The other stuff I alluded to a while back is completely unrelated to my gastric bypass, but now that it's resolved I need to focus attention back on anemia, and at this point I am convinced it must relate to the gastric bypass in some way. It could be just a matter of malabsorption leading to a slow loss of iron, leading to the acute episode that landed me in the hospital at the end of January.
I'm sure that the constant fighting with tiredness that I've been doing since the middle of last summer is due to anemia. I started taking iron supplements in November, but was only taking it twice a day maybe 4 times per week. My blood work did not show any anemia in the summer, so this was recommended as a "try it and see if it helps" thing at my 18 month post-op check.
I have an appointment early next week with my primary care physician. The acute episode in the hospital was managed by the GI docs there, but now we're dealing with chronic issues and it's me and my doctor. I have a good doctor, and she'll help me get to the bottom of this, but I'm one of her first patients to have a gastric bypass. Moreso than for other patients, I feel that I have to take charge of my own care. There are plenty of things I can't do and don't know, but I can keep on top of my care.
As part of this effort, I called my surgeon's office to talk with the PA. Anne at UC Surgeons is great. If you are in Cincinnati and looking into a gastric bypass, I highly recommend the UC Surgeon's practice.
She returned my call and went over my history, the numbers I had (RBC, hemoglobin counts), and described some treatment options and tests based on her experience with WLS patients. I am now better equipped to talk with my doctor next week.
For the WLS patients out there wondering about iron deficiency anemia issues, here's some more details in the hope that this might be informative.
We never found a real bleeder in my GI tract, but the small intestine was not checked. We found no blood, the colonoscopy and EGD found nothing that would cause significant blood loss. We did not do a capsule endoscopy, so the small intestine could still be hiding a bleeder, but I've seen no signs of blood when I go to the bathroom. There could also be a bleeder in my remnant stomach. There are no non-invasive tests to look in there for bleeding.
At this point, a complete blood work up is in order, and should be repeated at regular intervals until we resolve this or my blood and iron levels are acceptable. The recommended tests are:
- CBC
- Renal panel
- Hepatic panel
- Folic Acid
- B12
- B1
- Iron
I'd get most of those at my two year surgical followup, but I'll ask my doctor to do these next week and send the results to my surgeon.
Seeing another gastroenterologist (I liked the folks at the hospital, but I'd rather not be hospitalized to see them again) may also be indicated. Anne recommend doing a couple of hemoccult tests as well to make sure they didn't just miss my passing blood back in January and February. If we get a positive result, it's definitely time for a specialist.
If this is really just an iron deficiency due to malabsorption and oral iron isn't getting the job done, a series (3) of iron infusion treatments down here at University Hospital to jack up my iron levels. Once they are restored, oral supplementation seems successful at keeping WLS patients healthy if they stick with it.
I'll stick with it.
I'll report more as I get more information. And, to answer the inevitable question, I still think the gastric bypass was a great idea and I'd still get one. I'm better off than I was 160 pounds ago :)
Tags: bariatric, anemia, Gastric Bypass, health, Weight Loss Surgery, WLS