needed a transfusion back in July after my kidney stones surgery when I lost so much blood through the urine - my urine was bright red but since then, my UA's continue to show blood in the urine although I can't see it.  That is actually how I was diagnosed with the stones in the first place, my Endo found blood and protein in my urine and sent me to the urologist.  I had a super high ferritin due to inflamation - 495 and then after all the blood loss and the inflamation went down, in 2 months, it dropped down to 100.  I just had it retested today to see if it dropped any further.

just a thought. I wish you the best.

Well, the American Society for Metabolic and Bariatric Surgery disagrees with him.  They say ALL RNY patients should be on oral iron.  Why would you want to get infusions so that your iron level is good, then allow it to drop dangerously low again, get more infusions, and repeat over and over again?  Sounds expensive as well as harmful to your health.

It is my personal experience and belief that IV iron is not necessary.  I was anemic about a year ago -- sorry can't remember the number -- and have taken between 30 - 65 mg daily and my levels are normal.  Of course, frequent blood tests are required -- FULL labs, not a typical person's bloodwork -- and then adjusting any vitamin levels as necessary.

Of course, I don't know your iron numbers, but maybe they were so low that an initial IV was the best way to get you back on track?  After that, I believe that oral ones work great.  My personal choice is Celebrate Vitamin chewables.

good luck!   :)

IV iron isn't necessary for everyone.  I would love to see your labs because if you were anemic, I doubt taking 30-65mg of iron has gotten your levels up very high.  Maybe you aren't technically anemic anymore but you could still be iron deficient or have a really low ferritin level. You should get a copy of your labs - many times our doctors tell us everything is normal when we are at the bottom of the ranges,that isnt' good.

what are your hemoglobin, hemacrit, RBC, MCV, iron, iron Sat%, ferritin, B12, folate, B1, B6?

I was anemic and I take oral iron but I take 240mg of iron with 1600mg of vitamin C daily to get my levels up to a normal level.

I was simply posting my experience since the question was "any thoughts or experiences".  Since you said in another post that you can't make blanket statements about oral iron, I'm assuming you also understand that you can't make blanket statements about what works for some and doesn't work for others...right?

I was anemic, by virtue of what my doctor told me AND by reviewing the labs myself (not sure why you would assume I didn't do that).  And so far, the iron I'm taking has increased my levels sufficiently.

And by Hala's post, it seems that IV iron works really well for her situation, so I assume she is absolutely right.  I was simply sharing my situation.  Sure it's interesting that you needed to take 240 mg to get back to your normal range, but that doesn't mean everyone needs the same.

I took a lot of iron for 1.5 years.  Even the heme iron - but my number did not get better. They got worse.  In my case - the doc belived I needed the iron.  Some people can absorb after RNY - some of us -can't.