September 3, 2009 in Features

Dr. Gott: Patient’s health history offers important clues

Peter H. Gott, M.D.

DEAR DR. GOTT: My significant other’s health problems began six months ago with severe shortness of breath and an upset stomach occurring as soon as he ate anything. This progressed to fluid buildup and pain in the ankles, knees, wrists, hands and elbows. Each day, a different joint would be involved. He was about to finish a semester in college and tried to put off seeing a doctor, but things became so bad, he gave in. He was immediately admitted to the hospital in a wheelchair.

He was eventually diagnosed with iron-deficiency anemia. He had become dehydrated, and his hemoglobin level was so low that he was given two transfusions of blood. Thinking that he had a severe internal bleed, doctors began testing with endoscopies everywhere, and he ended up with a nine-day stay at the hospital. Once released, he was put on iron supplements.

After finally speaking to one of the doctors at the hospital who took a real interest, he sorted through all the records and found my companion had been taking prescription acid-reflux medicine for about five years, medication that can inhibit iron from being absorbed. Bingo!

Since this has happened, we have heard from several of our neighbors, friends and acquaintances who have been on prescription acid-reflux medicine for a period of time and who have also been diagnosed with iron-deficiency anemia. They, too, have had to endure long-term testing. Have you heard of this before? Or has the problem just popped up overnight?

DEAR READER: Iron-deficiency anemia is a condition in which blood lacks adequate amounts of healthy red blood cells, the same cells that carry oxygen to the body’s tissues and provide energy. Without significant iron, the body cannot produce enough hemoglobin, a component in red blood cells that allows oxygenated blood to be carried throughout the body. The result is fatigue, weakness, shortness of breath, poor appetite, irritability, a pale or ashen color to the skin and more.

The most common reasons for this condition are blood loss, a lack of iron in the diet and an inability to absorb iron. Afflictions such as Crohn’s or celiac disease affect the intestine’s ability to absorb nutrients from digested food. And some medications, such as those taken for combating excess stomach acid, are known to interfere with iron absorption. Thus, I’m quite surprised your partner’s primary-care physician, who prescribed the medication, was in the dark.

Diagnostic testing to identify possible underlying causes includes endoscopy, colonoscopy and ultrasound (for women). The endoscopy you refer to was to discover a possible bleed from an ulcer or hiatal hernia. A colonoscopy zeros in on possible bleeding from the colon. Ultrasound is ordered to rule out uterine fibroids or to identify other causes of heavy menstrual bleeding.

Unfortunately for your partner, he was late being diagnosed and his quality of life suffered dramatically. Fortunately, he finally found someone who took the time to get a complete history to include his medications and the physician made the connection. At long last, he is on the right track.

To provide related information, I am sending you a copy of my Health Report “Hiatal Hernia, Acid Reflux and Indigestion.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

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