Anemic

Went into the doctors today and could barely open my eyes I'm so tired! It was to get my back adjusted and both the doc and nurse asked if I was normally this pale. *L* They did a CBC and Hematocrite.

Hemoglobin was 9 (ref range 12 - 16)
Hematocrit was 29 (ref range 37 -42)

Anyways, no I know why I feel like crap. Heavy menstrual bleeding and bleeding hemorroids and taking their toll.

My question: which is the most easily digested iron? I currently have Bariatric Advantages 29mg Ferrous Fumerate dissolvable tabs. I can only swallow tiny caplets. Almost 11 months out.

Either carbonyl or heme iron.  Carbonyl works well for most people and it's a lot cheaper than heme.

They didn't check your iron?  Your ferritin?

Thanks Kelly! Not sure if they did. Only gave me those two results over the phone.

Do you know how much/day is the minimum dosage? for the carbonyl?

Well, the ASMBS says RNY folks should take at least 36 mg elemental iron a day.  Carbonyl is elemental iron.  The ASMBS says menstruating women  should take an additional 18-27 mg a day, for a total of 54-63 mg.

Now, some types of iron, like ferrous sulfate, are not all elemental iron.  Ferrous sulfate has some elemental iron and a bunch of iron salts.  The iron salts is what makes people constipated when they take ferrous sulfate.  325 mg ferrous sulfate has 65 mg elemental iron in it.  The rest is the iron salts.

Wow, you are severely anemic but you need more information.  If you know you are losing alot of blood then you can probably assume that it is caused by iron deficiency but anemia can also be caused by B12 and folate deficiency too.  I really recommend that you get more labs drawn ASAP.  You need to have another CBC done to see if the hemoglobin and hemacrit are staying the same or going down, a hemoglobin below 8 requires a blood transfusion, so you need to watch it.  Besides those 2 numbers, you need your RBC's, MCV, Platelets (make sure you are clotting properly), plus an iron, tibc, iron sat %, ferritin, B12, folate.  If possible, also a vitamin D level. 

At a year, you need a full battery of labs but with those levels  I wouldn't wait another month.

As far as iron goes, don't bother with the ferrous fumerate - we can't absorb anything with ferrous in the name.  We want carbonyl iron plus vitamin C to aid in absorbtion.  If you go to vitalady.com - she has 2 types.  There is  a chewable that is only 25mg and to that you have to add vitamin C and then there are capsules which are 60mg and they already have the vitamin C in them.  They aren't tiny though.  I would be concerned why at almost a year out you cant swallow a normal size pill.  Have you spoken to your surgeon about this?  YOu should be able to swallow large pills by 1 or 2months out.  With levels like yours, you should be taking atleast 120mg - 180mg per day, all in one dose and for every 30mg of iron, you need 200mg of vitamin C.  Just know, you can't take iron within 2-4 hours of your calcium and thyroid medication.

Yikes! At this point I think a blood transfusion would make me feel a lot better. I probably have too many antibodies for it to go well though.

I'll contact my surgeons office in the morning and see if they can get my lab request faxed up here.

I really appreciate everyone's suggestions. I didn't just have the RNY. I had a Nissan Fundoplication reversal and then the RNY. The psudo-sphincter is very small. My Lexapro and Armour Thyroid get stuck if I try to drink liquids immediately after taking them. Just last week I got salmon stuck and was throwing up all night. NOT fun.

I'll order that carbonyl tomorrow after hubby gets paid. Thank you!!