Need advice-Question re: Iron and Hemoglobin lab results

Hi everyone. I haven't posted in a while. I still read when I can, but with the West Coast time zone and time difference, I feel that I get on too late to dialogue and I started a new job so have had less free time. I am doing well in maintenance, eating protein forward, and continuing to work out with a trainer.

Anyway, I need some advice. My hemoglobin and iron levels have been declining. I am starting to get a bit worried about them. My primary doctor had me return to my bariatric surgeon to check things (which I was doing anyway) and he changed my iron a couple of months ago. That wasn't making a difference, so he had me start on the patches. I am very diligent about taking the vitamins and using the patches. I do eat red meat even though it is not my favorite. I think it is simply due to the RNY and malabsorption. The surgeon doesn't seem to be a fan of iron transfusions or getting more aggressive. I had lab work done a couple of weeks ago to see how the first month of the patch had changed things. It had not. I have an appointment with my primary doctor tomorrow (Thursday). I have to see him to get "notes" in the file so he can refer me elsewhere. What should I push for? I have seen some posts about ferritin levels. This is not something they have ever tested me for, even in regular physicals. Should I be asking about this? Below are the levels that I have tracked. My RNY was in May 2015. Any advice is appreciated. Thank you. Cory

Hemoglobin (normal 11.7-15.5)

13.7 January 2015

13.8 May 2015

12.9 December 2015

10.5 December 2016

9.4 March 2017

9.4 April 2017

9.4 May 2017

9.1 June 2017

Iron (normal 45-160)

63 May 2016

22 April 2017

16 May 2017

16 June 2017

You definitely want to get your ferritin (iron storage) labs checked. I'm surprised they didn't order it the minute your iron levels dropped below normal range. It's not part of the "regular panels" but should always be for post WLS (ask for a full bariatric panel.)

Ask about iron infusions... sounds dramatic but really it's just an IV drip. I did injectafer (www.injectafer.com) which is 2 bags, 30 minutes each, 1 week apart... 2 rounds and I was back in the black and have been for a few years now.

Once you drop (double edge of a malabsorptive procedure) it's hard to get back up with oral supplements... take them of course but be sure to ask about the infusions. Take your iron with C (helps with absorption) and eat plenty of iron rich foods (red meat, seafood, poultry, green leafy veg, lentils.) Despite doing all the right things its something I know I need to monitor.

Hope you are back in the black soon.

Thanks for the info. I had seen a previous post you had made about injectafer, so I will mention it to the doctor. I know he won't do any of this himself, but will refer me. I had asked about infusions before, so I'm definitely ready for them. I just need to get a doctor to do it if they think it is the right thing. I will ask about testing ferratin. It is odd that my bariatric surgeon has never run that test, although they take about a dozen vials when I go in for labs. I do eat shrimp just about every day, and of course chicken, steak, and green leafy vegies. Since I'm using the patch now, I'm not sure what to do about adding vitamin C to help with them.

Thanks again.

If your iron is that low - most likely the ferritin is very low. Make sure they also check your copper (critical) and I hope they are also testing your D and B12. If not - insist on that.

It is horrible that docs are not educated enough to know that at some point - nothing but iron infusion or blood transfusion can help the patient. Iron is much safer choice that blood transfusion.

The doc is clearly uninformed - offering you very poor support.

Too bad your surgeon is like that. Particularly since many post surgery patients require IV iron to maintain levels. I'm so glad the PA in my surgeons office orders IV iron when I need it.

If you regular doctor won't order it maybe a referral to a hemotologist. Your levels are not going to go up with diet or pills or patches alone. You need IV iron.

My own PCP dragged her feet on referring me to a hematologist until my iron reached a 4. She, too, thought it was just that I wasn't taking the "right" iron supplement. You are missing some other crucial test results, like transferrin, which makes me think your team isn't being aggressive enough with your issue. Ask for a hematologist referral.

I've had two rounds of 5 infusions since my surgery 6 years ago. I go back this week and I know she will order another round of 5.

Note: iron infusions are expensive. My series of 5 costs almost $5000. As my health insurance plan just started over again, this will be a monetary hit for me all at once. Just an FYI: you might want to check out your insurance coverage for them.

First, howdy stranger! You've been missed!

ALWAYS get ferritin checked. Any doctor that doesn't check a WLSer for ferritin is insane.

A lot of normies have iron issues. Always have. Add WLS on top of that, and it just compounds the problem.

Some of us take really large oral doses, and they just don't get absorbed well. There really isn't anything you can do.

You should also stop patches and oral doses for a few days before labwork. They can inflate the results. And if your numbers are actually lower . . .

I would be running to a hematologist.

Thanks everyone for the info. My primary doctor agreed that we had tried the necessary things and it was time to get an iron infusion so he is working on a referral to a hematologist. It's an HMO, but they are usually pretty quick when they refer to a physician in the network. He figures she will run some additional lab work before proceeding, but hopefully things will progress quickly. I'm going on vacation in less than two weeks, so I don't know if anything will happen before that or if I should wait until I return.