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  • Very different opinions from doctors - what to do?

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    Old 10-06-2009, 09:17 AM   #1
    Johanmi's Avatar
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    Very different opinions from doctors - what to do?

    I had an ultrasound yesterday to determine if the source of my anemia is from heavy menstrual bleeding. My ultrasound showed no fibroids, polyps, or anything unusual. I have a thick uterine lining but the doctor told me that it isn't unusually thick and that I look to her like a very fertile 32-year-old. She had a very different view of my anemia, and said she treats women with anemia all the time (since pregnant women tend to get anemia). The thing is, my regular doctor is taking this very seriously. She doesn't want to me to fly, she wants to figure out why I am so anemic, etc. Here are some of my numbers, which the gynecologist looked at: Ferritin - 2, H/H - 6.8 and 20, Iron absorbtion at 3%. My gynecologist seems to think all I need to do is eat some steak and broccoli and all will be well. She said this will resolve itself in a few months with changes to my diet and by taking iron supplements.

    I am waiting for my regular doctor to call, but am completely confused. We are supposed to go on a family vacation tomorrow and I haven't canceled our flight yet because I don't know if I should go away for five days or stay home.

    How can two doctors have such a differing opinion over something?

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    Old 10-06-2009, 12:46 PM   #2
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    Re: Very different opinions from doctors - what to do?

    Johanmi--Hello again!

    Both of your doctors are doing the right thing for you. What they are telling you is the truth. Primarily, you need to find a cause, if your periods are heavy this is probably the culprit for you at your age. You have seen a Hematologist, correct, and nothing unusual was flagged? The only doctor that you haven't seen is a GI doc at this point. And..... they deal with malabsorption syndromes that can also cause this to be happening, along with many other causes. I am still curious as to what your B-12 count was??? If you think your periods are the cause your GYN should be working with you to find a way to stop the heavy bleeding.

    The end result of decreased dietary iron, decreased iron absorption, or blood loss is iron deficiency anemia. This form of anemia is characterized by a decreased size of red blood cells, so that the mean corpuscular volume (MCV) is lower and IF there is a B-12 deficit it can make the MCV appear to be more on the normal end of the range. Also, the serum iron will be decreased, while the serum iron binding capacity is somewhat increased, so the percent T-Sat is much lower than normal--perhaps only 5 to 10%. You see you fall below this range. Your numbers are very low. This is why your PCP wants to find a reason. There is also an increase in risk to your health when you are at this stage of anemia. You mentioned that you had symptoms with your walks. If I were you, and this is only my personal opinion from my own experience, I would not take a vacation at this time. You will have to make that decision along with the advice of your doctor. But....I can always offer my opinion, so there you go. After all, thats what people come here for.

    Did your GYN adjust your iron dosage or suggest anything to you to get the right amount of iron that you need? I have provided some information below that you may find beneficial. So, not only do you need to find a cause but you need to stop any form of blood loss or at least lesson the amount. My doctor explained it to me as if I had a hole in my bucket that would never fill. If you continue to have heavy periods you will need to stay on iron too. This is not really a good solution, although many of us have to. So the thing is, you have to take in more iron on a daily basis than is lost.

    To correct the anemia:
    Usually oral dosage up to 200-300 mgs of elemental iron or more
    Correction of anemia takes about 2-3 months depending on severity
    6 months to a year of iron therapy after the correction of anemia is necessary to replete iron stores, assuming no further loss of iron/blood.

    So, from what I have learned, and taking your age into consideration (and heavy periods) I would try iron first, and stop any heavy blood loss. But it is prudent to take the correct dosage, or it will not work for you. If you do not see a typical response to oral iron therapy within a months time, you may want to consider seeing a GI doc for further evaluation. I would not be exerting myself at all, if you are having symptoms, then STOP the activity!

    Take care and keep us posted. FLFG
    Best of luck to you! FLFLOWERGIRL
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    Hashimoto's Thyroiditis
    Moderate Anemia (resolved) Low Ferritin-- Work in progress! Hiatal Hernia--GERD
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