Iron deficiency anemia post VSG!!

Last week I got routine pre-op labs ordered by my plastic surgeon.  I was told I was anemic and today I saw the hematologist.

I was shocked and stunned when he told me I will have to have iron infusions every few months for life, due to my post sleeve stomach's inability to break down the iron to an absorbable form.  He also wants me to do sublingual B12.

I can't stop thinking about this, and am feeling a bit depressed about it.  One reason I chose sleeve over RNY for my revision from band is "no malabsorption."  I guess this wasn't true....When he was leaving the room he said, "It's ok.  Things could be worse."

While I'm glad I don't have something worse like cancer, I just didn't expect this.

Megan

PS:  Regarding taking extra oral iron he said, "Don't waste your money.  You can not fix this with extra iron with your stomach."

Oh yes, I'm really not that happy that I was unable to get back to goal after getting the sleeve instead of my band to begin with.

I'm going to reply up here since it look slike the rest of the thread formatting got a bit messed up...

I get very concerned when I see VSGers or pre-op VSGers say they want a procedure without malabsorption so they don't have to worry about vitamin/mineral issues. Here's my very basic explanation of a few things:

- To absorb iron from food requires it to be broken down by stomach acid. With a reduced stomach size, we have less acid to work with, which means we likely are not absorbing iron from food as much as we used to. This makes iron supplementation necessary for some. You're not technically MALabsorbing it since you have nothing bypassed, but it's not getting absorbed.

- To absorb B12 in the digestive tract, you need intrinsic factor, which is produced naturally by the body. The greatest amount of intrinsic factor is typically created by the outer curvature of the stomach. So, once we have a VSG and that outer curvature is removed, many of us lack sufficient intrinsic factor for B12 absorption through normal dietary means. Therefore, we must instead supplement B12 either via sublingual supplements or injections.

My fault.

It's one of the Medscape pictures, but I'm not sure which one.

Oh, shocking - Andrea broke it!

But it looks like you also fixed it  :)

I had LapBand surgery about 4 years ago. It took almost all that time to lose a grand total of 97 lbs (and as I get it "adjusted" here and there I am still losing).. I have had different levels of iron deficient anemia over the four years (and even a small touch of it prior to surgery) and now my hemoglobin is at an all time low (9.8)  My internist is sending me to a hematologist for iron infusions which I understand that I will have to keep up forever. I can't tell you how terrible my diet is/was because of the lap band......Either I can eat so lttle of anything (even thick soups or drinks) or when I can get down something rich in vitamins and minerals it can come back up before even being digested or the tiny bit can cause me about 4 hours of GI misery. So, as a result, I usually eat cream of wheat, thinner soups, mashed potato, or something similar.  Taking a multivitamin causes such stomach upset that I am almost afraid to take it and it probably doesn't get absorbed anyway. Iron supplements (even taken directly with food) literaly make me vomit. So, if I receive iron infusions then that may be the only way to build up my blood. Does anyone know if liquid multivitamins (or soft chewables) also make you gassy and burpy?  Also, will iron poor blood cease to be a problem after menopause (which I am probably about 10 years away from)?

In ALL of my research on VSG as WLS and partial and full gastrectomies it was noted that we would always have to take some type of B-12 as we no longer have something called the intrinsic factor and don't produce b-12 in our stomachs (or something like that).  Vitamins is ALWAYS an issue when you alter your body and can no longer consume "normal" amounts of food for lack of a better word. 

With that said at my 2 year labs it was shown that I am Vitamin A and D deficient and anemic.  Not sure what your labs actually are but I would drop an email to www.vitalady.com or check the main board for Andrea U I believe.  They are both RnYers who take vitamins very seriously.  I take Vitalady's Tender Iron.  Andrea U was having severe issues with her iron and did research and started taking something called proferin I do believe.  Anyway it's definitely worth it to talk to them they have a HUGE amount of knowledge on vitamin and vitamin issues.

I'm sorry you never made it to goal after being sleeved after your revision.  From the sounds of it (reading previous posts) you don't have I guess as much restriction and you are always hungry.  Is that still the case?

Ms Shell

I guess I wouldn't say I'm always hungry, but it is definitely different than when I was banded and didn'tfeel hunger for 5 years!  I just read a study tonight that stated that iron deficiency anemia after VSG occurred in only 4.9% of the study group and was considered "statistically insignificant."  I guess I'm just iin the lucky 4.9.....

Actually, my B12 was 380 which falls within normal range, but because of the statement that says that "between 5-10% of pts with levels between 200-400 may experience hematologic and neuropsychiatric abnormalities from occult deficiency" he wants me to take the B12.

Other disturbing labs:
                                                                         normal range
Total iron                               32                          40-175
Iron binding capacity             510                         250-450
% saturation                            6                             15-60%
ferritin                                   3                              15-232 (females)
transferrin                              404                        188-341
hemoglobin                              10.6                          13.2-15.5 (females)

Here's a link to Andrea U's profile http://www.obesityhelp.com/member/aullberg/

Also if you want to get some GREAT vitamin and deficiency advice, post your lab numbers on the main forum.  RnYers and DSers "know" vitamin and subsequent issues.

Ms Shell

My lab numbers look VERY similar to yours (my ferratin is 4 even).  I mention this because I was diagnosed anemic just a week ago, and my dr insisted (after I had asked) that in NO way was I a candidate for infusions.  He put me on iron pills 3x a day for six months.  He said there is no reason for us not to absorb iron.  I had always been borderline low, so he attributes it mostly to diet and heavy periods.  If you are comfortable with the infusions, that is certainly a solution to the issue, but if you are not maybe you could talk to him about why he thinks supplementation would be a lost cause.