Iron issues, could use some input

I am over 9 months post op.   At 6 months I had full labs drawn and despite my ferritin being low (5) my surgeon and nutritionist blew it off saying my total iron,  hematocrit and hemoglobin were all in range, so I was fine.  I immediately upped my carbonyl iron intake from 64mg to 100mg a day.   I also sent my lab results over to my PCP who looked at them and scheduled me for a three month check in since my surgeon didn't want to see me or have labs drawn until my 1 year anniversary.

Today I got my re-draw results.  Everything else seems fine (she didn't do everything though), but my ferritin is even lower...4.2!!!

My PCP wasn't very concerned but wrote me a script for 325mg ferrous sulfate tablets and told me to start taking one a day and work up to two a day.   I told her I was concerned that the ferrous sulfate would be very constipating and could I just go up to that amount of carbonyl iron.  She said she didn't know and said I could ask the pharmacist.   

I cannot imagine what 325mg of ferrous sulfate is going to do to my digestion.  Just the 18mg that were in my original multis was making me miserable, but switching to the carbonyl made a huge difference.  Of course if I am not absorbing it...well what is the point.   Does anyone know if they are equivalent for dosing?   Is it a mistake to go to the ferrous sulfate prescription?  Should I be seeking out new doctors that are more concerned and knowledgeable -- my surgeon didn't care and my PCP was concerned but not very knowledgeable on the topic.    The only symptom I am having is some dizziness when I stand up quickly, otherwise I feel fine -- but I realize that ferritin are my iron stores and that it could have long term impacts.   I want to make the best decisions I can before this gets out of my control.

That would kill my stomach.  Do you need a referral to a hematologist....get there STAT and bring copies of your labs.  A good hematologist will order iron infusions without a flinch. 

Honestly I wonder about the medical community some days......why would they allow you to continue down this trail when it CONTINUES to drop.  You may never get your ferritin up on supplements alone and if you do it's going to take a LONG time and lots of exhausting days.

I don't need a referral to a hematologist from my insurance but I don't think hematologist will see you without one (since they are also oncologists).   I think you are right.   I will call my PCP tomorrow and ask for a referral.

When I got my labs (and my iron was OK but trending downward) I had had infusions about 15 months prior my PCP wasn't concerned because my ferritin was in range.  I looked up providers on my insurance and made an appt to see a hematologist.  He looked at my labs and said yes I needed infusions at the time BEFORE it became deficient again.  There was definitely a trend downward and not slow either.

I did voice my concern to be sure it wouldn't be a problem with my insurance.  He didn't think so and said he was prepared to argue why he chose to do them now (FTR I had the past 5 years of labs printed out and gave to him). 

I hope you can get in to see someone soon.  How do you feel?

At that level - you need iron infusions... find a good hematologist. I can't take most iron and even if i do - I don't absorb that well oif any. 

I think this is good advice.   I will call tomorrow and see if someone will see me.  I'm not excited about infusions, but it seems like a better option than doing nothing and watching it all tank.

Hemo that sees other WLS patient will be best to deal with. Ask around who other people in your are see for that.

Any idea what your B12 is like... If it's too low you can't absorb iron

B12 was 624, up from in the 500's at my three month

325 mg ferrous sulfate only gives you 65 mg elemental iron.  Carbonyl is all elemental iron.  So if you are currently taking 100 mg carbonyl iron, switching to 325 mg ferrous sulfate would actually be reducing your dose quite a bit.

Not only is ferrous sulfate very constipating, you need a lot of stomach acid to break it down for absorption and you don't have a lot of stomach acid anymore.  Carbonyl is absorbed a lot better.

What's your total iron?

I think you have a couple of options right now.

You could switch to heme iron, which is more expensive but supposed to be absorbed better and is not constipating.  I'm not sure what dosage you'd want.  If you contact Michelle (vitalady) at vitalady.com,, you can purchase the heme iron from her and she can advise you about the dose.

If your total iron is low too, I would make an appointment with a hematologist.  You could do that anyway.  A hematologist would probably be able to advise you and can also do iron infusions if necessary (IV iron).