Iron Issues

Hello WLS graduates, First of all I posted this question/concern on the revision forum and I also wanted to hear from the wls graduates also.  Here goes:  I want to get a revision and I am leaning towards being bypassed some more.  Here is the potential problem.  Three months ago my PCP ran a lot of blood work and everything looked good except for my iron level.  It was below "normal" so he put me on Tandem Dual Action capsules.  He told me to take 1 pill a day for 3 month and then he will check my iron again.  Well last Friday I had my iron level checked and today I talked with him and he said it was still below normal.  Tomorrow I have to go in and talk with him about taking a different medication.  My issue is that the surgeon I am considering for the revision may not want to bypass me if I am having iron problems.  I also worry about my iron levels if I have a revision.  I do not want to have iron infusions (whatever that is but it sounds scary).   I also worry about potential health problems down the road because of low iron).  Anyone out there with this issue?  Or have any advice or suggestions?

I've had iron issues since I had my son, which only got worse after WLS.  I don't  think surgery is possible if levels are too low, but I don't know what that level is or how it varies from doc to doc.  I don't really know what a mini-bypass is, but I'm certain some level of malabsorbtion is to be expected as a result of your initial procedure.  I am currently getting infusions (Infed) and although my levels are still low, it's working.  My hematologist doesn't think I can absorb iron any other way as a result of my WLS, but many post-ops do fine, especially with Vitalady's Tender Iron (which I plan on trying this week!).  Bypass=malabsorbtion and there's no way around it...you'll have to supplement for the rest of your life.

Hi there, I had major, major iron issues. I had blood work done in late 2005. All was good.....then I had my next appointment for early 2007. I was having heart palpatations so they referred me to a cardio. I went to the cardio, but when I got there, he told me he got my lab worked faxed over from my Primary doc. I had a hemoglobin of 6.2. They told me it was likely that I would have to have  a blood transfusion. I sure did, 4 units. My levels still weren't staying up so I did two rounds of iron transfusions and had an allergic reaction to the second one so they stopped.  I had a hysterectomy 5 weeks ago so I would not bleed anymore.....and I had several fibroids and cysts which could have been adding to the anemia.  I would think that bypassing more would mean losing more nutrients, but I could be wrong. I would definitely talk to the doc! Good luck!!

this surgery has caused me to have major iron issues.    I now go to a blood doctor to monitor it. I had to have six weeks of iron infusions and may need more later. the doctor said iron pills will not work on us because of the bypass.  So the only way to get the iron up is thru infusions. Also it's important they check your Ferritin level.  That's what binds the iron to the blood?  or something important like that. also low iron can cause heart attacks.  so be sure they fix yours. do you get those horrible headaches?  they are the worst.  I know when my iron is dropping.  I'll wake up with the headache. Good luck. Koukla

Repliva is the "instant" oral iron fix.  IT is suppost to work within a couple of months.....you can use an OTC gentle iron from vitalady but that would take a bit longer to build up your stores...and then there are iron transfusions for those with really bad levels.  You are right to worry, some surgeons won't perform surgery on you if your iron is off, and most won't perform it on you if your H&H Is off. Scott

Iron is absorbed by the duodenum.  That's the bottom part of the stomach that is normally bypassed.  My surgeon thinks that ferrous fumerate is the most absorbable for RNY patients.  That said, I'm almost 4 yrs out and am now getting iron infusions, probably every 6 weeks.  I get Venofer.  It takes about an hour and a half and the worst thing is the fatigue from the Benadryl.  My levels had been okay until last summer after I had surgery.  I was probably using up my iron stores and the surgery pushed me over the edge.  I'm no longer anemic, but I can't keep my ferritin levels up.   While I don't know for sure, I would say that bypassing more wouldn't make much difference.  Have you thought about lap band?   One severe complication that many of us are now facing is hypoglycemia.  I have nesidioblastosis, where the beta cells of the pancreas produce way too much insulin.  I had 60% of my pancreas removed and continue to have blood sugar issues.   Given what I now know and what the doctors now know, I don't think I would go the RNY route. 

A nutritionist should pipe in, but I do not take my iron with my calcium as I understand it reduces absorption. I do take my iron with my vitamin c as this is supposed to increase absorption.  All of my vitamins are scattered throughout the day and always taken with food or my protein drink.  It is essential that you have a well balanced diet and have a full course of all the needed vitamins in order for your body to utelize them properly.  Have you checked all of your other vit levels?  I am 2 years out and my labs have always been perfect, luckily.  I take 2 chewable caltrates, chewable vit c, iron, chewable centrum, a bari EFA, chewable biotin, chewable or sublingual b-12, and a cranberry capsule every single day.  I'll occassionally take a fish oil, folate, etc.  I still drink several smartforme protein drinks a day and usually have a dark green veggie and piece of fruit besides my main lean protein.  My only regular carb is either real oatmeal, total, or shredded wheat for breakfast. Getting your labs right is really important and most doctors will not operate until you get this straightened out.  I would insist on more regular testing and possibly increased supplementation and speak with a nutritionist as well. Your diet may be contributing to your inability to absorb and utilize your iron supplements.  Best of luck.  Sharon

Sharon, I had no issues until I was over 2 years out.  Is Caltrate calcium carbonate?  If so, you might want to switch to a citrate type of calcium.  As I understand it, calcium carbonate needs stomach acid to be absorbed.  We have very little.  Calcium citrate is more easily absorbed by RNYers.   I've always taken liquid cal citrate with magesium and Vit D.  I too, space everything out.  Calcium first thing in the morning, the 2 hours later I start the vitamins.  I use Optisource which are formulated for bariatric patients. I eat mainly protein as carbs make my blood sugar drop.  I use to be able to eat oatmeal without a problem.  Then 1 1/2 yrs ago, it became a serious problem.  I would drop down to the 40's with a bowl of oatmeal.  And I always eat the wt control oatmeal that has added protein and less carbs.  I would also add walnuts for even more protein.  Today I dropped to 67 after a nectur protein drink.  GRRR!   It seems to me that 2 years is when things start happening and not in a good way.  So all of you who are 2 years and less and think you're home free, you might not be.  So be very diligent in taking your supplements and getting your labs done.  I've done everything right and have many, many issues now at almost 4 years.  

Lyn, You're still having crashes since your surgery?   Has it been effective enough to recommend it to others?

Melting, Yes, I still have episodes of hypoglycemia.  But not nearly as often or not as low.  Would I recommend anyone else to have part of their pancreas removed?  I don't know that I could.  It's a very individual choice.  It depends on how much the hypoglcyemia is affecting that person's life.  For me, as an accountant, I was having trouble concentrating and I had issues trying to figure things out.  Not good for a bean counter.  It was greatley affecting my life.  The meds that were offered had all sorts of side effects for me.  Maybe someone else would do well on the drugs.   What I wouldn't recommend, is anyone having RNY.  I know that there are many out there that haven't had any problems.  But it seems to me that there is a growing number that are having serious issues with hypoglycemia, iron deficiency, bone loss.  I have all three.  Lucky me.  I'm glad I've lost 100 pounds.  However, knowing what I do now, I think I would have gone the lap band route.